PHARM QUIZLETS COMBINED (all material)

A nurse is teaching a group of nursing students about drug abuse. Which statement by a student indicates a need for further teaching?

"Patients who experience physical dependence will show compulsive drug-seeking behavior."

The nurse is teaching a nursing student about management of controlled substances in medication administration. Which statement by the nursing student indicates understanding of the teaching?

"Prescriptions for drugs in Schedules III and IV may be written to include up to 5 refills."

A nursing student is caring for a patient who is addicted to several drugs. The student tells the nurse that the patient "got this way on purpose." Which response by the nurse is most appropriate?

"Some individuals are more vulnerable to drug abuse than others."

A postoperative patient is being discharged home with acetaminophen for pain. the patient asks the nurse about using Tylenol for fever. Which statement by the nurse is correct?

"Taking the two medications together poses a risk for drug toxicity"

6. The prescriber orders 20 mg of hydrocortisone orally once each day. The nurse will make sure the drug is scheduled to be administered at what time?

0800 AM

A patient with severe glucocorticoid-induced osteoporosis will start therapy with teriparatide [Forteo]. What will the nurse expect to administer?

20 mcg once daily subQ

9. A nurse is caring for a woman during the perinatal and postnatal period. To stop postpartum hemorrhage, how will the nurse administer oxytocin [Pitocin] to this patient?

20 units in 1000mL of IV solution after delivery of the placenta

13. A patient received 500 mg of azithromycin [Zithromax] at 0800 as a first dose. What are the usual amount and time of the second dose of azithromycin?

250 mg at 0800 the next day

6. A patient is admitted to the unit for treatment for an infection. The patient receives IV amikacin [Amikin] twice a day. When planning for obtaining a peak aminoglycoside level, when should the nurse see that the blood is drawn?

30 minutes after the IV infusion is complete

10. A patient tells a nurse that she is thinking about getting pregnant and asks about nutritional supplements. What will the nurse recommend?

400 to 800 mg of folic acid per day

A child will receive 750mg of an antibiotic for 10 days. The child attends day care. The drug may be dosed in several ways and is available in two concentrations. Which dosing regimen will the nurse discuss with the child's provider?

500mg/5mL - 375mg PO twice daily

An adult male patient is 1 day postoperative from a total hip replacement. On a pain scale of 0 to 10, with 10 being the greatest pain, the patient reports a pain level of 10. Which medication would be most appropriate for the nurse to administer to this patient?

6 mg morphine sulfate IV

A 55-year-old female patient asks a nurse about calcium supplements. The nurse learns that the patient consumes two servings of dairy products each day. The patient's serum calcium level is 9.5 mg/dL. The serum vitamin D level is 18 ng/mL. The nurse will recommend adding ____ daily and ____ IU of vitamin D3 each day.

600 mg of Ca once; 10,000

16. A patient is receiving tobramycin 3 times daily. The provider has ordered a trough level with the 8:00 AM dose. The nurse will ensure that the level is drawn at what time?

7:45

A provider has written an order for a medication: drug A 100 mg PO every 6 hours. The half-life for the drug is approximately 6 hours. The nurse is preparing to administer the first dose at 8:00 AM on Tuesday. On Wednesday, when will the serum drug level reach plateau?

8:00 AM

4. A young, nonpregnant female patient with a history of a previous urinary tract infection is experiencing dysuria, urinary urgency and frequency, and suprapubic pain of 3 days' duration. She is afebrile. A urine culture is positive for more than 100,000/mL of urine. The nurse caring for this patient knows that which treatment is most effective?

A 3 day course of trimethoprim/sulfamethoxazole (Bactrim)

A nurse is preparing to administer medications. Which patient would the nurse consider to have the greatest predisposition to an adverse reaction?

A 30 y/o man with kidney disease

Which patient should receive dantrolene [Dantrium] with caution?

A 55 y/o woman with multiple sclerosis

A nurse is caring for four patients. The nurse would be concerned about which patient developing a substance use disorder?

A patient whose history indicates the use of prescription narcotic analgesics for back and headache pain

8. Which patient should begin treatment for tuberculosis?

A recent immigrant from a country with a high prevalence of TB with a 10 mm region of induration

4. A patient who recently started therapy with an HMG-COA reductase inhibitor asks the nurse, "How long will it take until I see an effect on my LDL cholesterol?" The nurse gives which correct answer?

A reduction usually is seen within 2 weeks

A pregnant patient in active labor is admitted to the ED. a toxicology screen and a physical assessment reveal that the patient is an active heroin addict. The nurse who cares for the neonate after delivery should anticipate which clinical manifestation?

A shrill cry and irritability

A patient is given a drug for the first time and develops SOB. The patient's HR is 76, RR is 20, and BP is 120/70; the nurse checks the drug administration manual to make sure the correct dose was given and learns that some patients taking the drug experience SOB. The nurse will contact the provider to report what?

A side effect

1. A patient has had blood pressures of 150/95 mm Hg and 148/90 mm Hg on two separate office visits. The patient reports a blood pressure of 145/92 mm Hg taken in an ambulatory setting. The patient's diagnostic tests are all normal. The nurse will expect this patient's provider to order:

A thiazide diuretic

1. A nurse is caring for a patient who is receiving verapamil [Calan] for hypertension and digoxin [Lanoxin] for heart failure. The nurse will observe this patient for:

AV blockade

7. A patient will be discharged home to complete treatment with intravenous cefotetan with the assistance of a home nurse. The home care nurse will include which instruction when teaching the patient about this drug treatment?

Abstain from alcohol consumption during therapy

13. A patient who is taking gentamicin and a cephalosporin for a postoperative infection requests medication for mild postsurgical pain. The nurse will expect to administer which of the following medications?

Acetaminophen

A patient who is an active alcoholic is admitted to the hospital for surgery. The nurse reviewing orders for this patient would be correct to question which postoperative medication for this patient?

Acetaminophen

A patient is being treated with interferon beta-1a [Avonex] for relapsing-remitting MS. The patient calls the clinic to report headache, fever, chills, and muscle aches after administering a dose. What will the nurse recommend?

Acetaminophen or ibuprofen

15. The nurse is preparing to administer amphotericin B intravenously. The nurse will expect to pretreat the patient with which medications?

Acetaminophen, diphenhydramine, and meperidine

6. An adolescent is brought to the emergency department by a parent who reports that the patient took a whole bottle of extended-release acetaminophen tablets somewhere between 8 and 10 hours ago. The nurse will anticipate administering which of the following?

Acetylcysteine (Mucomyst)

10. A patient complains of painful urination. A physical examination reveals vesicles on her labia, vagina, and the foreskin of her clitoris. The nurse will expect to teach this patient about which medication?

Acyclovir (Zovirax)

A nurse is teaching a group of students how the CNS adapts to psychotherapeutic medications. Which statement by a nursing student indicates a need for further teaching?

Adaptation results in an increased sensitivity to side effects over time

6. A patient who is receiving intravenous ciprofloxacin for pneumonia develops diarrhea. A stool culture is positive for Clostridium difficile. The nurse will expect the provider to:

Add metronidazole (Flagyl)

A postoperative patient has orders for morphine sulfate 1 to 2 mg IV every hour PRN for severe pain and acetaminophen-hydrocodone (Lortab) 7.5 mg PO every 4-6 hours PRN for moderate pain. The patient reports pain at a level of 8. Which action by the nurse is appropriate?

Administer morphine sulfate 2 mg IV and evaluate the patient's pain in 15-30 minutes

6. A prescriber has ordered cefoxitin for a patient who has an infection caused by a gram-negative bacteria. The nurse taking the medication history learns that the patient experienced a maculopapular rash when taking amoxicillin [Amoxil] several years earlier. What will the nurse do?

Administer the cefoxitin and observe for any side effects

A nurse is preparing to administer medications to a hospitalized patient who has been taking lithium [Lithobid] for 3 days. The patient is complaining of mild nausea and abdominal bloating. The patient's lithium level is 0.8 mEq/L. What will the nurse do?

Administer the dose and tell the patient that the side effects are temporary

A patient is given a new medication and reports nausea within an hour after taking the drug. The nurse consults the drug information manual and learns that nausea is not an expected adverse effect. When the next dose is due, what will the nurse do?

Administer the drug and tell the patient to report further nausea

10. A patient has a systemic candidal infection, and the provider has ordered oral fluconazole [Diflucan] 400 mg on day 1 and 200 mg once daily thereafter. What will the nurse do?

Administer the drug as ordered

9. A patient with stable exertional angina has been receiving a beta blocker. Before giving the drug, the nurse notes a resting heart rate of 55 beats per minute. Which is an appropriate nursing action?

Administer the drug as ordered, because this is a desired effect

1. A patient with renal failure is undergoing chronic hemodialysis. The patient's hemoglobin is 10.6 gm/dL. The provider orders sodium-ferric gluconate complex (SFGC [Ferrlecit]). What will the nurse expect to do?

Administer the drug intravenously with erythropoietin

5. A provider has ordered ceftriaxone 4 gm once daily for a patient with renal impairment. What will the nurse do?

Administer the medication as prescribed

1. A patient is taking oral ketoconazole [Nizoral] for a systemic fungal infection. The nurse reviews the medication administration record and notes that the patient is also taking omeprazole [Prilosec] for reflux disease. What action should the nurse take?

Administer the omeprazole at least 2 hours after the ktoconazole

5. A patient who took an overdose of verapamil has been treated with gastric lavage and a cathartic. The emergency department nurse assesses the patient and notes a heart rate of 50 beats per minute and a blood pressure of 90/50 mm Hg. The nurse will anticipate:

Administering IV norepinephrine and atropine and glucagon

A patient with PD is taking Levodopa/carbidopa and reports occasional periods of loss of drug effect lasting from minutes to several hours. The nurse questions the patient further and discovers that these episodes occur at different times related to the medication administration. The nurse will contact the provider to discuss

Administering a catechol-O-methyltransferase (COMT) inhibitor, such as entacapone

9. A nurse is caring for a patient who has been taking low-dose aspirin for several days. The nurse notes that the patient has copious amounts of watery nasal secretions and an urticarial rash. The nurse will contact the provider to discuss:

Administering epinephrine

6. A patient who takes warfarin [Coumadin] is brought to the emergency department after accidentally taking too much warfarin. The patient's heart rate is 78 beats per minute and the blood pressure is 120/80 mm Hg. A dipstick urinalysis is normal. The patient does not have any obvious hematoma or petechiae and does not complain of pain. The nurse will anticipate an order for:

A PT and an INR

2. An infertile patient has received two 5-day courses of clomiphene [Clomid] to help her conceive. An ultrasound 1 week after the last dose reveals that follicular maturation has occurred without ovulation. The nurse expects the next step for this patient to be:

Administration of human chorionic gonadotropin (Hcg)

A patient with bipolar disorder has been taking lithium [Lithobid] for several years. The patient has developed a goiter, and serum tests reveal hypothyroidism. What will the nurse expect the provider to order for this patient?

Administration of levothyroxine

5. A patient has received two doses of dinoprostone [Prepidil] to initiate labor. It has been 6 hours since the last dose. The nurse assesses the patient and notes that the cervix is ripe and dilated to 4 cm, but contractions are diminishing in intensity and frequency. What will the nurse expect to do?

Adminsiter oxytocin

A nursing student asks why albuterol, which is selective for beta-2 receptors, causes an increased HR in some patients. How should the nurse respond?

Adrenergic agonists can lose their selectivity when given at higher doses.

A nurse is caring for an older adult man who has Alzheimer's disease (AD). The patient's daughter wants to know if testing can be done to determine her risk for developing the disease. What will the nurse tell her?

Advancing age and family history are known risk factors

6. A child with moderate hemophilia A who weighs 20 kg is admitted to the hospital after a knee injury with bleeding into the joint. The nurse will expect the provider to order which medication?

Advate 400 units IV over 10 minutes

6. A patient with hypertension is admitted to the hospital. On admission the patient's heart rate is 72 beats per minute, and the blood pressure is 140/95 mm Hg. After administering an antihypertensive medication, the nurse notes a heart rate of 85 beats per minute and a blood pressure of 130/80 mm Hg. What does the nurse expect to occur?

A decrease in the heart rate back to baseline in 1-2 days

13. A patient who has recently immigrated to the United States from an impoverished country appears malnourished. The patient's folic acid levels are low, and the vitamin B12 levels are normal. The nurse expects this patient's treatment to include:

A diet high in folic acid

A nurse is caring for a woman with breast cancer who is receiving tamoxifen. A review of this patient's chart reveals a deficiency in the CYP2D6 gene. The nurse will contact the provider to suggest:

A different medication

A patient with cancer is admitted to the hospital. The nurse obtains an admission history and learns that the patient has been taking oxycodone and a nonsteroidal anti-inflammatory drug (NSAID) for a year. The patient reports a recent increase in the intensity of pain, along with a new pain described as "burning" and "shooting." The nurse anticipates that the prescriber will order:

A fentanyl transdermal patch, acetaminophen, and an adjunctive analgesic

A patient newly diagnosed with cancer is admitted to the hospital, and the provider orders oxycodone [OxyContin] every 4 to 6 hours PRN pain. The patient requests pain medication whenever he reports pain as a 7 or 8 on a scale of 1 to 10 (10 being the worst pain), but he tells the nurse the medication is not working well. The nurse will contact the provider to discuss:

A fixed dosing schedule for the oxycodone

A patient has localized muscle spasms after an injury. The prescriber has ordered tizanidine [Zanaflex] to alleviate the spasms. When obtaining the patient's health history, the nurse should be concerned about which possible reason for considering another drug?

A history of hepatitis

A patient is given a prescription for azithromycin and asks the nurse why the dose on the first day is twice the amount of the dose on the next 4 days. Which reply is correct?

A large initial dose helps to get the drug to optimal levels in the body faster.

A nurse provides teaching for a patient who is newly diagnosed with PD. Which statement by the patient indicates understanding of the drug therapy for the disease?

A levodopa/carbidopa combination is used to improve motor function

4. A 14-year-old male patient has not begun puberty. His parents tell the nurse that their son does not want to go to school, because he gets teased. The nurse learns that the boy's father did not begin puberty until age 16 years. Laboratory tests on this child do not reveal true hypogonadism. What will the nurse tell these parents when they ask what can be done for their son?

A limited course of androgen therapy may be prescribed, but it is not necessary

A postoperative patient who is worried about pain control will be discharged several days after surgery. The nurse providing discharge teaching tells the patient that the prescribed Lortab is not as strong as the morphine the patient was given in the immediate postoperative period. Which response is the patient likely to experience?

A negative placebo effect when taking the medication

7. A patient with a history of benign prostatic hyperplasia is admitted to the unit. The patient is taking multiple medications, including terazosin [Hytrin]. During the evening rounds, the patient begins to complain of dizziness and nasal congestion. Upon assessment, the patient is somnolent and has a blood pressure of 101/42 mm Hg. The nurse is correct to suspect:

Adverse effects

A patient with multiple sclerosis is to begin treatment with interferon beta. The patient comes to the clinic to have pretreatment laboratory tests. Which statement by the patient indicates a need for further teaching about these tests?

After the first year of treatment, i will need once yearly blood work

A nurse is teaching parents how to use an Epi-pen for their child, who has a peanut allergy. Which statement by the parents indicates understanding?

After using the Epi-pen, we must go to the ER.

During a health history, the nurse asks a male patient about alcohol use. The patient tells the nurse that he and his wife are trying to conceive a pregnancy and he is using alcohol to lower his inhibitions. What will the nurse counsel this patient?

Alcohol may cause testicular atrophy and sterility

13. A nursing student asks a nurse to discuss alcoholism and alcohol use disorder. Which statement by the nurse is correct?

Alcohol use disorder can occur without the development of tolerance or physical dependence

11. The patient with which of the following is most at risk for folic acid deficiency?

Alcoholism

9. A patient has heart failure and is taking an ACE inhibitor. The patient has developed fibrotic changes in the heart and vessels. The nurse expects the provider to order which medication to counter this development?

Aldosterone antagonist

A male patient is being treated for BPH and has stopped taking his alpha-adrenergic antagonist medication because of ejaculatory difficulties. Which medication does the nurse expect the provider to prescribe?

Alfuzosin (Uroxatral)

4. A nurse is discussing the care of a patient with cancer with a nursing student. The patient is about to begin chemotherapy with a bifunctional alkylating agent. Which statement by the student indicates an understanding of this chemotherapeutic agent?

Alkylating agents are toxic to tissues that have rapidly dividing cells

A patient who has chronic allergies takes loratadine [Claritin] and develops a severe reaction to bee stings. The patient asks the nurse why the antihistamine did not prevent the reaction. What will the nurse say?

Allergy symptoms that are severe are caused by mediators other than histamine

A patient brought to the ED requires sutures. The prescriber orders a local anesthetic with epinephrine. The nurse understands that epinephrine is ordered to:

Allow a reduced dose of the anesthetic

10. A nursing student asks a nurse why chemotherapeutic agents are given intermittently instead of continuously. The nurse will tell the student that intermittent dosing:

Allows normal cells to recover and repopulate

8. A nurse is preparing to administer medications to a patient recently started on delavirdine (Rescriptor). Which concurrent prescription should the nurse question before administration?

Alprazolam (Xanax)

A patient describes feelings of anxiety and fear when speaking in front of an audience and is having difficulty at work because of an inability to present information at meetings three or four times each year. The patient is reluctant to take long-term medications. The nurse will expect the provider to order which treatment?

Alprazolam (Xanax) as needed

A nurse is teaching a group of nursing students about administering medications to older adult patients. Which statement by a student indicates a need for further teaching?

Alteration in hepatic function requires more frequent dosing

8. A patient will begin chemotherapy with cisplatin. Which medications will the nurse expect to administer to offset this agent's side effects?

Amifostine (Ethyol), diuretics, and antiemetics

4. A patient is diagnosed with a lung infection caused by P. aeruginosa. The culture and sensitivity report shows sensitivity to all aminoglycosides. The nurse knows that the rate of resistance to gentamicin is common in this hospital. The nurse will expect the provider to order which medication?

Amikacin (Amikin)

1. A patient has a Pseudomonas aeruginosa infection that is sensitive to aminoglycosides, and the prescriber orders gentamicin. The patient tells the nurse that a friend received amikacin [Amikin] for a similar infection and wonders why amikacin was not ordered. What will the nurse tell the patient?

Amikacin is given when the infectious agents are resistant to other aminoglycosides

A nurse is obtaining a drug history from an older adult who is taking multiple medications prescribed by different providers. Which two medications taken together create a reason for concern?

Amitriptyline (Elavil) and diphenhydramine (Benadryl)

A nurse educator is conducting a continuing education class on pharmacology. To evaluate the learning of the nurses in the class, the nurse educator asks, "Which drug name gives information about the drug's pharmacologic classification? What is the correct response?

Amoxicillin

4. A patient is diagnosed with peptic ulcer disease. The patient is otherwise healthy. The nurse learns that the patient does not smoke and that he drinks 1 or 2 glasses of wine with meals each week. The nurse anticipates that the provider will prescribe which drugs?

Amoxicillin, clarithromycin, and omeprazole

5. A child with an ear infection is not responding to treatment with amoxicillin [Amoxil]. The nurse will expect the provider to order:

Amoxicillin-clavulanic acid (Augmentin)

10. The parent of an infant with otitis media asks the nurse why the prescriber has ordered amoxicillin [Amoxil] and not ampicillin [Unasyn]. What will the nurse tell the parent?

Ampicillin is not as acid stable as amoxic in illin

1. A nurse working in a family planning clinic is teaching a class on intrauterine devices (IUDs). Which patient should be advised against using an IUD for contraception?

An 18 y/o woman with multiple sex partners

11. A patient who is taking nelfinavir [Viracept] calls the nurse to report moderate to severe diarrhea. What will the nurse expect the provider to recommend?

An OTC antidiarrheal drug

A patient received atropine intravenously before surgery. The recovery room nurse notes that the patient is delirious upon awakening and has a heart rate of 96, RR of 22, and BP of 110/78. The nurse notifies the anesthesiology who will order

An acetylcholinesterase inhibitor to compete with the antimuscarinic agent at receptors

A nurse is teaching nursing students about inhalation anesthesia and asks, "What is balanced anesthesia?" Which response by a student is correct?

An anesthesia that combines other drugs with inhalation anesthesia to produce the desired effects

A patient with a seizure disorder is admitted to the hospital and has a partial convulsive episode shortly after arriving on the unit. The patient has been taking phenytoin [Dilantin] 100 mg three times daily and oxcarbazepine [Trileptal] 300 mg twice daily for several years. The patient's phenytoin level is 8.6 mcg/mL, and the oxcarbazepine level is 22 mcg/mL. The nurse contacts the provider to report these levels and the seizure. What will the nurse expect the provider to order?

An increased dose of phenytoin

10. A patient with hepatitis B begins treatment with adefovir [Hepsera] and asks the nurse how long the drug therapy will last. The nurse will tell the patient that the medication will need to be taken for:

An indefinite, prolonger period of time

9. Which patient with a urinary tract infection will require hospitalization and intravenous antibiotics?

An older adult man with a low grade fever, flank pain, and an indwelling catheter

A nurse is reviewing nursing actions for emergency treatment of malignant hyperthermia. Which statement by a student indicates need for further teaching?

Analgesics should be given to help with muscle pain

A nurse is discussing the administration of an intravenous infusion of rituximab (Rituxan) with a nursing student. Which statement by the student indicates a need for further education about the care of a patient receiving this drug?

Angioedema and hypersensitivity may occur, but they are usually self limiting and mild

13. A patient with high-risk factors for tuberculosis will begin therapy for latent TB with isoniazid and rifampin. The nurse learns that this patient takes oral contraceptives. The nurse will counsel this patient to discuss ____ with her provider.

Another birth control method

11. A patient who is receiving reperfusion therapy has a history of heparin-induced thrombosis (HIT). The patient has a creatinine clearance of 28 mL/min. In addition to the fibrinolytic agent, which medication will the nurse expect to administer to this patient?

Bivalirudin (angiomax)

9. A nursing student asks the nurse how antibodies provide immune suppression. The nurse responds by telling the student that antibodies:

Block T cell function

A patient tells a nurse that antihistamines help relieve cold symptoms and wants to know why they are not recommended or prescribed for this purpose. The nurse tells the patient that antihistamines provide only mild relief from some cold symptoms by:

Blocking H1 receptors in nasal passages

10. The potassium-sparing diuretic spironolactone [Aldactone] prolongs survival and improves heart failure symptoms by which mechanism?

Blocking aldosterone receptors

3. A nurse is educating the staff nurses about ketoacidosis. To evaluate the group's understanding, the nurse asks, "Which sign or symptom would not be consistent with ketoacidosis?" The group gives which correct answer?

Blood glucose level of 60 mg/dL

4. A prescriber has ordered filgrastim (granulocyte colony-stimulating factor) for a patient undergoing myelosuppressive chemotherapy. The nurse will prepare the patient for which potential side effect?

Bone pain

4. A nurse is caring for a child who has hemophilia. While reviewing this child's immunization records, the nurse notes that the child needs the tetanus and reduced diphtheria toxoids and acellular pertussis (Tdap) vaccine and the hepatitis A vaccine. The nurse should notify the provider and obtain an order to give:

Both vaccines intramuscularly

A nurse learns about a drug that interferes with transmitter storage in the PNS. The transmitter affected by this drug causes an increased heart rate. What response will the nurse expect to see when this drug is administered? a. Bradycardia b. Positive inotropic effects c. Prolonged receptor activation d. Tachycardia

Bradycardia

A patient receives an epidural anesthetic during labor and delivery. The nurse caring for the newborn in the immediate postpartum period will observe the infant for:

Bradycardia

A preoperative patient receives atropine before induction of anesthesia. The nurse caring for this patient understands that this agent is used to prevent:

Bradycardia

An anesthesiologist completes preoperative teaching for a patient the night before surgery. The patient asks the nurse to clarify the reason methohexital [Brevital] will be given as an adjunct to the anesthetic. Which statement by the patient indicates understanding?

Brevital is used to produce rapid unconsciousness before administration of the inhaled anesthetic

A patient who has been taking an SSRI tells the nurse that the drug has caused reduced sexual performance, weight gain, and sedation. The nurse will suggest that the patient ask the provider about using which drug?

Bupropion (wellbutrin)

A patient is diagnosed with anxiety after describing symptoms of tension, poor concentration, and difficulty sleeping that have persisted for over 6 months. Which medication will the nurse expect the provider to order for this patient?

Buspirone (Buspar)

18. The nurse has just received an order for tenecteplase [TNKase] for a patient experiencing an acute myocardial infarction. The nurse should administer this drug:

By bolus injection

2. A nurse is teaching a group of nursing students about cancer treatment. Which statement by a student indicates an understanding of the characteristics of cancer cells?

Cancer cells are characterized by unrestrained growth and division

5. The nurse is caring for a patient in the oncology unit who was recently diagnosed with advanced renal carcinoma. The nurse prepares to administer aldesleukin [Proleukin] as part of the treatment regimen. What is the primary adverse effect of this drug?

Capillary leakage syndrome

7. A nurse is reviewing a patient's medications before administration. Which drug-to-drug interactions will most concern the nurse in a patient with a history of heart failure and a potassium level of 5.5 mEq/L?

Captopril (Capoten) and spironolactone (aldactone)

A patient tells a nurse that she drinks wine for its cardioprotective effects. She wants to know how much is safe. The nurse is correct in telling her that:

Cardioprotective effects are greatest in people who live an unhealthy life

A nurse is teaching a nursing student about the 2 classes of adrenergic agonist drugs. Which statement by the nursing student indicates understanding of the teaching?

Catecholamines often require continuous infusion to be effective

2. A patient is taking a vasodilator that relaxes smooth muscles in veins. To help minimize drug side effects, the nurse caring for this patient will:

Caution the patient not to get up abruptly

A patient will begin taking propranolol (Inderal) for hypertension. Which statement by the nurse is important when teaching this patient about the medication? A. "Check your hands and feet for swelling and report that to your provider." B. "It is safe to take this medication with a calcium channel blocker." C. "Stop taking the drug if you become short of breath." D. "Take your pulse and do not take the medication if your heart rate is fast."

Check your hands and feet for swelling and report that to your provider

A nurse is screening a patient being admitted to the hospital. The patient reports being fired for drinking at work. On further questioning, the patient reveals a history of daily alcohol consumption of more than a six-pack of beer each day, regular morning drinking, and several unsuccessful attempts to stop drinking. The nurse detects alcohol on the patient's breath. The nurse will inform the provider of these findings and request an order for which medication?

Chlordiazepoxide (Librium)

8. Which condition would cause the nurse to withhold a PRN order for magnesium hydroxide?

Chronic renal failure

The parents of the child with asthma ask the nurse why their child cannot use oral corticosteroids more often, because they are so effective. The nurse will offer which information that is true for children?

Chronic steroid use can inhibit growth.

A patient with hepatitis requires ET intubation. Which agent does the nurse expect to be administered?

Cisatracurium (Nimbex)

12. A patient calls a family planning clinic and tells the nurse that her vaginal ring, which has been in place for 2 weeks, came out sometime during the night while she was sleeping. The nurse will instruct her to:

Clean the ring with warm water, reinsert it, and use condoms for 7 days

6. A patient newly diagnosed with tuberculosis asks the nurse why oral medications must be given in the clinic. The nurse will tell the patient that medications are given in the clinic so that:

Clinic staff can observe adherence to drug regimens

A nursing student asks the nurse why more is not known about the teratogenic effects of maternal medication ingestion during pregnancy. Which response by the nurse is correct?

Clinical trials to assess this risk would put the fetus at risk.

1. A patient is being treated for infertility. An examination reveals cervical mucus that is scant, thick, and sticky. The nurse suspects that the patient has been taking which medication?

Clomiphene (Clomid)

6. A nurse is explaining to a nursing student how clomiphene [Clomid] works to improve fertility. Which statement by the student indicates a need for further teaching?

Clomiphene directly stimulates the ovary, causing follicular maturation and ovulation

A patient with HTN has a previous history of opioid dependence. Which medication would the nurse question?

Clonidine

Supplemental oxygen has been shown to help reduce symptoms for which type of headache?

Cluster

A nurse is preparing to teach a forgetful older adult about a multiple drug regimen to follow after discharge from the hospital. To help promote adherence, what will the nurse do?

Cluster medication administration times as much as possible

17. A patient is about to begin therapy with ethambutol. The nurse knows that, before initiating treatment with this drug, it is important to obtain which test(s)?

Color vision and visual acuity

A nursing student wants to know why a patient who has been taking levodopa [Dopar] for years will now receive levodopa/carbidopa [Sinemet]. The nurse explains the reasons that levodopa as a single agent is no longer available. Which statement by the student indicates a need for further education?

Combination products cause fewer dyskinesias and decreased psychosis

2. The nurse is caring for a patient who is HIV positive and is taking zidovudine [Retrovir]. Before administering the medication, the nurse should monitor which laboratory values?

Complete blood count

14. A nurse is obtaining an admission history on a patient who reports daily drinking for several years. When the nurse questions the patient further, the patient reports drinking up to five or six drinks each day. The patient expresses worry about liver damage. What will the nurse do?

Contact the patient's provider to request liver function studies

A patient is receiving digoxin twice daily. When assessing the patient before giving a dose, the nurse counts a pulse of 60 bpm and learns that the patient is experiencing nausea. The nurse consults a drug manual and verifies that the ordered dose is correct. What should the nurse do?

Contact the prescriber to report the symptoms

8. A patient with no known drug allergies is receiving amoxicillin [Amoxil] PO twice daily. Twenty minutes after being given a dose, the patient complains of shortness of breath. The patient's blood pressure is 100/58 mm Hg. What will the nurse do?

Contact the provider and prepare to administer epinephrine

9. A patient taking high doses of a glucocorticoid develops weakness in the muscles of the upper arms and in the legs. What will the nurse do?

