Pharm II Final Exam Study prep
The 30-year-old female client is prescribed chorionic gonadotropin (Chorigon), a hormone substitute. Which intervention should the nurse implement? 1. Have the lab draw an FSH level every week. 2. Schedule for regular pelvic sonograms. 3. Discuss not becoming pregnant while taking this drug 4. Teach to take the medication with food.
2. This medication is given to trigger ovulation so the client should be monitored for overstimulation of the ovaries by pelvc sonograms
The client diagnosed with Parkinson's disease has been on long-term levodopa (L-dopa), an anti-Parkinson's disease drug. Which data supports the rationale for placing the client on a "drug holiday"? 1. The medication is expensive and difficult to afford for clients on a fixed income. 2. The therapeutic effects of the drug have diminished and the adverse effects have increased. 3. The client has developed hypertension that is uncontrolled by medication. 4. An overdose is being taken and the medication needs to clear the system.
2. With long term use, adverse effects tend to increase and therapeutic effects tend to decrease, a 10-day break from the drug may result in beneficial effects being achieved by lower doses
Which statement best describes the scientific rationale for prescribing the biguanide metformin (Glucophage)? 1. This medication decreases insulin resistance, improving blood glucose control. 2. This medication allows the carbohydrates to pass slowly through the large intestine. 3. This medication will decrease the hepatic production of glucose from stored glycogen 4. This medication stimulates the beta cells to release more insulin into the bloodstream.
3. Metformin decreases hepatic production of glucose from stored glycogen
The long term care facility nurse is caring for a client diagnosed with a CVA 6 months ago who has residual cognitive effects. The HCP has ordered Alprazolam (Xanex), an antianxiety medication, to be administered at bedtime. Which interventions should the nurse initiate for this client? Select all that apply. 1. Offer toileting every 2 hours 2. Move the client close to the nurses station 3. Administer the medication at 2100 4. Administer this medication with a full glass of water 5. Do not administer if the clients apical pulse is less than 60
1, 2 & 3 Alprazolam has a side effect of drowsiness, so it is taken at bedtime. This medication makes the client a fall risk so toileting should be offered every 2 hours and the patient should be moved to a room nearthe nurses station for closer monitoring
The nurse is caring for a client newly diagnosed with Parkinson's disease who is receiving levodopa (L-dopa). Which interventions should the nurse implement? Select all that apply. 1. Instruct the client to rise slowly from a seated or lying position. 2. Teach about on-off effects of the medication 3. Discuss taking the medication with meals or snacks. 4. Tell the client that the sweat and urine may become darker. 5. Inform the client about having routine blood levels drawn.
1, 2 & 4 Initially levodopa can cause orthostatic hypotension. The patient may experience on and off symptom control. Patients should be warned about darker urine and sweat as a harmless medication side effect
The client with a seizure disorder is prescribed the anticonvulsant fosphenytoin (Cerebyx). Which interventions should the nurse discuss with the client? Select all that apply. 1. Instruct the client to wear a MedicAlert bracelet and carry that apply identification. 2. Tell the client to not self-medicate with over-the-counter medications. 3. Encourage the client to decrease drinking of any type of alcohol. 4. Discuss the importance of maintaining good oral hygiene. 5. Explain the importance of maintaining adequate nutritional intake.
1, 2 & 5 The client should wear ID, and should not take OTCs. Since Dilantin causes anorexia, and N/V, the client should maintain adequate nutritional intake
The nurse is caring for the client diagnosed with type 2 diabetes complaining of headache, jitteriness, and nervousness. Which interventions should the nurse implement? Select all that apply. 1. Check the client's serum blood glucose level. 2. Give the client a glass of orange juice. 3. Determine when the last antidiabetic medication was administered 4. Assess the client's blood pressure and apical pulse 5. Administer prescribed insulin via sliding scale
1, 2, 3, 4 The patient is hypoglycemic, so thw nurse should do all of the following except administer the patient insulin
The client diagnosed with Cushing's disease is prescribed alendronate (Fosamax), a biphosphonate regulator, to prevent osteoporosis. Which information should the clinic nurse teach? Select all that apply. 1. Take the medication and sit upright for 30 minutes. 2. Take the medication just before going to bed. 3. Take the medication with an antacid to alleviate gastric disturbances. 4. Take the medication at least 30 minutes before breakfast. 5. Take the medication with a full glass of water.
1, 4, & 5 The client should take the medication with a full glass of water atleast 30 mins before any other food or fluid is consumed for the day and should remain upright for 30 minutes afterward
The client diagnosed with cerebrovascular accident (CVA) is complaining of a headache. Which interventions should the rehabilitation nurse implement? Rank in order of priority. 1. Assess the client's neurological status. 2. Administer oral acetaminophen 3. Have the client swallow a drink of water. 4. Ask the client to give his or her date of birth. 5. Ask the client to rate pain on a scale of 1-10.
1, 5, 4, 3, 2 1. Always assess the client first, determine if this is normal pain for which tylenol will helo or whether this requires medical intervention 5. Determine the pain level of the client 4. Identify the client before administering the medication 3. Determine if patient can swallow before giving the medication with water, it may need to be thickened 2. The nurse should administer thw medication after the previous steps have been completed
The client with epilepsy is seen in the clinic and has a serum Dilantin level of 5.4mg/dL. Which intervention should the nurse implement first? 1. Request the lab to verify the test results 2. Ask the client when the dose was taken last. 3. Instruct the client not to take the Dilantin for 2 days 4. Discuss the need to increase the dose of the medication.
