Pharm Exam 2 NCLEX Prep Questions
Glipizide (Glucotrol) Oral antidiabetic drugs are classified as pregnancy B or C drugs and are generally not recommended for pregnant patients.
When caring for a pregnant patient with gestational diabetes, the nurse should question a prescription for which drug? Insulin glargine (Lantus) Insulin glulisine (Apidra) Glipizide (Glucotrol) NPH insulin
antiretroviral
Medications used to treat HIV infections are more specifically classified as what type of drugs?
Antihistamines An allergist will usually recommend discontinuation of antihistamine drug therapy at least 4 days before allergy testing.
A client is making an appointment for allergy testing. The nurse instructs the client not take what class of medications at least 4 days before allergy testing? Antitussives Decongestants Antihistamines Bronchodilators
Terbinafine (Lamisil) Terbinafine (Lamisil) is classified as an allylamine antifungal drug and is currently the only drug in its class. It is available in a topical cream, gel, and spray for treating superficial dermatologic infections, including tinea pedis (athlete's foot), tinea cruris (jock itch), and tinea corporis (ringworm).
A client visits the health care provider for treatment of tinea pedis (athlete's foot). Which medication would the nurse MOST likely instruct the client to take to treat this condition?
herpes zoster
A new vaccination, Zostavax (Zoster Vaccine Live), has been approved to prevent the development of what condition in adults older than the age of 60 years?
longer duration of action Salmeterol has a longer duration of action, requiring the client to use it only twice a day instead of three or four times a day with albuterol.
A nurse is providing education to a client taking two different bronchodilator medications. The nurse identifies which characteristic as the advantage of salmeterol (Serevent) over other beta2 agonists such as albuterol (Proventil)? Shorter onset of action Extended time of action Longer duration of action Quicker peak action
b) sustained use of nasal decongestants over several days may result in rebound congestion. Oxymetazoline is an effective nasal decongestant, but overuse results in worsening or "rebound" congestion. It should not be used more than every 4 hours.
A patient complains of worsening nasal congestion despite the use of oxymetazoline (Afrin) nasal spray every 2 to 4 hours for the past 5 days. The nurse's response is based on knowledge that: a) oxymetazoline should be administered in an hourly regimen for severe congestion. b) sustained use of nasal decongestants over several days may result in rebound congestion. c) oxymetazoline is not an effective nasal decongestant. d) the patient is probably displaying an idiosyncratic reaction to oxymetazoline.
b) increase fluid intake and fiber in diet Opioid analgesics decrease GI intestinal motility (peristalsis), leading to constipation. Increasing fluid and fiber in the diet or use of stool softener or mild laxative can prevent constipation.
A patient is prescribed an opioid analgesic for chronic pain. Which information should the nurse discuss with the patient to minimize the GI adverse effects? a) avoid eating foods high in lactobacilli b) increase fluid intake and fiber in diet c) take diphenoxylate-atropine (Lomotil) with each dose. d) take the medication on an empty stomach.
Morphine An equianalgesic table is a conversion chart for commonly used opioids. It identifies oral and parenteral dosages that provide comparable analgesia. The equianalgesic table identifies dosages of various narcotics that are equal to 10 mg of morphine. It is important to use when changing to a new opioid or different route. Morphine is the drug prototype for all opioid drugs.
A patient needs to switch analgesic drugs secondary to an adverse reaction to the current treatment regimen. The patient is concerned that the new prescription will not provide optimal pain control. The nurse's response is based on knowledge that doses of analgesics are determined using an equianalgesic table with which drug prototype? Fentanyl Meperidine Morphine Codeine
c) "Massaging muscles activates large sensory nerve fibers that send signals to the spinal cord to close the gate, thus blocking painful stimuli from reaching the brain." The gate theory of pain control identifies large sensory nerve fibers that, when stimulated, send signals to the spinal cord to close the gate, blocking pain stimuli from reaching the brain. Therefore, the patient is not having the sensation of pain even if the stimulus is still present.
A patient prescribed massage therapy for musculoskeletal pain asks the nurse, "How is rubbing my muscles going to make the pain go away?" What is the nurse's best response? a) "Massaging muscles helps relax the contracted fibers and decrease painful stimuli." b) "Massaging muscles activates small sensory nerve fibers that send signals to the spinal cord to open the gate and allow endorphins to reach the muscles and relieve the pain." c) "Massaging muscles activates large sensory nerve fibers that send signals to the spinal cord to close the gate, thus blocking painful stimuli from reaching the brain." d) "Massaging muscles decreases the inflammatory response that initiates the painful stimuli."
c. "Vasoconstriction caused by epinephrine enhances the duration of action for lidocaine and minimizes bleeding at the laceration site." Epinephrine causes localized vasoconstriction, not only allowing for a bloodless field to suture but also delaying absorption of the lidocaine and thus enhancing its numbing effect.