Contact the provider to ask about reducing the dose

A patient is taking sertraline (Zoloft) for depression, and the provider orders azithromycin to treat an infection. What will the nurse do?

Contact the provider to discuss an alternative to azithromycin.

A nurse consults a drug manual before giving a medication to an 80 y/o patient. The manual states that older-adult patients are at increased risk for hepatic side effects. Which action by the nurse is correct?

Contact the provider to discuss an order for pretreatment laboratory work.

13. A nurse is preparing to administer intramuscular penicillin to a patient who is infected with T. pallidum and notes that the order is for sodium penicillin G. Which action is correct?

Contact the provider to discuss changing the drug to benzathine penicillin G

11. A patient is taking erythromycin ethylsuccinate for a chlamydial infection and develops vaginal candidiasis. The prescriber orders ketoconazole to treat the superinfection. What will the nurse do?

Contact the provider to discuss changing to a different antifungal med

14. A patient who has arthritis has been taking ibuprofen [Motrin] and a glucocorticoid medication. The patient reports having tarry stools but denies gastric pain. Which action by the nurse is correct?

Contact the provider to discuss ordering an antiulcer medication

2. A patient admitted to the hospital has a history of peptic ulcer disease. The patient takes ranitidine [Zantac] and sucralfate [Carafate]. The patient tells the nurse that discomfort is usually controlled but that symptoms occasionally flare up. What will the nurse do?

Contact the provider to discuss serologic testing and an antibiotic

An 8-year-old child with advanced cancer has an order for oxycodone [OxyContin] PO, PRN for moderate to severe pain. The nurse notes that the child is constantly playing computer games and repeatedly denies having pain. What will the nurse do?

Contact the provider to discuss using PCA

A patient who stopped taking teriflunomide [Aubagio] 1 year prior tells the nurse that she has just found out she is pregnant. Which action by the nurse is correct?

Contact the provider to obtain an order for serum drug levels

A nurse is assessing a patient who becomes motionless and seems to stare at the wall and then experiences about 60 seconds of lip smacking and hand wringing. What should the nurse do?

Contact the provider to report symptoms of a complex partial seizure

A patient with bipolar disorder who is taking divalproex sodium [Valproate] has just been admitted to the hospital. During the admission assessment, the patient tells the nurse about recent suicidal ideation. The nurse observes several areas of bruising over soft tissue areas and notes a weight gain of 10 pounds since the last admission 1 year ago. What will the nurse do?

Contact the provider to report these findings

A postoperative patient reports pain, which the patient rates as an 8 on a scale of 1 to 10. The prescriber has ordered acetaminophen 650mg PO every 6 hours PRN. What will the nurse do?

Contact the provider to request a different analgesic medication.

8. A patient with a urinary tract infection is given a prescription for TMP/SMZ. When reviewing the drug with the patient, the nurse learns that the patient has type 1 diabetes mellitus and consumes alcohol heavily. What will the nurse do?

Contact the provider to request a different antibiotic for this patient

A nurse is caring for a patient who has been taking an antiepileptic drug for several weeks. The nurse asks the patient if the therapy is effective. The patient reports little change in seizure frequency. What will the nurse do?

Contact the provider to request an order for serum drug levels

7. A patient with angina who uses sublingual nitroglycerin tells the nurse that the episodes are increasing in frequency and usually occur when the patient walks the dog. The patient reports needing almost daily doses of the nitroglycerin and states that one tablet usually provides complete relief. What will the nurse do?

Contact the provider to suggest ordering a transdermal patch for this patient

12. A patient who is taking clopidogrel [Plavix] calls the nurse to report black, tarry stools and coffee-ground emesis. The nurse will tell the patient to:

Continue taking the clopidogrel until talking to the provider

8. A patient who has undergone surgical removal of a solid tumor has just begun chemotherapy. The patient experiences severe nausea and vomiting as well as alopecia. The nurse will expect the provider to:

Continue the chemotherapetuci agent at the same dose

7. A patient comes to a clinic for tuberculosis medications 2 weeks after beginning treatment with a four-drug induction phase. The patient's sputum culture remains positive, and no drug resistance is noted. At this point, the nurse will expect the provider to:

Continue the four drug regimen and recheck the sputum in 2 weeks

7. A postpartum patient is receiving methylergonovine to prevent hemorrhage. The nurse assesses the patient and notes a heart rate of 76 beats per minute, a respiratory rate of 16 breaths per minute, and a blood pressure of 120/80 mm Hg. The patient's uterus is firm. The patient complains of mild to moderate cramping. Bleeding is minimal. What will the nurse do?

Continue to monitor and tell the patient to report increased cramping

A patient who has recurrent migraine headaches is prescribed sumatriptan [Imitrex]. Which aspect of this patient's history is of concern when taking this drug?

Coronary artery disease

7. A patient is admitted with nausea, vomiting, diarrhea, and abdominal pain. The patient appears emaciated and complains of feeling weak. The nurse notes a heart rate of 98 beats per minute and a blood pressure of 88/54 mm Hg. The nurse reviews the chart and notes an increased serum potassium level and a decreased serum sodium level. The nurse expects the provider to order which medication initially?

Cosyntropin (Cortosyn)

A nurse is making a home visit to an older adult woman who was recently discharged home from the hospital with a new prescription. The nurse notes that a serum drug level drawn the day before was subtherapeutic. What will the nurse do next?

Count the pills in the prescription bottle

A nurse is concerned about renal function in an 84 y/o patient who is taking several medications. What will the nurse assess?

Creatinine clearance

6. A patient is given 1 mg of dexamethasone at 11:00 PM; a plasma cortisol level recorded at 8:00 PM the next day is normal. The nurse knows that this is an indication that the patient has what condition?

Cushing's Syndrome

8. The nurse knows that which immunosuppressants are among the most effective?

Cyclosporine (sandimmune) and tacrolimus (Prograf)

11. The nurse is caring for a patient after recent renal transplantation. The patient is taking sirolimus [Rapamune] to prevent transplant rejection. What other medications would the nurse expect the patient to be taking?

Cyclosporine and glucocorticoids

14. A nurse is discussing the use of immunosuppressants for the treatment of inflammatory bowel disease (IBD) with a group of nursing students. Which statement by a student indicates understanding of the teaching?

Cyclosporine can be used to induce remission of IBD

5. A nurse is teaching a group of nursing students about how cytotoxic anticancer drugs affect normal cells. Which statement by a student indicates an understanding of this teaching?

Cytotoxic drugs lack tissue specificity

2. An adolescent female patient with multiple sexual partners asks a nurse about birth control methods. The patient tells the nurse she tried oral contraceptives once but often forgot to take her pills. The nurse will recommend discussing which contraception with the provider?

DMPA (Depo-Provera) and condoms

2. A nurse is caring for a patient who is receiving amphotericin B [Abelcet] for a systemic fungal infection. In spite of receiving diphenhydramine and acetaminophen before initiation of treatment, the patient has fever and chills with rigors. The nurse will contact the provider to discuss the addition of which drug?

Dantrolene

16. A college student is brought to the emergency department by a group of friends who report that they had been dancing at a nightclub when their friend collapsed. The patient has a temperature of 105°F and shows jaw clenching and confusion. The nurse will expect to administer which medication?

Dantrolene (Dantrium)

1. A nurse is preparing to administer an antibiotic to a patient with methicillin-resistant Staphylococcus aureus (MRSA). The nurse would expect the healthcare provider to order which antibiotic?

Daptomycin (Cubicin)

7. A patient who will begin combination estrogen/progestin therapy (EPT) for menopause asks the nurse why she can't take an estrogen-only preparation. The patient has not had a hysterectomy, has a slightly increased risk of cardiovascular disease, and has mild osteopenia. The nurse will tell her that the progestin is necessary to:

Decrease her risk of endometrial cancer

4. The nurse is caring for a patient who is taking a vasodilator that dilates capacitance vessels. The nurse will expect which effect in this patient?

Decrease in cardiac work

A patient who has developed opioid tolerance will experience which effect?

Decreased analgesic effect

A nurse is teaching a patient about a prescription that induces P-glycoprotein. The nurse will explain that this drug may cause which effect on other drugs?

Decreased elimination through the kidneys

5. A nurse is assessing a patient who has heart failure. The patient complains of shortness of breath, and the nurse auscultates crackles in both lungs. The nurse understands that these symptoms are the result of:

Decreased force of ventricular contraction

5. A 30-year-old male patient will begin a three-drug regimen to treat peptic ulcer disease. The regimen will consist of bismuth subsalicylate, tetracycline, and cimetidine [Tagamet]. The nurse will include which information when teaching this patient about this drug regimen?

Decreased libido, impotence, and gynecomastia are reversible side effects

2. A nurse is caring for a patient who is receiving a drug that causes constriction of arterioles. The nurse expects to observe which effect from this drug?

Decreased stroke volume

4. A patient newly diagnosed with heart failure is admitted to the hospital. The nurse notes a pulse of 90 beats per minute. The nurse will observe this patient closely for:

Decreased urine output

14. A patient who is taking azathioprine [Imuran] to prevent rejection of a renal transplant develops gout and the provider orders allopurinol. The nurse will contact the provider to discuss:

Decreasing the azathioprine dose

A patient with metastatic cancer has had several fractures secondary to bone metastases. The provider orders denosumab [Xgeva]. What will the nurse teach this patient?

Denosumab may delay healing of these fractures

A nurse is teaching a patient about a new prescription for reserpine (Serpasil) for HTN. Which statement by the patient indicates the need for further teaching?

Depressive side effects are common and will improve over time.

A patient reports becoming "immune" to a medication because it no longer works to alleviate symptoms. The nurse recognizes that this decreased effectiveness is likely caused by:

Desensitization of receptor sites by continual exposure to the drug

8. A patient with advanced cancer of the prostate begins treatment with leuprolide [Lupron Depot] injections and will receive 7.5 mg IM once per month. After the first injection, the patient experiences an increase in cancer symptoms. What will the nurse tell the patient?

Desensitization to the drug over time will result in a decrease in these symptoms

8. A nurse teaches a nursing student about the differences between desmopressin (DDAVP) and vasopressin [Pitressin]. Which statement by the student indicates a need for further teaching?

Desmopressin has a shorter duration of action than vasopressin

The US FDA recommends genetic testing of patients receiving certain medications. Genetic testing helps prescribers:

Determine whether a patient is a rapid or slow metabolizer of the drug

2. A nurse is reviewing a patient's most recent blood count and notes that the patient has a hemoglobin of 9.6 gm/dL and a hematocrit of 33%. The nurse will notify the provider and will expect initial treatment to include:

Determining the cause of anemia

5. A patient is hospitalized with head trauma after a motor vehicle accident. The nurse caring for the patient notes a marked increase in the output of pale, dilute urine. The nurse suspects which condition?

Diabetes inspidus

Which side effect of clindamycin (cleocin) causes the most concern and may warrant discontinuation of the drug

Diarrhea

11. A patient who is agitated and profoundly anxious is brought to the emergency department. The patient acts paranoid and keeps describing things in the room that do not exist. A cardiac monitor shows an irregular ventricular tachycardia. Which medication will the nurse expect to administer?

Diazepam (Valium)

A patient in the postanesthesia recovery unit received ketamine [Ketalar] for right open reduction internal fixation surgery. What drug would be beneficial as a premedication to help minimize adverse reactions?

Diazepam (Valium)

14. A patient has been receiving intravenous ketorolac 30 mg every 6 hours for postoperative pain for 4 days. The patient will begin taking oral ketorolac 10 mg every 4 to 6 hours to prepare for discharge in 1 or 2 days. The patient asks the nurse whether this drug will be prescribed for management of pain after discharge. The nurse will respond by telling the patient that the provider will prescribe a(n):

Different NSAID for home management of pain

A nurse is providing education to a patient who will begin taking alendronate [Fosamax]. Which complication should the patient be instructed to report immediately?

Difficultly swallowing

A nurse is preparing to administer IV calcium chloride to a patient with a low serum calcium level. Which drug on the patient's medication record, administered concurrently, would require additional patient monitoring by the nurse?

Digoxin (lanoxin)

A nurse is teaching nursing students about the use of alpha-adrenergic antagonists. Which statement by the student indicates the need for further teaching?

Dilation of veins by alpha-adrenergic antagonists improves cardiac output

A family is preparing for travel and the parents report that their 5-year-old child has frequent motion sickness. The nurse will tell the parents to ask the provider about which antihistamine to help prevent symptoms?

Dimenhydrinate (Dramamine)

11. A patient with colorectal cancer is admitted to the hospital oncology unit to receive cetuximab [Erbitux]. The nurse notes that the prescriber has not ordered any other medications. The nurse will contact the prescriber to request an order for which medication in order to minimize cetuximab's side effects?

Diphenhydramine (benadryl)

4. A nurse is preparing to administer a dose of growth hormone and reconstitutes the medication. After adding the diluent, the nurse notices that the preparation is cloudy. What will the nurse do?

Discard the drug and prepare another dose

A patient is taking hydrocodone and ibuprofen for cancer pain and is admitted to the hospital for chemotherapy. The nurse anticipates that the prescriber will ____ ibuprofen.

Discontinue the

7. A patient who has been receiving intravenous gentamicin for several days reports having had a headache for 2 days. The nurse will request an order to:

Discontinue the gentamicin

15. A nurse caring for a patient receiving heparin therapy notes that the patient has a heart rate of 98 beats per minute and a blood pressure of 110/72 mm Hg. The patient's fingertips are purplish in color. A stat CBC shows a platelet count of less than 100,000 mm3. The nurse will:

Discontinue the heparin and notify the provider

17. A patient is receiving fluorouracil [Adrucil] as a continuous intravenous dose to treat a solid tumor. The patient reports soreness and blisters in the mouth, loose stools, and tingling of the hands and feet. What will the nurse do?

Discontinue the medication and contact the provider to report these symptoms

10. A patient receiving a cephalosporin develops a secondary intestinal infection caused by Clostridium difficile. What is an appropriate treatment for this patient?

Discontinuing the cephalosporin and beginning metronidazole (Flagyl)

15. A patient is taking a thiazide diuretic for hypertension and quinidine to treat a dysrhythmia. The prescriber orders digoxin 0.125 mg to improve this patient's cardiac output. The nurse should contact the provider to request:

Discontinuing the quinidine

A patient will begin treatment with posaconazole (Noxafil) to treat oropharyngeal candidiasis that has not responded to fluconazole. The provider has ordered 200mg three times daily. Which action by the nurse is correct?

Discuss a 400 mg twice daily drug reigmen with the provider

5. A patient who is taking a combination oral contraceptive begins taking carbamazepine. After several weeks, the patient tells the nurse she has begun experiencing spotting during her cycle. What will the nurse tell her to do?

Discuss an oral contraceptive with increased estrogen

A patient has been taking fluoxetine [Prozac] for 2 years and reports feeling cured of depression. The nurse learns that the patient is sleeping well, participates in usual activities, and feels upbeat and energetic most of the time. The patient's weight has returned to normal. The patient reports last having symptoms of depression at least 9 months ago. What will the nurse tell this patient?

Discuss gradual withdrawal of the medication with the provider

A patient has been taking an SSRI antidepressant for major depression and reports having headaches and jaw pain. What will the nurse tell the patient?

Discuss these symptoms with a dentist

11. A patient takes an ACE inhibitor to treat hypertension and tells the nurse that she wants to become pregnant. She asks whether she should continue taking the medication while she is pregnant. What will the nurse tell her?

Discuss using methyldopa instead while she is pregnant

3. A nurse assisting a nursing student with medications asks the student to describe how penicillins (PCNs) work to treat bacterial infections. The student is correct in responding that penicillins:

Disrupt the bacterial cell wall synthesis

An older adult patient who is to begin taking imipramine [Tofranil] asks the nurse when the drug should be taken. The nurse will instruct the patient to:

Divide the daily dose into two equal doses 12 hours apart

15. A patient who reports regular consumption of two or three alcoholic beverages per day asks about taking acetaminophen when needed for occasional recurrent pain. What will the nurse tell the patient?

Do not take more than 2 gm of acetaminophen a day

A patient taking oral contraceptives thinks she may be pregnant. As part of the patient's history, what will the nurse ask?

Do you take seizure medication?

9. The nurse is caring for an older adult patient after a right hip open reduction internal fixation (ORIF). The patient is taking an opioid every 6 hours as needed for pain. The nurse discusses obtaining an order from the prescriber for which medication?

Docusate sodium (Colase)

A nursing student wants to know how carbidopa can be effective for treating Parkinson's disease if it prevents the conversion of levodopa to dopamine. The nurse explains that carbidopa:

Does not cross the BBB

18. The nurse is teaching a group of nursing students about dofetilide [Tikosyn] to treat dysrhythmias. Which statement by a student indicates understanding of the teaing?

Dofetilide is used for patients wtih severe symptoms of atrial dyshythmias

A patient taking fluoxetine [Prozac] complains of decreased sexual interest. A prescriber orders a "drug holiday." What teaching by the nurse would best describe a drug holiday?

Don't take the medication on Friday and Saturday

5. A male patient tells the nurse he awakens once or twice each night to void and has difficulty starting his stream of urine. He describes these symptoms as "annoying." The patient's provider examines him and notes that the prostate is moderately enlarged. The patient is sexually active and tells the nurse that he does not want to take any medication that will interfere with sexual function. The nurse anticipates the provider will order:

Doxazosin (Cardura)

6. A patient is diagnosed with pelvic inflammatory disease (PID). Which treatment regimen is most appropriate for reducing the risk of sterility in this patient?

Doxycycline (Vibramycin), 100mg IV twice daily, and cefoxitin, 2 gm IV every 6 hours in the hospital

3. A patient will be discharged from the hospital with a prescription for TMP/SMZ [Bactrim]. When providing teaching for this patient, the nurse will tell the patient that it will be important to:

Drink 8 to 10 glasses of water each day

10. A patient is taking clonidine for hypertension and reports having dry mouth and drowsiness. What will the nurse tell the patient?

Drink extra fluids and avoid driving when drowsy

A patient complains to the nurse that the clonidine recently prescribed for HTN is causing drowsiness. Which response by the nurse to this concern is appropriate?

Drowsiness is a common side effect initially, but it will lessen with time

4. A child has received amoxicillin [Amoxil] for three previous ear infections, but a current otitis media episode is not responding to treatment. The nurse caring for this child suspects that resistance to the bacterial agent has occurred by which microbial mechanism?

Drug inactivation

A patient is ready for discharge home from a lengthy hospital stay after a motor vehicle accident. The patient suffered multiple fractures and required large doses of morphine for several weeks. The nurse preparing the patient for discharge notes that the patient requests the maximum dose of the oral opioid analgesic at the exact intervals it is prescribed. The nurse is correct to suspect that what has occurred?

Drug tolerance

A nurse is teaching a group of students about neuropharmacology. Which statement by the student about peripheral nervous system drugs indicates a need for further teaching?

Drugs affecting anoxal conduction have a variety of uses.

9. A patient with acromegaly asks the nurse about treatments for this condition. What will the nurse tell the patient?

Drugs are generally used after surgical and radiation therapies have been tried

A pediatric nurse is teaching nursing students about medication administration in children. Which statement by a student indicates understanding?

Drugs effective in adults may not work in children; even if the dose is proportional for weight and size.

The spouse of a patient who is newly diagnosed with Alzheimer's disease asks the nurse if medications will prevent the need for nursing home care. Which response by the nurse is correct?

Drugs to treat AZ disease may slow the progression of memory loss

A nurse provides teaching for a patient about to begin taking an FGA drug for schizophrenia. Which statement by the patient indicates a need for further teaching about side effects of these drugs?

Dry mouth and constipation are uncommon with this medication

A provider has indicated that a serotonin/norepinephrine reuptake inhibitor (SNRI) will be prescribed for a patient who is experiencing major depression. When conducting a pretreatment health history, the nurse learns that the patient has a recent history of alcohol abuse. Which SNRI would be contraindicated for this patient?

Duloxetine (Cymbalta)

The spouse of a patient with bipolar disorder (BPD) tells the nurse that the patient will not stay on the lithium ordered by the provider longer than 1 or 2 months at a time. The nurse understands that adherence to medication regimens in patients with BPD is problematic and will tell the spouse:

During manic episodes, many patients don't see the benefit of prophylactic medications

A nurse is teaching a class to a group of pregnant patients. The nurse correctly teaches that the highest risk of teratogen-induced gross malformations exists during what time?

During the first trimester

A patient has just given birth to a baby boy with a cleft palate. The nurse will review the patient's medication history with special emphasis on drugs taken during which period?

During the first trimester

A patient who is morbidly obese is admitted for treatment. The prescriber orders lisdexamfetamine [Vyvanse]. The nurse will be concerned if this patient shows signs of:

Dyspnea

13. The nurse is caring for a patient who has been receiving vinorelbine [Navelbine] for about 5 days. Which assessment finding in this patient would cause the nurse to withhold the next dose and notify the prescriber?

Dyspnea and cough

6. A patient is started on immunosuppressant drugs after kidney transplantation and will be taking azathioprine [Imuran] as part of the drug regimen. The patient asks the nurse why it is necessary to have a specimen for a complete blood count drawn at the beginning of therapy and then periodically thereafter. The nurse explains that azathioprine can alter blood cells and tells the patient to report:

Easy bruising

A nurse is administering IV dopamine (Intropin) to a patient in the ICU. Which assessment finding would cause the most concern?

Edema at the IV site

11. Before giving methenamine [Hiprex] to a patient, it is important for the nurse to review the patient's history for evidence of which problem?

Elevated blood urea nitrogen and creatinine

8. An older adult patient with congestive heart failure develops crackles in both lungs and pitting edema of all extremities. The physician orders hydrochlorothiazide [HydroDIURIL]. Before administering this medication, the nurse reviews the patient's chart. Which laboratory value causes the nurse the most concern?

Elevated creatinine clearance

2. Which plasma lipoprotein level is most concerning when considering the risk of coronary atherosclerosis?

Elevated low-densoity lipoprotein

A surgical patient is receiving succinylcholine [Anectine] with an inhalation anesthetic. The patient is intubated, has an indwelling urinary catheter, and has ongoing monitoring of vital signs. Which symptom during the perioperative period is cause for concern?

Elevated temperature

17. An 88-year-old patient with heart failure has progressed to Stage D and is hospitalized for the third time in a month. The nurse will expect to discuss which topic with the patient's family?

End of life care

14. A postoperative patient reports pain in the left lower extremity. The nurse notes swelling in the lower leg, which feels warm to the touch. The nurse will anticipate giving which medication?

Enoxaparin (Lovenox)

3. A patient has been receiving heparin while in the hospital to treat deep vein thromboses and will be discharged home with a prescription for enoxaparin [Lovenox]. The nurse provides teaching for the nursing student who asks about the advantages of enoxaparin over heparin. Which statement by the student indicates a need for further teaching?

Enoxaparin is more cost-effective than heparin

A provider has ordered intravenous promethazine [Phenergan] for an adult patient postoperatively to prevent nausea and vomiting (N/V). What will the nurse do?

Ensure that the IV is infusing freely through a large-bore needle

13. The nurse is preparing to administer a first dose of ado-trastuzumab emtansine [Kadcycla] to a patient who has metastatic breast cancer. Which nursing action is correct?

Ensure that the patient has HER2 positive disease

18. A patient who has urinary bladder cancer will begin receiving the chemotherapeutic agent valrubicin [Valstar]. What will the nurse do when administering this drug?

Ensure the tubing used to administer the drug does not contain polyvinyl chloride

11. A patient has lamivudine-resistant hepatitis B and has been taking entecavir [Baraclude] for 2 years. The patient asks the nurse why the provider has recommended taking the drug for another year. What will the nurse tell the patient?

Entecavir can reserve fibrosis and cirrhosis of the liver when taken longterm

A nursing student asks the nurse why epinephrine and not other adrenergic agonists, is used to treat anaphylactic shock. What will the nurse tell the student?

Epinephrine has the ability to activate multiple types of adrenergic receptors.

A patient arrives in the emergency department complaining of numbness in the extremities. The nurse notes that the patient's hands and feet are cool and pale. When conducting a health history, the nurse learns that the patient has a history of migraine headaches. The nurse recognizes this patient's symptoms as:

Ergotism

10. A child with an upper respiratory infection caused by B. pertussis is receiving erythromycin ethylsuccinate. After 2 days of treatment, the parent asks the nurse why the child's symptoms have not improved. Which response by the nurse is correct?

Erythromycin eliminates the bacteria that causes the infection, but not the toxin that causes the symptoms

9. A 6-week-old infant who has not yet received immunizations develops a severe cough. While awaiting nasopharyngeal culture results, the nurse will expect to administer which antibiotic?

Erythromycin ethylsuccinate

14. A patient who has leukemia is receiving chemotherapy and develops severe anemia. The provider has ordered hospitalization and blood transfusions. The patient asks the nurse about using erythropoietin (epoetin alfa) instead. What will the nurse tell this patient?

Erythropoietin (epoetin alfa) can make your leukemia worse

1. A nursing student asks a nurse why patients with chronic renal failure (CRF) have low erythrocyte counts. Which response by the nurse is correct?

Erythropoietin is no longer produced by cells in the kidneys

7. A nurse is obtaining a medication history on a newly admitted patient, who reports taking minoxidil for hypertension. Admission vital signs reveal a heart rate of 78 beats per minute and a blood pressure of 120/80 mm Hg. What is an important part of the initial assessment for this patient?

Evaluating ankle edema

The FDA Amendments Act was passed in 2007 to address which aspect of drug safety?

Evaluating drug safety information that emerges after a drug has been approved and is in use

4. The nurse assesses a newly diagnosed patient for short-term complications of diabetes. What does this assessment include?

Evaluation for hyperglycemia, hypoglycemia, and keotacidosis

6. A patient has a viral sinus infection, and the provider tells the patient that antibiotics will not be prescribed. The patient wants to take an antibiotic and asks the nurse what possible harm could occur by taking an antibiotic. Which response by the nurse is correct?

Even normal flora can develop resistance and transfer this to pathogens

A nurse is providing education to a group of college students about the long-term effects of alcohol. Which statement by a student indicates understanding of the teaching?

Even small amounts of alcohol are related to the development of certain cancers

A nurse provides teaching for a patient with a newly diagnosed partial complex seizure disorder who is about to begin therapy with antiepileptic drugs (AEDs). Which statement by the patient indicates understanding of the teaching?

Even with an accurate diagnosis of my seizures, it may be difficult to find an effective drug

13. The nurse is caring for a 15-year-old patient who has undergone a liver transplant. Which provider order will the nurse question?

Everolimus (Zortress) 1 mg twice daily

5. A patient is taking cyclosporine [Sandimmune] and prednisone to prevent organ rejection after right renal transplantation. The patient is febrile and complains of right-sided flank pain. The nurse reviews the patient's chart and finds that the patient's BUN and serum creatinine are elevated. The cyclosporine trough is 150 ng/mL. What will the nurse do?

Expect the provider to order IV methylprednisolone

11. A female patient who begins taking spironolactone [Aldactone] as an adjunct to furosemide [Lasix] complains that her voice is deepening. What will the nurse do?

Explain that this drug binds with receptors for steroid hormones, causing this effect

1. A patient with epistaxis and a history of hemophilia A is admitted to the unit and is scheduled for replacement therapy. The nurse should prepare to administer which medication?

Factor VIII

9. A nurse is caring for an African American patient with severe hemophilia A who has been admitted for bleeding into the knee joint. The prescriber has ordered intravenous factor VIIa [NovoSeven RT]. A nursing student wants to know why this patient is not receiving factor VIII. Which statement by the nurse is correct?

Factor VIIa is used when patients develop antibodies against factor VII

A nurse is discussing partial versus generalized seizures with a group of nursing students. Which statement by a student indicates understanding of the teaching?

Febrile seizures are a type of generalized tonic-clonic seizures

A patient asks the nurse what can be given to alleviate severe, chronic pain of several months' duration. The patient has been taking oxycodone [OxyContin] and states that it is no longer effective. The nurse will suggest discussing which medication with the provider?

Fentanyl (Duragesic) transdermal patch

A patient has seasonal allergies and needs an antihistamine to control symptoms. The patient likes to have wine with dinner occasionally and wants to know which antihistamine will be the safest to take. The nurse will tell the patient to discuss which medication with the provider?

Fexofenadine (Allegra)

2. A nurse is discussing fibrinolytic therapy for the acute phase of STEMI management with a group of nursing students. Which statement by a student indicates understanding of this therapy?

Fibrinolytics should be used with caution in patients with a history of cerebrovascular accident

9. A patient is about to undergo a procedure to harvest hematopoietic stem cells from the bone marrow. Which medication will the nurse anticipate giving before this procedure?

Filgrastim (neupogen)

An older adult is admitted to the hospital for treatment of an exacerbation of a chronic illness. Admission lab work reveals an extremely low serum drug level of the drug used to treat this condition. The patient has brought the medication to the hospital, along with other medications taken. The patient's renal and hepatic function tests are normal. What will the nurse suspect as a likely cause of this finding?

Financial concerns

9. A patient is to undergo orthopedic surgery, and the prescriber will order a cephalosporin to be given preoperatively as prophylaxis against infection. The nurse expects the provider to order which cephalosporin?

First generation cephalosporin

2. A clinic nurse is assessing an adolescent male patient who has been receiving androgen therapy for hypogonadism via a transdermal patch. The patient's last clinic visit was 4 weeks earlier. Which part of the interval history is of most concern to the nurse?

Five pound weight gain

8. A patient with a history of congestive heart failure and renal impairment has esophageal candidiasis. Which antifungal agent would the nurse anticipate giving to this patient?

Fluconazole (diflucan)

10. A patient arrives in the emergency department acutely intoxicated and difficult to arouse. The patient's friends tell the nurse that the patient took a handful of diazepam [Valium] pills while at a party several hours ago. The nurse will expect to administer which drug?

Flumazenil (Romazicon)

15. A nurse is teaching a patient who will undergo chemotherapy with fluorouracil [Adrucil] to treat a solid tumor. Which statement by the patient indicates understanding of this chemotherapeutic agent's actions?

