Pharmacology Exam 2 (study)

The nurse is preparing to administer dexmedetomidine (Precedex) to a patient. Which is an appropriate indication for dexmedetomidine? (Select all that apply.) a. Procedural sedation b. Surgeries of short duration c. Surgeries of long duration d. Postoperative anxiety e. Sedation of mechanically ventilated patients

ANS: A, B, E Dexmedetomidine (Precedex) is used for procedural sedation and for surgeries of short duration, and it is also used in the intensive care setting for sedation of mechanically ventilated patients. The other options are incorrect.

A patient is to receive iron dextran injections. Which technique is appropriate when the nurse is administering this medication? a.Intravenous administration mixed with 5% dextrose b.Intramuscular injection in the upper arm c.Intramuscular injection using the Z-track method d.Subcutaneous injection into the abdomen

ANS: CIntramuscular iron is given using the Z-track method deep into a large muscle mass. If given intravenously, it is given with normal saline, not 5% dextrose

A patient is going home with a new prescription for the beta blocker atenolol (Tenormin). The nurse will include which content when teaching the patient about this drug? a. Never stop taking this medication abruptly. b. The medication will be stopped once symptoms subside. c. If adverse effects occur, stop taking the drug for 24 hours, and then resume. d. Be watchful for first-dose hypotension

ANS: A Patients need to be weaned off these medications slowly because rebound hypertension and chest pain are possible with abrupt withdrawal. The drugs should never be stopped abruptly nor doses skipped. First-dose hypotension occurs with alpha blockers

The nurse is reviewing the history of a patient who has a new order for a nonsteroidal antiinflammatory drug (NSAID) to treat tendonitis. Which conditions are contraindications to the use of NSAIDs? (Select all that apply.) a.Rhinitis b.Arthralgia c.Peptic ulcer disease d.Neuropathy e.Pericarditis

ANS: A, CContraindications to NSAIDs include known drug allergy as well as conditions that place the patient at risk for bleeding, such as rhinitis (risk for epistaxis, or nosebleed) and peptic ulcer disease. NSAIDs may be used to treat arthralgia and pericarditis. Neuropathy is not a contraindication.

The nurse is reviewing the indications for atropine sulfate. Atropine is appropriate for which of these patients? (Select all that apply.) a. A patient who has suddenly developed symptomatic bradycardia with a heart rate of 32 beats/minute b. A patient who has suddenly developed symptomatic tachycardia with a heart rate of 180 beats/minute c. A patient with severe narrow-angle glaucoma d. A patient who is about to have surgery e. A patient newly diagnosed with myasthenia gravis f. A patient with anticholinesterase inhibitor poisoning

ANS: A, D, F Anticholinergic drugs are used for symptomatic bradycardia and certain other cardiac conditions. It is given preoperatively to control secretions during surgery and is used as an antidote for anticholinesterase inhibitor poisoning. The other options are contraindications to the use of atropine

A patient will be taking oral iron supplements at home. The nurse will include which statements in the teaching plan for this patient? (Select all that apply.) a. Take the iron tablets with meals. b. Take the iron tablets on an empty stomach 1 hour before meals. c. Take the iron tablets with an antacid to prevent heartburn. d. Drink 8 ounces of milk with each iron dose e.Taking iron supplements with orange juice enhances iron absorption. f.Stools may become loose and light in color. g.Stools may become black and tarry.h.Tablets may be crushed to enhance iron absorption

ANS: A, E, G Iron tablets need to be taken with meals to reduce gastrointestinal distress, but antacids and milk interfere with absorption. Orange juice enhances the absorption of iron. Stools may become black and tarry in patients who are on iron supplements. Tablets need to be taken whole, not crushed, and the patient needs to be encouraged to eat foods high in iron.

