N362 Exam 1 PrepU

A client presents to the emergency department with symptoms of an acute opioid overdose. The primary health care provider orders naloxone for the client. Several minutes after administration, the client's respiratory depression and other symptoms have not changed. This is most likely due to which mechanism? A. The client is not experiencing an opioid overdose. B. The client was not administered a large enough dose of naloxone. C. The client overdosed on multiple opioids. D. The naloxone has not been given enough time to work.

A. The client is not experiencing an opioid overdose. Explanation: The nonimprovement in client symptoms may be because the client is not experiencing an opioid overdose but may have overdosed on a nonopioid substance, such as a benzodiazepine.

Which client should not receive sumatriptan (Imitrex) as ordered? A. The client with an elevated BUN B. The client with a blood pressure of 140/95 mm Hg C. The client with urinary output of 30 mL/hour D. The client reporting nausea

A. The client with an elevated BUN Explanation: The client with renal disease may have difficulty excreting the medication. An elevated BUN is an indication of renal disease.

The nurse is administering medications to a 2-year-old child with impaired renal function. What does the nurse understand about the dosage of medication for this child? A. The dose should be adjusted to achieve and maintain therapeutic drug levels. B. The dose should be increased to achieve and maintain therapeutic drug levels. C. Only medications not excreted through the urine should be administered to this child. D. The medication should be used in a half-dose so that the child will not become nephrotoxic.

A. The dose should be adjusted to achieve and maintain therapeutic drug levels.

Which of the following is correct regarding the use of atypical antipsychotic agents? A. They commonly cause weight gain and diabetes B. They cause more extrapyramidal symptoms C. They affect only the negative symptoms of schizophrenia D. They affect only the positive symptoms of schizophrenia

A. They commonly cause weight gain and diabetes

A nurse is caring for a patient who is on morphine therapy. An expected outcome of the morphine therapy would be that the patient has A. adequate pain control with minimal adverse effects. B. complete pain relief with minimal adverse effects. C. complete pain relief with adverse effects that can be treated. D. adequate pain relief with no addiction to the drug.

A. adequate pain control with minimal adverse effects. Explanation: Complete pain relief is not a realistic goal.

A nurse is caring for a patient with urinary retention. The patient has been prescribed Urecholine. For which category of patients should the nurse take precautions when administrating Urecholine? A. Patients with Raynaud's disease B. Patients with bradycardia C. Patients with recent myocardial infarction D. Patients with hyperthyroidism

B. Patients with bradycardia Explanation: The nurse should administer Urecholine cautiously in patients with bradycardia, hypertension, epilepsy, cardiac arrhythmias, recent coronary occlusion, and megacolon. The nurse need not take precautions for the patients with Raynaud's disease, recent myocardial infarction, and hyperthyroidism when administrating Urecholine.

The nurse is caring for a client in the emergency department who is experiencing status epilepticus. The client's electronic medical record reveals a recent diagnosis of tonic clonic seizures and prescription for phenytoin. Which is the priority action? A. Obtain phenytoin level. B. Provide lorazepam IVP. C. Provide phenytoin IV. D. Assess length of seizure.

B. Provide lorazepam IVP. Explanation: The priority action is to administer the drug of choice for status epilepticus, which is lorazepam, a short-acting benzodiazepine.

A nurse is caring for a client with renal impairment. The client has been prescribed an opioid analgesic. Which nursing intervention would be most appropriate? A. Provide aggressive bowel program. B. Administer the drug through the IV route. C. Consult with the prescriber about lowering the dosage of the drug. D. Administer an antacid with the drug.

C. Consult with the prescriber about lowering the dosage of the drug. Explanation: The nurse should lower the dosage of the drug when caring for a client with renal impairment who has been prescribed an opioid analgesic, but only after consulting with the prescriber and obtaining a prescription to do so.

For which adverse reactions should the nurse monitor the patient who has been administered antipsychotic drugs? A. Hypertension B. Skin eruptions C. Dry mouth D. Bradycardia

C. Dry mouth

A 28-year-old woman has been diagnosed with schizophrenia. The health care provider has prescribed a typical antipsychotic, haloperidol. Which will the nurse include in the teaching related to the most common adverse effects? A. Neuroleptic malignant syndrome B. Agranulocytosis C. Extrapyramidal symptoms D. Gastrointestinal problems

C. Extrapyramidal symptoms Explanation: Extrapyramidal symptoms (EPS) are the most common adverse effects of haloperidol.

Mr. A is a 29 year old male who has experienced two unprovoked seizures in the last month. Mr. A presents your clinic to help establish a medication regimen. As the nurse, you educate Mr. A that adherence to an AED regimen will be crucial for success of the therapy. Which of the following may warrant further investigation to ensure that Mr. A adheres to his new medication regimen? A. He currently takes no other medications B. He has no history of liver or kidney disease and his laboratory work is normal C. He was recently laid off of work and does not have health insurance D. All of the above

C. He was recently laid off of work and does not have health insurance

The nurse is explaining to a client about the analgesic and its possible adverse effects. The client is receiving an opioid analgesic. What would be important to teach this client is a possible adverse effect of this drug? A. Ataxia B. Blurred vision C. Hypotension D. Dysrhythmias