Fluorouracil acts to deprive cancer cells of the thymidylate needed to make DNA

A patient who has obsessive-compulsive disorder (OCD) has been undergoing behavioral therapy but continues to exhibit symptoms that interfere with daily life. Which intervention will the nurse expect the provider to order for this patient?

Fluoxetine (Paxil)

9. A patient with advanced prostate cancer will begin treatment with leuprolide [Lupron]. The provider has ordered flutamide to be given as adjunct therapy. The patient asks the nurse why both drugs are necessary. The nurse will tell the patient that:

Flutamide suppresses initial tumor flare caused by leuprolide

8. A nurse explains to a nursing student why opioid antidiarrheal medications are classified as drugs with little or no abuse potential. Which statement by the student indicates a need for further teaching?

Formulations for the treatment of diarrhea have very short half lives

3. A woman complains of burning on urination and increased frequency. The patient has a history of frequent urinary tract infections (UTIs) and is going out of town in 2 days. To treat the infection quickly, the nurse would expect the healthcare provider to order:

Fosfomycin (Monurol)

7. A 6-year-old child has frequent constipation. The nurse provides teaching after the parent asks the nurse why the provider recommended using laxatives only when needed. Which statement by the parent indicates a need for further teaching?

Frequent use of laxatives can cause diverticulitis

1. A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30 breaths per minute, intercostal retractions, and frothy, pink sputum. The nurse caring for this patient will expect to administer which drug?

Furosemide (Lasix)

A nurse is reviewing a MAR before administering medications. Which order will the nurse implement.

Furosemide (Lasix) 20 mg PO daily

3. A patient with chronic hypertension is admitted to the hospital. During the admission assessment, the nurse notes a heart rate of 96 beats per minute, a blood pressure of 150/90 mm Hg, bibasilar crackles, 2+ pitting edema of the ankles, and distension of the jugular veins. The nurse will contact the provider to request an order for which medication?

Furosemide (lasix)

Bethanechol (Urecholine) is used to treat urinary retention but is being investigated for use in which other condition?

GERD

10. A patient who is receiving a factor VIII concentrate to treat hemophilia A develops hives, a low-grade temperature elevation, and a stuffy nose. The nurse will prepare to:

GIve oral diphenhydramine

9. A patient admitted to the hospital is using metronidazole [Flagyl] 0.75% gel. The nurse understands that this agent is used to treat which condition?

Gardnerella vaginalis

A college student who is unresponsive is brought to the emergency department by friends, who say that their friend drank more than half of a large bottle of whiskey 3 hours ago. Assessment reveals a blood alcohol level of 0.32%. The vital signs are BP, 88/32 mm Hg; R, 6/min; T, 96.8°F; and P, 76/min and weak and thready. The nurse should prepare the patient for which intervention?

Gastric lavage and dialysis

A nurse is performing an admission assessment on a patient. The patient reports taking alprazolam [Xanax] for "nerves." The nurse knows that this patient is most likely being treated for which condition?

Generalized anxiety disorder

14. A patient is receiving gentamicin once daily. A nursing student asks the nurse how the drug can be effective if given only once a day. The nurse explains drug dosing schedules for aminoglycosides. Which statement by the student indicates a need for further teaching?

Gentamicin has a longer half life than other aminoglycosides

A patient complains of chronic insomnia and reports being tired of being tired all the time. The patient is reluctant to try pharmacologic remedies and asks the nurse what to do. What will the nurse suggest?

Get out of bed for awhile if you cannot fall asleep

1. A patient with HIV contracts herpes simplex virus (HSV), and the prescriber orders acyclovir [Zovirax] 400 mg PO twice daily for 10 days. After 7 days of therapy, the patient reports having an increased number of lesions. The nurse will expect the provider to:

Give IV foscamet every 8 hours for 2 to 3 weeks

5. A hospitalized patient complains of acute chest pain. The nurse administers a 0.3-mg sublingual nitroglycerin tablet, but the patient continues to complain of pain. Vital signs remain stable. What is the nurse's next step?

Give a second dose of nitroglycerin in 5 minutes

A 5-year-old child is brought to the emergency department after ingesting diphenhydramine [Benadryl]. The child is uncoordinated and agitated. The nurse observes that the child's face is flushed, the temperature is 37.1oC, and the heart rate is 110 beats per minute. The nurse will expect to:

Give activated charcoal to absorb the drug

16. A patient is admitted to the emergency department with chest pain. An electrocardiogram shows changes consistent with an evolving myocardial infarction. The patient's cardiac enzymes are pending. The nurse caring for this patient will expect to:

Give alteplase (Activase) within 2 hours

13. A nurse is preparing to administer digoxin [Lanoxin] to a patient. The patient's heart rate is 62 beats per minute, and the blood pressure is 120/60 mm Hg. The last serum electrolyte value showed a potassium level of 5.2 mEq/L. What will the nurse do?

Give the dose of digoxin and notify the provider of the potassium level

17. A patient is receiving tobramycin three times daily. A tobramycin peak level is 4.5 and the trough is 1.2. What will the nurse do?

Give the next dose as ordered

1. A nurse transcribes a new prescription for potassium penicillin G given intravenously (IV) every 8 hours and gentamicin given IV every 12 hours. Which is the best schedule for administering these drugs?

Give the penicillin at 0800, 1600, and 2400; give the gentamicin at 1800 and 0600

A patient who is taking a first-generation antipsychotic (FGA) drug for schizophrenia comes to the clinic for evaluation. The nurse observes that the patient has a shuffling gait and mild tremors. The nurse will ask the patient's provider about which course of action?

Giving an anticholinegic medication

6. A patient with chronic renal failure who is on dialysis receives an ESA. The nurse caring for this patient during dialysis notes that the patient's hemoglobin is 10.9 gm/dL, up from the 10.2 gm/dL recorded 2 weeks ago. The patient's blood pressure is 120/80 mm Hg. The nurse will contact the provider to suggest:

Giving heparin

14. A patient who has been prescribed oral ferrous sulfate reports taking extra doses for the past few months. The patient's serum iron level is 560 mcg/dL. What will the nurse expect the provider to order for this patient?

Giving parenteral deferoxamine (Desferal)

A patient is taking a drug that does not bind to albumin. Which aspect of renal drug excretion is affected by this characteristic?

Glomerular flitration

5. A patient who is a long-distance runner has been diagnosed with rheumatoid arthritis in both knees and will begin glucocorticoid therapy. When teaching the patient about the medication, the nurse will include what information?

Glucocorticoids are used as adjunctive therapy during acute flare ups

1. A nurse is discussing glucocorticoids with a group of nursing students. Which statement by a student indicates understanding of the teaching?

Glucocorticoids have both endocrine and nonendocrine uses

4. A nurse is teaching a group of nursing students why glucocorticoids are preferred over nonsteroidal anti-inflammatory drugs in the treatment of inflammation. Which statement by a student indicates a need for further teaching?

Glucocorticoids have fewer side effects than NSAIDs

9. What is the most reliable measure for assessing diabetes control over the preceding 3-month period?

Glycosylated hemoglobin level

3. An adolescent patient comes to the clinic complaining of a burning sensation upon urination and a pus-like discharge from the penis. The nurse is correct to suspect that the patient has which disorder?

Gonorrhea

4. A nurse caring for a patient notes that the patient has a temperature of 104°F and a heart rate of 110 beats per minute. The patient's skin is warm and moist, and the patient complains that the room is too warm. The patient appears nervous and has protuberant eyes. The nurse will contact the provider to discuss:

Graves' disease

7. A patient who experiences motion sickness is about to go on a cruise. The prescriber orders transdermal scopolamine [Transderm Scop]. The patient asks the nurse why an oral agent is not ordered. The nurse will explain that the transdermal preparation:

Has less intense anticholinergic effects than the oral form

5. A 12-year-old female patient is admitted to the hospital before sinus surgery. The nurse preparing to care for this patient notes that the admission hemoglobin is 10.2 gm/dL, and the hematocrit is 32%. The nurse will ask the child's parents which question about their daughter?

Has she begun menstruating

6. The nurse is performing a physical assessment on a patient who is receiving treatment with abacavir, zidovudine, and lamivudine [Trizivir]. The patient complains of fatigue. Upon further assessment, the nurse finds a rash and notes that the patient has a temperature of 101.1°F. What is the nurse's best course of action?

Have the patient hold the medications and arrange for an immediate evaluation by the prescriber

A patient is beginning therapy with oral methotrexate [Rheumatrex] for rheumatoid arthritis. The nurse will teach this patient about the importance of:

Having routine renal and hepatic function tests

4. A nurse is obtaining a history from a patient who will receive tadalafil [Cialis] for erectile dysfunction. The patient reports that he expects to have sexual activity three or four times a week. What should the nurse tell the patient?

He should take to his provider about daily dosing of tadalafil

9. A patient who takes the loop diuretic ethacrynic acid is given intravenous gentamicin for an infection. After several days of treatment with gentamicin, the nurse reviews the patient's most recent laboratory results and notes a gentamicin trough of 2.1 mcg/mL and normal blood urea nitrogen (BUN) and serum creatinine levels. The nurse will question the patient about:

Headache, dizziness, or vertigo

What is the target organ when a beta-1 agonist is administered?

Heart

A nurse is assisting the physician during a procedure in which a local anesthetic is administered. Within a few minutes of administration of the anesthetic, the patient has a pulse of 54 beats per minute, respirations of 18 breaths per minute, and a blood pressure of 90/42 mm Hg. The nurse should monitor the patient for further signs of:

Heart block

A patient is to receive a beta agonist. Before administration, which assessment finding would most concern the nurse?

Heart rate of 110 bpm

A child will begin taking methylphenidate [Ritalin] for attention-deficit/hyperactivity disorder. Important baseline information about this patient will include:

Height and weight

A patient with bipolar disorder has frequent manic episodes alternating with depressive episodes. The prescriber orders risperidone [Risperdal] in addition to the lithium [Lithobid] that the patient is already taking. The patient asks the nurse why another drug is needed. The nurse will tell the patient that the risperidone is used to:

Help control symptoms during manic episodes

1. A patient is admitted to the obstetric unit in preterm labor at 36 weeks' gestation. The prescriber orders a tocolytic agent. When teaching the patient about this medication, the nurse will tell her that tocolytics:

Help delay delivery while glucocorticoids are given

10. A patient is taking a calcium channel blocker (CCB) for stable angina. The patient's spouse asks how calcium channel blockers relieve pain. The nurse will explain that CCBs:

Help relax peripheral arterioles to reduce afterload

10. A nurse is caring for an African American patient who has been admitted to the unit for long-term antibiotic therapy with sulfonamides. The patient develops fever, pallor, and jaundice. The nurse would be correct to suspect that the patient has developed:

Hemolytic anemia

4. A patient diagnosed with STEMI is about to undergo a primary percutaneous coronary intervention (PCI). Which combination of pharmacotherapeutic agents will be given to augment this procedure?

Heparin, aspirin, and clopidogrel

3. A 45-year-old patient with a family history of breast cancer is considering using tamoxifen [Nolvadex] for cancer prevention. The nurse performs a health history and learns that the woman had a child when she was 35 years old, that she has not had a hysterectomy, and that she experienced DVT when she was pregnant. What will the nurse tell the patient?

Her history of DVT outweighs any possible benefits she may have with this drug

10. A patient who is recovering from a STEMI 3 months prior is in the clinic for a follow-up evaluation. The patient is taking 81 mg of aspirin, a beta blocker, and an ACE inhibitor daily and uses nitroglycerine as needed for angina. The patient's BMI is 24.5 kg/m2, and serum LDL is 150 mg/dL. The patient has a blood pressure of 135/80 mm Hg. What will the nurse expect the provider to order for this patient?

High-dose statin therapy

13. A school nurse is teaching a high school health class about the effects of marijuana use. Which statement by a student indicates a need for further teaching?

Higher doses of marijuana are likely to produce increased euphoria

A patient is taking drug X and receives a new prescription for drug Y, which is listed as an inducing agent. The nurse caring for this patient understands that this patient may require ___ doses of drug _____

Higher; X

2. A 43-year-old patient with a strong family history of breast cancer considers taking tamoxifen [Nolvadex] for cancer prevention. Which assessment finding is a possible contraindication?

History of DVT

10. The nurse is preparing to administer a dose of epoetin alfa to a patient and notes that the patient has a hemoglobin level of 11.7 gm/dL. Which action by the nurse is correct?

Hold the dose and notify the provider

6. A provider has ordered captopril [Capoten] for a patient who has hypertension. The patient reports a history of swelling of the tongue and lips after taking enalapril [Vasotec] in the past. Which action by the nurse is correct?

Hold the dose and notify the provider

A patient who is hospitalized for an acute gout attack has received several doses of hourly oral colchicine but still reports moderate to severe pain. As the nurse prepares to administer the next dose, the patient begins vomiting. What will the nurse do?

Hold the medication and notify the provider

A patient has been receiving IV penicillin for pneumonia for several days and begins to complain of generalized itching. The nurse auscultates bilateral wheezing and notes a temperature of 38.5 C (101F). Which action by the nurse is correct?

Hold the next dose and notify the prescriber of the symptoms

A young adult patient has been taking an antidepressant medication for several weeks and reports having increased thoughts of suicide. The nurse questions further and learns that the patient has attempted suicide more than once in the past. The patient identifies a concrete plan for committing suicide. The nurse will contact the provider to discuss:

Hospitalizing the patient for closer monitoring

12. The nurse is preparing to discharge a patient with HIV who will continue to take enfuvirtide [Fuzeon] at home. The nurse is providing patient education about the medication. What information about the administration of enfuvirtide is most appropriate for the patient?

How to reconstitute and self-administer a subcutaneous injection

17. The nurse is caring for a pregnant patient who is in labor. The woman reports having had mild preeclampsia with a previous pregnancy. The nurse notes that the woman has a blood pressure of 168/102 mm Hg. The nurse will contact the provider to request an order for which drug?

Hydralazine (Apresoline)

The nurse is caring for a patient receiving intravenous acyclovir. To prevent nephrotoxicity associated with IV acyclovir, the nurse will

Hydrate the patient during the infusion and for 2 hours after the infusion

13. Which two-drug regimen would be appropriate for a patient with hypertension who does not have other compelling conditions?

Hydrochlorothiazide and nadolol

9. A patient who stops taking an ACE inhibitor because of its side effects will begin taking an angiotensin II receptor blocker (ARB) medication. Which side effect of ACE inhibitors will not occur with an ARB medication?

Hypercalemia

9. After starting an antiviral protease inhibitor, a patient with HIV telephones the nurse, complaining, "I'm so hungry and thirsty all the time! I'm urinating 10 or 12 times a day." The nurse recognizes these findings to be consistent with:

Hyperglycemia

1. A patient is taking enalapril [Vasotec]. The nurse understands that patients taking this type of drug for heart failure need to be monitored carefully for:

Hyperkalemia

3. A patient has three separate blood pressure (BP) readings of 120/100 mm Hg, 138/92 mm Hg, and 126/96 mm Hg. Which category describes this patient's BP?

Hypertension

While preparing a patient for a procedure in which the neuromuscular blocking agent will be used, the nurse reviews the preprocedure laboratory values. Which abnormality would cause the most concern?

Hypokalemia

2. A nurse obtaining an admission history on an adult patient notes that the patient has a heart rate of 62 beats per minute, a blood pressure of 105/62 mm Hg, and a temperature of 96.2°F. The patient appears pale and complains of always feeling cold and tired. The nurse will contact the provider to discuss tests for which condition?

Hypothyroidism

A patient recently was diagnosed with bipolar disorder. The patient, who has a history of seasonal allergies, is an athlete who participates in track. The nurse is teaching the patient about lithium [Lithobid], which the prescriber has just ordered. Which statement by the patient indicates the need for further teaching?

I can continue to use ibuprofen as needed for muscle pain

11. A nurse is providing discharge teaching instructions for a patient taking cholestyramine [Questran]. Which statement made by the patient demonstrates a need for further teaching?

I can take cholestyramine with my hydrochlorothiazide

3. A nurse is teaching a patient who will begin taking verapamil [Calan] for hypertension about the drug's side effects. Which statement by the patient indicates understanding of the teaching?

I may become constipated, so I should increase fluids and fiber

15. A patient who has type 2 diabetes will begin taking glipizide [Glucotrol]. Which statement by the patient is concerning to the nurse?

I may continue to have a glass of wine with dinner

12. A nurse is providing teaching for a patient who will begin taking clarithromycin ER [Biaxin XL] to treat an Helicobacter pylori infection. Which statement by the patient indicates understanding of the teaching?

I may experience distorted taste when taking this medication

3. A patient is being treated for a systemic fungal infection with amphotericin B [Abelcet] and will be discharged home from the hospital to complete every other day infusions of the medication for 6 to 8 weeks. The nurse provides discharge teaching before dismissal. Which statement by the patient indicates a need for further teaching?

I may experience headaches and pain in the lower back, legs, and abdomen

11. A nurse is providing teaching for an adult patient with arthritis who has been instructed to take ibuprofen [Motrin] for discomfort. Which statement by the patient indicates a need for further teaching?

I may experience tinnitus with higher doses of this medication

1. The nurse is caring for a patient who is human immunodeficiency virus (HIV) positive and is taking high doses of zidovudine [Retrovir]. The nurse is providing patient education about the adverse effects of the medication. Which statement by the patient demonstrates a need for further teaching?

I may have a deficiency of Vitamin B

6. A nurse provides teaching for a patient who will begin taking procainamide [Procanbid] for long-term suppression of a dysrhythmia. Which statement by the patient indicates a need for further teaching?

I may have increased bruising, but this is a temporary side effect

10. A nurse is providing teaching to a patient who is admitted to the hospital for initiation of treatment with amiodarone [Cordarone] for atrial fibrillation that has been refractory to other medications. Which statement by the patient indicates a need for further teaching?

I may have itching, malaise, and jaundice, but these symptoms will subside

10. A patient with endometriosis is being treated with the gonadotropin-releasing hormone (GnRH) agonist leuprolide [Lupron Depot]. A nurse is teaching the patient about the drug. Which statement by the patient indicates understanding of the teaching?

I may have menopausal like symptoms when taking this medication

3. A nurse is teaching a patient who is about to undergo direct-current (DC) cardioversion to treat atrial flutter. The patient has been taking verapamil and warfarin for 6 months. Which statement by the patient indicates understanding of the teaching?

I may need long-term therapy with another cardiac medication after the procedure

A nurse is discussing motor symptoms with a patient with Parkinson's disease who has been taking levodopa/carbidopa [Sinemet] for 9 months and who is now having regular tics. Which statement by the patient indicates understanding of this symptom?

I may need to try a lower dose of Sinemet to reduce my tics

10. The nurse is providing patient education about glucocorticoid therapy to a patient preparing to be discharged home. Which statement made by the patient best demonstrates understanding of glucocorticoid therapy?

I may take two-thirds of the dose in the morning and one-third in the afternoon

9. A patient with chronic congestive heart failure has repeated hospitalizations in spite of ongoing treatment with hydrochlorothiazide [HydroDIURIL] and digoxin. The prescriber has ordered spironolactone [Aldactone] to be added to this patient's drug regimen, and the nurse provides education about this medication. Which statement by the patient indicates understanding of the teaching?

I need to stop taking potassium supplements

A patient with migraines is started on a beta blocker. The nurse explains the benefits of taking the medication for migraines. Which statement by the patient indicates an understanding of the medications effects?

I need to take it every day to reduce the frequency of migraines

5. A nurse is providing education to a patient who is beginning therapy with AndroGel testosterone gel. What statement made by the patient demonstrates a need for further teaching?

I should apply the medication to my genitals for best results

16. A patient who is an alcoholic is prescribed disulfiram [Antabuse] to help prevent relapse and the nurse provides teaching about the use of this drug. Which statement by the patient indicates understanding of the teaching?

I should avoid shaving lotion and mouthwashes that contain even small amounts of alcohol

A nurse counsels a patient who is to begin taking phenytoin [Dilantin] for epilepsy. Which statement by the patient indicates understanding of the teaching?

I should brush and floss my teeth regularly

A prescriber has ordered Clonidine (Catapres) For a patient who has HTN. The nurse teaches the patient about side effects of this drug. Which statement by the patient indicates understanding?

I should chew sugar-free gum or drink water to reduce dry mouth.

13. A nurse is providing medication teaching for a patient who will begin taking diclofenac [Voltaren] gel for osteoarthritis in both knees and elbows. Which statement by the patient indicates understanding of the teaching?

I should cover areas where the gel is applied to protect them from sunlight

5. A nurse provides teaching to a patient who will begin taking oral cyclophosphamide to treat non-Hodgkin's lymphoma. Which statement by the patient indicates an understanding about how to minimize side effects while taking this drug?

I should drink plenty of fluids while taking this drug

7. A nurse is teaching a male adult patient about the use of testosterone gel. Which statement by the patient indicates an understanding of the teaching?

I should not let my child touch the gel to prevent behavioral problems

A nurse provides teaching for a woman who will begin taking supplemental calcium. Which statement by the woman indicates understanding of the teaching?

I should not take more than 600mg of calcium at one time

1. A nurse is providing education about tetracycline [Sumycin]. Which statement by the patient best demonstrates understanding of the administration of this medication?

I should not take this medication with milk or other dairy products

13. A nurse is teaching a group of nursing students about influenza prevention. Which statement by a student indicates understanding of the teaching?

I should receive the vaccine every year in October or November

13. A nurse is teaching a patient who has taken glucocorticoids for over a year about glucocorticoid withdrawal. Which statement by the patient indicates a need for further teaching?

I should reduce the dose by half each day until I stop taking the drug

13. A nurse is teaching a patient who will begin taking methimazole [Tapazole] for Graves' disease about the medication. Which statement by the patient indicates understanding of the teaching?

I should report a sore throat or fever to my provider if either occurs

A nurse is providing teaching to a patient newly diagnosed with partial seizures who will begin taking oxcarbazepine [Trileptal]. The patient also takes furosemide [Lasix] and digoxin [Lanoxin]. Which statement by the patient indicates understanding of the teaching?

I should report any nausea, drowsiness, and headache to my provider

9. The nurse is providing patient education to a patient who will begin taking fludrocortisone [Florinef] as adjunctive therapy to hydrocortisone. Which statement by the patient indicates understanding of the teaching?

I should report any swelling of my hands and feet

A nurse is preparing a patient who will stop taking lorazepam [Ativan] for anxiety and begin taking buspirone [Buspar]. Which statement by the patient indicates a need for further teaching?

I should stop taking the Ativan when I start taking the Buspar

4. A nurse teaches a patient about sulfonamides. Which statement by the patient indicates a need for further teaching?

I should stop taking this drug when my symptoms are gone

8. A nurse provides teaching to a woman who is taking tranexamic acid [Lysteda] for menorrhagia. Which statement by the patient indicates a need for further teaching?

I should take an oral contraceptive to prevent pregnancy while taking this drug

5. A patient's provider has recommended a bulk-forming laxative for occasional constipation. Which statement by the patient indicates understanding of the teaching about this agent?

I should take each dose with a full glass of water

The nurse is discussing home management with a patient who will begin taking an alpha-adrenergic antagonist for hypertension. Which statement by the patient indicates understanding of the teaching?

I should take the first dose at bedtime.

3. A nurse provides teaching to a patient who has had a hysterectomy and is about to begin hormone therapy to manage menopausal symptoms. Which statement by the patient indicates understanding of the teaching?

I should take the lowest effective dose for the shortest time method

6. A patient is to begin taking doxycycline to treat a rickettsial infection. Which statement by the patient indicates a need for teaching about this drug?

I should take this drug with food to ensure more complete absorption

10. A female patient who is not taking any other medications is prescribed aliskiren [Tekturna], a direct renin inhibitor (DRI). The nurse reviews medication information with the patient. Which statement by the patient indicates understanding of the teaching?

I should take this medication 1 hour before sitting down to a meal

8. Tadalafil [Cialis] was prescribed 4 weeks ago for a patient with erectile dysfunction. The patient also takes prazosin [Minipress] for hypertension. Which statement by the patient best demonstrates understanding of the use of tadalafil [Cialis]?

I should take this medication no more than once a day

8. A patient who is taking furosemide [Lasix] and digoxin will begin taking captopril [Capoten]. The nurse is providing information about the drug. Which statement by the patient indicates a need for further teaching?

I should take this medication on a full stomach

3. A patient will receive oral ciprofloxacin [Cipro] to treat a urinary tract infection. The nurse provides teaching for this patient. Which statement by the patient indicates a need for further teaching?

I should take this medication with food or milk to improve absorption

A postmenopausal patient is at high risk for developing osteoporosis. The patient's prescriber orders raloxifene [Evista], and the nurse provides teaching about this drug. Which statement by the patient indicates understanding of the teaching?

I should walk as much as possible during long airline flights

3. A nurse is caring for a patient who will begin taking hydralazine to treat hypertension. Which statement by the patient indicates understanding of the nurse's teaching about this drug?

I will also take a beta blocker medication with this drug to prevent rapid heart rate

A nurse is teaching a patient who has a second-degree burn on one arm about the use of a topical anesthetic for pain. Which statement by the patient indicates understanding of the teaching?

I will apply a thin layer of the medication to a small area of the skin

A patient has begun taking phenobarbital after experiencing several seizures and is currently receiving 60 mg PO twice daily. After two weeks of therapy, the patient has a serum drug level of 30 mcg/mL and reports feeling drowsy much of the day. What will the nurse tell this patient?

I will contact your provider to discuss changing your dosing to once daily to minimize the drowsiness

4. A patient who has experienced preterm births with her previous two pregnancies will begin receiving hydroxyprogesterone caproate [Makena] to prevent preterm delivery with her current pregnancy. Which statement by the patient indicates a need for further teaching about this drug?

I will eventually learn to administer the injections of the drug myself

A nurse is helping a nursing student who is administering a medication to a patient with MG. Which statement by the student indicates the need for further teaching?

I will let the patient sleep after giving the medication, because rest is important.

4. A nurse is preparing to assist a nursing student to administer intravenous verapamil to a patient who also receives a beta blocker. The nurse asks the nursing student to discuss the plan of care for this patient. Which statement by the student indicates a need for further teaching?

I will monitor the heart rate frequently to assess for reflex tachycardia

A nurse provides teaching for a 25-year-old patient who will receive mitoxantrone [Novantrone] for worsening relapsing-remitting multiple sclerosis. Which statement by the patient indicates a need for further teaching?

I will need an infusion of this medication once weekly

7. A nurse is teaching a patient who is about to undergo allograft transplantation of the liver. Which statement by the patient indicates understanding of the post-transplant medications?

I will need to have periodic lab work to assess for toxicity

2. A nurse is providing teaching for a nondiabetic adult who develops growth hormone deficiency and who will begin treatment with somatropin [Humatrope]. Which statement by the patient indicates understanding of the teaching?

I will need to monitor my BP frequently while taking this drug

6. A patient who has been taking verapamil [Calan] for hypertension complains of constipation. The patient will begin taking amlodipine [Norvasc] to avoid this side effect. The nurse provides teaching about the difference between the two drugs. Which statement by the patient indicates that further teaching is needed?

I will need to take a beta blocker to prevent reflex tachycardia

3. A nurse provides teaching to a patient who has undergone kidney transplantation and will begin taking cyclosporine [Sandimmune], a glucocorticoid, and sirolimus [Rapamune]. Which statement by the patient indicates understanding of the teaching?

I will need to take an antibiotic to prevent lung infections

7. A patient has been taking chlorthalidone to treat hypertension. The patient's prescriber has just ordered the addition of spironolactone to the patient's drug regimen. Which statement by the patient indicates a need for further teaching?

I will need to take potassium supplements when adding this drug

12. A nurse is providing patient education about colesevelam [Welchol], a bile acid sequestrant. Which statement made by the patient demonstrates a need for further teaching?

I will need to take supplements of fat-soluble vitamins

11. A patient at increased risk for thromboembolic disorders will begin taking a progestin-only oral contraceptive. Which statement by the patient indicates understanding of how this oral contraceptive works?

I will need to use backup contraception if I miss a pill

8. A patient has been taking warfarin [Coumadin] for atrial fibrillation. The provider has ordered dabigatran etexilate [Pradaxa] to replace the warfarin. The nurse teaches the patient about the change in drug regimen. Which statement by the patient indicates understanding of the teaching?

I will stop taking the warfarin and will start taking the dabigatran when my INR is less than 2

A patient will begin using a transdermal preparation of muscarinic antagonist for overactive bladder (OAB). The nurse teaches the patient what to do if side effects occur. Which statement by the patient indicates the need for further teaching?

I will take Benadryl for any itching caused by a local reaction to the patch.

15. While giving discharge instructions to a patient who will be taking cholestyramine [Questran], the nurse wants to assess the patient's understanding of the treatment. Which statement made by the patient best demonstrates a need for additional teaching?

I will weigh myself weekly

A patient with bipolar disorder takes lamotrigine [Lamictal]. Which statement by the patient would prompt the nurse to hold the drug and notify the prescriber for further assessment?

I've broken out in a rash on my chest and back

8. A patient with vitamin B12 deficiency is admitted with symptoms of hypoxia, anemia, numbness of hands and feet, and oral stomatitis. The nurse expects the prescriber to order which of the following therapies?

IM cyanocobalamin and folic acid

3. A patient with new-onset exertional angina has taken three nitroglycerin sublingual tablets at 5-minute intervals, but the pain has intensified. The nurse notes that the patient has a heart rate of 76 beats per minute and a blood pressure of 120/82 mm Hg. The electrocardiogram is normal. The patient's lips and nail beds are pink, and there is no respiratory distress. The nurse will anticipate providing:

IV nitroglycerin and a beta blocker

16. A hospitalized patient is being treated for tuberculosis with a drug regimen that includes pyrazinamide. The patient complains of pain in the knee and shoulder joints. The nurse will contact the provider to request an order for:

Ibuprofen

6. A nurse is teaching a patient who has been diagnosed with hypothyroidism about levothyroxine [Synthroid]. Which statement by the patient indicates a need for further teaching?