A patient questions the use of epinephrine for repair of a laceration, stating, "I thought that was the drug used in the emergency department for someone who is coding." Which is the nurse's best response? a. "Epinephrine is used with lidocaine to prevent adverse effects." b. "The systemic absorption of lidocaine is maximized by the epinephrine, and the anesthetic effect is reached more quickly." c. "Vasoconstriction caused by epinephrine enhances the duration of action for lidocaine and minimizes bleeding at the laceration site." d. "Epinephrine is metabolized more quickly than lidocaine so that the anesthetic effect wears off more quickly after the laceration is sutured."
increasing fluid and fiber in the diet. Narcotic analgesics decrease intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can prevent constipation.
A patient receiving narcotic analgesics for chronic pain can minimize the GI side effects by: a) eating foods high in lactobacilli. b) taking Lomotil with each dose. c) taking the medication on an empty stomach. d) increasing fluid and fiber in the diet.
c) "PTU inhibits the formation of new thyroid hormone, thus returning your metabolism to normal." PTU is an antithyroid medication used to treat hyperthyroidism. It works by inhibiting the synthesis of new thyroid hormone. It does not inactivate present hormone.
A patient receiving propylthiouracil (PTU) asks the nurse, "How does this medication relieve symptoms?" What is the nurse's best response? a) "PTU causes the pituitary gland to secrete thyroid-stimulating hormone, which blocks the production of hormones by the thyroid gland." b) "PTU helps your thyroid gland synthesize and use iodine, which produces hormones better." c) "PTU inhibits the formation of new thyroid hormone, thus returning your metabolism to normal." d) "PTU removes thyroid hormones that are already circulating in your bloodstream, thus decreasing the adverse effects of this medication."
d) "Nausea and vomiting occur less frequently than in the past because of the use of a balanced approach to anesthesia." Explain to the patient the advances in anesthesia may help alleviate fear. Adverse effects such as nausea and vomiting are less common because drugs from several different classes rather than a single drug are used to produce anesthesia. This approach is referred to as balanced anesthesia.
A patient verbalizes concern to the nurse regarding postoperative nausea and vomiting from the anesthesia. Which is the nurse's best response? a) "I understand your concern but intermittent vomiting often occurs after surgery." b) "Don't worry because you'll be heavily or completely sedated if that occurs." c) "You will need to notify the charge nurse and health care provider if you feel nauseated after surgery." d) "Nausea and vomiting occur less frequently than in the past because of the use of a balanced approach to anesthesia."
Cough suppressant Codeine provides both analgesic and antitussive (cough suppressant) therapeutic effects.
A patient with a diagnosis of pneumonia asks the nurse, "Why am I receiving codeine when I have no pain?" The nurse's response is based on knowledge that codeine also has what effect? Bronchodilation Increases sputum production Expectorant Cough suppressant
a
Before discharge, the nurse is reviewing a client's prescribed medication regimen for tuberculosis (TB). The client asks the nurse why pyridoxine (vitamin B6) has been prescribed while continuing to take isoniazid (Nydrazid) to treat TB. What is the nurse's best response? a) "Pyridoxine will help prevent numbness, and tingling that can occur secondary to the isoniazid." b) "Pyridoxine is another antitubercular drug that will work synergistically with the isoniazid." c) "You really should not be on that drug. I will check with the health care provider." d) "Multidrug therapy is necessary to prevent the occurrence of resistant bacteria."
Propofol (Diprivan) Propofol is an IV sedative-hypnotic drug used for induction and maintenance of anesthesia as well as for sedation in patients who are intubated and mechanically ventilated in the ICU. It has a rapid onset and short duration of action, allowing for easy titration and maintenance of the patient's level of consciousness.
An intubated, mechanically ventilated patient in the intensive care unit (ICU) is becoming increasingly restless and anxious. The nurse expects to administer which intravenous (IV) anesthetic drug? Propofol (Diprivan) Isoflurane (Forane) Halothane (Fluothane) Nitrous oxide (Anesoxyn)
5:00 PM Breakfast eaten at 8:30 AM would cover the onset of NPH insulin, and lunch will cover the 2 PM time frame. However, if the patient does not eat a mid-afternoon snack, the NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia.
Assuming the patient eats breakfast at 8:30 AM, lunch at noon, and dinner at 6:00 PM, he or she is at highest risk of hypoglycemia after an 8:00 AM dose of NPH insulin at what time? 5:00 PM 2:00 PM 10:00 AM 8:00 PM
Cellulose Povidone Lactose Allergies to povidone, lactose, titanium dioxide, or cellulose derivatives are important to note because these are inactive ingredients in LTRAs.
Before administering an LTRA medication, the nurse would assess the client for allergies to which substance? (Select all that apply.) Latex Cellulose Chlorhexidine Povidone Lactose
history of medication use documentation of known allergies baseline vital signs head-to-toe physical assessment
Before administration of any antiviral medication, what nursing responsibilities would be performed? (Select all that apply.)
b) "This medication works by preventing the inflammation that causes your asthma attack." LTRAs drugs block the inflammatory response of leukotrienes and thus the trigger for asthma attacks. Response to these drugs is usually noticed within 1 week. They are not used to treat acute asthma attacks. Diarrhea, not constipation, is a common adverse effect of montelukast and zafirlukast
Client teaching regarding the use of leukotriene receptor antagonists (LTRAs) drugs such as zafirlukast (Accolate) would include which statement by the nurse? a) "It will take about 3 or 4 weeks before you notice a therapeutic effect." b) "This medication works by preventing the inflammation that causes your asthma attack." c) "Increase fiber and fluid in your diet to prevent the common adverse effect of constipation." d) "Take the medication when you are short of breath and begin wheezing."
tachycardia A beta-agonist bronchodilator stimulates the beta receptors of the sympathetic nervous system, resulting in tachycardia, bronchodilation, hyperglycemia, and increased alertness.