C. Hypotension Explanation: Orthostatic hypotension is commonly seen with some narcotics.

When assessing a client before starting a drug regimen, how should the nurse best assess the client's ability to excrete medications? A. Assess the client's nutritional and hydration status B. Weight the client and measure the client's abdominal girth C. Review laboratory values indicative of kidney function D. Review the client's AST, ALT, bilirubin and albumin levels

C. Review laboratory values indicative of kidney function

The nurse prepares to administer a preoperative anticholinergic to a client. What is a desired effect based upon the characteristics of the prescribed medication? A. wheezing B. heart rate 50 C. dry mucous membranes D. bilateral constricted

C. dry mucous membranes Explanation: Anticholinergic medications block the actions of the endogenous neurotransmitters of the parasympathetic stimulation. The medication would lead to drying of mucous membranes, a desired effect for a preoperative drug

What is the primary role of disulfiram in the treatment of alcohol abuse? A. minimizing the symptoms of alcohol withdrawal B. alerting the care team to alcohol use by the client C. providing a physiological disincentive for alcohol use D. aiding the client in identifying the consequences of alcohol abuse

C. providing a physiological disincentive for alcohol use Explanation: A client who drinks alcohol when taking disulfiram will experience unpleasant physiological effects. This is intended to mitigate the pleasure that the person normally receives from drinking alcohol.

The nurse is teaching a client taking a monoamine oxidase inhibitor (MAOI) about dietary changes required to minimize adverse effects of the drug. The nurse determines the client understands a low tyramine diet when what meal is chosen? A. A chop salad with blue cheese, sardines, and pepperoni B. A sandwich with turkey, avocado, and Swiss cheese C. Corned beef hash, eggs, and hash browns D. A hamburger, French fries, and a strawberry milkshake

D. A hamburger, French fries, and a strawberry milkshake

Mr. A's neurologist decides to put him on phenytoin (Dilantin) to control his seizures. You are completing medication teaching with Mr. A. As the nurse, you know that it is important to educate Mr. A that: A. This medication will require him to return for frequent blood level monitoring B. He should notify the clinic if any new medications are started, as phenytoin has several drug-drug interactions C. Good oral care is key due to the side effect of gingival hyperplasia D. All of the above are correct

D. All of the above are correct

Ms. B is being started on levodopa. Which of the following is true about levodopa? A. The medication will gradually be titrated up over time in order to decrease side effects B. The medication will be combined with carbidopa in order to decrease common side effects, like nausea and vomiting C. This medication will cure her PD D. Both a and b are correct

D. Both a and b are correct

Mr. C is a 22 year old male with no past medical history. He was diagnosed with depression. Which of the following are important considerations when choosing a medication regimen for him? A. TV advertising B. Insurance coverage and cost of the medication C. Potential side effects D. Both b and c are correct

D. Both b and c are correct

The nurse has developed a plan of care for an older adult client newly diagnosed with Parkinson's disease. What outcome is most likely to be appropriate for this client? A. Client will demonstrate a full return to independent activities of daily living with two weeks of starting treatment B. Client will return to pre-diagnosis levels of fine motor skill within 48 hours of beginning treatment C. Client will be oriented to person, place and time within 48 hours of beginning treatment D. Client will demonstrate the ability to ambulate the length of the hall within one week of starting medication

D. Client will demonstrate the ability to ambulate the length of the hall within one week of starting medication Explanation: Goals should be specific and measurable, so the ability to ambulate the length of the hall is a valid assessment. A full return to independence in ADLs may be unrealistic, as is a return to pre-diagnosis levels of fine motor skills. Cognition is not normally affected during early Parkinson's disease.

A middle-aged client was diagnosed with major depression after a suicide attempt several months ago and has failed to respond appreciably to treatment with SSRIs. As a result, the client was prescribed phenelzine. When planning this client's subsequent care, what nursing diagnosis should the nurse prioritize? A. Risk for Ineffective Peripheral Tissue Perfusion related to cardiovascular effects of phenelzine B. Risk for Constipation related to decreased gastrointestinal peristalsis C. Risk for Infection related to immunosuppressive effects of phenelzine D. Risk for Injury related to drug-drug interactions or drug-nutrient interactions

D. Risk for Injury related to drug-drug interactions or drug-nutrient interactions

The team has decided that Ms. F is a good candidate for IV tPA for her stroke. The risks and benefits are reviewed with the family and the order is placed to administer the drug. Which of the following best described the administration and monitoring for this drug? A. It is given as an IV bolus followed by IV drip B. The medication requires reconstitution and preparation C. An accurate weight will be required as the dose is weight-based D. The patient will require close monitoring for hypertension after the initiation of the drug E. All of the above are correct

E. All of the above are correct

Mr. C has been prescribed the SSRI sertraline (Zoloft). Based on the side effects of this medication, a potential nursing diagnosis to consider may include: A. Electrolyte imbalance B. Suicidal ideations C. Fluid volume deficit D. Sexual dysfunction E. Both b and d are correct

E. Both b and d are correct

When considering the half-life of naloxone, what are the implications for this medication therapy? A. Repeated doses of naloxone will likely be necessary. B. An increase in the dosage of naloxone will most likely be required. C. A different antidote will be required as the serum level of naloxone decreases. D. The antidote is unlikely to have a therapeutic effect on the client's symptoms.