If I take Calcium supplements, I may need to decrease my dose of Synthroid

1. A nurse is providing teaching for a patient with stable angina who will begin taking nitroglycerin. Which statement by the patient indicates understanding of the teaching?

If i take nitroglycerin before exertion, I can reduce the chance of an anginal attack

A patient has been newly diagnosed with multiple sclerosis (MS), and the nurse provides teaching about the medications for the disease. Which statement by the patient indicates a need for further teaching?

If medication is begun early, permanent remission can be achieved

A nurse is teaching the parent of a child with spastic quadriplegia about intrathecal baclofen [Lioresal]. Which statement by the parent indicates a need for further teaching?

If my child has a seizure, I should stop giving the medication immediately

2. A nurse is teaching a patient about the use of sildenafil [Viagra] for erectile dysfunction. Which statement by the patient indicates understanding of the teaching?

If my erection lasts longer than 4 hours, I should contact my provider

A patient with schizophrenia shows suicidal behaviors, and the provider orders clozapine [Clozaril]. The nurse teaches the family about the medication and its side effects. Which statement by a family member indicates a need for further teaching about this drug?

If the ANC is less than 3000, the drug will be discontinued permanently

The nurse provides teaching for a patient who will begin taking rotigotine [Neupro] to treat Parkinson's disease. What will the nurse include in teaching?

If you need to stop this drug, your provider will order a gradual withdrawal

A patient who has cancer reports pain as "burning" and "shooting" alternating with feelings of numbness and coldness. The nurse will contact the provider to discuss the use of which medication?

Imipramine (Tofranil)

A nurse is caring for an infant after a surgical procedure. After ensuring that the ordered dose is appropriate for the infant's age and weight, the nurse gives the narcotic analgesic IV. When assessing the infant 15 minutes later, the nurse notes respirations of 22, and a HR of 110. The infant is asleep in the parent's arms and does not awaken when VS are assessed. The nurse understands that these findings are a result of:

Immaturity of the blood-brain barrier in the infant

A woman with moderate migraine headaches asks a nurse why the provider has ordered metoclopramide [Reglan] as an adjunct to aspirin therapy, because she does not usually experience nausea and vomiting with her migraines. The nurse will tell her that the metoclopramide is used to:

Improve absorption of the aspirin

A patient tells the nurse that an analgesic he will begin taking may cause drowsiness and will decrease pain up to 4 hours at a time. Based on this understanding of the drug's effects by the patient, the nurse will anticipate which outcome?

Improved compliance with the drug regimen.

6. A patient with volume overload begins taking a thiazide diuretic. The nurse will tell the patient to expect which outcome when taking this drug?

Improved exercise tolerance

A nurse is obtaining a health history from an older adult patient in an outpatient clinic. The patient reports chronic difficulty falling asleep and staying asleep. The nurse knows that the best treatment for this patient will be:

Improved sleep hygiene

Dopamine is administered to a patient who has been experiencing hypotensive episodes. Other than an increase in BP, which indicator would the nurse use to evaluate a successful response?

Increase in urine output

A nurse is administering drug X to a patient. The drug information states that the drug acts by activating receptors in the peripheral nervous system by increasing transmitter synthesis. The nurse understands that the effect of this drug is to:

Increase receptor activation

7. A patient who has taken warfarin [Coumadin] for a year begins taking carbamazepine. The nurse will anticipate an order to:

Increase the dose of warfarin

6. A pregnant patient is being induced with oxytocin, which has been infusing for 1 hour. The initial rate was 6 milliunits/min, and the rate now is 18 milliunits/min. The nurse notes regular contractions occurring every 3 minutes, each lasting 35 seconds. The nurse will:

Increase the rate of infusion by 3 to 6 milliunits/min every 15 to 40 minutes

8. A nursing student asks a nurse how beta blockers increase the oxygen supply to the heart in the treatment of anginal pain. The nurse tells the student that beta blockers:

Increase the time the heart is in diastole

The nurse is caring for a child who has ingested a toxic amount of aspirin. The provider orders an IV drug that will increase pH in the blood and urine. the nurse understands that this effect is necessary to:

Increase the urinary excretion of aspirin

7. A recent campaign, initiated by the Centers for Disease Control (CDC), to delay the emergence of antibiotic resistance in hospitals, has what as one of its objectives?

Increased adherence to prescribed antibiotics

14. A nurse is reviewing a patient's medications and realizes that gemfibrozil [Lopid] and warfarin [Coumadin] are to be administered concomitantly. Which effect will the nurse anticipate in this patient?

Increased anticoagulant effects

A nurse is administering an agonist drug that acts on postganglionic neurons of the sympathetic nervous system. Which response will the nurse expect to see?

Increased cardiac output

3. A patient with a history of hypertension is admitted for a procedure. If the patient's arterial pressure decreases, which clinical manifestation would the nurse expect to see?

Increased heart rate

3. The nurse is caring for a patient who is HIV positive and has a previous history of drug and alcohol abuse. The patient is being treated with combination therapies, including didanosine [Videx]. Which laboratory findings would most concern the nurse?

Increased serum amylase and triglycerides and cecreased serum calcium

1. A nurse is administering a vasodilator that dilates resistance vessels. The nurse understands that this drug will have which effect on the patient?

Increased tissue perfusion

9. A nurse is teaching a community education class on contraceptives. The nurse tells the class that if spermicides containing nonoxynol-9 are used, the patient should take special precautions, because these spermicides have been linked to:

Increased transmission of the HIV

15. A nursing student asks a nurse how digoxin causes dysrhythmias. The nurse correctly states that digoxin:

Increases automaticity in the PUrkinje fibers

A patient who has begun taking levodopa/carbidopa [Sinemet] reports feeling lightheaded and dizzy, especially when standing up from a sitting position. What will the nurse recommend?

Increasing salt and water intake

A 20-kg child has been taking valproic acid [Depakote] for 1 week to treat a seizure disorder. The child is receiving 200 mg PO twice daily. The child's parents report no improvement in seizure activity. The nurse will anticipate that the provider will order which change in this child's drug regimen?

Increasing the dose of valproic acid to 300 mg PO twice daily

3. A clinic patient who has been taking a glucocorticoid for arthritis for several months remarks to the nurse, "It's a good thing my symptoms are better, because my mother has been quite ill, and I have to take care of her." The patient's blood pressure is 100/60 mm Hg. The nurse will report this to the provider and ask about:

Increasing the patient dose

3. A patient who is having her sixth child has gone beyond term, and her labor is being induced with oxytocin [Pitocin]. The patient is having increased frequency, duration, and intensity of contractions. The nurse will interrupt the oxytocin infusion if what occurs?

Individual contractions last 2 minutes

Parents ask the nurse why an OTC cough suppressant with sedative side effects is not recommended for infants. Which response is correct?

Infants are more susceptible to central nervous system effects than are adults.

A patient with cancer who has been receiving an opioid analgesic reports having pain at a new location even though the previous pain is well controlled. The nurse will contact the provider to discuss:

Infection or metastasis

5. A nurse is discussing intravenous amphotericin B treatment with a nursing student who is about to care for a patient with a systemic fungal infection. Which statement by the student indicates a need for further teaching?

Infusions of amphotericin B should be administered over 1 to 2 hours

A patient receiving botulinum toxin injections to control muscle spasticity asks how the drug works. The nurse knows that this drug affects the transmitter acetylcholine by

Inhibiting its release

8. A 12-year-old male patient diagnosed with hypogonadism will begin testosterone injections. What will the nurse include when teaching the family about this therapy?

Injections are given every 2 to 4 weeks for 3 to 4 years

A nurse is preparing a pediatric patient for surgery and is teaching the patient and the child's parents about the use of the patient-controlled analgesia pump. The parents voice concern about their child receiving an overdose of morphine. What will the nurse do?

Instruct the parents not to activate the device when their child is sleeping

2. A nurse administers an ACE inhibitor to a patient who is taking the drug for the first time. What will the nurse do?

Instruct the patient not to get up without assistance

9. The nurse is taking a medication history on a newly admitted patient. The patient reports taking folic acid and vitamin B12. The nurse notifies the provider because of the concern that folic acid can:

Mask the signs of vitamin B12 deficiency

A patient asks a nurse to explain what drug tolerance means. The nurse responds by telling the patient that when tolerance occurs, it means the patient

May need increased amounts of the drug over time

14. A patient has a positive test for influenza type A and tells the nurse that symptoms began 5 days before being tested. The prescriber has ordered oseltamivir [Tamiflu]. The nurse will tell the patient that oseltamivir:

May not be effective because of the delay in starting treatment

A nurse id dicussing alcohol abuse with a group of nursing students. One student asks whether alcohol consumption has any beneficial effects. The nurse replies that in moderate amounts, alcohol

May protect against dementia

10. A healthy male patient who does not have erectile dysfunction asks about medications to improve sexual stamina. What will the nurse tell this patient?

Medications for ED have no effect on erections in healthy men

A nurse is teaching a group of nursing students about the use of memantine [Namenda] for Alzheimer's disease. Which statement by a student indicates understanding of the teaching?

Memantine modulates the effects of glutamate to alter calcium influx into neurons

10. The nurse is preparing to administer medication to a patient receiving cyclophosphamide [Cytoxan]. To protect against the side effect of hemorrhagic cystitis, the nurse would expect to administer which drug?

Mesna (Mesnex)

A patient asks a nurse why a friend who is taking the same drug responds differently to that drug. The nurse knows that the most common variation in drug response is due to differences in each patient's:

Metabolism of drugs

17. In discussing the rationale for using methadone to ease opioid withdrawal, the nurse would explain that it has which pharmacologic properties or characteristics?

Methadone can prevent abstinence syndromes

12. A young adult patient is admitted to the hospital for evaluation of severe weight loss. The nurse admitting this patient notes that the patient has missing teeth and severe tooth decay. The patient's blood pressure is 160/98 mm Hg. The patient has difficulty answering questions and has trouble remembering simple details. The nurse suspects abuse of which substance?

Methamphetamine

8. A pregnant female patient with bacteriuria, suprapubic pain, urinary urgency and frequency, and a low-grade fever is allergic to sulfa, ciprofloxacin, and amoxicillin. The nurse knows that the best alternative for treating this urinary tract infection is with:

Methenamine (Hiprex)

A nurse is teaching students about the pharmacology of methyldopa. Which statement by a student indicates the need for further teaching?

Methyldopa reduces BP by reducing Cardiac output

5. A patient arrives in the emergency department complaining of dizziness, lightheadedness, and a pulsating headache. Further assessment reveals a blood pressure of 82/60 mm Hg and palpitations. The patient's friends tell the nurse that they were experimenting with "poppers." The nurse will expect to administer which medication?

Methylene blue and supplemental oxygen

A patient with Type 1 DM is taking NPH insulin, 30 units a day. A nruse notes that the patient is also taking Metoprolol (Lopressor). What education should the nurse provide to the patient?

Metoprolol may masks signs of hypoglycemia, so you need to monitor your blood glucose very closely

2. A patient on an oncology unit has been receiving ifosfamide [Ifex] for a few days. Before administering the next dose, the nurse reviews the patient's laboratory test results. Which finding would cause the nurse to hold the dose?

Microscopic hematuria

13. Which statement is correct about the contrast between acarbose and miglitol?

Miglitol has not been associated with hepatic dysfunction

A patient with cerebral palsy who has been receiving baclofen [Lioresal] via gastrostomy tube for 3 months is admitted to the hospital for evaluation of new-onset seizures. What may the nurse suspect to be the cause of these seizures?

Missed doses of baclofen

10. The nurse is caring for a patient who is taking a protease inhibitor (PI). Upon review of the laboratory test results, the nurse notes that the patient has newly elevated plasma triglycerides and cholesterol. The nurse expects that the prescriber will manage these levels with:

Modified diet and exercise

5. A nurse is preparing to administer oral ofloxacin to a patient. While taking the patient's medication history, the nurse learns that the patient takes warfarin and theophylline. The correct action by the nurse is to request an order to:

Monitor coagulation levels

A patient receives a drug that has a narrow therapeutic range. The nurse administering this medication will expect to do what?

Monitor plasma drug levels.

A patient will receive atracurium (Tracrium) during surgery for Neuromuscular blockade. The nurse caring for the patient will correctly perform which of the following actions?

Monitor the BP closely

A patient is taking a drug that has known toxic side effects. What will the nurse do?

Monitor the function of all organs potentially affected by the drug.

A nurse is caring for a patient and her newborn immediately after delivery. The patient's medication history includes prenatal vitamins, one or two glasses of wine before knowing she was pregnant, occasional use of an albuterol inhaler in her last trimester, and VI morphine-during labor. What will the nurse expect to do?

Monitor the infant's respirations and prepare to administer naloxone if needed.

11. A nurse is obtaining a drug history from a patient about to receive sulfadiazine. The nurse learns that the patient takes warfarin, glipizide, and a thiazide diuretic. Based on this assessment, the nurse will expect the provider to:

Monitor the patient's coagulation levels

A nurse administers atropine to a patient before induction of anesthesia for a surgical procedure. When evaluating the effects of this medication, the nurse will:

Monitor the patient's heart rate

12. A patient is about to begin treatment with isoniazid. The nurse learns that the patient also takes phenytoin [Dilantin] for seizures. The nurse will contact the provider to discuss:

Monitoring phenytoin levels

A postoperative patient is reporting pain as a 7 on a scale from 1 to 10, with 10 being the worst pain. The nurse caring for the patient assesses vital signs of HR, 76; RR, 16; and BP, 110/70. The patient has vomited twice. Which postoperative medications will the nurse expect to administer?

Morphine and ondansetron (Zofran)

5. A patient in the emergency department has severe chest pain. The nurse administers morphine intravenously. The patient asks the nurse why morphine is given. Which response by the nurse is correct?

Morphine helps by relieving pain and reducing the cardiac oxygen demand

A nurse is teaching a group of woman about medications. The women want to know why so many drugs have unpredictable effects in women. The nurse will tell them that:

Most known drug effects are based on drug trials in men

11. The nurse counseling a couple who cannot conceive learns that female infertility problems have been ruled out. What will the nurse expect to tell this couple?

Most male infertility is not linked to known endocrine disorders

9. A patient with hypertension will begin taking an alpha1 blocker. What will the nurse teach this patient?

Move slowly from sitting to standing when taking this drug

3. A patient who is taking simvastatin [Zocor] develops an infection and the provider orders azithromycin [Zithromax] to treat the infection. The nurse should be concerned if the patient complains of:

Muscle pain

Which areas of the body show the effects of neuromuscular blockers last?

Muscles of respiration and the diaphragm

3. An adult male patient will begin androgen therapy for testicular failure. Which statement by the patient indicates understanding of the treatment regimen?

My libido may improve while I am taking this medication

19. A patient with severe community-acquired pneumonia has been prescribed telithromycin [Ketek]. Which aspect of the patient's medical history is of concern to the nurse?

Myasthenia gravis

1. A patient is taking a beta1-adrenergic drug to improve the stroke volume of the heart. The nurse caring for this patient knows that this drug acts by increasing:

Myocardial contractility

12. A woman who has arthritis is breast-feeding her infant and asks the nurse if it is safe to take NSAIDs while nursing. What will the nurse tell this patient?

NSAIDS are safe to take while breast-feeding

In a discussion of drug-drug interactions, which would be the best example of a beneficial inhibitory interaction?

Naloxone blocking morphine sulfate's action

A young adult postoperative patient is receiving morphine 2 to 4 mg IV every 2 hours PRN pain. The last dose was 3 mg given 2 hours ago. The patient is asleep, and the nurse notes a heart rate of 86 beats per minute and a respiratory rate of 8 breaths per minute. Which PRN medication will the nurse give this patient?

Naloxone to block the effects of morphine

15. A patient who has undergone treatment for alcoholism several times, with relapse occurring shortly after each treatment, has just completed detoxification. The patient requests a medication to help maintain abstinence. Which drug will the nurse expect the provider to prescribe?

Naltrexone (ReVia)

A patient who has migraine headaches has been using sumatriptan [Imitrex] with good results, but reports frequent migraine recurrence 24 hours later. Which medication will the nurse expect the provider to order for this patient?

Naratriptan (Amerge)

8. A patient has a localized skin infection, which is most likely caused by a gram-positive cocci. Until the culture and sensitivity results are available, the nurse will expect the provider to order a ____-spectrum ____ agent.

Narrow; topical

6. A nurse is obtaining a history and reviewing the chart of an adult male patient who has been taking oral androgens. Which assessment would warrant notifying the provider?

Nausea, anorexia, and fatigue

9. A patient with histoplasmosis is being treated with itraconazole [Sporanox]. The nurse will teach this patient to report which symptoms?

Nausea, vomiting, anorexia

11. A patient shows signs and symptoms of conjunctivitis. Which aminoglycoside would the nurse expect to be ordered?

Neomycin

2. A patient with a liver transplant has been receiving cyclosporine [Sandimmune] for 6 months. The nurse reviews this patient's laboratory results and notes a sharp increase in the blood urea nitrogen (BUN) and serum creatinine. Vital signs are normal, and the patient reports no discomfort. What does the nurse suspect?

Nephrotoxicity

A nurse is preparing a patient to go home from the emergency department after receiving sutures for a laceration on one hand. The provider used lidocaine with epinephrine as a local anesthetic. Which symptom in this patient causes the most concern?

Nervousness and tachycardia

3. The nurse is caring for a pregnant patient recently diagnosed with hypothyroidism. The patient tells the nurse she does not want to take medications while she is pregnant. What will the nurse explain to this patient?

Neuropsychologic deficits in the fetus can occur if the condition is not treated

14. The nurse on an oncology unit prepares to administer the fourth cycle of docetaxel [Taxotere] to a patient with breast cancer. Which clinical finding would cause the nurse to withhold the dose and call the prescriber?

Neutrophil count below 1500/mm3

The spouse of a patient who smokes wonders why anyone would want to engage in such a disgusting habit. What will the nurse tell the spouse?

Nicotine increases alertness and promotes dopamine release

A patient reports a desire to stop smoking and asks what is available without a prescription to help. The nurse tells the patient that which method is best?

Nicotine replacement and 1-800-QUIT-NOW

A patient who just found out she is pregnant tells the nurse she wants to quit smoking. She asks about pharmacological aids to help her. The nurse is correct to tell her what?

Nicotine replacement therapy is harmful, but it is safer than smoking, So it can be used.

6. A patient has a positive test for hepatitis C and is admitted to the hospital. The admission laboratory tests reveal a normal ALT, and a liver biopsy is negative for hepatic fibrosis and inflammation. The nurse will prepare this patient for:

No medication therapy at this time

A patient who has been taking phenobarbital for epilepsy begins taking valproic acid [Depakote] as adjunct therapy. The nurse notes that the patient is very drowsy. What will the nurse do?

Notify the prescriber and request an order to reduce the dose of phenobarbital

A patient who will begin taking colchicine for gout reports taking nonsteroidal anti-inflammatory drugs, simvastatin, amoxicillin, and digoxin. What will the nurse do?

Notify the provider about the potential risk of muscle injury when simvastatin is taken with colchicine

6. A patient with hypertension with a blood pressure of 168/110 mm Hg begins taking hydrochlorothiazide and verapamil. The patient returns to the clinic after 2 weeks of drug therapy, and the nurse notes a blood pressure of 140/85 mm Hg and a heart rate of 98 beats per minute. What will the nurse do?

Notify the provider and ask about adding a beta blocker medication

12. A hospitalized patient has a blood pressure of 145/96 mm Hg. The nurse caring for this patient notes that the blood pressure the day before was 132/98 mm Hg. The patient reports ambulatory blood pressure readings of 136/98 and 138/92 mm Hg. The patient has a history of a previous myocardial infarction and has adopted a lifestyle that includes use of the DASH diet and regular exercise. What will the nurse do?

Notify the provider and discuss ordering a beta blocker for this patient

5. A patient with HIV and mucocutaneous HSV is being treated with foscarnet after failing treatment with acyclovir. After 2 weeks, the patient's dose is increased to 90 mg/kg over 2 hours from 40 mg/kg over 1 hour. The patient reports numbness in the extremities and perioral tingling. What will the nurse do?

Notify the provider and request an order for a serum calcium level

The nurse assesses a patient who has veen given phentolamine (OraVerse) to treat pheochromocytoma. The nurse notes a BP of 76/52 and a HR of 90. Which action by the nurse is correct?

Notify the provider and request an order for norepinephrine.

A patient who has recently begun taking interferon beta reports feeling depressed. Which action by the nurse is correct?

Notify the provider of these symptoms

10. A postoperative patient will begin anticoagulant therapy with rivaroxaban [Xarelto] after knee replacement surgery. The nurse performs a history and learns that the patient is taking erythromycin. The patient's creatinine clearance is 50 mL/min. The nurse will:

Notify the provider to discuss changing the patient's antibiotic

8. A patient with diabetes develops ventricular tachycardia and is in the hospital for evaluation of this condition. The nurse reviews the history and learns that the patient takes mexiletine [Mexitil] for pain caused by peripheral neuropathy. What should the nurse do?

Notify the provider to request that another drug be used for peripheral neuropathy pain

A nurse is preparing to administer a drug. Upon reading the medication guide, the nurse notes that the drug has been linked to symptoms of Parkinson's disease in some patients. What will the nurse do?

Observe the patient closely for such symptoms and prepare to treat them if needed.

6. A patient who has a long-term addiction to opioids takes an overdose of barbiturates. The nurse preparing to care for this patient will anticipate:

Observing pinpoint pupils, respiratory depression, and possibly coma in this patient

4. A patient is receiving intravenous promethazine [Phenergan] 25 mg for postoperative nausea and vomiting. What is an important nursing action when giving this drug?

Observing the IV insertion site frequently for patency

A patient is about to begin therapy with fingolimod [Gilenya] to treat multiple sclerosis. T in he nurse learns that the patient has not had chickenpox or the varicella zoster virus (VZV) vaccine. What will the nurse do?

Obtain an order for VZV antibody test

8. A patient with lung cancer receives filgrastim [Neupogen] after chemotherapy to reduce neutropenia. The patient reports a moderate degree of bone pain. What will the nurse do?

Obtain an order to administer acetaminophen

2. The nurse is caring for a patient on a medical-surgical unit who has a fever of unknown origin. The prescriber has ordered a broad-spectrum antibiotic. Which intervention is the priority?

Obtaining all cultures before the antibiotic is administered

6. A patient who has erectile dysfunction asks a nurse whether sildenafil [Viagra] would be a good medication for him to take. Which aspect of this patient's history would be of most concern?

Occasional use of nitroglycerin

A patient who has diabetes mellitus is diagnosed with schizophrenia and the provider orders thioridazine. The patient asks the nurse why the provider hasn't ordered olanzapine [Zyprexa], which the patient has seen advertised on television. Which response by the nurse is the most important reason that this patient is not receiving olanzapine?

Olanzapine causes more metabolic side effects than thioridazine

11. Insulin glargine is prescribed for a hospitalized patient who has diabetes. When will the nurse expect to administer this drug?

Once daily at bedtime

A patient newly diagnosed with cancer reports having pain at a level of 7 to 8 on a scale of 10. Which type of pain management will be used initially to treat pain in this patient?

Opioid analgesics

3. The nurse is caring for a patient who begins to complain of shortness of breath. The nurse assesses the patient and notes 3+ pitting edema bilaterally in the lower extremities. Which medication taken by the patient causes the most concern?

Oprelvekin (Interleukin-11)

5. Which statement is accurate about the long-term complications of diabetes?

Optimal control of both types of diabetes reduces the risk of eye, kidney, and nerve damage

2. A patient who is pregnant has a history of recurrent genital herpesvirus (HSV). The patient asks the nurse what will be done to suppress an outbreak when she is near term. The nurse will tell the patient that:

Oral acyclovir may be used during pregnancy

A prescriber has ordered medication for a newborn. The medication is eliminated primarily by hepatic metabolism. The nurse expects the prescriber to:

Order a dose that is lower than the adult dose

10. An older adult patient with chronic obstructive pulmonary disease (COPD) develops bronchitis. The patient has a temperature of 39.5°C. The nurse will expect the provider to:

Order empiric antibiotics while waiting for sputum culture results

11. A patient has been taking isoniazid [Nydrazid] for 4 months for latent tuberculosis. The patient reports bilateral tingling and numbness of the hands and feet, as well as feeling clumsy. The nurse expects the provider to:

Order pyridoxine 100mg per day

A nurse is discussing the differences between OxyContin OC and OxyContin OP with a group of nursing students. Which statement by a student indicates understanding of the teaching?

OxyContin OP is not easily crushed into a powder

An older patient who lives alone and is somewhat forgetful has an overactive bladder and reports occasional constipation. The patient has tried behavioral therapy to treat the OAB without adequate results. Which treatment will the nurse anticipate for this patient?

Oxybutynin (Oxytrol) transdermal patch

6. A patient has been taking psyllium [Metamucil] two to three times daily for several days. The patient complains of stomach pain but has not had a stool. What will the nurse do?

Palpate the patient's abdomen and auscultate for bowel sounds

A patient receives topical atropine to facilitate an eye examination. The nurse will tell the patient to remain in a darkened room or to wear sunglasses for several hours until the effects of the medication wears off. This teaching is based on the nurse's knowledge that muscarinic antagonists cause:

Paralysis of the iris sphincter

A patient is receiving IV gentamicin. A serum drug test reveals toxic levels. The dosing is correct, and the medication has been tolerated by this patient in the past. Which could be a probable cause of the test result?

Patient is taking another medication that binds to serum albumin.

7. A patient with infertility will begin taking menotropins [Repronex]. The nurse will evaluate this patient's history to determine whether the:

Patient's ovaries are capable of responding to gonadotropins

17. A nurse is teaching a nursing student about dalfopristin/quinupristin [Synercid]. Which statement by the student indicates an understanding of the teaching?

Patients taking this drug should have blood tests performed frequently

12. A nurse is providing teaching to a nursing student about to care for a woman with irritable bowel syndrome with diarrhea (IBS-D) who is receiving alosetron [Lotronex]. Which statement by the student indicates a need for further teaching?

Patients with diverticulitis and IBS-C may take this drug

15. A nurse is preparing to administer a dose of gentamicin to a patient who is receiving the drug 3 times daily. The nurse will monitor ____ levels.

Peak and trough

16. A 5-year-old patient seen in an outpatient clinic is noted to have hypertension on three separate visits. Ambulatory blood pressure monitoring confirms that the child has hypertension. As an initial intervention with the child's parents, the nurse will expect to:

Peform a detailed health history on the child

2. A patient is admitted with lower abdominal pain and nausea. The nurse performing the initial assessment notes that the patient's abdomen is distended and firm, and hypoactive bowel sounds are present. The patient has not had a stool for 3 days. The nurse will contact the provider, who will:

Perform diagnostic tests

A nurse administers the same medication in the same preparation in the same dose to several patients and notes that some patients have better response to the drug than others. What is the most likely explanation for this phenomenon?

Pharmacogenomic differences among individuals

3. A patient who has endometriosis has been unable to conceive. She asks the nurse about medications to treat the condition. What will the nurse tell the patient?

Pharmacologic agents used to treat endometriosis do not enhance fertility

The nurse is teaching a patient how a medication works to treat an illness. To do this, the nurse will rely on knowledge of which topic?

Pharmacotherapeutics

A patient with a new-onset seizure disorder receives a prescription for phenobarbital. The patient reports being concerned about the sedative side effects of this drug. Which response by the nurse is correct?

Phenobarbital doses for seizures are nonsedating

9. A nurse is caring for a patient who is addicted to barbiturates and who will begin receiving phenobarbital. The nurse discusses the care of this patient with a nursing student. Which statement by the student indicates understanding of the teaching?

Phenobarbital has a long half-life and can be tapered gradually to minimize abstinence symptoms

A nurse is discussing phentolamine with a student. Which statement by the student indicates the need for further teaching?

Phentolamine is a competitive adrenergic agonist that acts selectively on alpha 1 receptors

A patient is experiencing toxic side effects from atropine, including delirium and hallucinations. Which medication will the nurse expect to administer?

Physostigmine

A patient has developed muscarinic antagonist toxicity from ingestion of an unknown chemical. The nurse should prepare to administer which medication?

Physostigmine (Antilirium)

17. A patient who is taking warfarin [Coumadin] has just vomited blood. The nurse notifies the provider, who orders lab work revealing a PT of 42 seconds and an INR of 3.5. The nurse will expect to administer:

Phytonadione (Vit. K) 1 mg IV over 1 hour

The nurse is teaching a patient about home administration of insulin to treat DM. As part of the teaching, the patient and nurse identify goals to maintain specific blood glucose ranges. This represents which aspect of the nursing process?

Planning

4. The parent of a child with cerebral palsy reports that the child has pebble-like stools most of the time and seems uncomfortable if several days have passed between stools. The nurse will suggest that the parent discuss which medication with the child's provider?

Polyethylene glycol (MiraLax)

3. A patient with renal disease is scheduled for a colonoscopy. Before the procedure, the nurse will anticipate administering:

Polyethylene glycol and electrolytes

5. A patient with hemophilia is hospitalized for infusion of factor VIII replacement through a venous port. While giving the drug, the nurse notes that the patient's temperature is 101.5°F. The nurse will contact the provider to report which possibility?

Port infection

16. A patient will begin taking an immunosuppressant medication. The nurse learns that the patient has a history of frequent candidal infections. The nurse will expect the provider to order which drug as Prophylaxis?

Posaconazole (Noxafil)

12. A nurse is caring for a patient who takes an ACE inhibitor and an ARB medication who will begin taking TMP/SMZ to treat a urinary tract infection. Which serum electrolyte will the nurse expect to monitor closely?

