Pharmacology

A client receives a prescription for an oral opioid analgesic for post-operative pain. Which adverse effect should the practical nurse (PN) monitor for with the client? A) Constipation. B) Photosensitivity. C) Decreased heart rate. D) Frequent urination.

A) Constipation. Feedback: Opioid analgesics slow peristalsis, which leads to constipation (A), a common side effect of opiates. (B, C, and D) are not associated with opioid analgesics.

A postoperative patient is given an epidural infusion of morphine sulfate (Roxanol). The patient's respiratory rate decreases to 8 breaths/min. Which medication will the nurse expect to be prescribed to the patient? 1. Naloxone (Narcan) 2. Acetylcysteine (Mucomyst) 3. Methylprednisolone (Solu-Medrol) 4. Protamine sulfate (Protamine sulfate)

1. Naloxone (Narcan) Rationale: A respiratory rate of 8 breaths/min indicates respiratory depression. Naloxone (Narcan) is a narcotic antagonist that will reverse this effect of morphine sulfate. Acetylcysteine (Mucomyst) is used for acetaminophen toxicity. Methylprednisolone (Solu-Medrol) is administered to alleviate cytokine release syndrome caused by basiliximab (Simulect) and daclizumab (Zenapax), which are used to prevent rejection of transplanted kidneys. Protamine sulfate is used to reverse the drug effects of heparin.

Which medication is used to treat a patient experiencing severe adverse effects of an opioid analgesic? 1. Naloxone (Narcan) 2. Acetylcysteine (Mucomyst) 3. Methylprednisolone (Solu-Medrol) 4. Flumazenil (Romazicon)

1. Naloxone (Narcan) Rationale: Naloxone is the opioid antagonist that will reverse the effects, both adverse and therapeutic, of opioid analgesics. Acetylcysteine is the antidote for acetaminophen overdose. Methylprednisolone is a glucocorticoid that is used as an antiinflammatory. Flumazenil, a benzodiazepine antidote, can be used to acutely reverse the sedative effects of benzodiazepines.

When assessing for the most serious adverse reaction to an opioid analgesic, what does the nurse monitor for in the patient? 1. Respiratory rate 2. Heart rate 3. Blood pressure 4. Mental status

1. Respiratory rate Rationale: The most serious side effect of opioid analgesics is respiratory depression. When death occurs from opioid overdose, it is almost always due to respiratory depression. Opioids can also cause hypotension, bradycardia, and disorientation, but respiratory depression is the most important adverse effect for which the nurse should assess.

The nurse is preparing to administer an injection of morphine to a patient. Assessment notes a respiratory rate of 10 breaths/min. Which action will the nurse perform? 1. Administer a smaller dose and record the findings. 2. Notify the health care provider and delay drug administration. 3. Administer the prescribed dose and notify the health care provider. 4. Hold the drug, record the assessment, and recheck in 1 hour.

2. Notify the health care provider and delay drug administration. Rationale: Respiratory depression is a side effect of opioid analgesia. Therefore because the patient's respiratory rate is below normal, the nurse should withhold the morphine and notify the health care provider. Test-Taking Tip: If the question asks for an immediate action or response, all the answers may be correct, so base your selection on identified priorities for action.

A patient diagnosed with cholecystitis reports pain in the back and scapular areas. What does the nurse infer about the type of pain from the assessment? 1. The patient has vascular pain. 2. The patient has referred pain. 3. The patient has neuropathic pain. 4. The patient has phantom pain.

2. The patient has referred pain. Rationale: Patients with cholecystitis may report back pain and scapular pain. The signal for pain that is sent from the gallbladder to the spinal cord can get mixed up with signals from the back and scapular areas. Therefore, the brain receives a signal about back pain and scapular pain. It occurs due to misinterpretation of signals by the nervous system. This type of pain is called referred pain. Referred pain occurs when visceral nerve fibers synapse at a level in the spinal cord close to fibers that supply specific subcutaneous tissues in the body. Vascular pain originates from the vascular or perivascular tissues. Phantom pain is associated with the area of a body part that has been removed surgically or traumatically. Neuropathic pain results from damage to peripheral or central nervous system nerve fibers by disease or injury.

What is the primary indication for the administration of morphine (Roxanol)? 1. To diminish feelings of anxiety 2. To relieve acute and chronic pain 3. To induce a state of unconsciousness 4. To treat ischemic pain

2. To relieve acute and chronic pain Rationale: The principal indication for morphine is the relief of moderate to severe pain, including postoperative pain and cancer pain. In addition, morphine is used during acute myocardial infarction to relieve pain, anxiety, and dypsnea and to promote relaxation of vascular smooth muscle. Morphine may also be administered before surgery for sedation. The primary indication for morphine administration, however, is to relieve acute and chronic pain. Nitroglycerin (Nitrostat) is used to treat ischemic pain.

The nurse is assessing a patient who underwent surgery and is prescribed oxycodone (Dazidox). The patient complains of constipation. Which medicine does the nurse expect in the health care provider's prescription? 1. Naloxone (Narcan) 2. Meperidine (Demerol) 3. Polyethylene glycol (Miralax) 4. Tapentadol (Nucynta)

3. Polyethylene glycol (Miralax) Rationale: The patient is prescribed oxycodone (Dazidox) for pain management due to surgery. Oxycodone (Dazidox) is an opioid drug, which may decrease peristalsis because of its depressive effect on the central and peripheral nervous system, resulting in constipation. Therefore, stool softeners such as polyethylene glycol (Miralax) should be prescribed to the patient. Naloxone (Narcan) is an opioid antagonist and used in opioid toxicity. It may not completely relieve constipation in the patient. Meperidine (Demerol) is an opioid drug and not helpful for the management of constipation. Tapentadol (Nucynta) is an opioid drug and is used for pain management. It is not useful for the management of constipation.