A. Repeated doses of naloxone will likely be necessary. Explanation: The half-life of naloxone, a narcotic antagonist, is relatively short compared with the half-life of the longer-acting opioids such as methadone, and repeated doses may be needed to prevent recurrence of the toxic state.

Mr. A presents to the emergency room in status epilepticus. A priority nursing intervention for him includes: A. Safety measures including suction at the bedside, padded side rails and elevated head of bed B. Head of bed flat and bite block C. Administration of an oral anticonvulsant D. No interventions are required until seizure activity concludes

A. Safety measures including suction at the bedside, padded side rails and elevated head of bed

Teaching the client and caregiver about medications is an important step in reducing the risk of medication errors. What is an important teaching point about medications? A. Speak up B. Store medications in a warm humid place C. Adjust your medication according to your weight D. Keep a list of your prescribed medications

A. Speak up

Another name for "adrenergic agonist" is: A. Sympathomimetic B. Cholinergic C. Sympatholytic D. Parasympatholytic

A. Sympathomimetic

A client with recurrent urinary tract infections was prescribed sulfamethoxazole-trimethoprim and experienced an allergic reaction. The client states, "I don't understand. I had a two-day course of the same drug last year with no problems." What is the nurse's best response? A. "Allergic reactions happen after your body has been sensitized to a drug in the past." B. "It's likely that you didn't have an allergic reaction last time because you had such a short course of treatment." C. "If you were more ill with an infection last time, it's possible you confused an allergic reaction with your UTI symptoms." D. "Allergic reactions are usually dose-dependent, so it could be that you were treated with a lower dose last year."

A. "Allergic reactions happen after your body has been sensitized to a drug in the past."

The nurse obtains the following vital signs on a client: BP 160/85, P 90, RR 24. The client is recently divorced and reports taking alprazolam (Xanax) for the past seven weeks but stopped the medication yesterday. What is the nurse's first action? A. Ask the client about experiencing increased anxiety, difficulty concentrating, or tremors. B. Advise the client that increased blood pressure is an expected finding after discontinuing Xanax. C. Notify the health care provider of the abnormal vital signs. D. Document the client's vital signs in the electronic medical record and advise the charge nurse.

A. Ask the client about experiencing increased anxiety, difficulty concentrating, or tremors.

A client is agitated due to withdrawing from alcohol. Which group of drugs would assist the client? A. Benzodiazepines B. Beta adrenergic antagonists C. Antidepressants D. Antibiotics

A. Benzodiazepines Explanation: Benzodiazepines are the drugs of choice for treating withdrawal from alcohol and other CNS depressants.

Ms. F arrives to the ED with symptoms of a stroke that started 30 minutes prior to her arrival. Her initial CT was negative for hemorrhage. Which of the following is a priority to assess for? A. Contraindications for alteplase B. Temperature C. Insurance status D. Skin turgor

A. Contraindications for alteplase

A nurse is preparing to administer epinephrine to a patient who is having a severe allergic reaction. Which route of administration should the nurse use to provide the fastest and most complete absorption of epinephrine? A. IV B. IM C. SubQ D. Oral

A. IV

A client who has been receiving long-term levodopa therapy tells the nurse, "I was making good progress and then it was like the drug stopped working." The nurse interprets this as which of the following? A. On-off phenomenon B. Drug holiday C. Bradykinesia D. Choreiform movements

A. On-off phenomenon

Mrs. Janis' health care provider orders enteric-coated aspirin 81 mg by mouth once a day. When the nurse attempts to administer the medication, the client informs the nurse that the aspirin that she takes at home is not coated and works just fine. As part of the nurse's education plan, what does the nurse instruct the client to do? A. "Enteric-coated tablets and capsules are coated with a substance that is insoluble in stomach acid. This delays dissolution until the medication reaches the intestine, usually to avoid gastric irritation or to keep the drug from being destroyed by gastric acid." B. "Enteric-coated tablets and capsules are coated with a substance that is soluble in stomach acid. This delays dissolution until the medication reaches the intestine, usually to avoid gastric irritation or to keep the drug from being destroyed by gastric acid." C. "Enteric-coated tablets and capsules are coated with a substance that is insoluble in stomach acid. This delays dissolution until the medication reaches the intestine, usually causing gastric irritation or to keep the drug from being destroyed by gastric acid." D. "Enteric-coated tablets and capsules are coated with a substance that is insoluble in stomach acid. This delays dissolution until the medication reaches the liver, usually to avoid gastric irritation or to keep the drug from being destroyed by gastric acid."

A. "Enteric-coated tablets and capsules are coated with a substance that is insoluble in stomach acid. This delays dissolution until the medication reaches the intestine, usually to avoid gastric irritation or to keep the drug from being destroyed by gastric acid."

The nurse is caring for an adolescent client who began taking an antipsychotic drug last month to treat newly-diagnosed schizophrenia. The client's symptoms have improved only slightly and the client's parents wonder if the client is "beyond hope." What is the nurse's best response? A. "It's common for clients to have to try different drugs until the most effective one is identified." B. "Some clients do not respond to antipsychotic drugs and have to rely solely on cognitive behavioral therapy." C. "Do you feel like you've given the medication enough time to work?" D. "It might be necessary to take a combination of several antipsychotics before the benefits are seen."

