All of Pharmacology Test (part 2)

Which findings in a patient with heart failure would warrant that the nurse not administer digoxin and notify the prescriber? A. Digoxin 2.4 ng/mL B. Potassium 5.3 mEq/dL C. Heart Rate: 100 bpm D. Blood pressure 100/76 mm Hg

A Feedback: "Digoxin 2.4 ng/mL"is correct. Digoxin has a narrow therapeutic range: Drug levels only slightly higher than therapeutic greatly increase the risk of toxicity. f Digoxin levels are kept within the optimal therapeutic range—now considered to be 0.5 to 0.8 ng/mL. (Lehne Ch 48, pg 526)

Which nursing diagnosis has the highest priority for an older adult patient who has received a first-generation antipsychotic? A. Risk for falls B. Risk for infection C. Risk for acute confusion D. Sleep pattern disturbance

Answer Key: A Feedback: First-generation antipsychotic agents commonly produce sedation in the early days of treatment. This can pose a risk for the older adult. In addition, these agents can cause orthostatic hypotension, further increasing the risk for falls. The nurse should teach the patient to rise slowly and to be careful of these effects.

A patient is being started on nicotinic acid [Niaspan] to increase HDL levels. The nurse is providing patient education and should include teaching about which adverse effects? [Select all that apply]. A. Facial flushing B. Gastric upset C. Itching D. Gout

A, B, C, D Feedback: Facial flushing, gout, gastric upset, and Itching are correct. The most frequent adverse reactions involve the skin (flushing, itching) and GI tract (gastric upset, nausea, vomiting, diarrhea). Intense flushing of the face, neck, and ears. Patient with gout should exercise caution when taking the medication as Niaspan can elevate blood levels of uric acid. (Lehne Ch 50, pg 572)

What is the priority nursing action when caring for a client receiving nitroglycerin for the treatment of angina? A. Asking the client to sit or stand slowly B. Monitoring the client's urine output frequently C. Advising the client to report when experiencing a headache D. Advising the client to report if his heart races after taking nitroglycerine.

Answer Key: A

You are asked to educate the parents of a pediatric patient about the use of methylphenidate [Ritalin]. You are sure to mention some of the possible adverse effects that are associated with this drug and you include which of the following: [select all that apply] A. respiratory depression B. loquaciousness C. insomnia D. convulsions

Answer Key: B, C Feedback: Adverse effects of Methylphenidate include CNS stimulation (insomnia, reduced appetite, emotional lability and extreme loquaciousness. (Lehne ch 36, pg 396 and 397)

It is a priority to assess if a male patient has taken sildenafil [Viagra] within the past 24 hours if the nurse is preparing to administer which medication? A. Cimetidine [Tagamet] B. Doxazosin [Cardura] C. Finasteride [Proscar] D. sodium nitroprusside [Nitropress]

Answer Key: D Feedback: "sodium nitroprusside [Nitropress]"is correct. Nitropress is a vasodilator and when combined with viagra it can lead to life-threatening hypotension. (Lehne ch 66, pg 799)

In the treatment of benign prostatic hyperplasia (BPH), the therapeutic effect of 5-alpha-reductase inhibitors results in the reduction of _____ obstruction, while alpha1-adrenergic antagonists result in the reduction of _____ obstruction.

Answer Key: mechanical, dynamic Feedback: The 5-alpha-reductase inhibitors are most appropriate for men with very large prostates (mechanical obstruction), whereas alpha blockers are preferred for men with relatively small prostates (dynamic obstruction). (Lehne ch 105, pg 801) *think 5 mechanics, & 1D aka 1 direction*

After an intramuscular injection of penicillin, a patient develops severe difficulty breathing and a swollen tongue. Which medication should the nurse prepare to administer? Dopamine [Inotropin] Epinephrine [Adrenalin] Norepinephrine [Levophed] Pseudoephedrine [Sudafed]

Answer: B Rationale: Epinephrine is the drug of choice for patients in anaphylactic shock. Activates beta 2 receptors which are only activated by epi to cause bronchodilation

A patient is receiving dopamine [Inotropin] for the treatment of shock. What would indicate to the nurse that the medication is effective? Decreased mean arterial pressure Gain of 2 kg in 24 hours Increased heart rate Increased urine output

Answer: D Rationale: Dopamine is used for the treatment of shock. Improved clinical status will best be monitored by assessing the patient's urine output. Dopamine will dilate renal blood vessels, improve renal perfusion, and increase urine output. DA increases perfusion to kidneys so u will see increased urine output

A nurse is reviewing a patient's medications and realizes that gemfibrozil [Lopid] and warfarin [Coumadin] are to be administered concomitantly. Which effect will the nurse anticipate in this patient? A. Increased levels of gemfibrozil B. Increased anticoagulant effects C. Decreased levels of gemfibrozil D. Reduced anticoagulant effects

B Feedback: "Increased anticoagulant effects" is correct. Fibrates such as Gemfibrozil can increase the risk of bleeding in patients taking warfarin (an anticoagulant). (Lehne Ch 50, pg 574)

A female patient taking has been taking captopril [Capoten] and learns that she is pregnant. What will the nurse tell this patient? A. The fetus must be monitored closely while the patient is taking this drug. B. The patient should stop taking the medication and contact her provider immediately. C. he fetus most likely will have serious congenital defects. D. The patient's prescriber probably will change her medication to an ARB.

B Feedback: "The patient should stop taking the medication and contact her provider immediately" is correct. The use of ACE inhibitors during the second and third trimesters of pregnancy can injure the developing fetus. Women who become pregnant while using ACE inhibitors should discontinue treatment as soon as possible. Infants who have been exposed to ACE inhibitors during the second or third trimester should be closely monitored for hypotension, oliguria, and hyperkalemia. (Lehne ch 44, pg 476)

A nurse is providing discharge teaching instructions for a patient taking colesevelam [Welchol]. Which statement made by the patient demonstrates a need for further teaching? A. "I will take warfarin [Coumadin] 1 hour before the colesevelam." B. "I will increase the fluids and fiber in my diet." C. "I can take the colesevelam with my hydrochlorothiazide." D. "I can take my digoxin 4 hours after taking the colesevelam."

C Feedback: "I can take colesevelam with my hydrochlorothiazide" is the correct answer. The bile-acid sequestrants can form insoluble complexes with other drugs. Medications that undergo binding cannot be absorbed, and hence are not available for systemic effects. Drugs known to form complexes with the sequestrants include thiazide diuretics, digoxin, warfarin, and some antibiotics. (Lehne Ch 50, pg 573)

A client is admitted to the cardiac care unit with an anterior lateral myocardial infarction. The healthcare provider prescribes 500 mL of D5W with 50 mg of nitroglycerin to be administered intravenously to relieve pain. The nurse should assess for which common side effect of this medication? A. Nausea B. Syncope C. Bradycardia D. Hypotension

D

Which of the following is not an FDA approved use for hormone therapy among menopausal/postmenopausal women? A. Relief of vasomotor symptoms B. Maintenance urogenitary tissue and function C. Prevention of bone mass density D. Protective cardiovascular effect

