winter break review

The nurse is caring for a patient diagnosed with gout who has elevated uric acid levels. Which medication will likely be administered? a. Allopurinol (Zyloprim) b. Disulfiram (Antabuse) c. Lactulose (Cephulac) d. Memantine (Namenda)

ANS: A Allopurinol blocks the terminal step in uric acid formation by inhibiting the enzyme xanthine oxidase.

Which medication is contraindicated when a patient is taking warfarin (Coumadin)? a. Aspirin b. Acetaminophen (Tylenol) c. Propoxyphene (Darvon) d. Morphine (Roxanol)

ANS: A Salicylates enhance the anticoagulant effect of warfarin and increase the risk of bleeding

The nurse transcribes a new order for a daily diuretic on a patient diagnosed with congestive heart failure. The nurse will schedule this medication: a. in the morning. b. after lunch. c. with dinner. d. at bedtime.

ANS: A diuretics should not be taken at night to avoid frequent awakenings from nocturia

What is the advantage of taking a nonsteroidal anti inflammatory drug (NSAID) that is a COX 2 inhibitor? a. The medication is cheaper than aspirin. b. There are fewer GI adverse effects. c. They are more effective than COX 1 inhibitors. d. They have no known adverse effects.

ANS: B COX 2 inhibitor NSAIDs have fewer GI adverse effects than salicylates or COX 1 inhibitors. Aspirin is one of the least expensive analgesics available. The anti inflammatory actions of NSAIDs are caused by COX 2 inhibition; the unwanted adverse effects are caused by inhibition of COX 1.

The nurse monitors a patient receiving digoxin closely for toxicity when which other medication is prescribed? a. Potassium supplements b. Furosemide (Lasix) c. Acetylsalicylic acid (aspirin) d. Antibiotics

ANS: B Furosemide is a potassium depleting diuretic. Low potassium levels potentiate digoxin toxicity.

Which of the following nursing actions included in the plan of care for a patient with cirrhosis can the RN delegate to nursing assistive personnel? a. Assessing the patient for jaundice b. Providing oral hygiene before meals c. Palpating the abdomen for distention d. Assisting the patient in choosing the diet

ANS: B Providing oral hygiene is included in the education and scope of practice of nursing assistants. Assessments and assisting patients to choose therapeutic diets are nursing actions that require higher-level nursing education and scope of practice and would be delegated to LPNs/LVNs or RNs.

Which patient is at highest risk for obstructive sleep apnea (OSA)? a. 82-yr-old man with Parkinson's disease who has dysphagia b. 68-yr-old obese man who smokes one pack of cigarettes per day c. 18-yr-old woman with cystic fibrosis who has recurrent pneumonia d. 35-yr-old woman with a BMI of 22 kg/m2 who has seasonal allergies to pollen

ANS: B Risk of OSA increases with obesity (BMI >30 kg/m2), age older than 65 years, neck circumference greater than 17 inches, craniofacial abnormalities, and acromegaly. Smokers are more at risk for OSA

A patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix) has a serum potassium level of 3.2 mEq/L (3.2 mmol/L). Which action should the nurse take? a. Give both drugs as scheduled. b. Administer the spironolactone. c. Administer the furosemide and withhold the spironolactone. d. Withhold both drugs until talking with the health care provider.

ANS: B Spironolactone is a potassium-sparing diuretic and will help to increase the patients potassium level. Normal K+ levels are 3.5-5.0

An 86 year old patient who was admitted with GI bleeding as a result of salicylate therapy is being discharged. As the nurse reviews the discharge medication list, the patient states that she doesnt understand why Tylenol doesnt work as well as the aspirin she had been taking. What would be the nurses best response? a. Tylenol and aspirin are chemically the same drug. b. Tylenol is appropriate for only minor pain. c. Tylenol does not help with inflammatory discomfort. d. A therapeutic blood level must be established with Tylenol.

ANS: C Acetaminophen (Tylenol) is effective as an analgesic or antipyretic. Tylenol does not possess any anti inflammatory activity and is therefore ineffective in relieving symptoms related to inflammation.

Which drug will be administered to a patient being admitted with severe digoxin intoxication? a. Amiodarone (Cordarone) b. Spironolactone (Aldactone) c. Digoxin immune Fab (Digibind) d. Digitalis glycoside

ANS: C The antidote for digoxin intoxication is digoxin immune Fab (Digibind)

Why are statins, or HMG CoA reductase inhibitors, administered at bedtime? a. The stomach is empty. b. Metabolic needs of the body are decreased. c. Cholesterol production is at its peak. d. The body temperature is increased.

ANS: C The peak production of cholesterol is during the night. Therefore, HMG CoA reductase inhibitors are more effective when administered at bedtime.