A. "It's common for clients to have to try different drugs until the most effective one is identified.

The nurse is providing client teaching with a client who is newly diagnosed with epilepsy. The client asks, "Can I still drive to work?" What is the nurse's best response? A. "You likely won't be able to until your seizures are controlled by medication" B. "Yes, as long as your health care provider agrees and you take your medications regularly." C. "You can drive as soon as therapeutic drug levels are established." D. "You'll need to use public transportation because a seizure could occur anytime."

A. "You likely won't be able to until your seizures are controlled by medication" Explanation: After the client's seizures are controlled (usually for 6 months to 2 years depending on state law), the client may be able to regain the ability to drive

A nurse is preparing to administer a prescribed medication by subcutaneous injection. When determining the amount to give, the nurse would keep in mind the maximum volume that should be given in a subcutaneous injection as how much? A. 1 mL B. 0.5 mL C. 2 mL D. 3 mL

A. 1 mL Explanation: When administering a subcutaneous injection, a volume of 0.5 to 1 mL is used. Larger volumes (greater than 1 mL) are best given by IM injection.

The nurse is assisting with a phase I drug study. What potential participant would be most appropriate? A. 22-year-old male with an unremarkable health history B. 24-year-old female who takes oral contraceptives C. 49-year-old female who has completed menopause D. 17-year-old male who is in good health

A. 22-year-old male with an unremarkable health history Explanation: male adults are typically used for clinical trials

The client presents to the emergency department with a headache in the back of the head, diaphoresis and neck stiffness. The client's blood pressure measures 180/124 mm Hg and heart rate is 168 beats per minute. The spouse says the client is currently prescribed "something for depression" and denies any history of cardiac disease. The nurse should suspect the use of what medication? A. A monoamine oxidase inhibitor (MAOI) B. A selective serotonin reuptake inhibitor (SSRI) C. A tricyclic antidepressant (TCA) D. An atypical antipsychotic

A. A monoamine oxidase inhibitor (MAOI) Explanation: MAOIs have several serious adverse effects that can be fatal. This client's symptoms indicate fatal hypertensive crisis characterized by occipital headache, palpitations, neck stiffness, nausea, vomiting, sweating, dilated pupils, photophobia, tachycardia, and chest pain. It may progress to intracranial bleeding and fatal stroke.

Your patient was seen in the emergency room for evaluation following a motor vehicle accident. He is admitted with a closed head injury, confusion and bruised ribs. You understand that the following analgesic medication is safest for pain relief at this time: A. Acetaminophen (Tylenol) 650 mg PO every 6 hours PRN pain B. Oxycodone 5 mg PO every 4 hours PRN pain C. Fentanyl (Sublimaze) 50 mcg IV every 4 hours PRN pain D. Aspirin 325 mg every 6 hours PRN pain

A. Acetaminophen (Tylenol) 650 mg PO every 6 hours PRN pain Explanation: Wouldn't want to give B and C (opioids) because the patient already has confusion and we wouldn't want to cause more confusion/wonder if confusion is d/t head injury or d/t medication. Not D b/c aspirin may cause bleeding.

A nurse is caring for a client diagnosed with migraine headaches. Which nursing intervention should be implemented during an acute headache? A. Administer subcutaneous sumatriptan succinate (Imitrex). B. Administer naproxen. C. Administer ergotamine subcutaneously. D. Administer diclofenac.

A. Administer subcutaneous sumatriptan succinate (Imitrex). Explanation: Sumatriptan succinate (Imitrex) should be administered. Ergotamine is administered sublingually. Diclofenac and naproxen are NSAIDs.

The nurse administers a drug that causes vasoconstriction, contracted piloerection muscles, pupil dilation and urinary retention. What receptor is this drug most likely stimulating? A. Alpha 1-receptors B. Alpha 2-receptors C. Beta 1-receptors D. Beta 2-receptors

A. Alpha 1-receptors Explanation: Stimulation of Alpha1-receptors results in vasoconstriction of blood vessels, increased peripheral resistance with increased blood pressure, contracted piloerection muscles, pupil dilation, thickened salivary secretions and closure of the urinary bladder sphincter.

A client was diagnosed with Parkinson's disease and the client's provider prescribed levodopa 400 mg PO b.i.d. The client has experienced a reduction in tremors and an improvement in gait but is having significant adverse effects. Consequently, the client's medication has been changed to Sinemet. When educating the client, the nurse should explain that this drug: A. allows the client to benefit from levodopa while taking a lower dose. B. includes components that antagonize dopamine receptors. C. has recently been approved for the treatment of Parkinson's disease. D. is an adjunctive treatment for Parkinson's disease that has minimal adverse effects.

A. allows the client to benefit from levodopa while taking a lower dose. Explanation: The carbidopa component allows a greater proportion of the levodopa to cross the blood-brain barrier, allowing therapeutic benefits with a much lower dose than levodopa alone. This causes a reduction in the adverse effects of levodopa.