The nurse cares for a patient on the second day following a major abdominal surgery. The patient is given patient-controlled analgesia (PCA) morphine, and the current pain rating is 2 on a scale of 10. The patient tearfully says to the nurse, "I'm so worried that I won't be able to go back to work. How am I going to manage my bills?" What is the best response by the nurse? 1. "Everything will be fine. You will be back to work in about 6 weeks." 2. "The disability benefit of your insurance plan will help pay your bills." 3. "Your pain is well controlled now. Why are you feeling so worried?" 4. "Tell me more about your worried feelings and your fears."

4. "Tell me more about your worried feelings and your fears." Rationale: Anxiety exacerbates the pain experience. By demonstrating caring and concern and using therapeutic communication skills such as active listening and open-ended questions, the patient's anxiety can be relieved. Asking the patient to speak about feelings of worry may help the patient feel better. Telling the patient that it will take only 6 weeks to get well may be a false reassurance because it may take longer for the patient to recover. Telling the patient that the insurance plan will help to pay bills will not completely alleviate the patient's anxiety. Telling the patient that the pain is in control and not to worry is showing a lack of concern for the patient's feelings.

The nurse will advise a patient receiving opioid analgesics for chronic pain to perform which action to minimize the gastrointestinal (GI) side effects? 1. Take Lomotil with each dose. 2. Eat foods high in lactobacilli. 3. Take the medication on an empty stomach. 4. Increase fluid and fiber in the diet.

4. Increase fluid and fiber in the diet. Rationale: Opioid analgesics decrease intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can prevent constipation. Diphenoxylate/atropine (Lomotil) is an antidiarrheal preparation that will further decrease GI motility. The nurse should advise the patient to take the opioid with meals, not on an empty stomach, to decrease GI side effects.

The nurse prepares to administer morphine sulfate (Roxanol) 5 mg intravenous (IV) to a patient who underwent surgery 30 minutes earlier. What is the most important reason for the nurse to record baseline vital signs before administering this drug? 1. Morphine sulfate (Roxanol) causes the release of histamines. 2. Morphine sulfate (Roxanol) reduces the level of consciousness. 3. Morphine sulfate (Roxanol) dilates vascular smooth muscle. 4. Morphine sulfate (Roxanol) depresses the respiratory center.

4. Morphine sulfate (Roxanol) depresses the respiratory center. Rationale: Respiratory depression is the most important reason that the nurse records baseline vital signs before administering the morphine IV. Opioid analgesics can cause respiratory depression and death when administered in standard dosages and in an overdose, respectively. Because this patient is in the immediate postoperative period and is likely to experience residual effects of anesthesia, including an inability to maintain an airway and respiratory depression, the risk for respiratory depression is high. The patient is also at risk because the IV route of administration is used. IV administration of an opioid means that the onset of action occurs quickly, the peak drug level occurs more quickly, and the risk of respiratory depression increases as a result of a generally high plasma drug concentrations. The nurse records baseline data for comparison to vital signs taken 15 minutes after IV administration of morphine to determine whether the patient is experiencing adverse effects of therapy. Morphine dilates vascular smooth muscle, releases histamines, and causes sedation; however, airway and breathing issues are more important. Death following overdose is almost always a result of respiratory arrest.

Dietary trays usually arrive on the hospital unit at 7:30 AM. When should the practical nurse (PN) plan to administer NPH insulin 40 units subcutaneously to a client with diabetes mellitus? A) 6:30 and 7:00 AM. B) 7:00 and 7:30 AM. C) 7:30 and 8:00 AM. D) 8:00 and 8:30 AM.

A) 6:30 and 7:00 AM. Feedback: NPH, an intermediate-acting insulin, should be given 30 to 60 minutes (A) before the arrival of breakfast trays at 7:30 AM. (B, C, and D) delay the action of NPH.

Which serum laboratory result should the practical nurse (PN) monitor for the effectiveness of lactulose (Cephulac)? A) Ammonia. B) Potassium. C) Uric acid. D) Triglycerides.

A) Ammonia. Feedback: Lactulose reduces blood ammonia (A) levels to improve mental status of a client with hepatic encephalopathy resulting from cirrhosis or other liver problems. Changes in (B, C, and D) do not evaluate the therapeutic response of lactulose.

The healthcare provider prescribes an antibiotic for a male adolescent with an upper respiratory tract infection who asks the practical nurse (PN) how long the prescribed antibiotics should be taken. What information should the PN provide? A) Continue the medication until all of the prescription is taken. B) Use the medication for 24 hours after the cough subsides. C) Stop the medication when the temperature returns to normal. D) Take any remaining capsules if the infection occurs again.

A) Continue the medication until all of the prescription is taken. Feedback: Although the client may feel better after 24 hours of antibiotics, the prescription (A) should be taken until all of it is used. If the antibiotic is discontinued because symptoms have disappeared (B and C), pathogens have an opportunity to increase in virulence or become resistant to the drug. Antibiotics should not be saved (D) for other infections, but new symptoms should be evaluated by the healthcare provider.

A client with Attention Deficit Disorder (ADD) is prescribed amphetamine (Adderall). Which side effect should the practical nurse (PN) explain is commonly experienced? A) Difficulty sleeping. B) Increased fatigue. C) Improved appetite. D) Decreased heart rate.

A) Difficulty sleeping. Feedback: Adderall is a central nervous system stimulant, which often causes the client to experience difficulty sleeping (A). Due to central nervous stimulation, Adderall causes an increase in energy, a decrease in appetite, and an increase in heart rate, not (B, C, and D).

A male client diagnosed with tuberculosis asks the practical nurse (PN) about his course of drug therapy. Which information should the PN provide? A) Drug therapy requires compliance for 6 to 12 months. B) Medication is stopped when clinical symptoms subside. C) To prevent reactivation, drug therapy is maintained for life. D) To prevent resistance and side effects, drugs are changed.