During assessment of a patient with osteoarthritis pain, the nurse knows that which condition is a contraindication to the use of nonsteroidal antiinflammatory drugs (NSAIDs)? a.Renal disease b.Diabetes mellitus c.Headaches d.Rheumatoid arthritis

ANS: AContraindications to NSAIDs include known drug allergy and conditions that place a patient at risk for bleeding, such as rhinitis (risk for epistaxis [nosebleed]), vitamin K deficiency, and peptic ulcer disease. Patients with documented aspirin allergy must not receive NSAIDs. Other common contraindications are those that apply to most drugs, including severe renal or hepatic disease. The other options are not contraindications

A patient with a tracheostomy has difficulty removing excessive, thick mucus from the respiratory tract. The nurse expects that which drug will be ordered to aid in the removal of mucus? a. guaifenesin (Humibid) b. benzonatate (Tessalon Perles) c. diphenhydramine (Benadryl) d. dextromethorphan (Robitussin DM)

ANS: AExpectorants such as guaifenesin work to loosen and thin sputum and the bronchial secretions,thereby indirectly diminishing the tendency to cough. The other drugs listed do not have this effect

A patient is taking guaifenesin (Humibid) as part of treatment for a sinus infection. Which instruction will the nurse include during patient teaching? a.Force fluids to help loosen and liquefy secretions. b.Report clear-colored sputum to the prescriber. c.Avoid driving a car or operating heavy machinery because of the sedating effects d.Report symptoms that last longer than 2 days

ANS: AForcing fluids helps to loosen and liquefy secretions. The patient must be fully aware that any fever, chest tightness, change in sputum from clear to colored, difficult or noisy breathing, activity intolerance, or weakness needs to be reported. The patient also must report to the prescriber a fever of higher than 100.4F (38C) or symptoms that last longer than 3 to 4 days. Decongestants do not cause sedation, and therefore the patient does not need to avoid driving a car or operating heavy machinery.

The nurse is conducting a smoking-cessation program. Which statement regarding drugs used in cigarette-smoking-cessation programs is true? a.Rapid chewing of the nicotine gum releases an immediate dose of nicotine. b.Quick relief from withdrawal symptoms is most easily achieved by using a transdermal patch. c.Compliance with treatment is higher with use of the gum rather than the transdermal patch. d.The nicotine gum can be used only up to six times per day

ANS: AQuick or acute relief from withdrawal symptoms is most easily achieved with the use of the gum, because rapid chewing of the gum produces an immediate dose of nicotine. However, treatment compliance is higher with the use of the transdermal patch system. Nicotine gum can be used whenever the patient has a strong urge to smoke

A patient calls the clinic to ask about taking a glucosamine-chondroitin supplement for arthritis. The nurse reviews the medication history and notes that there will be a concern for drug interactions if the patient is also taking medications for which disorder? a.Type 2 diabetes mellitus b.Hypothyroidism c.Hypertension d.Angina

ANS: AThe glucosamine in glucosamine-chondroitin supplements may cause an increase in insulin resistance, necessitating the need for higher doses of oral hypoglycemics or insulin

A patient with gout has been treated with allopurinol (Zyloprim) for 2 months. The nurse will monitor laboratory results for which therapeutic effect? a.Decreased uric acid levels b.Decreased prothrombin time c.Decreased white blood cell count d.Increased hemoglobin and hematocrit levels

ANS: ATreatment of gout with allopurinol should result in decreased uric acid levels. The other options are incorrect

The nurse is reviewing herbal therapies. Which is a common use of the herb feverfew? a. Muscle aches b. Migraine headaches c. Leg cramps d. Incision pain after surgery

ANS: B Feverfew is commonly used for migraine headaches, menstrual problems, arthritis, and fever. Possible adverse effects include muscle stiffness and muscle and joint pain

A patient is in an urgent-care center with an acute asthma attack. The nurse expects that which medication will be used for initial treatment? a. An anticholinergic such as ipratropium (Atrovent) b. A short-acting beta 2 agonist such as albuterol (Proventil) c. A long-acting beta 2 agonist such as salmeterol (Serevent) d. A corticosteroid such as fluticasone (Flovent)

ANS: B The short-acting beta2agonists are commonly used during the acute phase of an asthmatic attack to reduce airway constriction quickly and to restore airflow to normal levels. The other drugs listed are not appropriate for acute asthma attacks. Anticholinergic drugs and long-acting beta2agonists are used to prevent attacks; corticosteroids are used to reduce airway inflammation

A patient is receiving gabapentin (Neurontin), an anticonvulsant, but has no history of seizures. The nurse expects that the patient is receiving this drug for which condition? a. Inflammation pain b. Pain associated with peripheral neuropathy c. Depression associated with chronic pain d. Prevention of seizures