D

Match the following mechanism of action with the appropriate laxative: 1. Psyllium [Metamucil] 2. Docusate sodium [Colace] 3. Biscodyl [Dulcolax] 4. Milk of Magnesia (MOM) A. swells with water to form a gel to soften and increase fecal mass. B. salts that draws water into the intestine to soften stool and stimulate peristalsis C. lowers surface tension to promote penetration of water into the stool D. stimulates peristalsis and increases water in the intestine

Psyllium [Metamucil]: swells with water to form a gel to soften and increase fecal mass. Docusate sodium [Colace]: lowers surface tension to promote penetration of water into the stool Biscodyl [Dulcolax]: stimulates peristalsis and increases water in the intestine Milk of Magnesia (MOM) salts that draws water into the intestine to soften stool and stimulate peristalsis

The mechanism of action of sildenafil [Viagra] is best described as the selective ____________ of PDE5 which preserves and ____________ cGMP levels to prolong erection. A. Inhibition, increases B. Degradation, decreases C. Destruction, decreases D. Reuptake, increases

Answer Key: A Feedback: "Inhibition, increases" is correct. Sildenafil causes selective inhibition of PDE5. By doing so, it increases and preserves cGMP levels in the penis, thereby making the erection harder and more long-lasting. (Lehne ch 66, pg 797)

A nurse is teaching a client about tricyclic antidepressants. Which potential side effects should the nurse include? [SELECT ALL THAT APPLY] A. Dry mouth B. Sedation C. Constipation D. Severe hypertension E. Orthostatic hypotension

Answer Key: A, B, C, E Feedback: "Severe hypertension" is not an adverse effect of TCAs. Adverse effects of Tricyclic antidepressants (TCAs) are orthostatic hypotension, sedation, anticholinergic effects (dry mouth, urinary retention, constipation), and weight gain (secondary to improved appetite). (Lehne Ch 22: pg 194, Ch29: pg 297)

Propranolol and metoprolol are in the same drug class and are similar in several ways. Which of the following represents these similarities? [Select all that apply] A. Decreased renin release. B. Decreased force of contraction C. Inhibition of glycogenolysis. D. Decreased heart rate.

Answer Key: A, B, D Feedback: "Inhibition of glycogenolysis is the only way these drugs are not similar. In contrast to propranolol, metoprolol causes minimal bronchoconstriction and does not interfere with beta2-mediated glycogenolysis. since metoprolol does not suppress beta2-mediated glycogenolysis, it can be used more safely than propranolol by patients with diabetes. (Lehne Ch 18, pg 164)

Which of the following drugs, when added to digoxin, would cause you to be concerned about an increased risk of digoxin toxicity? A. Spironolactone. B. Hydrochlorothiazide. C. Clonidine. D. Captopril

Answer Key: B Feedback: "Hydrochlorothiazide" is correct. The principal adverse effect of the thiazides such as hydrochlorothiazide is hypokalemia, which increases the risk of digoxin-induced dysrhythmias. (Lehne Ch 48, pg 520)

The nurse is aware that an older adult patient is at risk for which problem when prescribed tolteroldine (Detrol), an known anticholinergic drug. A. Impaired skin integrity. B. Disturbed vision. C. Diarrhea. D. Fluid volume deficit.

Answer Key: B Feedback: Disturbed Vision is correct. Tolterodine [Detrol] is a nonselective muscarinic antagonist. Muscarinic receptors on the iris sphincter cause mydriasis (dilation of the pupil). Classic adverse effects of anticholinergic drugs are dry mouth, blurred vision, photophobia, tachycardia, urinary retention, constipation, and anhidrosis (suppression of sweating).( Lehne ch 14, pg 123 & 125)

A patient is admitted with severe hypertensive crisis. The nurse will anticipate administering which medication? A. Sodium nitroprusside [Nitropress] B. Losartan [Cozaar] C. Verapamil [Calan] D. Captopril [Capoten]

A Feedback: "Sodium nitroprusside [Nitropress] IV" is correct. Sodium nitroprusside is potent and efficacious and acts faster than any other vasodilator available. Nitroprusside is a drug of choice for hypertensive emergencies and is administered via IV, with effect beginning immediately. (Lehne Ch 46, pg 497)

A primary healthcare provider prescribes 0.25 mg of diazepam [Valium] by mouth three times a day for a client with anxiety and physical symptoms related to work pressures. The nurse will educate the patient about which common side effect? A. Drowsiness B. Bradycardia C. Agranulocytosis D. Tardive dyskinesia

Answer Key: A Feedback: Diazepam, a benzodiazepine, potentiates the actions of gamma-aminobutyric acid, enhances presympathetic inhibition, and inhibits spinal polysynaptic afferent pathways. Drowsiness, dizziness, and blurred vision are common side effects. Diazepam may cause tachycardia, not bradycardia. Agranulocytosis is usually a side effect of the antipsychotics in the phenothiazine, not the benzodiazepine, group. Tardive dyskinesia occurs after prolonged therapy with antipsychotic medications; diazepam is an antianxiety medication, not an antipsychotic.

An antidepressant is prescribed for a depressed older adult client. After 1 week the client's son expresses concern that there does not seem to be much improvement. How should the nurse respond? A. "Antidepressant therapy requires several weeks before it becomes effective." B. "Antidepressant therapy will be more effective as the physical condition improves." C. "Additional medications may be required before behavioral changes will be observed." D. "Additional time is needed for the medication to become effective because of the prolonged depression."

Answer Key: A Feedback: "Antidepressant therapy requires several weeks before it becomes effective." Is Correct. Once a drug has been selected for initial treatment of depression, it should be used for 4 to 8 weeks to assess efficacy. (Lehne Ch 31, pg 341)

An infant has severe contact diaper dermatitis. The provider orders a topical glucocorticoid cream, triamcinolone acetonide [Kenalog] 0.1%, to be applied 3 times daily. When teaching the infant's parents about this medication, the nurse will instruct them to: A. Apply a thin layer and leave the diaper open as much as possible. B. Apply a thick layer and massage the cream into the skin. C. Apply the cream and place an occlusive dressing over the area. D. Apply the cream and put the infant's diaper on tightly.

Answer Key: A Feedback: "Apply a thin layer and leave the diaper open as much as possible." Is correct. Topical glucocorticoids should be applied in a thin film and gently rubbed into the skin. Occlusive dressings should not be used since it can lead to systemic toxicity. In infants, diaper and plastic pants can act as occlusive dressings, as a result, the diaper should be left open or not worn when glucocorticoids are applied. (Lehne Ch 105, pg 1279)

A nurse is discussing how beta blockers work to decrease blood pressure with a nursing student. Which statement by the student indicates an understanding of the effects of beta blockers on the cardiovascular system? A. "Beta blockers decrease heart rate and contractility." B. "Beta blockers increase peripheral vascular resistance." C. "Beta blockers prevent the release of angiotensin." D. "Beta blockers increase the actions of angiotensin II."