Discharge teaching to a patient receiving a beta-agonist bronchodilator should emphasize reporting which side effect? Tachycardia Nonproductive cough Hypoglycemia Sedation
increased bruising Levothyroxine can compete with protein-binding sites of warfarin, allowing more warfarin to be unbound or free, thus increasing effects of warfarin and risk of bleeding. Bleeding commonly presents as bruising.
For a patient taking levothyroxine (Synthroid) and warfarin (Coumadin) concurrently, the nurse would closely monitor for which possible serious adverse effect? Acute confusion Cardiac dysrhythmias Orthostatic hypotension Increased bruising
viral load
How is the effectiveness of antiviral drugs administered to treat HIV infection assessed and evaluated?
c) Impaired gas exchange related to respiratory depression Using Maslow's hierarchy of needs and the ABCs of prioritization, impaired gas exchange is a priority over pain, constipation, and a risk for injury. If a patient cannot oxygenate sufficiently, all of the other problems will not matter because the patient will not live to worry about them.
In developing a plan of care for a patient receiving morphine sulfate (MS Contin), which nursing diagnosis has the highest priority? a) Constipation related to decreased GI motility b) Acute pain related to metastatic tumor cancer c) Impaired gas exchange related to respiratory depression d) Risk for injury related to CNS adverse effects
The chemoreceptor trigger zone Morphine sulfate can irritate the gastrointestinal (GI) tract, causing stimulation of the chemoreceptor trigger zone in the brain, which in turn causes nausea and vomiting.
In monitoring a patient for adverse effects related to morphine sulfate (MS Contin), the nurse assesses for stimulation of which area in the central nervous system (CNS)? Autonomic control over circulation Sympathetic baroreceptors The cough reflex center The chemoreceptor trigger zone
Pramlintide slows gastric emptying. Pramlintide is a synthetic form of the naturally occurring hormone amylin. It works by slowing gastric emptying, suppressing glucagon secretion and hepatic glucose production, and increasing satiety (sense of having eaten enough). It is only administered via subcutaneously injection.
Pramlintide (Symlin) is prescribed as supplemental drug therapy to the treatment plan for a patient with type 1 diabetes mellitus. What information should the nurse include when teaching the patient about the action of this medication? Pramlintide stimulates glucose production. Pramlintide increases glucagon excretion. Pramlintide slows gastric emptying. Pramlintide corrects insulin receptor sensitivity.
CBC With antithyroid medications, the nurse should monitor for possible serious adverse reactions such as agranulocytosis, leukopenia, and thrombocytopenia. An abnormal CBC result would indicate bone marrow dysfunction.
When assessing for potential serious adverse effects to propylthiouracil (PTU), the nurse will monitor which laboratory test? Kidney function Brain natriuretic peptide Serum electrolytes Complete blood count (CBC)
Intravenously (IV)
The most significant drug interactions with use of antivirals occur when antivirals are administered via which route?
vitamin B6
The nurse anticipates a prescription for vitamin supplementation for a client who is receiving isoniazid (Nydrazid) therapy. What vitamin supplement is usually prescribed with isoniazid? Vitamin E Calcium Vitamin B6 Folate
75 mcg 150 mcg/day × 0.50 = 75 mcg
The nurse has a prescription to change the patient's levothyroxine (Synthroid) dosage from oral to intravenous (IV). The patient takes 150 mcg/day by mouth, and the prescription is to administer 50% of the oral dose by the IV route. How much will the nurse administer per day?
Impetigo Impetigo is a bacterial skin infection and would not be classified as a fungal skin infection. If the client included this in the discussion, further teaching is needed. All other skin infections listed are fungal and would be treated with antifungal medications.
The nurse has provided education to a client about fungal skin infections. Further client teaching is necessary when the client includes which condition in the discussion of fungal skin infections? Impetigo Vaginal yeast infection Athlete's foot Thrush
inhalation through the respiratory tract transplacentally from mother to infant through an animal bite ingestion via the GI tract
The nurse is aware that viruses can enter the body through various routes. Through which routes can viruses enter the body? (Select all that apply.)
Methadone (Dolophine) Methadone is a synthetic opioid analgesic with gentler withdrawal symptoms and is the drug of choice for detoxification treatment.
The nurse is caring for a patient with opioid addiction. The nurse anticipates that the patient will be prescribed which medication? Meperidine (Demerol) Naloxone (Narcan) Methadone (Dolophine) Morphine (MS Contin)
Loratadine (Claritin) Fexofenadine (Allegra) Cetirizine (Zyrtec) Antihistamines are drugs that directly compete with histamine for specific receptor sites. For this reason, they are also called histamine antagonists. H1 antagonists include drugs such as diphenhydramine (Benadryl), chlorpheniramine (generic), fexofenadine (Allegra), loratadine (Claritin), and cetirizine (Zyrtec).