ANS: B Anticonvulsants are often used as adjuvants for treatment of neuropathic pain to enhance analgesic efficacy. The other indications listed are not correct

A patient who has been diagnosed with Sjögren's syndrome will be given cevimeline for the treatment of xerostomia. The nurse will monitor for what therapeutic effect? a. Reduction of salivation b. Stimulation of salivation c. Reduction of gastrointestinal peristalsis d. Improvement of fine-motor control

ANS: B Cevimeline is a direct-acting cholinergic drug that is used to stimulate salivation in patients who have xerostomia (dry mouth), one of the manifestations of Sjögren's syndrome. The other options are incorrect.

In preparation for eye surgery, the nurse monitors for which desired drug effect in a patient who is receiving a cholinergic-blocking eyedrop medication? a. Miosis b. Mydriasis c. Increased intraocular fluid production d. Enhanced tear production

ANS: B Cholinergic-blocking eyedrops cause dilation of the pupil (mydriasis) and paralysis of the ocular lens (cycloplegia), both of which are important for eye surgery. The other options are incorrect.

A hospitalized patient is experiencing a severe anaphylactic reaction to a dose of intravenous penicillin. Which drug will the nurse expect to use to treat this condition? a. Ephedra b. Epinephrine c. Phenylephrine d. Pseudoephedrine

ANS: B Epinephrine is the drug of choice for the treatment of anaphylaxis. The other drugs listed are incorrect choices

A patient is recovering from abdominal surgery, which he had this morning. He is groggy but complaining of severe pain around his incision. What is the most important assessment data to consider before the nurse administers a dose of morphine sulfate to the patient? a. His pulse rate b. His respiratory rate c. The appearance of the incision d. The date of his last bowel movemen

ANS: B One of the most serious adverse effects of opioids is respiratory depression. The nurse must assess the patient's respiratory rate before administering an opioid. The other options are incorrect

A patient in a rehabilitation center is beginning to experience opioid withdrawal symptoms. The nurse expects to administer which drug as part of the treatment? a. diazepam (Valium) b. methadone c. disulfiram (Antabuse) d. bupropion (Zyban

ANS: B Opioid withdrawal can be managed with either methadone or clonidine (Catapres). Diazepam and disulfiram are used for treatment of alcoholism, and bupropion is used to assist with smoking cessation

The nurse notes in a patient's medication history that the patient is taking pilocarpine (Pilocar). Based on this finding, the nurse interprets that the patient has which disorder? a. Anticholinergic poisoning b. Glaucoma c. Bladder atony d. Myasthenia gravi

ANS: B Pilocarpine is a direct-acting drug that is used topically to reduce intraocular pressure in patients with glaucoma. The other disorders are not indications for pilocarpine

During the immediate postoperative period, the Post Anesthesia Care Unit nurse is assessing a patient who had hip surgery. The patient is experiencing tachycardia, tachypnea, and muscle rigidity, and his temperature is 103 F (39.4 C). The nurse will prepare for what immediate treatment? a. naltrexone hydrochloride (Narcan) injection, an opioid reversal drug b. dantrolene (Dantrium) injection, a skeletal muscle relaxant c. An anticholinesterase drug, such as neostigmine d. Cardiopulmonary resuscitation (CPR) and intubation

ANS: B Tachycardia, tachypnea, muscle rigidity, and raised temperature are symptoms of malignant hyperthermia, which is treated with cardiorespiratory supportive care as needed to stabilize heart and lung function as well as with immediate treatment with the skeletal muscle relaxant dantrolene. CPR is not immediately needed because the patient still has a pulse and respirations. Naltrexone and anticholinesterase drugs are not appropriate in this situation

An elderly patient tells the nurse that he uses aspirin for "anything that hurts." The nurse will assess for which most common signs of chronic salicylate intoxication in adults? a.Photosensitivity and nervousness b. Tinnitus and hearing loss c. Acute gastrointestinal bleeding and anorexia d. Hyperventilation and central nervous system (CNS) effects

ANS: B The most common manifestations of chronic salicylate intoxication in adults are tinnitus and hearing loss. Hyperventilation and CNS effects are most commonly seen in children