A) Drug therapy requires compliance for 6 to 12 months. Feedback: Antitubercular drug therapy is prescribed for 6 to 12 months, which requires continuous compliance to prevent resistance of the tubercle bacillus, to ensure encapsulation, and prevent reactivation. Drug therapy continues until sputum tests are negative for the tubercle bacillus, and the client is no longer infectious to others, not (B). (C) is inaccurate. Although antibiotics used in antitubercular drug protocols may be changed throughout the course of therapy (D), strict compliance for the duration of therapy is vital in preventing reinfection and spread to others.

A client who received succinylcholine (Anectine), a neuromuscular blocking agent, during a surgical procedure returns to the postoperative unit and is complaining of thirst and wants to drink something. What assessment is most important for the practical nurse (PN) to check before giving oral liquids? A) Gag and swallow reflexes. B) Appetite and interest in food. C) Sensation and movement of all limbs. D) Ability to breathe deeply on command.

A) Gag and swallow reflexes. Feedback: Anectine, a neuromuscular blocking agent, paralyzes musculoskeletal muscles and the gag reflex. To reduce the possibility of aspiration, the PN should confirm the return of the client's gag and swallow reflexes (A) before allowing intake of food or liquids. (B, C, and D) should be assessed but do not have the priority of initiating oral intake post-anesthesia.

An older client who takes risperidone (Risperdal), an antipsychotic, is complaining of constipation. Which dietary changes should the practical nurse (PN) recommend? A) Increase daily green vegetables and bran. B) Take a laxative and stool softener daily. C) Eat liver and turnips once a week. D) Use a retention enema every four days.

A) Increase daily green vegetables and bran. Feedback: Constipation, a side effect of antipsychotics, is managed by encouraging the client to drink additional water and increase dietary roughage, such as bran and green vegetables daily (A). (B, C, and D) are not routine recommendations for constipation.

The practical nurse (PN) is unable to arouse a client who is receiving meperidine (Demerol) for postoperative pain. The client is stuporous, has constricted pupils, and a respiratory rate of 8 breaths/minute. Which PRN prescription should the PN give the client? A) Naloxone (Narcan). B) Promethazine (Phenergan). C) Metoclopramide (Reglan). D) Bethanechol (Urecholine).

A) Naloxone (Narcan). Feedback: Narcan (A) is an opioid antagonist and should be administered to reverse the effects of a Demerol, an opioid, overdose. (B, C, and D) are common postoperative PRN prescriptions but are not indicated for narcotic overdose.

A client with gastroesophageal reflux disease (GERD) is having symptoms of reflux despite taking omeprazole (Prilosec) 20 mg daily. What action should the practical nurse (PN) implement? A) Notify the healthcare provider about the symptoms. B) Obtain vital signs every 30 minutes until symptoms are alleviated. C) Instruct the client to stop taking the medication. D) Tell the client to take an antacid in addition to the omeprazole.

A) Notify the healthcare provider about the symptoms. Feedback: Omeprazole, a proton pump inhibitor, acts to reduce gastric acid secretion. If once daily dosing fails to control the client's symptoms, the healthcare provider should be notified (A) for dose adjustment. (B) will not help to reduce the client's symptoms. Unless the client shows symptoms of a hypersensitivity to the medication, the client should not stop the medication (C). (D) should not suggested without a prescription from the healthcare provider.

The practical nurse asks a male client who came to the clinic with an upper respiratory infection if he has any drug allergies. The client cannot remember if he does or if he ever received penicillin. After administering the injection of penicillin, the PN tells the client to stay for 30 minutes of observation. Which finding should the PN identify that is indicative of a reaction to the medication? A) Rash, itching, and hives. B) Fever and abdominal pain. C) Drop in temperature and blood pressure. D) A vasovagal response with bradycardia.

A) Rash, itching, and hives. Feedback: A client who is unsure about the response to a new antibiotic, especially penicillin, should be assessed for allergy to the drug after receiving a parenteral dose. The symptoms that indicate an allergic reaction include rash, itching, hives (A) and anaphylactic reactions causing laryngeal edema with difficulty breathing. (B, C, and D) are not typical of allergic responses to penicillin.

A client who returns from surgery for bowel resection complains of severe pain around the incision. Which assessment is most important for the practical nurse (PN) to obtain prior to the administration of morphine sulfate? A) Rate of respirations. B) Core temperature. C) Appearance of the incision. D) Presence of bowel sounds.

A) Rate of respirations. Feedback: Opioids cause respiratory depression, so the respiratory rate (A) should be assessed prior to administration of morphine sulfate. (B, C, and D) do not address the concept of medication safety.

A male client who is hypertensive is starting a new prescription for clonidine (Catapress) 0.4 mg PO daily. In reviewing common side effects, what information should the practical nurse (PN) provide the client? A) Report problems with sexual function. B) Monitor respirations on a daily basis. C) Increased libido may be experienced. D) Weight gain may indicate fluid retention.

A) Report problems with sexual function. Feedback: Sexual dysfunction (A), such as impotence and decreased libido, is a common complication of antihypertensive medications in male clients. Respiratory changes (B), increased libido (C), and increased weight (D) do not commonly occur with this antihypertensive.

The practical nurse (PN) should recommend that oral contraceptives be avoided in which group of women? A) Women who smoke. B) Multigravidous women. C) Monogamous women. D) Women with an intrauterine device.

A) Women who smoke. Feedback: Oral contraceptives pose an increased risk of thromboembolism for women who smoke (A), and this risk is not increased in (B, C, and D).

Which International Normalized Ratio (INR) value indicates that warfarin (Coumadin) therapy is at a therapeutic range? A) 1.0 to 2.0 B) 2.1 to 3.0 C) 3.1 to 4.0 D) 4.1 to 5.0

B) 2.1 to 3.0 Feedback: Warfarin dosage for therapeutic anticoagulation is adjusted to target a client's INR range between 2 to 3 (B). (A, C, and D) are outside the narrow therapeutic range.

Which prescription should the practical nurse administer for a client who is experiencing an acute episode of bronchial asthma? A) Nedocromil (Tilade). B) Albuterol (Proventil). C) Zafirlukast (Accolate). D) Triamcinolone (Azmacort).