Which assessment should be made by the nurse before administering a new medication? A. determining the client's past medication history B. evaluating the client's health beliefs C. instructing the client on the effect of the medication D. teaching the client about the desired outcomes of drug therapy

A. determining the client's past medication history

Which medication will reduce the effects of sedation and respiratory depression in a client suspected of experiencing benzodiazepine toxicity? A. flumazenil B. olmesartan medoxomil C. pancrelipase D. pamidronate disodium

A. flumazenil Explanation: Toxic effects of benzodiazepines include excessive sedation, respiratory depression, and coma. Flumazenil is a specific antidote that competes with benzodiazepines for benzodiazepine receptors and reverses toxicity.

In patients treated with MAOIs, you should be concerned about the risk of hypertensive crisis in response to: A. food containing tyramine B. stress C. abrupt withdrawal of the drug D. an overdose of the drug

A. food containing tyramine

A drug has been approved by the Food and Drug Administration. What study phase would occur next? A. phase IV study B. phase III study C. phase II study D. phase I study

A. phase IV study Explanation: This is a phase of continual evaluation in which prescribers are obligated to report to the Food and Drug Administration any untoward or unexpected adverse effects associated with the drugs being used.

A nurse is administering drugs to a 70-year-old patient who has a reduced plasma albumin level. When assessing the patient for therapeutic outcomes of drug therapy, the nurse will also be careful to observe for A. possible drug toxicity. B. decreased therapeutic effects. C. altered drug absorption. D. increased drug metabolism.

A. possible drug toxicity Explanation: Decreased levels of plasma albumin can lead to fewer binding sites for protein-binding drug molecules. Decreased binding sites results in higher concentrations of unbound forms of a drug, which increases the risk of adverse effects and toxicity and can increase therapeutic effects

Your 75 year-old patient has been given 100 mcg of fentanyl IV to help control his pain after surgery 2 hours ago. You notice that his respiratory rate is 6/min, he is difficult to arouse, and his pupils are pinpoint. What should you do first? A. prepare to give naloxone (Narcan) B. nothing - let the patient sleep C. call the family D. sit the patient up and try to get him to drink water

A. prepare to give naloxone (Narcan) Explanation: it is preparing to give it so it may involve getting it ready and calling the provider! Not B, because we are concerned with the RR. Would do C, but wouldn't be the first thing. Would try to wake patient, but wouldn't want to try to give water because he may be at risk for aspiration.

A bipolar client is being discharged home in 48 hours. What statement by the client indicates an understanding of treatment with lithium? A. "I will increase my salt intake." B. "I will increase my fluid intake." C. "I will decrease my salt intake." D. "I will decrease my fluid intake."

B. "I will increase my fluid intake." Explanation: In order to maintain a therapeutic lithium level the client must increase fluids. A decrease in fluids can lead to toxicity. An increase in salt intake can lead to lithium excretion and a decrease in effectiveness. A decrease in salt intake can cause fluid retention, also leading to toxicity. Maintaining salt intake is necessary to keep serum levels in therapeutic range.

After seeking care for tremors that have become increasingly severe in recent months, a 71-year-old man has been diagnosed with Parkinson's disease and will soon begin treatment with carbidopa-levodopa. Which statement indicates that the patient has an accurate understanding of the new medication? A. "I'll have to learn how to modify each dose of carbidopa-levodopa based on how bad my symptoms are that day." B. "I've read that carbidopa-levodopa is quite short-acting so I'll have to take it several times a day." C. "I'll make sure to stop taking my other medications so that my carbidopa-levodopa doesn't interact with them." D. "I've heard that it can take up to a year for carbidopa-levodopa to cure someone of Parkinson disease."

B. "I've read that carbidopa-levodopa is quite short-acting so I'll have to take it several times a day." Explanation: The plasma half-life of both carbidopa-levodopa and carbidopa alone is roughly 1 to 2 hours, and the duration of action of a dose is 5 hours. Consequently, most patients must take the drug several times daily.

A client is admitted with a deep vein thrombosis in his or her left calf. The health care provider orders Heparin, 7,500 units subcutaneously every 12 hours. The medication vial reads Heparin, 10,000 units/mL. How many milliliters does the nurse administer? A. 0.5 mL B. 0.75 mL C. 1 mL D. 1.25 mL

B. 0.75 mL Explanation: [(amount of drug available)/(volume available)] = [(amount of drug prescribed)/(volume to administer)] Using the information supplied by the problem: 10,000 units/1 mL = 7,500/X. Cross-multiplying yields X = 0.75 mL for each dose

A nurse who works at an outpatient mental health clinic follows numerous clients who have schizophrenia, many of whom are being treated with olanzapine (Zyprexa). Which client likely has the highest susceptibility to the adverse effects of olanzapine? A. A client who is morbidly obese and who has a sedentary lifestyle B. A client who has type 1 diabetes and who practices poor glycemic control C. A client who has a body mass index of 16.5 (underweight) and who smokes one pack of cigarettes daily D. A client who was recently treated with intravenous antibiotics because of cellulitis in his lower leg

B. A client who has type 1 diabetes and who practices poor glycemic control Explanation: The use of olanzapine creates a significant risk of hyperglycemia. This is of particular concern in patients and clients who have diabetes mellitus.