The nurse is reviewing medications for the treatment of asthma. Which drugs are used for acute asthma attacks? (Select all that apply . ) a. salmeterol (Serevent) inhaler b. albuterol (Proventil) nebulizer solution c. epinephrine d. montelukast (Singulair) e. fluticasone (Flovent) Rotadisk inhaler f. aminophylline IV infusion

ANS: B, C, F Albuterol (a short-acting beta 2 agonist) and epinephrine (a beta 1 and beta 2 agonist) are used for acute bronchospasms. Aminophylline can be used for mild to moderate cases of acute asthma. Salmeterol is a long-acting beta 2 agonist that is indicated for maintenance treatment, not acute episodes. Fluticasone is an inhaled corticosteroid; montelukast is a leukotriene receptor antagonist (LTRA). These types of medications are used for asthma prophylaxis.

A nurse is providing teaching for a patient who will be taking varenicline (Chantix) as part of a smoking-cessation program. Which teaching points are appropriate for a patient taking this medication? (Select all that apply.) a.This drug is available as a chewing gum that can be taken to reduce cravings. b.Use caution when driving because drowsiness may be a problem. c.There have been very few adverse effects reported for this drug. d.Notify the prescriber immediately if feelings of sadness or thoughts of suicide occur. e.Avoid caffeine while on this drug

ANS: B, D Patients taking varenicline have reported drowsiness, which has prompted the FDA to recommend caution when driving and engaging in other potentially hazardous activities until the patient can determine how the drug affects his or her mental status. In addition, the FDA has warned about psychiatric symptoms including agitation, depression, and suicidality. Varenicline is an oral tablet, and common adverse effects include nausea, vomiting, headache, and insomnia. There are no cautions about taking caffeine while on this drug

The nurse notes in a patient's medication history that the patient is taking allopurinol (Zyloprim). Based on this finding, the nurse interprets that the patient has which disorder? a.Rheumatoid arthritis b.Gout c.Osteoarthritis d.Systemic lupus erythematosus

ANS: BAllopurinol is indicated for the treatment of gout but is not indicated for the other disorders listed.

The nurse is administering intravenous iron dextran for the first time to a patient with anemia. After giving a test dose, how long will the nurse wait before administering the remaining portion of the dose? a.30 minutes b.1 hour c.6 hours d.24 hours

ANS: BAlthough anaphylactic reactions usually occur within a few moments after the test dose, it is recommended that a period of at least 1 hour elapse before the remaining portion of the initial dose is given. The other options are incorrect

The nurse is monitoring drug levels for a patient who is receiving theophylline. The most recent theophylline level was 13 mcg/mL, and the nurse evaluates this level to be a.below the therapeutic level. b.at a therapeutic level. c.above the therapeutic level. d.at a toxic leve

ANS: BAlthough the optimal level may vary from patient to patient, most standard references have suggested that the therapeutic range for theophylline blood level is 10 to 20 mcg/mL However, most clinicians now advise levels between 5 and 15 mcg/m

A patient has been taking selegiline (Eldepryl), 20 mg per day for 1 month. Today, during his office visit, he tells the nurse that he forgot and had a beer with dinner last evening, and "felt awful." What did the patient most likely experience? a.Hypotension b.Hypertension c.Urinary discomfort d.Gastrointestinal upset

ANS: BAt doses that exceed 10 mg per day, selegiline becomes a nonselective monoamine oxidase inhibitor (MAOI), contributing to the development of the cheese effect, so-called because it interacts with tyramine-containing foods (cheese, red wine, beer, and yogurt) and can cause severe hypertension

A patient asks the nurse about the uses of echinacea. Which use will the nurse include in the response? a.Memory enhancement b.Boosting the immune system c.Improving mood d.Promoting relaxation

ANS: BCommon uses of echinacea include stimulation of the immune system, antisepsis, treatment ofviral infections and influenza-like respiratory tract infections, and promotion of the healing of wounds and chronic ulcerations. The other options are incorrect.

An oral iron supplement is prescribed for a patient. The nurse would question this order if the patient's medical history includes which condition a.Decreased hemoglobin b.Hemolytic anemia c.Weakness d.Concurrent therapy with erythropoietics

ANS: BHemolytic anemia is a contraindication to the use of iron supplements. Decreased hemoglobinand weakness are related to iron-deficiency anemia. Iron supplements are given with erythropoietic drugs to aid in the production of red blood cells.