The nurse is discussing use of antihistamines for allergic rhinitis. Which medications would be included in the list of H1antagonists used in the treatment of allergic rhinitis? (Select all that apply.) Nizatidine (Axid) Loratadine (Claritin) Fexofenadine (Allegra) Ranitidine (Zantac) Cetirizine (Zyrtec)
Drowsiness and dizziness Antitussive medications suppress cough through its action on the central nervous system, thus causing drowsiness and dizziness.
The nurse is discussing use of antitussive medications with a client. What common adverse effect does the nurse include in the client teaching? Diarrhea and abdominal cramping Drowsiness and dizziness Flushing and decreased heart rate Tremors and palpitations
Antihistamines Antitussives Expectorants Nasal decongestants Treatment of the common symptoms of upper respiratory tract infections involves the combined use of antihistamines, nasal decongestants, antitussives, and expectorants. Upper respiratory tract infections are often viral or allergic in nature and the symptoms would not be managed with antibiotics.
The nurse is discussing with the client the management of symptoms of an upper respiratory tract infection. Which classes of medications are often used in treating the symptoms of upper respiratory tract infections? (Select all that apply.) Antibiotics Antihistamines Antitussives Expectorants Nasal decongestants
Acyclovir (Zovirax)
The nurse is obtaining a medication history from a client diagnosed with genital herpes. Which drug would the nurse expect this client to be prescribed?
Metformin (Glucophage) The concurrent use of metformin with iodinated (iodine-containing) radiologic contrast media has been associated with both acute renal failure and lactic acidosis. Therefore, metformin should be discontinued the day of the test and for at least 48 hours after the patient undergoes any radiologic study that requires the use of such contrast media.
The nurse is preparing a patient for a computed tomography scan using iodine contrast media. Which medication should the nurse question if prescribed one day before the scheduled procedure? Pioglitazone (Actos) Acarbose (Precose) Repaglinide (Prandin) Metformin (Glucophage)
Respiratory rate The most serious adverse effect of opioid analgesics is respiratory depression.
When assessing for the MOST serious adverse effect to an opioid analgesic, what does the nurse monitor for in this patient? Blood pressure Respiratory rate Mental status Heart rate
a) Withhold the medication and notify the health care provider. Respiratory depression is an adverse effect of opioid analgesia. Therefore, because the patient's respiratory rate is below normal, the nurse should withhold the morphine and notify the health care provider.
The nurse is preparing to administer an intravenous injection of morphine to a patient. The nurse assesses a respiratory rate of 10 breaths/min. Which action should the nurse perform? a) Withhold the medication and notify the health care provider. b) Administer a smaller dose and document in the patient's record. c) Administer the next prescribed dose intramuscularly. d) Check the pulse oximeter reading and reevaluate respiratory rate in 1 hour.
coronary artery disease Nonselective adrenergic agonist bronchodilators stimulate beta1 receptors in the heart and beta2 receptors in the lungs. Stimulation of beta1 receptors can increase heart rate and contractility, increasing oxygen demand. This increased oxygen demand may lead to angina or myocardial ischemia in clients with coronary artery disease.
The nurse is providing care to a client prescribed a nonselective adrenergic agonist bronchodilator. Which condition documented in the client's medical history would alert the nurse to question this prescription? Coronary artery disease Thrombocytopenia Chronic obstructive pulmonary disease Mycobacterium tuberculosis
Intranasal steroids Inhaled intranasal steroids and anticholinergic drugs are not associated with rebound congestion and are often used prophylactically to prevent nasal congestion in clients with chronic upper respiratory tract symptoms. Local intranasal steroids would have the least likely possible systemic adverse effects of all the medication classes possible to use for chronic and long term use.
The nurse is providing education to a client with a history of chronic nasal congestion secondary to allergic rhinitis. Which class of medications should the nurse anticipate the provider would recommend for the client to use on a long-term basis? Intranasal steroids Expectorants Antihistamines Antitussives
30 minutes before a meal Glipizide works best if given 30 minutes before meals. This allows the timing of the insulin secretion induced by the glipizide to correspond to the elevation in the blood glucose level induced by the meal.
The nurse is providing education to a patient for the prescription glipizide (Glucotrol). The nurse explains this medication is more effective when administered at which time? 15 minutes postprandial At bedtime 30 minutes before a meal In the morning
c) joint pain, d) bone marrow toxicity, e) liver toxicity The most damaging or serious adverse effects of the antithyroid medications are liver and bone marrow toxicity. Myalgias and arthralgias (joint pain) may also occur with PTU.
The nurse is reviewing the adverse effects of antithyroid medications for a patient prescribed propylthiouracil (PTU). What potential serious adverse effects should the nurse discuss with the patient during discharge teaching? (Select all that apply.) a) Kidney damage b) Increased urination c) Joint pain d) Bone marrow toxicity e) Liver toxicity
Seafood
The nurse is teaching a patient taking an antithyroid medication to avoid food items high in iodine. Which food item should the nurse instruct the patient to avoid? Chicken Seafood Milk Eggs
Amphotericin B (Amphocin) The major adverse effects caused by antifungal drugs are encountered most commonly in conjunction with amphotericin B treatment. Drug interactions and hepatotoxicity are the primary concerns in clients receiving other antifungal drugs, but the IV administration of amphotericin B is associated with a multitude of adverse effects.