The client's spouse relays to the nurse a concern regarding having difficulty administering medications through the client's feeding tube and states, "I'm so concerned about doing it wrong, then I'm so flustered I forget how to do it." Which nursing diagnosis is most appropriate? A. Deficient Knowledge B. Anxiety C. Noncompliance D. Ineffective Self-Health Management

B. Anxiety

The nurse has administered a dose of naloxone (Narcan) and the client's respiratory depression improved within five minutes. When the nurse reassessed the client two hours later, the client demonstrates symptoms of respiratory depression. Which action should the nurse perform next? A. No further action is required because the naloxone has already been administered. B. Call the provider as another dose of opioid antagonist may be necessary. C. Administer a second dose and then notify the provider to obtain an order. D. Continue to monitor the client's vital signs and oxygen saturation levels.

B. Call the provider as another dose of opioid antagonist may be necessary.

The nurse is caring for a 7-year-old hospitalized client who is taking several different medications. The nurse educates the family about all of the medications being administered in order to best acheive which safety related nursing goal? A. Families need to understand the importance of the different classifications and actions of the drugs administered. B. Families become active partners with the rest of the health care team in preventing medication errors. C. Families should be aware of all the medications given so that they can check their bill when the child is discharged. D. Families should be aware of medications that the child is taking so that they can administer them if necessary

B. Families become active partners with the rest of the health care team in preventing medication errors.

The nurse administers a medication that stimulates the muscarinic receptors. What manifestations should the nurse expect to assess in this client? A. Pupil dilation B. Increased activity of bowel sounds C. Increased heart rate D. Muscle contractions

B. Increased activity of bowel sounds Explanation: Stimulation of muscarinic receptors increases gastrointestinal (GI) motility which would cause increased activity of bowel sounds. Other effects include pupil constriction, increased urinary bladder contraction, and a slowing of the heart rate. Stimulation of nicotinic receptors cause muscle contractions.

The nurse is caring for a client who has a sedative hypnotic ordered. The nurse should consider this drug contraindicated if the client had what disorder? A. Neurological diseases B. Liver failure C. Endocrine disorders D. Heart disease

B. Liver failure Explanation: Benzodiazepines undergo extensive hepatic metabolism. In the presence of liver disease, the metabolism of most benzodiazepines is slowed, with resultant accumulation and increased risk of adverse effects.

A nurse is caring for a patient with seizure disorders. The patient has been prescribed phenytoin. Which of the following ongoing assessment activities should a nurse perform during the treatment? A. Measure the respiratory rate of the patient. B. Measure regular serum plasma levels of the drug. C. Check for the patient's vital signs every three hours. D. Measure the pulse rate of the patient.

B. Measure regular serum plasma levels of the drug. Explanation: While caring for the patient on anticonvulsant treatment, the nurse should measure the regular serum plasma levels of the drug. The nurse need not check for the patient's vital signs every three hours, measure the respiratory rate of the patient, nor measure the pulse rate of the patient while caring for a patient on anticonvulsant treatment.

A patient has been prescribed lithium therapy. Which of the following signs and symptoms will the nurse tell the patient to report immediately? A. Increased urination B. Muscle twitching C. Hair loss D. Increased thirst

B. Muscle twitching Explanation: Muscle twitching is an early symptom of lithium toxicity and should be reported immediately. Muscle twitching indicates that a dosage change may be needed.

Ms. B has been diagnosed with Parkinson's Disease. Which of the following symptoms might be an indication that Ms. B may need to start on a medication to manage her symptoms? A. A minor tremor in her non-dominant that she is only able to detect some of the time B. She describes that sometimes it takes her 30-45 minutes to arise from bed in the morning. She describes her movements as slow and it is impacting her ability to get to work on time. C. A headache while at rest D. Some mild stiffening of her muscles that she notices more at night. It is not yet impacting her ability to do her activities of daily living

B. She describes that sometimes it takes her 30-45 minutes to arise from bed in the morning. She describes her movements as slow and it is impacting her ability to get to work on time.

A nurse has administered a scheduled dose of naproxen to a hospital client who has been taking the drug for several weeks. What assessment finding should cause the nurse to suspect that the client on long-term naproxen therapy is experiencing adverse effects of this treatment? A. There is an increase in the client's neutrophils but no increase in temperature. B. The client's stool tests positive for occult blood. C. The client complains of itchy, dry skin. D. The client has peripheral edema, and there is a steady increase in the client's weight.

B. The client's stool tests positive for occult blood. Explanation: Gastrointestinal (GI) bleeding is a significant adverse effect of naproxen.

Which of the following is NOT an effect of amphetamines? A. Insomnia B. Weight gain C. Elevated blood pressure D. Euphoria

B. Weight gain Explanation: Adderall and other ADHD medications that are amphetamine derivatives have been used (abused?) by those trying to lose weight.

A postsurgical client has been prescribed morphine to address the pain that is anticipated over the next 24 to 48 hours. What is the most effective strategy to manage a client's postsurgical pain for the initial 24 to 48 hours? A. administering the maximum safe dose of morphine for 12 to 24 hours and then transitioning to nonsteroidal anti-inflammatory drugs (NSAIDs) B. administering morphine on a scheduled basis and supplementing it with additional morphine when the pain worsens C. administering morphine every 4 hours, with gradually decreasing doses over the next several days D. encouraging the client to endure the pain as much as possible before administering morphine

B. administering morphine on a scheduled basis and supplementing it with additional morphine when the pain worsens Explanation: In general, morphine should be given continuously or on a regular schedule of intermittent doses, with supplemental or bolus doses when needed for breakthrough pain.