B) Albuterol (Proventil). Feedback: Albuterol (Proventil) (B), an adrenergic agonist, is the first line of treatment for acute episodes of bronchial asthma. (A, C, and D) are maintenance medications used in the prevention of asthmatic episodes and are routinely taken every day, not during an acute episode.

Which instruction should the practical nurse (PN) reinforce with a client who is taking disulfiram (Antabuse)? A) Cigarette smoking cessation program should be started. B) Avoid using any over-the-counter substances containing alcohol. C) This drug is similar to alcohol but without euphoric effects. D) Small amounts of mouthwash or cough medicine can be used.

B) Avoid using any over-the-counter substances containing alcohol. Feedback: The use of disulfiram (Antabuse) with over-the-counter (OTC) products that contain alcohol causes severe adverse reactions, such as severe nausea, vomiting, chest pain, hyperventilation, tachycardia, seizures, and cardiovascular collapse, and should be avoided (B). Although a smoking cessation program is always a good health recommendation (A), it is not a priority with Antabuse. (C) is inaccurate. Small amounts, as little as 7 ml, of mouthwash or cough syrup that contains alcohol can precipitate a disulfiram reaction and should not be used (D).

The practical nurse (PN) discusses antihypertensive drug therapy with several clients diagnosed with high blood pressure. To improve client understanding, the PN should emphasize that which medication preserves renal function in a client with diabetes? A) Verapamil (Calan). B) Captopril (Capoten). C) Clonidine (Catapres). D) Nifedipine (Procardia).

B) Captopril (Capoten). Feedback: Hypertension contributes to diabetic nephropathy, and angiotensin converting enzyme (ACE) inhibitors, such as captopril (B), slow progression of renal damage for clients with diabetes by reducing blood pressure, contributing to blood sugar control by increasing the body's sensitivity to insulin, and moving glucose from the bloodstream into cells. Verapamil (A), nifedipine (D), and clonidine (C) are used the treatment of hypertension, but do not provide the same effects on blood glucose as captopril does for clients with diabetes.

The practical nurse (PN) is reinforcing teaching for a client who is receiving diltiazem (Cardizem), a calcium channel blocker. Which drug action should the practical nurse explain? A) Increased force of contraction. B) Decreased rate of contraction. C) Decreased peripheral resistance. D) Increased speed of conduction.

B) Decreased rate of contraction. Feedback: Calcium-channel blockers decrease cardiac contractility (inotropy), atrioventricular-node conduction (dromotropy), and heart rate (chronotropy) (B). (A, C, and D) are not pharmacotherapeutic actions for Cardizem.

Which prescription should the practical nurse (PN) administer for a client who is experiencing an anaphylactic reaction to an antibiotic? A) Ephedra (ma-huang). B) Epinephrine (Adrenalin). C) Phenylephrin (Neo-Synephrine). D) Fexofenadine with pseudoephedrine (Allegra D).

B) Epinephrine (Adrenalin). Feedback: Epinephrine (Adrenalin), a potent sympathomimetic, is the drug of choice for the treatment of anaphylaxis (B). (A, C, and D) are not used for an acute immunololgical dysfunction that causes cardiovascular effects.

An older adult client receives a prescription for hydrochlorothiazide (HydroDIURIL), a thiazide diuretic for the treatment of heart failure. Which side effect(s) should the practical nurse reinforce with the client? (Select all that apply.) A) Constipation. B) Fatigue. C) Edema. D) Nausea. E) Dehydration. F) Blurred vision.

B) Fatigue. E) Dehydration. Feedback: Hydrochlorothiazide (HydroDIURIL), a thiazide diuretic, reduces blood pressure by reducing blood volume and reducing arterial resistance. Adverse effects of thiazides include hypokalemia, fatigue (B), dehydration (E), hyperglycemia, and hyperuricemia. Although (A, C, D and F) may be associated with aging or other pathology, they are not side effects commonly associated with HydroDIURIL.

Which adverse effect should the practical nurse monitor for in a client who is taking amikacin (Amikin)? A) Irritability. B) Constipation. C) Hearing loss. D) Insomnia.

C) Hearing loss. Feedback: Adverse effects associated with aminoglycoside antibiotics, such as amikacin, are nephrotoxicity and ototoxicity, so the client should be monitored for hearing loss (C). (A, B, and D) are not associated with amikacin.

A female client with recurring headaches tells the practical nurse (PN) that she has been taking at least 4 grams of acetaminophen a day. Which laboratory studies should the PN review for this client? A) Creatinine clearance. B) Hepatic enzymes. C) Coagulation values. D) Arterial blood gases.

B) Hepatic enzymes. Feedback: Liver toxicity can occur when doses of acetaminophen exceed 4 grams a day, resulting in an elevation in hepatic enzyme values (B). (A, C, and D) do not reveal findings related to acetaminophen toxicity.

A client who is receiving an antibiotic suddenly develops hives. The practical nurse should report that the client is most likely experiencing which type of drug response? A) Adverse response. B) Hypersensitivity reaction. C) Idiosyncratic reaction. D) Multiple drug interaction.

B) Hypersensitivity reaction. Feedback: Hives, a symptom of a hypersensitivity reaction (B), involve an abnormal immune response and are not uncommon with the use of antibiotics. Although (A, C, and D) are unexpected pharmacologic reactions, hives represent a life-threatening allergic response and should be reported to ensure prompt intervention.

Which client statement indicates to the practical nurse (PN) that a client understands discharge instructions about a new prescription for digoxin (Lanoxin)? A) I should double the dose if one is missed. B) I will take my pulse for one minute every day. C) I should take an antacid to minimize stomach upset. D) I will alternate my dose between morning and afternoon.

B) I will take my pulse for one minute every day. Feedback: The client is conveying understanding of the use of Lanoxin by the statement that daily pulse rates should be taken for a full one minute (B), which provides information about possible drug toxicity. (A, C, and D) are inaccurate.

