HESI & Final Pharmacology

B. By length of time (rapid, short, intermediate, long)

How are different insulins categorized? A. By route B. By length of time (rapid, short, intermediate, long) C. By mechanism of action D. By color

D. nausea and vomiting ***Ondansetron is an antiemetic used to treat postoperative nasuea and vomiting, as well as nausea and vomiting associated with chemotherapy. The other options are incorrect reasons for administering this medication.

A client has an as needed prescription for ondansetron. For which condition(s) should the nurse administer this medication? A. paralytic ileus B. incisional pain C. urinary retention D. nausea and vomiting

B. heartburn ***Omeprazole is a proton pump inhibitor classified as an antiulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often called heartburn by clients. Omeprazole is not used to treat the conditions identified in options 1, 3, and 4.

A client has been taking omeprazole for 4 weeks. The ambulatory care nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom? A. diarrhea B. heartburn C. flatulence D. constipation

D. one hour before meals and at bedtime ***Sucralfate is a gastric protectant. The medication should be scheduled for administration 1 hour before meals and at bedtime. The medication is timed to allow it to form a protective coating over the ulcer before food intake stimulates gastric acid production and mechanical irritation. The other options are incorrect.

A client with a gastric ulcer has a prescription for sucralfate 1 gram by mouth 4 times daily. The nurse should schedule the medication for which times? A. with meals and at bedtime B. every 6 hours around the clock C. one hour after meals and at bedtime D. one hour before meals and at bedtime

C. Intravenous ***Intravenous drugs are absorbed more quickly than oral, subcutaneous, or topical drugs. The bioavailability for intravenous drugs is 100% and requires the most immediate evaluation of therapeutic effect.

A drug administered by which route requires the most immediate evaluation of therapeutic effect? A. Oral B. Topical C. Intravenous D. Subcutaneous

D. rivastigmine

A drug used to treat mild to moderate dementia. Should be given PO BID or transdermal patch daily. Use cautiously in COPD/ asthma. Common side effects include weakness, dizziness, and nausea. May cause wt. loss. A. donepezil B. memantine C. galantamine D. rivastigmine

A. donepezil

A drug used to treat mild to moderate to severe dementia. Can cause headache, nausea, and dizziness. The nurse should assess for bradycardia and teach the pt. to take right before bed. A. donepezil B. memantine C. galantamine D. rivastigmine

B. memantine

A drug used to treat moderate to severe dementia. Is available in immediate and extended release capsules. Nurse should assess RBCs, hemoglobin, and hematocrit. Administer lower doses if pt. has renal failure. A. donepezil B. memantine C. galantamine D. rivastigmine

B. Help control symptoms during the severe manic episode ***Antipsychotic drugs are given to help control symptoms during severe manic episodes, even if psychotic symptoms are absent. Benzodiazepines are given for their sedating effects. Antidepressants help elevate mood during manic episodes.

A family member of a patient who is experiencing a severe manic episode asks the nurse why the patient is receiving an antipsychotic medication. The nurse informs the family member that antipsychotics are used to do what in the treatment of severe manic episodes? A. Elevate mood during the severe manic episode B. Help control symptoms during the severe manic episode C. Produce sedating effects during the severe manic episode D. Reduce the amount of physical pain the patient experiences during the severe manic episode

B. "Discuss tapering the drug with the provider before conception." ***Lorazepam is Pregnancy Risk Category D, so the nurse instructs should instruct the patient to taper therapy as a means of avoiding the adverse effects of withdrawal and to prevent fetal harm. Therapy must be stopped before conception because benzodiazepines are lipid soluble and cross the placenta thereby, increasing the risk of fetal harm. To promote fetal development, the nurse instructs would instruct the patient to visit an obstetrician for folic acid and prenatal vitamin prescriptions and to eat a well-balanced diet. To help prevent a crisis, the nurse instructs would instruct the patient to develop an alternative plan for managing anxiety with the assistance of a primary health carehealthcare provider.

A female patient who takes lorazepam [Ativan] for anxiety tells the nurse that she plans to become pregnant. What is the best instruction for the nurse to give the patient? A. "Eat a well-balanced diet that includes milk." B. "Discuss tapering the drug with the provider before conception." C. "Stop taking the drug and form another plan to manage anxiety." D. "Visit an obstetrician to determine the correct dose of lorazepam during pregnancy."

C. In 6 to 12 hours ***Low-dose (30 mL) milk of magnesia, an osmotic laxative, acts to retain water and soften the feces. Fecal swelling promotes peristalsis in 6 to 12 hours.

A nurse administering 30 mL of magnesium hydroxide (milk of magnesia) tells the patient to expect a bowel movement in which amount of time? A. In 1 to 3 days B. In 2 to 4 hours C. In 6 to 12 hours D. In 15 minutes to 1 hour

C. Increased pain ***Naloxone reverses the effects of narcotics. Although the patient's respiratory status will improve after administration of naloxone, the pain will be more acute.

A nurse administers naloxone [Narcan] to a postoperative patient experiencing respiratory sedation. What undesirable effect would the nurse anticipate after giving this medication? A. Drowsiness B. Tics and tremors C. Increased pain D. Nausea and vomiting

A. Omeprazole [Prilosec] ***Omeprazole causes irreversible inhibition of the proton pump, the enzyme that generates gastric acid. It is a powerful suppressant of acid secretion. Famotidine and ranitidine block histamine2 receptors on parietal cells. Misoprostol protects against ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs) by stimulating the secretion of mucus and bicarbonate to maintain submucosal blood flow.

A nurse administers which medication to inhibit an enzyme that makes gastric acid in a patient who has a duodenal ulcer? A. Omeprazole [Prilosec] B. Famotidine [Pepcid] C. Misoprostol [Cytotec] D. Ranitidine [Zantac]

B. Cimetidine [Tagamet] ***Cimetidine binds to androgen receptors, producing receptor blockade, which can cause enlarged breast tissue (gynecomastia), reduced libido, and impotence. All these effects reverse when dosing stops. Amoxicillin, metronidazole, and omeprazole are not associated with gynecomastia.

A nurse assesses a male patient who has developed gynecomastia while receiving treatment for peptic ulcers. Which medication from the patient's history should the nurse recognize as a contributing factor? A. Amoxicillin [Amoxil] B. Cimetidine [Tagamet] C. Metronidazole [Flagyl] D. Omeprazole [Prilosec]

D. Akathisia ***Haloperidol is a traditional antipsychotic medication with the adverse effects of extrapyramidal symptoms. Akathisia, or motor restlessness, is an extrapyramidal symptom. Dystonia manifests as severe spasm of the muscles of the tongue, face, neck, or back and may include upward deviation of the eyes, severe cramping, and impaired respiration. Tardive dyskinesia presents with involuntary twisting, writhing, wormlike movements of the tongue and face, lip smacking, and tongue flicking. Parkinsonism appears with bradykinesia, masklike facies, drooling, tremor, rigidity, shuffling gait, and stooped posture.

A nurse assesses a patient receiving haloperidol [Haldol]. The nurse notices that the patient is shifting in the chair, rocking back and forth, and tapping both feet constantly. What is the most accurate term to document these findings? A. Dystonia B. Tardive dyskinesia C. Parkinsonism D. Akathisia

D. Developed lithium toxicity ***Early lithium toxicity is evidenced by diarrhea, anorexia, muscle weakness, nausea, vomiting, tremors, slurred speech, and drowsiness. Later signs include blurred vision, seizures, trembling, confusion, and ataxia.

A nurse assesses a patient who takes a maintenance dose of lithium carbonate [Lithobid] for bipolar disorder. The patient complains of hand tremor, nausea, vomiting, and diarrhea. The patient's gait is unsteady. The patient most likely has done what? A. Consumed some foods high in tyramine B. Not taken the lithium as directed C. Developed tolerance to the lithium D. Developed lithium toxicity

C. Aged cheese and Chianti ***Foods that contain tyramine can produce a hypertensive crisis in individuals taking MAOI antidepressants. Many aged foods, such as cheese, contain tyramines.

A nurse teaches a patient taking a monoamine oxidase inhibitor (MAOI) about important dietary restrictions. Which foods will the nurse caution the patient to avoid? A. Potato and corn chips B. Coffee, colas, and tea C. Aged cheese and Chianti D. Grapefruit and other citrus juices

B. taking alcohol with Ativan may increase sedative effects. ***Alcohol and other CNS depressants should not be taken with benzodiazepines because respiratory depression could result.

A nurse caring for a patient in an outpatient setting notes that the patient is currently taking lorazepam (Ativan) for anxiety and her breath smells of alcohol. The nurse reports this to the health care provider because A. taking alcohol with Ativan can be fatal. B. taking alcohol with Ativan may increase sedative effects. C. all patients using alcohol should be referred for assistance. D. Ativan and alcohol antagonize one another.

C. Assess the patient for drug toxicity. ***When two protein-bound drugs are given concurrently, they compete for protein-binding sites, thus causing more free drug to be released into circulation. In this situation, drug accumulation and possible drug toxicity can result. Also, a low serum protein level decreases the number of protein-binding sites and can cause an increase in the amount of free drug in the plasma. Drug toxicity may then result. Drug dose is prescribed according to what percentage of the drug binds to protein.

A nurse is administering two protein-bound drugs to a patient. Which is the safest course of action for the nurse to take? A. Administer the drugs with food. B. Recommend a high protein diet. C. Assess the patient for drug toxicity. D. Assess baseline liver function tests.

B. Hypothyroidism ***The anterior pituitary increases production of TSH when thyroid hormone levels of T3 and T4 are reduced reflecting primary hypothyroidism. Patients may experience fatigue caused by a lowered basal metabolic rate. Thyrotoxicosis, hyperthyroidism, and Graves' disease are medical conditions indicative of excessive thyroid activity.

A nurse is caring for a patient with decreased triiodothyronine (T3) and thyroxine (T4) and elevated thyroid-stimulating hormone (TSH) levels. The nurse knows the patient is likely suffering from which condition? A. Thyrotoxicosis B. Hypothyroidism C. Graves' disease D. Hyperthyroidism

A. At times of stress, the patient increases the glucocorticoid dose. ***Patients with adrenal insufficiency require lifelong replacement doses of glucocorticoids. Failure to increase the dosage at times of stress and illness can be life-threatening. Wearing a Medic Alert bracelet, carrying injectable and oral forms of glucocorticoid, and dividing the daily glucocorticoid dose are important for a patient taking hydrocortisone, but they are not priorities over understanding the need to increase the dose during stress.

A nurse is developing a plan of care for a patient who has Addison's disease and is taking hydrocortisone [Cortef]. Which of these outcomes should receive priority in the plan? A. At times of stress, the patient increases the glucocorticoid dose. B. The patient wears a Medic Alert bracelet at all times. C. The patient carries an injectable form and an oral form of glucocorticoid. D. The patient divides the daily dose, taking two-thirds of it in the morning and one-third in the afternoon.

B. During times of stress, the patient increases the glucocorticoid dose. ***Patients with adrenal insufficiency require lifelong replacement doses of glucocorticoids. Failure to increase the dosage at times of stress and illness can be life threatening. Wearing a medical ID bracelet, carrying injectable and oral forms of glucocorticoid, and dividing the daily glucocorticoid dose are important for a patient taking hydrocortisone, but they are not priorities over understanding the need to increase the dose during times of stress.

A nurse is developing a plan of care for a patient with Addison's disease who is taking hydrocortisone [Cortef]. Which outcome is of the highest priority for this patient's care plan? A. The patient wears a medical ID bracelet at all times. B. During times of stress, the patient increases the glucocorticoid dose. C. The patient carries an injectable form and an oral form of glucocorticoid. D. The patient divides the daily dose taking two-thirds of it in the morning and one-third in the afternoon.

B. Additive effect ***An additive effect or an increased adverse effect is said to be present when two drugs with similar actions are administered together. When given together, warfarin and aspirin can have additive effects and cause bleeding. A synergistic effect is said to be present when the effect of two drugs administered together is greater than the sum of each drug taken separately; there is nothing in the question to indicate that this has occurred. Incompatibility occurs in situations when two parenteral drugs mixed together result in the chemical deterioration of one or both of the drugs or form a precipitate. An antagonistic effect occurs when the effect of two drugs given together is lower than the sum of each drug taken separately.

A nurse is educating a patient who is prescribed warfarin. The nurse advises the patient to avoid taking aspirin and explains that taking both drugs together may cause excessive bleeding. What is this phenomenon called? A. Incompatibility B. Additive effect C. Synergistic effect D. Antagonistic effect

D. Disruption of the bacterial cell wall, causing lysis and death ***Amoxicillin disrupts the cell wall of H. pylori, which causes lysis and death. Inhibition of an enzyme to block acid secretion is a function of the proton pump inhibitors (PPIs). Coating of the ulcer crater as a barrier to acid is an action of sucralfate [Carafate]. Selective blockade of parietal cell histamine2 receptors is an action of the histamine2 receptor antagonists cimetidine, ranitidine, famotidine, and nizatidine.

A nurse is planning care for a patient who has peptic ulcer disease and is taking amoxicillin [Amoxil]. The nurse is aware that the action of this medication is which of the following? A. Inhibition of an enzyme to block acid secretion B. Coating of the ulcer crater as a barrier to acid C. Selective blockade of parietal cell histamine2 receptors D. Disruption of the bacterial cell wall, causing lysis and death

B. A patient taking warfarin ***Vitamin K is not given to a patient taking warfarin, as this will interfere with the action of the warfarin. There is no contraindication to administering vitamin K for the other patients.

A nurse is reviewing the medication records for vitamin K. The nurse will hold vitamin K and call the provider regarding which patient? A. A newborn infant B. A patient taking warfarin C. A patient with celiac disease D. A patient with megaloblastic anemia

A ***All preganglionic and postganglionic neurons of the parasympathetic nervous system release acetylcholine as their transmitter; thus, the image with acetylcholine at both synapses should be used. All preganglionic neurons release acetylcholine but postganglionic neurons can release acetylcholine, norepinephrine, or epinephrine for the sympathetic nervous system. Motor neurons are part of the somatic motor system.

A nurse is teaching a class about the parasympathetic nervous system and transmitters. Which image will the nurse use in the teaching session?

B. "Agonist drugs decrease receptor activation." ***Drugs that directly activate receptors are called agonists, whereas drugs that prevent receptor activation are called antagonists. Local anesthetics are drugs that work by altering/suppressing axonal conduction.

A nurse is teaching a group of coworkers about the effects of drugs on receptors. Which comment by a coworker would need correction? A. "Agonist drugs increase receptor activation." B. "Agonist drugs decrease receptor activation." C. "Antagonist drugs decrease receptor activation." D. "Local anesthetics suppress axonal conduction."

B. Baroreceptor reflex ***From a pharmacologic perspective, the baroreceptor reflex is the most important feedback loop of the autonomic nervous system. This reflex is important because it frequently opposes our attempts to modify blood pressure with drugs. Autonomic tone is the steady, day-to-day influence exerted by the autonomic nervous system on a particular organ or organ system. Innervation refers to how nerves affect systems in the body and are not directly related to pharmacologic effects. Sensor and effector response are processes within every feedback loop.

A nurse is teaching a group of students about pharmacologic effects of the feedback loop on the autonomic nervous system. What will the nurse teach is the most important feedback loop? A. Autonomic tone B. Baroreceptor reflex C. Patterns of innervation D. Sensor and effector response

D. "Do not eat anything for at least 60 minutes after taking this medicine." ***After dosing, ibandronate [Boniva] requires 60 minutes before eating and 60 minutes remaining upright. Ibandronate [Boniva] can only be taken with water. Taking right before bedtime would require lying down, an action that is contraindicated for ibandronate [Boniva] for at least 60 minutes or longer.

A nurse is teaching a patient about ibandronate [Boniva]. Which information is essential to include in the teaching session? A. "Take this medicine right before bedtime." B. "Take this medicine with a full glass of milk or water." C. "Sit or stand for at least 30 minutes after taking this medicine." D. "Do not eat anything for at least 60 minutes after taking this medicine."

A. Avoid smoking. B. Avoid excessive alcohol. E. Perform regular weight-bearing exercise. ***Lifestyle measures that promote bone health are: (1) performing regular weight-bearing exercises (walking, yoga, dancing, racquet sports, weight lifting, stair climbing), (2) avoiding excessive alcohol, and (3) avoiding smoking. Adolescents need 1300 mg of calcium a day. Bone mineral density testing is not recommended for children or adolescents.

A nurse is teaching adolescents about bone health. Which information should be included in the teaching session? Select all that apply. A. Avoid smoking. B. Avoid excessive alcohol. C. Obtain 1200 mg of calcium a day. D. Have a bone mineral density test done. E. Perform regular weight-bearing exercise.

B. Reuptake of the transmitter ***5a is an image for reuptake of the transmitter into the nerve terminal; 2 is storage of the transmitter; 1 is synthesis of the transmitter; and 5b is enzymatic degradation of the transmitter.

A nurse is teaching the staff about the effects of drugs on receptor activity. The nurse is using the image in the teaching session. Which concept will the nurse teach about for 5a in the image? A. Storage of the transmitter B. Reuptake of the transmitter C. Synthesis of the transmitter D. Enzymatic degradation of the transmitter

A. Alcoholic drinks ***Through several mechanisms, regular alcohol consumption while taking acetaminophen [Tylenol] increases the risk of liver injury when dosages are excessive. Therapeutic doses of acetaminophen [Tylenol] may be safe for patients who drink alcohol; however, the U.S. Food and Drug Administration (FDA) requires that acetaminophen [Tylenol] labels state an alcohol warning for patients who consume three or more drinks a day to consult their prescriber to determine whether acetaminophen [Tylenol] can be taken safely. It is not necessary to avoid leafy green foods, bananas, or dairy products when taking acetaminophen.

A nurse provides discharge instructions for a patient who is taking acetaminophen [Tylenol] after surgery. The nurse should instruct the patient to avoid which product while taking acetaminophen? A. Alcoholic drinks B. Leafy green foods C. Bananas D. Dairy products

D. "I take a megadose multivitamin daily." ***Because vitamin A is highly teratogenic, it is essential for the nurse to discuss the practice of taking megadoses of vitamins. It is important to discuss vegetarianism to ascertain that the client is obtaining necessary nutrients; however, this is not teratogenic so it is not the priority. Grapefruit juice is only a problem if the client takes drugs metabolized by enzymes inhibited by grapefruit juice. Eating ready-to-eat cereals is not a concern.

A nurse reviews the 24-hour diet and supplement intake of a woman who is in the first trimester of pregnancy. Which information creates the priority concern for the nurse to follow up with the woman? A. "I am a vegetarian." B. "I drink grapefruit juice every morning." C. "I eat a variety of ready-to-eat cereals." D. "I take a megadose multivitamin daily."

C. "It would be better to eat five or six small meals a day instead of three larger ones." ***One optimal nondrug measure, in addition to drug management, to aid patients with peptic ulcers is changing the eating pattern to more frequent, smaller meals to avoid fluctuations in intragastric pH. No evidence indicates that beverages containing caffeine promote ulcer formation or that an "ulcer diet" improves healing. Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the biosynthesis of prostaglandins, which reduce mucosal blood flow and promote the secretion of gastric acid.

A nurse should give which nonmedication instruction to a patient who has peptic ulcers? A. "Reduce your intake of caffeine-containing beverages, such as coffee and colas." B. "Take a nonsteroidal anti-inflammatory drug once a day to help with pain." C. "It would be better to eat five or six small meals a day instead of three larger ones." D. "An ulcer diet of bland foods with milk and cream products will speed healing."

C. Renal failure ***High-dose aspirin therapy should be avoided in patients taking ACE inhibitors. In susceptible patients, these medications can impair renal function when they are combined with aspirin. Liver toxicity, congestive heart failure, and hemorrhage are not effects of ACE inhibitor and aspirin interactions.

A nurse should recognize that a patient who takes an angiotensin-converting enzyme (ACE) inhibitor while also taking high-dose aspirin is at risk of developing what complication? A. Congestive heart failure B. Liver toxicity C. Renal failure D. Hemorrhage

A. Aged cheese and sherry ***Foods that contain tyramine can produce a hypertensive crisis in individuals taking MAOI antidepressants. Many aged foods contain tyramines.

A nurse teaches a patient who takes an MAOI about important dietary restrictions. Which foods will the nurse caution the patient to avoid? A. Aged cheese and sherry B. Grapefruit and other citrus juices C. Coffee, colas, and tea D. Potato and corn chips

A. Antitussive ***Codeine provides both analgesic and antitussive therapeutic effects. Hence, it is administered to patients with pneumonia. Codeine does not have immunostimulant, immunosuppressant, or expectorant actions.

A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse, "Why am I receiving codeine? I do not need anything for pain; I need something for my cough." Which effect of codeine will the nurse discuss with the patient? A. Antitussive B. Expectorant C. Immunostimulant D. Immunosuppressant

D. Several weeks ***The nurse instructs the patient to adhere to therapy for several weeks to determine whether escitalopram [Lexapro] will be an effective antidepressant. Escitalopram [Lexapro] is a selective serotonin reuptake inhibitor (SSRI), and a delay in therapeutic effectiveness is characteristic of SSRIs. Such drugs do not become effective in 1 week or 2 to 3 days; however, the effect occurs long before 2 to 3 months.

A patient asks the nurse how long it will take for escitalopram [Lexapro] to be completely effective. Which time frame should the nurse include in patient teaching? A. 1 week B. 2 or 3 days C. 2 or 3 months D. Several weeks

A. "Glucocorticoids influence carbohydrate, lipid, and protein metabolism." ***Glucocorticoids influence the metabolism of carbohydrates, proteins, and fats. They are produced in increasing amounts during stress. They increase sodium and glucose levels and suppress the immune system.

A patient asks the nurse to explain the action of glucocorticoids. Which statement is the nurse's best response? A. "Glucocorticoids influence carbohydrate, lipid, and protein metabolism." B. Glucocorticoids decrease serum sodium and glucose levels." C. "Glucocorticoids are produced in decreased amounts during times of stress." D. "Glucocorticoids stimulate defense mechanisms to produce immunity."

C. St. John's wort ***Serotonin syndrome may occur with selective serotonin reuptake inhibitors (SSRIs) when they are combined with herbal products such as ginseng and St. John's wort.

A patient currently prescribed duloxetine [Cymbalta] comes to the health clinic complaining of restlessness, agitation, diaphoresis, and tremors. The nurse suspects serotonin syndrome and questions the patient regarding concurrent use of which substance? A. Gingko B. Ibuprofen C. St. John's wort D. Glucosamine chondroitin

D. Place in modified Trendelenburg's position. ***Placing the patient in modified Trendelenburg's position (legs elevated) and administering intravenous (IV) fluids may help with treatment of hypotension. Atropine is administered for bradycardia and atrioventricular (AV) block, not hypotension. Overdoses can be removed from the gastrointestinal (GI) tract with gastric lavage followed by activated charcoal; however, hypotension can occur in the absence of overdose. Hypotension is not treated with cardioversion.

A patient develops hypotension after administration of verapamil. Which intervention is appropriate? A. Administer atropine. B. Perform gastric lavage. C. Assist with cardioversion. D. Place in modified Trendelenburg's position.

A. "This medication will help you sleep." B. "This medication will decrease irritability." C. "This medication will help decrease anxiety." ***Lorazepam is an adjunctive drug used with patients who have schizophrenia. It serves to suppress anxiety and promote sleep. In patients experiencing an acute psychotic episode, it helps to suppress anxiety and irritability. It does not specifically treat the illness or help the patient cope with the illness.

A patient diagnosed with schizophrenia has been prescribed lorazepam. What should the nurse teach as the reason for this therapy ? Select all that apply A. "This medication will help you sleep." B. "This medication will decrease irritability." C. "This medication will help decrease anxiety." D. "This medication will help you cope with your illness." E. "This medication will relieve positive symptoms of schizophrenia."

B. Take on an empty stomach. ***The medication is to be taken on an empty stomach. There is no specification for it to be taken just before bedtime or immediately upon arising in the morning.

A patient diagnosed with thyroid cancer undergoes a thyroidectomy and is prescribed levothyroxine sodium [Synthroid]. What instructions should the nurse give the patient about taking this medication? A. Take on a full stomach. B. Take on an empty stomach. C. Take immediately after arising. D. Take immediately before bedtime.

A. Limit intake of acetaminophen to less than 2000 mg/day ***Patients who drink three or more alcoholic beverages per day should limit their acetaminophen dosage to less than 2000 mg/day to prevent hepatic injury.

A patient drinks five to six alcoholic beverages per day and takes acetaminophen [Tylenol] for pain relief. The nurse should caution the patient to do what? A. Limit intake of acetaminophen to less than 2000 mg/day B. Avoid taking acetaminophen for pain C. Take acetaminophen with food to reduce the risk of liver damage D. Avoid taking any pain reliever other than acetaminophen

C. Red blood cell count ***Deficiency of cyanocobalamin (vitamin B12) manifests as megaloblastic anemia so the nurse would assess the red blood cell count first. It does not affect platelets or white blood cells (a neutrophil is a type of white blood cell).

A patient has a low level of vitamin B12. Which laboratory result should the nurse assess first? A. Platelet count B. Neutrophil count C. Red blood cell count D. White blood cell count

A. Carvedilol ***Carvedilol is unusual in that it can block alpha1 receptors as well as beta receptors. Reserpine is an adrenergic neuron blocker. Methyldopa is a centrally acting alpha2 agonist. Propranolol is a beta-adrenergic blocker.

A patient has a prescription for hypertension that blocks both alpha and beta receptors. Which drug will the nurse administer? A. Carvedilol B. Reserpine C. Methyldopa D. Propranolol

C. Regular insulin [Novolin R] ***This patient has clinical indicators of diabetic ketoacidosis. The patient would require regular insulin [Novolin R] in its intravenous form to reduce the concentration of serum glucose. The nurse should prepare to administer regular insulin [Novolin R] because it is the only insulin that can be administered intravenously. Insulin lispro [Humalog] is a human recombinant rapid-acting insulin analogue. Insulin glargine [Lantus] is a long-acting recombinant DNA-produced insulin analogue, and it provides a constant level of insulin in the body. Insulin isophane suspension, also known as neutral protamine Hagedorn (NPH) insulin [Humulin N], is the only available intermediate-acting insulin product.

A patient has a serum glucose concentration of 375 mg/dL, urine output of 450 mL/hr, and an arterial pH of 7.1. The sliding scale requires intravenous insulin for a blood glucose concentration of more than 350 mg/dL. Which type of insulin is the nurse most likely to administer? A. Insulin lispro [Humalog] B. Insulin glargine [Lantus] C. Regular insulin [Novolin R] D. Neutral protamine Hagedorn (NPH) insulin [Humulin N]

B. Neurologic ***A severe deficiency in cyanocobalamin (vitamin B12) produces neurologic damage. While it is important to assess all systems for vitamin B12 deficiency, assessing the neurologic system is a priority.

A patient has a severe vitamin B12 deficiency. The nurse will make it a priority to assess for alterations in which system? A. Renal B. Neurologic C. Integumentary D. Gastrointestinal

C. Decrease in bleeding tendency ***Vitamin K is an essential nutrient for the synthesis of clotting factors. It also is the antidote for warfarin [Coumadin], an oral anticoagulant. Vitamin K enhances the coagulation process, thus minimizing a patient's risk for excessive bleeding. Increases in RBC indices or mental alertness or a decrease in pulse pressure is unrelated to the therapeutic effects of vitamin K.

A patient has an international normalized ratio [INR] that is elevated to an unsafe level. A nurse administers vitamin K expecting which therapeutic result? A. Decrease in pulse pressure B. Increase in mental alertness C. Decrease in bleeding tendency D. Increase in red blood cell [RBC] indices

A. Dantrolene (Dantrium) ***Treatment of NMS involves immediate withdrawal of antipsychotics, adequate hydration, hypothermic blankets, and administration of antipyretics, benzodiazepines, and muscle relaxants such as dantrolene (Dantrium). Tetrabenazine (Xenazine), used to improve symptoms of Huntington's disease, seems to be effective in treating tardive dyskinesia. Propanolol (Inderal) has been found to be effective in the treatment of akathisia. Acute dystonia may be treated with lorazepam (Ativan).

A patient has been diagnosed with neuroleptic malignant syndrome. The nurse anticipates administration of which medication to treat this patient? A. Dantrolene (Dantrium) B. Tetrabenazine (Xenazine) C. Propranolol (Inderal) D. Lorazepam (Ativan)

A. "I'll take this medication in the morning so as not to interfere with sleep." ***Levothyroxine is used to treat hypothyroidism by increasing the basal metabolism and thus wakefulness. It is administered as a once-daily dose and is a lifelong therapy. It is best taken on an empty stomach to enhance absorption.

A patient has been given instructions about levothyroxine [Synthroid]. Which statement by the patient indicates understanding of these instructions? A. "I'll take this medication in the morning so as not to interfere with sleep." B. "I'll plan to double my dose if I gain more than 1 pound per day." C. "It is best to take the medication with food so I don't have any nausea." D. "I'll be glad when I don't have to take this medication in a few months."

A. Anemia ***Celecoxib [Celebrex] is a COX-2 inhibitor that is contraindicated in patients with anemia. Celecoxib can cause an increased risk of gastrointestinal adverse effects, including bleeding, which can worsen anemia. The other conditions are not contraindications for use of the COX-2 inhibitor.

A patient has been prescribed celecoxib [Celebrex] to treat arthritis. The nurse will contact the healthcare provider if the patient shows symptoms of which condition? A. Anemia B. Cataracts C. Glaucoma D. Hyperthyroidism

C. Never abruptly withdraw therapy. ***Abrupt withdrawal of glucocorticoids may cause adrenal insufficiency or an adrenal crisis. Infection should be prevented, but the use of antibiotics without a known infection is inappropriate. Eye examinations are recommended every 6 months for patients on glucocorticoid therapy. Sodium restriction may be prescribed.

A patient has been prescribed pharmacologic doses of glucocorticoids. It is most important for the nurse to teach the patient to do what? A. Increase intake of dietary sodium. B. Take antibiotics to prevent infection. C. Never abruptly withdraw therapy. D. Have an eye examination every year.

B. Pentazocine ***Pentazocine would cause the nurse to question the prescription since it is an agonist-antagonist. When administered alone, the agonist-antagonist opioids produce analgesia. However, if given to a patient who is taking a pure opioid agonist (like codeine) long term (as indicated by the mention that the patient has developed drug tolerance), these drugs can antagonize analgesia caused by the pure agonist. Morphine, levorphanol, and oxymorphone are all opioid agonists and would not cause this problem.

A patient has been receiving codeine for pain and has developed tolerance to the drug. The provider wants to change the patient's pain medication. Which prescription will the nurse question? A. Morphine B. Pentazocine C. Levorphanol D. Oxymorphone

A. Hypoglycemia ***Cushing's syndrome is manifested by hyperglycemia, glycosuria, fluid and electrolyte disturbances, osteoporosis, muscle weakness, cutaneous striations, and lowered resistance to infection. Redistribution of fat produces a "potbelly," "moon face," and "buffalo hump."

A patient has been receiving long-term prednisone therapy for treatment of rheumatoid arthritis. The chart indicates that the patient has developed Cushing's syndrome. When performing a physical assessment, the nurse anticipates finding all but which manifestation of Cushing's syndrome? A. Hypoglycemia B. Muscle weakness C. Glucosuria D. "Buffalo hump"

A. Blood glucose control for 24 hours ***Insulin glargine is administered as a once-daily subcutaneous injection for patients with type 1 diabetes. It is used for basal insulin coverage, not mealtime coverage. It has a prolonged duration, up to 24 hours, with no peaks. Blood glucose monitoring is still an essential component to achieve tight glycemic control.

A patient is scheduled to start taking insulin glargine [Lantus]. On the care plan, a nurse should include which of these outcomes related to the therapeutic effects of the medication? A. Blood glucose control for 24 hours B. Mealtime coverage of blood glucose C. Less frequent blood glucose monitoring D. Peak effect achieved in 2 to 4 hours

B. Notify the healthcare provider the patient may need to be taken off the drug. ***The primary action is to notify the healthcare provider. Donezepil [Aricept] is known to cause slow heartbeat and fainting. The healthcare provider should be notified because the patient may need to be taken off the medication. The other actions can be performed after the healthcare provider is notified and the nurse is awaiting action.

A patient has been started on donepezil [Aricept]. The patient's family member notifies the nurse that the patient fainted at home. What is the highest priority action on the part of the nurse? A. Instruct the family member not to administer any further doses of the drug. B. Notify the healthcare provider the patient may need to be taken off the drug. C. Reassure the family member that this is an expected side effect of the medication. D. Instruct the family member to call if the patient continues to exhibit fainting episodes.

C. "I only have a bowel movement when I take the medicine." ***Docusate sodium is a surfactant laxative that softens stool by allowing water penetration. Chronic exposure to laxatives can diminish defecation reflexes, leading to further reliance on laxatives. Patient education is the key to reducing laxative abuse. Colon polyps, loss of tooth enamel, and tremors are unrelated to docusate sodium.

A patient has been taking docusate sodium [Colace] daily for 1 year. Which statement by the patient would indicate a complication associated with use of this drug? A. "My doctor says that I've developed colon polyps." B. "I've noticed that I'm having tremors now in my left hand." C. "I only have a bowel movement when I take the medicine." D. "The dental hygienist said I was losing the enamel on my teeth."

B. Take a stool softener E. Increase fluid intake throughout the day ***Constipation is one of the major side effects of morphine administration. It may be managed with increased intake of fluids, the use of stool softeners such as docusate sodium [Colace], or the use of stimulants such as bisacodyl [Dulcolax] or senna [Senokot]. Agents such as lactulose [Enulose], sorbitol (E420), and polyethylene glycol [Miralax] also have been proven effective. Less commonly used are bulk-forming laxatives such as psyllium [Metamucil], for which increased fluid intake is especially important to avoid fecal impactions or bowel obstructions. Adequate rest is required for a patient who has undergone surgery. It is, however, not an important part of patient teaching. The details of medication dosage are provided in the discharge summary. It is not necessary to decrease the dosage of medication. Animal protein and dairy products are not foods that should be recommended to a postoperative patient. Instead, the patient should increase the intake of foods that are high in fiber.

A patient has been taking morphine for postoperative pain. Before discharge, what patient teaching should be provided? Select all that apply. A. Increase rest periods B. Take a stool softener C. Decrease the medication dosage D. Eat more animal protein and dairy E. Increase fluid intake throughout the day

B. Respect the patient's right to refuse and notify the provider. ***The patient has the right to refuse a medication, and this right must be respected. The nurse should determine the cause of refusal, notify the provider, and make appropriate revisions in the nursing care plan. It is not safe to skip the dose and try to give it again after a few hours. Unwrapped medicine should never be returned to the container; agency policy usually requires it to be discarded. Forcing the patient to take a medicine is unethical and does not protect the patient's right to refuse.

A patient has refused to take his prescribed medication and is adamant that the tablet is worsening his condition. What does the nurse do? A. Mix the medication in the patient's food or drink. B. Respect the patient's right to refuse and notify the provider. C. Try to give the medication to the patient again after a few hours. D. Return the unwrapped medication to the container for safe future use.

C. It will take longer to be absorbed. ***Enteric coating is designed to protect a drug from dissolution until it can be absorbed in the intestines. Thus, it will take longer to be absorbed, because absorption does not occur in the stomach and gastric-emptying time varies.

A patient has taken an enteric-coated medication. How would this coating affect drug absorption? A. It will not be absorbed. B. Absorption will be increased. C. It will take longer to be absorbed. D. It will avoid first-pass metabolism.

D. Flumazenil [Romazicon] ***Oxazepam [Serax] is a benzodiazepine drug. Flumazenil [Romazicon] is an antidote for benzodiazepine overdoses. Naloxone [Narcan], naltrexone [ReVia], and nalmefene [Revex] are not antidotes for benzodiazepine overdoses.