The nurse needs to know that major adverse effects are MOST common by which drug? Griseofulvin (Fulvicin P/G) Ketoconazole (Nizoral) Amphotericin B (Amphocin) Fluconazole (Diflucan)
d) "This inhaler is not to be used alone to treat an acute asthma attack." Although ipratropium works to prevent bronchoconstriction and thus secondarily leads to bronchodilation, a direct-acting bronchodilator is needed to treat an acute asthma attack.
The nurse performs discharge teaching with a client who is prescribed the anticholinergic inhaler ipratropium bromide (Atrovent). Which statement by the client indicates to the nurse that teaching has been successful? a) "Nausea and vomiting are common adverse effects of this medication." b) "I may gain weight as a result of taking this medication." c) "I will not drink grapefruit juice while taking this drug." d) "This inhaler is not to be used alone to treat an acute asthma attack."
a) Pain relief is best obtained by administering analgesics around the clock. When pain is present for more than 12 hours a day, analgesic dosages are best administered around the clock rather than on an as-needed basis, but dosages should always be within the dosage guidelines for each drug used. The around-the-clock (or "scheduled") dosing maintains steady-state levels of the medication and prevents drug troughs and escalation of pain.
The nurse plans pharmacologic management for a patient with pain. The nurse should administer the pain medication based on what dosage schedule? a) Pain relief is best obtained by administering analgesics around the clock. b) Administer the analgesic when the pain level reaches a "6" on a scale of 1 to 10. c) Opioid analgesics should not be used for more than 24 hours to prevent drug addiction. d) Analgesics should be administered as needed (prn) to minimize adverse effects.
Therapeutic The therapeutic theophylline level is 10 to 20 mcg/mL.
The nurse receives laboratory values for a client with a theophylline level of 14 mcg/mL. How does the nurse interpret this theophylline level? Toxic Life threatening Therapeutic Subtherapeutic
Every 72 hours The fentanyl transdermal delivery system is designed to slowly release analgesic over a 72-hour time frame.
The nurse teaches a patient prescribed the fentanyl (Duragesic) transdermal delivery system to change the patch at what interval? When pain recurs Every 72 hours Once a week Every 24 hours
Glucagon (GlucaGen) Glucagon stimulates glycogenolysis, raising serum glucose levels.
The nurse will instruct the patient to treat hypoglycemia with which drug? Bumetanide (Bumex) Glucagon (GlucaGen) Acarbose (Precose) Propranolol (Inderal)
Hypertension Adrenergic drugs are contraindicated in clients with hypertension, narrow-angle glaucoma, diabetes, uncontrolled cardiovascular disease, hyperthyroidism, prostatitis, or a known hypersensitivity to such drugs.
The nurse would question a prescription for pseudoephedrine (Sudafed) in a client with a history of which condition? Pneumonia Peptic ulcer disease Hypertension Osteoporosis
Quinidine The nurse would question a prescription for quinidine because both voriconazole and quinidine are metabolized by the cytochrome P-450 enzyme system. The drugs will compete for the limited number of enzymes, and one of the drugs will end up accumulating.
The nurse would question a prescription for voriconazole (Vfend) if the client was taking which medication? Prednisone (Deltasone) Quinidine Clindamycin (Cleocin) Captopril (Capoten)
irritability Irritability is a symptom of hyperthyroidism and may indicate toxicity of the medication. The other choices are signs of hypothyroidism.
The nurse would suspect a patient is taking too much levothyroxine (Synthroid) when the patient exhibits which adverse effect? Lethargy Irritability Weight gain Feeling cold
a) "Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin." When insulins are mixed, withdraw the regular insulin (clear) first, followed by withdrawing the NPH insulin (cloudy).
The patient is prescribed 30 units of regular insulin and 70 units of insulin isophane suspension (NPH insulin) subcutaneously every morning. The nurse should provide which instruction to the patient for insulin administration? a) "Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin." b) "Inject the needle at a 30-degree angle." c) "Rotate sites at least once or twice a week." d) "Use a 23- to 25-gauge syringe with a 1-inch needle to increase insulin absorption."
CBC (complete blood count)
To assess for the dose-limiting toxicity of ganciclovir (Cytovene), the nurse will monitor which laboratory test result?
Less sedative effect Loratadine is a nonsedating antihistamine and it does not readily distribute into the central nervous system, which diminishes the sedative effects associated with traditional antihistamines.
What advantage does loratadine (Claritin) have compared with traditional antihistamines such as diphenhydramine (Benadryl)? Less sedative effect Minimal gastrointestinal upset Increase in bronchodilation Decreased risk of cardiac dysrhythmias
Blood urea nitrogen Daily weights Creatinine Intake and output Nursing interventions appropriate to clients receiving antifungal drugs vary depending on the particular drug. However, it is important for the nurse to monitor all clients for indications of possible medication-induced renal damage so that prompt interventions can occur to prevent further dysfunction. Monitoring intake and output amounts, daily weights, and renal function tests will help prevent such damage.