2. This level is below the therapeutic range of 10-20, the nurse should ask the client if they are taking the medication as directed
Which client should the nurse question when administering the muscarinic antagonist atropine? I. The 69-year-old client diagnosed with glaucoma. 2. The 60-year-old client diagnosed with symptomatic sinus bradycardia. 3. The 55-year-old client being prepped for an abdominal surgery. 4. The 28-year-old client with severe diarrhea.
1. Atropine is contraindicated in a client with glaucoma because atropine causes mydriasis and increases IOP and may cause blindness
The nurse administered 12 units of regular insulin to the patient with type 1 diabetes at 0700. Which meal prevents the client from experiencing hypoglycemia? 1. Breakfast. 2. Lunch. 3. Supper. 4. HS snack.
1. Breakfast would prevent hypoglycemia since regular insulin peaks at 2-4 hours
The overweight client diagnosed with type 2 diabetes reports to the clinic nurse that he has lost 35 pounds in the past 4 months. Which intervention should the nurse implement first? 1. Determine if the client has had an increase in hypoglycemic reactions. 2. Instruct the client to make an appointment with the healthcare provider 3. Ask the client if he has been trying to lose weight or has it happened naturally. 4. Check the client's last weight in the chart with the weight obtained in the clinic.
1. Changes in weight will affect the amount of medication needed to control blood glucose. The nurse should determine if the clients medication is too high by determining if the client had an increase in hypoglycemic reactions
The client diagnosed with a stroke has been prescribed phenytoin (Dilantin), an anticonvulsant. Which statement explains the scientific rationale for prescribing this medication? 1. The client's stroke was caused by some damage to cerebral tissue. 2. The stroke caused damage to the brain tissue that could result in seizures. 3. Hemorrhagic strokes leave residual blood in the brain that causes seizures. 4. This medication can help the client with cognitive deficits think more clearly .
2. Stroke leads to problems with nerve impulse transmission, this blocked transmission can initiate seizures
The client diagnosed with early-stage Parkinson's disease has been prescribed Pramipexole (Mirapex), a dopamine agonist medication. What side effects of this medication should the nurse discuss with the client? Select all that apply. 1. Daytime somnolence. 2. On-off effect. 3. Excessive salivation. 4. Pill rolling motion 5. Stiff muscles
1. Daytime somnolence 5. Stiff muscles Side effects of pramipexole
The nurse is administering medications. Which medication should the nurse question administering? 1. Morphine sulfate to a client diagnosed with pancreatitis. 2. Diphenhydramine to a client with an allergic reaction. 3. Methylprednisolone to a client with type 2 diabetes 4. Vasopressin (DDAVP) to a client diagnosed with diabetes insipidus.
1. Morphine can cause pancreatic duct spasms so the nurse would question this order
The middle-aged client with a pituitary tumor has enlarged viscera and bone deformities. Which medication should the nurse administer? 1. Octreotide (Sandostatin), a synthetic hormone analog. 2. Somatrem (Protropin), GH 3. Ketorolac (Toradol), an NSAID 4. Corticotropin (ACTH), a pituitary hormone.
1. Octreotide suppresses the pituitary glands secretion of GH for s/s of Acromegaly- enlarged viscera, bone deformities, etc
The nurse is discussing the oral hypoglycemic medication Micronase with the client diagnosed with type 2 diabetes. Which information should the nurse discuss with the client? 1. Instruct the client to take the oral hypoglycemic medication with food. 2. Explain that hypoglycemia will not occur with oral medications 3. Tell the client to notify the HCP if a headache, nervousness, or sweating occurs. 4. Recommend the client check the ketones in the urine every morning.
1. Oral hypogylcemics should be administered with food to decrease GI upset
The client with hyperthyroidism is administered radioactive iodine (I-131). Which ntervention should the nurse implement? 1. Explain that the medication will destroy the thyroid gland completely 2. Instruct the client to avoid close contact with children for 1 week. 3. Discuss the need to take the medication at night for 7 days 4. Administer the radioactive iodine in 8 ounces of cold orange juice.
2. The client will be emitting small amounts of radiation so they should avoid contact with children or pregnant women for 1 week following administration
Which statement is the scientific rationale for the combination drug carbidopa/ levodopa (Sinemet) prescribed to a client diagnosed with Parkinson's disease? 1. The carbidopa delays the breakdown of the levodopa in the periphery so more dopamine gets to the brain 2. The medication is less expensive when combined, so it is more affordable to clients on a fixed income. 3. The carbidopa breaks down in the periphery and causes vasoconstriction of the blood vessels. 4. Carbidopa increases the action of levodopa on the renal arteries, increasing renal perfusion.