A patient is admitted to the emergency department after an overdose of oxazepam [Serax]. Which antagonist may be used to treat this patient? A. Naloxone [Narcan] B. Naltrexone [ReVia] C. Nalmefene [Revex] D. Flumazenil [Romazicon]

A. vitamin D is fat-soluble.

A patient is admitted to the emergency department after taking high doses of vitamin B and vitamin D. The nurse is more concerned about the vitamin D because A. vitamin D is fat-soluble. B. vitamin D is water-soluble. C. vitamin D in high doses causes bleeding. D. vitamin D in low doses results in scurvy.

B. activated charcoal ***Activated charcoal is a general-purpose antidote that is used for various types of acute oral poisoning.

A patient is admitted to the emergency department with salicylate poisoning. Which drug should the nurse anticipate giving the patient? A. chlorpromazine B. activated charcoal C. magnesium citrate D. docisate

D. Candesartan [Atacand] ***Candesartan is an angiotensin II receptor blocker (ARB) and thus prevents the binding of angiotensin II at its receptor sites. Quinapril is an ACE inhibitor; aliskiren is a direct renin inhibitor, and eplerenone is a selective aldosterone receptor blocker.

A patient is admitted to the hospital with a diagnosis of hypertension. The nurse understands that which medication works by preventing angiotensin II from binding with its receptor sites? A. Quinapril [Accupril] B. Aliskiren [Tekturna] C. Eplerenone [Inspra] D. Candesartan [Atacand]

D. Serum potassium concentration ***Hypokalemia, usually diuretic induced, is the most frequent underlying cause of dysrhythmias. The nurse should monitor serum potassium concentrations. Because potassium competes with digoxin, when potassium levels are low, binding of digoxin to Na+, K+-ATPase (sodium, potassium-ATPase) increases. This increase can produce excessive inhibition of Na+, K+ -ATPase with resultant toxicity. Digoxin does not have any effect on liver enzymes, blood glucose, or serum calcium. Therefore, assessment of these parameters is not necessary before administering digoxin.

A patient is prescribed digoxin to treat heart failure. Which biochemical parameter should be assessed by the nurse to ensure safe drug administration? A. Liver enzyme concentration B. Blood glucose concentration C. Serum calcium concentration D. Serum potassium concentration

A. The patient is prone to stress ulcers. ***A critically ill patient is prone to stress-related mucosal damage. Therefore, these patients should be prescribed a histamine receptor blocker or a proton pump inhibitor. The patient's stress levels can cause gastrointestinal disorders, but these drugs do not lower stress levels. The general procedures performed on the patients, such as the use of nasal tubes or feeding tubes, only increase the chances of gastrointestinal disorders. Adverse effects are specific to the type of treatment received and can be addressed by specific drugs.

A patient is admitted to the intensive care unit after a myocardial infarction. The provider has ordered drugs to prevent gastrointestinal disorders. Which is a likely reason for administering acid-controlling drugs? A. The patient is prone to stress ulcers. B. The patient's stress levels are treated by these drugs. C. The general procedures for the treatment include these drugs. D. The adverse effects of the treatment are treated by these drugs.

D. Intravenous morphine sulfate ***When a drug is administered intravenously, it does not need to be absorbed because it is placed directly into general circulation and will have an immediate effect to decrease pain. The other medications will not have an immediate effect. Pain medications that are administered by mouth, suppository, or via a transdermal route take longer to have an effect.

A patient is complaining of pain rated 10 on a scale of 1 to 10. The nurse has several choices of pain medication to administer. Assuming there are no contraindications, which would be best for the nurse to administer at this time? A. Transdermal patch B. Tylenol suppository C. Oral morphine sulfate D. Intravenous morphine sulfate

B. Sympathetic system ***Stimulation of the sympathetic nervous system produces the fight-or-flight response. The baroreceptor reflex regulates blood pressure.

A patient is experiencing symptoms of the fight-or-flight response. Which autonomic process stimulates this response? A. Baroreceptor reflex B. Sympathetic system C. Parasympathetic system D. Predominant tone of the organs

C. 100% ***Bioavailability is the quantity of a drug available in the body after it is administered either orally or via other routes. Bioavailability of 100% is recorded when drugs are administered intravenously directly into the bloodstream. The bioavailability of atropine is 100% because it is administered intravenously. Many drugs administered by mouth go through first-pass metabolism in the liver before beginning systemic circulation. Therefore, the bioavailability of drugs taken orally is less than 100%.

A patient is given an intravenous drug. What is the bioavailability of the drug in this patient? A. 50% B. 60% C. 100% D. 110%

B. Grapefruit juice ***Grapefruit juice can inhibit the metabolism of carbamazepine, thereby causing plasma levels to rise. Grapefruit juice may increase the peak and trough levels of carbamazepine by up to 40%.

A patient is newly prescribed carbamazepine [Tegretol] for seizure control. It is most important for the nurse to teach the patient to avoid which food? A. Tomatoes B. Grapefruit juice C. Spinach D. Kiwi fruit

A. administer the bronchodilator 5 minutes before the glucocorticoid. ***When a bronchodilator and a glucocorticoid inhaler are ordered together, the bronchodilator is administered first. The nurse should then wait for 5 minutes before administering the glucocorticoid. This allows time for bronchodilation to occur so the glucocorticoid is deposited deep into the respiratory system.

A patient is ordered the following inhalers, a bronchodilator (ipratropium) and a gluco-corticoid (Beclamethasone). The nurse will A. administer the bronchodilator 5 minutes before the glucocorticoid. B. mix the drugs and administer them together. C. administer the glucocorticoid 10 minutes before the bronchodilator. D. administer the glucocorticoid immediately after the bronchodilator.

B. Destroy the bacteria in the stomach that are causing ulceration.

A patient is prescribed amoxicillin and tetracycline to treat peptic ulcer disease. The nurse will instruct the patient that these medications will do what? A. Prevent GI infections that cause gastric bleeding. B. Destroy the bacteria in the stomach that are causing ulceration. C. Reduce gastric acid production and alkalize the stomach fluids. D. Reduce the secretion of pepsin in the stomach.

D. Do not take the bisacodyl with an antacid. ***Instruct patients to take oral bisacodyl no sooner than 1 hour after ingesting milk or antacids. Instruct patients to swallow the tablets intact, without crushing or chewing. Inform patients that bisacodyl suppositories may cause a burning sensation, and warn them that prolonged use can cause proctitis. Senna can cause the patient's urine to turn a harmless yellow-brown or pink.

A patient is prescribed bisacodyl. Which of the following should the nurse include in patient teaching? A. Your urine will turn yellow-brown when taking this medication. B. Crush the bisacodyl tablet and sprinkle it on your food. C. Chew the bisacodyl tablet. D. Do not take the bisacodyl with an antacid.

A. "I will take the calcium 1 hour before eating." ***Dosing of calcium with or after meals, not before, promotes absorption of the medication; therefore, further patient teaching is necessary. Calcium salts should be taken with a large glass of water. Foods to be avoided include spinach, Swiss chard, beets, bran, and whole-grain cereals. Patients should be taught the symptoms of hypercalcemia such as nausea, vomiting, constipation, urinary frequency, lethargy, and depression and should promptly notify the healthcare provider if these occur.

A patient is prescribed calcium gluconate for treatment of hypocalcemia. Which statement by the patient indicates a need for further teaching? A. "I will take the calcium 1 hour before eating." B. "I will need to avoid eating whole-grain cereals." C. "I should drink a large glass of water each time I take my calcium." D. "I will need to call my healthcare provider if I develop vomiting, constipation, or frequency of urination."

B. Bleeding ***Celecoxib may increase the anticoagulant effects of warfarin; the risk of bleeding is increased.

A patient is prescribed celecoxib [Celebrex] and warfarin [Coumadin]. The nurse should monitor the patient for what? A. Renal toxicity B. Bleeding C. Stroke symptoms D. Dysrhythmias

D. Wait at least 1 hour between administration of the two medications.

A patient is prescribed cimetidine [Tagamet] and aluminum hydroxide [Maalox] for the treatment of peptic ulcer disease. What should the nurse teach the patient to do? A. Drink an 8-ounce glass of water when taking these medications. B. Take the medications together to enhance their effectiveness. C. Take the Tagamet 2 hours before the Maalox. D. Wait at least 1 hour between administration of the two medications.

D. "Take this medication 30 to 60 minutes before meals." ***Omeprazole [Prilosec] and other proton pump inhibitors act directly on the proton pump on parietal cells and decrease acid levels. For the drug to be absorbed and show its action, it should be administered at least 30 to 60 minutes before meals. Crushing and chewing the drug will damage its enteric coating and thus should be avoided. The medication can be given by dissolving in water only when the patient has difficulty swallowing and for patients with a nasogastric tube. The medication will have no effect when taken after meals because of the presence of food.

A patient is prescribed enteric-coated omeprazole [Prilosec] for hyperacidity. What instructions should the nurse provide to the patient regarding medication administration? A. "Take the medication by chewing or crushing it." B. "Take this medication 30 to 60 minutes after meals." C. "Take the medication by dissolving it in water or milk." D. "Take this medication 30 to 60 minutes before meals."

B. Fatigue C. Dizziness D. Headache ***Some of the common adverse effects of hydralazine include fatigue, dizziness, and headache. Nausea is associated with minoxidil. Joint pain is not a common adverse effect of hydralazine.

A patient is prescribed hydralazine [Apresoline] for the treatment of essential hypertension. Which expected adverse effects should the nurse discuss with the patient? (Select all that apply.) A. Nausea B. Fatigue C. Dizziness D. Headache E. Joint pain

B. Fatigue C. Dizziness D. Headache ***Some of the common adverse effects of hydralazine [Apresoline] include fatigue, dizziness, and headache. Nausea is associated with minoxidil [Loniten]. Joint pain is not a common adverse effect of hydralazine.

A patient is prescribed hydralazine [Apresoline] for the treatment of essential hypertension. Which expected adverse effects should the nurse discuss with the patient? Select all that apply. A. Nausea B. Fatigue C. Dizziness D. Headache E. Joint pain

C. Tomatoes D. Orange juice E. Strawberries ***Vitamin C (ascorbic acid) facilitates absorption of dietary iron. The main dietary sources of ascorbic acid are citrus fruits and juices, tomatoes, potatoes, strawberries, melons, spinach, and broccoli. Pasta is usually enriched with folate. Peanuts are high in niacin.

A patient is prescribed iron supplements. Which foods will the nurse encourage the patient to consume to increase iron absorption? Select all that apply. A. Pasta B. Peanuts C. Tomatoes D. Orange juice E. Strawberries

B. Decrease in blood pressure ***The therapeutic effect of ACE inhibitors is to reduce blood pressure in patients with hypertension. ACE inhibitors do not affect patients' heart rate. Dizziness and fainting are symptoms of hypotension. ACE inhibitors do not affect oxygen saturation.

A patient is prescribed lisinopril [Prinivil] 40 mg by mouth once a day for hypertension. For which therapeutic effect will the nurse monitor? A. Slowing of the heart rate B. Decrease in blood pressure C. Symptoms such as dizziness and fainting D. Pulse oximetry oxygen saturation of 100%

C. Crackles in the lungs are no longer heard ***Because ACE inhibitors promote venous dilation, they provide the therapeutic effect of reducing pulmonary congestion and peripheral edema. Absence of previously heard crackles would be an indicator of effectiveness. Edema and jugular vein distention are manifestations of heart failure. A potassium level of 3.5 mEq/L is a normal value.

A patient is prescribed lisinopril [Prinvil] as part of the treatment plan for heart failure. Which finding indicates the patient is experiencing the therapeutic effect of this drug? A. + 2 edema of the lower extremities B. Potassium level of 3.5 mEq/L C. Crackles in the lungs are no longer heard D. Jugular vein distention

D. Crackles in the lungs are no longer heard ***Because angiotensin-converting enzyme (ACE) inhibitors promote venous dilation, they provide the therapeutic effect of reducing pulmonary congestion and peripheral edema. Absence of previously heard crackles would be an indicator of effectiveness. Edema and jugular vein distention are manifestations of heart failure. A potassium level of 3.5 mEq/L is a normal value.

A patient is prescribed lisinopril [Prinvil] as part of the treatment plan for heart failure. Which finding indicates the patient is experiencing the therapeutic effect of this drug? A. Jugular vein distention B. Potassium level of 3.5 mEq/L C. + 2 edema of the lower extremities D. Crackles in the lungs are no longer heard

D. Teach the patient to avoid the abrupt cessation of treatment. ***The most important concept is to teach the patient to avoid the abrupt cessation of treatment. This could lead to a life-threatening seizure or to status epilepticus. The patient should not adjust the dose without consulting the prescriber. Although teaching the patient to take the medication with meals and teaching the patient how to avoid gingival hyperplasia are indicated, they are not the priority.

A patient is prescribed phenytoin [Dilantin] for epileptic seizures. Which of the following is the priority for patient teaching? A. Teach the patient to adjust the dose according to the presence of symptoms. B. Tell the patient to take the medication with meals. C. Inform the patient about the prevention of gingival hyperplasia. D. Teach the patient to avoid the abrupt cessation of treatment.

D. Serum creatinine levels ***Assessment of serum creatinine levels is useful for determining the kidney function that is required to prescribe H2 receptor antagonist drugs such as ranitidine [Zantac]. Monitoring blood glucose and blood pressure gives a general idea about the patient's well-being. Serum antibody levels detect possible infections in the patient.

A patient is prescribed ranitidine [Zantac] for the treatment of peptic ulcers. To ensure drug safety, what should the nurse assess before administering the drug? A. Blood glucose levels B. Blood pressure levels C. Serum antibody levels D. Serum creatinine levels

A. Activated partial thromboplastin time (aPTT) ***The most commonly used laboratory value that monitors the effect of heparin is the activated partial thromboplastin time (aPTT).

A patient is receiving an intravenous infusion of heparin to treat a pulmonary embolism. What laboratory value will the nurse monitor to evaluate treatment with this medication? A. Activated partial thromboplastin time (aPTT) B. Prothrombin time (PT) C. Platelet count D. Hemoglobin and hematocrit

D. Ankle edema ***Peripheral edema is an adverse effect of nifedipine [Adalat CC]. Headache is an adverse effect, not backache. Diarrhea is not an adverse effect of nifedipine [Adalat CC]. Flushing occurs, not pallor.

A patient is receiving nifedipine [Adalat CC]. Which adverse effect should the nurse monitor for in this patient? A. Pallor B. Diarrhea C. Backache D. Ankle edema

A. This medication provides blood glucose control for 24 hours. ***Insulin glargine is administered as a once-daily subcutaneous injection for patients with type 1 and type 2 diabetes. It is used for basal insulin coverage, not mealtime coverage. It has a prolonged duration, up to 24 hours, with no peaks. Blood glucose monitoring is still an essential component to achieve tight glycemic control.

A patient is scheduled to start taking insulin glargine [Lantus]. Which information should the nurse give the patient regarding this medication? A. This medication provides blood glucose control for 24 hours. B. The peak effect of this medication is achieved in 2 to 4 hours. C. This medication provides mealtime coverage of blood glucose. D. Less frequent blood glucose monitoring is required when taking this medication

D. Nausea and diarrhea ***Large doses of vitamin C can cause nausea and vomiting, headache, abdominal cramps, and the development of renal stones. Delayed healing, bone and joint pain, and loosening of the teeth are unrelated to the side effects of vitamin C; they actually are symptoms of scurvy, a deficiency of vitamin C.

A patient is scheduled to start taking vitamin C. The nurse should teach the patient to observe for which side effect? A. Delayed healing B. Bone and joint pain C. Loosening of the teeth D. Nausea and diarrhea

C. Nausea and diarrhea ***Large doses of vitamin C can cause nausea and vomiting, headache, abdominal cramps, and the development of renal stones. Delayed healing, bone and joint pain, and loosening of the teeth are unrelated to the side effects of vitamin C; they actually are symptoms of scurvy, a deficiency of vitamin C.

A patient is scheduled to start taking vitamin C. The nurse should teach the patient to observe for which side effect? A. Delayed healing B. Bone and joint pain C. Nausea and diarrhea D. Loosening of the teeth

A. hypercalcemia ***Watch for signs of hypercelemia in the patient receiving calcium carbonate.

A patient is taking calcium carbonate for peptic ulcer disease. The nurse should monitor the patient for: A. hypercalcemia B. hypocalcemia C. hyperkalemia D. hypokalemia

A. hypercalcemia ***Watch for signs of hypercalcemia in the patient receiving calcium carbonate.

A patient is taking calcium carbonate for peptic ulcer disease. The nurse should monitor the patient for? A. hypercalcemia B. hypocalcemia C. hyperkalemia D. hypokalemia

C. Muscle weakness ***Muscle weakness is a sign of hypokalemia, which can occur because fludrocortisone has mineralocorticoid properties, resulting in sodium and fluid retention and potassium excretion. Syncope and weight loss do not occur because of salt and water retention. Numbness and tingling may be associated with another problem but are not related to fludrocortisone.

A patient is taking fludrocortisone [Florinef]. A nurse should recognize that the patient is at risk for developing an electrolyte imbalance if the patient reports which symptom? A. Syncope B. Weight loss C. Muscle weakness D. Numbness and tingling

B. increase fiber and fluid intake to avoid constipation. E. take the iron supplement with orange juice.

A patient is taking iron supplementation. It is most important for the nurse to instruct the patient to: (Select all that Apply) A. increase fluid intake to avoid urinary calculi. B. increase fiber and fluid intake to avoid constipation. C. increase deep breathing to avoid atelectasis. D. use sunscreen to deal with photosensitivity. E. take the iron supplement with orange juice.

B. Avoid driving while taking valerian root. C. If you feel depressed, call your provider. D. Prolonged use can cause cardiac abnormalities. E. If you become pregnant, stop taking valerian root. ***Valerian root is generally well tolerated. However, potential adverse effects include drowsiness, dizziness, depression, dyspepsia, and pruritis; therefore, the patient should avoid driving and should alert the provider if any thoughts of depression occur. The effects of valerian root on pregnancy are not yet known, and until further study is done, its use should be avoided during pregnancy. Prolonged use can cause cardiac abnormalities, headache, or nervousness. Urinary retention is not a known side effect of valerian.

A patient is taking valerian root for the promotion of sleep. What should the nurse teach the patient about the adverse effects of valerian root? Select all that apply. A. Urinary retention can occur. B. Avoid driving while taking valerian root. C. If you feel depressed, call your provider. D. Prolonged use can cause cardiac abnormalities. E. If you become pregnant, stop taking valerian root.

C. decrease risk of infection. ***Side effects associated with orally inhaled glucocorticoids are generally local (throat irritation, hoarseness, dry mouth, coughing) rather than systemic. Oral, laryngeal, and pharyngeal fungal infections have occurred. Oropharyngeal infections may be prevented by using a spacer with the inhaler to reduce drug deposits in the oral cavity, rinsing the mouth and throat with water after each dose, and washing the apparatus daily with warm water.

A patient is using a glucocorticoid inhaler. The patient asks the nurse why he has to rinse his mouth out after using the glucocorticoid inhaler. The nurse should inform the patient that rinsing the mouth is done to A. avoid mucous membrane breakdown. B. increase hydration of the oral mucosa. C. decrease risk of infection. D. slow the development of cavities.

D. "It promotes the passage of glucose into cells for energy." ***Insulin promotes the passage of glucose into cells, where it is metabolized for energy. During or after a meal, the glucose that is ingested stimulates the pancreas to secrete insulin. Insulin stimulates the synthesis of proteins and not amino acids. Insulin stimulates the liver to convert glucose to glycogen.

A patient newly diagnosed with diabetes asks, "How does insulin normally work in my body?" Which response by the nurse is correct? A. "It stimulates the pancreas to reabsorb glucose." B. "It promotes synthesis of amino acids into glucose." C. "It stimulates the liver to convert glycogen to glucose." D. "It promotes the passage of glucose into cells for energy."

D. It promotes the passage of glucose into cells for energy. ***The hormone insulin promotes the passage of glucose into cells, where it is metabolized for energy. Insulin does not stimulate the pancreas to reabsorb glucose or synthesize amino acids into glucose. It does not stimulate the liver to convert glycogen into glucose.

A patient newly diagnosed with type 1 diabetes asks a nurse, "How does insulin normally work in my body?" The nurse explains that normal insulin has which action in the body? A. It stimulates the pancreas to reabsorb glucose. B. It promotes the synthesis of amino acids into glucose. C. It stimulates the liver to convert glycogen to glucose. D. It promotes the passage of glucose into cells for energy.

A. It promotes the passage of glucose into cells. ***The hormone insulin promotes the passage of glucose into cells where it is metabolized for energy. Insulin does not stimulate the pancreas to reabsorb glucose or synthesize amino acids into glucose. It does not stimulate the liver to convert glycogen into glucose.

A patient newly diagnosed with type 1 diabetes asks a nurse, "How does insulin normally work in my body?" The nurse should base his or her response on which understanding of the mechanism of insulin? A. It promotes the passage of glucose into cells. B. It stimulates the pancreas to reabsorb glucose. C. It stimulates the liver to convert glycogen to glucose. D. It promotes the synthesis of amino acids into glucose.

A. "This medication has a duration of action of 24 hours." ***Insulin glargine [Lantus] has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas. This medication cannot be mixed with other insulins and is not a short-acting insulin. The patient may need to receive this medication for a long time.

A patient newly diagnosed with type 2 diabetes mellitus has been ordered insulin glargine [Lantus]. Which information is essential for the nurse to teach this patient? A. "This medication has a duration of action of 24 hours." B. "This medication should be mixed with the regular insulin each morning." C. "This medication is very expensive, but you will be receiving it only a short time." D. "This medication is very short-acting. You must be sure you eat after injecting it."

B. increased risk for falls due to orthostatic hypotension. ***Orthostatic hypotension is the most common adverse reaction seen in patients treated with risperidone (Risperdal).

A patient on risperidone (Risperdal) may be at increased risk for injury due to A. increased potential for aspiration due to sedation. B. increased risk for falls due to orthostatic hypotension. C. increased risk for infection due to neutropenia. D. increased risk for suicide due to changes in thought processes.

A. "Stop taking the drug and visit the clinic immediately." ***The patient may have pain in both legs due to myopathy, an adverse effect of atorvastatin [Lipitor]. It progresses to a life-threatening condition called rhabdomyolysis, which involves the breakdown of muscle proteins leading to renal failure and death. The nurse should instruct the patient to stop taking the drug and immediately visit the clinic. The nurse will not instruct the patient to continue the drug as it is a life-threatening condition and requires immediate medical attention. The nurse will instruct the patient to watch for the symptoms; rhabdomyolysis further worsens the patient's condition, leading to renal failure. Administration of niacin [Niaspan], along with atorvastatin [Lipitor], further increases the breakdown of muscle proteins and causes rhabdomyolysis. The nurse should ask the patient to stop taking the medication until confirming the cause of the leg pain.

A patient receiving atorvastatin [Lipitor] therapy to reduce high cholesterol levels calls the clinic and reports, "I am experiencing severe pain in both my legs." What is the nurse's best response? A. "Stop taking the drug and visit the clinic immediately." B. "Continue taking the drug; leg pain is a common side effect." C. "Stop taking the drug if the symptoms persist for another week." D. "Continue taking the drug along with niacin [Niaspan] and a pain killer."

D. Ask whether the patient is using at least 8 ounces of fluid to prepare the psyllium. ***Bulk-forming laxatives, such as psyllium, must be given with at least 8 ounces (240 mL) of liquid, plus additional liquid each day, to prevent intestinal impaction. Another laxative may not be necessary at this time. A dosage increase and monitoring are appropriate after proper mixing of the medication has been validated.

A patient reports abdominal bloating and infrequent, small, hard stools after taking psyllium [Metamucil] for 2 weeks. Which is the nurse's priority action? A. Consult the physician about another laxative choice. B. Check the dose because an increase may be indicated. C. Ask whether the patient is toileting at the same time every day. D. Ask whether the patient is using at least 8 ounces of fluid to prepare the psyllium.

B. Pentazocine [Talwin] ***Pentazocine is an agonist-antagonist opioid. If pentazocine is given to a patient who is physically dependent on a pure opioid agonist such as morphine, withdrawal or abstinence syndrome will occur. Before an agonist-antagonist is administered, the patient should be slowly withdrawn from the opioid agonist. Promethazine is an antiemetic that may be given with opioids to reduce nausea and vomiting, but it may also result in increased constipation and urinary retention. Methylnaltrexone is a selective mu opioid antagonist indicated for opioid-induced constipation; the drug does not block opioid receptors in the CNS. Methylnaltrexone does not decrease analgesia and cannot precipitate opioid withdrawal. Dextromethorphan may increase analgesia and reduce tolerance to morphine.

A patient reports having taken morphine for the past 6 months. Which medication, if ordered by the physician, should the nurse question? A. Promethazine [Phenergan] B. Pentazocine [Talwin] C. Methylnaltrexone [Relistor] D. Dextromethorphan [Delsym]

A. Ibuprofen [Motrin] ***Ibuprofen [Motrin] can block the antiplatelet effects of aspirin; therefore, patients who take low-dose aspirin to protect against myocardial infarction and thrombosis should avoid taking ibuprofen [Motrin]. It is not necessary to avoid taking zolpidem [Ambien], loratadine [Claritin], or diphenhydramine [Benadryl] while taking aspirin.

A patient takes daily low-dose aspirin for protection against myocardial infarction and stroke. Which medication will the nurse teach the patient to avoid taking with aspirin? A. Ibuprofen [Motrin] B. Zolpidem [Ambien] C. Loratadine [Claritin] D. Diphenhydramine [Benadryl]

C. Blood pressure ***The adverse effects of cholinergic therapy that stimulate muscarinic receptors include orthostatic hypotension. Hence, the nurse monitors the patient's blood pressure for early detection of hypotension. Although muscarinic poisoning is likely to cause increased lacrimal secretion, diarrhea, and urinary frequency, these problems are less important than hemodynamic changes.

A patient takes more than one cholinergic agonist that stimulates muscarinic receptors. Which parameter does the nurse make a priority to monitor to help prevent serious adverse effects of therapy? A. Lacrimation B. Bowel pattern C. Blood pressure D. Urinary pattern

D. The patient should increase fluid and fiber in the diet. ***Narcotic analgesics reduce intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can help manage this adverse effect. If increased fluid and fiber is not sufficiently effective, use of a laxative may be considered.

A patient takes oxycodone [OxyContin] 40 mg PO twice daily for the management of chronic pain. Which intervention should be added to the plan of care to minimize the gastrointestinal adverse effects? A. The patient should take an antacid with each dose. B. The patient should eat foods high in lactobacilli. C. The patient should take the medication on an empty stomach. D. The patient should increase fluid and fiber in the diet.

A. Folic acid ***Folic acid deficiency during early pregnancy can cause neural tube defects (spina bifida). All women with the potential for becoming pregnant should consume folic acid every day. Vitamin B12, riboflavin, and vitamin D are not considered as important as folic acid to supplement before a woman becomes pregnant.

A patient tells the nurse that she is thinking about becoming pregnant. The nurse teaches the patient that which vitamin should be her priority for supplementation before planning a pregnancy? A. Folic acid B. Vitamin D C. Riboflavin D. Vitamin B12

D. Folic acid ***Folic acid deficiency during early pregnancy can cause neural tube defects [spina bifida]. All women with the potential for becoming pregnant should consume folic acid every day. Vitamin B12, riboflavin, and vitamin D are not considered as important as folic acid to supplement before a woman becomes pregnant.

A patient tells the nurse that she is thinking about becoming pregnant. The nurse teaches the patient that which vitamin should be her priority for supplementation before planning a pregnancy? A. Vitamin B12 B. Riboflavin C. Vitamin D D. Folic acid

D. Senna [Senokot] ***Stimulant laxatives are commonly used to treat opioid-induced constipation.

A patient who has been taking a long-acting morphine to treat severe pain for a few months complains of constipation. The nurse anticipates which of the following will be prescribed for the patient? A. Polycarbophil [FiberCon] B. Mineral oil C. Psyllium [Metamucil] D. Senna [Senokot]

A. Alcohol B. Opioids D. Antihistamines E. Muscle relaxants ***Because they are also central nervous system (CNS) depressants, the nurse instructs the patient to avoid alcohol, opioids, antihistamines, and muscle relaxants; when taken together with alprazolam [Xanax] they can cause significant CNS depression, including respiratory depression. Tobacco use is likely to be harmful, but it is unlikely to intensify the adverse effects of a benzodiazepine. Caffeine, a xanthine stimulant, is likely to ameliorate CNS depression associated with benzodiazepines.

A patient who has been taking alprazolam [Xanax] and has been compliant with the therapeutic regimen for 6 weeks is now complaining of adverse effects of the medication. Which substances will the nurse instruct the patient to avoid to help prevent intensification of this medication's adverse effects? Select all that apply. A. Alcohol B. Opioids C. Tobacco D. Antihistamines E. Muscle relaxants F. Caffeinated drinks

D. St. John's wort ***St. John's wort is an herb used as a medication to treat depression. It leads to serotonin syndrome when administered with other selective serotonin reuptake inhibitors, such as citalopram [Celexa]. Valerian causes central nervous system depression when used with sedatives. Saw palmetto changes the effects of hormones in oral contraceptive drugs or hormonal replacement therapies. Cranberry decreases the elimination of many medications excreted by the kidneys.

A patient who has depression is admitted to the emergency department with serotonin syndrome. The nurse learns that the patient is taking an herbal medication and citalopram [Celexa]. Which herbal medication is the patient most likely taking? A. Valerian B. Cranberry C. Saw palmetto D. St. John's wort

A. Neutralized gastric acid ***Antacids work by neutralizing, absorbing, or buffering gastric acid, which raises the gastric pH above 5. For patients with GERD, antacids can produce symptomatic relief. Increased barrier to pepsin is an effect of sucralfate [Carafate]. Reduced stomach motility is not an effect of milk of magnesia.

A patient who has gastroesophageal reflux disease (GERD) is taking magnesium hydroxide (milk of magnesia). Which outcome should a nurse expect if the medication is achieving the desired therapeutic effect? A. Neutralized gastric acid B. Reduced stomach motility C. Increased barrier to pepsin D. Reduced duodenal pH

C. Administer the drug with an aluminum hydroxide antacid. ***Magnesium hydroxide is a rapid-acting antacid with a prominent adverse effect of diarrhea. To compensate, it usually is administered in combination with aluminum hydroxide, which promotes constipation. A reduction in dose might be necessary if the diarrhea is severe, but this is not the priority action. Increasing dietary fiber and keeping a stool count are appropriate actions to implement after adding an antacid to counteract the diarrhea effect.

A patient who has peptic ulcer disease and is receiving magnesium hydroxide (milk of magnesia) is experiencing an increased number of bowel movements. Which is the nurse's priority action? A. Ask the healthcare provider for a reduction in dose. B. Encourage the patient to increase dietary fiber. C. Administer the drug with an aluminum hydroxide antacid. D. Instruct the patient to keep an accurate stool count.

D. Administer the drug with an aluminum hydroxide antacid. ***Magnesium hydroxide is a rapid-acting antacid with a prominent adverse effect of diarrhea. To compensate, it usually is administered in combination with aluminum hydroxide, which promotes constipation. A reduction in dose might be necessary if the diarrhea is severe, but this is not the priority action. Increasing dietary fiber and keeping a stool count are appropriate actions to implement after adding an antacid to counteract the diarrhea effect.

A patient who has peptic ulcer disease and is receiving magnesium hydroxide (milk of magnesia) is experiencing an increased number of bowel movements. Which is the nurse's priority action? A. Encourage the patient to increase dietary fiber. B. Ask the healthcare provider for a reduction in dose. C. Instruct the patient to keep an accurate stool count. D. Administer the drug with an aluminum hydroxide antacid.

C. "Full effects of this drug may not be seen for 4 weeks or more." ***The patient should not expect the problem to be cured quickly. The patient should be instructed that therapeutic effects may not be seen for 4 weeks or more.

A patient with schizophrenia begins a course of first-generation antipsychotic medications. What should the nurse teach the patient? A. "Assess your weight daily." B. "Your blood pressure may increase significantly. " C. "Full effects of this drug may not be seen for 4 weeks or more." D. "Call the healthcare provider if you do not feel better right away."

B. Recent heart bypass surgery ***Celecoxib [Celebrex] should be avoided in patients who have undergone recent heart bypass surgery. Because it does not inhibit COX-1, platelet aggregation is not suppressed. It does inhibit COX-2 in blood vessels, which results in increased vasoconstriction. Unimpeded platelet aggregation and increased vasoconstriction pose a higher risk of thrombotic events in patients with certain cardiovascular risk factors. Hypothyroidism, a penicillin allergy, and a positive tuberculin skin test result are not contraindications to taking celecoxib [Celebrex].

A patient who has rheumatoid arthritis is scheduled to start taking celecoxib [Celebrex]. A nurse should recognize which factor from the patient's history as a contraindication to taking this medication? A. Hypothyroidism B. Recent heart bypass surgery C. Positive tuberculin skin test result D. Allergy to penicillin

D. A therapeutic effect can be expected in another 2 to 4 weeks ***The full therapeutic effects of selective serotonin reuptake inhibitor (SSRI) therapy may take 4 to 6 weeks to occur, so this patient can anticipate experiencing a therapeutic effect in 2 to 4 more weeks. Knowing the time frame to achieve a therapeutic effect offers the patient realistic hope and provides a justification for adherence to therapy. Adverse effects can usually be managed, and relaxation exercises may provide some relief from anxiety. The patient must fulfill these tasks to get the full therapeutic effect of the medication, but it can be difficult for a patient with depression to do so. SSRIs can require considerable titration, but, because of the nature of the patient's illness, this information is unlikely to promote adherence to therapy.

A patient who has taken fluoxetine [Prozac] for 2 weeks to treat an anxiety disorder complains of dissatisfaction with the therapy. What is the best information for the nurse to include in patient education to promote adherence to the therapeutic regimen? A. This medication usually requires titration. B. The adverse effects can be managed well. C. Relaxation exercises can offer some relief. D. A therapeutic effect can be expected in another 2 to 4 weeks

B. A higher drug dose ***The bioavailability of drugs that have a high first-pass effect is less than 100% if administered via an oral route. The drug becomes inactive during its transit through the intestine and while passing through the liver. An oral formulation with the same dose as a parenteral formulation will have a decreased effect due to a lesser amount of active drug reaching the systemic circulation; therefore, a higher drug dose will be needed if an oral formulation is prescribed. An enteric coating does not prevent drug inactivation in the liver.

A patient will receive an intramuscular injection of a drug that has a high first-pass effect. The provider plans to change the drug to an oral formulation when the patient is discharged. Which type of prescription would the nurse anticipate for the patient? A. A lower drug dose B. A higher drug dose C. An enteric-coated oral formulation D. An oral formulation of the same dose

B. Uncontrollable voluntary movements ***Many patients tend to have on-off phenomena when they are taking a dopamine medication such as levodopa [Parcopa]. On-off phenomena are characterized by the increase and decrease of dopamine levels. This fluctuation causes dyskinesia, in which the patient has impaired voluntary movements. Levodopa [Parcopa] does cause suicidal intentions and aggressive behavior, but this is not related to the on-off phenomenon. Levodopa [Parcopa] does not alter the respiratory rate because it does not affect pulmonary function. The on-off syndrome is related to the efficacy of the drug; it is unrelated to delusions and hallucinations.

A patient with Parkinson's disease is treated with levodopa [Parcopa]. During the follow-up visit, the nurse finds that the patient is having an on-off phenomenon caused by the medication. Which findings would likely cause the nurse to come to this conclusion? A. Sudden increase in respiratory rate B. Uncontrollable voluntary movements C. Frequent delusions and hallucinations D. Suicidal intentions and aggressive behavior

D. "Are you having vivid dreams or hallucinations?" ***Patients taking levodopa/carbidopa [Sinemet] are at increased risk for the psychiatric side effects of levodopa, including visual hallucinations, vivid dreams, nightmares, and paranoid ideation. The other questions are not directly related to problems that are likely to occur with this drug.

A patient with Parkinson's disease who takes levodopa/carbidopa [Sinemet] comes to the clinic for a semiannual physical examination. Which question is the most important for the nurse to ask? A. "Have you had your flu vaccine?" B. "Have you noticed any swelling in your feet?" C. "Have you noticed any changes in your stool?" D. "Are you having vivid dreams or hallucinations?"