What are important for the nurse to monitor in a client receiving an antifungal medication? (Select all that apply.) Blood urea nitrogen Daily weights Creatinine Mental status Intake and output
central nervous The most common adverse effect of antihistamines is drowsiness, but the sedative effects vary among antihistamine drug classes.
What body system will the nurse assess for known common adverse effects of traditional antihistamines? Respiratory GI central nervous cardiovascular
Pancreatic failure Liver failure Drug allergy, liver failure, kidney failure, and porphyria (for griseofulvin) are the most common contraindications for antifungal drugs.
What conditions are considered contradictions for use of antifungal medications? (Select all that apply.) Heart failure Respiratory failure Pancreatic failure Liver failure Kidney failure
c) A nonharmful adverse effect of this medication is red-orange discoloration of urine, sweat, tears, skin, salvia, and feces.
What information should the nurse provide to a client prescribed rifampin (Rifadin)? a) Peripheral neuropathy is an expected side effect, and the patient should report any numbness or tingling of the extremities. b) Oral contraception is the preferred method of birth control when using rifampin. c) A nonharmful adverse effect of this medication is red-orange discoloration of urine, sweat, tears, skin, salvia, and feces. d) The patient will only need to take this medication for the prescribed 14-day period.
c) Emphasize that oral contraceptives become ineffective when given with rifampin.
What instruction should the nurse include for a client prescribed rifampin (Rifadin) and isoniazid (Nydrazid) prophylactically secondary to TB exposure? a) Remind that sunscreen is not needed during outdoor activities. b) Explain that isoniazid may decrease blood serum glucose in susceptible people. c) Emphasize that oral contraceptives become ineffective when given with rifampin. d) Advise that these drugs will only need to be taken for 7 to 10 days.
Nystatin (Mycostatin) Nystatin is an antifungal drug that is used for a variety of candidal infections. It is applied topically as a cream, ointment, or powder. It is also available as a troche and an oral liquid or tablet.
What is the MOST common drug used to treat oral candidiasis? Oseltamivir (Tamiflu) Griseofulvin (Fulvicin P/G) Amantadine (Symmetrel) Nystatin (Mycostatin)
Check for premedication prescriptions. Almost all clients given IV amphotericin B experience fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea and vomiting, and headache. Pretreatment with an antipyretic, antihistamine, and antiemetic can minimize or prevent these adverse reactions. The other choices are appropriate nursing actions after the IV infusion has begun.
What is the MOST important action for the nurse to complete before administration of intravenous (IV) amphotericin B? Monitor for cardiac dysrhythmias. Assess for nausea and vomiting. Monitor IV site for signs of phlebitis. Check for premedication prescriptions.
They decrease inflammation. Corticosteroids can suppress the immune system. They do not directly affect bronchodilation but rather prevent bronchoconstriction as a response to inflammation.
What is the role of corticosteroids in the treatment of acute respiratory disorders? They increase gas exchange in the alveoli. They stimulate the immune system. They directly dilate the bronchi. They decrease inflammation.
Constipation Inability to void Morphine sulfate causes a decrease in GI motility (delayed gastric emptying and slowed peristalsis). This leads to constipation, not diarrhea. Morphine can also cause urinary retention (inability to void).
When assessing a patient for adverse effects related to morphine sulfate (MS Contin), which clinical findings is the nurse MOST likely to find? (Select all that apply.) Weight gain Excessive bruising Constipation Inability to void Diarrhea
liver function tests, CBC
When assessing for adverse effects to Rifamate (combination isoniazid and rifampin), the nurse would monitor which laboratory values? (Select all that apply.) Liver function tests Complete blood cell count Sputum cultures Uric acid levels Cholesterol
c) Do not use in children younger than 2 years of age unless prescribed. OTC medications for allergies are not recommended for children younger than 2 years of age unless prescribed by a health care provider.
When providing general education on use of over-the-counter (OTC) medications for allergies, which instruction should the nurse to include? a) Discontinue use 4 days before allergy testing. b) It may cause dry mouth and difficulty urinating. c) Do not use in children younger than 2 years of age unless prescribed. d) The medication treats the signs and symptoms but is not a cure.
Oseltamivir (Tamiflu)
When providing health promotion teaching at a senior citizen center, the nurse would include information about which medication used to decrease the duration of influenza A and B?
c) "You cannot mix this insulin with regular insulin and thus will have to take two injections." Insulin glargine is a long-acting insulin with duration of action up to 24 hours. It should not be mixed with any other insulins. It is usually dosed once daily, but it may be dosed every 12 hours depending on the patient's glycemic response.
When teaching a patient about insulin glargine (Lantus), which statement by the nurse about this drug is correct? a) "It is often combined with regular insulin to decrease the number of insulin injections per day." b) "You can mix this insulin with NPH insulin to enhance its effects on glucose metabolism." c) "You cannot mix this insulin with regular insulin and thus will have to take two injections." d) "The duration of action for this insulin is 8 to 10 hours, so you will need to take it twice a day."