Potassium

2. A patient who is taking digoxin is admitted to the hospital for treatment of congestive heart failure. The prescriber has ordered furosemide [Lasix]. The nurse notes an irregular heart rate of 86 beats per minute, a respiratory rate of 22 breaths per minute, and a blood pressure of 130/82 mm Hg. The nurse auscultates crackles in both lungs. Which laboratory value causes the nurse the most concern?

Potassium level of 3.5 mEq/L

A patient who has been using secobarbital for several months to treat insomnia tells the nurse that the prescriber has said the prescription will be changed to temazepam [Restoril] because it is safer. The patient asks why this agent is safer. The nurse is correct in telling the patient that temazepam:

Potentiates endogenous gamma-aminobutyric acid producing a finite CNS depression

The nurse is teaching a patient about taking warfarin and asks if the patient takes aspirin. This assessment by the nurse reflects a knowledge of which type of drug interaction?

Potentiative effects

5. A postmenopausal patient who has had a hysterectomy and who has a family history of coronary heart disease reports experiencing vaginal dryness and pain with intercourse but tells the nurse that she doesn't want to take hormones because she is afraid of adverse effects. The nurse will suggest that the woman ask her provider about:

Premarin vaginal

A patient who has had abdominal surgery has been receiving morphine sulfate via a patient-controlled analgesia (PCA) pump. The nurse assesses the patient and notes that the patient's pupils are dilated and that the patient is drowsy and lethargic. The patient's heart rate is 84 beats per minute, the respiratory rate is 10 breaths per minute, and the blood pressure is 90/50 mm Hg. What will the nurse do?

Prepare to administer naloxone and possibly ventilatory support

A nurse is caring for a patient receiving intrathecal baclofen [Lioresal]. The patient is unresponsive. After asking a coworker to contact the provider, the nurse anticipates performing which intervention?

Preparing to support respirations

7. A patient who is taking doxycycline for a serious infection contacts the nurse to report anal itching. The nurse will contact the provider to discuss:

Prescribing an antifungal drug to treat a superinfection

A patient receives a neuromuscular blocking agent as an adjunct to inhalation anesthesia. When caring for this patient, it is important for the nurse to remember that neuromuscular blocking agents:

Prevent contraction of the diaphragm

A patient is taking alendronate [Fosamax] to treat Paget's disease. The patient asks the nurse why calcium supplements are necessary. The nurse will tell the patient that calcium supplements are necessary to:

Prevent hyperparathyroidism

2. A patient begins taking nifedipine [Procardia], along with metoprolol, to treat hypertension. The nurse understands that metoprolol is used to:

Prevent reflex tachycardia

the nurse administer's naloxone to a patient who has received a toxic dose of morphine sulfate. The nurse understands that the naloxone is effective because of which action?

Preventing activation of opioid receptors by neurochemical alterations

A patient receives morphine and shows signs of toxicity. The prescriber orders naloxone to reverse the effects of morphine. The nurse understands that the naloxone reverses morphine toxicity by which action on morphine receptor sites?

Preventing activation of receptors

A group of nursing students asks a nurse to explain the blood-brain barrier. the nurse would be correct to say that the BBB

Prevents some potentially toxic substances from crossing into the CNS

4. A nurse provides teaching to a group of nursing students about the risks and benefits of hormone therapy (HT), including estrogen therapy (ET) and combination estrogen/progestin therapy (EPT). Which statement by a student indicates understanding of the teaching?

Principle benefits of ET are suppression of menopausal symptoms and prevention of bone loss

A nurse is assisting a physician who is preparing to suture a superficial laceration on a patient's leg. The physician asks the nurse to draw up lidocaine with epinephrine. The nurse understands that epinephrine is used with the lidocaine to:

Prolong anesthetic effects and reduce the risk of systemic toxicity from lidocaine

A patient has been taking methadone [Dolophine] for 5 months to overcome an opioid addiction. The nurse should monitor the patient for which of the following electrocardiographic changes?

Prolonged QT interval

What is the primary reason for opioid abuse?

Prolonged sense of euphoria

4. A patient asks a nurse how nitroglycerin works to relieve anginal pain. The nurse correctly states, "Nitroglycerin:

Promotes vasodilation, which reduces preload and oxygen demand

11. A child with severe hemophilia A receives factor VIII. The nurse expects this drug to be given:

Prophylactically three times weekly to maintain factor VIII activity above 1% of normal

A surgical nurse is caring for a patient who is receiving isoflurane [Forane]. Which is true about this inhalation anesthetic?

Propofol is used for induction to minimize cough prior to administering isoflurane

14. A patient arrives in the emergency department with a heart rate of 128 beats per minute and a temperature of 105°F. The patient's skin feels hot and moist. The free T4 level is 4 ng/dL, the free T3 level is 685 pg/dL, and the TSH level is 0.1 microunits/mL. The nurse caring for this patient will expect to administer:

Propylthiouracil (PTU)

2. An older male patient comes to the clinic with complaints of chills, malaise, myalgia, localized pain, dysuria, nocturia, and urinary retention. The nurse would most likely suspect that the patient has:

Prostatitis

2. A patient is receiving heparin postoperatively to prevent deep vein thrombosis. The nurse notes that the patient has a blood pressure of 90/50 mm Hg and a heart rate of 98 beats per minute. The patient's most recent aPTT is greater than 90 seconds. The patient reports lumbar pain. The nurse will request an order for:

Protamine sulfate

1. A patient who takes nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis asks a nurse what can be done to prevent ulcers. The nurse will recommend asking the provider about using which medication?

Proton Pump Inhibitors

8. A hospitalized patient who is taking demeclocycline [Declomycin] reports increased urination, fatigue, and thirst. What will the nurse do?

Provide extra fluids and reassure the patient that these are expected side effects

12. A patient is brought to the emergency department after a motor vehicle accident. The patient's speech is slurred. The nurse notes the smell of alcohol on the patient's breath and observes hand tremors. The patient's blood alcohol level is 0.4%. The nurse will expect to:

Provide mechanical ventilation and oxygen

A nurse working in the ED is assigned to a child who is arriving by ambulance after being involved in a spill of organophosphate insecticides. What will the nurse expect to be the initial priority?

Providing mechanical ventilation and oxygen

5. A patient who takes warfarin for atrial fibrillation undergoes hip replacement surgery. On the second postoperative day, the nurse assesses the patient and notes an oxygen saturation of 83%, pleuritic chest pain, shortness of breath, and hemoptysis. The nurse will contact the provider to report possible ____ and request an order for ____.

Pulmonary embolism; heparin

A nurse is teaching a group of nursing students about the differences between pure opioid agonists and agonist-antagonist opioids. Which statement by a student indicates understanding of the teaching?

Pure agonists act as agonists at both mu receptors and kappa receptors

1. A patient presents to the emergency department with complaints of chills, severe flank pain, dysuria, and urinary frequency. The patient has a temperature of 102.9°F, a pulse of 92 beats per minute, respirations of 24 breaths per minute, and a blood pressure of 119/58 mm Hg. The nurse would be correct to suspect that the patient shows signs and symptoms of:

Pyelonephritis

12. A prescriber is considering prescribing the amiodarone derivative dronedarone [Multaq] for a patient with atrial flutter. The nurse should be concerned about which of the following?

QT interval of 520 msec

13. A patient with angina who is taking ranolazine [Ranexa] has developed a respiratory infection and a dysrhythmia. The provider has ordered azithromycin [Zithromax] for the infection and amlodipine for the dysrhythmia. A nursing student caring for this patient tells the nurse that the patient's heart rate is 70 beats per minute, and the blood pressure is 128/80 mm Hg. The nurse asks the student to discuss the plan for this patient's care. Which action is correct?

Question the doctor for azithromycin (Zithromax)

2. A patient is in preterm labor, and the prescriber orders magnesium sulfate for its neuroprotective effect on the fetus. The order calls for 4 gm given as an intravenous bolus over 20 minutes, followed by a maintenance infusion of 2 gm/hr. What will the nurse do?

Question the maintenance amount

9. A patient has an infection caused by Streptococcus pyogenes. The prescriber has ordered dicloxacillin PO. What will the nurse do?

Question the need for a penicillinase-resistant penicillin

An 18-month-old child develops an urticarial reaction after a transfusion. The prescriber orders intravenous promethazine [Phenergan]. What will the nurse do?

Question the order

1. A patient has undergone liver transplantation. The provider orders cyclosporine [Sandimmune], prednisone, and sirolimus [Rapamune]. What will the nurse do?

Question the order for sirolimus

A nurse is assisting a physician who is performing a circumcision on a newborn. The physician asks the nurse to prepare lidocaine and epinephrine for injection to provide anesthesia. What will the nurse do?

Question the use of the epinephrine for this procedure

The nurse is preparing to care for a patient who will be taking an antihypertensive medication. Which action by the nurse is part of the assessment step of the nursing process?

Questioning the patient about OTC use

A patient with a history of depression and suicidal ideation is taking fluoxetine [Prozac]. The patient reports difficulty maintaining sleep and is prescribed secobarbital [Seconal] as a sedative-hypnotic. The nurse preparing this patient for discharge from the hospital will:

REquest an order to change to trazodone (desyrel) for sleep

A child ingests a parent's aspirin tablets, and the prescriber orders sodium bicarbonate to block the toxic effects of the aspirin. The nurse caring for this patient knows that sodium bicarbonate is effective against the aspirin because it:

Raises the pH of the interstitial fluid to facilitate passage out of the cells.

A postmenopausal patient develops osteoporosis. The patient asks the nurse about medications to treat this condition. The nurse learns that the patient has a family history of breast cancer. The nurse will suggest discussing which medication with the provider?

Raloxifene (Evista)

8. A patient is diagnosed with Zollinger-Ellison syndrome. Which medication does the nurse expect the provider to order for this patient?

Ranitidine (zantac)

A child who receives valproic acid [Depakote] begins taking lamotrigine [Lamictal] because of an increase in the number of seizures. The nurse will observe this child closely for which symptom?

Rash

A patient has been diagnosed with PD and begins treatment with levodopa/carbidopa (Sinemet). After several months of therapy the patient reports no change in symptoms. The nurse will expect the provider to

Re-evaluate the diagnosis

9. A patient receives an injection of human chorionic gonadotropin after follicular maturation has been induced with another agent. The patient comes to the clinic 2 days later complaining of headache, irritability, and fatigue. What will the nurse do?

Reassure the patient that these are known adverse effects

A patient who has recently begun taking carbamazepine [Equetro] for bipolar disorder reports having vertigo and headaches. Which action by the nurse is appropriate?

Reassure the patient that these effects occur early in treatment and will resolve over time

12. A patient is receiving intravenous voriconazole [Vfend]. Shortly after the infusion starts, the patient tells the nurse, "Colors look different, and the light hurts my eyes." What will the nurse do?

Reassure the patient that these effects will subside in about 30 minutes

7. A nurse is preparing to administer a second infusion of trastuzumab [Herceptin] to a patient who has breast cancer. The patient tells the nurse that she experienced chills, fever, pain, and nausea after her first infusion. What will the nurse do?

Reassure the patient that these symptoms will diminish with each infusion

A young woman with migraine headaches who has recently begun taking sumatriptan [Imitrex] calls the nurse to report a sensation of chest and arm heaviness. The nurse questions the patient and determines that she feels pressure and not pain. What will the nurse do?

Reassure the patient that this is a transient, reversible side effect of sumatriptan

9. A patient is taking bismuth subsalicylate [Pepto-Bismol] to prevent diarrhea. The nurse performing an assessment notes that the patient's tongue is black. What will the nurse do?

Reassure the patient that this is an expected side effect of the drug

16. A patient has been taking a progestin-only, or "minipill," OC for 3 months and reports spotting and irregular menstrual cycles. The nurse will:

Reassure the patient that this is normal with this form of contraception

3. A nurse reads a tuberculin skin test on a patient and notes a 6- to 7-mm area of induration. The patient is a young adult who has recently immigrated from a country with a high prevalence of tuberculosis. The patient has no other risk factors. The nurse will expect the provider to:

Reassure thte patient that this is not considered a positive test result

9. A nursing student asks a nurse why a patient in hypertensive crisis is receiving both intravenous sodium nitroprusside [Nitropress] and oral hydralazine. The nurse will explain that this is done to prevent:

Rebound hypertension

7. A provider orders intravenous moxifloxacin [Avelox] for a patient who has sinusitis. Before administering the drug, the nurse will review this patient's chart for:

Recent serum electrolyte levels

4. A nurse checks a patient's vital signs in the hospital and notes a blood pressure of 146/98 mm Hg. What will the nurse do?

Recheck the patient's blood pressure in the other arm

A patient taking clonidine for several weeks complains of drowsiness and constipation. What will the nurse do?

Recommend that the patient take most of the daily dose at bedtime.

A nurse is explaining drug metabolism to a nursing student who asks about glucuronidation. The nurse knows that this is a process that allows drugs to be:

Recycled via the enterohepatic recirculation to remain in the body longer.

8. The nurse is caring for a patient who is receiving vancomycin [Vancocin]. The nurse notes that the patient is experiencing flushing, rash, pruritus, and urticaria. The patient's heart rate is 120 beats per minute, and the blood pressure is 92/57 mm Hg. The nurse understands that these findings are consistent with:

Red man syndrome

1. A nurse is performing a physical assessment on a patient with tuberculosis who takes rifampin [Rifadin]. What would be an expected finding?

Red-orange tinged urine

7. A patient with antidiuretic hormone deficiency is receiving desmopressin (DDAVP). The nurse will teach this patient to:

Reduce fluid intake

6. A patient who was in a motor vehicle accident sustained a severe head injury and is brought into the emergency department. The provider orders intravenous mannitol [Osmitrol]. The nurse knows that this is given to:

Reduce intracranial pressure

7. A patient with a hemoglobin of 7.2 gm/dL begins therapy with an ESA. Two weeks later the patient's hemoglobin is 8.3 gm/dL. The nurse anticipates that the provider will:

Reduce the ESA dose

7. A nurse is caring for a patient in the intensive care unit who is receiving intravenous lidocaine. The patient is drowsy and confused and reports numbness of the fingers and toes. Which standing order will the nurse initiate at this time?

Reduce the rate of infusion

12. A patient will receive intrathecal liposomal cytarabine [DepoCyt] to treat acute myelogenous leukemia. The provider has ordered the concurrent administration of dexamethasone. The nurse understands that this is given to:

Reduce the severity of chemical arachnoiditis

Which is a possible benefit of taking fish-oil supplements?

Reduced risk of dysrhythmia in patients after MI

11. A nursing student asks a nurse how cancer cells become resistant to methotrexate [Rheumatrex]. The nurse is correct to respond by saying that cancer cells acquire resistance to methotrexate by:

Reduced uptake of methotrexate into cells

A patient with Parkinson's disease is taking levodopa/carbidopa [Sinemet]. The prescriber orders bromocriptine [Parlodel] to treat dyskinesias. The nurse notes that the patient is agitated, and the patient reports having frequent nightmares. The nurse will contact the provider to discuss:

Reducing the dose of bromocriptine

A nurse is preparing to administer memantine [Nemanda] to a patient and notes a slight elevation in the patient's creatinine clearance level. What will the nurse expect the provider to order for this patient?

Reducing the dose of memantine

11. A patient with an infection caused by Pseudomonas aeruginosa is being treated with piperacillin. The nurse providing care reviews the patient's laboratory reports and notes that the patient's blood urea nitrogen and serum creatinine levels are elevated. The nurse will contact the provider to discuss:

Reducing the dose of piperacillin

9. A patient is admitted to the hospital and will begin taking levothyroxine [Synthroid]. The nurse learns that the patient also takes warfarin [Coumadin]. The nurse will notify the provider to discuss ____ the ____ dose.

Reducing; warfarin

A patient is being treated with warfarin [Coumadin] to prevent thrombus. The patient develops hyperuricemia, and the provider orders allopurinol [Zyloprim]. The nurse will contact the provider to discuss ____ the ____ dose.

Reducing; warfarin

5. A nurse is reviewing the phenomenon of reflex tachycardia with a group of nursing students. Which statement by a student indicates understanding of this phenomenon?

Reflex tachycardia can negate the desired effects of vasodilators

A provider orders clonidine for a patient withdrawing from opioids. When explaining the rationale for this drug choice, the nurse will tell this patient that clonidine (catapres) is used to:

Relieve symptoms of nausea, vomiting, and diarrhea

1. A patient with hypertension is prescribed an angiotensin-converting enzyme (ACE) inhibitor. The nurse reviewing this patient's chart before administering the medication will be most concerned about which other disease process?

Renal artery stenosis

5. A nurse preparing to administer intravenous gentamicin to a patient notes that the dose is half the usual dose for an adult. The nurse suspects that this is because this patient has a history of:

Renal disease

4. A nurse is caring for a patient after hip replacement surgery. The patient has been receiving iron replacement therapy for 2 days. The nurse notes that the patient's stools appear black. The patient is pale and complains of feeling tired. The patient's heart rate is 98 beats per minute, respirations are 20 breaths per minute, and the blood pressure is 100/50 mm Hg. The nurse will contact the provider to:

Request a hemoglobin and hematocrit

A patient who has had cancer for 1 year uses a fentanyl transdermal patch for pain relief. The patient reports having three or four episodes of pain (which she rates as 8 or 9 on a scale of 1 to 10) each day, and each episode lasts 15 to 30 minutes. The nurse will contact the provider to:

Request a strong, short-acting opioid PRN

A nurse is caring for a patient who has a superficial fungal infection and notes that the provider has ordered 200mg of ketoconazole 200mg PO once daily. Which action by the nurse is correct?

Request an order for a different antifungal medication.

3. A nurse is reviewing the culture results of a patient receiving an aminoglycoside. The report reveals an anaerobic organism as the cause of infection. What will the nurse do?

Request an order for a different class of antibiotics

While preparing a patient for a second esophageal dilation procedure, the nurse explains that succinylcholine (Anectine) will be used. The patient is anxious and reports not being able to swallow for several hours after the previous procedure. What will the nurse do?

Request an order for a pseudocholinesterase level.

7. A patient is about to receive penicillin G for an infection that is highly sensitive to this drug. While obtaining the patient's medication history, the nurse learns that the patient experienced a rash when given amoxicillin [Amoxil] as a child 20 years earlier. What will the nurse do?

Request an order for a skin test to assess the current risk

9. A patient has undergone a PCI, and the provider orders clopidogrel to be given for 12 months, along with an ACE inhibitor and heparin. What will the nurse do?

Request an order for aspirin

4. A nurse preparing to administer morning medications notes that a patient with a history of hypertension has been prescribed spironolactone [Aldactone]. The nurse assesses the patient and notes dyspnea, bilateral crackles, and pitting edema in both feet. Which intervention is appropriate?

Request an order for furosemide (Lasix)

A patient who has biliary colic reports a pain level of 8 on a 1 to 10 pain scale with 10 being the most severe pain. The patient has an order for ibuprofen as needed for pain. Which action by the nurse is correct?

Request an order for merperidine (Demerol)

A nurse is caring for an older adult during the immediate postoperative period after a total hip replacement. The surgeon has ordered meperidine (Demerol) for severe pain. What will the nurse do?

Request an order for morphine instead of meperidine (Demerol)

6. A patient is receiving intravenous potassium penicillin G, 2 million units to be administered over 1 hour. At 1900, the nurse notes that the dose hung at 1830 has infused completely. What will the nurse do?

Request an order for serum electrolytes and cardiac monitoring

1. A nurse caring for a patient who is undergoing a third round of chemotherapy is preparing to administer ondansetron [Zofran] 30 minutes before initiation of the chemotherapy. The patient tells the nurse that the ondansetron did not work as well the last time as it had the first time. What will the nurse do?

Request an order to administer dexamethasone with the ondansetron

A patient with schizophrenia has been taking an antipsychotic drug forcfrv several days. The nurse enters the patient's room to administer a dose of haloperidol [Haldol] and finds the patient having facial spasms. The patient's head is thrust back, and the patient is unable to speak. What will the nurse do?

Request an order to give diphenhydramine

10. A patient will undergo a colonoscopy, and the provider has ordered sodium phosphate as a bowel cleanser before the procedure. The nurse reviews the patient's chart and notes that the patient's creatinine clearance and blood urea nitrogen are both elevated. What will the nurse do?

Request an order to give polyethylene glycol and electrolytes (PEG-ELS) instead

A nursing student asks a nurse about flucytosine (ancoban). Which statement by the nurse is correct?

Resistance is common with this medication

7. A nurse is discussing microbial resistance among sulfonamides and trimethoprim with a nursing student. Which statement by the student indicates a need for further teaching?

Resistance to sulfonamides is less than resistance to trimethoprim

12. A patient with chronic myeloid leukemia (CML) begins treatment with imatinib [Gleevec]. Which statement by the patient indicates understanding of this medication?

Resistance to thsi drug may develop over time

A woman in labor receives meperidine [Demerol] for pain. The nurse caring for the infant will observe the infant closely for:

Respiratory depressions

A nurse is caring for a newborn 1 day after delivery. The infant's mother used betaxolol during pregnancy. The nurse will expect to monitor this infant for which condition?

Respiratory distress

A 4 y/o child is brought to the ED with symptoms of N/V and a weak, thready pulse of 120 bpm after ingesting several cigarretes at home. The nurse caring for the child will expect to provide which treatment

Respiratory support

A patient in the emergency department is given intravenous diazepam [Valium] for seizures. When the seizures stop, the nurse notes that the patient is lethargic and confused and has a respiratory rate of 10 breaths per minute. The nurse will expect to administer which of the following?

Respiratory support

A patient who has a seizure disorder is admitted to the hospital after an increase in seizure frequency, and the prescriber orders carbamazepine [Tegretol] 100 mg twice daily to be added to the patient's medication regimen. The nurse reviewing the patient's medical history notes that the patient is already taking lamotrigine [Lamictal] 375 mg twice daily. The nurse will contact the provider to discuss which action?

Reucing the lamotrigine dose to 225mg twice daily

7. A patient is taking gentamicin [Garamycin] and furosemide [Lasix]. The nurse should counsel this patient to report which symptom?

Ringing in the ears

A nurse provides teaching to a patient who will begin taking a drug with a known risk of hepatotoxicity. Which statement by the patient indicates a need for further teaching?

Routine testing and early detection of problems will prevent liver failure.

14. A nurse working in a family planning clinic is preparing to administer a first dose of intramuscular DMPA [Depo-Provera] to a young adult patient. The woman tells the nurse she has just finished her period. What will the nurse do?

Schedule an appointment for her to receive the injection in 3 weeks

14. A pregnant patient reports using marijuana during her pregnancy. She asks the nurse whether this will affect the fetus. What should the nurse tell her?

School-aged children born to patients who use marijuana often have difficulty with memory

8. A patient is admitted to the hospital with fever, headache, malaise, joint pain, and enlarged lymph nodes. Blood cultures are positive for Treponema pallidum. The nurse recognizes this as which type of syphilis?

Secondary

A patient has been diagnosed with multiple sclerosis (MS) for 10 years and has a history of 3 periods of neurologic dysfunction lasting several weeks separated by long periods of full recovery. In the past 6 months, the patient has had a prolonged period of neurologic dysfunction without remission. The nurse understands that the patient may have which MS subtype?

Secondary progressive MS

A university student who is agitated and restless and has tremors is brought to the emergency department. The patient's heart rate is 110 beats per minute, the respiratory rate is 18 breaths per minute, and the blood pressure is 160/95 mm Hg. The patient reports using concentrated energy drinks to stay awake during finals week. What complication will the nurse monitor for in this patient?

Seizures

A nurse is admitting a patient to the hospital. The patient reports taking oral baclofen [Lioresal] but stopped taking the drug the day before admission. The nurse would be correct to anticipate which adverse effects?

Seizures and Hallucinations

1. A patient who is receiving a final dose of intravenous (IV) cephalosporin begins to complain of pain and irritation at the infusion site. The nurse observes signs of redness at the IV insertion site and along the vein. What is the nurse's priority action?

Select an alternate intravenous site and administer the infusion more slowly

A patient reports having occasional periods of tremors, palpitations, nausea, and a sense of fear, which usually dissipate within 30 minutes. To treat this condition, the nurse anticipates the provider will prescribe a drug in which drug class?

Selective serotonin reuptake inhibitors

The nurse is assesing a newly admitted older patient who has recently lost 15 lbs. The nurse notes that the patient is taking Warfarin. Which laboratory result will the nurse discuss with the provider?

Serum albumin and coagulation studies

9. An Asian patient will begin taking rosuvastatin [Crestor] to treat hypercholesterolemia. What will the nurse include when teaching this patient about this medication?

Serum drug levels must be monitored more frequently than with other patients

7. A patient with heart failure who has been taking an ACE inhibitor, a thiazide diuretic, and a beta blocker for several months comes to the clinic for evaluation. As part of the ongoing assessment of this patient, the nurse will expect the provider to evaluate:

Serum electrolyte levels

12. A patient who has been taking a glucocorticoid for several months arrives in the clinic. The nurse notes that the patient's cheeks appear full and that a prominent hump of fat is present on the upper back. The nurse will ask the provider to order which test(s)?

Serum electrolytes

A nurse is preparing to care for a patient who is receiving digoxin. When screening for potential adverse effects from this drug, the nurse will review which of the patient's laboratory results?

Serum electrolytes

A patient is to begin taking phenytoin [Dilantin] for seizures. The patient tells the nurse that she is taking oral contraceptives. What will the nurse tell the patient?

She could consider a different form of birth control while taking phenytoin

7. A patient has just purchased a 1-year supply of 28-day-cycle oral contraceptives. She tells the nurse she wishes she had planned things better, because she has calculated that her period will begin during her upcoming honeymoon. What will the nurse suggest?

She should discard the inert pills and start a new pack during the honeymoon

8. A female patient who has hepatitis C is being treated with pegylated interferon alfa and ribavirin [Ribasphere]. It will be important for the nurse to teach this patient that:

She will need a monthly pregnancy test during her treatment

2. A nurse tells a nursing student that the glucocorticoids given for rheumatoid arthritis are nearly identical to substances produced naturally by the body. The student remarks that the drug must be very safe. Which response by the nurse is correct?

Side effects can occur and are dependent on the dose and duration of treatment

An infant is receiving a medication that has a narrow therapeutic range. the nurse reviews the medication information and learns that the drug is excreted by the kidneys. When giving this drug, the nurse will assess the infant for:

Signs of drug toxicity

A patient who has fibromyalgia is diagnosed with major depression. The provider orders a TCA. The nurse will teach this patient to:

Sit or lie down with feeling lightheaded

6. A patient with type 1 diabetes recently became pregnant. The nurse plans a blood glucose testing schedule for her. What is the recommended monitoring schedule?

Six or seven times a day

4. A nurse is teaching a nursing student how blood can return to the heart when pressure in the venous capillary beds is very low. Which statement by the student indicates a need for further teaching?

Skeletal muscles relax to allow the free flow of blood

1. A child with Prader-Willi syndrome (PWS) has short stature, and the provider is considering treatment with growth hormone. Which aspect of this child's history should the nurse report to the provider?

Sleep apnea

A nurse is teaching a group of nurses about Parkinson's medications. The nurse is correct to state that one side effect associated with pramipexole [Mirapex] that is less likely to occur with other dopamine agonists is:

Sleep attacks

A nurse is caring for an older adult patient who has Alzheimer's disease. The patient is taking a cholinesterase inhibitor drug. Which side effects would concern the nurse?

Slowed heart rate and lightheadedness

8. A patient is admitted with severe hypertensive crisis. The nurse will anticipate administering which medication?

Sodium nitroprusside (Nitropress) IV

19. A 60-year-old African American patient has a blood pressure of 120/80 mm Hg and reports a family history of hypertension. The patient has a body mass index of 22.3. The patient reports consuming alcohol occasionally. Which therapeutic lifestyle change will the nurse expect to teach this patient?

Sodium restriction

3. The nurse is teaching a nursing student about the mechanism by which antimicrobial agents achieve selective toxicity. Which statement by the student indicates a need for further teaching?

Some agents cause phagocytosis of bacterial cells

Which statement about food and drug interactions is true?

Some foods can inhibit CYP isoenzymes and alter drug metabolism.

A patient with schizophrenia has been taking an oral FGA for 1 week. The patient has been taking the drug daily in two divided doses. The individual complains of daytime drowsiness. The patient's family reports a decrease in the person's hostility and anxiety but states that the patient remains antisocial with disordered thinking. What will the nurse tell the patient and the family?

Some symptoms take months to improve

A nursing student asks the nurse about receptor specificity of adrenergic agonist medications. What will the nurse say?

Specificity is relative and is dose dependent

3. A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation of the lungs reveals crackles bilaterally, and the serum potassium level is 6 mEq/L. Which diuretic agent ordered by the prescriber should the nurse question?

Spironolactone (Aldactone)

5. A patient with hypertension is taking furosemide [Lasix] for congestive heart failure. The prescriber orders digoxin to help increase cardiac output. What other medication will the nurse expect to be ordered for this patient?

Spironolactone (Aldactone)

5. A patient with polycystic ovary syndrome (PCOS) asks the nurse what she can do to improve her chances of getting pregnant. Which statement by the patient indicates a need for further teaching?

Spironolactone, which reduces androgens and facial hair, is helpful if I'm trying to conceive

4. A patient who has been taking 25 mg of hydrocortisone each morning for several months reports feeling fatigued late in the day each day. What will the nurse tell the patient to discuss with the provider?

Splitting the daily dose into a morning and an afternoon dose

5. A nursing student asks a nurse to clarify the differences between the mechanisms of spontaneous mutation and conjugation in acquired resistance of microbes. What will the nurse say?