D. Blood pressure 160/94 mm Hg ***While the temperature is slightly low, it is an insignificant risk. Although the heart rate is slightly high, it does not put the patient at risk. The blood glucose level is within normal limits. An elevated blood pressure over 150/90 mm Hg puts the patient at a greater risk for hemorrhagic stroke. Given the patient's history, the primary care provider should be notified.

A patient with a history of stroke and myocardial infarction (MI) is on a daily aspirin regimen. Which of the following would alert the nurse to contact the primary healthcare provider? A. Temperature 97.9° F B. Heart rate 99 beats/min C. Blood glucose level 78 mg/dL D. Blood pressure 160/94 mm Hg

A. Vitamin A D. Vitamin D E. Vitamin E ***Vitamins are divided into two major groups: fat-soluble vitamins (A, D, E, and K) and water-soluble vitamins (vitamin C and members of the vitamin B complex).

A patient with a malabsorption disease is at risk for low levels of fat-soluble vitamins. The nurse anticipates the patient to have a deficiency of which vitamin(s)? Select all that apply. A. Vitamin A B. Vitamin B12 C. Vitamin C D. Vitamin D E. Vitamin E

A. Vitamin A D. Vitamin D E. Vitamin E F. Vitamin K ***Vitamins are divided into two major groups: fat-soluble vitamins (A, D, E, and K) and water-soluble vitamins (vitamin C and members of the vitamin B complex).

A patient with a malabsorption disease is at risk for low levels of fat-soluble vitamins. The nurse is aware that which vitamins are fat soluble? (Select all that apply.) A. Vitamin A B. Vitamin B12 C. Vitamin C D. Vitamin D E. Vitamin E F. Vitamin K

A. "Avoid taking the drug with grapefruit juice." B. "Notify your healthcare provider if your urine becomes discolored." D. "Notify your healthcare provider if muscle pain occurs after 3 days." ***Simvastatin [Zocor] is a HMG Co-A reductase inhibitor that causes rhabdomyolysis as an adverse effect. Grapefruit juice inhibits the enzyme CYP3A4 that is required for the metabolism of simvastatin [Zocor]. This will increase levels of the drug in the body, resulting in rhabdomyolysis. Rhabdomyolysis is associated with the breakdown of muscle proteins that are excreted in the urine, changing the color of the urine. Simvastatin [Zocor] starts acting after 3 days of administration and can cause muscle pains. These should be reported to the healthcare provider as it may progress to rhabdomyolysis if simvastatin [Zocor] administration is not stopped. Muscle pain after one day may be due to some other cause and not the drug. Taking a small dose of aspirin [Ecotrin] is suggested before taking niacin [Nicobid] to reduce the incidence of cutaneous flushing.

A patient with a serum cholesterol level of 275 mg/dL is prescribed simvastatin [Zocor]. What instructions should the nurse provide to the patient? Select all that apply. A. "Avoid taking the drug with grapefruit juice." B. "Notify your healthcare provider if your urine becomes discolored." C. "Notify your healthcare provider if muscle pain occurs within 1 day." D. "Notify your healthcare provider if muscle pain occurs after 3 days." E. "Take aspirin [Ecotrin] 30 minutes before taking simvastatin [Zocor]."

A. Muscle pain and tenderness ***The statins, such as rosuvastatin [Crestor], typically are well tolerated; however, in rare cases they can cause the serious adverse effect of myopathy and rhabdomyolysis. If unexplained muscle pain and tenderness develop, the prescriber should be notified. The other effects would not likely be caused by rosuvastatin [Crestor].

A patient with cardiovascular disease is taking rosuvastatin [Crestor]. Which finding would indicate a potential adverse effect of this drug? A. Muscle pain and tenderness B. Platelet count of 100 × 103/mm3 C. Blood pressure of 140/90 mm Hg D. Wheezing and shortness of breath

D. Benzodiazepines ***First-line approved choices for generalized anxiety disorder are benzodiazepines, buspirone, and four antidepresssants: venlafaxine, paroxetine, escitalopram, and duloxetine. With the benzodiazepines, onset of relief is rapid, so it will meet the need for immediate symptom relief. In contrast, with buspirone and the antidepressants, onset is delayed.

A patient with generalized anxiety disorder needs immediate relief of symptoms. Which class of medications is the drug of choice? A. Buspirone B. Antipsychotics C. Antidepressants D. Benzodiazepines

B. Reduced ammonia level ***Some practitioners use lactulose to reduce blood ammonia levels by forcing ammonia from the blood into the colon. Lactulose is useful for treating patients with hepatic encephalopathy. It does not result in less ascitic fluid, a normal serum sodium level, or release of glycogen stores.

A patient with hepatic encephalopathy receives lactulose. The nurse expects which therapeutic outcome if the medication is having the desired effect? A. Less ascitic fluid B. Reduced ammonia level C. Release of glycogen stores D. Normal serum sodium level

C. The patient has hepatic disease. ***Lovastatin [Mevacor] can cause an increase in liver enzymes and should not be prescribed to patients with preexisting liver disease. Statins induce cell death in malignant cells. Cell death occurs via apoptosis and lovastatin [Mevacor] concentrations are used in the treatment of leukemia. Statins slow down the progress of chronic kidney disease by reducing kidney inflammation or improving the function of kidney tissues. Statins reduce chronic obstructive pulmonary disease (COPD).Lovastatin [Mevacor] can be prescribed to the patient with leukemia, renal disease and COPD.

A patient with hypercholesterolemia is prescribed lovastatin [Mevacor]. After reviewing the patient's medical history, the nurse discovers that the medication is not safe to prescribe for the patient and reports this finding to the healthcare provider. What did the nurse find in the patient's medical history? A. The patient has leukemia. B. The patient has renal disease. C. The patient has hepatic disease. D. The patient has chronic pulmonary disease.

D. By producing drowsiness, lethargy, and blurred vision ***Drowsiness, lethargy, and blurred vision are adverse effects of baclofen that initially make it difficult for the patient to participate actively in rehabilitation activities. These adverse effects are most common during the early phase of therapy but subside with continued use. These effects can be reduced by starting with a small dose and gradually increasing it.

A patient with multiple sclerosis (MS) is participating in a rehabilitation program. The patient has just been started on baclofen [Lioresal] 5 mg three times a day to help manage spasticity. How will the baclofen interfere with rehabilitation activities? A. By causing gastrointestinal distress B. By impairing coordinated movements C. By reducing sensation in the extremities D. By producing drowsiness, lethargy, and blurred vision

B. vitamin B12.

A patient with pernicious anemia most likely has a deficiency of A. iron. B. vitamin B12. C. vitamin K. D. selenium.

D. The medication may cause headaches and insomnia. ***Side effects include headache, nervousness, restlessness, insomnia, blurred vision, tremors, GI distress, and sexual dysfunction. The drug takes about 2 to 4 weeks for onset, decreases libido, and has no interaction with grapefruit juice.

A patient with reactive depression is ordered to receive fluoxetine (Prozac). Which information will the nurse include when teaching this patient? A. The medication takes effect in 1 week. B. The medication increases libido. C. The medication should be taken with grapefruit juice. D. The medication may cause headaches and insomnia.

D. Polyethylene glycol-electrolyte solution [GoLYTELY] ***GoLYTELY, an osmotic laxative, produces a watery stool in 2 to 6 hours. It is isosmotic with body fluids so it causes no fluid or electrolyte imbalance and thus can be used safely in patients with an electrolyte impairment. Magnesium salts are contraindicated in patients with renal dysfunction. Mineral oil is more useful when administered by enema for fecal impaction. Docusate sodium produces results in 1 to 3 days.

A patient with renal impairment requires bowel cleansing before a diagnostic procedure. The nurse prepares to administer which laxative? A. Mineral oil B. Docusate sodium [Colace] C. Magnesium salts (magnesium citrate) D. Polyethylene glycol-electrolyte solution [GoLYTELY]

C. Neck and back pain ***Neck and back pain from a vertebral compression fracture may occur because of the development of osteoporosis as a result of glucocorticoid therapy. Other possible adverse effects of prednisone include hypertension, hypokalemia, and hyperglycemia.

A patient with systemic lupus erythematosus is prescribed prednisone. It is most important for the nurse to monitor the patient for what? A. Hypotension B. Elevated potassium levels C. Neck and back pain D. Hypoglycemia

D. Make sure the patient eats breakfast immediately. ***Insulin aspart [NovoLog] is a rapid-acting insulin that acts in 15 minutes or less. It is imperative that the patient eat as the insulin starts to work. The patient should have had a fingerstick blood sugar test done before receiving the medication. There is no need to check the urine. This medication is given subcutaneously.

A patient with type 1 diabetes mellitus has been ordered insulin aspart [NovoLog] 10 units at 7:00 AM. Which nursing intervention should the nurse perform after administering this medication? A. Flush the intravenous line. B. Perform a fingerstick blood sugar test. C. Have the patient void and dipstick the urine. D. Make sure the patient eats breakfast immediately.

D. Administer the ordered dose of digoxin. ***Therapeutic serum digoxin levels are 0.5 to 0.8 ng/mL. The patient should receive the next dose to keep the level in therapeutic range. Because the dose is in the therapeutic range, it would not be appropriate to hold the dose, administer an antidote, or notify the provider.

A patient's serum digoxin level is noted to be 0.5 ng/mL. Which action by the nurse is appropriate? A. Notify the provider. B. Administer an antidote. C. Hold the ordered dose of digoxin. D. Administer the ordered dose of digoxin.

C. "After taking the medication, sit or stand for 30 minutes." ***Oral alendronate may result in esophageal ulceration if it fails to pass completely through the esophagus and thus is not administered properly. Sitting or standing for 30 minutes after dosing is recommended to prevent prolonged contact with the esophageal mucosa. Symptoms of esophageal injury are heartburn and pain and should be reported. Because of its poor bioavailability, alendronate must be given before eating or drinking even orange juice or coffee.

A patient, who is postmenopausal, is scheduled to begin taking alendronate [Fosamax] to prevent osteoporosis. Which instruction should the nurse give the patient? A. "It will be normal to experience some heartburn." B. "Take the medication with orange juice or coffee." C. "After taking the medication, sit or stand for 30 minutes." D. "For the best absorption, take the drug while eating a meal."

A. Naloxone [Narcan] ***Naloxone is a narcotic antagonist that can reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.

A postoperative patient has an epidural infusion of morphine sulfate [Astramorph]. The patient's respiratory rate declines to 8 breaths per minute. Which medication would the nurse anticipate administering? A. Naloxone [Narcan] B. Acetylcysteine [Mucomyst] C. Methylprednisolone [Solu-Medrol] D. Protamine sulfate

B. Just before bedtime ***Oral bisacodyl is a stimulant laxative that acts within 6 to 12 hours. When given at bedtime, it produces a response the next morning. Administration at another time might produce a bowel movement at an inconvenient time, such as during a meal or in the middle of the night.

A postoperative patient is scheduled to start taking a daily oral dose of bisacodyl [Dulcolax]. When does the nurse administer the medication? A. After ambulating B. Just before bedtime C. At the evening meal D. Before the morning bath

D. Naloxone [Narcan] ***After surgery, naloxone may be used to reverse the excessive respiratory and central nervous system depression that can be caused by opioids.

A postoperative patient who received an intravenous infusion of morphine has a respiratory rate of 8 breaths per minute and is lethargic. Which as-needed medication should the nurse administer to the patient? A. Methadone [Dolophine] B. Nalbuphine [Nubain] C. Tramadol [Ultram] D. Naloxone [Narcan]

A. "Inject this insulin with your first bite of food, because it is very fast acting." ***Lispro is a rapid-acting insulin and has an onset of action of 15 to 30 minutes with a peak action of about 2 hours, not 8 to 10 hours. Because of its rapid onset, it is administered immediately before a meal or with meals to control the blood glucose rise after meals. Lispro insulin must be combined with an intermediate- or a long-acting insulin, not regular insulin (which also is a short-duration insulin), for glucose control between meals and at night. To achieve tight glycemic control, patients must combine different types of insulin based on their duration of action.

A teaching plan for a patient who is taking lispro [Humalog] should include which instruction by the nurse? A. "Inject this insulin with your first bite of food, because it is very fast acting." B. "The duration of action for this insulin is about 8 to 10 hours, so you'll need a snack." C. "This insulin needs to be mixed with regular insulin to enhance the effects." D. "To achieve tight glycemic control, this is the only type of insulin you'll need."

B. Facial grimacing and tongue spasms ***Pseudoparkinsonism, which resembles symptoms of Parkinson's disease, is a major side effect of typical antipsychotic drugs such as fluphenazine (Prolixin). Anticholinergic medications may be used to control this side effect.

A young woman is being treated for psychosis with fluphenazine (Prolixin). Which sign would indicate the need to add an anticholinergic to the patient's medication regimen? A. A decrease in pulse and respiratory rate B. Facial grimacing and tongue spasms C. An increase in hallucinations D. A decrease in the patient's level of orientation

B. Absence of jaundice ***Acetylcysteine [Mucomyst] substitutes for depleted glutathione in the reaction that removes the toxic metabolite of acetaminophen [Tylenol] (which accumulates with acetaminophen poisoning) and thereby minimizes liver damage. Severe hepatic injury may occur with acetaminophen [Tylenol] poisoning, which is manifested by jaundiced sclera and skin. The assessment of bowel sounds, breath sounds, and pedal pulses is not used to determine the therapeutic effects of acetylcysteine [Mucomyst] for the treatment of acetaminophen overdose.

After administering acetylcysteine [Mucomyst] to a patient who overdosed on acetaminophen [Tylenol], a nurse should recognize which outcome as an indicator of the therapeutic effects of acetylcysteine? A. Clear breath sounds B. Absence of jaundice C. Palpable pedal pulses D. Increased bowel sounds

C. Assessment ***Collecting information about the patient's home environment is included in the assessment phase of the nursing process. The other phases of the nursing process build on the information gathered in the assessment phase.

After an elderly patient is prescribed a drug that may cause sedation, the home health nurse checks the home environment for items that increase the risk of falls. Which phase of the nursing process is addressed in the nurse's actions? A. Planning B. Evaluation C. Assessment D. Implementation

A. Respiratory rate ***Monitoring the respiratory rate in all patients who are receiving morphine is a priority. If the respiratory rate is 12 or fewer breaths per minute, the nurse should withhold the medication and notify the prescriber.

After surgery, a patient has morphine prescribed for postoperative pain. It is most important for the nurse to make which assessment? A. Respiratory rate B. Heart rate C. Pain level D. Constipation

D. Gamma-aminobutyric acid (GABA) ***Alprazolam is a benzodiazepine; this class of drugs reduces anxiety by potentiating the action of GABA.

Alprazolam [Xanax] is prescribed for an adult with panic attacks. The nurse recognizes that this drug exerts its therapeutic effect by interacting with which neurotransmitter? A. Norepinephrine B. Acetylcholine C. Serotonin (5-HT) D. Gamma-aminobutyric acid (GABA)

C. Obtain baseline serum thyroid and liver function studies. ***Amiodarone may cause hypothyroidism or hyperthyroidism and may also injure the liver. Serum thyroid and liver function levels should be assessed before treatment with amiodarone is started and periodically during treatment. Patients who develop changes in visual acuity or peripheral vision while taking amiodarone should have an ophthalmologic evaluation, but this is not necessary before starting therapy. A dermatologic examination and TEE are not necessary before initiation of amiodarone therapy. Although patients with atrial fibrillation are at risk for mural thrombus, amiodarone therapy itself does not pose a risk of systemic embolization.

Amiodarone [Cordarone] is prescribed for a patient with atrial fibrillation. What is the most important nursing intervention before administering this medication? A. Document an ophthalmic examination was performed. B. Explain a dermatologic evaluation is needed. C. Obtain baseline serum thyroid and liver function studies. D. Maintain NPO for transesophageal echocardiogram (TEE).

C. New onset of disorientation to time and place ***Effects on the central nervous system are most likely to occur in elderly patients who have renal or hepatic impairment. Patients may experience confusion, hallucinations, lethargy, restlessness, and seizures. The remaining options are not adverse effects of cimetidine.

An 80-year-old patient with a history of renal insufficiency recently was started on cimetidine. Which assessment finding indicates that the patient may be experiencing an adverse effect of the medication? A. +3 pitting edema B. Pain with urination C. New onset of disorientation to time and place D. Heart rate changes from a baseline of 70 to 80 beats per minute (bpm) to 110 to 120 bpm

C. "Let's discuss this effect with your prescriber. There are other drugs available to manage your blood pressure that may not have the same adverse effect." ***Many antihypertensive medications can produce adverse sexual side effects, including impotence. It is important for the nurse to listen to the patient's concerns and to avoid making value judgments. Other antihypertensive medications may manage this patient's blood pressure without causing adverse sexual effects. Reducing the undesired effects of antihypertensive medication will improve the patient's adherence.

An adult male patient is taking medication for blood pressure management. The patient states to the nurse, "I'm not going to take these drugs anymore, because they are interfering with my sex life." What is the most appropriate response by the nurse? A. "It is unfortunate these drugs can cause erectile dysfunction but managing your blood pressure is more important than your sexual performance." B. "I understand how discouraging it must be to live with this adverse effect, but you could have a stroke if you do not take your blood pressure medications." C. "Let's discuss this effect with your prescriber. There are other drugs available to manage your blood pressure that may not have the same adverse effect." D. "I am glad you told me about your experience with this common side effect. Sexual performance can be a difficult subject to discuss."

D. The patient is using a calcium-based antacid. ***Renal stones may occur from the deposition of calcium from milk and calcium-based antacids. The fact that the patient takes an over-the-counter antacid explains the patient's digestive issues and low gastric pH (hyperacidity). A lower dose of antacid would not be effective for treating hyperacidity or cause renal stones. The fact that the patient drinks two glasses of milk every day is an indication that the patient can process milk.

An assessment reveals that a patient has renal calculi. During the assessment, the nurse learns that the patient has taken over-the-counter antacids for a long time. The patient also consumes two glasses of milk every day. What should the nurse infer from this information? A. The patient has high gastric pH. B. The patient is unable to process milk. C. The patient is taking a lower dose of antacid. D. The patient is using a calcium-based antacid.

C. confusion ***Cimetidine is a histamine (H2)-receptor antagonist. Older clients are especially susceptible to central nervous system side effects of cimetidine. The most frequent of these is confusion. Less common central nervous system side effects include headache, dizziness, drowsiness, and hallucinations.

An older client recently has been taking cimetidine. The nurse monitors the client for which MOST frequent central nervous system effect of this medication? A. tremors B. dizziness C. confusion D. hallucinations

A. renal impairment

Antacids should be used with cation in patients with: A. renal impairment B. COPD C. gastric ulcers D. dueodenal ulcers

C. Absorption A. Distribution D. Biotransformation B. Elimination ***The first step in the process of pharmacokinetics is absorption. The drug moves from the gastrointestinal tract to body fluids by passive absorption, active absorption, or pinocytosis. The absorbed drug is distributed by blood flow, the tissue's affinity for the drug, and the protein-binding effect. The distributed drug undergoes metabolism or biotransformation in various organs of the body; however, the liver is the primary site of metabolism. The kidneys filter free, unbound drugs; water-soluble drugs; and drugs that are unchanged through the process of elimination or excretion.

Arrange the processes of pharmacokinetics for parenteral drugs in the order of their occurrence. A. Distribution B. Elimination C. Absorption D. Biotransformation

D. rhabdomyolysis. ***NMS symptoms include muscle rigidity, sudden high fever, altered mental status, blood pressure fluctuations, tachycardia, dysrhythmias, seizures, rhabdomyolysis, acute renal failure, respiratory failure, and coma.

Assessment findings for a patient with neuroleptic malignant syndrome (NMS) include A. bradycardia. B. hypothermia. C. muscle weakness. D. rhabdomyolysis.

C. dietary intake. ***Certain drug and food interactions with MAO inhibitors can be fatal. Foods that contain tyramine have sympathomimetic-like effects and can cause a hypertensive crisis. These types of food must be avoided by MAOI users.

Before administering an MAO inhibitor, it is most important for the nurse to assess the patient's A. sexual history. B. socioeconomic status. C. dietary intake. D. hydration status.

D. Stop the infusion and discard the IV solution. ***If a precipitate appears in the IV solution, that solution should be discarded.

Before administrating the dosage of a prescribed medication, the nurse observes precipitation in the intravenous (IV) solution. What is the priority nursing action? A. Verify the prescription. B. Prepare another dose to administer. C. Check the expiration date of the drug. D. Stop the infusion and discard the IV solution.

D. Sympathetic nerves to sweat glands promotes secretion of sweat E. Piloerection induced by sympathetic nerves causes heat conservation ***The sympathetic nervous system helps regulate body temperature in three ways. (1) By regulating blood flow to the skin, sympathetic nerves can increase or decrease heat loss. By dilating surface vessels, sympathetic nerves increase blood flow to the skin and thereby accelerate heat loss. Conversely, constricting cutaneous vessels conserves heat. (2) Sympathetic nerves to sweat glands promote secretion of sweat, thereby helping the body cool. (3) By inducing piloerection (erection of hair), sympathetic nerves can promote heat conservation.

By which of these ways does the sympathetic nervous system (SNS) help to regulate body temperature? Select all that apply. A. By dilating cutaneous vessels to conserve heat B. By compensating for blood loss by causing vasoconstriction C. By constricting surface vessels to increase blood flow to the skin D. Sympathetic nerves to sweat glands promotes secretion of sweat E. Piloerection induced by sympathetic nerves causes heat conservation

C. Beta1 ***Calcium channels are coupled to beta1-adrenergic receptors in the heart. For that reason, calcium channel blockers affect the heart in ways similar to the beta blockers. Both types of drugs cause a decrease in the force of contraction, heart rate, and cardiac impulse conduction.

Calcium channel blockers work by reducing calcium influx into the cells of the heart and blood vessels. Calcium channels are coupled to which type of autonomic nervous system receptors? A. Alpha1 B. Alpha2 C. Beta1 D. Beta2

C. Producing miosis in certain eye diseases ***Cholinergic agents stimulate the pupil to constrict (miosis), thus decreasing intraocular pressure as they are direct-acting drugs. Indirect-acting drugs are used for treating patients with bradycardia. Cholinergic drugs might directly affect the bladder but not on a muscular level. They increase salivation and sweating.

Cholinergic (parasympathomimetic) drugs that stimulate muscarinic receptors are indicated for which situation? A. Preventing salivation and sweating B. Inhibiting muscular activity in the bladder C. Producing miosis in certain eye diseases D. Treating a postoperative patient who has bradycardia

C. Apply direct pressure over the puncture site. ***Alteplase may cause bleeding, and the management of bleeding depends on its severity. Oozing at sites of cutaneous puncture can be controlled with direct pressure or a pressure dressing. If severe bleeding occurs, alteplase should be discontinued. Excessive fibrinolysis can be reversed with IV aminocaproic acid [Amicar], a compound that prevents activation of plasminogen and directly inhibits plasmin.

During administration of alteplase [Activase], the patient's IV site starts to ooze blood around the catheter. Which action by the nurse is most appropriate? A. Discontinue the infusion of alteplase. B. Assess the patient's vital signs. C. Apply direct pressure over the puncture site. D. Administer aminocaproic acid [Amicar].

D. Severe pain resulting from cancer metastasis ***Transdermal fentanyl [Duragesic] is indicated only for persistent severe pain in patients who already tolerate opioids because it can cause fatal respiratory depression in patients who are opioid naive. For this reason, the patch is not indicated for acute pain such as postoperative pain, intermittent pain, or pain that responds to a less powerful analgesic.

For which type of pain is a fentanyl [Duragesic] transdermal patch best suited? A. Pain after abdominal surgery B. Acute treatment of a migraine headache C. Lower back pain related to lumbar strain D. Severe pain resulting from cancer metastasis

C. Every 72 hours ***The fentanyl [Duragesic] transdermal delivery system is designed to slowly release analgesic over a 72-hour period. Fentanyl [Duragesic] patches are used for nonescalating pain and not for acute pain relief. A new patch needs to be applied every 72 hours.

How often does the nurse tell the patient to change a fentanyl [Duragesic] transdermal patch? A. Once a week B. Every 24 hours C. Every 72 hours D. When pain recurs

A. "Seek medical help for nausea and vomiting." ***Nausea and vomiting are symptoms of a cholinergic crisis due to an overdose of anticholinesterase therapy. Hence, the nurse should instruct the patient to report these symptoms immediately so that prompt action can be taken to reverse the adverse effects. The nurse should instruct the patient to take the medication before eating to strengthen the muscles involved in chewing and swallowing in order to prevent aspiration or choking. The nurse should instruct the patient to take the medication at the first sign of muscle weakness, not after meals. The medication will relieve, not cause, ptosis.

How should the nurse instruct a patient who is prescribed pyridostigmine [Mestinon]? A. "Seek medical help for nausea and vomiting." B. "Ask for help to change positions or to stand." C. "Take the medication 30 minutes after eating." D. "Lower the dose if the usual dose results in ptosis."

B. Impaired night vision ***Vitamin A plays an important role in adaptation to dim light and night blindness, which often are the first indicators of deficiency. Vitamin A is used primarily for the prevention or correction of vitamin A deficiency. Tender, bleeding gums, disturbed sleep patterns, and excessive sweating are not related to manifestations of vitamin A deficiency.

In assessing a patient with a vitamin A deficiency, the nurse should determine if the patient has which manifestation? A. Excessive sweating B. Impaired night vision C. Tender, bleeding gums D. Disturbed sleep patterns

D. Assess respiratory rate and depth ***Morphine sulfate can cause life-threatening respiratory depression. Although nausea can be a side effect of the drug, it will not be life threatening.

In monitoring a patient for adverse effects related to morphine sulfate, which is a priority assessment? A. Assess circulation B. Assess cough reflex C. Assess for nausea and vomiting D. Assess respiratory rate and depth

A. Tachycardia ***Increased sympathetic activity results in an increased heart rate (tachycardia), increased contractility, increased venous tone, and increased arteriolar tone (elevated blood pressure). Sympathetic stimulation also causes bronchodilation (not bradypnea) and possibly hyperglycemia.

In the failing heart, arterial pressure falls, stimulating the baroreceptor reflex to increase sympathetic nervous system activity. The nurse understands increased sympathetic activity will produce which response? A. Tachycardia B. Bradypnea C. Hypotension D. Hypoglycemia

B. Assessment C. Nursing diagnosis A. Planning E. Implementation D. Evaluation ***Patient assessment is the first stage of the nursing process. The nurse validates and documents patient data during the assessment stage. The nurse formulates a nursing diagnosis by analyzing patient data. The nursing diagnosis helps the nurse to focus on the patient's chief concerns. Consequently, the nursing diagnosis helps the nurse to plan effective interventions for the patient during the planning phase. The nurse implements the planned interventions during the implementation phase. The nurse evaluates the success of patient outcomes during the evaluation phase.

In which order would the nurse apply the nursing process to ensure patient-centered collaborative care? A. Planning B. Assessment C. Nursing diagnosis D. Evaluation E. Implementation

C. A patient with a hemorrhagic stroke ***The patient contraindicated to take a low-dose aspirin is the patient with a hemorrhagic stroke. The patient with a thrombosis, deep vein thrombosis, and a heart problem would benefit from a low-dose aspirin.

In which patient would a low-dose aspirin be contraindicated? A. A patient with thrombosis B. A patient with a heart problem C. A patient with a hemorrhagic stroke D. A patient with a deep vein thrombosis

C. Rapid

Insulin aspart is a ________ acting insulin. A. Intermediate B. Long C. Rapid D. Short

D. Increases sedation, decreases anxiety and has anticonvulsant effects

Intensifying the effect of GABA has what effect on the body? A. Decreases signs of depression in long term use B. Increases sedation, but does decreases seizure threshold C. Increases mental alertness and focus D. Increases sedation, decreases anxiety and has anticonvulsant effects

B. liver failure patients

Lactulose is an osmotic laxative that is also used in: A. renal failure patients B. liver failure patients C. Cushing's disease patients D. Addison's disease patients

A. dry mouth B. blurry vision D. constipation E. difficulty urinating H. sedation ***Cant see, cant pee, cant spit, cant sh**

List some effects of anticholinergic agents: Select all that apply. A. dry mouth B. blurry vision C. diarrhea D. constipation E. difficulty urinating F. incontinence G. hyperactivity H. sedation

D. They are safe to use in children with chickenpox or influenza. ***As with aspirin, these drugs should not be given to children with chickenpox or influenza, owing to the possibility of precipitating Reye's syndrome. All other statements are true.

Nonaspirin NSAIDs differ from aspirin in all but which way? A. They cause reversible inhibition of COX, so their effects decline as soon as their blood levels decline. B. They can suppress platelet aggregation, but they are not used to prevent MI and stroke. C. They increase the risk of MI and stroke and therefore should be used in the lowest effective dosage for the shortest possible time. D. They are safe to use in children with chickenpox or influenza.

B. fracture C. pneumonia E. acid rebound F. intestinal infection w/ C. diff

Proton pump inhibitors can increase the risk of serious adverse effects including: (select all that apply). A. H. pylori infection B. fracture C. pneumonia D. hypothyroidism E. acid rebound F. intestinal infection w/ C. diff

A. sulfonylureas (glyburide) D. biguanides (metformin - glucophage) ***Sulfonylureas are containdicated in sulfa allergy. Metformin should not be given if pt. is scheduled to have contrast dye for CT scan (could cause renal toxicity).

Prototype for oral antidiabetic drugs, is used to treat type 2 diabetes: select all that apply. A. sulfonylureas (glyburide) B. aspirin NSAIDs C. insulin D. biguanides (metformin - glucophage)

B. decreased TSH, increased T3 & T4 D. intolerance to heat E. goiter F. weight loss and muscle wasting F. restlessness and anxiety

Signs of hyperthyroidism: select all that apply. A. increased TSH, decreased T3 & T4 B. decreased TSH, increased T3 & T4 C. brittle hair and nails D. intolerance to heat E. goiter F. weight loss and muscle wasting G. lethargy and fatigue F. restlessness and anxiety

A. increased TSH, decreased T3 & T4 C. brittle hair and nails D. lethargy and fatigue F. intolerance to cold

Signs of hypothyroidism: select all that apply. A. increased TSH, decreased T3 & T4 B. increase secretion of thyroid hormone C. brittle hair and nails D. lethargy and fatigue E. restlessness and anxiety F. intolerance to cold

A. Hold the medication ***A therapeutic drug level for phenytoin is 10 to 20 mcg/mL. The nurse should hold the medication and then call the healthcare provider.

The client's serum phenytoin [Dilantin] level is 31 mcg/mL. What is the nurse's best action? A. Hold the medication B. Increase the medication dose C. Administer the medication intravenously D. Have the client continue the current regimen

B. "Thyroid drugs should not be taken to treat obesity." ***Thyroid drugs should not be taken to treat obesity. Thyroid drugs may increase the activity of oral anticoagulants. Thyroid drugs may decrease serum digitalis levels when administered concurrently. Cholestyramine decreases the absorption of thyroid drugs by binding to thyroid hormone in the gastrointestinal tract. This may reduce the absorption of both drugs.

The clinical instructor asks the nursing student about various drug interactions of thyroid drugs. Which statement by the nursing student indicates effective learning? A. "Thyroid drugs may increase serum digitalis levels." B. "Thyroid drugs should not be taken to treat obesity." C. "Thyroid drug absorption is increased by cholestyramine." D. "Thyroid drugs may decrease the activity of oral anticoagulants."

B. Increased heart rate ***Dobutamine mimics the action of norepinephrine (NE) at receptors on the heart, thereby causing an increase in the heart's rate and force of contraction.

The drug dobutamine acts as an agonist of norepinephrine (NE) receptors. Which effect is the nurse most likely to observe in a patient receiving this medication? A. Sinus bradycardia B. Increased heart rate C. Reduced cardiac output D. Atrioventricular heart block

D. Use of herbs or over-the-counter medications ***The nurse will ask the patient about any herbs or other nonprescription medications taken. The patient is of Asian culture and may use herbal remedies that are not considered medications.

The emergency department nurse is documenting the medication history of an Asian immigrant. The patient denies taking any medications, but the nurse notes a bottle of capsules in the patient's bag. What information will the nurse collect next? A. Vital signs B. Insurance information C. Primary care provider name D. Use of herbs or over-the-counter medications

B. A different drug may be ordered instead. C. The dosage of the drug may be reduced. ***Due to the reduction in kidney function, the healthcare provider may choose to reduce the dosage of the medication to prevent toxicity or may put the patient on a completely different drug. There would be no reason to stop all drug therapy due to a potential problem with one drug.

The healthcare provider is considering placing the patient on memantine [Namenda]. The patient's family member tells the nurse that the patient has a history of kidney disease. Based on this information, the nurse should anticipate which action on the part of the healthcare provider? Select all that apply. A. All drug therapy will be stopped. B. A different drug may be ordered instead. C. The dosage of the drug may be reduced. D. The dosage of the drug may be increased

C. 750 mg ***The patient taking a medication every 8 hours will take it three times in a 24-hour period: 250 mg times 3 equals 750 mg for a 24-hour period.

The healthcare provider ordered lithium 250 mg PO every 8 hours for a patient experiencing acute mania. What will the patient's total dose be in 24 hours? A. 250 mg B. 500 mg C. 750 mg D. 1000 mg

30 minutes ***The medication is 100 mg in 50 mL and is ordered to run at 100 mL per hour. Since the medication is only 50 mL, the infusion would be complete in 30 minutes.

The healthcare provider ordered thiamine solution 100 mg in 50 mL IV piggyback for a patient with a history of alcohol abuse. The dose is ordered to run at 100 mL per hour. The nurse knows that the infusion will require how much time? Record your answer using a whole number. _____ minutes

C. 2 ***The ordered dose is 150 mcg. The available tablets are 75 mcg. 75 multiplied by 2 equals 150. Therefore, 2 tablets is the correct dose.

The healthcare provider orders 150 mcg of levothyroxine [Synthroid] PO every morning. The medication available is levothyroxine [Synthroid] 75 mcg tablets. How many tablets will the nurse administer? A. 0.5 B. 1 C. 2 D. 4

B. 5 mL *** Each dose will be 5 mL. The total of 20 mg is divided into two doses of 10 mg. The concentration is 2 mg/mL. Divide 10 mg by 2 mg to equal 5 mL.

The healthcare provider orders Namenda syrup 20 mg PO daily in two divided doses. The concentration available is Namenda 2 mg/mL. How many mL will the patient receive for each dose? A. 2 mL B. 5 mL C. 10 mL D. 20 mL

B. Monitor electrocardiogram. ***Monitor the electrocardiogram (ECG) continuously during IV administration of diltiazem for AV block, sudden reduction in heart rate, and prolongation of the PR or QT interval. Cardioversion is not necessary; however, have equipment for cardioversion available. Baseline laboratory studies are needed for liver and kidney function. Increased urinary output is not an adverse effect of diltiazem.

The healthcare provider prescribes an intravenous dose of diltiazem [Cardizem] for treatment of a patient with atrial fibrillation. What is the priority nursing intervention? A. Assist with cardioversion. B. Monitor electrocardiogram. C. Obtain baseline coagulation studies. D. Assess for increased urinary output.

B. "Do not start any new medications without first talking to your healthcare provider." C. "Before starting this medication a blood test will be done to check your total cholesterol level and to measure liver enzymes." D. "Lower the total fat and saturated fat in your diet by increasing your intake of fresh fruits and vegetables and whole grains." ***Lovastatin [Mevacor], simvastatin [Zocor], and atorvastatin [Lipitor] levels may be elevated when these drugs are combined with other drugs that inhibit CYP3A4. Caution is warranted if these drugs are combined,. Before starting a statin, obtain a baseline lipid profile that includes total cholesterol and obtain baseline liver function tests (LFTs). The statins are taken once daily with food. It is recommended to take them with the evening meal because endogenous cholesterol synthesis increases during the night. The statins do not typically cause flushing and itching; that effect occurs with niacin [Niacor]. A diet low in total fat and saturated fat is recommended when antilipemic drugs are prescribed.