Answer Key: A Feedback: "Beta blockers decrease heart rate and contractility." is correct. Beta-blockers works on the cardiovascular system by decreasing heart rate, AV conduction, and contractility, therefore lowering blood pressure (Lehne ch 45, pg 488)

A patient who has been taking an SSRI tells the nurse that the drug has caused reduced sexual performance, weight gain, and sedation. The nurse will suggest that the patient ask the provider about using which drug? A. Bupropion [Wellbutrin] B. Imipramine [Tofranil] C. Isocarboxazid [Marplan] D. Trazodone [Oleptro]

Answer Key: A Feedback: "Bupropion [Wellbutrin]" is correct. In contrast to SSRIs, bupropion does not cause weight gain or sexual dysfunction. In fact, it appears to increase sexual desire and pleasure, so bupropion has been used to counteract sexual dysfunction in patients taking SSRIs and heighten sexual interest in women with hypoactive sexual desire disorder. (Lehne Ch 32, pg 356)

You are teaching a fellow classmate about the possible adverse effects of levodopa. Which of the following would not be included in your teaching? A. constipation B. Postural hypotension C. Nausea/vomiting D. Insomnia/nightmares

Answer Key: A Feedback: "Constipation," is correct. Adverse effects of levodopa involves the following: nausea and vomiting, postural hypotension, insomnia, nighmares, psychosis, darken sweat and urine, to name a few. (Lehne Ch 21, pg 179)

Which answer best describes the mechanism of action of Finasteride [Proscar]? A. Finasteride inhibits the conversion of testosterone to dihydrotestosterone to stop the growth of epithelial cells in the prostate. B. Finasteride inhibits phosphodiesterase 5 to preserve the levels of cGMP. C. Finasteride acts on the receptors of the smooth muscles of the bladder neck. D. Finasteride binds with a hormonal complex inside the cell to promote synthesis of mRNA.

Answer Key: A Feedback: "Finasteride inhibits the conversion of testosterone to dihydrotestosterone to stop the growth of epithelial cells in the prostate." Is correct. Finasteride acts in reproductive tissue to inhibit 5-alpha reductase, an enzyme that converts testosterone to dihydrotestosterone (DHT), the active form of testosterone in the prostate. Treatment reduces levels of DHT in blood by 70%. By decreasing DHT availability, finasteride promotes regression of prostate epithelial tissue, and thereby decreases mechanical obstruction of the urethra. (Lehne ch 66, pg 802)

A provider has ordered captopril [Capoten] for a patient who has hypertension. The patient reports a history of swelling of the tongue and lips after taking enalapril [Vasotec] in the past. Which action by the nurse is correct? A. Hold the dose and notify the provider. B. Request an order to administer fosinopril instead of captopril. C. Administer the captopril and monitor for adverse effects. D. Reassure the patient that this is not a serious side effect

Answer Key: A Feedback: "Hold the dose and notify the provider." Is correct. Captopril and Enalapril are both ACE Inhibitors and have adverse effects which includes angioedema. Since the patient experienced this adverse effect in the past, the patient might need a different prescription. (Lehne Ch 47, pg 508)

Which statement by the client indicates to the nurse that the teaching about taking an antidepressant medication has been understood? A. "I need to take every dose of my medication as prescribed." B. "I need to discontinue the medication if I have side effects." C. "I don't have to be concerned about taking my medications." D. "I can double the dose of the medication if I still feel depressed."

Answer Key: A Feedback: "I need to take every dose of my medication as prescribed." Is Correct. Once a drug has been selected for initial treatment, it should be used for 4 to 8 weeks to assess efficacy. With all antidepressants, symptoms resolve slowly. Initial responses develop in 1 to 3 weeks. Maximal responses may not be seen until 12 weeks. Because therapeutic effects are delayed, antidepressants cannot be used PRN. Patients should be encouraged to take their drugs even if they are symptom free, and hence feel that continued dosing is unnecessary. (Lehne Ch 32, pg 341)

A patient has taken carbidopa/levodopa [Sinemet] for Parkinson's disease for 2 weeks but reports little improvement in the symptoms. Which response by the nurse is correct? A. "It may take up to 3 months for a full response to occur." B. "Double the dose to see whether an effect occurs." C. "Let's talk to the prescriber about another agent to manage your symptoms." D. "Take the medication with a large meal."

Answer Key: A Feedback: "It may take up to 3 months for a full response to occur," is correct. With Sinemet, it can take weeks to months for the patient to experience any therapeutic effects. As a result, patients should not expect immediate improvement. Rather, they should be informed that beneficial effects are likely to increase steadily over the first few months. (Lehne Ch 21, pgs 178 &189)

A patient in the emergency department is given intravenous diazepam [Valium] for seizures. When the seizures stop, the nurse notes that the patient is lethargic and confused and has a respiratory rate of 8 breaths per minute. The nurse will do which of the following? A. Provide respiratory support B. Order toxicology testing C. Administer naloxone [Narcan] D. Administer a gastric lavage

Answer Key: A Feedback: "Provide respiratory support" is correct Respiratory depression with oral therapy is rare, but benzodiazepines can cause severe respiratory depression when administered intravenously. Therefore respiratory support is indicated. (Lehne Ch 34, pg 376)

A 75 year old male who has recently been diagnosed with benign prostatic hyperplasia is given a new prescription for an alpha1-adrenergic antagonist. In reviewing his chart, you would be least concerned about which of the following: A. SD recently finished taking 10 days of erythromycin. B. SD takes nitroglycerin PRN. C. SD is scheduled for cataract surgery next month. D. SD currently takes an antihypertensive drug each day.

Answer Key: A Feedback: "SD recently finished taking 10 days of erythromycin." Is correct. Caution should be taken in patients who are using vasodilators such as Nitroglycerin and other hypotensive medications because they can lead to excessive hypotension when combined with Alpha1-Adrenergic Antagonists. For men undergoing cataract surgery, alpha blockade increases the risk of intraoperative floppy-iris syndrome, which can increase postoperative pain, delay recovery, and reduce the hoped-for improvement in visual acuity. In severe cases, blindness can occur. (Lehne ch 66, pg 803)

A patient has been followed by her primary care provider for treatment of depression for the past 4 months and has been doing well on fluoxetine [Prozac]. However, one issue arises during her visit that provides a clue that she's experiencing a common side effect of fluoxetine. Which is it? A. She has gained about 7 pounds. B. She has a resting tremor. C. She states that she has a pounding headache after she drinks red wine. D. She describes frequent constipation.

Answer Key: A Feedback: "She has gained about 7 pounds" is correct. The most common side effects of Prozac are sexual dysfunction, nausea, headache, and manifestations of CNS stimulation, including nervousness, insomnia, and anxiety. Weight gain can also occur. (Lehne Ch 32, pg 344)

The nurse instructs a young adult patient about triazolam [Halcion], an oral benzodiazepine, for the short-term management of anxiety. Which statement, if made by the patient, indicates an understanding of the instructions? A. "Taken as directed, the medication will not affect my breathing." B. "I can safely drink wine while taking this drug." C. "My chance of addiction to this drug is high." D. "This drug is safe to use if I am pregnant."

Answer Key: A Feedback: "Taken as directed, the medication will not affect my breathing" is correct. Benzodiazepines are weak respiratory depressants. Death from overdose with oral benzodiazepines alone has never been documented. Although respiratory depression with oral therapy is rare, benzodiazepines can cause severe respiratory depression when administered intravenously. In addition, substantial respiratory depression can result from combining oral benzodiazepines with other CNS depressants (eg, alcohol, barbiturates, opioids). Patients should be advised to take Triazolam as directed (Lehne Ch 34, pg 376)

A client takes nitroglycerine routinely for angina. The client states, "I would like to start taking sildenafil (Viagra) for erectile dysfunction but I was told I can't because it would be dangerous." You correctly explain that: A. "These drugs use the same mechanism to promote vasodilation increasing the risk for severe hypotension." B. "Nitroglycerine counteracts the effect of sildenafil making it ineffective." C. "You were given incorrect information. It is safe to use these drugs together if they are taken separately." D. "Sildenafil increases the metabolism of nitrates making it ineffective for angina."