1. Parkinson's is a decreased amount of dopamine, carbidopa delays the breakdown of levodopa (dopamine) in the periphery so that more levodopa crosses the blood brain barrier and reaches the brain
Which antidiabetic agent is prescribed to decrease insulin resistance? 1. Pioglitazone 2. Acarbose 3. Metformin 4. Glipizide
1. Pioglitizone and rosiglitazone are prescribed to decrease insulin resistance
The client is diagnosed with primary hyperaldosteronism and prescribed the aldosterone agonist spironolactone (Aldactone). Which data supports that the medication is effective? 1. Potassium level is 4.2 mEq /L 2. Urinary output is 30 mL/hr. 3. Blood pressure is 140/96. 4. 4. Serum sodium is 137 mEq/L
1. Potassium level within normal rangw indicates the medication has been effective Hyperaldosteronism causes hypokalemia and spironalactone is a k-sparing diuretic
The client newly diagnosed with a seizure disorder also has type 2 diabetes. The healthcare provider prescribes phenytoin (Dilantin) for the client. Which intervention should the nurse implement? 1. Instruct the client to monitor his or her blood glucose more closely 2. Explain that the Dilantin will not affect the client's antidiabetic medication. 3. Discuss the need to discontinue oral hypoglycemic medication and take insulin. 4. Call the health-care provider to discuss prescribing the Dilantin.
1. Serum glucose should be closely monitored because phenytoin may inhibit insulin release, causing an increased glucose level
Which complication should the nurse assess for in the elderly client newly diagnosed with hypothyroidism who has been prescribed levothyroxine (Synthroid)? 1. Cardiac dysrhythmias 2. Respiratory depression. 3. Paralytic ileus. 4. Thyroid storm.
1. Synthroid precipitates BMR which can precipitate cardiac arrhythmias especially in elderly clients
The nurse is caring for a client diagnosed with a hemorrhagic stroke. Which medication should the nurse question administering? 1. Clopidogrel (Plavix), an antiplatelet. 2. Mannitol (Osmitrol), an osmotic diuretic. 3. Nifedipine (Procardia), a calcium channel blocker. 4. Dexamethasone (Decadron), a glucocorticoid
1. The client has experienced a bleed into the cranium. Plavix interferes with the clotting abilities of the client, therefore it should be held and discussed the the HCP
The client is admitted into the emergency department complaining of profuse salivation, excessive tearing, and diarrhea. The client tells the nurse he had been camping and living off the land. Which medication should the nurse anticipate administering? 1. Atropine 2. Diphenhydramine 3. Magnesium/aluminum hydroxide 4. Pantoprazole
1. The client likely has muscarinic poisoning from eating wild mushrooms, the nurse should administer the antidote, atropine
The client who has been prescribed phenytoin (Dilantin) for epilepsy calls the clinic and reports a measles-like rash. Which intervention should the nurse implement? 1. Instruct the client to come to the clinic immediately 2. Determine if the client is drinking grapefruit juice 3. Encourage the client to apply a hydrocortisone cream to the rash 4. Explain that this is a common side effect of this medication
1. The client should come into the clinic immediately as the rash can progress and the medication should be stopped immediately
The client with increased ICP is receiving Mannitol. Which data would cause the nurse to hold the administration of this medication? 1. The serum osmolality is 330 mOsm/kg 2. The urine osmolality is 550 mOsm/kg 3. The BUN level is 8 mg/dL 4. The creatinine level is 1.8 mg/dL
1. The normal serum osmolality is 275-300 mOm/kg. Mannitol is held if osmolality exceeds 310-320 mOm/kg
The nurse is discussing storage of insulin vials with the client. Which statement indicates the client understands the teaching concerning the storage of insulin? I. "I will keep my unopened vials of insulin in the refrigerator." 2. "I can keep my insulin in the trunk of my car so I will have it at all times." 3. "It is all right to put my unopened insulin vials in the freezer." 4. "If I prefill my insulin syringes, I must use them within 1-2 days."
1. Unopened vials are kept in the refrigerator and once opened can be at room temperature for 1 month. Prefilled syringes kept in the fridge need to be used within 1-2 weeks, not 1-2 days
The nurse administered 25 units of Humulin N to a client with type 1 diabetes at 1600. Which intervention should the nurse implement? 1. Assess the client for hypoglycemia around 1800 2. Ensure the client eats the nighttime (HS) snack. 3. Check the client's serum blood glucose level. 4. Serve the client the supper tray
2. The nurse should ensure the client gets a bedtime snack since Humulin N peaks at 6-8 hours
The client diagnosed with type 1 diabetes is complaining of a dry mouth, extreme thirst and increased urination. Which interventions shoudl thw njrse implement? Select all that apply. 1. Administer one amp of intravenous 50 % glucose 2. Prepare to administer intravenous regular insulin. 3. Inject Humulin N subcutaneously in the abdomen. 4. Hang an intravenous infusion of D5W at a keep open rate. 5. Check the client's blood glucose level via a glucometer.
2 & 5 The client is experiencing DKA, which would be treated with intravenous regular insulin and the clients blood glucose level should be checked
The client diagnosed with Which assessment data supports the client needs to take hypothyroidism is prescribed levothyroxine (Synthroid). more medication? Select all that apply. 1. The client has a 2-kg weight loss. 2. The client complains of being too cold. 3. The client has exophthalmos. 4. The client's radial pulse rate is 90 bpm. 5. The client complains of being constipated.