The nurse is administering liquid oral iron supplements. Which intervention is appropriate when administering this medication? a.Have the patient take the liquid iron with milk. b.Instruct the patient to take the medication through a plastic straw. c.Have the patient sip the medication slowly. d.Have the patient drink the medication, undiluted, from the unit-dose cup

ANS: BLiquid oral forms of iron need to be taken through a plastic straw to avoid discoloration of tooth enamel. Milk may decrease absorption

During drug therapy with epoetin alfa (Epogen), the nurse knows that therapy must be stoppedif which laboratory result is noted? a.White blood cell count of 550 cells/mm3 b.Hemoglobin level of 13 g/dL c.Potassium level of 4.2 mEq/L d.Glucose level of 78 mg/dL

ANS: BWhen hemoglobin levels are above 12 g/dL and the epoetin alfa is continued, patients may experience serious adverse events, including heart attack, stroke, and death. Epoetin must notbe given to patients with renal disorders unless their hemoglobin level is less than 12 g/dL. In cancer patients, the hemoglobin level needs to be less than 10 g/dL. The other options are incorrect

A patient has been taking haloperidol (Haldol) for 3 months for a psychotic disorder, and the nurse is concerned about the development of extrapyramidal symptoms. The nurse will monitor the patient closely for which effects? a. Increased paranoia b. Drowsiness and dizziness c. Tremors and muscle twitching d. Dry mouth and constipation

ANS: C Extrapyramidal symptoms are manifested by tremors and muscle twitching, and the incidence of such symptoms is high during haloperidol therapy. The other options are incorrect.

The nurse is assessing a patient who has been admitted to the emergency department for a possible opioid overdose. Which assessment finding is characteristic of an opioid drug overdose? a. Dilated pupils b. Restlessness c. Respiration rate of 6 breaths/minute d. Heart rate of 55 beats/minute

ANS: C The most serious adverse effect of opioid use is CNS depression, which may lead to respiratory depression. Pinpoint pupils, not dilated pupils, are seen. Restlessness and a heart rate of 55 beats per minute are not indications of an opioid overdose.

A patient has been admitted to the emergency department with a suspected overdose of a tricyclic antidepressant. The nurse will prepare for what immediate concern? a. Hypertension b. Renal failure c. Cardiac dysrhythmias d. Gastrointestinal bleeding

ANS: C Tricyclic antidepressant overdoses are notoriously lethal. The primary organ systems affected are the central nervous system and the cardiovascular system, and death usually results from either seizures or dysrhythmias.

The nurse will teach a patient who is receiving oral iron supplements to watch for which expected adverse effects? a. Palpitations b. Drowsiness and dizziness c. Black, tarry stools d. Orange-red discoloration of the urine

ANS: C Black, tarry stools and other gastrointestinal disturbances may occur with the administration of iron preparations. The other options are incorrect

The nurse is assessing a patient for contraindications to drug therapy with acetaminophen (Tylenol). Which patient should not receive acetaminophen? a. A patient with a fever of 101 F (38.3 C) b. A patient who is complaining of a mild headache c. A patient with a history of liver disease d. A patient with a history of peptic ulcer disease

ANS: C Liver disease is a contraindication to the use of acetaminophen. Fever and mild headache are both possible indications for the medication. Having a history of peptic ulcer disease is not a contraindication

A 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually awakening, he requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is very lethargic and his respirations are shallow, with a rate of 7 per minute. The nurse prepares for which priority action at this time? a. Assessment of the patient's pain level b. Immediate intubation and artificial ventilation c. Administration of naloxone (Narcan) d. Close observation of signs of opioid tolerance

ANS: C Naloxone, an opioid-reversal agent, is used to reverse the effects of acute opioid overdose and is the drug of choice for reversal of opioid-induced respiratory depression. This situation is describing an opioid overdose, not opioid tolerance. Intubation and artificial ventilation are not appropriate because the patient is still breathing at 7 breaths per minute. It would be inappropriate to assess the patient's level of pain.