Answer Key: A Feedback: "These drugs use the same mechanism to promote vasodilation increasing the risk for severe hypotension." Is correct, nitroglycerine promote hypotension, by increasing cGMP. If nitroglycerine and viagra are combined, life-threatening hypotension could result. Therefore, Viagra is absolutely contraindicated for men taking nitrates.(Lehne ch 66, pg 799)

A nurse is caring for several clients who have severe psychiatric disorders. The nurse knows that the primary reason that a health care provider prescribes an antipsychotic medication for these clients is: A. To reduce the symptoms of psychosis B. To promote social skills C. To improve judgment D. To diminish neurotic behavior

Answer Key: A Feedback: "To reduce the symptoms of psychosis" is correct. The antipsychotic agents are a chemically diverse group of compounds used for a broad spectrum of psychotic disorders. Specific indications include schizophrenia, delusional disorders, bipolar disorder, depressive psychoses, and drug-induced psychoses. (Lehne Ch 31, pg 317)

You are asked to educate the parents of a young patient about the therapeutic benefits of methylphenidate [Ritalin]. They are very nervous about their child taking this medication because of some things they've read. While educating the parents, you would include all of the following except: A. "When stimulants are used for ADHD, there is an increased risk for drug abuse." B. "Stimulants like Ritalin will help reduce hyperactive behavior and impulsivity." C. "Ritalin will help increase your child's focus to be more productive." D. "Stimulants are the most effective treatment for ADHD and are quite safe."

Answer Key: A Feedback: "When stimulants are used for ADHD, there is an increased risk for drug abuse." Is correct. When using stimulants for treatment of true ADHD and in therapeutic doses, there is little potential for abuse. Use of stimulants by someone without ADHD can cause euphoria and lead to higher potential for abuse.

A patient newly diagnosed with PUD reports taking low-dose aspirin (ASA) for prevention of cardiovascular disease. The nurse learns that the patient drinks 1-2 cups of coffee each day and has a glass of wine with dinner 3 or 4 nights per week. The patient eats three meals a day. The nurse should counsel this patient to: A. change the meal pattern to five or six smaller meals per day. B. discontinue taking aspirin, because it can irritate the stomach. C. stop drinking wine or any other alcoholic beverage. D. switch to a decaffeinated coffee and reduce the number of servings.

Answer Key: A Feedback: "change the meal pattern to five or six smaller meals per day." is correct. Diet plays a minor role in ulcer management. The traditional "ulcer diet," consisting of bland foods together with milk or cream, does not accelerate healing. A change in eating pattern may be beneficial: Consumption of five or six small meals a day, rather than three larger ones, can reduce fluctuations in intragastric pH, and may thereby facilitate recovery. (Lehne Ch 78, pg 950)

When a patient with HF is prescribed digoxin and furosemide [Lasix], the nurse understands that he/she should carefully assess the patient for which early signs of digoxin toxicity? A. Blurred vision and nausea. B. Muscle spasms and convulsions. C. Bone pain and constipation. D. Diarrhea and muscle cramps.

Answer Key: A Feedback: Blurred vision and nausea is correct. Noncardiac adverse effects: Early toxicity= GI effects: anorexia, nausea, and vomiting Fatigue, muscle weakness Visual disturbances: Blurred vision, halos around dark objects, yellow-tinted vision. (Lecture #9, slides 14 & 15)

You are caring for a patient who reports a mild fever, sore throat and nasal congestion. You review the chart and see that the patient is taking clozapine [Clozaril]. It is a priority that the patient is assessed for which condition? A. Agranulocytosis B. Anticholinergic reactions C. Allergy to clozapine D. Failed antipsychotic therapy

Answer Key: A Feedback: Clozapine [Clozaril] can cause potentially fatal agranulocytosis. Regular blood tests are mandatory, and the drug should be reserved for patients who have not responded to other antipsychotics.

You are explaining the effects of estrogen therapy to a patient. Which effect mentioned by the patient indicates a need for additional teaching? A. Prevention of breast cancer B. Improvement of atrophic vaginitis C. Decrease in vasomotor symptoms

Answer Key: A Feedback: Estrogen therapy *increases the chances of breast cancer in women.* Estrogen therapy leads to *improvement* of *atrophic vaginitis, female hypogonadism, insufficient primary ovarian function, abnormal uterine bleeding, and severe vasomotor symptoms* in women. It is also used to treat prostate cancer.

A patient has been taking colesevelam [Welchol] for several weeks and complains of frequent constipation. What will the nurse recommend that the patient do to resolve this issue? A. Increase daily intake of fiber and fluids. B. Assure the patient that this is a transient side effect that will go away. C. Begin taking daily laxatives with the colesevelam. D. Discontinue the medication and notify the provider.

Answer Key: A Feedback: Increase daily intake of fiber and fluids is correct. Constipation is a common adverse effect of colesevelam [Welchol] and adverse effects are often limited to the GI tract. Constipation can be minimized by increasing dietary fiber and fluids. If necessary, a mild laxative may be used. (Lehne Ch 50, pg 572)

A patient has been taking a statin for about 1 year with good results, although she has not reached her LDL goal. Her primary care provider has added gemfibrozil [Lopid} to further decrease her LDLs. The nurse recognizes that this puts her at increased risk for which side effect? A. Myopathy. B. Renal toxicity. C. Hyperglycemia. D. Peripheral neuropathy

Answer Key: A Feedback: Myopathy is correct. Gemfibrozil and other fibrates increase the risk of statin-induced myopathy when used in combination with a statin. (Lehne Ch 50, pg 574)

You are shadowing a nurse on the oncology unit who is caring for a patient having an EKG. You look at a current reading of her heart activity and it looks like torsades de pointes. Looking at the patient's list of medications, you know this may be caused by which drug? A. Ondansetron B. Aprepitant C. Promethazine D. Dimenhydrinate

Answer Key: A Feedback: Ondansetron prolongs the QT interval and hence poses a risk of torsades de pointes, a potentially life-threatening dysrhythmia. The drug should not be given to patients with long QT syndrome, and should be used with caution in patients with electrolyte abnormalities, heart failure, or bradydysrhythmias, and in those taking other QT drugs. (Lehne Ch 80, pg 971)

You are teaching another student about a medication you administered during your clinicals today, prazosin [Minipress] (an alpha blocker). Which of the following statements does not reflect the copious amounts of time you spent studying this drug? A. It's safest to take the first dose in the morning." B. "Orthostatic hypotension is the most common adverse effect of this drug." C. "Patients may experience reflexive tachycardia while taking this drug." D. "The MOA of prazosin involves selective blockade of alpha 1 receptors, causing dilation of the arterioles and veins."