The practical nurse (PN) is caring for a client who is receiving dexamethasone (Decadron) after abdominal surgery. Which finding should the PN report to the charge nurse? A) Weight loss. B) Impaired healing. C) Bradycardia. D) Hyperkalemia.

B) Impaired healing. Feedback: Glucocorticoids, such as Decadron, are used in the treatment of allergic, inflammatory, and debilitating conditions. A common side of exogenous corticosteroid therapy is hyperglycemia and delayed wound healing (B). (A, C, and D) are side effects not associated with the administration of Decadron.

A client receives a prescription for clotrimazole 1% (Gyne-Lotrimin) vaginal cream for Candidiasis. Which information should the practical nurse provide the client? A) Discontinue medication if menstruation begins. B) Instill cream using the intravaginal applicator each night for 7 days. C) Use daily douching as part of the treatment for vaginal yeast infections. D) Abstain from sexual intercourse until treatment is completed.

B) Instill cream using the intravaginal applicator each night for 7 days. Feedback: The intravaginal cream should be instilled each night for 7 days to complete the medication (B) even if symptoms are relieved. Medication should be continued until it is completed, even during menstruation (A). Douching (C) is contraindicated. Abstinence (D) is not required.

The practical nurse (PN) should emphasize the importance of monitoring for which side effect(s) in a client who takes a daily antilipemic agent? A) Photosensitivity. B) Liver dysfunction. C) Upper respiratory infections (URI). D) Water soluble vitamin deficiencies.

B) Liver dysfunction. Feedback: Antilipemic agents (lipid-regulating agents) are metabolized by the liver and require regular monitoring of liver function studies for hepatic dysfunction (B). Photosensitivity (A), URI (C), and vitamin deficiencies (D) are not side-effects of antilipemics.

A client who is comatose is admitted after an overdose of baclofen (Lioresal). What nursing action should the practical nurse (PN) implement? A) Provide continuous telemetry monitoring. B) Monitor for signs of respiratory arrest. C) Administer prescribed naloxone (Narcan). D) Keep a dose of diazepam at the bedside.

B) Monitor for signs of respiratory arrest. Feedback: An overdose of baclofen (Lioresal), a centrally acting muscle relaxant, can cause coma and respiratory depression that requires respiratory support. Monitoring for early signs of respiratory arrest (B) is most important so immediate respiratory resuscitation can be provided. Although telemetry (A) provides close cardiac monitoring, early recognition of respiratory arrest is indicated due to the actions of Lioresal. Narcan (C) is ineffective for baclofen overdose. (D) is not indicated.

The practical nurse (PN) is caring for a client who has been taking prednisone (Deltasone) daily for a year. Which adverse effect should the PN document in the client's record? A) Photosensitvity. B) Weight gain. C) Loss of hair. D) Pale skin color.

B) Weight gain. Feedback: Long term use of prednisone causes fluid retention and redistribution of fat deposition. Weight gain (B) and moon face reflect adverse effects of long-term prednisone use and should be documented. (A, C, and D) do not occur with treatment using prednisone.

A client receives a new prescription for beclomethasone (Beclovent Oral Inhaler). What information should the practical nurse (PN) reinforce with the client about the use of this medication? A) Use for rapid results in acute asthmatic attacks. B) Most effective in preventing upper respiratory infections. C) Daily use provides prophylaxis in asthma management. D) Inhale when exposed to allergens in the environment.

C) Daily use provides prophylaxis in asthma management. Feedback: Beclovent Oral Inhaler, an inhaled glucocorticoid, is used for prophylaxis in the management of chronic asthma (C) and should be administered on a fixed schedule, not (D). Inhaled beta 2 agonists, not a glucocorticoid, work rapidly in acute asthma attacks (A) precipitated by environmental allergen exposure (D).

On which therapeutic action should the practical nurse (PN) base an explanation to a client who is receiving a cardiac glycoside? A) Decreased cardiac output. B) Increased renal perfusion. C) Decreased rate of contraction. D) Increased blood volume.

C) Decreased rate of contraction. Feedback: Cardiac glycosides increase the force of cardiac contraction (inotropy) and decrease the heart rate (chronotropy) (C) by decreasing the speed of conduction through the heart (dromotropy). (A, B, and D) are incorrect.

The practical nurse (PN) is administering an enteric-coated form of erythromycin (EES) to a male client with an upper respiratory infection. The client tells the PN that the medication should be taken with his meals. What information should the PN offer the client? A) Taking EES with food anytime is recommended. B) EES should be taken on an empty stomach. C) ESS may be taken without regard to meals. D) The best time to take EES is once daily at night.

C) ESS may be taken without regard to meals. Feedback: The enteric-coated formulation of erythromycin may be taken without regard to meals (C). Because an enteric coating makes the drug less irritating to the gastrointestinal tract, this is likely to enhance compliance with drug therapy without regard to meals. (A, B, and D) are not indicated.

A client who has been taking phenazopyridine (Pyridium) for symptoms of urethritis and cystitis comes to the clinic because her urine is reddish-orange. Which question should the practical nurse ask to determine if the medication has been effective? A) How much water have you been drinking each day? B) Does the urine color stain your toilet bowl or undergarments? C) Have you had any relief from urinary pain, burning, or urgency? D) Did your urine appear cloudy or have a foul odor on voiding?

C) Have you had any relief from urinary pain, burning, or urgency? Feedback: Phenazopyridine, an over-the-counter urinary analgesic, acts on the mucosa of the urinary tract to relieve urinary pain, burning, itching, or urgency (C) associated with urethritis and cystitis. Although determining if the client is forcing fluids (A), experiencing staining from Pyridium's side effect (B), or having signs of a urinary infection (D) are worthwhile assessments, the therapeutic response of Pyridium is related to urinary discomforts only.