The healthcare provider prescribes lovastatin [Mevacor] for a patient discharged from the hospital post-myocardial infarction. Which instructions are most appropriate for the nurse to include in the patient's teaching plan? Select all that apply. A. "Take your medication in the morning, with a full glass of water, for best results." B. "Do not start any new medications without first talking to your healthcare provider." C. "Before starting this medication a blood test will be done to check your total cholesterol level and to measure liver enzymes." D. "Lower the total fat and saturated fat in your diet by increasing your intake of fresh fruits and vegetables and whole grains." E. "Take one 325-mg aspirin 30 minutes before your dose to lessen the problem of flushing and itching that can occur with this drug."

B. Ventricular wall thickening ***An increase in ventricular wall thickness, also called ventricular hypertrophy, is characteristic of the remodeling process during the initial phase of heart failure. The ventricles also dilate and become more spherical (less cylindric). This change in cardiac shape typically occurs after cardiac injury under the influence of the neurohormonal systems, such as the sympathetic nervous system and renin-angiotensin-aldosterone system.

The heart undergoes cardiac remodeling during the initial phase of heart failure. Which cardiac geometric change occurs during heart failure? A. Ventricular constriction B. Ventricular wall thickening C. Ventricular atrophy D. Ventricles become more cylindric

A. It is a synthetic steroid identical to cortisol. C. It has glucocorticoid and mineralocorticoid actions. D. It is a preferred drug for adrenocortical insufficiency. ***Hydrocortisone is a synthetic steroid with a structure identical to that of cortisol. Hydrocortisone is a preferred drug for all forms of adrenocortical insufficiency. Oral hydrocortisone is ideal for chronic replacement therapy. Parenteral administration is used for acute adrenal insufficiency and to supplement oral doses during times of stress. Despite being classified as a glucocorticoid, hydrocortisone also has mineralocorticoid actions.

The nurse administering hydrocortisone to a patient recognizes which statement(s) as true regarding the medication? Select all that apply. A. It is a synthetic steroid identical to cortisol. B. It should not be given during times of stress. C. It has glucocorticoid and mineralocorticoid actions. D. It is a preferred drug for adrenocortical insufficiency. E. It is given intravenously for chronic replacement therapy.

A. Blood pressure reduction ***All angiotensin receptor blockers (ARBs), such as candesartan [Atacand], are approved for hypertension. Reduction in blood pressure equals those seen with angiotensin-converting enzyme (ACE) inhibitors. ARBs will decrease pulmonary congestion. Because ARBs promote vasodilation, the nurse expects the patient's extremities to be warm and pink from increased perfusion. In contrast to ACE inhibitors, ARBs do not cause clinically significant hyperkalemia.

The nurse administers candesartan [Atacand] to a patient. Which assessment finding should the nurse use as a clinical indicator of the therapeutic effectiveness of the medication? A. Blood pressure reduction B. Serum potassium retention C. Peripheral perfusion reduction D. Pulmonary congestion retention

C. Reduction of cardiac output ***When the blood pressure rises too high, the baroreceptor reflex causes reduction of cardiac output and vasodilation. The baroreceptor reflex works rapidly but does not have sustained action. The baroreceptors' most noticeable response is reflex tachycardia.

The nurse administers the beta blocker medication metoprolol [Lopressor] to a patient who has hypertension. This medication works on the baroreceptors when blood pressure is too high. What is another effect the nurse would expect from the baroreceptor reflex when the blood pressure is too high? A. Vasoconstriction B. Reflex bradycardia C. Reduction of cardiac output D. Sustained action of response

C. Postural hypotension ***The main adverse effect of cholinergic drugs in the patient is postural hypotension, which results in dizziness and fainting. This effect can be decreased by changing positions slowly when standing. These drugs do not affect muscular function, gastrointestinal function, or respiratory function. Therefore, muscle cramps, nausea or vomiting, and dyspnea are not adverse effects related to cholinergic drugs.

The nurse advises a patient who is taking cholinergic drugs to avoid standing quickly and to rise to an upright position slowly. Which complication associated with the drug is the nurse trying to prevent? A. Dyspnea B. Muscle cramps C. Postural hypotension D. Nausea and vomiting

D. Medication reconciliation ***Medication reconciliation is a process in which the nurse asks the patient to provide a list of all medications including herbal and over-the-counter drugs that the patient is currently taking. This knowledge prevents medication errors. Error reporting involves notifying the appropriate people about errors related to medication administration. Medication reconciliation helps in quality improvement. Notifying the patient is a process whereby the patient is informed about possible medication errors.

The nurse asks a patient to provide a list of all medications including herbal and over-the-counter drugs that the patient takes. Which term best describes the nurse's action? A. Error reporting B. Patient notification C. Quality improvement D. Medication reconciliation

B. Hematemesis ***Ibuprofen is a member of the nonaspirin first-generation nonsteroidal anti-inflammatory drugs (NSAIDs). Through inhibition of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), ibuprofen poses a risk for gastric ulceration and bleeding, which may lead to hematemesis. Ibuprofen is used to reduce inflammation, fever, and pain and therefore is effective in reducing dysmenorrhea (painful menstrual cramping). It is not known to cause hives or jaundice, which are signs of impaired liver function.

The nurse assesses a patient who takes ibuprofen [Advil] on a regular basis. Which finding does the nurse know is an adverse effect of ibuprofen [Advil] therapy? A. Hives B. Hematemesis C. Dysmenorrhea D. Jaundice

C. Hematemesis ***Ibuprofen is a member of the nonaspirin, first-generation nonsteroidal anti-inflammatory drugs (NSAIDs). Through inhibition of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), ibuprofen poses a risk for gastric ulceration and bleeding, which may lead to hematemesis (vomiting of blood). Ibuprofen is used to reduce inflammation, fever, and pain and therefore is effective in reducing dysmenorrhea (painful menstrual cramping). It is not known to cause drowsiness or jaundice.

The nurse assesses a patient who takes ibuprofen [Advil] on a regular basis. Which finding in the patient would prompt the nurse to contact the healthcare provider immediately? A. Jaundice B. Drowsiness C. Hematemesis D. Dysmenorrhea

C. 2 ***The ordered dose is 400 mg, and the available tablets are 200 mg. 200 mg × 2 tablets equals the 400-mg ordered dose.

The nurse is preparing to administer quetiapine extended release 400 mg PO every day as ordered. The available medication is quetiapine 200-mg extended-release tablets. How many tablets should the nurse administer? A. 0.5 B. 1 C. 2 D. 4

A. Withhold the dose. ***If heart rate is less than 60 beats/min or if a change in rhythm is detected, digoxin should be withheld and the prescriber notified. Checking potassium level before giving is not a priority as the drug should not be administered with this pulse rate. Administering the drug to a patient in such a condition would reduce the patient's heart rate, causing bradycardia. Administering the drug by reducing the dose to half would worsen the condition by causing bradycardia, and the nurse should not administer a drug to a patient without the prescription of a provider.

The nurse assesses a patient's pulse before administering digoxin and notes a rate of 55 beats/min. What is the priority intervention by the nurse? A. Withhold the dose. B. Administer the drug. C. Check potassium level before giving. D. Reduce the dose to half the prescribed dose.

A. Garlic B. Ginger D. Feverfew E. Ginkgo biloba ***Several herbal products, including feverfew, Ginkgo biloba, and garlic, suppress platelet aggregation. Ginger can inhibit production of thromboxane by platelets, resulting in suppression of platelet aggregation.

The nurse collects a medication history on a patient admitted with gastrointestinal bleeding. Which herbal drugs taken by the patient likely contributed to the bleeding? A. Garlic B. Ginger C. Valerian D. Feverfew E. Ginkgo biloba

A. "I will take the cimetidine with my meals." B. "I'll know the medication is working if my diarrhea stops." D. "Taking the cimetidine with an antacid will increase its effectiveness." ***Cimetidine, a histamine (H2)-receptor antagonist, helps to alleviate the symptom of heartburn, not diarrhea. Because cimetidine crosses the blood-brain barrier, central nervous system side and adverse effects, such as mental confusion, agitation, depression, and anxiety, can occur. Food reduces the rate of absorption, so if cimetidine is taken with meals, absorption will be slowed. Antacids decrease the absorption of cimetidine and should be taken at least 1 hour apart. If cimetidine is concomitantly administered with warfarin therapy, warfarin doses may need to be reduced, so prothrombin and international normalized ratio results may be followed.

The nurse determines the client needs further instruction on cimetidine if which statements were made? Select all that apply. A. "I will take the cimetidine with my meals." B. "I'll know the medication is working if my diarrhea stops." C. "My episodes of heartburn will decrease if the medication is effective." D. "Taking the cimetidine with an antacid will increase its effectiveness." E. "I will notify my health care provider if I become depressed or anxious." F. "Some of my blood levels will need to be monitored closely since I also take warfarin for atrial fibrillation."

A. A patient with chronic pain D. A patient who recently delivered a child E. A patient recovering from cardiac surgery ***Laxatives are used for correcting constipation associated with certain drugs, especially opioid analgesics, which would probably be used for chronic pain. By softening the stool, laxatives can reduce the painful elimination that can be associated with episiotomy and hemorrhoids associated with childbirth. In patients with cardiovascular diseases (eg, aneurysm, myocardial infarction, disease of the cerebral or cardiac vasculature), softening the stool decreases the amount of strain needed to defecate, thereby avoiding dangerous elevation of blood pressure.

The nurse expects laxatives to be ordered for which patient(s)? Select all that apply. A. A patient with chronic pain B. A patient with no bowel sounds C. A patient with acute food poisoning D. A patient who recently delivered a child E. A patient recovering from cardiac surgery

A. The nurse assesses the patient's needs and develops new goals. ***The nurse may sometimes find that patient goals are not met due to noncompliance with therapy. The nurse should then assess the patient's needs in an attempt to understand the problems and develop new goals to promote health. The nurse does not formulate a diagnosis after evaluating the outcome of the goals. The nurse first assesses the patient's concerns. It is not effective to inform the patient about the consequences of noncompliance as the patient may not be in control of the circumstances preventing compliance. Instead, the nurse may provide information about a generic drug that the patient can afford or inform the patient about programs that cover costs of drugs when patients cannot afford them. The nurse cannot implement new nursing interventions before assessing the patient's needs.

The nurse finds that a patient discontinued drug therapy due to an inability to afford the medications. As a result, the expected patient goals were not met. What action does the nurse take? A. The nurse assesses the patient's needs and develops new goals. B. The nurse implements new nursing interventions to meet the goals. C. The nurse formulates a nursing diagnosis for the patient's condition. D. The nurse informs the patient about the consequences of noncompliance.

D. The patient took an antacid immediately following drug administration. ***Antacids raise stomach pH and bind certain drugs. The pH of the stomach affects absorption of drugs dependent on the pH of the drug. Alkaline drugs are absorbed more readily in an alkaline environment, and acidic drugs are absorbed more readily in an acidic environment. Position, drug schedule, and drug tolerance will not influence absorption.

The nurse has administered several oral medications to a patient. Which factor will influence the absorption of these medications? A. The patient must remain in a supine position. B. One of the drugs is a Schedule III medication. C. The patient has developed a tolerance to one of the drugs. D. The patient took an antacid immediately following drug administration.

B. Temperature of 101°F ***Sudden high fever is a symptom of neuroleptic malignant syndrome, a rare but serious complication of high-potency, first-generation antipsychotics, such as haloperidol. The other findings are potential side effects of the drug but would not necessarily need to be reported to the healthcare provider.

The nurse has just administered the first dose of haloperidol [Haldol] to a patient with schizophrenia. Which finding, if present, is the most important for the nurse to report to the healthcare provider before administering the next dose of medication? A. Dry mouth B. Temperature of 101°F C. BP of 104/72 mm Hg D. Drowsiness

C. Atrial fibrillation ***Nifedipine produces very little blockade of the calcium channels of the heart; therefore, it is ineffective for treating dysrhythmias, such as atrial fibrillation. Therapeutic uses for nifedipine include the treatment of angina pectoris, essential hypertension, and vasospastic angina.

The nurse is caring for several patients. For which patient diagnosis would a prescription for nifedipine [Adalat] be least appropriate? A. Angina pectoris B. Essential hypertension C. Atrial fibrillation D. Vasospastic angina

B. Monitor blood pressure. ***First-dose hypotension is a serious potential adverse effect of angiotensin-converting enzyme (ACE) inhibitors such as enalapril [Vasotec]. Monitoring the blood pressure is the priority nursing intervention. If hypotension develops, the nurse will place the patient in the supine position and possibly increase intravenous fluids. The other interventions may be appropriate for this patient; however, in the hours immediately after the first dose of an ACE inhibitor, monitoring of the blood pressure is most important.

The nurse has just administered the initial dose of enalapril [Vasotec] to a newly admitted patient with hypertension. What is the priority nursing intervention over the next several hours? A. Check the heart rate. B. Monitor blood pressure. C. Auscultate lung sounds. D. Draw a potassium level.

A. Monitor blood pressure. ***First-dose hypotension is a serious potential adverse effect of ACE inhibitors, such as enalapril. Monitoring the blood pressure is the priority nursing intervention. If hypotension develops, the nurse will place the patient in the supine position and possibly increase intravenous fluids. The other interventions may be appropriate for this patient; however, in the hours immediately after the first dose of an ACE inhibitor, monitoring of the blood pressure is most important.

The nurse has just administered the initial dose of enalapril [Vasotec] to a newly admitted patient with hypertension. What is the priority nursing intervention over the next several hours? A. Monitor blood pressure. B. Check the heart rate. C. Auscultate lung sounds. D. Draw a potassium level.

C. Assess the patient's condition. ***The primary concern in any situation is patient safety. The nurse should assess the patient's condition to ensure that no harm has come to the patient. Once the patient is assessed, the nurse should notify the healthcare provider. The supervisor should also be notified. The verification of the right drug to be given is one of the first steps in the drug administration process.

The nurse has made a medication error. What is the nurse's initial action? A. Notify the shift supervisor. B. Notify the healthcare provider. C. Assess the patient's condition. D. Verify the drug that should have been given.

A. Lithium C. Carbamazepine E. Divalproex sodium [Depakote] ***Lithium, divalproex sodium [Valproate], and carbamazepine are the principal mood stabilizers used in the treatment of bipolar disorder. Risperidone is an antipsychotic used in the management of bipolar disorder. Venlafaxine [Effexor] is an antidepressant used in the treatment of bipolar disorder.

The nurse identifies which drug(s) as the principal mood stabilizers used in the treatment of bipolar disorder? Select all that apply. A. Lithium B. Risperidone C. Carbamazepine D. Venlafaxine [Effexor] E. Divalproex sodium [Depakote]

A. Lithium C. Divalproex sodium [Depakote] D. Carbamazepine ***Lithium, divalproex sodium [Valproate], and carbamazepine are the principal mood stabilizers used in the treatment of bipolar disorder. Risperidone is an antipsychotic used in the management of bipolar disorder. Venlafaxine [Effexor] is an antidepressant used in the treatment of bipolar disorder.

The nurse identifies which drugs as the principal mood stabilizers used in the treatment of bipolar disorder? (Select all that apply.) A. Lithium B. Risperidone C. Divalproex sodium [Depakote] D. Carbamazepine E. Venlafaxine [Effexor]

B. Orthostatic hypotension ***Orthostatic hypotension is the most common adverse effect of tricyclic antidepressant therapy.

The nurse identifies which most common serious adverse effect of TCA therapy? A. Excitation B. Orthostatic hypotension C. Skin rash D. Sexual dysfunction

C. Bisacodyl [Dulcolax] ***Stimulant laxatives (bisacodyl, senna, castor oil) are most commonly abused by the general public. The nurse should discourage use of these drugs for occasional relief of constipation.

The nurse identifies which of the following as the most common type of laxative abused by the general public? A. Magnesium hydroxide [Milk of Magnesia] B. Docusate sodium [Colace] C. Bisacodyl [Dulcolax] D. Polyethylene glycol [MiraLax]

B. Lactulose ***In addition to its laxative action, lactulose can enhance intestinal excretion of ammonia. This property has been exploited to lower blood ammonia content in patients with portal hypertension and hepatic encephalopathy secondary to chronic liver disease.

The nurse identifies which of the following laxatives as having the added response of ridding the body of ammonia? A. Polyethylene glycol B. Lactulose C. Lubiprostone D. Mineral oil

B. Flumazenil [Romazicon] ***Flumazenil [Romazicon], a benzodiazepine receptor antagonist, is the treatment of choice for overdose of the benzodiazepine diazepam [Valium]. Naloxone [Narcan] is used to reverse opioid overdose. Acetylcysteine [Mucomyst] is used to reverse acetaminophen [Tylenol] overdose. Vitamin K is used to reverse warfarin toxicity.

The nurse in the emergency department is caring for a patient with a suspected overdose of diazepam [Valium]. Which agent is most likely to be administered to reverse the effects of diazepam? A. Naloxone [Narcan] B. Flumazenil [Romazicon] C. Acetylcysteine [Mucomyst] D. Vitamin K

D. Blood pressure of 80/60 mm Hg ***Blood pressure that goes below 100 mm Hg should immediately be reported to the healthcare provider, and the medication should be held. The other assessment findings are within normal limits and do not require immediate action.

The nurse is administering an antihypertensive medication. What assessment finding requires immediate action? A. Calcium level of 8 mEq/dL B. Potassium level of 5 mEq/dL C. Apical pulse of 100 beats/min D. Blood pressure of 80/60 mm Hg

A. Bronchial dilation B. Increased heart rate F. Increased force of heart contraction ***Activation of beta1 and beta2 receptors results in dilation of the bronchi, increased cardiac output (by increasing the heart rate and force of contraction); and elevation of the blood glucose level.

The nurse is administering isoproterenol, a beta1 and beta2 agonist. The nurse understands activation of these two receptors will result in which expected drug effects? Select all that apply. A. Bronchial dilation B. Increased heart rate C. Excessive drowsiness D. Decreased cardiac output E. Decreased glucose levels F. Increased force of heart contraction

A. Once a day ***A major cause of treatment failure in patients with chronic hypertension is lack of adherence to a prescribed regimen. To promote adherence, the dosing schedule should be as simple as possible, just once or twice daily dosing.

The nurse reviews the medication treatment regimen for a patient with chronic hypertension. To promote optimal medication adherence, which frequency of drug dosing should the nurse advocate for this patient? A. Once a day B. Three times a day C. Four times a day D. Every 8 hours

B. Assess the patient for medication toxicity. ***The nurse should assess for toxicity. The kidneys are responsible for the majority of drug excretion. With excretion impaired, the medication can remain in the system longer, thus increasing the chance for toxicity to develop. Because most drugs are excreted by the renal system, it would not be appropriate to hold all drugs, as some may have more benefits than risks. Decreased urinary output is not an indication that medications should be held. Medications administered via the intravenous route are still metabolized in the body.

The nurse is administering medications to a patient with kidney disease. Which is the nurse's priority action? A. Hold medications if urinary output is low. B. Assess the patient for medication toxicity. C. Administer all medications via the intravenous route. D. Hold all drugs that are excreted by the renal system.

C. The nurse administers carbamazepine with grapefruit juice. ***Carbamazepine is not to be given with grapefruit juice as this can lead to increased toxicity of the drug. Dilantin is adminstered IV with a filter. Gabapentin can safely be given without regard to meals. Phenobarbital elixir can be administered with fruit juice, but the oral pill form of the drug should be given with water.

The nurse is administering morning medications. Which administration technique is an error? A. The nurse administers intravenous Dilantin with a filter. B. The nurse adminsters phenobarbital elixir with fruit juice. C. The nurse administers carbamazepine with grapefruit juice. D. The nurse administers gabapentin without checking when the patient ate

C. Administer the medication no faster than 50 mg/min ***Intravenous phenytoin should be given no faster than 50 mg/min into a 20-gauge or larger catheter. It can only be mixed or diluted in normal saline for infusion. The medication should not be given with dextrose or given quickly through a central line.

The nurse is administering phenytoin [Dilantin] intravenously. What intervention is essential? A. Push the medication quickly through a central line B. Mix the medication in 5% dextrose with 0.9% saline C. Administer the medication no faster than 50 mg/min D. Administer the medication in a 22-gauge or smaller catheter

D. Valsartan [Exforge] ***Valsartan [Exforge] is an angiotensin II receptor blocker (ARB) that is indicated for management of hypertension. Furosemide is a loop diuretic. Eplerenone [Inspra] is an aldosterone antagonist. Enalapril is an angiotensin-converting enzyme (ACE) inhibitor.

The nurse is administering several medications at 8 AM. Which medication will decrease blood pressure by blocking angiotensin II receptor sites? A. Enalapril B. Furosemide C. Eplerenone [Inspra] D. Valsartan [Exforge]

B. "Take the drug in the evening." ***Cholesterol production by the liver usually occurs at night; thus, statin drugs such as atorvastatin [Lipitor] work by decreasing the cholesterol synthesis and are generally administered in the evening to reduce cholesterol production. All statins should be taken once daily during the evening meal or at bedtime. The drug need not be administered after breakfast because cholesterol level production is lesser in the mornings. Antacids may not be administered along with the drug as it doesn't cause gastric irritation. The desired therapeutic effects may not be produced if the drug is administered on an empty stomach.

The nurse is assessing a patient who has been prescribed atorvastatin [Lipitor]. What instruction should the nurse provide for the patient to ensure proper administration of the medication? A. "Take the drug after breakfast." B. "Take the drug in the evening." C. "Take the drug with an antacid." D. "Take the drug on an empty stomach."

D. The patient is experiencing adverse effects of the thyroid drugs. ***Anxiety, tachycardia, and insomnia are among the adverse effects of levothyroxine [Synthroid]. These adverse effects may be due to accumulation of the drug in the body; thus, they appear as symptoms of hyperthyroidism. These are not signs and symptoms of an allergic (hypersensitivity) reaction. Anxiety, tachycardia, and insomnia are not anticipated age-related symptoms. If the patient was not responding to the medication, then the patient would have decreased thyroid hormone levels, which would more likely be manifested by bradycardia and increased drowsiness or sleep.

The nurse is assessing an elderly patient who has been taking levothyroxine [Synthroid] for 6 months. The nurse finds that the patient has anxiety, tachycardia, and insomnia. What should the nurse interpret from these findings? A. The patient is hypersensitive to thyroid drugs. B. The patient has common age-related symptoms. C. The patient is not responding to the thyroid drugs. D. The patient is experiencing adverse effects of the thyroid drugs.

C. Diverticulitis D. Abdominal pain E. Bowel obstruction ***Laxatives are contraindicated for individuals with abdominal pain, nausea, cramps, and other symptoms of appendicitis, regional enteritis, diverticulitis, and obstruction of the bowel. Laxatives should be used with caution during pregnancy and lactation. Laxatives are used to treat constipation.

The nurse is aware that laxatives are contraindicated in patients with which condition(s)? Select all that apply. A. Pregnancy B. Constipation C. Diverticulitis D. Abdominal pain E. Bowel obstruction

A. Abdominal pain B. Diverticulitis D. Bowel obstruction ***Laxatives are contraindicated for individuals with abdominal pain, nausea, cramps, and other symptoms of appendicitis, regional enteritis, diverticulitis, and obstruction of the bowel. Laxatives should be used with caution during pregnancy and lactation. Laxatives are used to treat constipation.

The nurse is aware that laxatives are contraindicated in patients with which of the following? (Select all that apply.) A. Abdominal pain B. Diverticulitis C. Constipation D. Bowel obstruction E. Pregnancy

D. Carbidopa-levodopa [Sinemet] ***Tremors in the fingers, mask-like facial expressions, and bradykinesia are symptoms of parkinsonism. The patient should be prescribed anti-Parkinson's drugs such as carbidopalevodopa [Sinemet] to relieve the symptoms. This medication increases dopamine levels and reduces tremors and bradykinesia. Modafinil [Provigil] stimulates the central nervous system, is prescribed for the treatment of narcolepsy, and induces wakefulness. Bromocriptine [Parlodel] is a direct-acting dopamine agonist prescribed to younger patients. Since the patient is older, he or she will not be prescribed. Methylphenidate [Ritalin] is a stimulant prescribed for attention-deficit/hyperactivity disorder (ADHD).

The nurse is caring for a geriatric patient. During the assessment, the nurse finds that the patient has tremors in the fingers, a mask-like facial expression, and bradykinesia. Which drug would the nurse expect the primary healthcare provider to prescribe to the patient? A. Modafinil [Provigil] B. Bromocriptine [Parlodel] C. Methylphenidate [Ritalin] D. Carbidopa-levodopa [Sinemet]

C. To reduce the risk of suicide with overdose ***The SSRIs may be chosen because they have fewer side effects and are safer if an overdose occurs. However, the SSRIs can cause sexual dysfunction and weight gain, and they carry a risk of serotonin syndrome.

The nurse is caring for a group of patients being treated for depression. Why might a selective serotonin reuptake inhibitor (SSRI) be chosen over a tricyclic antidepressant (TCA)? A. To help prevent sexual dysfunction B. To prevent the risk of serotonin syndrome C. To reduce the risk of suicide with overdose D. To avoid weight gain and other gastrointestinal (GI) effects

A. To reduce the risk of suicide with overdose ***The SSRIs may be chosen because they have fewer side effects and are safer with overdose. However, the SSRIs can cause sexual dysfunction and weight gain, and they carry a risk of serotonin syndrome.

The nurse is caring for a group of patients being treated for depression. Why might an SSRI be chosen over a TCA? A. To reduce the risk of suicide with overdose B. To avoid weight gain and other gastrointestinal (GI) effects C. To help prevent sexual dysfunction D. To prevent the risk of serotonin syndrome

C. Acetylcholine ***Acetylcholine (ACh) levels naturally decline by a small percentage with age. Patients with severe AD may have ACh levels that are as much as 90% below normal. This is likely part of the explanation for the pathophysiology of AD.

The nurse is caring for a group of patients diagnosed with Alzheimer's disease (AD). Which neurotransmitter level is decreased by as much as 90% in patients with severe AD? A. Norepinephrine B. Serotonin C. Acetylcholine D. Dopamine

C. Acetylcholine ***Acetylcholine (ACh) levels naturally decline by a small percentage with age. Patients with severe AD may have ACh levels that are as much as 90% below normal. This is likely part of the explanation for the pathophysiology of AD.

The nurse is caring for a group of patients diagnosed with Alzheimer's disease (AD). Which neurotransmitter level is decreased by as much as 90% in patients with severe AD? A. Serotonin B. Dopamine C. Acetylcholine D. Norepinephrine

B. Notify the provider that the patient should not be started on heparin. ***A potential medication error is to give heparin in combination with enoxaparin.

The nurse is caring for a newly admitted patient who will begin heparin therapy. While documenting the patient's history, the nurse notes that the patient is currently undergoing treatment with enoxaparin. What is the nurse's highest priority? A. Notify the provider that the patient is at risk for an allergic reaction. B. Notify the provider that the patient should not be started on heparin. C. Notify the provider that the dosage of heparin will need to be increased. D. Notify the provider that the dosage of heparin will need to be decreased.

B. Serotonin syndrome ***Serotonin syndrome can occur within 2 to 72 hours after initiation of treatment with a selective serotonin reuptake inhibitor (SSRI). The symptoms include altered mental status, incoordination, myoclonus, hyperreflexia, excessive sweating, tremor, and fever.

The nurse is caring for a patient in the emergency department who reports the onset of agitation, confusion, muscle twitching, diaphoresis, and fever about 12 hours after beginning a new prescription for escitalopram [Lexapro]. Which is the most likely explanation for these symptoms? A. Cholinergic crisis B. Serotonin syndrome C. Depressive psychosis D. Escitalopram overdose

B. Serotonin syndrome ***Serotonin syndrome can occur within 2 to 72 hours after initiation of treatment with an SSRI. The symptoms include altered mental status, incoordination, myoclonus, hyperreflexia, excessive sweating, tremor, and fever.

The nurse is caring for a patient in the emergency department who reports the onset of agitation, confusion, muscle twitching, diaphoresis, and fever about 12 hours after beginning a new prescription for escitalopram [Lexapro]. Which is the most likely explanation for these symptoms? A. Depressive psychosis B. Serotonin syndrome C. Escitalopram overdose D. Cholinergic crisis

C. Vomiting and diarrhea ***Vomiting and diarrhea can lead to hypokalemia, which increases the risk of digoxin toxicity. These symptoms, along with nausea, fatigue, and visual disturbances, also may precede digoxin toxicity and warrant further attention. The heart rate, potassium level, and digoxin level are within the normal range.

The nurse is caring for a patient prescribed digoxin [Lanoxin] for heart failure. Which finding would require immediate attention by the nurse? A. Potassium level of 3.7 mEq/L B. Digoxin level of 0.7 ng/mL C. Vomiting and diarrhea D. Heart rate of 68 beats per minute

A. Vomiting and diarrhea ***Vomiting and diarrhea can lead to hypokalemia, which increases the risk of digoxin toxicity. These symptoms, along with nausea, fatigue, and visual disturbances, also may precede digoxin toxicity and warrant further attention. A heart rate of 68 beats/min, potassium level of 3.7 mEq/L, and digoxin level of 0.7 ng/mL (0.5 to 0.8 being the optimal range) are within the normal range.

The nurse is caring for a patient prescribed digoxin [Lanoxin] for heart failure. Which finding would require immediate attention by the nurse? A. Vomiting and diarrhea B. Heart rate of 68 beats/min C. Digoxin level of 0.7 ng/mL D. Potassium level of 3.7 mEq/L

B. Respiratory ***Pulmonary toxicity is the most serious potential adverse effect of amiodarone. It may manifest as pneumonitis or pulmonary fibrosis, with symptoms such as dyspnea, cough, and chest pain.

The nurse is caring for a patient receiving amiodarone [Cordarone]. Which body system should the nurse assess for serious adverse effects of this medication? A. Musculoskeletal B. Respiratory C. Integumentary D. Gastrointestinal

C. Dizziness ***Buspirone is an antianxiety medication with few side effects. The most common effects are dizziness, nausea, headache, nervousness, lightheadedness, and excitement. Buspirone does not cause drowsiness, risk for abuse, or weight gain.

The nurse is caring for a patient receiving buspirone [BuSpar] for the treatment of anxiety. Which symptom is most likely explained as an adverse effect of this drug? A. Diarrhea B. Risk for abuse C. Dizziness D. Weight gain

A. Continue as planned, because the level is within normal limits. ***The therapeutic range for phenytoin is 10 to 20 mcg/mL. Because this level is within normal limits, the nurse would continue with the routine plan of care.

The nurse receives a laboratory report indicating that the phenytoin [Dilantin] level for the patient seen in the clinic yesterday is 16 mcg/mL. Which intervention is most appropriate? A. Continue as planned, because the level is within normal limits. B. Tell the patient to hold today's dose and return to the clinic. C. Consult the prescriber to recommend an increased dose. D. Have the patient call 911 and meet the patient in the emergency department.

D. White blood cell (WBC) count of 2000/mm3 ***Clozapine, an atypical antipsychotic, carries a risk of fatal agranulocytosis. For this reason, the WBC count should be monitored and should be greater than 3500/mm3. Renal function (blood urea nitrogen) should not be affected by clozapine. Clozapine may cause metabolic effects, including diabetes, that would result in an increased blood glucose level (greater than 110 mg/dL). Elevated bilirubin indicates liver disease and is not commonly an adverse effect of clozapine.

The nurse is caring for a patient receiving clozapine [Clozaril]. Which assessment finding is most indicative of an adverse effect of this drug? A. Blood urea nitrogen level of 25 mg/dL B. Blood glucose level of 60 mg/dL C. Bilirubin level of 2.5 mg/dL D. White blood cell (WBC) count of 2000/mm3

C. Sexual dysfunction ***Fluoxetine [Prozac], a selective serotonin reuptake inhibitor (SSRI), does not cause anticholinergic effects, orthostatic hypotension, or cardiotoxicity, as do the tricyclic antidepressants. The most common adverse effects are sexual dysfunction, nausea, headache, and central nervous system stimulation.

The nurse is caring for a patient receiving fluoxetine [Prozac] for depression. Which adverse effect is most likely associated with this drug? A. Dry mouth B. Bradycardia C. Sexual dysfunction D. Orthostatic hypotension

A. Sexual dysfunction ***Fluoxetine [Prozac], a selective serotonin reuptake inhibitor (SSRI), does not cause anticholinergic effects, orthostatic hypotension, or cardiotoxicity, as do the tricyclic antidepressants. The most common adverse effects are sexual dysfunction, nausea, headache, and central nervous system stimulation.

The nurse is caring for a patient receiving fluoxetine [Prozac] for depression. Which adverse effect is most likely associated with this drug? A. Sexual dysfunction B. Dry mouth C. Orthostatic hypotension D. Bradycardia

D. To protect against reflex tachycardia ***Hydralazine is a vasodilator that lowers blood pressure, but it also can trigger reflex tachycardia. Beta blockers, such as propranolol, are added to the regimen to normalize the heart rate.

The nurse is caring for a patient receiving hydralazine [Apresoline]. The healthcare provider prescribes propranolol [Inderal]. The nurse knows that a drug such as propranolol often is combined with hydralazine for what purpose? A. To reduce the risk of headache B. To improve hypotensive effects C. To prevent heart failure D. To protect against reflex tachycardia

A. Swollen, tender gums B. Measles-like rash D. Unusual hair growth ***Adverse effects associated with phenytoin at therapeutic doses include mild sedation, gingival hyperplasia (swollen, tender gums), morbilliform (measles-like) rash, cardiovascular effects, and other effects, such as hirsutism (unusual hair growth) and interference with vitamin D metabolism.

The nurse is caring for a patient receiving phenytoin [Dilantin] for treatment of tonic-clonic seizures. Which symptoms, if present, would indicate an adverse effect of this drug? (Select all that apply.) A. Swollen, tender gums B. Measles-like rash C. Productive cough D. Unusual hair growth E. Nausea and vomiting

C. "I will drink grapefruit juice instead of coffee with breakfast." ***Grapefruit juice can greatly increase buspirone levels and should be avoided. The other statements are appropriate.

The nurse is caring for a patient taking buspirone [BuSpar]. Which statement by the patient indicates a need for further teaching about this drug? A. "This medication should not make me feel drowsy." B. "This medication should help me feel less anxious." C. "I will drink grapefruit juice instead of coffee with breakfast." D. "I will take my medication three times per day."

C. Aspirin (ASA) for mild headache ***Aspirin is safe to use as an analgesic with lithium. Other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can increase lithium levels by as much as 60%. Diuretics increase lithium levels by reducing the serum sodium level. Diphenhydramine has anticholinergic properties and can aggravate lithium-induced polyuria by causing urinary hesitancy.

The nurse is caring for a patient taking lithium [Lithobid]. The nurse understands that many drugs interact with lithium. Which agent is safe to administer with lithium? A. Ibuprofen [Motrin] for muscle pain B. Hydrochlorothiazide (HCTZ) for edema C. Aspirin (ASA) for mild headache D. Diphenhydramine [Benadryl] for cold symptoms

A. Toxicity ***Toxicity is the degree of detrimental physiologic effects caused by excessive drug dosing. A side effect is a nearly unavoidable secondary drug effect produced at a therapeutic dose. An allergic reaction is an immune response. An idiosyncratic effect is an uncommon drug response resulting from a genetic predisposition.

The nurse is caring for a patient who has a respiratory rate of 6 breaths/min following a large dose of pain medication. Which term most accurately describes this reaction? A. Toxicity B. Side effect C. Allergic reaction D. Idiosyncratic effect

C. Muscle spasticity ***Baclofen [Lioresal] is a muscle relaxant that is used to treat the spasticity of the muscles that occurs with multiple sclerosis. It does not specifically address muscle aching nor deterioration of muscle tissue.