Answer Key: A Feedback: Prazosin (Minipress), our prototype, is a competitive antagonist that produces selective blockade of alpha1-adrenergic receptors and is used for hypertension. Adverse effects includes: orthostatic hypotension, reflex tachycardia, and nasal congestion. 1% of patients lose consciousness 30 to 60 minutes after receiving their initial prazosin dose. This "first-dose" effect is the result of severe postural hypotension, as a result, the first dose should be taken immediately before going to bed, not in the morning. (Lehne ch 18, pg 158)

Which answer best explains why medications such as haloperidol [Haldol] or other antipsychotics have a black box warning from the US FDA when it comes to use among elderly patients with dementia? A. Drugs in this category significantly increase the risk of death during treatment. B. These drugs cause increased memory loss, blindness, and slurred speech. C. These drugs causes depression and cardiac arrest in patients over 60 years old. D. These drugs cause severe nausea and vomiting increasing risk of dehydration.

Answer Key: A Feedback: Rationale:halperidol [Haldol] and other antipsychotic drugs (SGAs and FGAs) should not be used as a routine method to restrain elderly patients with dementia due to the significant increase in the risk of death related to cardiovascular function and pneumonia

Which of the following changes could theoretically happen in a patient when the parasympathetic system is inhibited using a pharmacological agent? A. Constriction of the pupil (miosis). B. Dry mouth (xerostomia). C. Reduction in heart rate. D. Increase in gastric motility.

Answer Key: B Feedback: Dry mouth (xerostomia) is correct. Blockade of muscarinic receptors on salivary glands can inhibit salivation, thereby causing dry mouth. (Lehne Ch 14, pg 117)

A patient tells the nurse that he is planning on stopping his clonidine [Catapres] because he has to constantly drink water. The nurse is most concerned about which possible adverse effect if the patient suddenly stops taking clonidine [Catapre]? A. Rebound hypertension B. Sedation C. Reflex tachycardia D. Xerostomia

Answer Key: A Feedback: Suddenly stopping Clonidine can lead to rebound hypertension. Rebound hypertension is characterized by a large increase in blood pressure occurring in response to abrupt clonidine withdrawal. This rare but serious reaction is caused by overactivity of the sympathetic nervous system, and can be accompanied by nervousness, tachycardia, and sweating. Rebound effects can be avoided by withdrawing clonidine slowly (over 2 to 4 days). (Lehne Ch 19, pg 168)

You are providing education for a patient who is starting a new prescription for conjugated estrogens [Premarin]. You would educate her about which effect most commonly associated with estrogen therapy? A. Nausea B. Dry skin C. Weight loss D. Higher-pitched voice

Answer Key: A Feedback: The most common undesirable effect of estrogen use is nausea. Photosensitivity may also occur with estrogen therapy. One common dermatologic effect of note is chloasma (patchy brown facial pigmentation), not dry skin. Weight loss and a higher-pitched voice are not caused by estrogen therapy.

Which of the following is a progestin-only form of contraception? [select all that apply] A. Depo-Provera B. Mirena IUD C. Nuva Ring D. Paragard IUD

Answer Key: A, B Feedback: Depo-Provera and Mirena IUD are correct. Progestin-only contraceptive methods include the levonorgestrel intrauterine system [Mirena], medroxyprogesterone acetate injection [Depo-Provera], the etonogestrel subdermal implant [Nexplanon], and the "minipill". (Lehne ch 62, pg 754)

You are caring for a patient newly diagnosed with Parkinson's Disease and explain that the pathology of the disease is related to dopamine depletion in the brain. The patient asks why he can't just take dopamine to replace the lost dopamine. You explain to the patient that: [Select all that apply] A. dopamine has a short half life and is inactivated quickly. B. dopamine is unable to cross the blood-brain-barrier. C. dopamine is converted to levodopa in the periphery. D. dopamine causes excessive nausea and vomiting.

Answer Key: A, B Feedback: There are two reasons why the patient can't just take dopamine. 1) Dopamine cannot cross the blood-brain barrier. Levodopa crosses the barrier by means of an active transport system, a system that does not transport dopamine. 2) Dopamine has such a short half-life in the blood that it would be impractical to use even if it could cross the blood-brain barrier. (Lehne Ch 21, pg 179)

When using topical glucocorticoids, you understand that the following increase the risk of adverse effects [Select all that apply]: A. potency B. a large surface area C. duration of use D. the time of day it's applied

Answer Key: A, B, C Feedback: Factors that increase the risk of adverse effects include the use of a high-potency glucocorticoid, an occlusive dressing, prolonged therapy, and application over a large area.Topical glucocorticoids can be absorbed into the systemic circulation. The extent of absorption is proportional to the duration of use and the surface area covered. (Lehne Ch 105, pg 1279)

Glucocorticoids (a.k.a. topical steroids) have a therapeutic effect on inflammation and swelling through which mechanism of action? [Select all that apply] A. Promotion of vasoconstriction. B. Suppression of prostaglandins and histamines. C. Decrease local tissue injury by preventing the infiltration of phagocytes. D. Promotion of vasodilation.

Answer Key: A, B, C Feedback: Glucocorticoids have a therapeutic effect on inflammation and swelling by inhibiting the synthesis of chemical mediators, suppressing infiltration of phagocytes to prevent the release of lysosomal enzymes to decrease tissue injury, and suppressing proliferation of lymphocytes to decrease immune response. The end result is reduced swelling, warmth, redness, and pain. (Lecture 25, slide #7)

Neuroleptic Malignant Syndrome (NMS) is a rare, but potentially fatal condition associated with first generation antipsychotics. Fatalities from NMS have dramatically decreased from 30% to 4% due to early identification and treatment. Which of the following are signs/symptoms of NMS? [Select all that apply] A. High fever. B. "Lead pipe" rigidity. C. Fluctuating blood pressure. D. Opisthotonus.

Answer Key: A, B, C Feedback: Opisthotonus is a hyperreflexive spasm associated with acute dystonia, an EPS that may result from use of first generation antipsychotics. High fever, "lead pipe" rigidity and labile blood pressures are signs of NMS that should be identified quickly and treated.

A 30-year-old male patient will begin a three-drug regimen to treat peptic ulcer disease. The regimen will consist of bismuth subsalicylate, tetracycline, and cimetidine [Tagamet]. The nurse will include which information when teaching this patient about this drug regimen? [SELECT ALL THAT APPLY] A. "Decreased libido, impotence, and gynecomastia may occur when taking cimetidine." B. "Central nervous system symptoms such as depression and confusion may occur with cimetidine." C. "Taking multiple antibiotics reduces the likelihood that H. pylori will develop resistance." D. "Cimetidine is taken to eradicate H. pylori."