2 & 5 Client reporting being cold and constipated indicates hypothyroidism and the clieny will need more thyroid hormone
The female client has secondary adrenal insufficiency and is prescribed adrenocorticotrophic hormone ACTH. Which information should the nurse discuss with client? 1. Explain ACTH will increase metabolism. 2. Instruct the client to limit dietary salt. 3. Inform the client that an increase in growth may occur. 4. Tell the client that normal menses is expected
2. The patient should decrease salt intake, this medication causes Na absorption and causes edema
Which antidiabetic agent is used to slow the digestion of carbohydrates in the small intestine? 1. Pioglitizone 2. Acarbose 3. Metformin 4. Glipizide
2. Acarbose is administered to allow carbohydrates to pass slowly through the intestine
The client diagnosed with hyperthyroidism is prescribed the antithyroid medication propylthiouracil (PTU). Which statement by the client warrants immediate intervention by the nurse? 1. "I seem to be drowsy and sleepy all the time." 2. "I have a sore throat and have had a fever." 3. "I have gained 2 pounds since I started taking PTU." 4. "Since taking PTU I am not as hot as I used to be."
2. Antithyroid medication may effect the bodys immune system and the nurse shoukd intervene if there are any signs of infection such as malaise, sore throat, fever, chills, or weakness
Which statement is the scientific rationale for prescribing and administering donepezil (Aricept), a cholinesterase inhibitor? I. Aricept works to bind the dopamine at neuron receptor sites to increase ability. 2. Aricept increases the availability of acetylcholine at cholinergic synapses. 3. Aricept decreases acetylcholine in the periphery to increase movement. 4. Aricept delays transmission of acetylcholine at the neuronal junction.
2. Cholinesterase inhibitors increase the availability of ACh at cholinergic synapses resulting in increased transmission of ACh by cholinergic neurons that havent already been destroyed by the alzheimers disease
Which data should the nurse assess for the client with a seizure disorder who is taking valproic acid (Depakote)? 1. Creatinine and BUN. 2. White blood cell count. 3. Liver enzymes 4. Red blood cell count.
3. Liver enzymes should be monitored since valproic acid is hepatotoxic
The client diagnosed with Parkinson's disease is prescribed the antiviral drug amantadine (Symmetrel). Which information should the nurse teach the client? I. Do not get the flu vaccine because there may be interactions. 2. If the symptoms return, the client should notify the HCP. 3. The dose should be decreased if taking other PD medications. 4. If a dry mouth develops, discontinue the medication immediately.
2. Effectiveness may deminish in 3-6 months, the client should notify the HCP of the s/s of parkinsons returns
6. The client with a head injury is ordered a CT scan of the head with contrast dye. Which statements by the client warrant immediate intervention? Select all that apply. 1. "I take Tenormin for my high blood pressure." 2. "I am allergic to many types of fish." 3. "I get nauseated whenever I take aspirin." 4. "I am taking Glucophage for my diabetes." 5. "I had about three beers before I fell and hit my head."
2. Iodine allergy is a contraindication 4. contrast dye can increase metformin levels due to damaged kidneys
The male client diagnosed with urinary retention is receiving bethanechol, a muscarinic agonist. Which intervention should the nurse implement? l. Limit the client's fluid intake to 1000 mL daily. 2. Have the client's urinal readily available. 3. Maintain hourly intake and output for the client. 4. Monitor the client's serum creatinine level.
2. Since this medication relaxes the urinary sphincters and increases voidong pressure by contracting the detrussor bladder muscle, the client will need the urinal available for frequent urination
9. The client with increased ICP receiving mannitol. Which intervention should the nurse implement to evaluate the effectiveness of the medication? 1. Monitor the client's vital signs. 2. Maintain strict intake and output. 3. Assess the client's neurological status 4. Check the client's serum osmolality level.
3. Mannitol is administeres to decrease ICP, changes to ICP affect neurological status, which should be ordered to evaluate medication effectiveness
The following clients have a head injury. Which clients should the nurse question administering the osmotic diuretic mannitol (Osmitro)? Select all that apply. 1. The 34-year-old client who is HIV-positive. 2. The 84-year-old client who has glaucoma. 3. The 68-year-old client who has cor pulmonale. 4. The 16-year-old client who has cystic fibrosis. 5. The 58-year-old with congestive heart failure.
3 & 5 Fluid overload is a side effect of mannitol. Cor pulmonale is right-sided heart failure s/t COPD and a CHF pt would not be able to handle the fluid overload
The client diagnosed with type 2 diabetes is receiving the combination oral antidiabetic medication glyburide/metformin (Glucovance). Which data indicates the medication is effective? 1. The client's skin turgor is elastic. 2. The client's urine ketones are negative. 3. The serum blood glucose level is 118 mg/dL 4. The client's glucometer level is 170 mg/dL
3. A level of 118 is close to normal (70-110) so this would indicate the medication is effective
The nurse is preparing to administer medications to the following clients. Which medication should the nurse question administering? 1. Furosemide to a client with a serum potassium level of 4.2 mEq/L 2. Mannitol to a client with a serum osmolality of 280 mOsm/kg. 3. Digoxin to a client with a digoxin level of 2.4 mg/dL 4. Phenytoin to a client with Dilantin level of 14 pg/mL
3. A normal digoxin level is 0.8-2.0mg/dL.
Which assessment data best indicates the client with type 1 diabetes is adhering to the medical treatment regimen? 1. The client's fasting blood glucose is 100 mg/dL 2. The client's urine specimen has no ketones 3. The client 's glycosylated hemoglobin is 5.8 % 4. The client's glucometer reading is 120 mg/dL.