The nurse is caring for a patient who has been diagnosed with multiple sclerosis. The healthcare provider opts to include baclofen [Lioresal] as part of this patient's treatment regimen. The nurse recognizes that this is an appropriate medication for this patient because the drug will treat which symptom? A. Muscle aching B. Muscle wasting C. Muscle spasticity D. Muscle deterioration

A. High levels of low-density lipoproteins (LDL) ***High level of low-density lipoproteins (LDL) refers to high cholesterol levels in the blood, as LDL is almost entirely composed of cholesterol. This cholesterol is bad cholesterol, which promotes the formation of atherosclerotic plaque resulting in CHD. High-density lipoproteins (HDL) are good cholesterol, which has a cardioprotective action. Low levels of very-low-density lipoproteins (VLDL) are due to a low fat diet; however, it does not cause high cholesterol levels. Low levels of intermediate-density lipoproteins (IDL) do not increase the risk of CHD; they are useful for the production of bile acids.

The nurse is caring for a patient who has coronary heart disease (CHD). The nurse tells the patient, "Your cholesterol levels are abnormal; you are at a high risk of having a heart attack." What did the nurse discover regarding the lipoprotein levels in the patient's blood report? A. High levels of low-density lipoproteins (LDL) B. High levels of high-density lipoproteins (HDL) C. Low levels of very-low-density lipoproteins (VLDL) D. Low levels of intermediate-density lipoproteins (IDL)

B. Antagonist ***An antagonist drug is one that blocks the histamine receptors to prevent excessive gastric secretion. Drugs that produce a response are called agonists. For example, epinephrine [Adrenalin] is an agonist that stimulates beta1 and beta2 receptors. Nonspecific drugs affect various sites in the body. Bethanechol [Urecholine] is a nonspecific cholinergic drug that affects cholinergic receptors located in the eye, heart, blood vessels, stomach, bronchus, and bladder. Nonselective drugs affect various receptors. Chlorpromazine [Thorazine] acts on the norepinephrine, dopamine, acetylcholine, and histamine receptors, and a variety of responses result from action at these receptor sites.

The nurse is caring for a patient who is prescribed a drug to block the histamine receptors to prevent excessive gastric secretion. Which category of drugs does this medication belong to? A. Agonist B. Antagonist C. Nonspecific D. Nonselective

A. Monitor the patient's plasma drug level periodically. ***The therapeutic range of a drug is the range between the minimum effective concentration of the drug in the plasma to obtain the desired drug action and the minimum toxic concentration. The nurse must monitor the plasma drug level periodically to avoid drug toxicity while caring for a patient receiving a drug with a low therapeutic index, such as digoxin. Some medications, such as diphenhydramine [Benadryl], cause drowsiness as a side effect. In such cases, the nurse instructs patients not to drive after taking the medication. Some drugs bind to the protein molecules in the body. The nurse monitors serum albumin levels in patients receiving those drugs to determine the possibility of drug toxicity. Patients who are prescribed enteric-coated tablets should not eat a high-fat meal before taking the drug, as that will decrease the absorption rate of the drug.

The nurse is caring for a patient who is receiving a drug with a low therapeutic index. Which is the most important nursing intervention for this patient? A. Monitor the patient's plasma drug level periodically. B. Monitor the patient's serum albumin levels periodically. C. Instruct the patient not to drive after taking the medication. D. Instruct the patient not to take the drug after a high-fat meal.

C. Notify the healthcare provider of this information. ***Carvedilol [Coreg] should be used with caution in patients with a history of asthma. The priority for the nurse is to notify the healthcare provider of this information.

The nurse is caring for a patient who is scheduled to begin treatment with carvedilol [Coreg]. While updating the history, the patient tells the nurse that he experiences frequent attacks of asthma. What is the nurse's highest priority action? A. Expect a decreased effect from the medication. B. Expect an increased effect from the medication. C. Notify the healthcare provider of this information. D. Monitor the patient for a toxic reaction to the drug.

A. Cimetidine [Tagamet] ***Cimetidine will elevate phenytoin levels by reducing the rate at which phenytoin is metabolized. Phenytoin levels may increase to toxic levels. The use of cimetidine should generally be avoided in patients who are treated with phenytoin, because safer alternatives are available.

The nurse is caring for a patient who is taking phenytoin [Dilantin]. Which medication, if ordered by the physician, should the nurse question? A. Cimetidine [Tagamet] B. Captopril [Capoten] C. Pantoprazole [Protonix] D. Ondansetron [Zofran]

B. "You can try enteric-coated aspirin." ***Gastric distress is a common problem with uncoated aspirin. Enteric-coated tablets can be used. Changing to another medication is not the first intervention in this case, and ibuprofen can also cause gastric distress. Milk may not relieve gastric distress.

The nurse is caring for a patient who states, "I probably shouldn't take aspirin. Won't it make my stomach hurt?" What is the nurse's best response to the patient? A. "Try taking the aspirin with milk." B. "You can try enteric-coated aspirin." C. "You should take ibuprofen instead." D. "I'll get you a prescription pain reliever."

A. Notify the provider of the new development. ***Angiotensin-converting enzyme (ACE) inhibitors prevent the breakdown of bradykinins, frequently causing a nonproductive cough. The patient should be switched to a different medication if the side effect cannot be tolerated. The cough will not subside in a few days. This is not a sign of infection but is a known side effect of ACE inhibitors. Medications will not make the cough subside.

The nurse is caring for a patient who takes an angiotensin-converting enzyme (ACE) inhibitor. If the patient develops a persistent nonproductive cough, what should the nurse do? A. Notify the provider of the new development. B. Tell the patient that the cough will subside in a few days. C. Assess the patient for other symptoms of upper respiratory infection. D. Instruct the patient to take antitussive medication until the symptoms subside.

A. Verify the patient's prescription. ***The nurse should listen and honor the patient's concerns. If the patient expresses a doubt regarding the medication, the nurse should cross-check the prescription. This helps the nurse to avoid medication errors. After cross-checking the prescription and finding the medication to be appropriate, the nurse can suggest that the patient take the medication. Many times the color of medications will be different because the pharmacy at the healthcare facility may use a different manufacturer than the one that produced the medication the patient has at home. Without confirming the medication, the nurse should not inform the patient that the new medication is prescribed. After cross-checking the prescription and finding the medication to be inappropriate, the nurse can notify the primary healthcare provider to change it.

The nurse is caring for a patient who tells the nurse, "I cannot take this medication because this tablet is white, and I take pink tablets at home." Which action is most appropriate? A. Verify the patient's prescription. B. Suggest the patient take the medication. C. Inform the patient that a new medication is prescribed. D. Notify the primary healthcare provider to change the medication.

D. Rise slowly from a sitting to standing position. ***Vasodilators place patients at increased risk of falls. Patients should also be taught that they can minimize postural (orthostatic) hypotension by avoiding abrupt transitions from a supine or seated position to an upright position. Grapefruit does not affect the metabolism of vasodilators. Wearing hats and using a straw are not necessary with vasodilators.

The nurse is caring for patients receiving vasodilators. Which instruction should the nurse give the patients to combat a common adverse effect? A. Wear a hat when outdoors. B. Avoid taking with grapefruit juice. C. Drink the oral solution through a straw. D. Rise slowly from a sitting to standing position.

D. The patient should have effective relief from the manic symptoms. ***There is a narrow therapeutic window between the therapeutic and toxic serum levels of lithium. A serum lithium level of 1 to 1.4 mEq/L is optimum for the treatment of acute mania. Therefore, a serum lithium level of 1.2 mEq/L indicates that the patient will have effective relief from the manic symptoms. If the serum lithium level is less than 1 mEq/L, then the patient may have persistent manic symptoms. If the lithium serum level is more than 1.5 mEq/L, then the patient may have lithium toxicity, which is characterized by impaired liver and renal functioning. The adverse effects of lithium toxicity include cardiac dysrhythmia and tremors.

The nurse is caring for a patient with acute mania who has been prescribed lithium carbonate [Lithobid]. The blood tests of the patient indicate the serum lithium level to be 1.2 mEq/L. What does the nurse interpret from this? A. The patient will have persistent manic symptoms. B. The patient may have cardiac dysrhythmia and tremors. C. The patient may have impaired liver and renal functioning. D. The patient should have effective relief from the manic symptoms.

A. Sodium level of 128 mEq/L ***The sodium level is well below the normal range of 135 to 145 mEq/L. When the serum sodium level is reduced, lithium excretion also is reduced, and lithium accumulates. Because lithium has a narrow therapeutic index, this is a dangerous situation that can result in symptoms of toxicity and even death.

The nurse is caring for a patient with bipolar disorder (BPD) who is taking lithium [Lithobid]. Which abnormal laboratory value is most essential for the nurse to communicate to the healthcare provider because this patient is taking lithium? A. Sodium level of 128 mEq/L B. Prothrombin time of 8 seconds C. Potassium level of 5.6 mEq/L D. Blood urea nitrogen level of 25 mg/dL

A. Sodium level of 128 mEq/L ***The sodium level is well below the normal range of 135 to 145 mEq/L. When the serum sodium level is reduced, lithium excretion also is reduced, and lithium accumulates. Because lithium has a narrow therapeutic index, this is a dangerous situation, which can result in symptoms of toxicity and even death.

The nurse is caring for a patient with bipolar disorder (BPD) who is taking lithium [Lithobid]. Which abnormal laboratory value is most essential for the nurse to communicate to the healthcare provider because this patient is taking lithium? A. Sodium level of 128 mEq/L B. Prothrombin time of 8 seconds C. Blood urea nitrogen level of 25 mg/dL D. Potassium level of 5.6 mEq/L

C. "Discontinue administering the medication." ***The presence of myoglobin in the urine indicates that the patient has rhabdomyolysis, an adverse effect of statins such as simvastatin [Zocor]. Rhabdomyolysis is characterized by the breakdown of muscle proteins and can be fatal. The primary healthcare provider would instruct the nurse to discontinue the medication. Reducing the dose of the medication to 10 mg, giving the medication before meals, or administering the medication with high amounts of fluids does not prevent rhabdomyolysis.

The nurse is caring for a patient with hypercholesterolemia who is taking 20 mg of simvastatin [Zocor] as prescribed. After a few days, the patient's urinalysis reports indicated the presence of myoglobin. What instruction would the nurse receive from the primary healthcare provider? A. "Give 10 mg of medication daily." B. "Give the medication before meals." C. "Discontinue administering the medication." D. "Give the medication with 250 mL of water."

B. Peripheral vasodilation C. Coronary vasodilation ***Verapamil causes peripheral vasodilation and coronary vasodilation, which lead to decreased blood pressure and improved coronary perfusion. It does not cause vasoconstriction and usually has little effect on the heart rate or contractility in healthy hearts.

The nurse is caring for a patient with hypertension who is receiving verapamil [Calan]. The patient has a healthy heart. What pharmacodynamic effects does the nurse expect from this drug? (Select all that apply.) A. Peripheral vasoconstriction B. Peripheral vasodilation C. Coronary vasodilation D. Increased heart rate E. Increased force of contraction

C. The nurse should administer the medication 30 minutes before meals. ***Patients with myasthenia gravis have difficulty in swallowing food. To prevent dysphagia, the nurse should administer the medication 30 minutes before meals, so the drug exerts its effects (ie, decreases dysphagia in the patient). The nurse should not avoid giving fluids such as fruit juices or fiber-rich food such as oats and beetroot, unless this is recommended by the primary healthcare provider. Administering the drug at bedtime, when the patient does not need the added boost of muscle strength, will not be helpful for the patient.

The nurse is caring for a patient with myasthenia gravis who has been prescribed cholinergic medications. Which nursing action should the nurse adopt while caring for the patient? A. The nurse should administer the medication at bedtime. B. The nurse should avoid giving oats and beetroot to the patient. C. The nurse should administer the medication 30 minutes before meals. D. The nurse should avoid giving fruit juices and corn soup to the patient.

D. Serum albumin levels ***A patient with renal failure is likely to have low serum albumin levels, resulting in fewer protein-binding sites. This can lead to an excess of free drug, which in turn causes drug toxicity. The nurse need not assess the lipid profile, as it is used to determine the risk for cardiovascular disease. The hemoglobin level is used to detect anemia. Blood glucose level is used to determine whether the patient is diabetic or has a normal blood sugar level.

The nurse is caring for a patient with renal failure who is prescribed a protein-bound drug. Which parameter in the patient must the nurse assess before administering the medication? A. Lipid profile B. Hemoglobin level C. Blood glucose level D. Serum albumin levels

B. The active drug is reduced from its original quantity. C. The drug enters the hepatic portal circulatory system. E. Prodrugs are converted to the active form before entering the systemic circulation. ***When some medications are administered orally, the drug goes from the intestinal lumen to the liver via the hepatic portal vein. This process is called the first-pass effect or hepatic first pass. First-pass metabolism takes place in the liver, where the drug is metabolized to an inactive form that is excreted. This reduces the amount of active drug. Prodrugs are converted to their active form.

The nurse is caring for an adult patient who is prescribed a medication as an injection because it has extensive first-pass metabolism. What happens when a drug is affected by first-pass metabolism? Select all that apply. A. The drug goes directly into the systemic circulation. B. The active drug is reduced from its original quantity. C. The drug enters the hepatic portal circulatory system. D. It bypasses absorption and goes directly into distribution. E. Prodrugs are converted to the active form before entering the systemic circulation.

B. Hepatotoxicity ***In the United States, kava is promoted as a natural alternative to benzodiazepines to treat anxiety and stress. However, kava has the risk for the serious adverse effect of hepatotoxicity, which led the U.S. Food and Drug Administration (FDA) to issue a public warning in March 2002. In addition, in 2002, the Centers for Disease Control and Prevention issued a report on kava-related hepatotoxicity.

The nurse is completing an admission assessment for a patient who requires treatment of an anxiety disorder. The patient states, "I take the dietary supplement kava every day to help my anxiety and stress." The nurse understands the patient is at risk for which serious adverse effect? A. Stroke B. Hepatotoxicity C. Suicidal behavior D. Acute renal failure

A. "Be sure to call the clinic if you or your family notice increased anxiety or agitation." B. "You may have some mild sedation. Do not drive until you know how this drug will affect you." D. "It is very important to have good oral hygiene and to visit your dentist regularly." ***Patients taking an antiepileptic drug are at increased risk for suicidal thoughts and behavior beginning early in their treatment. The U.S. Food and Drug Administration (FDA) advises that patients, families, and caregivers be informed of the signs that may precede suicidal behavior and be encouraged to report these immediately. Mild sedation can occur in patients taking phenytoin, even at therapeutic levels. Carbamazepine, not phenytoin, increases the risk for hematologic effects, such as easy bruising. Phenytoin causes gingival hyperplasia in about 20% of patients who take it; dental hygiene is important. Patients receiving phenytoin should avoid alcohol and other central nervous system depressants, because they have an additive depressant effect.

The nurse is conducting discharge teaching related to a new prescription for phenytoin [Dilantin]. Which statements are appropriate to include in the teaching for this patient and family? (Select all that apply.) A. "Be sure to call the clinic if you or your family notice increased anxiety or agitation." B. "You may have some mild sedation. Do not drive until you know how this drug will affect you." C. "This drug may cause easy bruising. If you notice this, call the clinic immediately." D. "It is very important to have good oral hygiene and to visit your dentist regularly." E. "You may continue to have wine with your evening meals, but only in moderation."

C. "I will use a salt substitute to lower my sodium intake." ***Salt substitutes contain potassium and may increase the risk of hyperkalemia with ACE inhibitors, such as fosinopril. The patient should not take potassium supplements or use salt substitutes. The other statements are appropriate for this patient.

The nurse is evaluating the teaching done with a patient who has a new prescription for fosinopril [Monopril]. Which statement by the patient indicates a need for further teaching? A. "I can take this medicine with breakfast each morning." B. "I will call if I notice a rash or wheals on my skin." C. "I will use a salt substitute to lower my sodium intake." D. "I will call if I develop a bothersome cough."

C. Angioedema ***Angioedema is a strong vascular reaction involving inflammation of submucosal tissue (eg, laryngeal edema) and can result in anaphylaxis. Fatigue and a dry, nonproductive cough are adverse reactions but are not life-threatening. Diarrhea is not an adverse effect.

The nurse is instructing a patient about potential adverse effects of a prescribed angiotensin-converting enzyme (ACE) inhibitor. The nurse should instruct the patient to immediately seek medical attention if which adverse effect occurs? A. Fatigue B. Diarrhea C. Angioedema D. Dry, nonproductive cough

C. "You should discuss any plans to take herbal medications with your primary healthcare provider." ***Herbal drugs, as conventional drugs, may interact with drugs being taken for a number of conditions and/or may worsen those conditions, so decisions should be made in consultation with the primary care provider. Most herbal medications are available at a lower cost because of the low cost of production. Overall, herbal medications tend to be less expensive than conventional medications. Herbal supplements are made from natural substances, so they have fewer side effects compared to conventional medications. Herbal medications are supplied without a prescription.

The nurse is interviewing a patient who has chronic obstructive pulmonary disease (COPD). The patient wants to use herbal medications rather than conventional medications to treat a cold. Which statement made by the nurse is appropriate? A. "Herbal supplements have more side effects than conventional medications." B. "Many herbal medications are very expensive compared to conventional medications." C. "You should discuss any plans to take herbal medications with your primary healthcare provider." D. "You will need a prescription from your primary healthcare provider for herbal medications."

D. "Have you had any changes in your mood or anxiety level?" ***In the early phase of treatment for depression, suicide risk may increase. Patients should be monitored closely for worsening mood, unusual changes in behavior, and suicide risk. The other questions would be useful in assessing the patient for adverse effects of amitriptyline [Elavil], but assessing suicide risk is the most important intervention.

The nurse is monitoring a patient with depression in the early phase of treatment with amitriptyline [Elavil]. Which question is most important for the nurse to ask the patient? A. "Have you noticed dry mouth or blurred vision?" B. "Have you had any changes in your urine function?" C. "When was your last bowel movement?" D. "Have you had any changes in your mood or anxiety level?"

B. Anorexia C. Vomiting E. Visual disturbances ***Anorexia, vomiting, visual disturbances (blurred or yellow vision or appearance of halos around dark objects), fatigue, and nausea frequently foreshadow more serious toxicity (dysrhythmias) and should be reported immediately. Dry cough is a common side effect associated with angiotensin-converting enzyme inhibitors. Digoxin rarely causes diarrhea.

The nurse is monitoring a patient with suspected digoxin toxicity. Which assessment findings would be consistent with digoxin toxicity? Select all that apply. A. Diarrhea B. Anorexia C. Vomiting D. Dry cough E. Visual disturbances

D. It has more side effects and drug interactions. ***Phenelzine [Nardil], a monoamine oxidase inhibitor (MAOI), is considered a second- or third-line treatment because of the risk of triggering hypertensive crisis when the patient eats foods high in tyramine. Also, an increased incidence of drug-drug interactions is seen with phenelzine. Phenelzine does not pose an increased risk for suicide, psychoses, or parkinsonism, and it is as effective as the tricyclic and SSRI antidepressants.

The nurse is preparing to administer phenelzine [Nardil] to a patient with depression. Why is this drug considered a second- or third-line agent in the treatment of depression? A. It increases the risk of suicide in the early phase. B. It is less effective than the tricyclic antidepressants. C. It increases the risk of psychoses and parkinsonism. D. It has more side effects and drug interactions.

D. Ask the patient about pain status, location, type of pain, how the pain changes with time, what makes it better, or worse, and how much it impairs the ability to function. ***Assessment before opioid administration should include: (1) asking the patient about pain status, (2) where the pain is located, (3) what type of pain is present, (4) how the pain changes with time, (5) what makes it better or worse, and (6) how much it impairs his or her ability to function. It is not as important to ask the patient about what type of medication he or she prefers, what he or she takes at home, the anxiety level, depressive state, fears, or anger.

The nurse is performing an assessment on a patient. What is essential before opioid administration? A. Ask the patient about pain status and what is preferred for pain. B. Ask the patient about pain status, anxiety level, depressive state, fears, and if there is any anger. C. Ask the patient about pain status, what type of pain medicine is taken at home, and if a pill or an injection is preferred. D. Ask the patient about pain status, location, type of pain, how the pain changes with time, what makes it better, or worse, and how much it impairs the ability to function.

B. Inserting a Foley catheter ***Morphine can cause urinary hesitancy and urinary retention. If bladder distention or inability to void is noted, the prescriber should be notified. Urinary catheterization may be required. Morphine acts as a cough suppressant and an antidiarrheal, so neither of those types of drugs would be needed to counteract an adverse effect of morphine. Liver toxicity is not a common adverse effect of morphine.

The nurse is planning care for a patient receiving morphine sulfate [Duramorph] by means of a patient-controlled analgesia (PCA) pump. Which intervention may be required because of a potential adverse effect of this drug? A. Administering a cough suppressant B. Inserting a Foley catheter C. Administering an antidiarrheal D. Monitoring liver function tests

C. Sedation and dry mouth ***Anticholinergic effects (dry mouth, blurred vision, constipation, tachycardia, urinary retention) and sedation are potential adverse effects of the tricyclic antidepressants (TCAs), such as imipramine [Tofranil]. The most serious common adverse effect is orthostatic hypotension; therefore, a blood pressure of 160/90 mm Hg probably is not caused by this drug. Respiratory problems are not commonly associated with the TCAs.

The nurse is planning care for a patient taking imipramine [Tofranil]. Which finding, if present, would most likely be an adverse effect of this drug? A. Blood pressure of 160/90 mm Hg B. Insomnia and diarrhea C. Sedation and dry mouth D. Tachypnea and wheezing

C. Fluid volume deficit ***Acute adrenal insufficiency (adrenal crisis) is characterized by hypotension, dehydration, weakness, lethargy, and gastrointestinal (GI) symptoms of nausea and vomiting. Rapid replacement of fluid, salt, and glucocorticoids is essential to prevent shock and death. Comfort, nutrition, and activity are important to address once fluid balance has been restored.

The nurse is planning care for a patient with signs of acute adrenal insufficiency. What is the priority nursing diagnosis? A. Altered comfort B. Altered nutrition C. Fluid volume deficit D. Activity intolerance

A. Analyze heart rate and rhythm. ***Before giving digoxin, the nurse will assess the heart rate and rhythm. The dosage will be held and the prescriber notified if the heart rate is below 60 beats per minute or if the cardiac rhythm has changed. Digoxin can cause bradycardia and electrical changes in the heart.

The nurse is preparing to administer a daily dose of digoxin [Lanoxin]. What is the priority nursing intervention? A. Analyze heart rate and rhythm. B. Assess for Homans' sign. C. Check blood pressure. D. Palpate the pedal pulses.

D. Analyze heart rate and rhythm. ***Before giving digoxin [Lanoxin], the nurse should assess heart rate and rhythm. The dosage will be held and the prescriber notified if the heart rate is below 60 beats/min or if the cardiac rhythm has changed. Digoxin [Lanoxin] can cause bradycardia and electrical changes in the heart.

The nurse is preparing to administer a daily dose of digoxin [Lanoxin]. What is the priority nursing intervention? A. Check blood pressure. B. Palpate the pedal pulses. C. Assess for Homans' sign. D. Analyze heart rate and rhythm.

B. Notify the healthcare provider and delay drug administration. ***Respiratory depression is a side effect of opioid analgesia. Therefore, because the patient's respiratory rate is below normal, the nurse should withhold the morphine and notify the healthcare provider.

The nurse is preparing to administer an injection of morphine to a patient. Assessment notes a respiratory rate of 10 breaths/min. Which action will the nurse perform? A. Administer a smaller dose and record the findings. B. Notify the healthcare provider and delay drug administration. C. Hold the drug, record the assessment, and recheck in 1 hour. D. Administer the prescribed dose and notify the healthcare provider.

A. Give the medication. ***Determine heart rate and rhythm prior to administration. If heart rate is less than 60 beats/min or if a change in rhythm is detected, withhold digoxin and notify the healthcare provider.

The nurse is preparing to administer an oral dose of digoxin [Lanoxin]. The apical pulse rate is 64. What nursing action is most appropriate? A. Give the medication. B. Obtain a serum digoxin level. C. Notify the healthcare provider. D. Assess for signs of digoxin toxicity.

A. Give the medication. ***Determine heart rate and rhythm prior to administration. If heart rate is less than 60 beats/min or if a change in rhythm is detected, withhold digoxin and notify the healthcare provider.

The nurse is preparing to administer an oral dose of digoxin [Lanoxin]. The apical pulse rate is 64. Which nursing action is most appropriate? A. Give the medication. B. Obtain a serum digoxin level. C. Notify the healthcare provider. D. Assess for signs of digoxin toxicity.

D. It has more hazardous side effects and drug interactions. ***Phenelzine [Nardil], a monoamine oxidase inhibitor (MAOI), is considered a second- or third-line treatment because of the risk of triggering hypertensive crisis when the patient eats foods high in tyramine. Also, an increased incidence of drug-drug interactions is seen with phenelzine. Phenelzine does not pose an increased risk for suicide, psychoses, or parkinsonism, and it is as effective as the tricyclic and selective serotonin reuptake inhibitor (SSRI) antidepressants.

The nurse is preparing to administer phenelzine [Nardil] to a patient with depression. Why is this drug considered a second- or third-line agent in the treatment of depression? A. It increases the risk of suicide in the early phase. B. It is less effective than the tricyclic antidepressants. C. It increases the risk of psychoses and parkinsonism. D. It has more hazardous side effects and drug interactions.

C. Evaluate the patient's overall knowledge related to the diagnosis and medication. ***The highest priority nursing action for this patient is to evaluate the patient's overall knowledge related to his diagnosis and medications. Knowing what the patient already knows provides a foundation for additional teaching. Questioning does not indicate a risk for medication noncompliance. Reassurance of monitoring does not address the patient's concerns for learning about the diagnosis and medications. Determining coping skills, while important, does not address the patient's questions.

The nurse is providing care for a newly admitted patient. The patient has many questions about the admission diagnosis and medication. What should be the highest priority nursing action for this patient? A. Determine the patient's coping skills for dealing with his diagnosis. B. Reassure the patient that nurses will monitor for adverse effects to medication. C. Evaluate the patient's overall knowledge related to the diagnosis and medication. D. Document that the patient displays a risk for medication noncompliance due to knowledge deficit.

D. "Confirm with your healthcare provider that any herbs you take will not interact with prescribed medications." ***The highest priority teaching point is that the patient should seek education and confirm with a healthcare provider that any herbs taken will not have an adverse effect if taken with prescribed medications.

The nurse is providing education to a group of patients interested in complementary medicine. Which teaching point should the nurse include as priority education for the group? A. "Understand the use of any herb before taking it." B. "Stop taking any herb if you note any adverse effects." C. "Read the directions and labels of all herbs before taking." D. "Confirm with your healthcare provider that any herbs you take will not interact with prescribed medications."

B. Assessing lithium levels every other week

The nurse is reviewing a patient's medication history and notes that the patient recently began taking lithium (Lithibid). What intervention is a priority for this patient? A. Monitoring for the recurrence of seizure activity B. Assessing lithium levels every other week C. Asking the patient if they have ringing in the ears D. Monitoring the patient's intake and output

A. Release of renin B. Increased heart rate D. Increased AV conduction velocity ***Beta1 receptors are located in the heart and the kidney. The response to receptor activation will result in increased heart rate, increased force of contraction of heart, increased AV conduction velocity, and release of renin. It is beta2 receptors that result in dilation of arterioles.

The nurse is reviewing medications that act as beta1 receptors. Which of these are responses to beta1 receptor activation? Select all that apply. A. Release of renin B. Increased heart rate C. Dilation of arterioles D. Increased AV conduction velocity E. Decreased force of contraction of heart

A. Reports sore throat ***Sore throat is a sign of neutropenia in a patient receiving an angiotensin-converting enzyme (ACE) inhibitor. Neutropenia, with its associated risk of infection, is a rare but serious complication. Calcium channel blockers (CCB), verapamil, and hydrochlorothiazide can be used safely in patients with bronchial asthma, a condition that precludes the use of beta2-adrenergic antagonists. ACE inhibitors can benefit patients with diabetic nephropathy, slowing the progression of renal disease. ACE inhibitors can cause severe renal insufficiency in patients with bilateral renal artery stenosis or stenosis in the artery to a single remaining kidney; however, this patient has no history of this.

The nurse is reviewing the chart for a patient who has been receiving an angiotensin-converting enzyme (ACE) inhibitor for 4 days. Which finding would cause the nurse to hold the ACE inhibitor until evaluated by the patient's primary care provider? A. Reports sore throat B. Has bronchial asthma C. Diabetic with nephropathy D. No history of renal artery stenosis

B. Clopidogrel [Plavix] 75 mg daily ***For patients who lack risk factors for GI bleeding, combined use of clopidogrel with a PPI, such as omeprazole, may reduce the effects of clopidogrel without offering any real benefits and thus should be avoided. This is due to inhibition of CYP2C19, which converts the drug to its active form. Nothing in the question indicates that the patient is at risk for GI bleeding. The other options are not cause for concern.

The nurse is reviewing the prescriber's orders and notes that omeprazole [Prilosec] has been ordered for a patient admitted with acute coronary syndrome (ACS). The nurse should be concerned if this medication is combined with which medication noted on the patient's record? A. Aspirin 81 mg daily B. Clopidogrel [Plavix] 75 mg daily C. Heparin 5000 units subQ every 12 hours D. Metoprolol 50 mg every 8 hours

B. Stimulation of sympathetic nerves to veins causes vasoconstriction. ***Stimulation of sympathetic nerves to arteries and veins causes vasoconstriction; stimulation to the heart causes increased cardiac output, and stimulation to the adrenal medulla causes vasoconstriction in vascular beds.

The nurse is reviewing the sympathetic nervous system (SNS) effects on the heart and blood vessels. Which statement is correct regarding the effect of SNS stimulation? A. Stimulation of sympathetic nerves to arteries causes vasodilation. B. Stimulation of sympathetic nerves to veins causes vasoconstriction. C. Stimulation of sympathetic nerves to the heart decreases cardiac output. D. Stimulation of sympathetic nerves to the adrenal medulla causes increased heart rate.

B. A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L ***Lithium levels above 1.5 mEq/L should be reported, because this level may indicate impending serious toxicity. The other findings may be side effects of the drugs the patients are taking, but they are not priority problems.

The nurse is seeing several patients in the outpatient clinic today. Which patient most requires the nurse's immediate attention? A. A female patient with BPD who takes valproic acid [Depakene] and who reports nausea and vomiting B. A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L C. A male patient with depression who takes fluoxetine [Prozac] and who reports sexual dysfunction D. A female patient with schizophrenia who takes haloperidol [Haldol] and who has a blood pressure of 102/72 mm Hg

C. Low-density lipoprotein (LDL) ***Cholesterol is the primary core lipid of LDLs, which are responsible for carrying cholesterol to tissues outside the liver. Of all the lipoproteins, LDLs are the most significant contributors to coronary atherosclerosis. When pharmacologic agents are used to lower cholesterol, the primary goal is to reduce elevated LDL levels.

The nurse understands that cholesterol is carried through the blood by lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis? A. Very-low-density lipoprotein (VLDL) B. Apolipoprotein B-100 C. Low-density lipoprotein (LDL) D. High-density lipoprotein (HDL)

A. A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L ***Lithium levels above 1.5 mEq/L should be reported because this level may indicate impending, serious toxicity. The other findings may be side effects of the drugs the patients are taking, but they are not priority problems.

The nurse is seeing several patients in the outpatient clinic. Which patient most requires the nurse's immediate attention? A. A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L B. A male patient with depression who takes fluoxetine [Prozac] and who reports sexual dysfunction C. A female patient with schizophrenia who takes haloperidol [Haldol] and who has a blood pressure of 102/72 mm Hg D. A female patient with bipolar disorder (BPD) who takes valproic acid [Depakene] and who reports nausea and vomiting

A. "The SNS regulates control of vision." ***Regulation of vision control is a function of the parasympathetic nervous system. The cardiovascular system, body temperature, and acute stress response are all regulated by the sympathetic nervous system.

The nurse is teaching a group of coworkers about the functions of the sympathetic nervous system (SNS). Which statement by a coworker would require correction? A. "The SNS regulates control of vision." B. "The SNS regulates body temperature." C. "The SNS regulates the acute stress response." D. "The SNS regulates the cardiovascular system."

C. Increased heart rate E. Release of renin from kidneys ***Beta1 receptors are located in the heart and the kidney. Cardiac beta 1 receptors have great therapeutic significance. Activation of these receptors increases heart rate, force of contraction, and velocity of impulse conduction through the atrioventricular node. Activation of beta 1 receptors in the kidney causes release of renin into the blood. Relaxation of the uterus and dilation of bronchi is a function of Beta2, and penile ejaculation is a function of alpha1 receptors.

The nurse is teaching a group of nurses the significance of beta1 receptor activation. What are the responses of this activation? Select all that apply. A. Penile ejaculation B. Dilation of bronchi C. Increased heart rate D. Relaxation of the uterus E. Release of renin from kidneys

C. "Read food labels and reduce your intake of saturated fats." ***An increase in dietary cholesterol intake does not produce a large increase in blood cholesterol because of the body's feedback system. When cholesterol intake increases, endogenous production decreases. However, because the body uses dietary saturated fats to make cholesterol, an increase in saturated fat intake can produce a significant increase in blood cholesterol levels. To lower blood cholesterol, it is most important to lower saturated fat intake. Although red meat and pork should be limited, it is not necessary to eliminate them from the diet. Sodium intake is not directly related to lowering cholesterol levels.

The nurse is teaching a group of patients about dietary approaches to reduce cholesterol levels. Which statement is most important to include in the teaching? A. "Lower your cholesterol to 300 mg/day." B. "Eliminate red meat and pork from your diet." C. "Read food labels and reduce your intake of saturated fats." D. "Reduce salt consumption to keep your sodium intake to 2400 mg/day."

A. The nurse will obtain a translator to assist with teaching. ***The nurse should arrange a translator while interacting with the patient who has a language barrier. It helps the patient to effectively understand all teaching regarding precautions and the frequency of drug administration. The nurse should clearly explain the instructions before asking the patient to read the black box warning as patients might not understand some of the instructions. The nurse should arrange for a translator rather than asking the patient to call the healthcare provider. The healthcare provider may not be able to properly convey the instructions given by the nurse. The nurse's teaching techniques, such as how to provide a self-injection of insulin therapy, will not help the patient understand the complete drug information. The nurse should demonstrate the technique in the presence of a translator so the patient can follow the instructions of the nurse.

The nurse is teaching a patient about his medications. The nurse notes that the patient has difficulty understanding instructions because of a language barrier. Which action will help the patient understand the instructions? A. The nurse will obtain a translator to assist with teaching. B. The nurse will instruct the patient to read the black box warnings. C. The nurse will advise the patient to call the provider for more information. D. The nurse will demonstrate how to administer the medication and provide written information.

A. "Do not take more than 4000 mg per day." E. "Watch over-the-counter medications for acetaminophen in the product to prevent an overdose." ***Over-the-counter medication such as cold medications can contain acetaminophen, which could increase the dosage. The maximum daily dosage is 4000 mg. While drinking alcohol increases the risk for liver damage, the recommendation is to decrease the dosage to 2000 mg for those individuals who drink more than three alcoholic beverages per day. Undernourished individuals should decrease the dosage to no more than 3000 mg per day.

The nurse is teaching a patient about the appropriate dose for acetaminophen. What should the nurse include? Select all that apply. A. "Do not take more than 4000 mg per day." B. "Undernourished patients should not take acetaminophen." C. "Drinking alcohol and taking acetaminophen will cause death." D. "There are no risks associated with acetaminophen consumption." E. "Watch over-the-counter medications for acetaminophen in the product to prevent an overdose."

A. It maintains the body temperature. C. It regulates the cardiovascular system. D. It implements the "fight-or-flight" reaction. ***The functions of the sympathetic nervous system include regulating the cardiovascular system, implementing the fight-or-flight reaction, and maintaining the body temperature. The sympathetic nervous system dilates bronchial smooth muscles. The parasympathetic nervous system is responsible for controlling the amount of gastric secretions.

The nurse is teaching a patient about the functions of the sympathetic nervous system related to a prescribed medication. What should the nurse tell the patient about the functions of this system? Select all that apply. A. It maintains the body temperature. B. It alters the secretion of gastric juices. C. It regulates the cardiovascular system. D. It implements the "fight-or-flight" reaction. E. It constricts the bronchial smooth muscles.