The nurse is caring for a client with a drug allergy and understands the allergy is the result of the client developing: A. antigens. B. antibodies. C. antihistamine. D. secondary effects.

B. antibodies

A client has been admitted to the emergency department after overdosing on oxycodone. What nursing diagnosis should the nurse prioritize? A. impaired swallowing B. impaired gas exchange C. ineffective airway clearance D. ineffective role performance

B. impaired gas exchange

In light of current treatment modalities, the nurse should anticipate that the client newly diagnosed with schizophrenia will most likely be prescribed what drug? A. chlorpromazine B. olanzapine C. haloperidol D. prochlorperazine

B. olanzapine Explanation: The "atypical" antipsychotics, such as olanzapine, are the drugs of choice, especially for clients who are newly diagnosed with schizophrenia.

When planning treatment for substance abuse disorder, what goal should the nurse first address? A. compliance with treatment B. safe detoxification C. taking ownership of the problem D. adequate stimulation of the central nervous system (CNS)

B. safe detoxification Explanation: Ensuring the client's safety during detoxification is a priority over compliance with treatment.

An 80-year-old man has been prescribed oxycodone for severe, noncancer, chronic pain. He tells the nurse that he has difficulty swallowing and asks if he can crush the tablet before swallowing. The nurse will advise the client that: A. the tablet would have no effect if crushed and ingested. B. there is risk of an extremely high dose available all at once if the tablet is crushed. C. crushing the tablet increases the drug's efficacy. D. crushing the tablet is a safe option.

B. there is risk of an extremely high dose available all at once if the tablet is crushed.

An 11 year-old male client has been diagnosed with epilepsy and prescribed phenytoin 100 mg PO b.i.d. What statement by the client's parent suggests an accurate understanding of the client's medication regimen? A. "I will make sure he takes the medication on an empty stomach." B. "I will stop the drug immediately if any side effects occur." C. "I will make sure he has routine visits to the dentist." D. "I will weigh him daily and feed him a high-calorie diet."

C. "I will make sure he has routine visits to the dentist." Explanation: Gingival hyperplasia is common in clients, especially children, who take phenytoin, which makes regular dentist visits important to oral health.

The nurse should share with the client receiving intravenous (IV) morphine that maximum relief of pain will occur in what time frame? A. 3 to 5 minutes B. 5 to 10 minutes C. 10 to 20 minutes D. 30 to 45 minutes

C. 10 to 20 minutes

A nurse is preparing to give a client an extended-release medication. For how long will the effects of this type of drug typically last? A. 3 to 6 hours B. 6 to 12 hours C. 12 to 24 hours D. 24 to 36 hours

C. 12 to 24 hours

Ms. B is 45 years old. She is seeing a movement disorders specialist, who recommends that she start an anti-parkinsonian medication. You anticipate that the physician might explain to Ms. B that: A. Levodopa-carbidopa is the first line treatment in all patients under age 65 B. A dopamine releasing agent alone is the best option for her age and symptoms C. A dopamine agonist medication, like bromocriptine, is an option for her age in order to delay the initiation of levodopa-carbidopa and reduce side effects D. A COMT inhibitor is the best first line option

C. A dopamine agonist medication, like bromocriptine, is an option for her age in order to delay the initiation of levodopa-carbidopa and reduce side effects

Which of the following best describes a patient who might be a candidate to receive tNK? A. A stroke patient within three hours of onset and no tPA available B. A patient with massive PE C. A patient with acute STEMI and no availability to transport to a primary PCI center for intervention due to snowmageddon D. All of the above are correct

C. A patient with acute STEMI and no availability to transport to a primary PCI center for intervention due to snowmageddon

According to Quality and Safety Education for Nurses (QSEN), what intervention will best help reduce the risk of medication errors? A. Providing adequate lighting in the medication dispensing area B. Storing the drugs in alphabetical order to maximize organization C. Alerting other staff to minimize interrupting the nurse preparing medications D. Requiring staff to prepare all drugs for administration in areas away from patients and visitors

C. Alerting other staff to minimize interrupting the nurse preparing medications

A 28-year-old client asks his nurse how phenelzine therapy will help him. Which would be an appropriate response by the nurse? A. "This therapy will help reduce the severity of your bipolar episodes." B. "The drug will enable you to gain the appropriate weight." C. "The drug will help increase your attention level." D. "This therapy will improve your overall mood and increase your social activity."

D. "This therapy will improve your overall mood and increase your social activity."

A postsurgical client has been provided with a morphine patient-controlled analgesic (PCA) but has expressed reluctance to use it for fear of becoming addicted. How can the nurse best respond to this client's concerns? A. "You don't need to worry. It's actually not true that you can get addicted to the medications we use in a hospital setting." B. "If you do become addicted, we'll make sure to provide you with the support and resources necessary to help you with your recovery." C. "It's important that you accept that your current need to control your pain is more important than fears of becoming addicted." D. "It is not uncommon to develop a dependence on pain medications, but this usually takes place over a long period and is not the same as addiction."

D. "It is not uncommon to develop a dependence on pain medications, but this usually takes place over a long period and is not the same as addiction."