When treating patients with medications for Parkinson's disease, the nurse knows that the wearing-off phenomenon occurs for which reason? a. There are rapid swings in the patient's response to levodopa. b. The patient cannot tolerate the medications at times. c. The medications begin to lose effectiveness against Parkinson's disease. d. The patient's liver is no longer able to metabolize the drug

ANS: C The wearing-off phenomenon occurs when antiparkinson medications begin to lose their effectiveness, despite maximal dosing, as the disease progresses. The other options are incorrect.

The nurse is reviewing a patient's medication history and notes that the patient is taking the cholinergic blocker tolterodine (Detrol). Which is an indication for this medication? a. Irritable bowel disease b. Induction of mydriasis c.Urge incontinence d. Reduction of secretions preoperatively

ANS: C Tolterodine (Detrol) is used for urinary frequency, urgency, and urge incontinence caused by bladder (detrusor) overactivity. The conditions in the other options are not indications

The nurse is administering a stat dose of epinephrine. Epinephrine is appropriate for which situation? a. Severe hypertension b. Angina c. Cardiac arrest d. Tachycardia

ANS: C Treatment of cardiac arrest is an indication for the use of epinephrine. The other options are not indications for epinephrine

A nurse is giving instructions to a patient who will be receiving oral iron supplements. Which instructions will be included in the teaching plan? a.Take the iron tablets with milk or antacids .b.Crush the pills as needed to help with swallowing. c.Take the iron tablets with meals if gastrointestinal distress occurs. d.If black tarry stools occur, report it to the doctor immediately

ANS: CAlthough taking iron tablets with food may decrease absorption, doing so helps to reduce gastrointestinal distress. Antacids and milk may cause decreased iron absorption; iron tablets must be taken whole and not crushed. Black, tarry stools are expected adverse effects of oral iron supplements

A patient with end-stage renal failure has been admitted to the hospital for severe anemia. She is refusing blood transfusions. The nurse anticipates drug therapy with which drug to stimulate the production of red blood cells a.folic acid b.cyanocobalamin (vitamin B12) c.epoetin alfa (Epogen) d.filgrastim (Neupogen

ANS: CEpoetin alfa is a colony-stimulating factor that is responsible for erythropoiesis, or formation of red blood cells. The other options are incorrect

A patient is taking the nonsteroidal antiinflammatory drug indomethacin (Indocin) as treatment for pericarditis. The nurse will teach the patient to watch for which adverse effect? a.Tachycardia b.Nervousness c.Nausea and vomiting d.Dizziness

ANS: CGastrointestinal effects include dyspepsia, heartburn, epigastric distress, nausea, vomiting, anorexia, abdominal pain, and others. See Table 44-3 for the other adverse effects of nonsteroidal antiinflammatory drugs (NSAIDs). The other options are not adverse effects of NSAIDs.

During therapy with the hematopoietic drug epoetin alfa (Epogen), the nurse instructs the patient about adverse effects that may occur, such as a.anxiety. b.drowsiness. c.hypertension. d.constipation.

ANS: CHypertension is an adverse effect of hematopoietic drugs, along with headache, fever, pruritus,rash, nausea, vomiting, arthralgia, cough, and injection site reaction. The other options are incorrect

During initial rounds, the nurse notes that a dobutamine infusion has extravasated into the forearm of a patient. After stopping the infusion, the nurse follows standing orders and immediately injects phentolamine (Regitine) subcutaneously in a circular fashion around the extravasation site. What is the mechanism of action of the phentolamine in this situation? a. It neutralizes the extravasated dobutamine immediately. b. It causes arterial vasoconstriction and reduced pain and swelling at the site. c. It increases peripheral vascular resistance and reduces arterial pressure at the site. d. It increases blood flow to the ischemic site by vasodilation to prevent tissue damage.