A client's tissue culture results indicate the wound is infected with methicillin-resistant Staphylococcus aureus (MRSA). What action should the practical nurse (PN) implement first? A) Provide sterile wound care as prescribed. B) Give the first dose of Vancomycin (Vancocin). C) Implement contact isolation precautions. D) Document wound site appearance and drainage.

C) Implement contact isolation precautions. Feedback: The risk of transmitting a hospital acquired infectious disease among clients is high with an organism such as MRSA. Infection prevention and control practices, including contact isolation precautions, should be implemented first (C). (A, B, and D) may be implemented after isolation precautions are in place.

The practical nurse (PN) administers isoproterenol (Isuprel) to a client with heart block. The PN should evaluate the client for which physiological response? A) Thirst and dry mucous membranes. B) Decrease in gastric motility. C) Increased heart rate. D) Bronchoconstriction.

C) Increased heart rate. Feedback: Isoproterenol (Isuprel) acts on beta 1 receptors in the heart, causing an increased cardiac reactivity in AV heart block and an increase in the client's heart rate (C). (A and B) are anticholinergic responses and are not typical with adrenergic agents, such as isoproterenol. By activating beta 2 receptors found in the smooth muscle of bronchioles, isoproterenol causes bronchodilation, not (D).

A client with type 1 diabetes mellitus received an early AM dose of regular insulin per sliding scale. At 10:00 AM, the practical nurse (PN) should report which signs indicative of hypoglycemia? A) Urticaria and rash. B) Nausea and diarrhea. C) Irritability and confusion. D) Fruity, acetone odor to the breath.

C) Irritability and confusion. Feedback: Irritability and confusion (C) are early signs of hypoglycemia. (A, B, and D) are not signs of hypoglycemia.

A client receives a prescription for nystatin (Mycostatin) oral suspension for the treatment of oral thrush. Which information should the practical nurse (PN) provide? A) Take on an empty stomach. B) Mix the suspension with water. C) Swish then swallow the medication. D) Keep in the refrigerator.

C) Swish then swallow the medication. Feedback: The client should swish the suspension in the mouth for as long as possible before swallowing it (C). The method of swish and swallow distributes the medication within the oral cavity to ensure topical coverage of the affected mucosal surfaces. Although (A, B, and D) are medication administration instructions, swish and swallow is the most specific administration information for nystatin.

The practical nurse (PN) should reinforce what time frame with a client about self-administration of lispro insulin (Humalog)? A) Take after a meal is completed. B) Take once daily at the midday meal. C) Take within 15 minutes of beginning a meal. D) Take only before bedtime with an evening snack.

C) Take within 15 minutes of beginning a meal. Feedback: Lispro, a very rapid acting insulin, has on onset of 5 to15 minutes after administration with a duration of 4 to 6 hours, so the client should self-administer this insulin within 15 minutes before a meal (C). (A, B, and D) are inaccurate.

Which information should the practical nurse (PN) provide a client who receives a new prescription for a benzodiazepine medication? A) A list of foods to avoid while taking this prescription. B) Symptoms that indicate increasing the dose of medication. C) The interactions of alcohol consumption and CNS depressant drugs. D) Explanations that support taking a work absence during drug therapy.

C) The interactions of alcohol consumption and CNS depressant drugs. Feedback: The concomitant use of alcohol and benzodiazepines (C), both CNS depressants, causes an increase in sedation, which places the client at risk for injury and should be avoided. (A, B, and D) are not indicated.

An adult male arrives in the clinic requesting a prescription for sildenafil (Viagra). Which client history should the practical nurse (PN) report to the healthcare provider? A) Hypogonadism. B) Fluid retention. C) The use of nitrates. D) Benign prostatic hypertrophy.

C) The use of nitrates. Feedback: Sildenafil can lower blood pressure by causing vasodilation. A client who takes a nitrate (C), a vasodilator, for a pre-existing cardiovascular disease can experience significant hypotension if Viagra is taken concomittently with nitrates, such as nitroglycerin, which should be reported to the healthcare provider. (A, B, and D) are not contraindications for the use of Viagra.

What assessment is most important for the practical nurse (PN) to obtain prior to initiating medication therapy with phenelzine (Nardil) for a client with depression? A) Activity level. B) Mood and affect. C) Understanding of diet modification. D) The client's support system.

C) Understanding of diet modification. Feedback: To prevent a potentially lethal hypertensive crisis, a tyramine-free diet should be maintained during antidepressant therapy with Nardil, a monoamine oxidase inhibitor (MAOI). It is most important to determine if the client understands diet modification (C) before Nardil is initiated to prevent consumption of foods that interact with Nardil. Although a client's activity level (A) and mood and affect (B) should be monitored during antidepressant therapy, it is most important that the client understand diet modifications. The client's support system (D) and network of family and friends is important, but the client should understand the responsibility of dietary compliance with the medication regimen.

What side effect should the practical nurse (PN) report to the healthcare provider for a client who is taking prednisone (Deltasone)? A) Dehydration. B) Hypoglycemia. C) Thickened skin. D) Gastric bleeding.

D) Gastric bleeding. Feedback: Prednisone, a glucocorticoid, decreases the viscosity of gastric mucus, which normally protects the lining of the stomach from irritants, which increases the risk of gastric erosion by hydrochloric acid, resulting in gastric bleeding (D). Other adverse effects include sodium and fluid retention, hyperglycemia, and skin fragility, not (A, B, and C).

A client who is transferred to the cardiac rehabilitation unit after a myocardial infarction is ready for discharge with a new prescription for metoprolol (Lopressor). The client asks, I don't have high blood pressure, so why did my healthcare provider give me this medicine? What information should the practical nurse (PN) provide? A) Anticoagulation is the most important action of metoprolol. B) Beta-blockers are routinely prescribed after heart damage. C) Heart failure is prevented as a complication while healing. D) A slower heart rate reduces the heart's oxygen demand.

D) A slower heart rate reduces the heart's oxygen demand. Feedback: Lopressor, a beta-blocker, slows the heart rate and is prescribed after a myocardial infarction to reduce the heart's work load and oxygen demand (D). (A, B, and D) are incorrect.