When asked by a client about the generic name of a drug, what is the nurse's best response? A. "The generic name describes the molecular structure of the drug." B. "The generic name is the drug name registered by the manufacturer." C. "The generic name is written in capital letters on the drug container." D. "The generic name is the official name given by the U.S. Food and Drug Administration."

D. "The generic name is the official name given by the U.S. Food and Drug Administration." Explanation: Generic names are written in lowercase letters. The chemical name describes the molecular structure. The trade name is the name registered by the manufacturer.

A client has been administered phenylephrine, a medication that affects alpha-1 receptors. The nurse should anticipate what effects on the client? A. increased BP B. pupil dilation (mydriasis) C. drowsiness D. A and B

D. A and B

A client taking carbidopa-levodopa for the treatment of Parkinson's disease reports blurred vision and the nurse observes that the clients has worsening ataxia. Which nursing diagnosis should the nurse prioritize? A. Impaired verbal communication B. Ineffective role performance C. Disturbed body image D. Risk for injury

D. Risk for injury Explanation: The client has blurred vision and ataxia (muscular incoordination) placing the client at risk for falls and injury. Impaired verbal communication would be appropriate if the client was experiencing difficulty with speech. Disturbed body image would be appropriate if the client was voicing complaints related to appearance or effect of the disease or drug therapy on his appearance or body. Ineffective role performance would be appropriate if the client verbalized problems in fulfilling his role due to the changes in vision and the motor problems.

You are a nurse interviewing an 80-year-old patient. Which antidepressant drug class is the first choice for older adults? A. Older adults should not be placed on anti-depressants B. MAOIs C. Tricyclic Antidepressant D. SSRI

D. SSRI Explanation: SSRIs are the drugs of choice in older adults, as in younger ones, because they produce fewer sedative, anticholinergic, cardiotoxic, and psychomotor adverse effects than the TCAs and related antidepressants

Three days after discontinuing diazepam with medical guidance, an older adult continues to demonstrate impaired memory and confusion. The nurse should consider what possible explanation for the client's current status? A. Benzodiazepines can occasionally cause permanent alterations in personality and level of consciousness. B. The client may have decreased liver function. C. The client may have been experiencing a hypersensitivity to the drug, rather than an adverse effect. D. The adverse effects of benzodiazepines can persist for several days after stopping the drug.

D. The adverse effects of benzodiazepines can persist for several days after stopping the drug.

A neonate has been prescribed a water-soluble drug for the treatment of an acute infection. The nurse recognizes that the percentage of body water in an infant is significantly higher than that of an adult. What implication does this have for pharmacotherapy of an infant and the nurse providing care? A. The drug will need to be emulsified before administration. B. The infant's fluid intake will be reduced before and after administration. C. The infant will have a fat-soluble drug substituted. D. The infant may require an increased dose of the drug.

D. The infant may require an increased dose of the drug. Explanation: Newborns are 80% total body water, so water-soluble drugs will be diluted easily and readily move into intercellular tissue. As a result, increased dosages of water-soluble drugs may be needed to maintain therapeutic drug levels

The nurse doesn't understand why a patient is to receive a prescribed medication. What should the nurse do? A. Verify the dosage calculation with another nurse before administration B. Ask the patient to tell you the reason before administration C. Read the medication label carefully before administering the drug to the patient D. Verify with the prescribing provider the reason for the medication

D. Verify with the prescribing provider the reason for the medication

A patient has been prescribed an antipsychotic agent to relieve psychotic symptoms. Which of the following symptoms will be relieved more quickly with the onset of the drug regimen? A. altered thought B. delusions C. hallucinations D. combative behavior

D. combative behavior Explanation: Manifestations of hyperarousal, such as anxiety, hyperactivity, insomnia, aggressive, or combative behavior, are relieved more quickly. Symptoms such as hallucinations, delusions, and altered thought processes are relieved when the medication regimen is more effectively established.

The elderly client with multiple health problems, including peripheral vascular disease, and is now being seen for a respiratory infection. The client is prescribed an antibiotic. Considering the situation, which route of admininstration is least preferred for this client when an antibiotic is prescribed? A. oral liquid. B. oral tablet. C. intravenous. D. intramuscular.

D. intramuscular.

T/F Your patient has just been started on Levodopa. He can expect maximum improvement in symptoms within 2 weeks.

False - Patients should be informed that benefits are likely over months.

A nurse gives a medication that inhibits acetylcholinesterase. How would this drug affect autonomic activity? a. Parasympathetic activity would increase b. Parasympathetic activity would be depressed c. Sympathetic activity would increase d. Respiratory centers would be depressed

a. Parasympathetic activity would increase

A nurse is preparing to give a drug that stimulates the parasympathetic nervous system. Which patient response might be an expected outcome of this drug? a. Wheezing decreases due to bronchodilation b. Heart rate decreases to 60 beats per minute c. Diarrhea stool count decreases d. Blood pressure increases

b. Heart rate decreases to 60 beats per minute

A nurse is preparing to give a medication that stimulates the beta2 receptors. What response will the nurse expect from this drug? a. Increased peristalsis b. Constriction of the pupil c. Hypoglycemia d. Bronchodilation

d. Bronchodilation