D. oral anticoagulants ***Cimetidine may increase the blood levels of oral anticoagulants by reducing their metabolism in the liver and excretion.

The nurse understands that which drug or drug type may interact with the H2-receptor antagonist cimetidine? A. hormonal contraceptives B. antilipemic agents C. digoxin D. oral anticoagulants

B. "Our goal is to reduce your seizures to an extent that helps you live a normal life." ***Epilepsy is treated successfully with medication in most patients. However, the dosages needed to completely eliminate seizures may cause intolerable side effects. Neurosurgery is indicated only for patients in whom medication therapy is unsuccessful.

The nurse is teaching a patient newly diagnosed with epilepsy about her disease. Which statement made by the nurse best describes the goals of therapy with antiepilepsy medication? A. "With proper treatment, we can completely eliminate your seizures." B. "Our goal is to reduce your seizures to an extent that helps you live a normal life." C. "Epilepsy medication does not reduce seizures in most patients." D. "These drugs will help control your seizures until you have surgery."

C. Avoid potassium salt substitutes. D. A persistent dry cough may occur. E. Report difficulty in breathing immediately. ***Salt substitutes contain potassium and may increase the risk of hyperkalemia with ACE inhibitors. A persistent, dry, nonproductive cough may develop. Angioedema includes edema of the tongue, glottis, and pharynx that may cause difficulty breathing which requires immediate medical attention. Captopril [Capoten] must be taken at least one hour before meals. A sore throat and fever are not expected adverse effects. ACE inhibitors can lower white cell count and decrease the body's ability to fight an infection. Early signs of infection include fever and sore throat.

The nurse is teaching a patient prescribed captopril [Capoten] for the treatment of hypertension. Which instructions should the nurse include? (Select all that apply.) A. Take the medication with food. B. Expect a sore throat and fever. C. Avoid potassium salt substitutes. D. A persistent dry cough may occur. E. Report difficulty in breathing immediately.

A. Expect a persistent dry cough. D. Avoid potassium salt substitutes. E. Report difficulty in breathing immediately. ***Salt substitutes contain potassium and may increase the risk of hyperkalemia with angiotensin-converting enzyme (ACE) inhibitors. A persistent, dry, nonproductive cough may develop. Angioedema includes edema of the tongue, glottis, and pharynx that may cause difficulty breathing, which requires immediate medical attention. Captopril [Capoten] must be taken at least one hour before meals. A sore throat and fever are not expected adverse effects. ACE inhibitors can lower white cell count and decrease the body's ability to fight an infection. Early signs of infection include fever and sore throat.

The nurse is teaching a patient prescribed captopril [Capoten] for the treatment of hypertension. Which instructions should the nurse include? Select all that apply. A. Expect a persistent dry cough. B. Take the medication with food. C. Expect a sore throat and fever. D. Avoid potassium salt substitutes. E. Report difficulty in breathing immediately.

A. "This medication may cause some sexual side effects. Let your healthcare provider know about this if it occurs." B. "When you stop taking this medication, you should not withdraw it abruptly." E. "Let your family or your healthcare provider know if you experience a worsening mood, agitation, or increased anxiety." ***Citalopram [Celexa] and other SSRIs can cause sexual side effects that patients may be hesitant to report. SSRIs should be withdrawn slowly to prevent dizziness, headache, dysphoria, and/or other symptoms of withdrawal. The SSRIs do not generally cause orthostatic hypotension or drowsiness. All antidepressants initially increase the risk of suicide, and patients should be monitored for worsening mood and other signs of suicide risk.

The nurse is teaching a patient who has a new prescription for citalopram [Celexa]. Which statement is appropriate to include in the teaching plan? (Select all that apply.) A. "This medication may cause some sexual side effects. Let your healthcare provider know about this if it occurs." B. "When you stop taking this medication, you should not withdraw it abruptly." C. "You will need to move slowly from a sitting to a standing position to prevent dizziness from low blood pressure." D. "This medication often causes drowsiness. You should take it at bedtime." E. "Let your family or your healthcare provider know if you experience a worsening mood, agitation, or increased anxiety."

B. "I will rise slowly when changing from a sitting to a standing position." ***Vasodilators may cause postural hypotension and reflex tachycardia. Patients should be taught to move slowly when changing positions to prevent dizziness.

The nurse is teaching a patient who has just been prescribed a vasodilator. Which statement by the patient indicates that the teaching was effective? A. "I can take this medication in the morning to reduce nighttime urination." B. "I will rise slowly when changing from a sitting to a standing position." C. "My heart rate may slow down with this drug. I will call if my pulse is below 60." D. "I need to increase my intake of fluids and foods that are high in fiber."

A. "I will rise slowly when changing from a sitting to a standing position." ***Vasodilators may cause postural hypotension and reflex tachycardia. Patients should be taught to move slowly when changing positions to prevent dizziness.

The nurse is teaching a patient who has just been prescribed a vasodilator. Which statement by the patient indicates that the teaching was effective? A. "I will rise slowly when changing from a sitting to a standing position." B. "I need to increase my intake of fluids and foods that are high in fiber." C. "I can take this medication in the morning to reduce nighttime urination." D. "My heart rate may slow down with this drug. I will call if my pulse is below 60."

A. Sweating B. Headache F. Tachycardia ***The effects of hypoglycemia are largely attributable to stimulation of the central nervous system because low blood glucose stresses the body. When hypoglycemia occurs, the sympathetic nervous system responds in an attempt to increase blood glucose. Clinical indicators of hypoglycemia mimic sympathetic nervous system stimulation; they include headaches, diaphoresis (sweating), tachycardia, palpitations, and anxiety.

The nurse is teaching a patient who has type 1 diabetes mellitus how to prevent hypoglycemia. Which clinical indicators of hypoglycemia should the nurse identify for the patient and family? Select all that apply. A. Sweating B. Headache C. Polyphagia D. Weight loss E. Dehydration F. Tachycardia

A. "When it is time to discontinue this drug, you will need to taper it off slowly." ***Alprazolam [Xanax] is a benzodiazepine for which abrupt discontinuation can precipitate withdrawal symptoms. Patients should withdraw the drug gradually over several weeks. The other statements are not related to alprazolam [Xanax].

The nurse is teaching a patient with a new prescription for alprazolam [Xanax]. Which statement is the most appropriate to include in the teaching plan? A. "When it is time to discontinue this drug, you will need to taper it off slowly." B. "Protect your skin from the sun to prevent rash and exaggerated sunburn." C. "Increase your intake of fluid and high-fiber foods to prevent constipation." D. "Take this medication on an empty stomach at least 2 hours after meals."

C. "With the first patch, it will take about 24 hours before you feel the full effects." ***Full analgesic effects can take up to 24 hours to develop with fentanyl patches. Most patches are changed every 72 hours. Fentanyl has the same adverse effects as other opioids, including respiratory depression. Patients should avoid exposing the patch to external heat sources, because this may increase the risk of toxicity.

The nurse is teaching a patient with cancer about a new prescription for a fentanyl [Sublimaze] patch, 25 mcg/hr, for chronic back pain. Which statement is the most appropriate to include in the teaching plan? A. "You will need to change this patch every day, regardless of your pain level." B. "This type of pain medication is not as likely to cause breathing problems." C. "With the first patch, it will take about 24 hours before you feel the full effects." D. "Use your heating pad for the back pain. It will also improve the patch's effectiveness."

A. "I will increase my intake of fluid and foods high in fiber." C. "I will call my healthcare provider if I notice swelling in my ankles." ***Verapamil often causes constipation and can also cause peripheral edema. Patients should take measures to prevent constipation and should call about new symptoms of peripheral edema. Patients taking verapamil should not experience photosensitivity, hyperkalemia, or increased bruising and bleeding.

The nurse is teaching a patient with essential hypertension who has a new prescription for verapamil [Calan]. Which statements by the patient indicate that the teaching was effective? (Select all that apply.) A. "I will increase my intake of fluid and foods high in fiber." B. "I should stay out of direct sunlight to prevent exposing my skin to the sun." C. "I will call my healthcare provider if I notice swelling in my ankles." D. "I need to avoid salt substitutes and potassium supplements." E. "I may notice easy bruising and bleeding with this drug."

D. "Take this medicine on an empty stomach in the morning, at least 30 to 60 minutes before eating." ***Patients who are prescribed thyroid replacements or antithyroid drugs should be advised to take the medicine on an empty stomach in the morning, at least 30 to 60 minutes before eating. This helps enhance the absorption of the drug. Taking the medication twice a day after meals may reduce the therapeutic effectiveness of the medication and cause adverse effects. A patient needs to avoid eating foods that may reduce thyroid hormone production and reduce the effectiveness of the medication. Therefore, the nurse should not give false information that the patient need not follow dietary restrictions. This medication should be taken with water rather than orange juice, as it helps enhance the disintegration and absorption of the drug.

The nurse is teaching safe administration of medication to a patient who has been prescribed levothyroxine [Levoxyl]. Which statement should the nurse include in the teaching session? A. "Take this medication with 250 mL of orange juice." B. "Always take the medication three times a day, after meals." C. "There are no dietary restrictions while taking this medication." D. "Take this medicine on an empty stomach in the morning, at least 30 to 60 minutes before eating."

B. "When I am traveling for work I will take lower doses." ***To mimic normal cortisol secretion, patients can take the entire daily dose in the morning immediately after waking. If this schedule results in afternoon or evening fatigue, patients may split the dosage, taking two-thirds in the morning and one-third around 4:00 in the afternoon. Stress, such as travel for work, may require an increase in medication.

The nurse is teaching the patient about oral steroid therapy for chronic adrenal insufficiency. Which statement by the patient indicates a need for further teaching? A. "I can take my full dose in the morning." B. "When I am traveling for work I will take lower doses." C. "I understand that I shouldn't experience many adverse effects." D. "I can break up my dose and take some in the afternoon if I get tired."

D. "When I am traveling for work I will take lower doses." ***To mimic normal cortisol secretion, patients can take the entire daily dose in the morning, immediately after waking. If this schedule results in afternoon or evening fatigue, patients may split the dosage, taking two-thirds in the morning and one-third around 4:00 in the afternoon. Stress, such as travel for work, may require an increase in medication.

The nurse is teaching the patient about oral steroid therapy. Which statement by the patient indicates a need for further teaching? A. "I can take my full dose in the morning." B. "I can break up my dose and take some in the afternoon if I get tired." C. "I understand that I shouldn't experience many adverse effects." D. "When I am traveling for work I will take lower doses."

A. "Hypertension is a risk factor for stroke." C. "Hypertension is a risk factor for heart failure." E. "Hypertension is a risk factor for cardiovascular disease." ***Hypertension is a risk factor for cardiovascular disease, stroke, and heart failure. It is not a risk factor for emphysema or diabetes.

The nurse is teaching the patient why hypertension must be treated. What information should be included in the teaching plan? Select all that apply. A. "Hypertension is a risk factor for stroke." B. "Hypertension is a risk factor for diabetes." C. "Hypertension is a risk factor for heart failure." D. "Hypertension is a risk factor for emphysema." E. "Hypertension is a risk factor for cardiovascular disease."

B. The nurse will call the healthcare provider. ***If the nurse cannot understand all components of a drug order, the nurse needs to call the healthcare provider who wrote the order. There is no substitute for talking to the healthcare provider to explain the order; however, part of any assessment includes looking up the name of the medication and asking the patient what medications were taken at home. The pharmacy could be called with general questions, but the person who wrote the order is the one who needs to be contacted whenever there is confusion or misunderstanding.

The nurse is unable to read the drug name on a medication order. What action will the nurse perform first? A. The nurse will call the pharmacy. B. The nurse will call the healthcare provider. C. The nurse will look up the generic name of the medication. D. The nurse will ask the patient what medications he or she was taking at home.

D. Digoxin immune Fab antibody fragments ***When digoxin overdose is especially severe (normal range is 0.5-0.8 ng/mL), digoxin levels can be lowered using digoxin immune Fab antibody fragments. Potassium supplements are helpful when hypokalemia is present, not hyperkalemia. Giving digoxin would make the situation worse. Although the patient has dysrhythmias, quinidine should not be used as it causes plasma levels of digoxin to rise. Rather, phenytoin and lidocaine are most effective.

The nurse reviews a patient's laboratory values and observes a digoxin level of 2.5 ng/mL and a potassium level of 5.9 mEq/L. Upon physical assessment, the patient begins to experience changes in heart rate and rhythm (dysrhythmias). Which drug should the nurse be prepared to administer? A. Digoxin B. Quinidine C. Potassium supplements D. Digoxin immune Fab antibody fragments

B. The development of opioid dependence is rare when opioids are used for acute pain. ***The development of dependence on or addiction to opioids as a result of clinical exposure is extremely rare. In fact, some estimate that only 25% of patients receive doses of opioids that are sufficient to relieve suffering. Only about 8% of the population is estimated to be prone to drug abuse. Morphine is a drug of abuse, but this fact is not helpful in guiding clinical practice. A patient-controlled analgesia (PCA) pump provides the most consistent pain relief, better than PRN and fixed-dosing schedules.

The nurse is working on a postoperative unit in which pain management is part of routine care. Which statement is the most helpful in guiding clinical practice in this setting? A. At least 30% of the U.S. population is prone to drug addiction and abuse. B. The development of opioid dependence is rare when opioids are used for acute pain. C. Morphine is a common drug of abuse in the general population. D. The use of PRN (as needed) dosing provides the most consistent pain relief without risk of addiction.

B. Diazepam [Valium] ***Diazepam [Valium] is known for being used to treat anxiety and muscle spasm and spasticity. Temazepam [Restoril] and quazepam [Doral] are used to treat insomnia. Clonazepam [Klonopin] is used to treat seizures and anxiety.

The nurse is working with a patient who asks for medication for anxiety and a drug to relieve muscle spasms. Which benzodiazepine does the nurse anticipate will be ordered for the patient? A. Quazepam [Doral] B. Diazepam [Valium] C. Temazepam [Restoril] D. Clonazepam [Klonopin]

C. "Cholinesterase inhibitors do not cure AD or slow the progression of the disease." ***Cholinesterase inhibitors do not cure AD or slow the progression of the disease. There are three cholinesterase inhibitor medications. Memantine is not a cholinesterase inhibitor. Cholinesterase inhibitors are not very effective. Unlike donepezil, which cause reversible inhibition of AChE, rivastigmine causes irreversible inhibition.

The nurse is working with a student in the care of a patient with AD. Which statement by the student demonstrates an understanding of the cholinesterase inhibitor medications used for AD? A. "There are four cholinesterase inhibitor medications available to treat AD. They are galantamine, rivastigmine, donepezil, and memantine." B. "Cholinesterase inhibitors are very effective in treating AD." C. "Cholinesterase inhibitors do not cure AD or slow the progression of the disease." D. "All of the cholinesterase inhibitors cause reversible inhibition of AChE."

C. "Cholinesterase inhibitors do not cure AD or slow the progression of the disease." ***Cholinesterase inhibitors do not cure AD or slow the progression of the disease. There are three cholinesterase inhibitor medications. Memantine is not a cholinesterase inhibitor. Cholinesterase inhibitors are not very effective. Unlike donepezil, which causes reversible inhibition of AChE, rivastigmine causes irreversible inhibition.

The nurse is working with a student in the care of a patient with Alzheimer's disease (AD). Which statement by the student demonstrates an understanding of the cholinesterase inhibitor medications used for AD? A. "Cholinesterase inhibitors are very effective in treating AD." B. "All of the cholinesterase inhibitors cause reversible inhibition of AChE." C. "Cholinesterase inhibitors do not cure AD or slow the progression of the disease." D. "There are four cholinesterase inhibitor medications available to treat AD. They are galantamine, rivastigmine, donepezil, and memantine."

A. Dystonia ***Dystonia, an impairment of muscle tone, is the only extrapyramidal side effect listed. The other side effects also occur but are not extrapyramidal effects.

The nurse monitors a patient taking an antipsychotic medication for extrapyramidal side effects. What should the nurse assess for in the patient? A. Dystonia B. Orthostatic hypotension C. Dry mouth and constipation D. Neuroleptic malignant syndrome

A. Nausea B. Malaise C. Jaundice D. Vomiting ***Drug toxicity is an adverse drug reaction in which certain drugs are toxic to specific organs. Signs and symptoms of liver toxicity include jaundice, dark urine, light-colored stools, nausea, vomiting, malaise, abdominal discomfort, and loss of appetite.

The nurse monitors for adverse effects in a patient prescribed isoniazid for the treatment of tuberculosis. Which signs and symptoms would alert the nurse to the presence of drug-induced liver toxicity? Select all that apply. A. Nausea B. Malaise C. Jaundice D. Vomiting E. Cloudy urine

8 minutes ***The nurse administers IV phenytoin no faster than 50 mg/min to reduce the risk of cardiovascular collapse. Calculation: (1 min/50 mg) × 400 mg = 400 ÷ 50 = 8 minutes.

The nurse needs to administer phenytoin [Dilantin] 400 mg IV bolus to a patient. At a minimum, over how many minutes should the nurse administer this dose? Record your answer using a whole number. _____ minutes

A. Metabolic syndrome ***Olanzapine [Zyprexa] is approved for monotherapy of acute mania in patients with bipolar disorder. This drug has a high risk of metabolic effects, and patients should be taught about assessing for potential weight gain, diabetes, and dyslipidemia.

The nurse notes olanzapine [Zyprexa] on a patient's drug history upon admission. The nurse should plan to teach the patient about which disorder? A. Metabolic syndrome B. Paranoid schizophrenia C. Obsessive-compulsive disorder D. Schizophrenia positive symptoms

C. Airway maintenance ***An overdose of baclofen [Lioresal] can cause respiratory depression as a result of excessive central nervous system depression so the nurse has to maintain an open airway with the use of oxygen and a bag for ventilation. General supportive therapy and seizure therapy, including cardiac monitoring, gastric lavage, and fluid therapy, are instituted to maintain vital functions until the depressant effects of baclofen [Lioresal] wear off. An antidote to baclofen [Lioresal] does not exist. Although comfort measures are usually appropriate, the nurse's priority is the maintenance of vital functions.

The nurse notes that a patient has taken an excessive dose of baclofen [Lioresal]. Which action does the nurse implement immediately? A. Comfort measures B. Seizure precautions C. Airway maintenance D. Antidote preparation

C. Erythromycin ***Erythromycin increases the levels of buspirone 5- to 13-fold. Garlic, ginseng, and St. John's wort are not included in the medications that increase the effects of buspirone.

The nurse obtains a medication history from a patient diagnosed with generalized anxiety disorder who is prescribed buspirone. The nurse recognizes that teaching is needed when the nurse notes that the patient is taking which medication with buspirone? A. Garlic B. Ginseng C. Erythromycin D. St. John's wort

A. A patient with liver cirrhosis B. A patient with kidney disease C. A patient with a nutritional deficiency ***Patients who are on protein-bound drugs must have adequate levels of protein components, such as albumin and globulin. Patients with liver cirrhosis have low serum albumin levels, resulting in fewer protein-binding sites. This leads to excess free drugs, causing drug toxicity. Patients with kidney disease have low serum albumin levels and renal dysfunction; both lead to drug toxicity. Patients with nutritional deficiencies due to old age or malnutrition have low serum albumin levels, also resulting in excess free drugs and leading to drug toxicity. A patient who has had gastric surgery will have decreased absorption in the pharmaceutic phase of drug action. A patient with peripheral vascular disease will have decreased distribution of the drug to the extremities.

The nurse obtains a patient's history to identify factors that may affect drug pharmacokinetics. Which patients who are on protein-bound drugs are most likely to experience drug toxicity? Select all that apply. A. A patient with liver cirrhosis B. A patient with kidney disease C. A patient with a nutritional deficiency D. A patient who has had gastric surgery E. A patient with peripheral vascular disease

C. In the morning after breakfast ***Bisacodyl suppositories act rapidly (in 15 to 60 minutes). They can be given at any time, but for patient convenience, they should not be given at bed time to avoid disrupting sleep. For convenience and patient ease, a fast acting laxative should not be given before a meal, which could cause the urge to have a bowel movement during the meal.

The nurse prepares to administer a bisacodyl suppository to a patient who has not had a bowel movement in several days. When should the nurse administer the PRN medication? A. In the evening before bed B. In the afternoon before lunch C. In the morning after breakfast D. In the morning before breakfast

D. Antagonist ***An antagonist is a drug that prevents receptor activation. A selective drug has only the desired response but may not activate receptors. An agonist is a molecule that activates receptors. A potent drug requires a lower dose to achieve its effect.

The nurse prepares to give a drug that will prevent receptor activation. Which term would describe this drug? A. Potent B. Agonist C. Selective D. Antagonist

A. Calcium-containing antacids cause constipation. C. Aluminum-containing antacids cause constipation. D. Antacids neutralize the acid present in the stomach. ***Both calcium- and aluminum-containing antacids cause constipation as an adverse effect. Antacids neutralize the excess acid secreted in the stomach by forming salts. Agents protective against ulcers, such as sucralfate [Carafate], form a mucous barrier in the stomach; the antacids do not. Antacids can only neutralize the acid secreted in the stomach; they cannot influence the secretion of acids. Magnesium-containing antacids reduce the effect of constipation resulting from aluminum- and calcium-containing antacids.

The nurse provides a patient with educational materials about antacids. Which statements about antacids are appropriate? Select all that apply. A. Calcium-containing antacids cause constipation. B. Antacids form a protective barrier in the stomach. C. Aluminum-containing antacids cause constipation. D. Antacids neutralize the acid present in the stomach. E. Magnesium-containing antacids cause constipation. F. Antacids decrease the secretion of acid in the stomach.

D. "I must make sure I swallow the pill whole." ***"SR" indicates that the drug is sustained release; therefore, the patient must swallow the pill intact, without chewing or crushing, which would result in a bolus effect. Grapefruit juice should be avoided, because it can inhibit intestinal and hepatic metabolism of the drug, thereby raising the drug level. Constipation, not loose stools, is a common side effect of Calan; increasing fluids and dietary fiber can help prevent this adverse effect.

The nurse provides discharge instructions to a patient prescribed verapamil [Calan] SR 120 mg PO daily for essential hypertension. Which statement by the patient indicates understanding of the medication? A. "I will take the medication with grapefruit juice each morning." B. "I should expect occasional loose stools from this medication." C. "I'll need to reduce the amount of fiber in my diet." D. "I must make sure I swallow the pill whole."

B. This medication will be 50% eliminated in 12 hours . ***The half-life (T½) of a drug is the time it takes for one-half of the drug concentration to be eliminated. Metabolism and elimination affect the half-life of a drug. For example, with liver or kidney dysfunction, the half-life of the drug is prolonged; thus, less of the drug is metabolized and eliminated. When a drug is taken continually, drug accumulation may occur.

The nurse reads that the half-life of the medication being administered is 12 hours. Which interpretation should guide the nurse's care of this patient? A. The medication will not work for the first 12 hours. B. This medication will be 50% eliminated in 12 hours . C. The patient will require two doses of the medication before there is an effect. D. The medication will be administered every 6 hours to maintain consistent blood levels.

B. "I can stop this drug after 3 weeks if I feel better." ***Lorazepam should not be discontinued abruptly, but gradually, over a period of several days. Caffeine and alcohol should be avoided when taking lorazepam, a benzodiazepine. This drug should not be taken during pregnancy because of possible teratogenic effects.

The nurse realizes more medication teaching is necessary when the 30-year-old patient taking lorazepam (Ativan) states A. "I must stop drinking coffee and colas." B. "I can stop this drug after 3 weeks if I feel better." C. "I must stop drinking alcoholic beverages." D. "I should not become pregnant while taking this drug."

A. Continue as planned, because the level is within normal limits. ***The therapeutic range for phenytoin is 10 to 20 mcg/mL. Because this level is within normal limits, the nurse would continue with the routine plan of care.

The nurse receives a laboratory report indicating that the phenytoin [Dilantin] level for the patient seen in the clinic yesterday is 16 mcg/mL. Which intervention is most appropriate? A. Continue as planned, because the level is within normal limits. B. Tell the patient to hold today's dose and return to the clinic. C. Consult the prescriber to recommend an increased dose. D. Have the patient call 911 and meet the patient in the emergency department.

A. Once a day ***A major cause of treatment failure in patients with chronic hypertension is lack of adherence to a prescribed regimen. To promote adherence, the dosing schedule should be as simple as possible, just once or twice daily dosing

The nurse reviews the medication treatment regimen for a patient with chronic hypertension. To promote optimal medication adherence, which frequency of drug dosing should the nurse advocate for this patient? A. Once a day B. Every 8 hours C. Four times a day D. Three times a day

B. The nurse should obtain a prescriber order to administer the phenytoin at 9:30 AM daily. ***Sucralfate can impede the absorption of phenytoin; therefore, a period of 2 hours should separate these drugs. The nurse should consult the prescriber for a time administration change. Based on this information, it is not appropriate to administer the drugs as ordered, switch the phenytoin to the IV form, or administer the phenytoin with the sucralfate.

The nurse reviews the patient's medication record and notes the following: sucralfate [Carafate] 1 gram orally four times daily before meals (7:30 AM, 11:30 AM, and 4:30 PM) and at bedtime (10:00 PM); phenytoin [Dilantin] 200 mg orally daily at 8:00 AM. Which modifications, if any, should be made to the medication regimen? A. The medications can be administered as ordered. B. The nurse should obtain a prescriber order to administer the phenytoin at 9:30 AM daily. C. The nurse should obtain a prescriber order for intravenous phenytoin to avoid a drug interaction. D. The nurse should administer the phenytoin with the 7:30 AM dose of sucralfate [Carafate], because this is more time efficient.

B. The pH of the stomach C. Form of drug preparation D. Presence of food in the stomach ***Because of multiple factors, the rate and extent of drug absorption following oral administration can be highly variable. Factors that can influence absorption include food in the gut, gastric and intestinal pH, solubility and stability of the drug, gastric emptying time, coadministration of other drugs, and special coatings on the drug preparation.

The nurse should be aware that which factors will affect the absorption of orally administered medications? Select all that apply. A. Time of day B. The pH of the stomach C. Form of drug preparation D. Presence of food in the stomach E. Patient position upon intake of medication

A. "You cannot mix this insulin with any other insulin in the same syringe." ***Insulin glargine [Lantus] is a long-acting insulin with a duration of action up to 24 hours. It should not be mixed with any other insulins. The insulin is not fast acting.

The nurse should include which statement when teaching a patient about insulin glargine [Lantus]? A. "You cannot mix this insulin with any other insulin in the same syringe." B. "You should inject this insulin just before meals because it is very fast acting." C. "You can mix this insulin with neutral protamine Hagedorn (NPH) insulin to enhance its effects." D. "The duration of action for this insulin is approximately 8 to 10 hours, so you will need to take it twice a day."

C. "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." D. "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." ***Acetaminophen [Tylenol] is used to treat fever and pain. It is not an antiinflammatory drug. The most serious side effect of acetaminophen therapy is liver failure; therefore, the healthcare provider should be notified if indications of jaundice are seen, such as yellowing of the skin or sclera. Acetaminophen therapy has no antiplatelet activity; therefore, it is not used to prevent heart attack or stroke. Routine use of acetaminophen may blunt the immune response to vaccines; therefore, it should be avoided as routine treatment for vaccine-associated fever and pain.

The nurse should include which statement(s) when teaching a patient about the use of acetaminophen [Tylenol]? Select all that apply. A. "Use of this drug can prevent heart attack and stroke." B. "The most common side effect of treatment with this drug is kidney failure." C. "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." D. "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." E. "Acetaminophen is a useful drug for the treatment of inflammation such as rheumatoid arthritis."

B. Hepatitis ***In 2002, the Food and Drug Administration (FDA) issued a consumer warning letter regarding the risk of liver toxicity with the use of kava. Therefore, the nurse should question and teach a patient with a history of hepatitis about this risk. Kava may actually prove beneficial to patients with anxiety, hypertension, or cardiovascular disease because its therapeutic action is the reduction of stress.

The nurse should question the use of kava in a patient with a history of which condition? A. Anxiety B. Hepatitis C. Hypertension D. Cardiovascular disease

B. Benzodiazepines ***Neuroleptics cause central nervous system depression that can be intensified with benzodiazepines.

The nurse should teach a patient who is prescribed a neuroleptic to avoid what other medications? A. Aspirin B. Benzodiazepines C. Antidiarrheal medications D. Non-steroidal anti-inflammatory drugs

B. The patient is walking with a staggering gait. D. The patient complains of double vision. E. The nurse observes rapid back-and-forth movement of the patient's eyes. ***Manifestations of phenytoin toxicity can occur when plasma levels are higher than 20 mcg/mL. Nystagmus (back-and-forth movement of the eyes) is a common indicator of toxicity, as are ataxia (staggering gait), diplopia (double vision), sedation, and cognitive impairment. Hirsutism (excess hair growth in unusual places) and gingival hyperplasia (swollen, tender, bleeding gums) are adverse effects of phenytoin.

The nurse suspects that a female patient is experiencing phenytoin toxicity if which manifestation is noted? (Select all that apply.) A. The patient complains of excessive facial hair growth. B. The patient is walking with a staggering gait. C. The patient's gums are swollen, tender, and bleed easily. D. The patient complains of double vision. E. The nurse observes rapid back-and-forth movement of the patient's eyes.

A. Regulation of gastric glands B. Regulation of bronchial glands C. Regulation of the blood vessels D. Regulation of muscles of the bronchi ***Functions of the ANS include regulation of the heart, gastric glands, bronchial glands, muscles of the bronchi, and the blood vessels.

The nurse teaches a group of student nurses the overall primary functions of the autonomic nervous system (ANS). Which of these are functions of the ANS? Select all that apply. A. Regulation of gastric glands B. Regulation of bronchial glands C. Regulation of the blood vessels D. Regulation of muscles of the bronchi E. Regulation of the skeletal muscle movement

B. Low-density lipoprotein (LDL) ***Cholesterol is the primary core lipid of low-density lipoproteins (LDLs), which are responsible for carrying cholesterol to tissues outside the liver. Of all the lipoproteins, LDLs are the most significant contributors to coronary atherosclerosis. When pharmacologic agents are used to lower cholesterol, the primary goal is to reduce elevated LDL levels.

The nurse understands that cholesterol is carried through the blood by lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis? A. Apolipoprotein B-100 B. Low-density lipoprotein (LDL) C. High-density lipoprotein (HDL) D. Very-low-density lipoprotein (VLDL)

D. oral anticoagulants ***Cimetidine may increase the blood levels of oral anticoagulants by reducing their metabolism in the liver and excretion.

The nurse understands that which drug or drug type may interact with the H2-receptor antagonist cimetidine? A. hormonal contraceptives B. antilipemic agents C. digoxin D. oral anticoagulants

C. "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." D. "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." ***Acetaminophen [Tylenol] is used to treat fever and pain. It is not an anti-inflammatory drug. The most serious side effect of acetaminophen therapy is liver failure; therefore, the healthcare provider should be notified if indications of jaundice are seen, such as yellowing of the skin or sclera. Acetaminophen therapy has no antiplatelet activity; therefore, it is not used to prevent heart attack or stroke. Routine use of acetaminophen may blunt the immune response to vaccines; therefore, it should be avoided as routine treatment for vaccine-associated fever and pain.

The nurse will include which statements when teaching a patient about the use of acetaminophen [Tylenol]? (Select all that apply.) A. "Acetaminophen is a useful drug for the treatment of inflammation, such as a rheumatoid arthritis." B. "The most common side effect of treatment with the drug is kidney failure." C. "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." D. "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." E. "Use of this drug can prevent heart attack and stroke."

A. Antacids ***Antacids do not act through receptors. Antacids neutralize gastric activity by direct chemical interaction with stomach acid.

The nursing student learns that not all drugs produce effects by binding to a receptor. Which drugs do not act through receptors? A. Antacids B. Analgesics C. Antihistamines D. Steroid hormones

C. prevention of gastric ulcers caused by long-term NSAIDs therapy

The only approved GI indication for Misoprostol is: A. GERD B. PUD C. prevention of gastric ulcers caused by long-term NSAIDs therapy D. prevention of gastric ulcers caused by chemotherapy

D. "Take the medication when you eat your meal or shortly after a meal." ***When the medication order says to administer a drug with food, it means to administer a drug with food or shortly after a meal. To administer a drug on an empty stomach means to administer it at least 1 hour before a meal or 2 hours after.

The patient asks what it means when a medication order says to administer a drug "with food." How will the nurse reply? A. "Take the medication before the meal." B. "Take the medication 2 hours after a meal." C. "Take the medication 1 hour before the meal." D. "Take the medication when you eat your meal or shortly after a meal."

C. Preparation before a colonoscopy ***Magnesium oxide/anhydrous citric acid/sodium picosulfate [Prepopik] is approved for preparation of colonoscopy in adults. Sodium picosulfate is a stimulant laxative and the magnesium oxide and citric acid combine to form magnesium citrate, an osmotic laxative. Prepopik is given in a split dose regimen. The first dose is taken the evening before the colonoscopy and the second dose the next morning prior to the procedure.

The patient has an order for magnesium oxide/anhydrous citric acid/sodium picosulfate [Prepopik] to be given in two doses. The nurse knows that this medication is used for which indication? A. Prevention of constipation B. Treatment of constipation C. Preparation before a colonoscopy D. Preparation before an abdominal surgery

A. "Inject this insulin with meals because it is very fast acting." ***Lispro is a fast-acting insulin and has an onset action of 15 to 30 minutes with a peak action of about 2 hours, not 8 to 10 hours. Because of its rapid onset, it is administered immediately before a meal or with meals to control the blood glucose rise after meals. Lispro insulin must be combined with an intermediate- or a long-acting insulin, not regular insulin (which also is a short-duration insulin), for glucose control between meals and at night. To achieve tight glycemic control, patients must combine different types of insulin based on their duration of action.

The patient has been prescribed lispro [Humalog] for treatment of type 1 diabetes mellitus. The nurse should give the patient which instruction? A. "Inject this insulin with meals because it is very fast acting." B. "This insulin needs to be mixed with regular insulin to enhance the effects." C. "To achieve tight glycemic control, this is the only type of insulin you'll need." D. "The duration of action for this insulin is about 8 to 10 hours, so you'll need a snack."

A. Garlic D. Ginger root E. Gingko biloba ***Garlic, ginger root, and gingko biloba can increase the risk of bleeding in patients receiving anticoagulants or antiplatelet drugs. Valerian and echinacea do not interfere with Coumadin therapy.

The patient is prescribed warfarin [Coumadin] to treat deep vein thrombosis. The nurse is teaching the patient about dietary supplements that have the potential to interfere with Coumadin therapy. What herbs should the nurse include in the teaching? Select all that apply. A. Garlic B. Valerian C. Echinacea D. Ginger root E. Gingko biloba

True

True or False: If a patient has used benzodiazepines consistently for a long period of time and suddenly stops, they will most likely experience withdrawal symptoms or a paradoxical response.

D. Antagonistic ***When the patient is known to have a morphine overdose, naloxone is known to have an antagonistic effect since each drug will cancel the effect of the other.

The patient received an overdose of morphine. Naloxone is given to block the narcotic response. What is the effect achieved when naloxone is administered known as? A. Additive B. Negative C. Synergistic D. Antagonistic

D. "Do you know what the tea is made of? We want to be sure that none of its ingredients will react poorly with your new medications." ***The nurse should be concerned about what is in the tea as this may interact with the medication. Patients may derive both psychologic and physical benefits from taking traditional remedies, but it is essential to ensure that the traditional remedies do not interfere with the action of the conventional medications the patient has been prescribed. Because patients may achieve health benefits or psychologic comfort from their traditional remedies, they should not be told that the remedies are forbidden or useless; however, they should be instructed not to continue the remedies until it has been determined that the remedies will not affect the action of the patient's conventional medications.