Answer Key: A, B, C Feedback: The goal of drug therapy is to (1) alleviate symptoms, (2) promote healing, (3) prevent complications (hemorrhage, perforation, obstruction), and (4) prevent recurrence. drugs act in three basic ways to promote ulcer healing. Specifically, they can (1) eradicate H. pylori (antibiotics do this), (2) reduce gastric acidity (antisecretory agents, misoprostol, and antacids do this), and (3) enhance mucosal defenses (sucralfate and misoprostol do this). (Lehne Ch 78, pg 949) With Cimetidine, the drug can cause gynecomastia, reduced libido, and impotence—all of which reverse when dosing stops. (Lehne Ch 78, pg 952)

The nurse suspects serotonin syndrome in a client prescribed a SSRI for depression. Which assessment findings observed by the nurse help identify this syndrome [SELECT ALL THAT APPLY] A. sweating B. fever C. altered mental status D. incoordination

Answer Key: A, B, C, D Feedback: All the options are correct. By increasing serotonergic transmission in the brainstem and spinal cord, fluoxetine and other SSRIs can cause serotonin syndrome. This syndrome usually begins 2 to 72 hours after treatment onset. Signs and symptoms include altered mental status (agitation, confusion, disorientation, anxiety, hallucinations, poor concentration) as well as incoordination, myoclonus, hyperreflexia, excessive sweating, tremor, and fever. Deaths have occurred. (Lehne Ch 32, pg 345)

You are explaining the potential adverse effects of sildenafil [Viagra] to a patient. The patient demonstrates an understanding by which of the following statements? [Select all that apply] A. "I may experience a small decrease in blood pressure when taking Viagra." B. "Taking Viagra with grapefruit juice may prolong the effects of Viagra." C. "It is safe to take nitroglycerin and Viagra as long as they aren't taken simultaneously." D. "Some common side effects of Viagra are headache and flushing."

Answer Key: A, B, D Feedback: Adverse effects of Viagra include the following: hypotension, painful erection lasting more than 6 hours, irreversible blurring or loss of vision, sudden hearing loss, headache, flushing, and dyspepsia. Grapefruit juice inhibits CYP3A4, suppressing metabolism of sildenafil, thereby increasing its levels. (Lehne ch 66, 797 -799)

A patient with multiple warts on his feet has been prescribed a high concentration salicylic acid for treatment. Knowing that this topical agent is easily absorbed, you will educate the patient to look for and report which signs of salicylism? [Select all that apply] A. tinnitus B. hyperpnea C. striae D. psychological disturbances

Answer Key: A, B, D Feedback: Due to the patient's use of a high concentration of salicylic acid for treatment, nurses should be aware of the signs and symptoms of salicylism, which includes tinnitus, hyperpnea, and psychological disturbances. (Lecture 25, slide #14)

A patient with depression has been prescribed fluoxetine [Prozac]. Which of the following statements made by the patient indicates a need for further education regarding fluoxetine? [SELECT ALL THAT APPLY] A. "Disorientation and hallucinations are common." B. "The drug may enhance my interest in sex." C. "It may take several weeks before my mood is elevated." D. "I can stop this medication when I feel less depressed.

Answer Key: A, B, D Feedback: It may take several weeks before my mood is elevated, is true about Fluoxetine. The most common side effects of Fluoxetine are sexual dysfunction, nausea, headache, and manifestations of CNS stimulation, including nervousness, insomnia, and anxiety. Weight gain can also occur. (Lehne Ch 32, pg 344)

A nurse receives a call from a female patient requesting Plan-B, but she is very concerned about taking emergency contraception. The nurse should include which of the following when educating the patient about this medication? [Select all that apply] A. "If pregnancy has occurred, Plan B will not disrupt the pregnancy." B. "It is most effective if taken within 72 hours of unprotected intercourse." C. "It is a very effective abortive medication." D. "It is available over the counter if you're 18 years or older."

Answer Key: A, B, D Feedback: Plan B One-Step works primarily by delaying or stopping ovulation. The tablet should be taken within 72 hours of unprotected intercourse.The drug is not effective after fertilization has occurred and will not disrupt an existing pregnancy. For women age 15 and older, Plan B One-Step is now available over the counter. (Lehne ch 62, pg 761)

Antipsychotic drugs can cause extrapyramidal side effects. Which responses should the nurse document as indicating Parkinsonism? [SELECT ALL THAT APPLY] A. Rigidity B. Tremors C. Mydriasis D. cogwheeling E. Bradykinesia

Answer Key: A, B, D, E Feedback: Antipsychotic-induced parkinsonism is characterized by bradykinesia, mask-like facies, drooling, tremor, rigidity, shuffling gait, cogwheeling, and stooped posture. (Lehne Ch 31, pg 321)

Which side effects are common in second-generation antipsychotic drugs? [Select all that apply]. A. Agranulocytosis B. Anticholinergic effects C. Extrapyramidal symptoms D. Postural hypotension E. weight gain

Answer Key: A, B, D, E Feedback: Common adverse effects of first-generation antipsychotics include sedation and Metabolic Effects: Weight Gain, Diabetes, and Dyslipidemia, orthostatic hypotension (from blocking alpha-adrenergic receptors); and dry mouth, blurred vision, urinary retention, constipation, and tachycardia (from blocking muscarinic cholinergic receptors). (Lehne Ch 31, pg 326)

While preparing for your pharm quiz, you teach your friend about omeprazole [Prilosec]. What will you include when teaching your friend about this drug? [Select all that apply] A. This drug works by irreversibly blocking H+,K+-ATP-ase to reduce gastric acid production. B. Report signs of breast enlargement when taking this medication. C. A patient may experience dyspepsia after discontinuing this medication. D. This drug blocks the histamine receptors in the parietal cells to decrease acid production.

Answer Key: A, C Feedback: Omeprazole is a prodrug that undergoes conversion to its active form within parietal cells of the stomach. The active form then causes irreversible inhibition of H+,K+-ATPase (proton pump), the enzyme that generates gastric acid. Rebound Acid Hypersecretion.(Lehne Ch 78, pg 954)

First generation antipsychotics have the ability to block which of the following receptor types? [Select all that apply] A. Dopamine. B. Serotonin. C. Acetylcholine. D. Histamine.

Answer Key: A, C, D

A patient with Stage A heart failure is prescribed captopril [Capoten]. The nurse knows that ACE inhibitors are effective in which of the following ways? [Select all that apply] A. Dilates veins. B. Decreases force of contraction by direct action on the heart. C. Retards cardiac remodeling. D. Decreases aldosterone release from the adrenal cortex.

Answer Key: A, C, D Feedback: "Decreases force of contraction by direct action on the heart" is correct. ACE inhibitors such as Captopril produce multiple benefits in heart failure. By lowering arteriolar tone, these drugs improve regional blood flow, and, by reducing cardiac afterload, they increase cardiac output. By causing venous dilation, they reduce pulmonary congestion and peripheral edema. By dilating blood vessels in the kidney, they increase renal blood flow, and thereby promote excretion of sodium and water. (Lehne Ch 44, pg 465)

An elderly man is brought to the hospital after ingesting a large quantity of carvedilol [Coreg] tablets, a drug that nonselectively blocks α1,β1, β2 adrenergic receptors. You do not anticipate the following effects: [Select all that apply] A. Tachycardia. B. Bradycardia. C. Dilation of the pupils. D. Increased blood pressure.

Answer Key: A, C, D Feedback: Bradycardia WOULD be anticipated because it is an adverse effect of carvedilol. By blocking beta1 receptors in the heart, all of the beta blockers can cause bradycardia. (Lehne Ch 18, pg 165)

Patients taking monoamine oxidase inhibitors are at risk for hypertensive crisis when they eat certain foods. Which mechanism plays a role in this hypertensive response? [Select all that apply] A. Monoamine oxidase inhibitors prevent inactivation of dietary tyramine. B. Monoamine oxidase activates tyramine in the liver. C. Monoamine oxidase inhibitors increase concentration of norepinephrine in the nerve terminals. D. Systemic tyramine triggers release of catecholamines in the peripheral nervous system.