3. An A1C of 5.8 is close to normal range (4.0-5.5% for blood glucose average of 70-110) and best indicates compliance
Which client diagnosed with Parkinson's disease should the nurse question administering the benztropine (Cogentin)? 1. The client diagnosed with congestive heart failure. 2. The client who has had a myocardial infarction. 3. The client diagnosed with glaucoma 4. The client who is undergoing hip replacement surgery.
3. Anticholinergics may precipitate or aggrevate glaucoma
The older adult client diagnosed with Parkinson's disease (PD) has been prescribed carbidopa/levodopa (Sinemet). Which data indicates the medication is effective? 1. The client has cogwheel motion when swinging the arms. 2. The client does not display emotions when discussing the illness. 3. The client is able to walk upright without stumbling. 4. The client eats 30 %-40 % of meals within 1 hour .
3. Being able to walk upright without stumbling indicates the medication has been effective
The client with type 2 diabetes is prescribed exenatide (BYETTA), a subcutaneous antidiabetic medication. Which information should the nurse discuss with the client? 1. Keep the BYETTA pen at room temperature after opening the pen 2. Instruct the client to notify the health-care provider if nauseated. 3. Tell the client to take the medication 1 hour before the morning and evening meals. 4. Explain that this medication is a type of regular-acting insulin.
3. Byetta is injected twice a day at any time within 1 hour of the clients morning and evening meal
The client diagnosed with a pituitary tumor has the pituitary hormone vasopressin (DDAVP) ordered. Which statement by the client indicates the medication is effective? 1. "My headaches are much better since I have been on this medication." 2. "My nasal drainage was initially worse, but now I don't have any." 3. "I am not so thirsty when I take this medication 4. "My seizures have been eliminated."
3. Lack of thirst indicted the medication has been effective. DDAVP is a synthetic form of the an- tidiuretic hormone vasopressin. With- out vasopressin, the body does not conserve water and a large amount of dilute urine is excreted. The body very will attempt to have the client replace the fluid by producing the symptom of extreme thirst.
The 10-year-old male client is receiving the growth hormone somatropin. Which signs or symptoms warrant intervention by the nurse? 1. A 3-cm increase in height. 2. A moon face and buffalo hump 3. Polyuria, polydipsia, and polyphagia. 4. T 99.4°E, P 108, R 22, and BP 121/70.
3. Growth hormones increase glucose levels, so the 3Ps should be reported
The client presents to the emergency department complaining of a migraine headache. The health-care provider prescribes sumatriptan (Imitrex), a serotonin receptor agonist. When the nurse enters the room to administer the medication, the client is laughing with his or her significant other. Which intervention should the nurse implement? 1. Notify the health-care provider of the clients drug-seeking behavior. 2. Ask the client how bad is the headache if he or she is able to laugh 3. Administer the medication after checking for allergies and the ID bracelet. 4. Discharge the client and recommend taking over-the-counter medication.
3. Pain is what the patient says it is, the nurse should check 2 patient identifiers and the allergy band before administering medications
The client diagnosed type 2 diabetes is prescribed Glipzide, a sulfonylurea. Which statement by the client warrents intervention by the nurse ? 1. "I have to eat my diabetic diet even if I am taking this medication." 2. "I will need to check my blood glucose level atleast once a day" 3. "I usually have one glass of wine with my evening meal. 4. "I do not like to walk every day, but I will if it will help my diabetes."
3. Sulfonylureas and biguanides may cause an antabuse-like reaction when taken with alcohol, causing nausea and vomiting. The client should avoid alcohol and OTCs containing alcohol as well (such as mouth wash)
The nurse is discussing the thyroid hormone levothyroxine (Synthroid) with a client diagnosed with hypothyroidism. Which intervention should be included in the client teaching? 1. Discuss the importance of not using iodized salt. 2. Explain the importance of not taking medication with grapefruit juice. 3. Instruct the client to take the medication in the morning. 4. Teach the client to monitor daily glucose levels.
3. The client should take the medication in the morning Iodine increases thyroid hormone production; glucose levels are not effected by thyroid hormones; grapefruit juice is not contraindicated with thyroid hormone therapy
The client is undergoing electroconvulsive therapy for major depression and is receiving Tubocurarine, a nondepolarizing neuromuscular blocker. Which data warrents immediate intervention by the nurse? 1. Apical pulse of 58 2. Oral temp 99.8 3. Respiratory rate of 10 4. Bp of 110/70
3. The primary effect of tubocurarine is skeletal muscle relaxation and to priduce a state of flaccid paralysis. Respiratory muscle paralysis can cause reapiratory arrest and is the immediatw concern of the nurse
The nurse is teaching a client with newly diagnosed type 1 diabetes about insulin ther- apy. Which statements indicate the client needs more teaching concerning insulin therapy? Select all that apply. 1. "If I have a headache or start getting nervous, I will drink some orange juice." 2. "If I pass out at home, a family member should give me a glucagon injection." 3. "Because I am taking my insulin daily I do not have to adhere to a diabetic diet." 4. "I will check my blood glucose with my glucometer at least once a day." 5. "I should administer my insulin in my abdomen for best absorption."
3. This statement indicates the client needs more teaching
The client with a seizure disorder is prescribed the anticonvulsant phenytoin (Dilantin). Which statement indicates the client understands the medication teaching? 1. "If my urine turns a reddish-brown color, I should call my doctor." 2."I should take my medication on an empty stomach." 3. "I will use a soft-bristled toothbrush to brush my teeth." 4. "I may get a sore throat when taking this medication."