Stimulate insulin secretion from beta cells Enhance action of insulin in various tissues Inhibit breakdown of insulin by liver The sulfonylureas stimulate insulin secretion from the beta cells of the pancreas; enhance the actions of insulin in muscle, liver, and adipose tissue; and prevent the liver from breaking insulin down as fast as it ordinarily would (reduced hepatic clearance). Increased hepatic glucose production would serve to increase serum glucose levels, the opposite effect of oral hypoglycemic drugs.
Which actions describe the beneficial effects produced by sulfonylurea oral hypoglycemics? (Select all that apply.) Increase hepatic glucose production Stimulate insulin secretion from beta cells Enhance action of insulin in various tissues Inhibit breakdown of insulin by liver
Fluconazole (Diflucan) Fluconazole is an antifungal drug that does not cause the major adverse effects of amphotericin when given intravenously. It is also very effective against vaginal yeast infections, and a single dose is often sufficient to treat vaginal infections.
Which antifungal drug can be given intravenously to treat severe yeast infections as well as a one-time oral dose to treat vaginal yeast infections? Nystatin (Mycostatin) Caspofungin (Cancidas) Fluconazole (Diflucan) Voriconazole (Vfend)
d) "I will need to have my vision checked periodically while I am taking this drug."
Which client statement indicates to the nurse that the client understands the discharge teaching for ethambutol (Myambutol)? a) "Constipation will be a problem, so I will increase the fiber in my diet." b) "This medication may cause my bodily secretions to turn red-orange-brown." c) "Dizziness and drowsiness are common adverse effects with this drug." d) "I will need to have my vision checked periodically while I am taking this drug."
"I don't need to use condoms as long as I take my medication as prescribed"
Which client statement regarding his or her diagnosis of HIV infection indicates a need that further teaching is necessary?
St. John's Wort St. John's wort has been shown to enhance the rate of theophylline metabolism, thus decreasing serum levels.
Which herbal product, when taken with theophylline, can decrease theophylline's serum drug levels? Peppermint oil St. John's wort Garlic Echinacea
Report symptoms of anorexia and fatigue. Advise to avoid smoking and alcohol consumption. Oral hypoglycemic drugs must be taken on a daily scheduled basis to maintain euglycemia and prevent long-term complications of diabetes. Skipping meals can cause low blood glucose levels and should be avoided. Patients with type 2 diabetes mellitus are managed with lifestyle changes.
Which information should the nurse include in a teaching plan for patients taking oral hypoglycemic drugs? (Select all that apply.) Explain dietary changes are not necessary. Instruct that it is okay to skip breakfast 1 to 2 times per week. Report symptoms of anorexia and fatigue. Advise to avoid smoking and alcohol consumption. Take your medication only as needed.
b) Increase fluid intake to decrease viscosity of secretions. Expectorant drugs are used to decrease viscosity of secretions and allow them to be more easily expectorated. Increasing fluid intake helps this action.
Which instruction should the nurse include when teaching a client who is prescribed an expectorant? a) Take a drug with oral codeine when cough worsens. b) Increase fluid intake to decrease viscosity of secretions. c) Take the medication once a day at bedtime. d) Restrict fluids to decrease mucus production.
Regular insulin (Humulin R) Regular insulin is the only insulin used for IV therapy.
Which insulin can be administered by continuous intravenous (IV) infusion? Insulin aspart (Novolog) Insulin detemir (Levemir) Insulin glargine (Lantus) Regular insulin (Humulin R)
Insulin aspart (NovoLog)
Which is a rapid-acting insulin with an onset of action of less than 15 minutes? Regular insulin (Humulin R) Insulin glargine (Lantus) Insulin detemir (Levemir) Insulin aspart (NovoLog)
Liver enzymes Because use of zafirlukast may lead to liver dysfunction, liver enzyme levels should be monitored regularly, especially early in the course of therapy.
Which laboratory value would the nurse assess before administering zafirlukast (Accolate) to a client? Renal function tests Complete blood count Liver enzymes Cardiac enzymes
Insulin glargine (Lantus) Insulin glargine has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas.
Which long-acting insulin mimics natural, basal insulin with no peak action and a duration of 24 hours? Insulin glulisine (Apidra) Insulin glargine (Lantus) Regular insulin (Humulin R) NPH insulin
Naloxone (Narcan) Naloxone is the narcotic antagonist that will reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.
Which medication is used to treat a patient with severe adverse effects of a narcotic analgesic? Flumazenil (Romazicon) Methylprednisolone (Solu-Medrol) Acetylcysteine (Mucomyst) Naloxone (Narcan)
Repaglinide (Prandin) Repaglinide is known as the "Humalog of oral hypoglycemic drugs." The drug's very fast onset of action allows patients to take the drug with meals and skip a dose when they skip a meal.
Which oral hypoglycemic drug has a quick onset and short duration of action, enabling the patient to take the medication 30 minutes before eating and skip the dose if he or she does not eat? Pioglitazone (Actos) Repaglinide (Prandin) Acarbose (Precose) Metformin (Glucophage)
d) "This drug will be taken up by the thyroid gland and destroy thyroid tissue." Radioactive iodine is an antithyroid medication that is administered orally. It concentrates in the thyroid gland, where its radioactivity destroys thyroid tissue.