Answer Key: A, C, D Feedback: First, inhibition of neuronal MAO augments NE levels within the terminals of sympathetic neurons that regulate cardiac function and vascular tone. Second, inhibition of intestinal and hepatic MAO allows dietary tyramine to pass directly through the intestinal wall and liver, and then enter the systemic circulation intact. Third, upon reaching peripheral sympathetic nerves, tyramine stimulates the release of the accumulated NE, thereby causing massive vasoconstriction and intense stimulation of the heart. Hypertensive crisis results. (Lehne Ch 32, pg 353)

Digoxin causes several positive outcomes in patients with heart failure including an increase in urine output. This occurs because [Select all that apply] A. Digoxin increases cardiac output which increases perfusion to the kidneys. B. Digoxin inhibits the reabsorption of sodium in the renal tubule. C. Digoxin increases sympathetic tone in the renal blood vessels. D. Digoxin blocks the release of renin in the kidney.

Answer Key: A, D Feedback: D: "Digoxin increases cardiac output which increases perfusion to the kidneys" (See pg. 525 in Lehne)

The nurse should hold the next dose of antipsychotic medication for which patients? [Select all that apply]. A. The patient who has a sudden high fever. B. The patient who has pill-rolling motions of the hand. C. The patient with a blood pressure of 130/90 mm Hg when sitting and 100/80 mm Hg when standing. D. The patient who presents with protrusion and rolling of the tongue and smacking movements of the lips

Answer Key: A, D Feedback: The patient with protrusion and rolling of the tongue and smacking movements of the lips most likely is displaying symptoms of tardive dyskinesia. The medication should be stopped in any patient displaying these symptoms. A patient with a sudden high fever may be experiencing neuroleptic malignant syndrome; immediate withdrawal of the medication is needed. Orthostatic hypotension is a common occurrence with many antipsychotic medications and is not a reason to stop the medication. Pill-rolling motions of the hand may indicate parkinsonian-like extrapyramidal side effects. This is not a reason to stop the medication. Treatment is aimed at controlling the side effects.

A recent study in 2017 used the Women's Health Initiative data to establish that estrogen alone or in combination with progesterone did not increase the absolute risk for which of the following conditions? [Select all that apply] A. Breast cancer B. Colon cancer C. Endometrial cancer D. Cardiovascular events

Answer Key: A, D Feedback: The recent study determined that the absolute risk for cardiovascular events such as stroke, MI, thrombosis and breast cancer did not significantly increase among participants using estrogen alone or in combination when compared to those who were in the placebo group.

A patient who has recently begun hormone replacement therapy with estrogen asks you how the hormone will affect her nonreproductive tissues. Which response(s) by are appropriate? [Select all that apply]. A. It suppresses bone resorption. B. It reduces fat deposits in the liver. C. It improves glomerular filtration rates. D. It promotes and suppresses coagulation. E. It reduces low-density lipoproteins (LDLs).

Answer Key: A, D, E Feedback: Estrogens have a positive effect on bone mass, blocking bone resorption. They also have favorable effects on cholesterol levels in that low-density lipoprotein (LDL) levels are reduced, and the levels of high-density lipoprotein (HDL) are elevated. Estrogens promote coagulation by increasing factors II, VII, and others; they also suppress coagulation, increasing the activity of factors that promote the breakdown of fibrin. Estrogens do not improve the glomerular filtration rate or reduce fatty deposits in the liver.

Orthostatic hypotension occurs with the use of sublingual nitroglycerin primarily because the drug: A. Slows the heart rate. B. Causes venous pooling. C. Dilates the coronary arteries. D. Shuts down the baroreceptors.

Answer Key: B

A nurse is caring for a patient who has been taking captopril for approximately 3 weeks, but complains of a frequent dry cough since starting the medication. The nurse understands that this likely due to which of the following? A. Binding of angiotensin II to its receptor sites. B. An increase in bradykinin levels. C. Conversion of Angiotensin I to Angiotensin II. D. Release of renin.

Answer Key: B Feedback: "An increase in bradykinin levels" is correct. Elevation of bradykinin causes vasodilation (secondary to increased production of prostaglandins and nitric oxide), and can also promote cough and angioedema, which. All ACE inhibitors can cause persistent, dry, irritating, nonproductive cough. Severity can range from a scratchy throat to severe hacking cough. The underlying cause is accumulation of bradykinin secondary to inhibition of kinase II (another name for ACE). (Lehne Ch 44, pg 473 & 476)

An agitated, extremely anxious patient is brought to the emergency department. The prescriber orders diazepam [Valium]. The nurse understands that benzodiazepines are used in this clinical situation based on which principle? A. Physical dependence is not a risk when taking benzodiazepines. B. Benzodiazepines have a rapid onset of action. C. Benzodiazepines are known to cure generalized anxiety. D. Benzodiazepines have a very short half-life.

Answer Key: B Feedback: "Benzodiazepines have a rapid onset of action" is correct. Diazepam's onset of relief is rapid. Accordingly, benzodiazepines are preferred drugs for immediate stabilization of anxiety, especially when anxiety is severe.(Lehne ch 34, pg 388)

During your OB clinicals, a patient asks you how the promethazine [Phenergan] is able to improve her severe nausea and vomiting. You explain that the drug: A. Blocks serotonin from signaling the chemoreceptor trigger zone B. Blocks dopamine from signaling the chemoreceptor trigger zone C. Blocks neurokinins from signaling the chemoreceptor trigger zone D. Blocks acetylcholine from signaling the chemoreceptor trigger zone

Answer Key: B Feedback: "Blocks dopamine from signaling the chemoreceptor trigger zone CTZ" is correct. Promethazine suppresses emesis by blocking dopamine2 receptors in the CTZ. These drugs can reduce emesis associated with surgery, cancer chemotherapy, and toxins. (Lehne Ch 80, pg 974)

A nurse teaches a client about the side effects and precautions associated with haloperidol [Haldol]. The nurse concludes that the teaching has been understood by the client when he states: A. "I'll be sure to drink enough fluids because the drug may make me urinate more than usual." B. "I'll contact the provider if I experience any breast enlargement." C. "I won't eat anything containing tyramine while I'm taking this drug." D. "I'll call my doctor right away if I have any diarrhea or vomiting."

Answer Key: B Feedback: "I'll contact the provider if I experience any breast enlargement." Is Correct. Antipsychotics such as Haldo can increase levels of circulating prolactin by blocking the inhibitory action of dopamine on prolactin release. Elevation of prolactin levels promotes gynecomastia (breast growth) and galactorrhea in up to 57% of women. (Lehne Ch 31, pg 323)

A patient taking carbidopa/levodopa [Sinemet] for Parkinson's disease experiences frequent "on-off" episodes (i.e., the abrupt loss of effect). Which action by the nurse is best? A. Administer the medication when the patient has an empty stomach. B. Instruct the patient to avoid high-protein foods. C. Have the patient increase the intake of vitamin B6. D. Discontinue the drug for 10 days (for a "drug holiday").