3. Using a soft bristled toothbrush will prevent gum irritation as gingival hyperplasia is a side effect of dilantin
Which antidiabetic agents mechanism of action includes stimilating pancreatic beta cells to release more insulin into the bloodstream? 1. Metformin 2. Acarbose 3. Rosiglitazone 4. Meglitinide
4. Meglitinide and sulfonylureas are prescribed to stimulate the beta cells to release more insulin into the blood stream
The client with type 2 diabetes is admitted into the unit with a wound on the left leg that will not heal. The HCP prescribes sliding-scale insulin. The client tells the nurse, "I don't want to have to take shots. I take pills at home." Which statement is the nurse's best response? 1. "If you can't keep your glucose under control with pills, you must take insulin." 2. "You should discuss the insulin order with your HCP because you don't want to take it." 3. "You are worried about having to take insulin. I will sit down and we can talk." 4. " During illness you may need to take insulin to keep your blood glucose level down."
4. Blood glucose levels elevate during times of stress, surgery, or serious infection so a type two diabetic may need temporarily to take insulin to manage blood glucose levels
Which statement is an advantage of administering a COMT inhibitor, Entacapone (Comtan), to a client diagnosed with Parkinson's disease? 1. Comtan increases the vasodilating effect of levodopa. 2. Levodopa can be discontinued while the client is taking Comtan. 3. There are no side effects of the drug to interfere with treatment. 4. Comtan causes blood levels of levodopa to be smoother and more sustained.
4. Comtan increases the half life of levodopa by 50-70% , leading to smoother levodopa blood levels and delays the "off" effects while prolonging the "on" effects of levodopa
The client diagnosed with Parkinson's disease has been taking amantadine (Symmetrel), an antiparkinsonian drug. The home health nurse notes a new finding of mottled discoloration of the skin. Which intervention should the nurse implement? 1. Ask the client if he or she has changed soap products. 2. Prepare the significant other for the client's imminent death 3. Notify the health-care provider to discontinue the medication. 4. Explain that this is expected and document the finding.
4. Explain that this is an expected finding for clients taking amantadine for over 1 month, but is not a reason to discontinue the medication if it is still effective. Effectiveness begins to wear off around 3-6 months
The 8-year-old male client has been determined to have a benign brain tumor in the anterior pituitary gland. Surgery has resulted in an inadequate production of growth hormone (GH). The nurse is teaching the parents about GH therapy. Which statemert indicates the parent understands the medication? 1. "If I give too much, then my child will grow to be a giant." 2. "After a few months I can taper my child off the GH." 3. "If I don't give the hormone, my child will become retarded." 4. "I should monitor my child's blood glucose levels.
4. GH can cause hyperglycemia
Which statement best describes the pharmacodynamics of insulin 1. Insulin causes the pancreas to secrete glucose into the bloodstream 2. Insulin is metabolized by the liver and muscle and excreted in the urine. 3. Insulin is needed maintain colloidal osmotic pressure in the bloodstream 4. Insulin lowers blood glucose by promoting use of glucose in the body cells.
4. Insulin lowers blood glucose levels by promoting the use of glucose by the cells
The client newly diagnosed with type 2 diabetes who has been prescribed an oral hypoglycemic medication calls the clinic and tells the nurse that the sclera has a yellow color. Which intervention should the clinic nurse implement? 1. Ask the client if he or she has been exposed to someone with hepatitis. 2. Determine if the client has a history of alcohol use or is currently drinking alcohol. 3. Check to see if the client is taking the cardiac glycoside digoxin. 4. Make an appointment for the client to come to the healthcare provider's office.
4. Oral hypogylcemics are metabolized in the liver and could cause elevated liver enzymes. The client should report signs of yellow skin or sclera, pale stools or dark urine to the HCP
The nurse is discussing the thyroid hormone levothyroxine (Synthroid) with the client diagnosed with hypothyroidism. Which intervention should the nurse discuss with the client? 1. Encourage the client to decrease the fiber in the diet. 2. Discuss the need to monitor the T3, T4 levels daily. 3. Tell the client to take the medication with food only 4. Instruct the client to report any significant weight changes.
4. The clients weight should be monitored weekly as weight changes help to determine the effectiveness of the therapy
The client with a head injury is experiencing increased ICP. The neurosurgeon prescribes Mannitol. Which intervention should the nurse implement when administering this medication? 1. Monitor the client's arterial blood gases during administration 2. Do not administer if the client's blood pressure is less than 90/60. 3. Ensure that the client's cardiac status is monitored by telemetry. 4. Use a filter needle when administering the medication.
4. The nurse must use a filter needle when administering mannitol because crystals may form in the solution and syringe and be inadvertently injected into the client if a filter needle is not used.
The client with hyperthyroidism is prescribed the thioamide propylthiouracil (PTU). Which laboratory data should the nurse monitor? 1. Arterial blood gases. 2. Serum potassium level. 3. Red blood cell (RBC) count. 4. White blood cell (WBC) count.