ANS: D Phentolamine is an alpha blocker that reduces peripheral vascular resistance when given systemically, but local subcutaneous injection around the site of extravasated vasoconstrictive drugs, such as dobutamine, causes an alpha-adrenergic receptor blockade and vasodilation. This allows for increased blood flow to the ischemic tissue and may prevent permanent tissue damage

The nurse working in a preoperative admitting unit administers an anticholinergic medication to a patient before surgery. What is the purpose of this drug in the preoperative setting? a. Control the heart rate b. Relax the patient c. Reduce urinary frequency d. Reduce oral and gastrointestinal secretions

ANS: D Anticholinergic drugs are given preoperatively to control oral and gastrointestinal secretions during surgery. The other options are incorrect

A patient has had an overdose of an intravenous cholinergic drug. The nurse expects to administer which drug as an antidote? a. atenolol (Tenormin) b. bethanechol (Urecholine) c. dobutamine d. atropine sulfate

ANS: D Prompt administration of atropine sulfate can reverse a toxic dose of cholinergic drugs. The other drugs listed are not antidotes to cholinergic toxicity

When assessing patients in the preoperative area, the nurse knows that which patient is at a higher risk for an altered response to anesthesia? a. The 30-year-old patient who has never had surgery before b. The 45-year-old patient who stopped smoking 10 years ago c. The 21-year-old patient who is to have a kidney stone removed d. The 78-year-old patient who is to have gallbladder removal

ANS: D The elderly patient is more affected by anesthesia than the young or middle-aged adult patient because of the effects of aging on the hepatic, cardiac, respiratory, and renal systems

A patient has been taking tolterodine (Detrol), but today her prescriber changed her to a newer drug, darifenacin (Enablex). What advantage does darifenacin have over the tolterodine? a. The newer cholinergic-blocker drugs are more effective. b. It helps reduce urinary retention. c. It can be used in patients with narrow-angle glaucoma. d. The incidence of dry mouth is much lower with darifenacin

ANS: D The incidence of dry mouth is much lower with use of the newer cholinergic-blocker drugs, such as darifenacin, because the actions of these drugs are more specific for the bladder as opposed to the salivary glands. These drugs are contraindicated if narrow-angle glaucoma or urinary retention is present. The newer cholinergic-blocker drugs are not necessarily more effective

The nurse is teaching a patient with iron-deficiency anemia about foods to increase iron intake. Which food may enhance the absorption of oral iron forms? a.Milk b.Yogurt c.Antacids d.Orange juice

ANS: DOrange juice contains ascorbic acid, which enhances the absorption of oral iron forms; antacids, milk, and yogurt may interfere with absorption.

A mother brings her toddler into the emergency department and tells the nurse that she thinks the toddler has eaten an entire bottle of chewable aspirin tablets. The nurse will assess for which most common signs of salicylate intoxication in children? a.Photosensitivity and nervousness b.Tinnitus and hearing loss c.Acute gastrointestinal bleeding d.Hyperventilation and drowsiness

ANS: DThe most common manifestations of chronic salicylate intoxication in adults are tinnitus and hearing loss. Those in children are hyperventilation and CNS effects, such as dizziness, drowsiness, and behavioral changes

The nurse has given medication instructions to a patient receiving phenytoin (Dilantin). Which statement by the patient indicates that the patient has an adequate understanding? a. "I will need to take extra care of my teeth and gums while on this medication." b. "I can go out for a beer while on this medication." c. "I can skip doses if the side effects bother me." d. "I will be able to stop taking this drug once the seizures stop."

a. "I will need to take extra care of my teeth and gums while on this medication."

The nurse is giving an intravenous dose of phenytoin (Dilantin). Which action is correct when administering this drug? a. Give the dose as a fast intravenous (IV) bolus. b. Mix the drug with normal saline, and give it as a slow IV push. c. Mix the drug with dextrose (D5W), and give it as a slow IV push. d. Mix the drug with any available solution as long as the administration rate is correct.

b. Mix the drug with normal saline, and give it as a slow IV push.

A patient has a 9-year history of a seizure disorder that has been managed well with oral phenytoin (Dilantin) therapy. He is to be NPO (consume nothing by mouth) for surgery in the morning. What will the nurse do about his morning dose of phenytoin? a. Give the same dose intravenously. b. Give the morning dose with a small sip of water. c. Contact the prescriber for another dosage form of the medication. d. Notify the operating room that the medication has been withheld.

c. Contact the prescriber for another dosage form of the medication.

When teaching a patient about taking a newly prescribed antiepileptic drug (AED) at home, the nurse will include which instruction? a. "Driving is allowed after 2 weeks of therapy." b. "If seizures recur, take a double dose of the medication." c. "Antacids can be taken with the AED to reduce gastrointestinal adverse effects." d. "Regular, consistent dosing is important for successful treatment."

d. "Regular, consistent dosing is important for successful treatment."