Which patient statement demonstrates understanding of radioactive iodine (I-131) therapy? a) "I will need to take this drug on a daily basis for at least 1 year." b) "I will isolate myself from my family for 1 week so there is no risk of radiation exposure." c) "This drug will help decrease my cold intolerance and weight gain." d) "This drug will be taken up by the thyroid gland and destroy thyroid tissue."
Teach to turn, cough, and deep breathe. Frequent turning, coughing, and deep breathing can help prevent postoperative atelectasis, a sequela of generalized anesthesia and mechanical ventilation.
Which postoperative nursing action will help the patient avoid serious complications from general anesthesia? Teach to turn, cough, and deep breathe. Monitor input and output closely. Place in a semi-Fowler's position. Provide a quiet, calm environment.
c) "I will rinse my mouth with water after each use." Flunisolide is an inhaled corticosteroid. Rinsing the mouth immediately after each use of the inhaler or nebulizer will help prevent oral candidal infections. It is not used to treat an acute asthma attack and should be taken with the client's bronchodilator medications. The plastic inhaler casing is washed in warm, soapy water every week.
Which statement by a client best indicates an understanding of the teaching on flunisolide (AeroBid)? a) "I will wash the plastic inhaler casing once a month." b) "I will not use my albuterol inhaler while I am taking AeroBid." c) "I will rinse my mouth with water after each use." d) "I will take two puffs to treat an acute asthma attack."
c) "This medication will help prevent the inflammatory response of my allergies." Beclomethasone diproprionate is a steroid spray administered nasally. It is used to prevent and treat allergy symptoms. Its effect is localized, and therefore the client does not have systemic adverse effects with the recommended dose. There is no need to taper off gradually as with oral corticosteroids.
Which statement by the client demonstrates an understanding about beclomethasone diproprionate (Beconase) mechanism of action? a) "I will monitor my blood sugar because I may develop drug-induced diabetes." b) "I only need to take this medication when my symptoms get bad." c) "This medication will help prevent the inflammatory response of my allergies." d) "I will need to taper off the medication to prevent acute adrenal crisis."
d) "Wait 1 to 2 minutes before you take a second puff of the same drug." If a second puff of the same drug is ordered, instruct the client to wait 1 to 2 minutes between puffs. If a second type of inhaled drug is prescribed, instruct the client to wait 2 to 5 minutes between the medications or to take as prescribed.
Which statement by the nurse should be included when teaching a client about the proper use of metered-dose inhalers? a) "After you inhale the medication once, repeat until you obtain relief." b) "Make sure that you puff out air several times after you inhale the medication." c) "Hold the inhaler in your mouth, take a deep breath, and then compress the inhaler." d) "Wait 1 to 2 minutes before you take a second puff of the same drug."
c) "I will take this medication in the morning so it does not affect my sleep at night." Levothyroxine increases basal metabolic rate and thus may cause insomnia. Patients should not double the dose or stop taking the medication abruptly. It may take up to 4 weeks for a therapeutic response to occur.
Which statement by the patient indicates an understanding of discharge instructions given by the nurse about the newly prescribed medication levothyroxine (Synthroid)? a) "I can expect improvement of my symptoms within 1 week." b) "I will stop the medication immediately if I feel pain or weakness in my muscles." c) "I will take this medication in the morning so it does not affect my sleep at night." d) "I will take a double dose to make up for the missed one."
nonnucleoside reverse transcriptase inhibitors protease inhibitors fusion inhibitors reverse transcriptase inhibitors
Which types of antiviral drugs are used to treat HIV infection? (Select all that apply.)
Acetylcysteine (Mucomyst) Acetylcysteine is the antidote for acetaminophen overdose. It must be administered as a loading dose followed by subsequent doses every 4 hours for 17 additional doses and started as soon as possible after the acetaminophen ingestion (ideally within 12 hours).
While admitting a patient for treatment of an acetaminophen (Tylenol) overdose, the nurse prepares to administer which medication to prevent toxicity? Methylprednisolone (Solu-Medrol) Acetylcysteine (Mucomyst) Naloxone (Narcan) Phytonadione (vitamin K)
a) It produces muscle relaxation and loss of consciousness. General anesthesia produces muscle relaxation (both visceral and skeletal) as well as loss of consciousness. The other answers are incorrect.
While completing preoperative patient teaching, which information should the nurse include for a surgery with a general anesthetic? a) It produces muscle relaxation and loss of consciousness. b) It affects a specific region of the body to block pain sensation. c) It uses only one type of medication to produce sedation. d) It provides moderate sedation that allows you to relax.
Anesthetic-induced complications A patient with a history of substance abuse is at higher risk of anesthetic-related complications and will require closer monitoring by the anesthesia team.
While taking a patient's history before surgery for a cardiac problem, the patient tells the nurse, "I am addicted to cocaine." The nurse notifies the anesthesiologist of this finding because use of cocaine can cause which effect when a patient is under anesthesia? Blood-clotting problems Complications during recovery Immediate withdrawal symptoms Anesthetic-induced complications