4. WBC count Patients taking PKU are at risk for developing agranulocytosis, putting them at a greater risk for infection
Which would the nurse expect to administer to a patient experiencing symptomatic sinus bradycardia? A. Atropine B. Belladonna C. Digoxin D. Propranolol
A. Atropine is the drug of choice to treat symptomatic sinus bradycardia.
Which food should the patient taking an MAO inhibitor avoid? A. Cheese B. Apples C. Carrots D. Beer
A. Cheese Tyramine-rich foods include red wine, aged cheese, smoked meats, and fava beans
Which drug does the nurse recognize as a catecholamine? A. Dopamine B. Albuterol C. Prazosin D. Labetalol
A. Dopamine Dopamine is a catecholamine.
Desflurane is which type of anesthetic? A. General B. Local C. Topical D. IV
A. General administered by inhalation.
An 11-year-old patient develops myoclonic seizures. Which potential adverse reaction makes it unlikely that valproic acid will be prescribed for this patient? A. Liver toxicity B. CNS sedation C. Respiratory depression D. Hyperthermia
A. Liver toxicity When administered to children and patients taking other anticonvulsants, valproic acid carries a risk of potentially fatal liver toxicity.
Which benzodiazepine is used primarily to treat anxiety A. Lorazepam B. Estazolam C. Triazolam D. Flurazepam
A. Lorazepam
Which adverse reaction is a patient most likely to experience after receiving general anesthesia for surgery? A. Nausea and vomiting B. Seizures C. Cyanosis D. Increased heart rate
A. Nausea and vomiting
Which medication interacts with allopurinol? A. Oral anticoagulants B. Antihistamines C. Cardiac glycosides D. Antidiabetic agents
A. Oral anticoagulants
Urinary tract antispasmodics are used to treat: A. overactive bladder. B. erectile dysfunction. C. hypertension. D. seizures.
A. Overactive bladder
What's an adverse reaction to aminoglycosides? A. Peripheral nerve toxicity B. Cardiotoxicity C. Hepatotoxicity D. Toxic megacolon
A. Peripheral nerve toxicity Also- ototoxicity and renal toxicity
Which type of insulin would the nurse expect to administer to a patient with DKA? A. Regular B. Intermediate-acting C. Long-acting D. Ultra-long-acting
A. Regular Use regular insulin in a patient with circulatory collapse DKA, or hyperkalemia
Potassium should be used cautiously in patients receiving: A. Spironolactone B. furosemide C. digoxin D. cetirizine
A. Spironalactone a potassium-sparing diuretic
Which administration method for parenteral iron helps avoid leakage into subcutaneous tissue? A. Z-track method B. IM injection into the deltoid C. Subcutaneous injection D. Intradermal injection
A. Z-track method
The effectiveness of levodopa can be reduced when taking: A. pyridoxine. B. amantadine. C. bromocriptine. D. topiramate.
A. pyridoxine. Levodopa's effectiveness can be reduced when taking pyridoxine (vitamin B6), phenytoin, and benzodiazepines
Which assessment finding indicates that a patient is having an adverse reaction to catecholamines? A. Diarrhea B. Palpitations C. Nausea and vomiting D. Decreased glucose levels
B. Palpitations Adverse reactions to catecholamines include palpitations, restlessness, anxiety, dizziness, headache, cardiac arrhythmias, hypotension, hypertension and hypertensive crisis, stroke, angina, and increased glucose levels.
The client diagnosed with hyperthyroidism is prescribed an antithyroid medication. Which interventions should the nurse implement? Select all that apply. 1. Monitor the client's thyroid function tests. 2. Monitor the client's weight weekly. 3. Monitor the client for gastrointestinal distress. 4. Monitor the client's vital signs. intolerance 5. Monitor the client for activity
All of the above Thyroid function tests determine drug effectiveness; weight gain is expected with a slower metabolism; can cause changes in BP and N/V; causes catabolism, increased metabolism and overactivity leading to exhaustion
A 15-year-old patient has a tonic-clonic seizure disorder and is prescribed phenytoin. Which term best describes the absorption rate of oral phenytoin? A. Rapid B. Slow C. Erratic D. Moderate
B. Slow Phenytoin is absorbed slowly through the GI tract. It's absorbed much more rapidly when administered IV.
A topical anesthetic can be used: A. as a general elderly or debilitated patient. B. to numb a mucosal surface before tube insertion. C. when anesthesia is needed for only a short period. D. to prevent or relieve muscle pain in a specific area.
B. to numb a mucosal surface before tube insertion. as well as relieve or prevent pain, relieve itching and irritation, anesthetize an area for injection, and alleviate throat or mouth pain.
When teaching a patient about diuretics, you should tell the patient to: A. take the drug in the evening B. call the practitioner if losing more than 2 lb (0.9 kg) per day C. eat a high-sodium diet D. avoid sun exposure for several hours afer taking the medication to prevent a photosensitivity reaction
B. A weight loss of more than 2 lb (0.9 kg) per day indicates excessive diuresis.
Which implementation step is appropriate for a patient who's taking zidovudine for an HIV infection? A. Anticipate the need for dosage adjustment for impaired hepatic function B. Administer the drug every 4 hours, around the clock C. Administer one dose daily D. Monitor the patient's cardiac status.
B. Administer the drug every 4 hours , around the clock Zidovudine is usually administered over 1 hour at a constant rate and is given every 4 hours around the clock.