The patient tells the nurse, "I have brought along the tea that I drink every day. My family has been drinking this kind of tea for generations because it promotes good health and long life. I hope I can continue drinking this tea while I am on my new medications." What is the nurse's best response? A. "You should not use any kind of traditional remedy while you are taking this new medication." B. "If you have been drinking this tea every day, then you should continue drinking it to maintain your health." C. "Traditional remedies have no health benefits. You should stop drinking the tea; it's a waste of time and money." D. "Do you know what the tea is made of? We want to be sure that none of its ingredients will react poorly with your new medications."

B. Beta1 C. Nicotinic ***Beta1 receptors affect the heart by increasing the heart rate. Nicotinic receptors release epinephrine, which can increase heart rate. Alpha1 receptors are present on veins and on arterioles in many capillary beds. Activation of alpha1 receptors in blood vessels produces vasoconstriction, which can increase cardiac output and blood pressure, but not heart rate. Dopamine causes vasodilation, which decreases heart rate. Muscarinic receptors decrease heart rate.

The patient with a heart rate of 48 beats/min has been prescribed a medication to increase heart rate. The nurse recalls that which activated receptors can increase heart rate? Select all that apply. A. Alpha1 B. Beta1 C. Nicotinic D. Dopamine E. Muscarinic

True

True or False: SSRI's work by preventing reuptake of serotonin into presynaptic nerve terminals.

D. Analyze the patient's serum thyroid-stimulating hormone levels. ***Drug efficacy is assessed by monitoring the thyroid-stimulating hormone [1] [2] (TSH) levels. The nurse will also monitor other thyroid tests, if ordered, and will assess for symptom improvement. Anxiety and palpitations would indicate a hyperthyroid state, which could occur with drug accumulation or excess. The other items, while important, do not address monitoring for a euthyroid (normal) state.

The primary healthcare provider prescribes a thyroid replacement drug to a patient with hypothyroidism. How should the nurse monitor for return to a euthyroid state? A. Assess for anxiety and palpitations. B. Verify the medication history of patient and family. C. Evaluate the patient's knowledge of thyroid therapy. D. Analyze the patient's serum thyroid-stimulating hormone levels.

A. The patient has developed tolerance. ***Tolerance can be defined as a state in which a larger dose is required to produce the same response that could formerly be produced with a smaller dose. The provider did not switch drugs, just the dose so cross-tolerance cannot occur. Cross-tolerance exists among the opioid agonists (eg, oxycodone, methadone, fentanyl, codeine, and heroin). Accordingly, individuals tolerant to one of these agents will be tolerant to all the others. The patient has developed a tolerance so an overdose is unlikely. The provider did not stop the drug, so abstinence syndrome cannot occur. Abstinence syndrome will occur if drug use is abruptly stopped.

The provider has to increase the fentanyl dose for a patient who has been taking fentanyl long term to achieve pain relief. What will the nurse communicate to the oncoming shift? A. The patient has developed tolerance. B. The patient has developed cross-tolerance. C. The patient will probably experience an overdose. D. The patient will probably experience an abstinence syndrome.

B. Angiotensin II ***Angiotensin II is a potent vasoconstrictor. It participates in all the pathways regulated by the renin-angiotensin-aldosterone system. Angiotensin I is a precursor to angiotensin II; angiotensin III is formed by degradation of angiotensin II and is less potent. Renin catalyzes the conversion of angiotensinogen to angiotensin I.

The renin-angiotensin-aldosterone system plays an important role in maintaining blood pressure. Which compound in this system is most powerful at raising the blood pressure? A. Angiotensin I B. Angiotensin II C. Angiotensin III D. Renin

A. 2-3 weeks

To avoid the occurrence of serotonin syndrome, how long should patients wait when switching antidepressant meds? A. 2-3 weeks B. 6-8 weeks C. 48 hours D. 6 hours

A. Overdose of baclofen [Lioresal] ***Baclofen [Lioresal] is used for the treatment of muscle spasms. An overdose of baclofen would result in GABA and dominant cholinergic effects. Symptoms such as dizziness, nausea, and hypotension would be observed in patients as a result of an overdose of this medication. An overdose of neostigmine [Prostigmin] can cause a cholinergic reaction and result in symptoms of nausea, abdominal cramps, excessive salivation, and sweating. An overdose of orphenadrine citrate [Norflex] would cause excitement and severe confusion leading to coma and convulsions. An overdose of pyridostigmine bromide [Mestinon] would result in cholinergic crisis manifesting in symptoms such as extreme muscle weakness, sweating, and tearing.

Upon assessing a patient who is being treated for muscle spasms, the nurse finds that the patient has hypotension, dizziness, and nausea. What should the nurse infer as the reason for these complications in the patient? A. Overdose of baclofen [Lioresal] B. Overdose of neostigmine [Prostigmin] C. Overdose of orphenadrine citrate [Norflex] D. Overdose of pyridostigmine bromide [Mestinon]

B. Increased intake of vitamin E ***High-dose vitamin E inhibits platelet aggregation, which can promote bleeding. Biotin appears devoid of toxicity; subjects given large doses experienced no adverse effects. Decreased intake of folic acid and vitamin B12 can lead to anemia.

Upon completing the patient history, which finding will cause the nurse to monitor for bleeding? A. Increased intake of biotin B. Increased intake of vitamin E C. Decreased intake of folic acid D. Decreased intake of vitamin B12

B. Confusion, fever, muscle rigidity, and increase serum creatinine

What are some signs and symptoms of the rare, yet fatal and very serious, side effect of atypical antipsychotic called neuroletic malignant syndrome? A. Insomnia, muscular flaccidity, hyperactivity B. Confusion, fever, muscle rigidity, and increase serum creatinine C. Hypothermia and hyperkalemia D. Thrombocytopenia, anemia, fever

B. Odd facial and tongue movements (like lip smacking or puffing of cheeks)

What are symptoms of tardive dyskinesia? A. Shuffling gait B. Odd facial and tongue movements (like lip smacking or puffing of cheeks) C. An overall muscular rigidity; this is a medical emergency D. Contractures of the arms or legs

A. It is patient-centered. B. It states the expected change. C. It is acceptable to the patient. D. It identifies components for evaluation. ***An effective goal is patient-centered as it helps to involve the patient in the decision-making process. The patient goal should be realistic and state the expected change in the patient, which will also later help to evaluate the success of the goal. The goal should be acceptable to the patient so that the patient is willing to make efforts to improve. The goal should contain components that the nurse can evaluate such as patient behavior or attitude. The nurse formulates the nursing diagnoses during the nursing diagnosis stage of the nursing process.

What are the qualities of effective goal setting? Select all that apply. A. It is patient-centered. B. It states the expected change. C. It is acceptable to the patient. D. It identifies components for evaluation. E. It helps to formulate nursing diagnoses.

A. Cloudy

What color is NPH? A. Cloudy B. Clear / yellow C. Clear D. Amber

C. Dopamine melatonin, and serotonin

What do antipsychotics block in the brain? A. Dopamine, serotonin and the adrenergic receptors B. Melatonin C. Dopamine melatonin, and serotonin D. The adrenergic receptors

B. Muscle coordination/movements

What does dopamine affect / address in relation to antipsychotic meds? A. The sleep-wake cycle B. Muscle coordination/movements C. Water absorption / reabsorption D. Your pain threshold

A. Adrenal insufficiency B. Osteoporosis E. Cataracts ***Adverse effects of long-term glucocorticoid therapy include adrenal insufficiency, osteoporosis, hyperglycemia, hypokalemia, and cataracts.

What does the nurse identify as a possible adverse effect of long-term glucocorticoid therapy? (Select all that apply.) A. Adrenal insufficiency B. Osteoporosis C. Hypoglycemia D. Hyperkalemia E. Cataracts

B. Knowing pharmacology ***Knowledge of pharmacology will help the nurse to understand the action of the drug and the patient's response to the drug. The better the nurse's knowledge of pharmacology, the better he or she will be able to anticipate drug responses and not simply react to them after the fact. A nursing diagnosis helps the nurse to understand the patient's needs and plan effective interventions. Monitoring drug effects occurs after drug responses have already occurred. Patient-centered care aims to involve the patient in the care process but does not address anticipation of drug responses.

What helps the nurse to anticipate drug responses in a patient? A. Monitoring drug effects B. Knowing pharmacology C. Using a nursing diagnosis D. Providing patient-centered care

D. "There is a good chance that you will become seizure free on this one medication." ***About 70% of clients become seizure free on one medication. Most clients are on the medications for life. The client should not stop the medication as increased seizures can result. If a client has seizures while on a medication, then that medication can be decreased and another one tried. It does not mean they will always have seizures.

What information is essential to teach the client who will begin taking an antiepileptic drug? A. "You will most likely not be on this medication very long." B. "If you develop seizures while on this medication, you will always have seizures." C. "If you find you cannot tolerate the drug, stop it and call your healthcare provider." D. "There is a good chance that you will become seizure free on this one medication."

B. "Use birth control while on this medication." ***The nurse should tell the young woman to use birth control while on the medication as an increased incidence of fetal defects occurred in those who took phenytoin while pregnant.

What information should the nurse include in the care plan of a young woman who has been prescribed phenytoin [Dilantin]? A. "Take your blood pressure daily." B. "Use birth control while on this medication." C. "Do not take this medication with grapefruit juice." D. "If your weight increases, call your healthcare provider."

A. Hypertensive crisis

What is a major side effect of MAOI's? A. Hypertensive crisis B. Guillan-Barre Syndrome C. Hypoxia D. Ischemic bowel

D. The inability to rest or relax

What is akathisia (an extrapyramidal symptom)? A. Spasms of the facial muscles B. Shuffling gait C. Spasms of the back muscles D. The inability to rest or relax

C. constipation

What is an adverse effect of sucralfate? A. diarrhea B. infection C. constipation D. insomnia

A. They are more prone for suicide tendencies

What is an essential thing to remember when a patient is started on any antidepressant? A. They are more prone for suicide tendencies B. It drastically decreases their appetite C. If they notice worsening symptoms, it is okay to take an additional tablet prior to notifying the physician D. They may have severe periods of mania

C. Higher degree of selectivity ***Selectivity is one of the most desirable qualities a drug can have. Many neuropharmacologic drugs are highly selective, because the nervous system works through multiple receptors to regulate processes under its control.

What is the advantage of patients having multiple types of receptors to regulate bodily functions? A. Lower therapeutic index B. Improved maximal efficacy C. Higher degree of selectivity D. Reduction of side effects and toxicity

C. Protamine sulfate ***Protamine sulfate is an antidote to severe heparin overdose.

What is the antidote for heparin? A. Ferrous sulfate B. Atropine sulfate C. Protamine sulfate D. Magnesium sulfate

B. To validate and document patient data ***The main purpose of the assessment phase is to validate subjective and objective patient data and to document it. Important methods of data collection are the patient interview, medical and drug-use histories, the physical examination, observation of the patient, and laboratory tests. The planning phase involves setting goals for the patient's recovery. The nurse implements the appropriate nursing interventions during the implementation phase. The nurse evaluates the success of patient outcomes during the evaluation phase.

What is the main purpose of the assessment phase of the nursing process? A. To set goals for the patient's recovery B. To validate and document patient data C. To use appropriate nursing interventions D. To evaluate the success of patient outcomes

C. To determine if patient outcomes are met ***The main purpose of the evaluation phase of the nursing process is to determine the success of patient outcomes. The conclusions drawn during evaluation provide the basis for modifying nursing interventions and the drug regimen. The nurse may need to assess patient needs and revise the nursing interventions if patient outcomes are not met. The nurse analyzes the patient's symptoms during the nursing diagnosis phase. The nurse determines the best interventions for the patient during the planning phase. The nurse obtains objective data from the patient during the assessment phase.

What is the main purpose of the evaluation phase of the nursing process? A. To analyze the patient's symptoms B. To obtain objective data from the patient. C. To determine if patient outcomes are met D. To determine the best interventions for the patient

B. Sexual dysfunction

What is the main side effect of SSRI? A. Weight gain B. Sexual dysfunction C. Kidney failure D. Hypertensive crisis

C. Notify the healthcare provider of nausea, vomiting, and visual changes. ***Verapamil can raise digoxin blood serum levels, increasing the risk of digoxin toxicity. Symptoms of digoxin toxicity may include nausea, vomiting, and visual changes. Increase intake of oral fluids and high-fiber food to decrease the adverse effect of constipation. An apical pulse should be taken for a full minute prior to administering digoxin. Verapamil and digoxin can cause bradycardia not tachycardia.

What is the most appropriate nursing consideration for a patient who is prescribed verapamil [Calan] and digoxin [Lanoxin]? A. Restrict intake of oral fluids and high-fiber food. B. Take an apical pulse for 30 seconds before administration. C. Notify the healthcare provider of nausea, vomiting, and visual changes. D. Hold the medications if the heart rate is greater than 110 beats per minute.

D. Helicobacter pylori ***AKA H. pylori.

What is the most common cause of peptic ulcers? A. parasite's B. surgical C. food being digested D. Helicobacter pylori

C. To develop an individualized care plan ***The main purpose of formulating nursing diagnoses is to develop an individualized care plan. This is possible because the nursing diagnoses help the nurse to understand the chief concerns of the patient. The nurse validates the subjective patient data to formulate an accurate nursing diagnosis. The nurse organizes the patient data in a framework so that it is easily accessible to other healthcare members. The nurse assesses the patient's learning needs to evaluate the requirement for further learning.

What is the purpose of formulating nursing diagnoses? A. To organize data in a framework B. To validate subjective patient data C. To develop an individualized care plan D. To understand the patient's educational needs

A. NSAIDs

What is the second most common causes of peptic ulcers? A. NSAIDs B. H. pylori C. virus D. food being digested

B. -tidine ***Examples: Ranitidine, Famotidine, Cimetidine

What is the suffix for H2-receptor antagonists? A. -pril B. -tidine C. -olol D. -prazole

D. -prazole ***Examples: Omeprazole, Esomeprazole, Lansoprazole, Pantoprazole

What is the suffix for Proton Pump Inhibitors? A. -tidine B. -olol C. -pril D. -prazole

C. Pharmacodynamics ***Pharmacodynamics is the study of what drugs do to the body. Pharmacokinetics is the study of drug movement throughout the body. Pharmacotherapeutics is the use of drugs to diagnose, prevent, or treat disease or to prevent pregnancy. Pharmacology is the study of drugs in humans.

What is the term for the study of how drugs influence the body? A. Pharmacology B. Pharmacokinetics C. Pharmacodynamics D. Pharmacotherapeutics

B. Alprazolam [Xanax] ***The approved first-line choices are benzodiazepines, and alprazolam [Xanax] is a benzodiazepine. Trazodone and phenelzine are monoamine oxidase inhibitors (MAOIs). Amoxapine is a tricyclic antidepressant.

What medication would the nurse anticipate a provider prescribing for treatment of generalized anxiety disorder? A. Phenelzine [Nardil] B. Alprazolam [Xanax] C. Trazodone [Desyrel] D. Amoxapine [Asendin]

B. GABA

What neurotrasmitter to benzodiazepines intensify the action of? A. Melatonin B. GABA C. Endorphin D. Histamine

B. benzodiazipines or cogentin ***Signs of extrapyrdaminal syndrome: acute dystonia, akathisa (can stay still), pseudoparkinsonism syndrome (ridgid), tardive dyskinesia (rolling of tongue).

What should extrapyramidal syndrome be treated with? A. chlorpromazine B. benzodiazipines or cogentin C. lithium or phenytoin

C. Renal function ***As metformin [Glucophage] is excreted by the kidneys, it is necessary to assess the patient's renal function. If the patient's kidneys are not able to excrete the drug, it will accumulate in the patient's system, thereby causing lactic acidosis. One of the adverse effects of metformin [Glucophage] is weight loss, not weight gain. Headaches are not caused by metformin [Glucophage]. Cholesterol levels may be high in some diabetic patients but can be treated with medications and lifestyle changes.

What should the nurse assess in a patient who is prescribed metformin [Glucophage] for treatment of type 2 diabetes? A. Headache B. Weight gain C. Renal function D. Cholesterol level

A. Common side effects can be relieved by increasing fluid and fiber intake and sucking hard candy.

When teaching a patient about the use of tricyclic antidepressants, what will the nurse emphasize? A. Common side effects can be relieved by increasing fluid and fiber intake and sucking hard candy. B. The patient should notify the health care provider if therapeutic effects are not noted within 10 days. C. The drugs are often given with monoamine oxidase inhibitors (MAOIs) for synergistic effect. D. Dietary restrictions of beer and chocolate are needed to prevent a hypertensive crisis

C. "Wear sunblock and protective clothing when you are outdoors." D. "Check your pulse daily and report excessive slowing to your healthcare provider immediately." E. "Immediately notify your healthcare provider of shortness of breath, cough, or chest pain." ***Patients frequently experience photosensitivity reactions while taking amiodarone. To reduce this risk, patients should avoid sunlamps and wear sunblock and protective clothing when outdoors. Excessive slowing of the heart rate may indicate that the patient is experiencing sinus bradycardia or an AV block. Dyspnea, cough, and chest pain may indicate pulmonary toxicity. Grapefruit juice should be avoided, because it may increase amiodarone levels and thus the risk of toxicity. Gastrointestinal side effects of amiodarone can be reduced by taking the drug on a full stomach.

What should the nurse include in the discharge teaching for a patient prescribed amiodarone [Cordarone]? (Select all that apply.) A. "Take amiodarone with grapefruit juice." B. "Take the medication on an empty stomach." C. "Wear sunblock and protective clothing when you are outdoors." D. "Check your pulse daily and report excessive slowing to your healthcare provider immediately." E. "Immediately notify your healthcare provider of shortness of breath, cough, or chest pain."

A. "Do not chew or crush the tablet." ***Enteric-coated tablets disintegrate in the alkaline medium of the small intestine. Patients should be instructed not to chew or crush enteric-coated tablets because they will then be absorbed in the acidic medium of the stomach rather than in the small intestine. An enteric-coated tablet will not dissolve if it is placed under the tongue. The tablet must not be dissolved in water or milk to prevent alteration of the time and place of absorption. The patient should not eat a high-fat meal before taking the tablet because this will cause a delay in absorption.

What should the nurse teach a patient who is prescribed enteric-coated tablets? A. "Do not chew or crush the tablet." B. "Place the tablet under the tongue." C. "Dissolve the tablet in water or milk." D. "Eat a high-fat meal before taking the medication."

A. Planning nursing interventions to meet patient goals ***The nurse will understand the patient's chief concerns after formulating the nursing diagnosis. The nurse then proceeds to the planning phase during which the nurse plans interventions that will meet the patient goals. The nurse will implement nursing interventions for health promotion during the implementation phase. The implementation phase will also include patient teaching, which will optimize the patient's health status. The nurse will evaluate the effectiveness of the nursing interventions during the last phase of the nursing process.

What step of the nursing process occurs after the nurse formulates a nursing diagnosis from patient assessment data? A. Planning nursing interventions to meet patient goals B. Implementing nursing interventions for health promotion C. Evaluating the effectiveness of the nursing interventions D. Undertaking patient teaching to optimize patient health status

C. Drowsiness ***Morphine sulfate depresses the central nervous system, resulting in drowsiness. It also causes a decrease in gastrointestinal motility leading to constipation. Morphine sulfate can cause constipation, not increased bowel sounds. This effect is helpful in treating diarrhea. Morphine sulfate does not cause insomnia. It is an opioid and causes drowsiness.

When assessing a patient for adverse effects of morphine sulfate, which finding would a nurse expect? A. Diarrhea B. Insomnia C. Drowsiness D. Increased bowel sounds

A. Nausea C. Urinary retention D. Decreased peristalsis E. Delayed gastric emptying ***Morphine sulfate causes a decrease in gastrointestinal motility (delayed gastric emptying and decreased peristalsis). This leads to constipation, not diarrhea. Morphine can also cause urinary retention and nausea.

When assessing a patient for adverse effects related to morphine sulfate, which effects would the nurse expect to find? Select all that apply. A. Nausea B. Diarrhea C. Urinary retention D. Decreased peristalsis E. Delayed gastric emptying

A. Osteoporosis B. Moon face C. Glycosuria E. Mood swings ***Cushing's syndrome results from excess secretion of adrenocorticotropic hormone (ACTH), and these effects result in manifestations such as redistribution of fat to the face and belly, excess blood sugar, mood changes, and calcium loss from bone. Ketoacidosis does not occur.

When assessing a patient who has Cushing's syndrome, a nurse associates which clinical manifestations with this disorder? (Select all that apply.) A. Osteoporosis B. Moon face C. Glycosuria D. Ketonuria E. Mood swings

A. When SSRIs are taken with MAOI's and TCAs

When can Serotonin Syndrome occur? A. When SSRIs are taken with MAOI's and TCAs B. When SSRIs are taken with green leafy vegetables C. When SSRI's are taken on an empty stomach D. When SSRIs are suddenly stopped

B. After 5 hours

When do you need look for signs/symptoms of hypoglycemia after giving regular insulin? A. 1 hour later B. After 5 hours C. Within 15 minutes D. 24 hours later

A. Yogurt ***When taking monamine oxidase inhibitors (MAOIs), patients should avoid cheese, red wine, beer, liver, bananas, yogurt, and sausage.

When providing dietary teaching for a patient taking monamine oxidase inhibitors (MAOIs), the nurse should teach the patient to avoid which food? A. Yogurt B. Avocado C. Grapefruit D. Potato chips

A. "Do not stop the medication abruptly." ***The medication cannot be stopped abruptly as this can cause rebound hypertension. The medication should not be taken with an antacid as this may delay absorption. The patient is typically tired at the beginning of therapy and should not stop the medication. Using a hot tub or staying in hot water for long periods is not recommended.

When teaching a patient about the drug metoprolol, what information will the nurse include in the teaching plan? A. "Do not stop the medication abruptly." B. "Stop the medication if you feel tired." C. "If you have gastric upset, take the medication with an antacid." D. "Use a hot tub daily to help vasodilation so that the medication will work more effectively."

A. In the evening ***The liver produces the majority of cholesterol during the night. Thus, it is best to give HMG-CoA reductase inhibitors (statins), which work to decrease this synthesis, during the evening so that blood levels are highest coinciding with this production. Since this drug has a tendency to elevate the liver enzyme level, it may not be advisable to take the drug on an empty stomach. Since the liver produces the majority of cholesterol during the night, it is not ideal to give the drug during breakfast. An antacid is generally given to prevent stomach upset.

When will the nurse administer hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins)? A. In the evening B. With breakfast C. With an antacid D. On an empty stomach

A. Clear / regular

When you mix regular insulin and NPH, which do you draw up first? A. Clear / regular B. Cloudy / NPH

B. Cloudy / NPH

When you mix regular insulin and NPH, which do you draw up second? A. Clear / regular B. Cloudy / NPH

C. Hold the vitamin and consult the prescriber. ***Vitamin D is contraindicated in patients with hypercalcemia, a clinical manifestation of hyperparathyroidism. The prescriber should be consulted about the patient's most recent calcium level and clinical symptoms. Checking deep tendon reflexes, giving milk, and asking about NSAID use are unnecessary actions to take in the administration of vitamin D.

Which action should a nurse take when preparing to administer vitamin D to a patient diagnosed with hyperparathyroidism? A. Assess deep tendon reflexes. B. Give the vitamin with 8 ounces of milk. C. Hold the vitamin and consult the prescriber. D. Determine whether the patient takes nonsteroidal anti-inflammatory drugs (NSAIDs).

A. Eating aged cheese ***Eating foods high in tyramine, including aged cheese, can cause a hypertensive crisis in patients taking MAO inhibitors.

Which activity should the patient be cautioned to avoid while taking an monoamine oxidase inhibitor (MAOI)? A. Eating aged cheese B. Sunbathing at the pool C. Participating in a bowling league D. Smoking a low-nicotine cigarette

A. Break the tablet in half so it is easier to swallow. C. Allow the tablet to dissolve in water before administering it. D. Administer the tablet with sips of water 1 hour before meals. ***Sucralfate acts through a compound that is a sticky gel, which adheres to an ulcer crater, creating a barrier to back-diffusion. The drug is best taken on an empty stomach. The tablet form should not be crushed because crushing it could reduce the effectiveness of the drug. Sucralfate tablets are large and difficult to swallow but can be broken or dissolved in water prior to ingestion. Sucralfate acts under mildly acidic conditions; antacids raise the gastric pH above 4 and may interfere with the effects of sucralfate.

Which administration technique(s) would be appropriate when giving a sucralfate [Carafate] tablet to a patient with a duodenal ulcer? Select all that apply. A. Break the tablet in half so it is easier to swallow. B. Administer the tablet with an antacid for maximum benefit. C. Allow the tablet to dissolve in water before administering it. D. Administer the tablet with sips of water 1 hour before meals. E. Crush the tablet into a fine powder before mixing it with water.

D. It may take 1 to 2 weeks before you have any benefits from taking the medication. ***The effectiveness of lithium may not be evident until 1 to 2 weeks after the start of therapy. The patient should be taught to maintain adequate sodium intake and to avoid crash diets that affect physical and mental health. Lithium levels are maintained by taking the drug on a daily basis. The patient should be taught to take lithium with meals to decrease gastric irritation.

Which advice will the nurse include when teaching the patient about lithium therapy? A. Take the drug on an empty stomach. B. Eliminate all sodium from your diet. C. Stop taking the lithium when you feel better. D. It may take 1 to 2 weeks before you have any benefits from taking the medication.

A. Morphine [Duramorph] ***Morphine is a strong opioid agonist and as such has the highest likelihood of causing respiratory depression. Pentazocine, a partial agonist, and hydrocodone, a moderate to strong agonist, may cause respiratory depression, but they do not do so as often or as seriously as morphine. Nalmefene, an opioid antagonist, would be used to reverse respiratory depression with opioids.

Which agent is most likely to cause serious respiratory depression as a potential adverse reaction? A. Morphine [Duramorph] B. Pentazocine [Talwin] C. Hydrocodone [Lortab] D. Nalmefene [Revex]

B. Na HCO3

Which antacid is useful in the treatment of acidosis and elevated pH to promote excretion of acidic drugs after overdose? A. Ca carbonate B. Na HCO3 C. Al hydroxide D. Mg hyrdoxide

A. Reduction of LDLs B. Elevation of HDLs C. Stabilization of the plaque in coronary arteries D. Reduction of risk of cardiovascular events ***The statin drugs have many benefits, the most important being reduction of LDLs. They also promote an increase in HDLs, stabilization of atherosclerotic plaque, and reduced inflammation at the plaque site. Among other benefits, they also slow progression of coronary artery calcification. The statins reduce the overall risk of cardiovascular events. They can have serious adverse effects on the liver, but these are relatively rare.

Which are beneficial effects that can be derived from simvastatin [Zocor] and other drugs in this class? (Select all that apply.) A. Reduction of LDLs B. Elevation of HDLs C. Stabilization of the plaque in coronary arteries D. Reduction of risk of cardiovascular events E. Improvement of liver function

B. Beta blocker and ACE inhibitor ***Beta blockers and ACE inhibitors, as well as aldosterone antagonists, are the drug classes recommended for initial therapy of hypertension after an MI. Diuretics and calcium channel blockers are not part of initial therapy for hypertension after an MI.

Which classes of medications are prescribed as initial therapy for hypertension after a myocardial infarction (MI)? A. Diuretic and beta blocker B. Beta blocker and ACE inhibitor C. ACE inhibitor and calcium channel blocker D. Diuretic and calcium channel blocker

A. Lispro [Humalog] B. Aspart [NovoLog] C. Glulisine [Apidra] ***Lispro [Humalog], Aspart [NovoLog], and Glulisine [Apidra] are rapid-acting insulins that have an onset of action of 15 minutes. Regular insulin [Humulin R] is a short-acting insulin that has an onset of action of 30 to 60 minutes. Glargine [Lantus] is a long-acting insulin, which is dosed every 12 hours depending on the patient's glycemic response.

Which are rapid-acting insulins that can be administered to patients with diabetes mellitus? Select all that apply. A. Lispro [Humalog] B. Aspart [NovoLog] C. Glulisine [Apidra] D. Glargine [Lantus] E. Regular insulin [Humulin R]

C. Black, tarry stools ***Black, tarry stools may indicate bleeding higher up in the gastrointestinal tract. This is a serious side effect that requires immediate intervention. Headaches, nonproductive coughs, and palpitations are not usually side effects of NSAID therapy.

Which assessment finding in a patient taking nonsteroidal anti-inflammatory drugs (NSAIDs) requires immediate intervention? A. Headache B. Palpitations C. Black, tarry stools D. Nonproductive cough

D. Pain has decreased from a 6 to a 1 on a scale of 10. ***Prostaglandins are produced in response to activation of the arachidonic acid pathway. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen work by blocking cyclooxygenase, the enzyme responsible for conversion of arachidonic acid into prostaglandins. Decreasing the synthesis of prostaglandins results in decreased pain and inflammation. The length of the PTT, the bleeding time, and the increased extremity circulation are not therapeutic effects of the medication.

Which assessment finding indicates that the nonsteroidal anti-inflammatory drug has been effective? A. PTT is 100 seconds. B. Patient's bleeding time is prolonged. C. Patient has increased circulation to his legs. D. Pain has decreased from a 6 to a 1 on a scale of 10.

B. Pinpoint pupils ***Morphine sulfate is an opioid drug used for pain management. After administration of morphine sulfate, the nurse should assess the patient's pupillary reaction to light. Pinpoint pupils, when accompanied by decreased responsiveness and respiratory depression, may indicate an overdose of morphine sulfate. Overdose of morphine sulfate does not cause blood in the urine. Increased peristalsis is not a sign of morphine sulfate overdose. Constipation due to decreased peristalsis is an adverse effect associated with morphine sulfate. Administration of opioid drugs causes urinary retention. Therefore, increased urinary output is not observed in the patient.

Which assessment finding indicates that the patient has overdosed on morphine sulfate? A. Blood in urine B. Pinpoint pupils C. Increased peristalsis D. Increased urinary output

C. Blood pressure ***Hydralazine [Apresoline] is a vasodilator that causes arteriolar dilation, decreased resistance, and decreased blood pressure. Monitoring of the blood pressure and heart rate is the highest assessment priority.

Which assessment finding is most important for the nurse to obtain before administering hydralazine [Apresoline]? A. Capillary refill B. Homans' sign C. Blood pressure D. Peripheral pulses

C. Blood pressure ***Hydralazine is a vasodilator that causes arteriolar dilation, decreased resistance, and decreased blood pressure. Monitoring of the blood pressure and heart rate is the highest assessment priority.

Which assessment finding is most important for the nurse to obtain before administering hydralazine [Apresoline]? A. Peripheral pulses B. Homans' sign C. Blood pressure D. Capillary refill

D. Respiratory rate ***The most serious side effect of narcotic analgesics is respiratory depression. This is the priority for the nurse to monitor. The other assessments should also be made; however, a decrease in respiratory rate is the highest priority for the nurse to address.

Which assessment is most important for the nurse to monitor in a patient receiving an opioid analgesic? A. Heart rate B. Mental status C. Blood pressure D. Respiratory rate

A. Pulse ***It is crucial to measure the patient's pulse before administering digoxin because digoxin causes a decrease in heart rate. In fact, if the heart rate is below 60, digoxin cannot be given. Respiratory rate is not a priority before administration of digoxin because it does not cause respiratory depression. Blood pressure is not as important as pulse because digoxin increases the strength of cardiac contractions. Weight in kilograms is not necessary before administering digoxin.

Which assessment is most important for the nurse to obtain prior to administering digoxin to a patient with heart failure? A. Pulse B. Blood pressure C. Respiratory rate D. Weight in kilograms

D. Takes with grapefruit juice ***If the patient consumes grapefruit juice, it can raise the levels of diltiazem [Cardizem] and verapamil [Calan]. The other drinks (tea, apple juice, lemonade) can be used by the patient when taking diltiazem [Calan] as they have no significant interaction.

Which behavior by a patient indicates more teaching is needed about taking diltiazem [Cardizem]? A. Takes with tea B. Takes with lemonade C. Takes with apple juice D. Takes with grapefruit juice

A. lorazepam ***Benzodiazepines used to treat anziety include lorazepam, alprazolam, chlordiazepoxide, hydrochloride, clonazepam, clorazepate dipotassium, diazepam, halazepam, and oxazepam.

Which benzodiazepine is used primarily to treat anxiety? A. lorazepam B. estazolam C. triazolam D. flurazepam

B. Rivastigmine [Exelon] ***All these drugs have the potential to cause GI distress, including nausea, vomiting, anorexia, and weight loss. Rivastigmine is thought to have the highest probability of producing these effects. Memantine (NMDA) is not a cholinesterase inhibitor.

Which cholinesterase inhibitor has the highest incidence of adverse gastrointestinal (GI) effects? A. Donepezil [Aricept] B. Rivastigmine [Exelon] C. Galantamine [Reminyl] D. Memantine [NMDA]

D. H2-receptor antagonists ***This class of meds promotes healing by suppressing secretion of gastric acid.

Which class of antiulcer drugs are the first-choice drugs in the treatment of gastric and duodenal ulcers? A. antacids B. PPIs C. NSAIDs D. H2-receptor antagonists

D. Proton pump inhibitors

Which class of drugs is the most effective for suppressing secretion of gastric acid? A. Beta blockers B. H2-receptor blockers C. Antacids D. Proton pump inhibitors

A. bulk-forming

Which class of laxatives is preferred? A. bulk-forming B. surfactant C. osmotic D. stimulant

D. Increased bronchial secretion ***By preventing the breakdown of acetylcholine by cholinesterase, cholinesterase inhibitors increase muscarinic receptor activation. This causes an increase in secretions from the pulmonary system. Muscarinic stimulation also causes contraction of smooth muscle in the bronchi, increases bladder tone (but relaxes urinary sphincters promoting urination), and slows the heart rate.

Which clinical indicators should the nurse monitor when a patient takes a cholinesterase inhibitor? A. Urinary retention B. Increased heart rate C. Decreased gastric secretion D. Increased bronchial secretion

D. "If I develop a chronic cough, I need to notify my provider." ***A patient on therapy with an angiotensin-converting enzyme (ACE) inhibitor such as enalapril should report a nonproductive chronic cough, as this is a potential side effect. There is no treatment other than to change the medication therapy. The patient should not double the dose of an antihypertensive. Ringing in the ears in not a concern for ACE inhibitors and the patient need not avoid the sun.

Which comment by a patient indicates correct understanding about the use of enalapril? A. "If I feel tired, I should double the dose." B. "I cannot go out in the sun while on this therapy." C. "I should stop the drug if I have ringing in my ears." D. "If I develop a chronic cough, I need to notify my provider."

B. Intranasal C. Intraocular D. Transdermal ***Drugs administered through intranasal, intraocular, and transdermal routes circumvent first-pass metabolism because they are absorbed and distributed before they go to the liver for metabolism. First-pass metabolism occurs when drugs first go to the liver and much of the dose is metabolized before being absorbed into the systemic circulation and distributed to the site of action. Drugs administered orally or via a nasogastric tube are subjected to first-pass metabolism.

Which drug administration routes avoid first-pass metabolism in the liver? Select all that apply. A. Oral B. Intranasal C. Intraocular D. Transdermal E. Nastrogastric tube

C. Fluoxetine [Prozac] E. Sertraline [Zoloft] ***Fluoxetine [Prozac] and sertraline [Zoloft] are selective serotonin reuptake inhibitors. Bupropion [Wellbutrin] is an atypical antidepressant. Imipramine [Tofranil] is a tricyclic antidepressant. Desvenlafaxine [Pristiq] is a serotonin/norepinephrine reuptake inhibitor (SNRI).

Which drug does the nurse identify as a selective serotonin reuptake inhibitor? (Select all that apply.) A. Bupropion [Wellbutrin] B. Imipramine [Tofranil] C. Fluoxetine [Prozac] D. Desvenlafaxine [Pristiq] E. Sertraline [Zoloft]

D. Beta-adrenergic blocker ***Beta-adrenergic blockers block the initial sympathetic response to hypoglycemia; therefore, the patient may not exhibit the initial symptoms of nervousness, diaphoresis, and sweating that typically alert the patient to the onset of hypoglycemia. Aspirin increases glucose tolerance by stimulating insulin secretion. Thiazide diuretics worsen insulin sensitivity. There are no known interactions of codeine and insulin.