Spontaneous mutation leads to resistance to only one antimicrobial agent

3. A 68-year-old male patient receives a prescription for 25-mg tablets of sildenafil [Viagra] for erectile dysfunction. When he asks the nurse how to take the medication, the nurse will tell him to:

Start with one tablet about 1 hour before anticipated sexual activity

A patient who has been diagnosed with rheumatoid arthritis (RA) for 1 month and has generalized symptoms is taking high-dose nonsteroidal anti-inflammatory drugs (NSAIDs) and an oral glucocorticoid. The provider has ordered methotrexate [Rheumatrex]. The patient asks the nurse why methotrexate is necessary since pain and swelling have been well controlled with the other medications. The nurse will tell the patient that:

Starting methotrexate early can help delay joint degeneration

A patient has received an initial dose of glatiramer acetate [Copaxone] for relapsing-remitting multiple sclerosis. The nurse notes that the patient appears flushed and anxious and has urticaria. The patient reports palpitations, chest pain, and a feeling of laryngeal constriction. What will the nurse do?

Stay with the patient until this self-limiting episode passes

A patient who has been taking a monoamine oxidase inhibitor (MAOI) for depression for several months tells the provider that the medication has not helped with symptoms. The provider plans to switch the patient to an SSRI. The nurse will teach this patient to:

Stop taking the MAOI 2 weeks before starting the SSRI

11. A patient reports taking an oral bisacodyl laxative [Dulcolax] for several years. The provider has suggested discontinuing the laxative, but the patient is unsure how to do this. The nurse will tell the patient to:

Stop taking the laxative immediately and expect no stool for several days

A patient reports experiencing weakness, fatigue, nausea, vomiting, constipation, and nocturia. Total serum calcium is 10.5 mg/dL. A dipstick urinalysis shows a positive result for protein. When questioned, the patient reports taking vitamin D and calcium supplements. The nurse will counsel the patient to:

Stop taking vitamin D, reduce the amount of calcium, and increase the fluid intake

18. A child has been receiving chloramphenicol for a Neisseria meningitidis central nervous system (CNS) infection. The nurse administers the dose and subsequently notes that the child has vomited and appears dusky and gray in color. The child's abdomen is distended. What will the nurse do?

Stop the infusion immediately and notify the provider

2. A patient who takes daily doses of aspirin is scheduled for surgery next week. The nurse should advise the patient to:

Stop using aspirin immediately

A nurse is teaching nursing students about pediatric medication administration. What will the nurse include when discussing pediatric drug research?

Studies showed a significant percentage of unanticipated and potentially lethal side effects in children

A patient who has cancer asks the nurse about using acupuncture to manage cancer pain. What will the nurse tell this patient?

Studies to date do not clearly indicate effectiveness of acupuncture for alleviating cancer pain

A patient asks a nurse why drugs that have been approved by the FDA still have unknown side effects. What will the nurse tell the patient?

Subjects in drug trials do not always represent the full spectrum of possible patients.

8. A patient who is an opioid addict has undergone detoxification with buprenorphine [Subutex] and has been given a prescription for buprenorphine with naloxone [Suboxone]. The patient asks the nurse why the drug was changed. Which response by the nurse is correct?

Suboxone has a lower risk of abuse

11. A nursing student is caring for a patient who is taking sucralfate [Carafate] and ciprofloxacin [Cipro] to treat peptic ulcer disease. The student asks the nurse about the pharmacokinetics of sucralfate. Which statement by the student indicates a need for further teaching?

Sucralfate has a moderate acid-neutralizing capacity

3. A patient is being treated for chemotherapy-induced nausea and vomiting (CINV) with ondansetron [Zofran] and dexamethasone. The patient reports getting relief during and immediately after chemotherapy but has significant nausea and vomiting several days after each chemotherapy treatment. What will the nurse do?

Suggest adding aprepitant (emend) to the medication regimen

7. A patient is diagnosed with moderate vitamin B12 deficiency. The nurse reviews the laboratory work and notes that the plasma B12 is low; also, a Schilling test reveals B12 malabsorption. The provider orders oral cyanocobalamin 500 mcg per day. The nurse will contact the provider to:

Suggest an increased dose

A patient with chronic gout has an acute gouty episode and is admitted to the hospital. The patient has been taking nonsteroidal anti-inflammatory drugs for several months. The prescriber plans to begin therapy with probenecid. What will the nurse do?

Suggest delaying the probenecid therapy until the acute episode has subsided.

8. The nurse is caring for a patient who will begin receiving intravenous ciprofloxacin [Cipro] to treat pyelonephritis. The nurse learns that the patient has a history of myasthenia gravis. Which action by the nurse is correct?

Suggest that the provider order a different antibiotic for this patient

10. An older adult patient is diagnosed with hypothyroidism. The initial free T4 level is 0.5 mg/dL, and the TSH level is 8 microunits/mL. The prescriber orders levothyroxine [Levothroid] 100 mcg/day PO. What will the nurse do?

Suggest the provider lower the dose

A patient is using a metered-dose inhaler containing albuterol for asthma. The medication label instructs the patient to administer "2 puffs every 4 hours as needed for coughing or wheezing." The patient reports feeling jittery sometimes when taking the medication, and she doesn't feel that the medication is always effective. Which action is outside the nurse's scope of practice?

Suggesting that the patient use one puff to reduce side effects.

2. A patient who is taking immunosuppressant medications develops a urinary tract infection. The causative organism is sensitive to sulfonamides and to another, more expensive antibiotic. The prescriber orders the more expensive antibiotic. The nursing student assigned to this patient asks the nurse why the more expensive antibiotic is being used. Which response by the nurse is correct?

Sulfonamides are bacteriostatic and depend on host immunity to work

1. The nurse has been caring for a patient who has been taking antibiotics for 3 weeks. Upon assessing the patient, the nurse notices the individual has developed oral thrush. What describes the etiology of the thrush?

Superinfection

10. The nurse would be correct to state that the purpose of angiogenesis inhibitors is to:

Suppress the formation of new blood vessels in tumors

A patient has been taking high doses of clorazepate [Tranxene] for several months for an anxiety disorder. The nurse assessing the patient observes that the patient is agitated, euphoric, and anxious. What will the nurse do?

Suspect a possible paradoxical reaction tot he clorazepate

8. A patient who has been taking gentamicin for 5 days reports a headache and dizziness. What will the nurse do?

Suspect ototoxicity and notify the provider

7. A patient who is a heroin addict is admitted to a methadone substitution program. After administering the first dose of methadone, the nurse notes that the patient shows signs of euphoria and complains of nausea. What will the nurse do?

Suspect that the patient exaggerated the amount of heroin used.

A nurse is caring for a patient who has MG. The prescriber has ordered neostigmine (Prostigmin). An important initial nursing action before administration of the medication includes assesing:

Swallowing ability

7. A patient is about to receive prednisone for tendonitis. The nurse reviewing the chart would be concerned about which of the following in the patient's medical history?

Systemic fungal infection

A nurse is teaching a group of nursing students about tricyclic antidepressants (TCAs). Which statement by a student indicates a need for further teaching?

TCAs have many side effects, but none of them are serious

A patient claims to get better effects with a tablet of Brand X of a drug than with a tablet of Brand Y of the same drug. Both brands contain the same amount of the active ingredient. What does the nurse know to be most likely?

Tablets can differ in composition and can have differing rates of disintegration and dissolution, which can alter the drug's effects in the body

A patient is wheezing and SOB. The nurse assess the HR of 88, RR of 24, BP of 124/78. The prescriber orders a nonspecific beta agonist medication. Besides evaluating the patient for a reduction in respiratory distress, the nurse will monitor for which side effect?

Tachycardia

A patient has begun taking dimethyl fumarate [Tecfidera] to treat relapsing MS and calls the clinic to report flushing of the skin with itching and burning sensations. What will the nurse recommend to this patient?

Take a non-enteric coated aspirin 30 minutes before each dose

8. A patient calls the nurse to report that she forgot to take a combination OC pill during the third week of her cycle. She tells the nurse that she missed another pill earlier that week. The nurse will tell her to:

Take a pill now, continue the pack, skip the placebo pills, and start a new pack on week 4

A patient who has myasthenia gravis will be taking medication neostigmine. What will the nurse emphasize when teaching the patient about the medication?

Take a supplementary dose before exercise

10. Lovastatin [Mevacor] is prescribed for a patient for the first time. The nurse should provide the patient with which instruction?

Take lovastatin with your evening meal

A patient administers interferon beta-1a SQ [Rebif] 22 mcg/0.5 mL three times each week. The patient calls the nurse to report unrelieved itching and erythema at the injection site, despite the use of topical hydrocortisone for several weeks. What will the nurse tell this patient to do?

Take oral diphenhydramine (Benadryl)

7. The nurse is providing education to a patient who has been prescribed both an antacid and cimetidine [Tagamet]. Which instruction should the nurse give the patient about taking the medications?

Take the antacid 1 hour after the ranitidine

4. A patient who is taking calcium supplements receives a prescription for ciprofloxacin [Cipro] for a urinary tract infection. The nurse will teach this patient to:

Take the calcium either 6 hours before or 2 hours after taking the ciprofloxacin

A woman who is breastfeeding her infant must take a prescription medication for 2 weeks. The medication is safe, but the patient wants to make sure her baby receives as little of the drug as possible. What will the nurse tell the patient to do?

Take the medication immediately after breastfeeding

6. A patient will begin taking atorvastatin [Lipitor] to treat elevated LDL levels. The patient asks the nurse what to do to minimize the risk of myositis associated with taking this drug. What will the nurse counsel this patient?

Take vitamin D and coenzyme Q supplements

A patient newly diagnosed with Parkinson's disease has been taking levodopa/carbidopa [Sinemet] for several weeks and complains of nausea and vomiting. The nurse tells the patient to discuss what with the provider?

Taking a lower dose with a low-protein snack

2. A nurse is teaching a patient who has chronic renal failure who will begin receiving epoetin alfa [Epogen] about this drug therapy. Which statement by the patient indicates understanding of the teaching?

Taking this drug will not eliminate my need for blood transfusions

4. A prescriber orders ramipril [Altace] for an obese patient with type 2 diabetes mellitus who has developed hypertension. The nurse provides teaching before dismissing the patient home. Which statement by the patient indicates understanding of the teaching?

Taking this medication helps reduce my risk of stroke and heart attack

A nurse is caring for an intubated patient who is receiving mancuronium for neuromuscular blockade. the patient's eyes are closed and the patient is not moving any extremities. The HR is 76, BP is 110/70. The nurse caring for the patient will do what?

Talk to the patient while giving care and explain all procedures.

A patient is taking an FGA for schizophrenia. The nurse notes that the patient has trouble speaking and chewing and observes slow, wormlike movements of the patient's tongue. The nurse recognizes which adverse effect in this patient?

Tardive dyskinesia

A patient in whom drug therapy has failed several times in the past is readmitted to a hospital to begin therapy for schizophrenia. What will the nurse do to help improve adherence?

Teach the patient about drug side effects and how to manage them

A patient is being discharged after surgery. During the admission history, the nurse learned that the patient normally consumes 2 or 3 glasses of wine a day. The prescriber has ordered hydrocodone with acetaminophen for pain. What will the nurse do?

Tell the patient not to drink wine while taking this.

16. A patient who has been taking linezolid [Zyvox] for 6 months develops vision problems. What will the nurse do?

Tell the patient that this symptom is reversible when the drug is discontinued

An older adult patient with Alzheimer's disease is admitted to the hospital. The patient's spouse reports that the patient is often confused and gets lost walking to the store, which is three blocks from their home. That evening, the nurse observes the patient pacing the hall and screaming. What will the nurse do?

Tell the spouse that this is an expected progression of the disease

A patient has been diagnosed with primary progressive multiple sclerosis for 1 year and reports a recent brief period of being symptom free. The nurse will tell the patient that this indicates what?

Temporary improvement

1. A nurse provides teaching for a female patient with anemia who has had cancer chemotherapy and who will begin treatment with testosterone. Which statement by the patient indicates understanding of the teaching?

Testosterone treats anemia by stimulating the synthesis of a renal hormone

6. A patient is receiving oral iron for iron deficiency anemia. Which antibiotic drug, taken concurrently with iron, would most concern the nurse?

Tetracycline

2. A pregnant adolescent patient asks the nurse whether she should continue to take her prescription for tetracycline [Sumycin] to clear up her acne. Which response by the nurse is correct?

Tetracycline can be harmful to the baby's teeth and should be avoided

A nurse caring for a 5 y/o child notes that the child has discoloration of several teeth. When taking a medication history, the nurse will ask about which group of medications?

Tetracyclines

A patient will begin taking hydroxychloroquine [Plaquenil] for rheumatoid arthritis. The patient is currently taking high-dose NSAIDs and methotrexate. What will the nurse teach the patient?

That an eye exam is necessary at the beginning of therapy with this drug

A patient who has just learned she is pregnant has stopped using a prescription medication that she takes for asthma because she doesn't want to harm her baby. What will the nurse tell her?

That her baby's health is dependent on hers

A woman who is nursing a newborn develops postpartum depression and her provider orders sertraline [Zoloft] to treat her symptoms. The patient is concerned about the safety of this medication for her infant. What will the nurse tell her about this medication?

That sertraline is safer than other antidepressants for nursing mothers

A child who has juvenile idiopathic arthritis and who has been taking methotrexate [Rheumatrex] will begin a course of abatacept [Orencia]. What will the nurse include when teaching the child's family about this drug?

That signs of infection may warrant immediate discontinuation of abatacept

3. A patient is receiving chemotherapy. Seven days after a dose, the patient's neutrophil count is 1000 cells/mm3. The nurse will tell this patient:

That the provider will probably repeat the lab work in 3 to 5 days

A patient asks about nicotine patches for smoking cessation and wants to know the difference between the 24 hour period and the 16 hour. Which response by the nurse is correct?

The 16 hour patch stimulates usual nicotine ingestion patterns

5. A patient who does not consume alcohol or nicotine products reports a strong family history of hypertension and cardiovascular disease. The patient has a blood pressure of 126/82 and a normal weight and body mass index for height and age. The nurse will expect to teach this patient about:

The DASH diet, sodium restriction, and exercise

1. The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients who were just admitted. Which patient should the nurse assess first?

The NPO patient with a blood glucose level of 80 mg/dL who just received 20 unites of 70/30 Novolin insulin

A 65-year-old female patient tells a nurse that she has begun taking calcium supplements. The nurse learns that the patient consumes two servings of dairy products and takes 1200 mg in calcium supplements each day. The patient's serum calcium level is 11.1 mg/Dl. What will the nurse tell this patient?

The amount of calcium she takes increases her risk for heart attack and stroke

A male patient tells a nurse that he drinks a six-pack of beer a day. When the nurse begins to question him further about his alcohol consumption, he says, "You sound like my wife. She's always nagging me to quit. It's only beer!" Which response by the nurse is most appropriate?

The amount you drink is equivalent to six shots of whiskey each day

4. A child with otitis media has had three ear infections in the past year. The child has just completed a 10-day course of amoxicillin [Amoxil] with no improvement. The parent asks the nurse why this drug is not working, because it has worked in the past. What will the nurse tell the patient?

The bacteria have synthesized penicillinase

12. A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why is the nurse concerned?

The beta blocker can mask the symptoms of hypoglycemia

8. A patient has undergone a primary percutaneous coronary intervention with a stent placement. The provider has ordered a daily dose of 81 mg of aspirin and clopidogrel. The patient asks the nurse how long the medications must be taken. What will the nurse tell this patient about the medication regimen?

The clopidogrel will be discontinued in one year and the aspirin will be given indefinitely

13. A woman has been taking a progestin-only oral contraceptive and will begin using a vaginal ring. The nurse will teach the patient to insert the ring:

The day the last pill is taken and use backup contraception for 7 days

A nurse is teaching a patient about a medication that alters sympathetic nervous system functions. To evaluate understanding, the nurse asks the patient to describe which functions the sympathetic nervous system regulates. Which answer indicates the need for further teaching?

The digestive functions of the body

An older adult patient has confusion, memory loss, and disorientation in familiar surroundings. The patient has been taking donepezil [Aricept] 10 mg once daily for 6 months. The patient's symptoms have begun to worsen, and the patient's spouse asks if the medication dose can be increased. What will the nurse tell the spouse?

The dose can be increased because the patient has been taking the drug for longer than 3 months

A patient who wants to quit smoking has a prescription for Vernicline (Chantix) which will be used with nicotine patch. The patient asks the nurse why the varenicline is necessary. Which statement by the nurse is correct?

The drug blocks nicotine's access to pleasure receptors

15. An immunocompromised child is exposed to chickenpox and the provider orders valacyclovir [Valtrex] to be given orally three times daily. The nurse will contact the provider to change this order for which reason?

The drug may cause serious adverse effects in imunocompromised patients

A patient who takes teriparatide [Forteo] administers it subcutaneously with a prefilled pen injector. The patient asks why she must use a new pen every 28 days when there are doses left in the syringe. Which is the correct response by the nurse?

The drug may not be stable after 28 days

7. A patient starting therapy with efavirenz [Sustiva] asks about the timing of the medication with regard to meals. What patient education about the administration of this medication should the nurse provide?

The drug should be taken once daily on an empty stomach

1. A nursing student who is preparing to care for a postoperative patient with deep vein thrombosis asks the nurse why the patient must take heparin rather than warfarin. Which response by the nurse is correct?

The onset of warfarin is delayed

12. A hospitalized patient with cancer is receiving chemotherapy and reports oral pain. Inspection of this patient's oral mucosa reveals erythema and inflammation without denudation or ulceration. The nurse understands that:

The patient can use a mouthwash with a topical anesthetic to control pain

3. A nurse is evaluating a patient admitted to the emergency department with an evolving STEMI for possible administration of thrombolytic therapy. Which information, identified during history taking, would contraindicate this type of therapy?

The patient has a history of a small cerebral aneursym

A patient who is experiencing alcohol withdrawal is given a benzodiazepine. The nurse understands that this drug is effective because:

The patient has cross-dependence to the benzodiazepine

13. A nurse is reviewing the medications of a patient with diabetes before discharge. The nurse realizes that the patient will be going home on colesevelam, a bile acid sequestrant, and insulin. What patient education should the nurse provide in the discharge teaching for this patient?

The patient needs to monitor the blood sugar carefully, because colesevelam can cause hypoglycemia

A prescriber orders hydroxyzine [Vistaril] for a patient with acute urticaria. The nurse will include which information when teaching the patient about this drug?

The patient should avoid drinking alcohol while taking the drug

5. A patient with type 2 diabetes mellitus takes glipizide. The patient develops a urinary tract infection, and the prescriber orders TMP/SMZ. What will the nurse tell the patient?

The patient should check the blood glucose level more often while taking TMP/SMZ

5. A patient in her twenties with Graves' disease who takes methimazole [Tapazole] tells a nurse that she is trying to conceive and asks about disease management during pregnancy. What will the nurse tell her?

The patient should dicuss changing to propylthiouracil from now until her second trimester with her provider

15. A patient is taking a combination oral contraceptive (OC) and tells the nurse that she is planning to undergo knee replacement surgery in 2 months. What will the nurse recommend for this patient?

The patient should discuss an alternate method of birth control prior to surgery

A patient with cancer has been taking an opioid analgesic four times daily for several months and reports needing increased doses for pain. What will the nurse tell the patient?

The patient should discuss increasing the dose with the provider

3. A patient is taking a combination oral contraceptive (OC) and reports breast tenderness, edema, and occasional nausea. What will the nurse recommend?

The patient should request an OC containing less estrogen

3. A patient recently began receiving clindamycin [Cleocin] to treat an infection. After 8 days of treatment, the patient reports having 10 to 15 watery stools per day. What will the nurse tell this patient?

The patient should stop taking the clindamycin now and contact the provider immediately

12. A female patient taking an ACE inhibitor learns that she is pregnant. What will the nurse tell this patient?

The patient should stop taking the medication and contact her provider immediately

4. A patient tells the nurse that she takes aspirin for menstrual cramps, but she does not feel that it works well. What will the nurse suggest?

The patient should use a first generation NSAID instead

A patient will receive intravenous midazolam [Versed] combined with fentanyl while undergoing an endoscopic procedure. The nurse is explaining the reasons for this to a nursing student before the procedure. Which statement by the student indicates understanding of the teaching?

The patient will not remember the procedure

5. A patient taking gemfibrozil [Lopid] and rosuvastatin [Crestor] concurrently begins to complain of muscle aches, fatigue, and weakness. What should the nurse monitor?

The patient's creatinine kinase levels

13. A patient has just been diagnosed with cancer and will begin chemotherapy. The patient asks the nurse about the possibility of nausea and vomiting. The nurse will tell the patient that:

The provider will order drugs to help prevent N/V before each dose

A patient who is taking a fixed-dose combination drug with an opioid and acetaminophen for cancer pain reports increased muscular pain. The patient asks the nurse if the pain medication dose can be increased. What will the nurse tell this patient?

The provider will prescribe separate dosing of the opioid and acetaminophen

A patient with a form of epilepsy that may have spontaneous remission has been taking an AED for a year. The patient reports being seizure free for 6 months and asks the nurse when the drug can be discontinued. What will the nurse tell the patient?

The provider will withdraw the drug over a 6 to 12 week period

11. A female patient who swims competitively admits to using anabolic steroids to increase her muscle mass and improve her performance. What will the nurse tell this patient?

The risk of liver disease will increase

A nurse is teaching the parents of a child who has attention-deficit/hyperactivity disorder about methylphenidate [Concerta]. Which statement by the child's parents indicates understanding of the teaching?

The tablet needs to be swallowed whole, not crushed or chewed

1. The nurse wants to evaluate a nursing student's understanding of chemotherapy. The nurse asks, "Which factor would be a major obstacle to successful chemotherapy?" What is the student's best response?

The toxicity of anticancer drugs to normal tissues

An adult patient will begin taking atomoxetine [Strattera] for attention-deficit/hyperactivity disorder. What will the nurse teach this patient?

Therapeutic effects may not be felt for 1 to 3 weeks after beginning therapy

A nursing student asks the nurse why the provider has ordered a combination product containing an opioid analgesic and an NSAID for a patient who has cancer. Which response by the nurse is correct?

There is increased pain relief with the combination than when either product is used alone

11. A 50-year-old female patient asks a nurse about taking aspirin to prevent heart disease. The patient does not have a history of myocardial infarction. Her cholesterol and blood pressure are normal, and she does not smoke. What will the nurse tell the patient?

There is most likely no protective benefit for patients her age

2. A pregnant patient who is taking ondansetron [Zofran] for morning sickness tells the nurse she is experiencing headache and dizziness. What will the nurse tell her?

These are common side effects of ondansetron

A patient taking risedronate IR [Actonel] for osteoporosis reports experiencing diarrhea and headaches. What will the nurse tell this patient?

These are common side effects of the drug

A nurse is teaching a group of students how CNS drugs are developed. Which statement by a student indicates a need for further teaching?

These drugs are developed based on scientific knowledge of CNS transmitters and receptors

6. A nurse is discussing vesicant chemotherapeutic agents with a nursing student. Which statement by the student indicates a need for further teaching about this type of drug?

These drugs may be administered orally as well as intravenously

A nursing student asks about drugs that interfere with the termination of transmitter action. Which statement by the nurse is correct?

These drugs reduce either reuptake or degradation of the transmitter, causing an increase in receptor activation.

An alcoholic patient's spouse asks a nurse about recovery from chronic alcoholism. THe patient is confused and has abnormal eye movements and nystagmus. Which statement by the nurse is correct?

These symptoms can be reversed with vitamin therapy and good nutrition

A nursing student is preparing to give a medication that has a boxed warning. The student asks the nurse what this means. What will the nurse explain about boxed warnings?

They alert prescribers to measures to mitigate potential harm from side effects.

A nurse is teaching nursing students about the use of nonproprietary names for drugs. The nurse tells them which fact about nonproprietary names?

They are assigned by the US Adopted Names Council

18. A college student tells the nurse that several friends have been using synthetic marijuana to get high. What will the nurse tell this patient about this type of substance?

They can cause hypertension, nausea, vomiting, and hallucinations

A pregnant patient asks the nurse about the safe use of medications during the third trimester. What will the nurse tell her about drugs taken at this stage?

They may need to be given in higher doses if they undergo renal clearance.

8. The nurse is providing patient education about the application of transdermal estrogen spray. Which statement made by the patient best demonstrates understanding of the application of this medication? "I should apply this medication to my:

Thighs and calves

A nurse is preparing to give medications to four older patients who are all taking multiple medications. Which patient is most likely to have an adverse drug reaction related to increased drug effects?

Thin patient with a chronically low appetite

10. A pregnant patient with fever, flank pain, and chills has a history of two previous bladder infections before getting pregnant. She is allergic to several antibiotics. She reports having taken methenamine successfully in the past. What will the nurse tell her?

This agent is not effective against infections of the upper urinary tract

A nurse is providing teaching for a patient with osteoporosis who has just switched from alendronate [Fosamax] to zoledronate [Reclast]. Which statement by the patient indicates a need for further teaching?

This drug is less likely to cause osteonecrosis of the jaw

A patient will begin taking a cholinesterase inhibitor for early Alzheimer's disease. The nurse is teaching the patient's spouse about the medication. Which statement by the spouse indicates a need for further teaching?

This drug significantly slows the progression of the disease

15. A patient with Crohn's disease will begin receiving an initial infusion of infliximab [Remicade]. The nurse explains how this drug works to treat this disease. Which statement by the patient indicates a need for further teaching?

This drug sometimes providers a complete cure of IBD

12. The nurse prepares a patient with Graves' disease for radioactive iodine (131I) therapy. Which statement made by the patient best demonstrates understanding of 131I therapy?

This drug will be taken up by the thyroid gland and will destroy the cells to reduce my hyperthyroidism

A child is diagnosed with attention-deficit/hyperactivity disorder (ADHD). The prescriber orders a central nervous system stimulant. Which statement by the child's parent indicates a need for further teaching?

This drug will make him less impulsive while he's at school

The nurse is preparing to administer penicillin G intramuscularly to a child. The child's parents ask why the drug cannot be given in an oral liquid form. What is the nurse's reply?

This drug would be inactivated by the enzymes in the stomach.

A pediatric nurse is teaching nursing students to calculate medication doses for children using a formula based on body surface area. Which statement by the nursing student indicates understanding of the teaching?

This formula helps approximate the first dose, other doses should be based on clinical observations.

10. A patient with type 1 diabetes reports mixing NPH and regular insulin to allow for one injection. What should the nurse tell the patient?

This is an acceptable practice

14. A patient who is taking ketoconazole tells the nurse that her periods have become irregular. What will the nurse tell her?

This is caused by a reversible effect on estradiol synthesis

A patient has been taking narcotic analgesics for chronic pain for several months. The nurse caring for this patient notes that the prescribed dose is higher than the recommended dose. The patient has normal VS, is awake and alert, and reports mild pain. What does the nurse recognize about this patient?

This patient has developed pharmacodynamic tolerance, which has increased the minimal effective concentration needed for analgesic effect.

A nurse is giving an enteral medication. The patient asks why this method is preferable for this drug. How will the nurse reply?

This route is safer, less expensive, and more convenient.

4. A patient with cancer has a tumor composed mostly of G0 cells. When teaching this patient about the disease, the nurse will make which statement?

This tumor will be managed primarily with surgery

Which superficial mycosis is generally treated with oral antifungal agents?

Tinea capitis

16. A patient will begin receiving vincristine [Oncovin] to treat Hodgkin's lymphoma. Which side effect(s) will the nurse tell the patient to report immediately?

Tingling of the extremities

12. A patient who is taking nitrofurantoin calls the nurse to report several side effects. Which side effect of this drug causes the most concern and would require discontinuation of the medication?

Tingling of the fingers

2. A nurse is discussing the difference between stable and variant angina with a group of nursing students. Which statement by a student indicates the need for further teaching?

Variant angina is the result of increased oxygen demand by the heart

A nurse is discussing the use of cocaine as a local anesthetic with a nursing student. Which statement by the student indicates understanding of this agent?

Vasoconstrictors should not be used as adjunct agents with this drug

2. A patient who is at risk for osteoporosis will begin taking the selective estrogen receptor modulator raloxifene [Evista]. Which statement will the nurse include when teaching this patient about the medication?

Vasomotor symptoms are a common side effect of this drug

16. The nurse is teaching a class on dysrhythmias and associated therapy. The nurse asks the class, "Which cardiac dysrhythmia would result in the lowest cardiac output, and what treatment would be effective?" The class best demonstrates understanding by responding that ____ results in the lowest cardiac output, and treatment includes ____.

Ventricular fibrillation; defibrillation

6. A patient who has begun using transdermal nitroglycerin for angina reports occasional periods of tachycardia. The nurse will expect the prescriber to order:

Verapamil as an adjunct to nitroglycerin therapy

12. A patient is admitted to the hospital. The patient's initial laboratory results reveal megaloblastic anemia. The patient complains of tingling of the hands and appears confused. The nurse suspects what in this patient?

Vitamin B12 deficiency

A patient has an invasive aspergillosis infection. Which antifungal agent is the drug of choice for this infection?

Voriconazole (Vfend)

10. A nurse is discussing various ways to obtain a medical abortion with a patient. Which statement by the patient best demonstrates understanding of mifepristone (RU 486) [Mifeprex]? "This drug is most effective if I use it:

WIthin 7 weeks of conception

16. A nurse is caring for a patient with cancer who has been undergoing chemotherapy. The patient has oral mucositis as a result of the chemotherapy, and the provider has ordered palifermin [Kepivance]. Which is an appropriate nursing action when giving this drug?

Warning the patient about the potential for distortion of taste

6. The nurse is caring for a patient receiving desmopressin [Stimate]. The nurse is performing a physical assessment and notes that the patient is drowsy and listless and complains of a recent onset of headache. Which finding would be most consistent with these symptoms?

Water intoxification

The spouse of a patient with Alzheimer's disease asks a nurse for more information about the rivastigmine [Exelon] transdermal patch that is being used. Which statement by the spouse indicates a need for further explanation?

We only need to change the patch every 2 weeks

1. A patient has a free T4 level of 0.6 ng/dL and a free T3 of 220 pg/dL. The patient asks the nurse what these laboratory values mean. How will the nurse respond?