Which drug can cause hypokalemia? A. Digoxin B. Amphotericin B C. Spironolactone D. Lansoprazole
B. Amphotericin B
Which food should the patient receiving antitubercular therapy avoid? A. Red wine B. Chocolate C. Coffee D. Eggs
B. Chocolate Patients taking antitubercular therapy should avoid fish (such as tuna) and tyramine (aged cheese, beer and chocolate)
The drug commonly prescribed to treat an opioid overdose is: A. butorphanol B. naloxone C. pentazocine D. nalbuphine
B. Naloxone
What are the most common adverse reactions to aspirin? A. Increased rate and depth of respirations B. Nausea, vomiting, and GI distress C. Dizziness and vision changes D. Bladder infection
B. Nausea, vomiting, and GI distress
Which test should the nurse check in her assessment of a patien receiving heparin? A. Complete blood count B. PTT C. Arterial blood gas levels D. Hemoglobin level
B. PTT
Which noncatecholamine does the nurse recognize as being dual-acting? A. Albuterol B. Isoetharine C. Ephedrine D. Terbutaline
C. Ephedrine is a dual-acting noncatecholamine.
The nurse is monitoring a patient receiving prednisone for which adverse reaction should the nurse monitor the patient? A. Somnolence B. Hyperglycemia C. Hyperkalemia D. Hypercalcemia
C. Hyperglycemia Endocrine system reactions may include decreased glucose tolerance, resulting in hyperglycemia
How does the topical anesthetic benzocaine relieve sunburn pain? A. It numbs the skin surface, decreasing the perception of pain. B. It freezes the skin, which prevents nerve impulse transmission. C. It blocks nerve impulse transmission by preventing nerve cell depolarization. D. It occupies sites on specialized receptors, modifying the release of neurotransmitters.
C. It blocks nerve impulse transmission by preventing cell depolarization. thus blocking nerve impulse transmission and relieving pain.
Calcium gluconate is given to reverse respiratory depression caused by the administration of which drug? A. Potassium B. Calcium C. Magnesium sulfate D. Sodium bicarbonate
C. Magnesium Sulfate
When caring for a patient taking hydrochlorothiazide, you should monitor the patient for: A. hypertension. B. hypernatremia. C. hypokalemia D. hypoglycemia.
C. hypokalemia
Anticonvulsants fall into several major classes, including: A. anticholinergics B. fluoroquinolones C. succinimides D. dopaminergics
C. succinimides Major classes of anticonvulsants include succinimides, hydantoins, barbiturates, benzodiazepines, and sulfonamides
What's the most common adverse reaction experienced with IV antiplatelet drugs? A. Nausea B. Joint pain C. Headache D. Bleeding
D. Bleeding
Which drug causes toxicity in a patient taking a beta-adrenergic blocker? A. An antacid B. Rifampin C. An NSAID D. Digoxin
D. Digoxin Increased effects or toxicity can occur when digoxin, calcium channel blockers (primarily verapamil), and cimetidine are taken with beta-adrenergic blockers.
Which adverse reaction is common in the patient taking buspirone? A. Nausea B. Diarrhea C. Constipation D. Headache
D. Headache Common reactions include headache, dizziness, light-headedness, insomnia, rapid heart rate, and palpitations
Which effect does the nurse expect may occur when using cholinergic agonists? A. Dry mouth B. Tachycardia C. Pupil dilation D. Increased bladder tone
D. Increased bladder tone Effects of cholinergic agonists include increased tone and contraction of bladder muscles, salivation, bradycardia, dilated blood vessels, constricted pulmonary bronchioles, increased activity of the GI tract, and constricted pupils
The mechanisms of drug actions is called: A. pharmacokinetics B. pharmacotherapeutics C. transport. D. pharmacodynamics.
D. Pharmacodynamics is the biochemical and physical ef- fects of drugs and the mechanisms of drug actions.
4. How does sodium bicarbonate correct metabolic acidosis? A. It lowers blood pH after being metabolized. B. It increases hydrogen ion concentration. C. It combines with hydrogen ions to alkalinize the blood. D. It decreases hydrogen ion concentration.
D. Sodium bicarbonate corrects acidosis by decreasing hydrogen ion concentration.
Which drug or drug type would likely cause hyperglycemia if taken with glyburides A. Procainamide B. Cimetidine C. Warfarin D. Thiazide diuretics
D. Thiazide diuretics Hyperglycemia may occur if glyburide is taken with a thiazide diuretic
When teaching a patient how to take hormonal contraceptives which of the following instructions should you give? A. Take the drug in the morning. B. If you miss a dose, skip it and take it the next day. C. If you miss one menstrual period, stop taking the drug and take a pregnancy test D. Use an addlitional form of birth control if you're taking certain antibiotics.
D. Use an addlitional form of birth control if you're taking certain antibiotics.
Before administering buprenorphine hydrochloride, the nurse asks a patient if he has used opioids. Administering a mixed opioid agonist-antagonist to a patient dependent on opioid agonists may cause which reaction? A. Hypersensitivity reaction B. Constipation C. Urinary incontinence D. Withdrawal symptoms
D. Withdrawal symptoms They can counteract the effects of opioid agonists, mixed opioid agonist-antagonists can cause withdrawal symptoms in the patient who's dependent on opioid agonists.
Barbiturate anticonvulsants effective in treating all of these seizure types except: A. partial seizures. B. tonic-clonic seizures. C. febrile seizures . D. absence seizures.
D. absence seizures. Barbiturate anticonvulsants are effective in treating partial, tonic-clonic, and febrile seizures. They're an ineffective treatment for absence seizures.