What laboratory results should the practical nurse monitor to evaluate the therapeutic effects of heparin? A) Platelet count. B) Hematocrit. C) Prothrombin time (PT). D) Activated partial thromboplastin time (APTT).

D) Activated partial thromboplastin time (APTT). Feedback: Ongoing APTT (D) values measure the prolongation times of thromboplastin in the clotting cascade, which is monitored during heparin therapy. (A, B, and C) do not indicate the therapeutic action of heparin.

Which information should the practical nurse (PN) reinforce with a client who is self-administering insulin injections? A) Shake the vial of insulin to mix the contents before administration. B) Store opened vials of insulin in a refrigerator no more than 30 days. C) Use a different syringe to prepare and inject each type of insulin. D) Aspirate regular insulin in the syringe first when mixing insulins.

D) Aspirate regular insulin in the syringe first when mixing insulins. Feedback: When administering two types of insulin, the regular insulin should be prepared first (D) to prevent the contamination of the regular insulin vial with long-acting insulins. Gently rolling the vial of insulin between the palms of the hands is recommended, not (A). Opened vials of insulin can be stored at room temperature for 30 days after being opened, and refrigeration (B) is not necessary. Different syringes (C) are not needed when administering two types of insulin.

A client with schizophrenia has been taking clozapine (Clozaril) for several months. The practical nurse (PN) monitors the client for extrapyramidal symptoms (EPS). Which reason supports the PN's assessment? A) Prolonged use of antidepressant medications reduce skeletal muscle tone. B) The excess amount of norepinephrine causes an increase in blood pressure. C) The increased availability of serotonin affects mood and behavior. D) Atypical antipsychotics can deplete the brain's supply of dopamine.

D) Atypical antipsychotics can deplete the brain's supply of dopamine. Feedback: The use of an atypical antipsychotic, such as clozapine, should include an assessment of musculoskeletal functioning for signs and symptoms of any EPS reaction that can occur from a lack of the brain neurotransmitter dopamine (D). (A, B, and C) do not explain the cause of EPS.

The practical nurse (PN) observes a thick white coating on the tongue of a client who takes fluphenazine (Prolixin). What instructions should the PN reinforce with the client about this medication? A) No treatment is needed as the coating should subside in a couple of weeks. B) Attempt to stop smoking if the white coating on your tongue persists. C) If you are taking any inhalants, wash the mouthpiece after each use. D) Brush your teeth and tongue, floss, gargle, and notify the healthcare provider.

D) Brush your teeth and tongue, floss, gargle, and notify the healthcare provider. Feedback: Fluphenazine (Prolixin), an antipsychotic with anticholinergic effects, causes dry mouth, which contributes to a thick white coating on the tongue that alters the normal flora in the mouth. Regular brushing of the tongue and teeth is a good preventive measure, and the healthcare provider should be notified (D) because treatment may be indicated if an oral infection develops. (A) is inaccurate. (B and C) do not convey the importance of calling the healthcare provider.

A client with chest pain is diagnosed with angina pectoris. On discharge the client receives a prescription for sublingual nitroglycerin tablets PRN. Which instruction should the practical nurse (PN) reinforce with this client? A) Take up to five doses at 15 minute intervals for an anginal attack. B) Chew the tablet for maximal effect because does not dissolve quickly. C) Seek immediate hospitalization after the first dose is taken for chest pain. D) Change positions slowly after taking a dose to reduce the chance of falling.

D) Change positions slowly after taking a dose to reduce the chance of falling. Feedback: Sublingual nitroglycerin may cause hypotension, so the client should be instructed to change positions slowly to avoid injury falling or fainting after taking a dose (D). (A, B, and C) are inaccurate.

The healthcare provider prescribes cycloplegic and mydriatic ophthalmic drops for a client who is having a cataract removal. What explanation about the drug actions should the practical nurse (PN) provide the client? A) Reduces intraocular pressure. B) Relieves eye pain. C) Treats conjunctivitis. D) Dilates the pupil.

D) Dilates the pupil. Feedback: Cycloplegic drugs cause ciliary paralysis, and mydriatics dilate the pupil (D), which facilitates access into the anterior chamber for removal of the lens in cataract surgery. (A, B, and C) are incorrect actions.

A client is receiving the third course of 5-fluorouracil (5FU) therapy for a tumor of the liver. Which action should the practical nurse implement to reduce the client's risk for stomatitis? A) Use commercial oral products to reduce the risk of oral infections. B) Observe for black, tarry stools or bleeding ulcerations. C) Increase intake of foods containing fiber and citric acid. D) Examine mouth daily for bleeding, white spots, and ulcerations.

D) Examine mouth daily for bleeding, white spots, and ulcerations. Feedback: 5-fluorouracil (5FU) is an antimetabolite, antineoplastic agent that causes sloughing of the rapid proliferating epithelial cells of the oral mucosa causing ulceration, bleeding, and oral candidiasis (thrush). Daily examination of the oral mucosa (D) should be implemented to identify signs of stomatitis, such as white spots, ulcerations, and bleeding of the mouth, so early intervention can be implemented. Oral commercial products usually contain alcohol, which contributes to inflammation of the oral mucosa, and should be avoided (A). Although monitoring the stool for bleeding (B) should be implemented, stomatitis occurs in 75% of clients who receive 5FU. Foods high in fiber and citric acid should also be avoided (C) to reduce pain and trauma to the mouth.

What side effect should the practical nurse (PN) report to the healthcare provider for a client who is taking prednisone (Deltasone)? A) Dehydration. Feedback: INCORRECT B) Hypoglycemia. Feedback: INCORRECT C) Thickened skin. Feedback: INCORRECT D) Gastric bleeding. Feedback: CORRECT

D) Gastric bleeding. Feedback: Prednisone, a glucocorticoid, decreases the viscosity of gastric mucus, which normally protects the lining of the stomach from irritants, which increases the risk of gastric erosion by hydrochloric acid, resulting in gastric bleeding (D). Other adverse effects include sodium and fluid retention, hyperglycemia, and skin fragility, not (A, B, and C).