We will need to obtain a TSH level to better evaluate your diagnosis

2. A patient who has been newly diagnosed with adrenal hormone deficiency will begin taking hydrocortisone. The nurse provides teaching for this patient. Which statement by the patient indicates understanding of the teaching?

When I am sick, I should take three times the normal dose for 3 days in a row

6. A patient with osteopenia asks a nurse about the benefits of hormone therapy in preventing osteoporosis. Which statement by the nurse is correct?

When hormone therapy is discontinued, bone mass is quickly lost

18. A nurse has provided education for a patient newly diagnosed with hypertension who is just beginning therapy with antihypertensive medications. Which statement by the patient indicates a need for further teaching?

When my symptoms subside, I may discontinue the medications

A patient who has developed postmenopausal osteoporosis will begin taking alendronate [Fosamax]. The nurse will teach this patient to take the drug:

While sitting upright with plenty of water

A patient who is newly diagnosed with Parkinson's disease is prescribed levodopa [Dopar]. The patient asks the nurse about drugs to prevent disease progression. What will the nurse tell this patient?

While some drugs show promise, there are no studies that have proven a neuroprotective effect

7. An older male patient with an increased risk of MI is taking furosemide [Lasix] and low-dose aspirin. The patient is admitted to the hospital, and the nurse notes an initial blood pressure of 140/80 mm Hg. The patient has had a 10-pound weight gain since a previous admission 3 months earlier. The patient has voided only a small amount of concentrated urine. The serum creatinine and blood urea nitrogen (BUN) levels are elevated. The nurse will contact the provider to discuss:

Withdrawing the aspirin

5. A patient with CRF who will begin receiving an erythropoiesis stimulating agent (ESA) is admitted to the hospital. The nurse notes that the patient's heart rate is 82 beats per minute, and the blood pressure is 140/100 mm Hg. A complete blood count reveals a hemoglobin of 8 gm/dL and a hematocrit of 29%. What will the nurse do?

Withhold the ESA and request an order for an antihypertensive medication

A patient with chronic gout is admitted to the hospital for treatment for an infection. The patient is receiving allopurinol and ampicillin. The nurse is preparing to administer medications and notes that the patient has a temperature of 101°F and a rash. What will the nurse do?

Withhold the allopurinol and notify the prescriber of the drug regimen

5. A patient who takes aspirin for rheumatoid arthritis is admitted to the hospital complaining of headache and ringing in the ears. The plasma salicylate level is 300 mcg/mL, and the urine pH is 6.0. What will the nurse do?

Withhold the aspirin until the patient's symptoms have subsided

A nurse prepares to administer propranolol (Inderal) to a patient recovering from acute MI. The patient's HR is 52, and the rhythm is regular. What action should the nurse take next?

Withhold the dose and notify the prescriber.

9. A patient with bronchitis is taking TMP/SMZ, 160/800 mg orally, twice daily. Before administering the third dose, the nurse notes that the patient has a widespread rash, a temperature of 103°F, and a heart rate of 100 beats per minute. The patient looks ill and reports not feeling well. What will the nurse do?

Withhold the dose and notify the provider of the symptoms

2. A 65-year-old patient who receives glucocorticoids for arthritis is admitted to the hospital for treatment of a urinary tract infection. The prescriber has ordered intravenous ciprofloxacin [Cipro]. Before administering the third dose of this drug, the nurse reviews the bacterial culture report and notes that the causative organism is Escherichia coli. The bacterial sensitivity report is pending. The patient complains of right ankle pain. What will the nurse do?

Withhold the dose of ciprofloxacin and notify the provider of teh patient's symptoms

5. A patient is taking digoxin [Lanoxin] and quinidine to treat sustained ventricular tachycardia. Before giving medications, the nurse reviews the patient's electrocardiogram (ECG) and notes a QRS complex that has widened by 50% from the baseline ECG. What will the nurse do?

Withhold the quinidine and contact the provider to report the ECG finding

12. A patient comes to the clinic and receives valacyclovir [Valtrex] for a herpes-zoster virus. The nurse instructs the patient to take the medication:

Without regard to meals

2. A nurse is teaching a group of adolescent students about sexually transmitted diseases. Which statement by a student indicates understanding of infections caused by C. trachomatis?

Women with asymptomatic Chlamydia trachomatis infections can become sterile

A patient is brought to the emergency department by friends, who report finding the patient difficult to awaken. The friends report removing two fentanyl transdermal patches from the patient's arm. On admission to the emergency department, the patient has pinpoint pupils and a respiratory rate of 6 breaths per minute. A few minutes after administration of naloxone, the respiratory rate is 8 breaths per minute and the patient's pupils are dilated. The nurse recognizes these symptoms as signs of:

Worsening hypoxia

A patient with chronic pain has been receiving morphine sulfate but now has decreased pain. The prescriber changes the medication to pentazocine [Talwin]. The nurse will monitor the patient for:

Yawning and sweating

A patient who has a lower back injury exhibits muscle spasms. The provider orders cyclobenzaprine [Flexeril] 10 mg three times a day. What will the nurse include when teaching this patient about this drug?

You may experience blurred vision, dry mouth, or constipation

10. A patient is about to begin treatment for latent tuberculosis. The patient is an alcoholic, has difficulty complying with drug regimens, and has mild liver damage. What will the nurse tell this patient?

You must take isoniazid with close monitoring of hepatic function

9. A healthcare worker who is asymptomatic has a screening TST result of 10 mm of induration during a pre-employment physical. What will the nurse reading this test tell the patient?

You need to have a chest radiograph and a sputum culture

7. A patient has begun taking an HMG-COA reductase inhibitor. Which statement about this class of dru1gs made by the nurse during patient education would be inappropriate?

You should come into the clinic for liver enzymes in 1 month

8. A nurse is instructing a patient receiving a cholesterol-lowering agent. Which information should the nurse include in the patient education?

You should continue your exercise program to increase your HDL serum levels

15. A patient who takes nitroglycerine to treat stable angina reports having erectile dysfunction and states that he plans to ask his primary provider for a prescription for tadalafil [Cialis]. What will the nurse tell this patient?

You should discuss another anti-angina medication with your provider

1. A male patient is being treated for benign prostatic hyperplasia (BPH) by another provider but cannot remember which drug he is taking. He comes to the clinic seeking treatment for erectile dysfunction and receives a prescription for sildenafil [Viagra]. What will the nurse teach this patient?

You should not take sildenafil if you are taking silodosin (Rapaflo)

A patient who wants to quit smoking has begun taking Vernicline (Chantix). The patient reports experiencing mood swings and depression and a desire to cause harm to herself. What will the nurse tell this patient?

You should notify your provider of these symptoms immediately

12. A patient who has gastroesophageal reflux disease (GERD) receives a prescription for a proton pump inhibitor (PPI) medication. What will the nurse include when teaching the patient about this drug?

You should report any fever and cough to your provider

1. A patient with a history of elevated triglycerides and LDL cholesterol begins taking nicotinic acid [Niacin]. The patient reports uncomfortable flushing of the face, neck, and ears when taking the drug. What will the nurse advise the patient?

You should take 325mg of aspirin a half hour before each dose of Niacin to prevent this effect.

17. A patient with gastroesophageal reflux disease (GERD) is to begin taking oral metoclopramide [Reglan]. The patient asks the nurse about the medication. Which response by the nurse is correct?

You should take the drug 30 minutes before each meal and at bedtime

A prescriber has ordered nicotine nasal spray for a patient to assist with smoking cessation. Which statement will the nurse include when teaching the patient about the medication.

You should use 1 spray in each nostril per dose up to 5 times per hour

8. A nurse provides dietary counseling for a patient newly diagnosed with type 1 diabetes. Which instruction should be included?

You should use a carbohydrate counting approach to maintain glycemic control

A patient who has esophageal cancer is experiencing dry mouth and the provider orders oral pilocarpine to treat this. What will the nurse expect to teach the patient?

You will begin taking 5mg three times daily and may increase the dose to 10 mg

5. A patient who is taking didanosine [Videx] reports nausea, vomiting, and abdominal pain. What will the nurse recommend to this patient?

You will need laboratory tests to determine if these are serious effects of the drug

A prescriber has ordered methyldopa for a patient with HTN. The nurse teaches the patient about drug actions, adverse effects, and the ongoing blood tests necessary with this drug. The nurse is correct to tell the patient what?

You will need to contact the provider and stop taking the medication if your eyes look yellow.

A 30 year old male patient reports having two to four urinary tract infections a year. What will the nurse expect to teach this patient?

You will need to know a low dose of medication of 6 months to prevent infections

16. A patient who has renal impairment will begin taking ranolazine [Ranexa] as an adjunct to nitroglycerine to treat angina. What will the nurse include when teaching this patient?

You will need to monitor your blood pressure closely while taking this drug

A patient with schizophrenia receives a dose of risperidone [Risperdal Consta] IM. The nurse teaching this patient about this medication will make which statement?

You will need to take an oral antipsychotic drug for 3 weeks

2. A patient who has drug-sensitive tuberculosis has completed 2 months of the standard four-drug therapy and asks the nurse how long he will have to take medication. Which response by the nurse is correct?

You will need to take only two drugs for the next 4 months

A patient who has gout will begin taking febuxostat [Uloric] and colchicine. What will the nurse include when teaching this patient about this drug regimen?

You will stop taking the colchicine within 6 months after starting therapy

A patient with gout who has increasingly frequent acute gouty attacks will begin receiving allopurinol [Zyloprim] and colchicine. The nurse will include which statement when teaching the patient about this drug regimen?

You will take both drugs initially and then stop taking the colchicine

4. A newborn infant has been given erythromycin ophthalmic ointment as a routine postpartum medication. The infant's mother learns that she has a C. trachomatis infection and asks the nurse if her baby will need to be treated. Which response by the nurse is correct?

Your baby will need to be treated with oral erythromycin

13. The parent of a 5-year-old child who has had four urinary tract infections in the past year asks the nurse why the provider doesn't just order an antibiotic for the child's current symptoms of low-grade fever, flank pain, and dysuria since these are similar symptoms as before. Which is the most important reason given by the nurse?

Your child may need tests to assess for urinary tract abnormalities

9. A parent asks a nurse if the provider will prescribe an antibiotic for a child who attends school with several children who have strep throat. The child is complaining of a sore throat and has a fever. What will be the nurse's response?

Your child should come to the clinic to have a throat culture done today

A child has ringworm of the scalp. A culture of the lesion reveals a dermatophytic infection. The nurse teaching the child's parents about how to treat this infection will include which statement?

Your child will need to take this oral medication for 6 to 8 weeks

A patient who travels frequently for business reports occasional instances of being unable to fall asleep. The patient tells the nurse that job demands require staying up late and then getting up early for meetings. The nurse expects that the provider will prescribe which medication for this patient?

Zaleplon (Sonata)

A patient with Parkinson's disease is taking levodopa/carbidopa [Sinemet] along with amantadine [Symmetrel] 400 mg/day to treat dyskinesias. The patient reports having increased dyskinesias several months after beginning the amantadine. The nurse will contact the provider to discuss which action?

Interrupting treatment with amantadine for several weeks

10. The nurse is preparing to administer basiliximab [Simulect] to a patient to prevent acute rejection. By which route will the nurse administer the drug?

Intravenous

8. A patient with hypothyroidism begins taking PO levothyroxine [Synthroid]. The nurse assesses the patient at the beginning of the shift and notes a heart rate of 62 beats per minute and a temperature of 97.2°F. The patient is lethargic and difficult to arouse. The nurse will contact the provider to request an order for which drug?

Intravenous levothyroxine

A nurse is teaching a group of nursing students about irreversible cholinesterase inhibitors. Which statement by a student indicates understanding?

Irreversible cholinesterase inhibitors are rapidly absorbed by all routes.

A neonate is born to a patient who reports taking venlafaxine [Effexor XR]. The nurse caring for the infant will observe the infant for:

Irritability, tremor, and respiratory distress

7. A nursing student asks a nurse why pegylated interferon alfa is used instead of regular interferon for a patient with hepatitis C. The nurse will tell the student that pegylated interferon:

Is administered less frequently than interferon

A patient will begin taking etanercept [Enbrel] for severe rheumatoid arthritis. The patient has been taking methotrexate [Rheumatrex]. The patient asks if the etanercept is stronger than the methotrexate. The nurse will tell the patient that etanercept ____ methotrexate.

Is better at delaying progression of joint damage than

16. A patient with heart failure who takes a thiazide diuretic and digoxin [Lanoxin] is admitted for shortness of breath. The patient's heart rate is 66 beats per minute, and the blood pressure is 130/88 mm Hg. The serum potassium level is 3.8 mEq/L, and the digoxin level is 0.8 ng/mL. The nurse admitting this patient understands that the patient:

Is experiencing worsening of the disease

15. A patient who is being treated for HIV infection has a 5-mm area of induration after a routine TST. The patient's chest radiograph is normal, and there are no other physical findings. The nurse will expect this patient to begin treatment with which drugs?

Isoniazid and rifabutin

5. A patient with HIV who takes protease inhibitors develops tuberculosis and will begin treatment. Which drug regimen will be used for this patient?

Isoniazid, pyrazinamide, ethambutol + rifabutin

4. A patient is beginning treatment for active tuberculosis (TB) in a region with little drug-resistant TB. Which treatment regimen will be used initially?

Isoniazid, rifampin, pyrazinamide, and ethambutol

Two nurses are discussing the major differences between physostigmine (Antilirium) and neostigmine (Prostigmin). One nurse correctly makes which statement about physostigmine?

It can readily cross the blood-brain barrier.

A nurse is preparing to administer a medication and learns that it is a nonselective agonist. What does the nurse understand about this drug?

It directly activates receptors to affect many physiologic processes

12. A patient asks a nurse why he cannot use digoxin [Lanoxin] for his heart failure, because both of his parents used it for HF. The nurse will explain that digoxin is not the first-line therapy for which reason?

It does not correct the underlying pathology of heart failure

17. The nurse educator is providing patient education about the Cardiac Arrhythmia Suppression Trial (CAST). The nurse correctly explains that the trial demonstrated what effect from the pharmacologic suppression of dysrhythmias?

It doubled the risk of a second MI

What is a desired outcome when a drug is described as easy to administer?

It enhances patient adherence to the drug regimen.

6. A patient with second-degree burns is treated with silver sulfadiazine [Silvadene]. A nursing student asks the nurse about the differences between silver sulfadiazine and mafenide [Sulfamylon], because the two are similar products, and both contain sulfonamides. What does the nurse tell the student about silver sulfadiazine?

It has antibacterial effects related to release of free silver

3. A patient who is taking acetaminophen for pain wants to know why it does not cause gastrointestinal upset, as do other over-the-counter pain medications. The nurse will explain that this is most likely because of which property of acetaminophen?

It has minimal effects at peripheral sites

A patient is taking a beta-adrenergic antagonist medication for angina pectoris and asks the nurse how the drug works to relieve the discomfort associated with this condition. Which statement by the patient after the nurse's teaching indicates understanding?

It helps reduce the heart's oxygen needs.

During an admission history, a patient reports a frequent need to return to a room multiple times to make sure an iron or other appliance is unplugged. What does the nurse understand about this patient's behavior?

It helps the patient reduce anxiety about causing a fire

What occurs when a drug binds to a receptor in the body?

It increases or decreases the activity of that receptor.

4. A patient is diagnosed with periodontal disease, and the provider orders oral doxycycline [Periostat]. The patient asks the purpose of the drug. What is the nurse's response?

It inhibits collagenase to protect connective tissue in the gums

13. A patient has been taking senna [Senokot] for several days, and the nurse notes that the urine is yellowish-brown. What does the nurse know about this symptom?

It is an expected, harmless effect of senna

9. A patient will begin taking dabigatran etexilate [Pradaxa] to prevent stroke. The nurse will include which statement when teaching this patient?

It is important not to crush, chew, or open capsules of dabigatran

A nursing student caring for a patient with cancer tells the nurse that the patient seems to be exaggerating when reporting the degree of pain. Which statement by the nurse is an appropriate response to this concern?

It is important to give pain medication as ordered for the degree of pain the patient reports

The nurse is teaching a patient who is newly diagnosed with MG about managing the disease. Which is important when teaching this patient about adverse effects of cholinesterase inhibitors?

It is important to notify your provider if you have excessive saliva.

14. A patient is about to begin treatment for latent tuberculosis with a short course of daily rifampin. The patient asks why rifapentine [Priftin] cannot be used, because it can be given twice weekly. What will the nurse tell this patient about rifapentine?

It is not approved for treatment of latent TB

A patient with pheochromocytoma is admitted for surgery. The surgeon has ordered an alpha-blocking agent to be given preoperatively. What does the nurse understand about this agent?

It is ordered to prevent perioperative hypertensive crisis

A patient who is taking morphine for pain asks the nurse how a pain medication can also cause constipation. What does the nurse know about morphine?

It is selective to receptors that regulate more than one body process.

2. The parents of a boy with hemophilia A want to know why their son will receive factor replacement on an ongoing basis rather than when needed for bleeding episodes. They tell the nurse that the boy's grandfather, who had the same disease, received the drug only when he had bleeding. The nurse will give the parents which information about ongoing therapy?

It is used to minimize long-term damage to the joints

5. A patient begins taking an ACE inhibitor and complains of a dry cough. What does the nurse correctly tell the patient about this symptom?

It may be uncomfortable enough that the drug will need to be discontinued

A patient has taken Levodopa (Dopar) for parkinson's disease for 2 weeks but reports no improvement in the symptoms. Which response by the nurse is correct?

It may take several months for a response to occur

13. The nurse is providing education to a patient with ulcerative colitis who is being treated with sulfasalazine [Azulfidine]. What statement by the patient best demonstrates understanding of the action of sulfasalazine?

It reduces the inflammation

12. A nursing student is helping to care for a patient who takes verapamil for stable angina. The nurse asks the student to explain the purpose of verapamil in the treatment of this patient. Which statement by the student indicates a need for further teaching?

It relaxes coronary artery spasms

A nurse working the night shift begins taking modafinil [Alertec]. The nurse is telling a coworker about the medication. Which statement is correct?

It will not interfere with my normal sleep

A patient with bone cancer has recently undergone chemotherapy and radiation therapy to reduce the size of the tumor. The patient is taking a large dose of an opioid analgesic, along with acetaminophen and an antidepressant. The nursing student caring for this patient is concerned that the patient is showing drug-seeking behaviors, because the individual requested an increased dose of the opioid. The student discusses this concern with the nurse. Which statement by the student indicates a need for further teaching?

It would probably help this patient more to give a larger antidepressant dose

A nurse is teaching a group of nursing students about neurotransmitters. Which statement by a student about acetylcholine indicates a need for further teaching?

Its transmission is terminated by reuptake into the cholinergic nerve terminal

11. A nurse is admitting a patient to the hospital who reports having recurrent, crampy abdominal pain followed by diarrhea. The patient tells the nurse that the diarrhea usually relieves the pain and that these symptoms have occurred daily for the past 6 months. The patient undergoes a colonoscopy, for which the findings are normal. The nurse will plan to teach this patient to:

Keep a food, stress, and symptom diary

A patient who has occasional migraine headaches tells a nurse that the abortive medication works well, but she would like to do more to prevent the occurrence of these headaches. The nurse will suggest that the patient:

Keep a headache diary to help determine possible triggers

1. A pregnant patient is treated with trimethoprim/sulfamethoxazole (TMP/SMZ) [Bactrim] for a urinary tract infection at 32 weeks' gestation. A week later, the woman delivers her infant prematurely. The nurse will expect to monitor the infant for:

Kernicterus

3. A patient with Cushing's syndrome has undergone surgery and radiation treatment. The nurse will expect to teach the patient about which medication?

Ketoconazole (Nizoral)

12. The nurse is administering medications to a patient who is receiving cyclosporine [Sandimmune]. Which medication, when administered concurrently with cyclosporine, would warrant a reduction in the dosage of cyclosporine?

Ketoconazole (nizoral)

A nurse is teaching a drug prevention class to a group of parents of adolescents. Which statement by a parent indicates understanding of the teaching?

LSD does not cause an abstinence syndrome when it is withdrawn.

12. A patient with a history of chronic alcohol abuse has been admitted to the unit with cirrhosis. Upon review of the patient's laboratory test results, the nurse notes that the patient's ammonia level is elevated at 218 mcg/dL. What medication should the nurse prepare to administer?

Lactulose

A patient taking a beta blocker complains of SOB. The patient has respirations of 28, BP of 162/90, and a pulse of 88. The nurse auscultates crackles in all lung fields. The nurse understands that these assessments are consistent with

Left-sided heart failure

9. A patient with non-Hodgkin's lymphoma is about to begin chemotherapy with a massive dose of methotrexate [Rheumatrex]. The nurse will expect to administer which medication concurrently with this drug?

Leucovorin

Which type of drugs taken by a pregnant patient are more likely to have effects on the fetus?

Lipid-soluble drugs

2. A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding scale and are ordered before a meal and at bedtime. The patient's blood sugar level is 317 mg/dL. Which formulation of insulin should the nurse prepare to administer?

Lispro (Humalog)

A patient is admitted to a hospital for treatment for first-time symptoms of mania and is exhibiting euphoric mania. Which medication will the provider order?

Lithium (lithobid)

10. A 14-year-old male patient who plays football is admitted to the hospital. The nurse notes that the patient has short stature for his age according to a standard growth chart. The patient is muscular, has a deep voice, and needs to shave. The nurse notifies the provider of these findings. Which test will the nurse expect the provider to order?

Liver function tests and serum cholesterol

A nurse is teaching a group of nursing students about local anesthetics. Which statement by a student reflects an understanding of the teaching?

Local anesthetics affect motor and sensory nerves

A patient asks a nurse about the effects of chronic alcohol use on the heart. The nurse's best response would be which statement?1. A patient asks a nurse about the effects of chronic alcohol use on the heart. The nurse's best response would be which statement?

Long-term alcohol use can damage the heart and cause heart failure

9. An older adult patient with severe gastroesophageal reflux disease (GERD) has had only minimal relief using a histamine2-receptor antago in nist (H2RA). The patient is to begin taking omeprazole [Prilosec]. What will the nurse teach this patient?

Long-term therapy may be needed

A nurse is reviewing an older adult's chart before giving medications. Which patient information is of most concern?

Low serum albumin

A nurse is caring for a patient in the immediate postoperative period after surgery in which a spinal anesthetic was used. The patient has not voided and complains of headache. The patient has a pulse of 62 beats per minute, a respiratory rate of 16 breaths per minute, and a blood pressure of 92/48 mm Hg. Which action by the nurse is appropriate?

Lower the head of the bed to a 10 to 15 degree head-down position

13. A prescriber orders verapamil [Covera-HS] for a patient who is taking digoxin [Lanoxin] and warfarin. The nurse will expect the prescriber to ____ the dose of ____.

Lower; digoxin

A prescriber has ordered pilocarpine (Pilocar). A nurse understands that the drug stimulates muscarinic receptors and would expect the drug to have which action?

Lowering of intraocular pressure in patients with glaucoma

4. A patient is being treated with amphotericin B [Abelcet] for a systemic fungal infection. After several weeks of therapy, the provider orders flucytosine [Ancobon] in addition to the amphotericin. The nurse understands that the rationale for this combination is that it:

Lowers the dose of amphotericin B and reduces toxicity

12. A nurse is discussing methicillin-resistant Staphylococcus aureus (MRSA) with a group of nursing students. Which statement by a student correctly identifies the basis for MRSA resistance?

MRSA bacteria have developed PBPs with a low affinity for penicillins

A patient is brought to the emergency department by friends, who say that they were at a party where alcohol and a mix of barbiturates and benzodiazepines were all available. They tell the nurse that the patient was among the first to arrive at the party, which started several hours ago. The patient is nonresponsive and has pinpoint pupils and respirations of 6 breaths per minute. After oxygen has been administered, the nurse should prepare the patient for which intervention?

Maintaining adequate oxygenation to the brain

A patient whose spouse has died recently reports feeling down most of each day for the past 2 months. On further questioning, the nurse learns that the patient has quit participating in church and social activities, has difficulty falling asleep, and has lost 5 pounds. The patient reports feeling tired and confused all the time but does not have suicidal thoughts. What does the nurse suspect?

Major depression

2. A patient has an infection caused by Pseudomonas aeruginosa. The prescriber has ordered piperacillin and amikacin, both to be given intravenously. What will the nurse do?

Make sure to administer the drugs at different times using different IV tubing

7. A female patient has come to the STD clinic and has been diagnosed with a Trichomonas vaginalis infection. What education should be provided to this patient?

Male partners should always be treated, even if they are asymptomatic

A hospitalized patient with Parkinson's disease who is receiving apomorphine to treat "off" episodes develops nausea and vomiting. The nurse will discuss the use of which medication with the patient's provider?

Trimethobenzamide (Tigan)

A patient taking an FGA medication develops severe parkinsonism and is treated with amantadine [Symmetrel]. The amantadine is withdrawn 2 months later, and the parkinsonism returns. The nurse will expect the provider to:

Try a second-generation antipsychotic (SGA)

10. A patient stops taking a proton pump inhibitor (PPI) after 6 weeks of therapy for treatment of peptic ulcer disease. The patient reports symptoms of dyspepsia to the nurse. The nurse will tell this patient to:

Try an antacid to see whether it relieves these symptoms

14. A nursing student asks the nurse why multi-drug therapy is often used to treat hypertension. Which statement by the student indicates a need for further teaching?

Two or more drugs will lower blood pressure more quickly

3. A 20-year-old female patient has suprapubic discomfort, pyuria, dysuria, and bacteriuria greater than 100,000/mL of urine. Which are the most likely diagnosis and treatment?

Uncomplicated lower UTI treatable with short course therapy

A patient about to begin therapy with etanercept has a positive tuberculin skin test. A chest radiograph is negative. The nurse will expect this patient to:

Undergo tuberculosis treatment prior to beginning etanercept treatment

7. An adolescent patient recently attended a health fair and had a serum glucose test. The patient telephones the nurse and says, "My level was 125 mg/dL. Does that mean I have diabetes?" What is the nurse's most accurate response?

Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes

10. A nurse is teaching a nursing student who wants to know how aspirin and nonaspirin first-generation NSAIDs differ. Which statement by the student indicates a need for further teaching?

Unlike aspirin, first generation NSAIDS do not carry a risk of hypersensitivity reactions

4. A premenopausal woman has ER-positive breast cancer, and her prescriber has ordered tamoxifen [Nolvadex]. She asks the nurse if anastrozole [Arimidex] would work better for her. What will the nurse tell her?

Until she is postmenopausal, anastrozole will not be effective

A patient has had three gouty flare-ups in the past year. Which drug class will the nurse expect the provider to order for this patient?

Urate-lowering drugs

6. A nurse is teaching an adolescent female patient about 28-day monophasic combination oral contraceptives. The provider has instructed the patient to begin taking the pills on the first Sunday after the onset of her next period. What will the nurse tell the patient?

Use another form of contraception for the next month

18. A patient who has traveler's diarrhea asks the nurse about using loperamide to stop the symptoms. What will the nurse tell the patient about this drug?

Use of this drug may prolong symptoms by slowing peristalsis

A patient with a desire to stop smoking asks a nurse about nicotine chewing gum (Nicorette). The patient currently smokes 30 cigarettes per day. Which statement by the nurse is correct?

Use the 4mg strength gum and chew one piece every 2-3 hours

10. A patient is preparing to travel to perform missionary work in a region with poor drinking water. The provider gives the patient a prescription for ciprofloxacin [Cipro] to take on the trip. What will the nurse instruct this patient to do?

Use the drug if symptoms are severe or do not improve in a few days

6. A patient has come to the clinic with tinea corporis, and the prescriber has ordered clotrimazole. When educating the patient about this medication, the nurse will include which statement?

Use the medication for at least 1 week after the symptoms have cleared

12. A patient who has cystic fibrosis has a Pseudomonas aeruginosa infection and the provider has ordered aztreonam [Cayston]. What will the nurse teach this patient about administration of this drug?

Use the nebulizer to administer the drug three times daily

A patient is diagnosed with major depression with severe symptoms and begins taking an antidepressant medication. Three weeks after beginning therapy, the patient tells the nurse that the drug is not working. The nurse will counsel this patient to ask the provider about:

Using nondrug therapies to augment the medication

8. A 60-year-old female patient is about to begin long-term therapy with a glucocorticoid. Which of the following will be important for minimizing the risk of osteoporosis?

Calcium and Vitamin D supplements

10. A patient is receiving an intraperitoneal aminoglycoside during surgery. To reverse a serious side effect of this drug, the nurse may expect to administer which agent?

Calcium gluconate

The nurse receives an order to give morphine 5 mg IV every 2 hours PRN for pain. Which action is not part of the 6 rights of med adm?

Assessing the patient's pain level 15 to 30 minutes after giving the medication.

9. A prescriber has ordered propranolol [Inderal] for a patient with recurrent ventricular tachycardia. The nurse preparing to administer this drug will be concerned about what in the patient's history?

Asthma

A nurse caring for a patient after a cesarean section learns that the patient received isoflurane [Forane] during the surgery. What will the nurse monitor most closely in this patient?

Uterine tone

15. A patient develops CDAD. Which antibiotic is recommended for treating this infection?

Vancomycin

A nurse is teaching a class on addiction. Which statement by one of the class participants indicates a need for further teaching?

"Addictive drugs lead to dopamine release in amounts similar to those released by normal reward circuits."

14. A nurse provides teaching to a patient with angina who also has type 2 diabetes mellitus, asthma, and hypertension. Which statement by the patient indicates a need for further teaching?

Beta blockers can help me control HTN

11. A patient with variant angina wants to know why a beta blocker cannot be used to treat the angina. Which response by the nurse is correct?

Beta blockers do not help relax coronary artery spasm

A postoperative patient complains of abdominal bloating and discomfort. The nurse caring for this patient will contact the provider to request which medication?