Which drug interacts with insulin and increases the risk for unrecognized hypoglycemia in a patient? A. Aspirin B. Codeine C. Thiazide diuretics D. Beta-adrenergic blocker

D. thiazide diuretics ***Hyperglycemia may occur if glyburide is taken with a thiazide diuretic.

Which drug or drug type would likely cause hyperglycemia if taken with glyburide? A. procainamide B. cimetidine C. warfarin D. thiazide diuretics

A. Weak acid drugs B. Lipid-soluble drugs E. Large nonionized particles ***Weak acid drugs, such as aspirin, pass through the gastric membrane, as they are less ionized in the gastric acid of the stomach. Lipid-soluble drugs pass through the gastric membrane easily because the membrane is mainly composed of lipids and proteins. Large nonionized particles do not have a positive or negative charge and can pass through the membrane. Water-soluble drugs pass through the membrane only if they bind with a carrier, which may be an enzyme or protein. It is difficult for large ionized particles to pass through the membrane.

Which drugs are absorbed quickly across the gastric membranes? Select all that apply. A. Weak acid drugs B. Lipid-soluble drugs C. Water-soluble drugs D. Large ionized particles E. Large nonionized particles

B. Tremor C. Irritability D. Sweating E. Confusion ***Early symptoms of hypoglycemia involve the central nervous system, as the brain needs a constant supply of glucose to function. Hence confusion, irritability, tremors, and sweating are symptoms seen in patients. When these symptoms occur, the family should have the patient immediately ingest a fast-acting carbohydrate source such as glucagon, milk, or juice. Coma occurs if the patient's glucose levels are not restored.

Which early symptoms of hypoglycemia should the nurse instruct a patient's family to treat with a fast-acting carbohydrate source? Select all that apply. A. Coma B. Tremor C. Irritability D. Sweating E. Confusion

D. Monoamine oxidase enzyme

Which enzyme in the brain do MAOI's inhibit? A. Protease B. Acetylcholinerterase C. Catalase D. Monoamine oxidase enzyme

B. Relief of chronic pain is best obtained by administering analgesics around the clock. ***Studies have demonstrated that for chronic pain such as pain due to cancer, analgesics administered around-the-clock rather than on an as-needed basis provide the optimal pain relief. Narcotic analgesics have a potential for addiction, but pain management is more important. A rating of 3 on the pain scale indicates effective pain relief.

Which factor will the nurse consider while planning pharmacologic therapy for a patient with pain? A. Analgesics should be administered as needed to minimize adverse effects. B. Relief of chronic pain is best obtained by administering analgesics around the clock. C. Patients should request analgesics when the pain level reaches a 3 on a scale of 1 to 10. D. Narcotic analgesics should not be used for more than 24 hours because of the risk of addiction.

B. Excessive bruising ***Levothyroxine intensifies the effect of warfarin, an anticoagulant that increases the patient's risk for bleeding. The warfarin dose may need to be reduced. Bruising, weight loss, and shortness of breath are not effects associated with interactions of levothyroxine and warfarin.

Which finding in a patient taking levothyroxine [Synthroid] and warfarin [Coumadin] would require follow-up by a nurse? A. Cardiac dysrhythmias B. Excessive bruising C. Weight loss of 5 kg D. Shortness of breath

A. Excessive bruising ***Levothyroxine intensifies the effect of warfarin, an anticoagulant that increases the patient's risk for bleeding. The warfarin dose may need to be reduced if there is excessive bruising. Cardiac dysrhythmias, weight loss, and shortness of breath are not effects associated with interactions of levothyroxine and warfarin.

Which finding in a patient taking levothyroxine [Synthroid] and warfarin [Coumadin] would require follow-up by a nurse? A. Excessive bruising B. Weight loss of 5 kg C. Shortness of breath D. Cardiac dysrhythmias

A. Cheese ***Certain foods can interact with MAO inhibitors and produce serve reactions. The most serious reactions involve tyamine-rich foods, such as red wine, aged cheese, smoked meats, and fave beans.

Which food should the patient taking an MAO inhibitor avoid? A. Cheese B. Apples C. Carrots D. Beer

A. Hypersecretion of parietal cells ***Hydrochloric acid, which is necessary for digestion, is secreted by the parietal cells lining the stomach. Hypersecretion of these cells causes acidity or more severe disorders. Inhibition of the proton pump reduces the hypersecretion of acid. Proteolytic enzymes such as pepsinogen, which is activated by hydrochloric acid, are secreted by the chief cells of the stomach and are responsible for the cleaving of proteins. Acetylcholine receptors also mediate the proton pump, and inhibition of these receptors helps to prevent the effects caused by a highly acidic environment.

Which increases the concentration of gastric acids? A. Hypersecretion of parietal cells B. Inhibition of proton pump activity C. Inhibition of acetylcholine receptors D. Hypersecretion of proteolytic enzymes

B. I will need to take this for the rest of my life. ***For treatment to be effective, medication must be taken lifelong. It is difficult to convince people who are feeling good to take drugs that may make them feel worse. Some people may decide that exposing themselves to the negative effects of therapy today is paying too high a price to avoid the adverse consequences of hypertension at some indefinite time in the future. Patients must understand that drugs do not cure hypertension—they only control symptoms.

Which information from the patient will most likely promote adherence to the medication regimen? A. I feel good even without my medication. B. I will need to take this for the rest of my life. C. I can take these drugs to cure my hypertension. D. I hope this will prevent complications in the future.

C. "Do not take your metformin on the day of the test." ***Angiography uses iodinated (iodine-containing) radiologic contrast media, which interact with metformin [Glucophage] and may cause acute renal failure or lactic acidosis. Hence, the nurse should instruct the patient to discontinue the drug on the day of the test. To prevent any adverse effects, metformin [Glucophage] can be taken 48 hours after the test. Chances of renal failure after the test only occur if metformin is taken during the test. Blood glucose levels are regularly evaluated in diabetic patients, but it is not a priority in this case.

Which instruction should the nurse give when a patient receiving metformin [Glucophage] therapy will undergo angiography? A. "There are chances of renal failure after the test." B. "Your blood glucose levels need to be reevaluated." C. "Do not take your metformin on the day of the test." D. "You can take the medication an hour after the test."

A. "Take the medication with a glass of grapefruit juice each morning." ***Grapefruit juice can inhibit the metabolism of carbamazepine, possibly leading to increased plasma drug levels; therefore, it should be avoided. Carbamazepine can inhibit renal excretion of water by promoting increased secretion of antidiuretic hormone. Weight gain and swollen extremities can be a sign of water retention and should be reported to the physician. Nausea, vomiting, and indigestion are common adverse effects of valproic acid, and the patient should be made aware of them. Liver function studies are monitored for patients taking valproic acid because of the risk of liver toxicity.

Which instruction would be inappropriate to include in the teaching plan for a patient being started on carbamazepine [Tegretol]? A. "Take the medication with a glass of grapefruit juice each morning." B. "Notify the physician if you are gaining weight or your legs are swollen." C. "Nausea, vomiting, and indigestion are common side effects of carbamazepine." D. "Have liver function tests performed on a routine basis."

A. Weigh yourself daily at the same time each day. C. Notify the healthcare provider if a skin rash develops. E. Rise slowly from a lying to a sitting position. ***An adverse effect of diltiazem is heart failure. Daily weighing monitors for signs of fluid retention, which may indicate cardiac dysfunction. Chronic eczematous rash may occur, especially in older patients. Orthostatic hypotension is an adverse effect; patients must be taught to rise slowly from lying to sitting positions. Diltiazem causes vasodilation, which can cause dizziness or headache. Daily calcium supplements do not affect the action of diltiazem.

Which instructions should the nurse include when developing a teaching plan for a patient prescribed diltiazem [Cardizem] for atrial fibrillation? (Select all that apply.) A. Weigh yourself daily at the same time each day. B. The medication will not cause dizziness or headache. C. Notify the healthcare provider if a skin rash develops. D. Do not take daily oral calcium supplements. E. Rise slowly from a lying to a sitting position.

C. Administering it by slow IV push ***The priority is to administer Dilantin slowly to prevent irritation to veins. Monitoring side effects, flushing the tubing, and monitoring serum drug levels are all interventions that are done after administering the drug. The priority is the first intervention, which is proper administration of the medication.

Which intervention is a priority in the administration of intravenous (IV) Dilantin therapy? A. Monitoring for side effects B. Monitoring serum drug levels C. Administering it by slow IV push D. Flushing the tubing after administration

D. Distribution rates among various body systems ***Pharmacokinetics involves how the drug moves through the body, including absorption, distribution, metabolism, and excretion.

Which is included in the study of pharmacokinetics? A. Interactions among various drugs B. Adverse reactions to medications C. Physiologic effects of drugs on the body D. Distribution rates among various body systems

B. Hypotension

Which is not a symptom of serotonin syndrome? A. Confusion B. Hypotension C. Tremors D. Anxiety

D. Parenteral formulation improves adherence for acutely psychotic patients. ***The primary benefit of administering a parenteral form of an antipsychotic agent is that patient adherence to therapy improves because fewer doses are required to achieve therapeutic effectiveness. It is very effective when used for acutely psychotic patients. Parenteral antipsychotic agents are long-acting medications. Route of administration does not have much effect on the drug's effectiveness or duration of action.

Which is the most important benefit of a parenteral formulation of an antipsychotic medication? A. Patient consent for treatment is avoided. B. Parenteral administration is faster than oral administration. C. Parenteral formulation is more effective than oral formulations. D. Parenteral formulation improves adherence for acutely psychotic patients.

B. Administer intravenous glucose. ***This patient is showing signs of hypoglycemia. In the hospital setting or when the patient is unconscious, intravenous glucose is an obvious option to treat hypoglycemia.

Which is the nurse's best action when finding a patient with type 1 diabetes mellitus unresponsive, cold, and clammy? A. Start an insulin drip. B. Administer intravenous glucose. C. Draw blood glucose level and send to the laboratory. D. Administer subcutaneous regular insulin immediately.

C. Serum electrolytes ***Serum sodium levels need to be monitored in patients taking lithium. Lithium tends to deplete sodium. Lithium must be used with caution, if at all, by patients taking diuretics.

Which laboratory test is most important for the nurse to monitor when a patient is receiving lithium (Lithobid)? A. Urinalysis B. Serum glucose C. Serum electrolytes D. Complete blood count

B. "Reduce the amount of alcohol you consume." D. "Incorporate daily physical exercise into your life." E. "Decrease the amount of carbohydrates in your diet." ***Alcohol is limited because it is broken down into simple carbohydrates and can elevate the patient's blood glucose levels. The patient should perform physical exercises every day to help lower glucose levels. The nurse should advise the patient to decrease the amount of carbohydrates in the diet to lower blood glucose levels. Potassium and sodium are restricted in cardiac patients. Adequate rest is required for respiratory patients to prevent respiratory complications due to physical activity.

Which lifestyle changes should the nurse instruct a patient to implement in order to successfully manage diabetes mellitus? Select all that apply. A. "Restrict potassium and sodium in your diet." B. "Reduce the amount of alcohol you consume." C. "Include rest periods between physical activities." D. "Incorporate daily physical exercise into your life." E. "Decrease the amount of carbohydrates in your diet."

A. Insulin glargine [Lantus] ***Insulin glargine [Lantus] has a duration of action of 24 hours with no peaks, mimicking natural, basal insulin secretion by the pancreas. Insulin aspart [NovoLog] is a rapid-acting human insulin analog used to lower blood glucose, which has a different dosage. Regular insulin [Humulin R] has its duration of action of 6 to 10 hours, with a peak plasma concentration of 2.5 hours. Ultralente insulin [Humulin U] has an active duration of 28 hours.

Which long-acting insulin mimics natural, basal insulin with its duration of 24 hours? A. Insulin glargine [Lantus] B. Insulin aspart [NovoLog] C. Regular insulin [Humulin R] D. Ultralente insulin [Humulin U]

B. Unstable body temperature ***One function of the hypothalamus is the regulation of body temperature, and a tumor that compresses the hypothalamus would impair this function. Regulation of mood swings, respiratory rate, and heart rate are not functions of the hypothalamus.

Which manifestation would the nurse most clearly associate with a tumor of the hypothalamus? A. Mood swings B. Unstable body temperature C. Irregular respirations D. Increased heart rate

A. Tachycardia ***High doses of levothyroxine may cause thyrotoxicosis, a condition of profound excessive thyroid activity. Tachycardia is the priority assessment, because it can lead to severe cardiac dysfunction. Tremors, insomnia, and irritability are other symptoms of thyrotoxicosis and should be assessed after tachycardia.

Which manifestations should a nurse investigate first when monitoring a patient who is taking levothyroxine [Synthroid]? A. Tachycardia B. Tremors C. Insomnia D. Irritability

D. Diltiazem [Cardizem] ***Nifedipine, amlodipine, and isradipine, which are dihydropyridine calcium channel blockers, cause less risk of constipation than diltiazem and verapamil.

Which medication is most likely to cause the side effect of constipation? A. Nifedipine [Adalat] B. Amlodipine [Norvasc] C. Isradipine [DynaCirc] D. Diltiazem [Cardizem]

D. Sucralfate

Which medication is used to promote gastric ulcer healing by providing a protective barrier? A. Cimetidine B. Misoprostol C. Omeprazole D. Sucralfate

A. Naloxone [Narcan] ***Naloxone is the opioid antagonist that will reverse the effects, both adverse and therapeutic, of opioid analgesics. Acetylcysteine is the antidote for acetaminophen overdose. Methylprednisolone is a glucocorticoid that is used as an antiinflammatory. Flumazenil, a benzodiazepine antidote, can be used to acutely reverse the sedative effects of benzodiazepines.

Which medication is used to reverse life-threatening complications caused by an opioid analgesic? A. Naloxone [Narcan] B. Flumazenil [Romazicon] C. Acetylcysteine [Mucomyst] D. Methylprednisolone [Solu-Medrol]

C. Lorazepam [Ativan] 0.1 mg/kg IV at a rate of 2 mg/min ***Intravenous benzodiazepines, such as lorazepam or diazepam, are used for abrupt termination of convulsive seizure activity. Lorazepam is preferred over diazepam because of its longer effects. Once seizures have been stopped with a benzodiazepine, phenytoin may be administered for long-term suppression. Phenytoin and valproic acid are not benzodiazepines.

Which medication should the nurse anticipate administering to a patient in convulsive status epilepticus to halt seizure activity? A. Phenytoin [Dilantin] 200 mg IV over 4 minutes B. Phenobarbital 30 mg IM C. Lorazepam [Ativan] 0.1 mg/kg IV at a rate of 2 mg/min D. Valproic acid [Depacon] 250 mg in 100 mL of normal saline infused IV over 60 minutes

C. Norepinephrine and serotonin

Which neurotransmitter(s) do tricyclic antidepressants prevent reuptake of? A. Histamine B. Melatonin C. Norepinephrine and serotonin D. Epinephrine

A. Risk for falls ***First-generation antipsychotic agents commonly produce sedation in the early days of treatment. This can pose a risk for the older adult. In addition, these agents can cause orthostatic hypotension, further increasing the risk for falls. The nurse should teach the patient to rise slowly and to be careful of these effects.

Which nursing diagnosis has the highest priority for an older adult patient who has received a first-generation antipsychotic? A. Risk for falls B. Risk for infection C. Risk for acute confusion D. Sleep pattern disturbance

B. donepezil C. memantine D. galantamine E. rivastigmine

Which of the following are Alzheimer's drugs? Select all that apply. A. hydrocoritsone B. donepezil C. memantine D. galantamine E. rivastigmine

A. milk of magnesia C. miralax

Which of the following are examples of osmotic laxatives? Select all that apply. A. milk of magnesia B. Bisacodyl [Dulcolax] C. miralax D. docusate sodium

A. Attention deficit hyperactivity disorder

Which of the following is NOT an indication for benzodiazepines? A. Attention deficit hyperactivity disorder B. Anxiety C. Alcohol withdrawal D. Seizures

C. bisacodyl [dulcolax] ***Works in 6-12 hours if given my mouth. As a suppository, can work within minutes. Stimulates peristalsis and increases water and electrolyte absorption in GI tract.

Which of the following is an example of a stimulant laxative? A. milk of magnesia B. lactulose C. bisacodyl [dulcolax] D. docusate sodium

D. hydrocoritsone E. fludrocortisone

Which of the following is given during adrenal insufficiency? Select all that apply. A. calcitonin B. levothyroxine C. vitamin D D. hydrocoritsone E. fludrocortisone

A. calcitonin ***Calcitonin is a hormone that decreases plasma levels of Ca+.

Which of the following is given during hyperparathyroidism? A. calcitonin B. levothyroxine C. vitamin D D. hydrocoritsone E. fludrocortisone

C. vitamin D ***Vitamin D is a hormone that increases plasma Ca+ levels.

Which of the following is given during hypoparathyroidism? A. calcitonin B. levothyroxine C. vitamin D D. hydrocoritsone E. fludrocortisone

B. levothyroxine ***But side effects look like hyperthyroidism.

Which of the following is given during hypothyroidism? A. calcitonin B. levothyroxine C. vitamin D D. hydrocoritsone E. fludrocortisone

C. None

Which other insulin can you mix glargine with? A. NPH B. Levamir C. None D. Novolin R / Regular

B. Absence of chest pain ***Calcium channel blockers (CCBs) are given for angina, so an absence of chest pain is a therapeutic effect as is decreased blood pressure and dysrhythmias. Dizziness may be a side effect of the medication. Decreased swelling is not a therapeutic effect of CCBs; in fact, some may cause peripheral edema. Eczematous eruptions are an adverse effect of CCBs in older patients.

Which patient assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker (CCB)? A. Absence of dizziness B. Absence of chest pain C. Decreased swelling in the ankles D. Decreased eczematous eruptions

C. Patient taking oral contraceptives to prevent pregnancy ***Oral contraceptives decrease the effects of warfarin; therefore, warfarin doses may need to be increased. Acetaminophen and cimetidine increase the effects of warfarin. Prednisone increases the risk of bleeding.

Which patient does the nurse identify as most likely needing an increased dose of warfarin [Coumadin] to have the same anticoagulant effect? A. Patient taking acetaminophen [Tylenol] for back pain B. Patient taking cimetidine [Tagamet] to prevent gastric ulcers C. Patient taking oral contraceptives to prevent pregnancy D. Patient taking prednisone [Deltasone] for rheumatoid arthritis

B. The patient with an elevated creatinine level ***Losartan [Cozaar] has been shown to be beneficial in patients with hypertension and heart failure. Patients with renal or hepatic dysfunction should be assessed carefully due to the potential for toxicity and increased side effects. An elevated creatinine level is an indication of renal dysfunction. The other findings are not.

Which patient receiving losartan [Cozaar] should be monitored closely while receiving this therapy? A. The patient with constipation B. The patient with an elevated creatinine level C. The patient with a heart rate of 90 beats/min D. The patient with a potassium level of 3.4 mEq/L

A. Fatigue B. Vomiting D. Blurred vision ***Fatigue, vomiting, and blurred vision are common noncardiac symptoms that can provide advance warning of digoxin toxicity. Muscle weakness is an early sign of hypokalemia. Constipation is not a symptom of digoxin toxicity.

Which patient symptoms should alert the nurse to be concerned about digoxin [Lanoxin] toxicity? Select all that apply. A. Fatigue B. Vomiting C. Constipation D. Blurred vision E. Muscle weakness

A. Fatigue B. Vomiting D. Blurred vision ***Fatigue, vomiting, and blurred vision are common noncardiac symptoms that can provide advance warning of digoxin toxicity. Muscle weakness is an early sign of hypokalemia. Dizziness is not a symptom of digoxin toxicity.

Which patient symptoms should cause the nurse to be concerned about digoxin [Lanoxin] toxicity? (Select all that apply.) A. Fatigue B. Vomiting C. Dizziness D. Blurred vision E. Muscle weakness

A. Hallucinations C. Restless activity D. Chaotic thinking E. Defective insight ***Positive symptoms of schizophrenia include psychotic behaviors such as hallucinations. They also include conceptual disorganization such as chaotic thinking and poor insight. Agitation or restless activity is also a positive symptom. Negative symptoms include catatonia characterized by agitation and muscle rigidity and social withdrawal.

Which phenomena should the nurse recognize as positive symptoms of schizophrenia? Select all that apply. A. Hallucinations B. Muscle rigidity C. Restless activity D. Chaotic thinking E. Defective insight F. Social withdrawal

D. An effect that mimics the natural neurotransmitter for that receptor ***Receptor activation is an effect on receptor function equivalent to that produced by the natural neurotransmitter at a particular synapse. Activation of a receptor may slow down or speed up the process, depending on the function of that particular receptor. Activation does not have to do with improving receptor function or sensitivity.

Which phrase best describes activation of a receptor? A. An effect that improves the function of the receptor B. An effect that causes the receptor to be more sensitive C. An effect that causes the physiologic process to speed up D. An effect that mimics the natural neurotransmitter for that receptor

D. A calcium channel blocker (CCB) to an African American patient with hypertension ***CCBs and alpha and beta blockers are also effective in African American patients. In contrast, monotherapy with beta blockers or angiotensin-converting enzyme (ACE) inhibitors is less effective in blacks than in whites. Drugs recommended for treatment of hypertension in children 1 to 18 years old include ACE inhibitors, diuretics, beta blockers, and calcium channel blockers (not centrally acting alpha2 agonist or adrenergic neuron blockers).

Which prescription will the nurse administer to provide the most safe and effective care to patients with hypertension? A. An adrenergic neuron blocker to a 16-year-old with hypertension B. A beta blocker to an African American patient with hypertension C. A centrally acting alpha2 agonist to a 16-year-old with hypertension D. A calcium channel blocker (CCB) to an African American patient with hypertension

D. Parenteral thiamine to a patient with suspected Wernicke-Korsakoff syndrome ***If Wernicke-Korsakoff syndrome (thiamine deficiency) is suspected, parenteral thiamine should be administered immediately. Taking high-dose folic acid to reduce cancer risk is ineffective and should be discouraged. High doses of beta-carotene (vitamin A) were associated with an increase in lung cancer for smokers, and high doses of vitamin E were associated with an increase in prostate cancer and stroke.

Which prescription will the nurse recognize as appropriate? A. Parenteral vitamin E for a patient with prostate cancer B. Folate supplements orally to a patient for cancer prevention C. Vitamin A supplements orally to a patient who smokes three packs a day D. Parenteral thiamine to a patient with suspected Wernicke-Korsakoff syndrome

A. Do you use any herbal supplements during the day? B. How many alcoholic drinks do you consume in a day? E. How often do you take over-the-counter products for common ailments? ***When eliciting a patient's drug history, the nurse should ask questions related to the use of herbal supplements, alcohol, and over-the-counter (OTC) drugs. Asking questions about herbal supplements helps the nurse to know whether the patient needs to change any current drugs or whether any teaching is needed for safe use. All can cause interactions with selected drugs. Alcohol may affect the metabolism of many OTC drugs and herbs; therefore, it is important to know whether the patient takes alcohol with these drugs. The frequency of OTC drugs is important to decide whether the patient is using them safely. Asking about family and friends and food preferences may not be helpful in describing the patient's use of OTC medications.

Which questions will a nurse ask in order to obtain information that is important for the medication history? Select all that apply. A. Do you use any herbal supplements during the day? B. How many alcoholic drinks do you consume in a day? C. What kind of food do you prefer to eat when dining out? D. How often do you visit your family members and friends? E. How often do you take over-the-counter products for common ailments?

A. Weight B. Lipid profile C. Fasting blood glucose ***Risperidone [Risperdal] can cause metabolic effects such as weight gain, diabetes, and dyslipidemia. The nurse should assess weight, blood glucose levels, and lipid levels.

Which should the nurse assess to determine whether a patient has metabolic effects from risperidone [Risperdal] therapy? Select all that apply. A. Weight B. Lipid profile C. Fasting blood glucose D. Complete blood count E. Kidney function studies

B. Abdomen ***The abdomen has the most consistent absorption capacity because muscular movements do not affect the blood flow to subcutaneous tissue as much. The deltoid is used for immunization of children and adults. The vastus lateralis is used for immunization of infants. The gluteus maximus is not recommended for injections because of its close proximity to the sciatic nerve and major blood vessels.

Which site should be used for injecting insulin for the most consistent absorption? A. Deltoid B. Abdomen C. Vastus lateralis D. Gluteus maximus

B. The drug should be discontinued slowly. ***When discontinuing TCAs such as amitriptyline (Elavil), the drug should be gradually decreased to avoid withdrawal symptoms such as nausea, vomiting, anxiety, and akathisia. TCAs are given at night to minimize problems caused by their sedative action. The onset of the antidepressant effect of amitriptyline is 1 to 4 weeks. Orthostatic hypotension is a common side effect of amitriptyline (Elavil).

Which statement about amitriptyline (Elavil) does the nurse identify as being true? A. The drug is administered first thing in the morning. B. The drug should be discontinued slowly. C. The onset of antidepressant effect is 48 hours. D. Hypertension is a frequent side effect of this drug.

C. "When I start to feel better, I will cut the dose of my medication in half." ***The drug should be taken exactly as ordered. Antipsychotics do not cure the mental illness but do alleviate symptoms. Compliance with drug regimen is extremely important.

Which statement by a patient indicates that more teaching on phenothiazine therapy for the treatment of psychosis is needed? A. "It might take 6 weeks or more for the drug to take effect." B. "I will get up slowly from a seated position." C. "When I start to feel better, I will cut the dose of my medication in half." D. "I will avoid exposure to direct sunlight."

C. "I will take the medication only when I need it." ***Oral hypoglycemic agents must be taken on a daily scheduled basis to maintain euglycemia and prevent long-term complications of diabetes. When alcohol is ingested with certain oral hypoglycemic drugs, the hypoglycemic effect can be intensified. The patient may experience fatigue and loss of appetite as side effects of the medication, and these should be reported to the healthcare provider. The patient needs to closely monitor blood sugar.

Which statement indicates that the patient needs additional teaching on oral hypoglycemic agents? A. "I will monitor my blood sugar daily." B. "I will limit my alcohol consumption." C. "I will take the medication only when I need it." D. "I will report symptoms of fatigue and loss of appetite.

D. An important way to minimize adverse drug-drug interactions is to avoid detrimental interactions by taking a thorough drug history from the patient and to minimize the number of drugs the patient receives. ***The only true and accurate statement regarding minimizing adverse drug-drug interactions is to avoid detrimental interactions by taking a thorough drug history from the patient and to minimize the number of drugs the patient receives. The most obvious way to minimize adverse drug-drug interactions is to decrease, not increase, the number of drugs a patient receives. A great way to minimize adverse drug-drug interactions is to have the patient, rather than a family member, tell you what drugs he or she takes at home. An important way to avoid adverse drug-drug interactions is to get a thorough drug history, not just the prescription drugs the patient has taken over the past 2 weeks.

Which statement is accurate when discussing how to minimize adverse drug-drug interactions? A. The most obvious way to minimize adverse drug-drug interactions is to increase the number of drugs a patient receives. B. An important way to avoid adverse drug-drug interactions is to get a list of prescribed drugs the patient has taken over the past 2 weeks. C. A great way to minimize adverse drug-drug interactions is to have a family member tell you what drugs he or she thinks the patient takes at home. D. An important way to minimize adverse drug-drug interactions is to avoid detrimental interactions by taking a thorough drug history from the patient and to minimize the number of drugs the patient receives.

A. "You need to notify your doctor if you have a sore throat and fever." ***Agranulocytosis (the absence of granulocytes to fight infection) is the most serious toxicity associated with methimazole. Sore throat and fever may be the earliest signs. Nausea, muscle soreness, and headache and dizziness are other adverse effects of methimazole that are not as serious as agranulocytosis.

Which statement is the most important for a nurse to make to a patient who is taking methimazole? A. "You need to notify your doctor if you have a sore throat and fever." B. "Another medication can be given if you experience any nausea." C. "You may experience some muscle soreness with this medicine." D. "Headache and dizziness may occur but not very frequently."

A. "I need to change positions slowly to prevent dizziness." C. "I will need to wear sunscreen and protective clothing when outdoors." E. "I should call my provider if I notice any uncontrollable movements of my tongue." ***Phenothiazines have the risk for several adverse effects, such as early extrapyramidal reactions, acute dystonia, parkinsonism, and akathisia. In addition, sedation, orthostatic hypotension, anticholinergic effects, gynecomastia, galactorrhea, and menstrual irregularities can result. Tardive dyskinesia (TD), neuroleptic malignant syndrome (NMS), convulsions, and agranulocytosis are side effects that are rarer. Patients should change position slowly to prevent dizziness, wear sunscreen and protective clothing due to dermatologic side effects with the sun, and notify their healthcare provider if they notice uncontrolled movements. Alcohol should not be taken with these medications. While some of these drugs are older, they have quite a few potential side effects.

Which statement made by a patient demonstrates understanding of patient teaching regarding phenothiazine drug therapy? Select all that apply. A. "I need to change positions slowly to prevent dizziness." B. "This is an older drug and has very few risks of side effects." C. "I will need to wear sunscreen and protective clothing when outdoors." D. "It is okay to take this drug with a small glass of wine to help me relax." E. "I should call my provider if I notice any uncontrollable movements of my tongue."

A. "I'm glad I can still have a glass or two of wine at dinner." ***Alcohol can intensify the central nervous system (CNS) depressant effects of baclofen; therefore, further instruction is needed if the patient states that it is okay to have wine at dinner. The statement regarding difficult with urinating indicates that the patient understands that urinary retention is a potential side effect. Baclofen should not be discontinued abruptly, because this can lead to hallucinations, paranoid ideation, and seizures. Patients should discuss withdrawal of baclofen with their healthcare provider, because it should be done over 1 to 2 weeks. Allergy medications should be evaluated by the healthcare provider to determine whether they contain antihistamines, which intensify the depressant effects.

Which statement made by a patient indicates a need for further discharge instruction about baclofen [Lioresal]? A. "I'm glad I can still have a glass or two of wine at dinner." B. "If I develop any difficulty urinating, I will call my physician." C. "I'll contact my healthcare provider when I feel I no longer need the medication." D. "I'll need to check with my healthcare provider before taking my allergy medications."

A. Change positions slowly. ***Postural hypotension is common early in treatment, so the patient should be instructed to change positions slowly. Administration with meals should be avoided, if possible, because food delays the absorption of the levodopa component. If the patient is experiencing side effects of nausea and vomiting, administration with food may need to be considered. The levodopa component in Sinemet may darken the color of the urine. Carbidopa has no adverse effects of its own.

Which statement should the nurse include in the teaching plan for a patient being started on levodopa/carbidopa [Sinemet] for newly diagnosed Parkinson's disease? A. Change positions slowly. B. Carbidopa has many adverse effects. C. Take the medication on a full stomach. D. The drug may cause the urine to be very diluted.

A. It is a synthetic steroid identical to cortisol. B. It is a preferred drug for adrenocortical insufficiency. C. It has glucocorticoid and mineralocorticoid actions. ***Hydrocortisone is a synthetic steroid with a structure identical to that of cortisol. Hydrocortisone is a preferred drug for all forms of adrenocortical insufficiency. Oral hydrocortisone is ideal for chronic replacement therapy. Parenteral administration is used for acute adrenal insufficiency and to supplement oral doses at times of stress. Despite being classified as a glucocorticoid, hydrocortisone also has mineralocorticoid actions.

Which statements about hydrocortisone are correct? (Select all that apply.) A. It is a synthetic steroid identical to cortisol. B. It is a preferred drug for adrenocortical insufficiency. C. It has glucocorticoid and mineralocorticoid actions. D. It is given IV for chronic replacement therapy. E. It should not be given during times of stress.

B. Levothyroxine can be given by IV but is usually taken orally. C. Levothyroxine brands should not be changed if possible. E. Levothyroxine can affect the metabolism of other medications. ***Levothyroxine is almost always administered by mouth. Oral doses should be taken once daily on an empty stomach (to enhance absorption). Dosing is usually done in the morning, at least 30 to 60 minutes before breakfast. Maintain patients on the same brand-name levothyroxine product. Intravenous administration is used for myxedema coma and for patients who cannot take levothyroxine orally. Levothyroxine affects the metabolism of other medications, including warfarin.

Which statements about levothyroxine [Synthroid] are correct? (Select all that apply.) A. Levothyroxine should be taken with food. B. Levothyroxine can be given by IV but is usually taken orally. C. Levothyroxine brands should not be changed if possible. D. Levothyroxine should be taken at night to avoid adverse effects. E. Levothyroxine can affect the metabolism of other medications.

C. Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. ***Drawing up the regular insulin into the syringe first prevents accidental mixture of neutral protamine Hagedorn (NPH) insulin into the vial of regular insulin, which could cause an alteration in the onset of action of the regular insulin. The medications do not have to be in separate syringes and can be administered together. The Z-track method is an intramuscular technique that is not used with insulin.

Which technique is most appropriate regarding mixing insulin when a patient must administer 30 units regular insulin and 70 units neutral protamine Hagedorn (NPH) insulin in the morning? A. Use the Z-track method for administration. B. Draw the medication into two separate syringes but inject into the same spot. C. Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. D. Administer these insulins at least 10 minutes apart, so you will know when they are working

A. regular ***Use regular insulin in a patient with circulatory collapse, DKA, or hyperkalemia.

Which type of insulin would the nurse expect to administer to a patient with DKA? A. regular B. intermediate-acting C. long-acting D. ultra-long-acting

B. "What supplements do you take, and how often do you take them?" ***A goal of the admission interview is to determine what medications, including herbs, the patient takes, as this may affect the patient's treatment or interfere with medications. The patient does not need to stop herbal supplements before being admitted to the hospital. The nurse does not have to ask the patient's opinion about herbal supplements. Rather than asking if the healthcare provider is aware, the nurse should specifically ask what herbal supplements the patient uses.

While performing an admission interview, which question would be the most appropriate for the nurse to ask the patient concerning the use of herbal supplements? A. "What is your opinion about herbal supplements?" B. "What supplements do you take, and how often do you take them?" C. "Is your healthcare provider aware of the herbal supplements you take?" D. "Are you aware that you must stop all herbal supplements before being admitted?"

C. They act directly on the proton pump. ***Erosive esophagitis is a condition in which irritation is caused by acid in the esophagus. PPIs directly inhibit the hydrogen-potassium-ATPase pump, thus reducing the release of hydrogen ions that form acid. Food digestion and absorption are unaltered by these drugs. About 90% of acid secretion is stopped within 24 hours of administration, bringing relief to the patient. PPIs inhibit only the proton pump of parietal cells and reduce only gastric acids.

Why are proton pump inhibitors (PPIs) used in the treatment of patients with bleeding due to erosive esophagitis? A. They affect the absorption of food. B. They do not alter the levels of acid. C. They act directly on the proton pump. D. They inhibit the proton pumps in all cells of the digestive system.

D. The highest dose needed to produce a therapeutic effect is close to the lethal dose. ***A low therapeutic index indicates that the high doses needed to produce therapeutic effects in some people may be large enough to cause death. A high therapeutic index is more desirable, because the average lethal dose is higher than the therapeutic dose. Low variability of responses to a drug is not the definition of a low therapeutic index.

Why does the nurse monitor the patient closely after administering a drug with a low therapeutic index? A. There is a low variability of responses to this drug. B. The average lethal dose of the drug is much higher than the therapeutic dose. C. The dose required to produce a therapeutic response in 50% of patients is low. D. The highest dose needed to produce a therapeutic effect is close to the lethal dose.

A. IV administration is irreversible. ***The intravenous (IV) route allows precise control over levels of drug in the blood and results in rapid onset of action. Absorption of IV medication is instantaneous and complete. Once a drug has been injected, there is no turning back; the drug is in the body and cannot be retrieved.

Why should the nurse follow safe medication administration for intravenous (IV) medications? A. IV administration is irreversible. B. The IV route results in a delayed onset of action. C. Control over the levels of drug in the body is unpredictable. D. The IV route can result in delayed absorption of the medication.