A male client tells the practical nurse (PN) that he takes acetylsalicylic acid (aspirin) 325 mg daily. Which finding should alert the PN that the client may be experiencing a side effect of salicylate therapy? A) Skin tears. B) Hypothermia. C) Hepatotoxicity. D) Gastrointestinal distress.

D) Gastrointestinal distress. Feedback: Salicylates, such as aspirin, commonly irritate the gastric mucosa, causing gastrointestinal distress (D). (A, B, and C) are inaccurate.

The practical nurse (PN) is reviewing the discharge plan for a client with mania who is receiving lithium carbonate (Eskalith). To achieve a stable serum level, which information should the PN reinforce with the client? A) How to inject this drug. B) When to increase the dosage. C) When to stop using this drug. D) How to recognize symptoms of toxicity.

D) How to recognize symptoms of toxicity. Feedback: Lithium carbonate has a very narrow therapeutic serum range, so the client should understand the signs and symptoms of toxicity (D). (A) is not available. (B) increases the client's risk for toxicity. (C) will precipitate recurrence of mania.

A client with Parkinson's disease has been taking antiparkinsonian medications for three months. Which client finding should the practical nurse (PN) identify as a therapeutic response? A) Decreased appetite. B) Gradual development of cogwheel rigidity. C) Occurrence of confusion. D) Improved ability to perform activities.

D) Improved ability to perform activities. Feedback: Therapeutic responses to antiparkinsonian agents include an improved sense of well-being and improved ability to think clearly and perform activities (D). An increase in appetite, not (A), and less-intense parkinsonism manifestations are expected, not (B or C).

The healthcare provider prescribes celecoxib (Celebrex), a nonsteroidal antiinflammatory drug (NSAID), for a client with osteoarthritis. Which finding in the client's history should the practical nurse (PN) report? A) Gout. B) Hypertension. C) Diabetes mellitus. D) Peptic-ulcer disease.

D) Peptic-ulcer disease. Feedback: Celecoxib (Celebrex), an NSAID, causes gastrointestinal irritation and bleeding. Peptic-ulcer disease is a contraindication to therapy with NSAIDs (D). (A, B, and C) are inaccurate.

Which action should the practical nurse implement when administering a buccal medication? A) Encourage the client to swallow. B) Administer water with medication. C) Ensure the medication is positioned under the tongue. D) Place the medication between the upper molar teeth and cheek.

D) Place the medication between the upper molar teeth and cheek. Feedback: Buccal medications are placed between the upper molar teeth and the cheek (D) for absorption by the capillaries of the oral mucosa. The client should be cautioned against swallowing, not (A). Buccal medications are not administered with water (B). (C) describes sublingual administration.

A client with tuberculosis (TB) asks the practical nurse (PN) the value of prescribed multidrug therapy. What explanation should the PN provide? A) Required to eradicate TB. B) Enhances the effect of each drug. C) Provides a faster effect than single drug therapy. D) Reduces development of TB resistant drugs.

D) Reduces development of TB resistant drugs. Feedback: The use of multiple medications reduces the possibility of the tubercle bacilli becoming drug resistant (D). (A, B, and C) are incorrect.

A male client who has been receiving an antineoplastic drug has developed thrombocytopenia. What instructions should the practical nurse (PN) reinforce? A) Use suppository form of drugs. B) Avoid large public gatherings. C) Rise slowly when standing up. D) Shave with an electric razor.

D) Shave with an electric razor. Feedback: Thrombocytopenia is a common side effect of bone marrow depression caused by several antineoplastic agents. The client is experiencing a low platelet count and should use an electric razor (D) to reduce his risk of bleeding. (A, B, and C) are not indicated for a client who needs to implement thrombocytopenia precautions.

The practical nurse (PN) is reinforcing information to a client about the use of an antiemetic to help manage nausea and vomiting during a course of chemotherapy. Which information is most important for the PN to provide? A) Eat small amounts of food, such as crackers, to soothe the stomach lining. B) Drink any palatable liquid as tolerated when nauseated. C) Ensure safety by taking at bedtime if drowsiness occurs. D) Take at least 30 minutes before a chemotherapeutic agent is received.

D) Take at least 30 minutes before a chemotherapeutic agent is received. Feedback: Antiemetics should be given before any chemotherapeutic agent is administered, often 30 minutes to 3 hours before treatment (D). Although (A, B, and C) are useful tips, if tolerated, they do not ensure the maximum therapeutic response.

A 35-week gestation primigravida who takes lithium (Eskalith) tells the practical nurse (PN) that she would like to breastfeed her infant. What information should the PN provide to the client? A) The medication does not cross the placental barrier. B) Mood swings will occur if lithium is discontinued. C) Breast milk should be discarded after each oral dose of lithium. D) The drug is excreted in breast milk so use formula to feed the infant.

D) The drug is excreted in breast milk so use formula to feed the infant. Feedback: Lithium crosses the placental barrier and is excreted in the breast milk, so the client should formula feed her newborn. (A and C) are inaccurate information. Although (B) may occur, the option of the mother discontinuing the prescribed lithium should not be suggested.

The practical nurse (PN) is assessing a client who takes olanzapine (Zyprexa), an antipsychotic. Which side effect should the PN most likely note in this client? A) Insomnia and irritability. B) Hand tremors and tearing. C) Nausea and frontal headache. D) Weight gain and constipation.

D) Weight gain and constipation. Feedback: Olanzapine (Zyprexa), an atypical antipsychotic, causes orthostatic hypotension, weight gain, and anticholinergic effects, such as constipation (D). Common anticholinergic side effects include dry mouth, blurred vision, nasal stuffiness, weight gain, difficulty urinating, decreased sweating, increased sensitivity to sunlight, and constipation (D). (A, B, and C) are not expected side effects of this medication.