Bethanechol

2. A patient with diabetes develops hypertension. The nurse will anticipate administering which type of medication to treat hypertension in this patient?

ACE inhibitors

5. A patient is recovering from a myocardial infarction but does not have symptoms of heart failure. The nurse will expect to teach this patient about:

ACE inhibitors and beta blockers

3. A patient who has been taking an antihypertensive medication for several years is recovering from a myocardial infarction. The prescriber changes the patient's medication to an ACE inhibitor. The patient asks the nurse why a new drug is necessary. What is the nurse's response?

ACE inhibitors can prevent or reverse pathologic changes in the heart's structure

8. A child with hemophilia A who weighs 30 kg receives factor VIII on an ongoing basis as prophylaxis. The provider orders desmopressin [Stimate] to be used for nosebleeds. The nurse will instruct the child's parents to give the medication as ____ nostril as needed.

1 spray in one

A prescriber orders clonidine (Kapvay) ER tablets for a 12 y/o. The nurse understands that this drug is being given to treat which condition?

ADHD

15. A patient with a recent onset of nephrosclerosis has been taking an ACE inhibitor and a thiazide diuretic. The patient's initial blood pressure was 148/100 mm Hg. After 1 month of drug therapy, the patient's blood pressure is 130/90 mm Hg. The nurse will contact the provider to discuss:

Adding a calcium channel blocker to this patient's drug regimen

14. A nurse is discussing adenosine with a nursing student. Which statement by the student indicates a need for further teaching?

Adenosine can be used to prevent paroxysmal supraventricular tachycardia and wolff-parkinson-white syndrome

A nurse is discussing the role of vitamin D in calcium regulation with a nursing student. Which statement by the student indicates a need for further teaching?

Adequate amounts of vitamind d occur naturally in the diet

A patient who has migraine headaches is prescribed sumatriptan [Imitrex] 5 mg unit-dose nasal spray. The patient has administered two sprays at 1400, 1600, and 1800 and calls to report little relief from headache pain. What will the nurse instruct the patient to do?

Administer 2 sprays at 2000 and call the provider if no relief

An older adult patient who has cancer and Alzheimer's disease is crying but shakes her head "no" when asked about pain. The prescriber has ordered morphine sulfate 2 to 4 mg IV every 2 hours PRN pain. It has been 4 hours since a dose has been given. What will the nurse do?

Administer 4 mg of morphine and monitor this patient's verbal and nonverbal responses

6. A female patient with essential hypertension is being treated with hydralazine 25 mg twice daily. The nurse assesses the patient and notes a heart rate of 96 beats per minute and a blood pressure of 110/72 mm Hg. The nurse will request an order to:

Administer a beta blocker

A patient is admitted for treatment of gout that has been refractory to treatment with allopurinol and probenecid. The patient is taking colchicine, and the prescriber orders pegloticase [Krystexxa]. Before administering this drug, the nurse will expect

Administer an antihistamine and a glucocorticoid

4. A patient with atrial fibrillation is receiving warfarin [Coumadin]. The nurse notes that the patient's INR is 2.7. Before giving the next dose of warfarin, the nurse will notify the provider and:

Administer dose as ordered

2. A patient is diagnosed with an infection caused by Staphylococcus aureus, and the prescriber orders intravenous gentamicin and penicillin (PCN). Both drugs will be given twice daily. What will the nurse do?

Administer gentamicin flush the line and given the penicillin

1. A patient who has chronic adrenal insufficiency is admitted to the hospital for an open cholecystectomy. The nurse obtaining the admission history learns that the patient takes hydrocortisone 25 mg PO daily in the morning. The patient's surgery is scheduled for the next morning. The nurse will expect an order to:

Administer hydrocortisone 50 mg IV before surgery

A prescriber has ordered bethanechol (Urecholine) for a postoperative patient who has urinary retention. The nurse reviews the chart before giving the drug. Which part of the patient's history would be a contraindication to using the drug?

Asthma as a child

15. A woman who is breastfeeding is prescribed a low pharmacologic dose of a glucocorticoid and asks the nurse about potential effects on her infant. What will the nurse tell her about this medication?

At this dose, the concentration in your breast milk is safe

Someone asks a nurse about a new drug that is in preclinical testing and wants to know why it cannot be used to treat a friend's illness. Which statement by the nurse is correct?

At this stage of drug development, the safety and usefulness of the medication is unknown.

2. A patient with atrial fibrillation is taking verapamil [Calan]. The patient has read about the drug on the Internet and wants to know why a drug that affects the rate of ventricular contraction is used to treat an abnormal atrial contraction. What will the nurse tell the patient?

Atrial dysryhthmias can have life-threatening effects on ventricular function

1. A nurse is teaching a group of nursing students about cyclooxygenase (COX) inhibitors. A student asks the nurse about characteristics of COX-1 inhibitors. Which statement by the nurse is true?

COX-1 inhibitors protect against myocardial infarction and stroke

11. A male patient reports decreased libido and the nurse notes galactorrhea during a physical assessment. The nurse will report these findings to the provider and will anticipate an order for which medication?

Cabergoline

9. A patient who has erectile dysfunction asks about medications to treat this disorder, but tells the nurse he doesn't want to have to plan sexual activity several hours in advance. Which medication will the nurse expect the provider to order for this patient?

Avanafil (stendra)

6. When metronidazole [Flagyl] is a component of the H. pylori treatment regimen, the patient must be instructed to do what?

Avoid any alcholic beverages

A young adult begins taking clonidine [Kapvay] to treat ADHD symptoms after suffering anorexia with methylphenidate [Ritalin]. What will the nurse include when teaching this patient about taking clonidine?

Avoid consuming alcohol while taking this medication

A patient asks a nurse about ways to minimize side effects of chemotherapy. Which response is correct?

Avoid contact with people who are ill

8. A patient with Stage C heart failure (HF) who has been taking an ACE inhibitor, a beta blocker, and a diuretic begins to have increased dyspnea, weight gain, and decreased urine output. The provider orders spironolactone [Aldactone]. The nurse will instruct the patient to:

Avoid potassium supplements

A patient will receive buprenorphine [Butrans] as a transdermal patch for pain. What is important to teach this patient about the use of this drug?

Avoid prolonged exposure to the sun

6. A patient who is in her first trimester of pregnancy asks the nurse to recommend nonpharmaceutical therapies for morning sickness. What will the nurse suggest?

Avoiding fatty and spicy foods

1. During a routine screening, an asymptomatic, pregnant patient at 37 weeks' gestation learns that she has an infection caused by Chlamydia trachomatis. The nurse will expect the provider to order which drug?

Azithromycin

7. A nursing student asks a nurse to explain the differences between amphotericin B [Abelcet] and the azoles group of antifungal agents. Which statement by the nurse is correct?

Azoles have lower toxicity than amphotericin B

A patient has severe Paget's disease of the bone. The patient asks the nurse what can be done to alleviate the pain. The nurse will suggest that the patient discuss the use of which medication with the provider?

Calcitonin-salmon (Miacalcin)

6. A patient is admitted to the coronary care unit from the emergency department after initial management of STEMI. A primary percutaneous coronary intervention has been performed. The nurse notes an initial heart rate of 56 beats per minute and a blood pressure of 120/80 mm Hg. The patient has a history of stroke and a previous myocardial infarction. Which order will the nurse question?

Beta blocker

A patient is admitted to the ICU for treatment of shock. the prescriber orders isoproterenol (Isuprel). The nurse expects this drug to increase tissue perfusion in this patient by activating:

Beta 1 receptors to cause a positive inotropic effect

An infant has allergies and often develops a pruritic rash when exposed to allergens. The infant's parents ask the nurse about using a topical antihistamine. What should the nurse tell them?

Applying an antihistamine to the skin can cause toxicity in this age group.

5. A nursing student is discussing with a nurse the plan of care for a patient about to undergo a third round of chemotherapy with cisplatin. Which statement by the nursing student about the treatment of CINV is correct?

Aprepitant (Emend) will be necessary to treat CINV caused by cisplatin

7. A patient who has a brain tumor will receive a nitrosourea agent. A nursing student asks why this type of drug is used for this type of cancer. The nurse will tell the student that nitrosoureas are useful because they:

Are lipophilic

A nurse is explaining activation of Beta-2 receptors to nursing students during a clinical rotation. Which statement by a student demonstrates a need for further teaching?

Beta 2 activation results in contraction of uterine muscle

A pregnant patient is in premature labor. Which class of drug will she be given?

Beta 2 agonist

1. A nurse is taking a history on a clinic patient who reports being constipated. Upon further questioning, the nurse learns that the patient's last stool was 4 days ago, that it was of normal, soft consistency, and that the patient defecated without straining. The patient's abdomen is not distended, and bowel sounds are present. The patient reports usually having a stool every 1 to 2 days. What will the nurse do?

Ask about recent food and fluid intake

7. A patient is taking a drug that interferes with venous constriction. The nurse will tell the patient to:

Ask for assistance when getting out of bed

A patient takes temazepam [Restoril] for insomnia. The patient tells the nurse that a recent telephone bill lists several calls to friends that the patient does not remember making. What will the nurse do?

Ask the patient about any alcohol consumption in conjunction with the benzodiazepine

10. A patient taking a glucocorticoid for arthritis reports feeling bloated. The nurse notes edema of the patient's hands and feet. Which action by the nurse is correct?

Ask the patient about sodium intake

A patient tells a nurse that a medication prescribed for recurrent migraine headaches is not working. What will the nurse do?

Ask the patient about the number and frequency of tablets taken.

A pregnant patient in labor tells the nurse that she is afraid she may have harmed her fetus by consuming alcohol. What is an appropriate response by the nurse?

Ask the patient how much alcohol she consumed and at which stage of pregnancy

A patient with asthma uses albuterol (Ventolin) for wheezing. The nurse assesses the patient and notes VS of HR 96, RR 18, BP 116/78. The patient has clear breath sounds and hand tremors. What will the nurse do

Ask the patient how often the inhaler is used

A patient who is taking oral contraceptives begins taking valproic acid [Depakote] for seizures. After a week of therapy with valproic acid, the patient tells the nurse that she is experiencing nausea. What will the nurse do?

Ask the patient if she is taking the valproic acid with food, because taking the drug on an empty stomach can cause GI side effects

A patient who has been taking alprazolam [Xanax] to treat generalized anxiety disorder (GAD) reports recently stopping the medication after symptoms have improved but reports having feelings of panic and paranoia. Which initial action by the nurse is correct?

Ask the patient if the medication was stopped abruptly

A patient in her second trimester tells the nurse she is worried that a medication she took before knowing she was pregnant might have harmed the fetus. What will the nurse do?

Ask the patient what she took and when she learned she was pregnant.

7. A patient has been taking levothyroxine for several years and reports that "for the past 2 weeks, the drug doesn't seem to work as well as before." What will the nurse do?

Ask the patient when the prescription was last refilled

A patient has been receiving an antibiotic with a small therapeutic index for 10 days. Upon assessment, the nurse notes an increase in the drug's side effects. What would be the nurse's priority action?

Ask the prescriber to order a plasma drug level test

A child has been taking SD methylphenidate [Ritalin], 10 mg at 0800 and 1200 and 5 mg at 1600, for 2 months. The parents tell the nurse that the child sometimes misses the noon dose while at school. The child's appetite is normal. The teacher has reported a slight improvement in hyperactivity and impulsivity. What will the nurse do?

Ask the prescriber whether this child could be given methylphenidate (Concerta)

4. A patient with a history of lung transplantation is admitted for treatment for a respiratory infection. The patient has been taking cyclosporine [Sandimmune], prednisone, and azathioprine [Imuran] for 8 months. The provider has ordered azithromycin [Zithromax] to treat the infection and acetaminophen [Tylenol] as needed for fever. The nurse will contact the provider to:

Ask whether a different antibiotic can be used

A nurse is preparing to give an antibiotic to a patient who reports being allergic to antibiotics. Before giving the med, what will the nurse do?

Ask whether the patient has taken this antibiotic for other infections

1. Which two classes of antidysrhythmic drugs have nearly identical cardiac effects?

Beta blockers and calcium channel blockers

5. A patient with arthritis is admitted to the hospital. The patient's serum glucose level is 350 gm/dL, and the blood pressure is 182/98 mm Hg. The nurse notes that the patient's face appears rounded and puffy. The patient complains of feeling weak. What will the nurse do?

Ask which drugs the patient takes for arthritis

11. A child is to begin long-term glucocorticoid therapy. The parents ask the nurse about the effects of this drug on the child's growth. Which response by the nurse is correct?

Ask your provider about every other day dosing

A patient newly diagnosed with diabetes is to be discharged from the hospital. The nurse teaching the patient about home management should begin by doing what?

Asking the patient to demonstrate how to measure and administer insulin.

8. A nurse is discussing how beta blockers work to decrease blood pressure with a nursing student. Which statement by the student indicates a need for further teaching?

Beta blockers block the actions of angiotensin II

1. A patient arrives in the emergency department complaining of chest pain that has lasted longer than 1 hour and is unrelieved by nitroglycerin. The patient's electrocardiogram reveals elevation of the ST segment. Initial cardiac troponin levels are negative. The patient is receiving oxygen via nasal cannula. Which drug should be given immediately?

Aspirin 325 mg chewable

7. A nurse is giving aspirin to a patient during acute management of STEMI. The patient asks why a chewable tablet is given. Which response by the nurse is correct?

Aspirin is absorbed more quickly when it is chewed

8. A pregnant patient in her third trimester asks the nurse whether she can take aspirin for headaches. Which response by the nurse is correct?

Aspirin may cause premature closure of the ductus arteriosus in your baby

13. A patient is admitted to the hospital with unstable angina and will undergo a percutaneous coronary intervention. Which drug regimen will the nurse expect to administer to prevent thrombosis in this patient?

Aspirin, heparin, abciximbal (ReoPro)

8. A patient receiving menotropins [Repronex] for infertility comes to the clinic for evaluation on the ninth day of treatment. Her serum estrogen level is 200 pg/mL per maturing follicle. An ultrasound reveals that follicles have enlarged to 22 mm. The patient complains of left lower abdominal pain. What will the nurse do?

Assess for abdominal fullness and distention and auscultate lung sounds

14. A patient with heart failure who has been given digoxin [Lanoxin] daily for a week complains of nausea. Before giving the next dose, the nurse will:

Assess the HR and give the dose if the HR is greater than 60 beats per minute

A patient has allergies and takes an antihistamine. The patient wants to know how the drug works. The nurse understands that antihistamines work because they are what? a. Activators b. Agonists c. Antagonists d. Antidotes

Antagonists

Many medications list side effects that include dry mouth, constipation, and urinary retention. What kinds of effects are these?

Anticholinergic

4. A nurse is teaching a group of nursing students about antidysrhythmic medications. Which statement by a student indicates understanding of the teaching?

Antidysrhthmic drugs can cause new dysthythmias or worsen existing ones

1. A nursing student asks the nurse what differentiates antiestrogen drugs from aromatase inhibitors in the treatment of breast cancer. What is the correct response by the nurse?

Antiestrogen drugs increase the risk of endometrial cancer

A nurse is teaching a group of nursing students about antihistamines. Which statement by a student indicates an understanding of the mechanism of action of the antihistamines?

Antihistamines block H1 receptors to prevent actions of histamine at these sites

A pregnant patient asks the nurse if she can take antihistamines for seasonal allergies during her pregnancy. What will the nurse tell the patient?

Antihistamines should be avoided unless absolutely necessary

A 25-year-old patient has been newly diagnosed with Parkinson's disease, and the prescriber is considering using pramipexole [Mirapex]. Before beginning therapy with this drug, the nurse will ask the patient about:

Any history of alcohol abuse or compulsive behaviors

An infant who receives a drug that does not produce CNS side effects in adults exhibits drowsiness and sedation. The nurse understands that this is because of the differences in which physiologic system?

BBB

A patient with cerebral palsy has severe muscle spasticity and muscle weakness. The patient is unable to take anything by mouth. The nurse is correct to anticipate that which medication will be ordered for home therapy?

Baclofen (Lioresal)

A patient with multiple sclerosis needs pharmacologic treatment for spasticity to begin strengthening exercises to improve walking ability. The nurse anticipates that which medication will be ordered for spasticity?

Baclofen (Lioresal)

A patient with MG who is taking a cholinesterase inhibitor is being admitted to the ICU and is on mechanical ventilation. The prescriber has ordered a challenge dose of Edrophonium to distinguish between a myasthenic crisis and a medication overdose. The nurse will expect

Be prepared to administer atropine and O2 if muscle weakness increases.

A nurse and a nursing student are discussing the plan of care for a patient with schizophrenia. The patient, who has been taking a high-potency FGA for 2 months, has become restless and constantly needs to be in motion. Which statement by the student indicates a need for further education?

Because this may be an exacerbation of psychosis

9. A male patient with hepatitis C will begin triple drug therapy with pegylated interferon alfa 2a [Pegasys], ribavirin [Ribasphere], and boceprevir [Victrelis]. The patient tells the nurse that his wife is pregnant. What will the nurse tell him?

Becoprevir is contraindicated in males whose partners are pregnant

18. A patient who is taking drugs to treat HIV has tuberculosis and has been on a four-drug regimen for 3 months without improvement in symptoms. Which drug will the nurse anticipate that the provider will add to this patient's regimen?

Bedaquiline (Sirturo)

4. An infertile couple begins treatment with menotropins. To enhance the therapeutic effects of the medication, the nurse will advise the patients to have intercourse:

Before HCG injection and the following 2 to 3 days

7. A patient has a positive urine culture 1 week after completion of a 3-day course of antibiotics. The nurse anticipates that the prescriber will:

Begin a 2 week course of antibiotics

5. A patient with a history of renal calculi has fever, flank pain, and bacteriuria. The nurse caring for this patient understands that it is important for the provider to:

Begin antibiotic therapy after urine culture and sensitivity results are unavilable

9. A patient with cancer who is receiving chemotherapy develops a fever. The patient's chest radiograph is normal. The patient's neutrophil count is 750/mm3. The nurse expects the provider to:

Begin empiric therapy with IV antibiotics

14. An elderly patient who has type 2 diabetes has a history of severe hypoglycemia. The patient's spouse asks the nurse what the optimum A1c level is for the patient. Which is correct?

Below 8.0

A nurse is discussing the use of benzodiazepines as sedative-hypnotic agents with a group of nursing students. A student asks about the actions of these drugs in the central nervous system. The nurse makes which correct statement?

Benzodiazepines affect the hippocampus and the cerebral cortex to cause anterograde amnesia

An agitated, extremely anxious patient is brought to the emergency department. The prescriber orders a benzodiazepine. The nurse understands that benzodiazepines are used in this clinical situation based on which principle?

Benzodiazepines have a rapid onset of action

8. A nurse is explaining congenital adrenal hyperplasia (CAH) to a group of nursing students. Which statement by a student indicates understanding of the teaching?

CAH is the result of an inability to synthesize glucocorticoids

Which cephalosporin may be used to treat meningitis

Cefotaxime

11. A patient has a skin infection and the culture reveals methicillin-resistant Staphylococcus aureus (MRSA). What is an appropriate treatment for this patient?

Ceftaroline

5. An adolescent patient with mild cervicitis is diagnosed with gonorrhea. The nurse will expect the provider to order which drug(s)?

Ceftriaxone (Rocephin), 250mg IM once, and azithromycin (Zithromax), 1 gm PO once

1. A nursing student asks about the differences between cell-cycle phase-specific chemotherapeutic agents and those that are cell-cycle phase nonspecific. What will the nurse explain?

Cell cycle phase specific drugs do not harm "resting' cells

12. A nurse is explaining to nursing students why a cephalosporin is used in conjunction with an aminoglycoside for a patient with an infection. Which statement by a student indicates understanding of the teaching?

Cephalosporins enhance the actions of aminoglycosides by weakening bacterial cell walls

4. A nurse is teaching a nursing student what is meant by "generations" of cephalosporins. Which statement by the student indicates understanding of the teaching?

Cephalosporins have increased activity against gram negative bacteria with each generation

A 5-year-old child with seasonal allergies has been taking 2.5 mL of cetirizine [Zyrtec] syrup once daily. The parents tell the nurse that the child does not like the syrup, and they do not think that the drug is effective. The nurse will suggest they discuss which drug with their child's healthcare provider?

Cetirizine (Zyrtec) 5 mg chewable tablet once daily

4. A patient has been experiencing side effects with a combination oral contraceptive, and her provider has ordered a different combination product. The nurse will instruct the patient to do what?

Change products at the beginning of her next cycle

3. A patient is receiving intravenous vincristine [Oncovin]. The patient complains of pain at the IV insertion site. The nurse examines the site and notes an area of erythema and edema. What will the nurse do?

Change the IV site and notify the provider of the extravasation

11. A 1-year-old child with cretinism has been receiving 8 mcg/kg/day of levothyroxine [Synthroid]. The child comes to the clinic for a well-child checkup. The nurse will expect the provider to:

Change the dose of levothyroxine to 6 mcg/kg/day

3. A patient newly diagnosed with PUD reports taking low-dose aspirin (ASA) for prevention of cardiovascular disease. The nurse learns that the patient drinks 2 to 3 cups of coffee each day and has a glass of wine with dinner 3 or 4 nights per week. The patient eats three meals a day. The nurse will counsel this patient to:

Change the meal pattern to five or six small meals per day

A psychiatric nurse is teaching a patient about an antidepressant medication. The nurse tells the patient that therapeutic effects may not occur for several weeks. The nurse understands that this is likely the result of

Changes in the brain as a result of prolonged drug exposure

6. A patient will begin taking tamoxifen [Nolvadex] to treat breast cancer. The nurse performs a medication history and learns that the patient is taking sertraline [Zoloft] for depression. The nurse will tell the patient to contact her provider to ask about:

Changing from sertraline to escitalopram (lexapro)

A patient with moderate to severe chronic pain has been taking oxycodone [OxyContin] 60 mg every 6 hours PRN for several months and tells the nurse that the medication is not as effective as before. The patient asks if something stronger can be taken. The nurse will contact the provider to discuss:

Changing the medication to a continued-release preparation

18. A patient has been taking digoxin [Lanoxin] 0.25 mg, and furosemide [Lasix] 40 mg, daily. Upon routine assessment by the nurse, the patient states, "I see yellow halos around the lights." The nurse should perform which action based on this assessment?

Check the patient for other symptoms of digitalis toxicity

11. A nurse prepares to administer a scheduled dose of digoxin. The nurse finds a new laboratory report showing a plasma digoxin level of 0.7 ng/mL. What action should the nurse take?

Check the patient's apical pulse, and if it is within a safe range, administer the digoxin

3. A patient with hemophilia B is admitted to the hospital for surgery. The patient's history reveals long-term use of factor replacement as prophylaxis for bleeding episodes. The nurse anticipates that the provider will order which medication to prevent excessive perioperative bleeding?

Tranexamic acid

7. A patient with hemophilia A is undergoing a tooth extraction at the dentist's office. As an adjunct to factor VIII, what other drug should the nurse anticipate being ordered for this patient?

Tranexamic acid (Cyklokapron)

1. A 50-year-old postmenopausal patient who has had a hysterectomy has moderate to severe vasomotor symptoms and is discussing estrogen therapy (ET) with the nurse. The patient is concerned about adverse effects of ET. The nurse will tell her that:

Transdermal preparations have fewer side effects

6. A nurse explains to a patient with cancer why it is difficult to achieve 100% cell kill to cure cancer with chemotherapy. Which statement by the patient indicates a need for further teaching?

The immune system attacks chemotherapeutic agents and renders them important

4. A nurse provides teaching for a patient with cytomegalovirus (CMV) retinitis who will receive the ganciclovir ocular implant [Vitrasert]. Which statement by the patient indicates a need for further teaching?

The implant will remain in place permanently

Based on changes in hepatic function in older adult patients, which adjustment should the nurse expect for oral medications that undergo extensive first-pass metabolism?

The interval between doses should be increased

The nurse is teaching a group of nursing students about adherence to medication in older adults. Which statement by the student indicates understanding?

The majority of older patients who do not adhere to drug regimens do so intentionally.

A patient will begin taking fexofenadine [Allegra] for hay fever. The nurse teaching this patient will tell the patient that:

The medication may be taken once or twice daily

4. A patient taking stavudine [Zerit] telephones the clinic and reports numbness and tingling in the hands and feet. What should the nurse tell the patient?

The medication will probably be stopped, the patient should come into the clinic for further education

17. A postmenopausal woman will begin taking atorvastatin [Lipitor] to treat hypercholesterolemia. The woman reports a history of osteopenia with a family risk of osteoporosis. What will the nurse include when teaching this patient?

The need to discuss taking a biphosphorate medication with her provider

A patient with rheumatoid arthritis is taking leflunomide [Arava] and an oral contraceptive. She tells the nurse she would like to get pregnant. What will the nurse tell her?

To ask her provider about an 11 day course of cholestyramine

A prescriber orders transdermal clonidine [Catapres TTS] for a patient with hypertension. What will the nurse teach this patient? a. That medication given by transdermal patch has fewer systemic side effects b. That localized skin reactions are uncommon c. To apply the patch to intact skin on the forearm or leg d. To change the patch every week

To change the patch every week

A nursing students asks a nurse about pharmaceutical research and wants to know the purpose of randomization in drug trials. The nurse explains that the randomization is used to do what?

To ensure that differences in outcomes are the result of the treatment and not differences in subjects.

A patient taking an MAOI is seen in the clinic with a blood pressure of 170/96 mm Hg. What will the nurse ask this patient?

To list all foods eaten that day

To prevent yellow or brown discoloration of teeth in children tetracyclines should not be given

To pregnant patients after the fourth month of gestation

A patient who will undergo electroconvulsive therapy to treat severe depression will be given succinylcholine just prior to the procedure. When teaching the patient about the procedure the nurse will explain that the succinylcholine is given for what purpose?

To prevent harm caused by electroshock-induced convulsions

15. A college student admits frequent use of LSD to a nurse and reports plans to stop using it. What will the nurse tell this student?

Tolerance to the effects of LSD will fade quickly once use of the drug has stopped

10. A clinic patient who has cirrhosis of the liver develops hypervolemic hypernatremia. Which medication will the nurse expect the provider to order?

Tolvaptan (Samsca)

A patient shows loss of consciousness, jaw clenching, contraction and relaxation of muscle groups, and periods of cyanosis. The nurse correctly identifies this as which type of seizure?

Tonic-clonic

3. A 7-year-old child who is otherwise healthy is receiving mecasermin [Increlex] replacement therapy to treat severe primary deficiency of insulin-like growth factor-1 (IGF-1). The child develops tonsillar hypertrophy. The nurse anticipates that the provider will recommend:

Tonsillectomy

A patient who has a history of asthma experiences three or four migraine headaches each month. The patient uses sumatriptan [Imitrex] as an abortive medication and has developed medication overuse headaches. The patient asks the nurse what can be done to prevent migraines. The nurse will suggest that the patient discuss which preventive medication with the provider?

Topiramate (Topamax)

11. A patient is in the intensive care unit after a myocardial infarction. The nurse notes that the QT interval on this patient's electrocardiogram has been elongating. The nurse is concerned that which cardiac dysrhythmia may occur?

Torsades de pointes

9. An adolescent male patient is beginning androgen therapy for delayed puberty. His parents ask the nurse when this treatment may be stopped. The nurse will offer which response?

When testicular enlargement occurs

2. A nurse is discussing heart failure with a group of nursing students. Which statement by a student reflects an understanding of how compensatory mechanisms can compound existing problems in patients with heart failure?

When the heart rate increases to increase cardiac output, it can prevent adequate filling of the ventricles

A hospitalized patient who is given one dose of flurazepam continues to show drowsiness the next day. A nursing student asks the nurse the reason for this, because the drug's half-life is only 2 to 3 hours. Which response by the nurse is correct?

When this drug is metabolized, the resulting compound has longer-lasting effects

A patient tells the nurse that the oral drug that has been prescribed has caused a lot of stomach discomfort in the past. what will the nurse ask the prescriber?

Whether an enteric-coated form of the drug is available

3. A patient was given a 30-day supply of Feosol and has been taking the drug for 4 weeks for iron deficiency anemia. The patient's initial hemoglobin was 8.9 gm/dL. The nurse notes that the hemoglobin has risen to 9.7 gm/dL. What will the nurse ask the patient about?

Whether the prescription needs to be refilled

A psychiatric nurse is caring for a drug-addicted patient. The nurse knows that the ideal goal of drug rehabilitation for this patient is:

abstinence from the drug.

A first-time parent of a 6-week-old infant tells the nurse that she feels anxious and sad, cries a lot, and has difficulty sleeping. What will the nurse do?

ask her to complete the Edinburgh Postnatal Depression Scale

A patient receives a neuromuscular blocking agent before a procedure. The patient's eyes close. The nurse knows this is a sign the patient is?

beginning to feel the drug's effects

Because they cause vasoconstriction, alpha 1 -adrenergic agonists are especially useful for:

causing hemostasis in skin and mucuous membranes

A prescriber orders sumatriptan [Imitrex] for a patient for a migraine headache. Before administration of this drug, it would be most important for the nurse to assess whether the patient:

has taken ergotamine in the past 24 hours

A child is diagnosed with absence seizures, and the prescriber orders ethosuximide [Zarontin]. When teaching the child's parents about dosage adjustments for this drug, the nurse will stress the importance of:

recording the number of seizures the child has each day

7. These patients are receiving chemotherapy. Which patient should the nurse see first?

the patient with a fever of 100.3 F

13. A provider has ordered oral voriconazole [Vfend] for a patient who has a systemic fungal infection. The nurse obtains a medication history and learns that the patient takes phenobarbital for seizures. The nurse will contact the provider to discuss which possibility?

using a different antifungal agent

A patient who has been taking a medication with a side effect of drowsiness stops taking the medication after several weeks. The patient reports feeling anxious and jittery. The nurse understands that this response is due to:

withdrawal syndrome.