A student asks the pharmacology instructor to explain the action of anticholinergic agents. What would be the instructors best response? A) They block nicotinic receptors. B) They compete with serotonin for muscarinic acetylcholine receptor sites. C) They act to block the effects of the parasympathetic nervous system. D) They increase norepinephrine at the neuromuscular junction.

ANS: C. Drugs that are used to block the effects of acetylcholine are called anticholinergic drugs. Because this action lyses, or blocks, the effects of the parasympathetic nervous system, they are also called parasympatholytic agents.

Which lipoprotein contributes to the development of atherosclerosis? a. Chylomicrons b. Very-low-density lipoprotein (VLDL) c. Low-density lipoprotein chylomicron (LDL C) d. High-density lipoprotein chylomicron (HDL C)

ANS: C. LDL-C

In which case would the nurse be correct in withholding an opiate agonist? a. Evidence of postural hypotension b. Presence of constipation c. Pain rating of 7 on a 0 to 10 scale d. Respiratory rate of 10 breaths/min

ANS: D The nurse would withhold the medication if respirations are less than 12 breaths/min, because opioids can cause respiratory depression

Which action will the nurse take when a patient receiving morphine sulfate via percutaneous coronary angioplasty (PCA) has a shallow, irregular respiratory rate of 6 breaths/min? a. Elevate the patients head of bed to facilitate lung expansion. b. Increase the patients primary intravenous (IV) flow rate. c. Complete the FLACC scale. d. Notify the health care provider and prepare to administer naloxone (Narcan).

ANS: D The patient is exhibiting signs of respiratory depression. Administration of the antidote naloxone would be the most appropriate nursing intervention.

A patient who was admitted with acute bleeding from esophageal varices asks the nurse the purpose for the ordered ranitidine (Zantac). Which response by the nurse is most appropriate? a. The medication will reduce the risk for aspiration. b. The medication will decrease nausea and anorexia. c. The medication will inhibit the development of gastric ulcers. d. The medication will prevent irritation to the esophageal varices.

ANS: D The therapeutic action of H2 receptor blockers in patients with esophageal varices is to prevent irritation and bleeding from the varices caused by reflux of acid gastric contents. Although ranitidine does decrease the risk for peptic ulcers, reduce nausea, and help prevent aspiration pneumonia, these are not the primary purpose for H2 receptor blockade in this patient.

The nurse administers atropine preoperatively for what purpose? A) Providing sedation B) Dilating the pupils C) Relaxing bladder muscles D) Decreasing secretions

Ans : D. decreasing secretions. atropine is a anticholinergic (parasympatholytic)

A high school student starts vomiting and goes to see the school nurse. The student asks the nurse what part of his brain makes him vomit. What area of the brain will the nurse tell the student must be stimulated for vomiting to occur? A) Chemoreceptor trigger zone (CTZ) B) Forebrain C) Hypothalamus D) Thalamus

Ans: A. CTZ

What does parasympathetic nervous system blockade cause? (Select all that apply.) A) Decrease in heart rate B) Decrease in urinary bladder tone C) Increase in heart rate D) Pupil constriction E) Decrease in gastrointestinal (GI) activity

Ans: B, C, E parasympathetic = rest and digest

Anticholinergic drugs are used in ophthalmology because they produce what effect? A) Sedation B) Pupil dilation C) Pupil constriction D) Decreased lacrimal secretions

Ans: B. Anticholinergic = parasympatholytic

A patient is brought to the emergency department having a cholinergic reaction, which includes a severe drop in blood pressure. What drug will the nurse expect to administer? A) Atropine (generic) B) Edrophonium (Enlon, Reversol) C) Propranolol (Inderal) D) Succinylcholine (Anectine)

Ans: A Feedback: The antidote for a cholinergic reaction is atropine.

A nurse is writing a plan of care for a patient who is taking bethanechol (Urecholine). What would be an appropriate outcome for this patient? A) Pupillary dilation B) Increased blood pressure C) Improved bladder function D) Decreased secretions

Ans: C Feedback: Bethanechol is prescribed for nonobstructive urinary retention and neurogenic bladder. The appropriate outcome for this patient would be improved bladder function.

A nurse is teaching a client who has Raynaud's disease. Which of the following information should the nurse include in the teaching? a. Protect against the cold by wearing layers of clothing. b. Begin an exercise program of 2 mile walks per week c. Increase vitamin A in the diet d. Elevate the hands above heart level when resting

a. Protect against the cold by wearing layers of clothing.

A patient with hepatitis B surface antigen (HBsAg) present in the serum is being discharged with pain medication after knee surgery. Which medication order should the nurse question? a. Tramadol b. Hydromorphone (Dilaudid) c. Oxycodone with aspirin (Percodan) d. Hydrocodone with acetaminophen

d. Hydrocodone with acetaminophen