During a routine appointment, a patient with a history of seizures is found to have a phenytoin (Dilantin) level of 23 mcg/mL. What concern will the nurse have, if any? a. The patient is at risk for seizures because the drug level is not at a therapeutic level. b. The patient's seizures should be under control because this is a therapeutic drug level. c. The patient's seizures should be under control if she is also taking a second antiepileptic drug. d. The drug level is at a toxic level, and the dosage needs to be reduced.

d. The drug level is at a toxic level, and the dosage needs to be reduced.

A patient has experienced insomnia for months, and the physician has prescribed a medication to help with this problem. The nurse expects which drug to be used for long-term treatment of insomnia? a. secobarbital (Seconal), a barbiturate b. diazepam (Valium), a benzodiazepine c. midazolam (Versed), a benzodiazepine d. eszopiclone (Lunesta), a nonbenzodiazepine sleep aid

d. eszopiclone (Lunesta), a nonbenzodiazepine sleep aid

A 22-year-old patient has been taking lithium for 1 year, and the most recent lithium level is 0.9 mEq/L. Which statement about the laboratory result is correct? a. The lithium level is therapeutic. b. The lithium level is too low. c. The lithium level is too high. d. Lithium is not usually monitored with blood levels.

ANS: A Desirable long-term maintenance lithium levels range between 0.6 and 1.2 mEq/L. The other responses are incorrect.

During a teaching session about self-monitoring while taking a beta blocker at home, the nurse has taught the patient to take his apical pulse daily for 1 minute. If the pulse rate decreases to less than 60 beats per minute, the nurse will instruct the patient to: a. notify his prescriber. b. reduce the dose of his beta blocker by half. c. continue the medication because this is an expected effect. d. skip the medication dose that day, and check his pulse again the next day

ANS: A Cardiac depression can occur with beta blockers; instruct the patient to contact his prescriber if his pulse rate decreases to less than 60 per minute. The medication dose may need to be changed, but it is not appropriate for the nurse to change the dosage. The other options are incorrect

Before a patient receives triptans for the treatment of migraines, the nurse will assess for the presence of which condition, which is a contraindication if present? a. Hypotension b. Renal disease c. Liver damage d. Cardiovascular disease

ANS: D Triptans are contraindicated in patients with serious cardiovascular disease because of the vasoconstrictive potential of these medications. The other options are incorrect

A patient has been receiving epoetin alfa (Epogen) for severe iron-deficiency anemia. Today, the provider changed the order to darbepoetin (Aranesp). The patient questions the nurse, "What is the difference in these drugs?" Which response by the nurse is correct? a."There is no difference in these two drugs." b."Aranesp works faster than Epogen to raise your red blood cell count." c."Aranesp is given by mouth, so you will not need to have injections." d."Aranesp is a longer-acting form, so you will receive fewer injections."

ANS: DDarbepoetin (Aranesp) is longer-acting than epoetin alfa (Epogen); therefore, fewer injections are required. The other options are incorrect.

The U.S. Food and Drug Administration has issued a warning for users of antiepileptic drugs. Based on this report, the nurse will monitor for which potential problems with this class of drugs? a. Increased risk of suicidal thoughts and behaviors b. Signs of bone marrow depression c. Indications of drug addiction and dependency d. Increased risk of cardiovascular events, such as strokes

a. Increased risk of suicidal thoughts and behaviors

A patient is taking gabapentin (Neurontin), and the nurse notes that there is no history of seizures on his medical record. What is the best possible rationale for this medication order? a. The medication is used for the treatment of neuropathic pain. b. The medication is helpful for the treatment of multiple sclerosis. c. The medication is used to reduce the symptoms of Parkinson's disease. d. The medical record is missing the correct information about the patient's history of seizures.

a. The medication is used for the treatment of neuropathic pain.

Phenytoin (Dilantin) has a narrow therapeutic index. The nurse recognizes that this characteristic means that a. the safe and the toxic plasma levels of the drug are very close to each other. b. phenytoin has a low chance of being effective. c. there is no difference between safe and toxic plasma levels. d. a very small dosage can result in the desired therapeutic effect.

a. the safe and the toxic plasma levels of the drug are very close to each other.