Answer Key: B Feedback: "Instruct the patient to avoid high-protein foods," is correct. High-protein meals can reduce therapeutic responses to levodopa. Neutral amino acids compete with levodopa for absorption from the intestine and for transport across the blood-brain barrier. Therefore, a high-protein meal can significantly reduce both the amount of levodopa absorbed and the amount transported into the brain. It has been suggested that a high-protein meal could trigger an abrupt loss of effect (ie, an "off" episode). (Lehne ch 21, pg 181)

Which enzyme is inhibited by the anti-Parkinson drug selegiline [Eldepryl]? A. Monoamine oxidase A B. Monoamine oxidase B C. Superoxide dismutase (SOD) D. Catechol O-methyltransferase (COMT)

Answer Key: B Feedback: "Monoamine oxidase B" is correct. For patients with mild parkinson symptoms, treatment can begin with selegiline, an MAO-B inhibitor that confers mild, symptomatic benefit. (Lehne ch 21, pg 178)

A patient with Type II DM is diagnosed with schizophrenia and the provider prescribes haloperidol [Haldol]. The nursing student asks the nurse why the provider hasn't ordered a more popular antipsychotic like olanzapine [Zyprexa]. Which response by the nurse is the most important reason that this patient is not receiving olanzapine [Zyprexa]? A. "Olanzapine is more expensive than haloperidol." B. "Olanzapine causes more metabolic side effects than haloperidol." C. "Haloperidol has a faster onset of action than olanzapine." D. "Haloperidol has fewer side effects than olanzapine."

Answer Key: B Feedback: "Olanzapine causes more metabolic side effects than haloperidol." Is correct. Second generation antipsychotics can cause a group of closely linked metabolic effects—obesity, diabetes, and dyslipidemia—all of which increase the risk of cardiovascular events. Patients with documented diabetes at treatment onset should be monitored for worsening of glucose control due to the drug. (Lehne Ch 31, pg 326)

You are providing education to a male patient who has just received a prescription for sildenafil [Viagra]. You include all of the following in your teaching except: A. "When taken with high fat meals, Viagra may not work as quickly." B. "Priapism is an common adverse effect of Viagra." C. "Grapefruit juice should be avoided when taking Viagra." D. "Viagra only enhances an erectile response in the presence of a stimuli."

Answer Key: B Feedback: "Priapism is a common adverse effect of Viagra." Is correct, priapism, is not a common side effect of Viagra, as it only occurs in rare/few cases. However, if priapism occurs, it should be treated as a medical emergency. (Lehne ch 66, pg 799)

Which of these findings would be considered a medical emergency if it occured 4 hours after sexual activity in a patient who uses sildenafil [Viagra]? A. Blood pressure 115/75 mm/Hg B. Priapism C. Headache D. Blood pressure 150/80 mm/Hg

Answer Key: B Feedback: "Priapism" is correct and considered an adverse effect of Viagra. If an erection persists for more than 4 hours, immediate medical intervention is required. Left untreated, priapism can damage penile tissue, causing permanent ED. (Lehne ch 66, pg 799)

Lovastatin [Mevacor] is prescribed for a patient for the first time. The nurse should provide the patient with which instruction? A. "You may take lovastatin without regard to meals." B. "Take lovastatin with your evening meal or before bed." C. "Take this medicine before breakfast." D. "Take this medicine on an empty stomach."

Answer Key: B Feedback: "Take lovastatin with your evening meal or before bed" is correct. Lovastatin should be taken once daily, preferably in the evening either with the evening meal or at bedtime. Because endogenous cholesterol synthesis increases during the night, statins have the greatest impact when given in the evening (Lehne Ch 50, pg 570)

Floppy Iris Syndrome is most often associated with _________________ due to its selective blockade of ___________ receptors in the iris. A. Doxazosin [Cardura], alpha 1a B. Tamsulosin [Flomax], alpha 1a C. Tamsulosin [Flomax], alpha 1b D. Doxazosin [Cardura], alpha 1

Answer Key: B Feedback: "Tamsulosin [Flomax], alpha 1a" is correct. Tamsulosin is a selective alpha 1a blockers and can lead to increased risk of intraoperative floppy-iris syndrome during cataract surgery. (Lehne ch 66, pg 803, & Lecture 24 slide #23)

A provider has prescribed Ritalin to a young patient newly diagnosed with ADHD. The parents are fearful of their child taking a stimulant and request atomoxetine [Strattera] instead. As the provider educates the family about the different drugs, you would expect to hear all of the following except: A. "Non-stimulants like atomoxetine [Strattera] are not as effective as stimulants." B. "The potential risk for drug abuse is the same for both stimulants and non-stimulants." C. "Stimulants are the most effective treatment for ADHD." D. "Strattera has been shown to increase the risk for suicidal thinking and behavior."

Answer Key: B Feedback: "The potential risk for drug abuse is the same for both stimulants and non-stimulants." Is correct. In contrast to the CNS stimulants, Strattera has no potential for abuse and hence is not regulated as a controlled substance. (Lehne Ch 36, pg 401)

A patient is using a high-concentration keratolytic agent containing 20% salicylic acid to remove warts. The nurse will teach this patient all of the following except? A. Systemic effects may occur with this medication. B. Tinnitus is a common side effect of little concern. C. Peeling and drying are desired effects of this drug. D. Tissue injury is unlikely at this dose.

Answer Key: B Feedback: "Tinnitus is a common side effect of little concern." Is correct, tinnitus is not a common side effect and indicates systemic toxicity (salicylism). (Lehne ch 105, pg 1279)

A patient taking an MAOI is seen in the clinic with a blood pressure of 170/96 mm Hg. What will the nurse ask this patient? A. Whether SSRIs are taken in addition to the MAOI B. To list all foods eaten that day C. Whether the patient drinks grapefruit juice D. Whether any antihypertensive medications are used

Answer Key: B Feedback: "To list all foods eaten that day" is correct. Drug-food interactions sometimes increase toxicity. The most dramatic example is the interaction between monoamine oxidase (MAO) inhibitors (a family of antidepressants) and foods rich in tyramine (eg, aged cheeses, yeast extracts, Chianti wine). If an MAO inhibitor is combined with these foods, blood pressure can rise to a life-threatening level. (Lehne ch 6, pg 60 & Lehne Ch 21 pg 353)

A patient is taking a vasodilator that primarily affects the veins. To help minimize risks associated with drug side effects, the nurse caring for this patient will prioritize which instruction? A. tell the patient to report shortness of breath. B. caution the patient not to get up abruptly. C. warn the patient about the possibility of bradycardia. D. encourage the patient to increase fluid intake.

Answer Key: B Feedback: "caution the patient not to get up abruptly." Is correct. Competitive antagonist produces selective blockade of alpha1-adrenergic receptors. The result is dilation of arterioles and veins, and relaxation of smooth muscle in the bladder neck (trigone and sphincter) and prostatic capsule, which can cause orthostatic hypotention. Patients should be informed that orthostatic hypotension can be minimized by moving slowly when changing from a supine or sitting position to an upright position. (Lehne Ch 18, pg 158)

A female patient with mild psoriasis is prescribed a low-potency topical glucocorticoid for treatment. She asks you what the potential adverse effects are when using the medication for a prolonged period of time. You include all of the following except: A. striae B. hair loss C. thinning of the skin D. hair growth

Answer Key: B Feedback: "hair loss" is correct, adverse effects of prolonged topical glucocorticoids use include the following: thinning of the skin, striae, acne, and hair growth. (Lecture 25, slide #10)

A child takes amphetamine/dextroamphetamine [Adderrall XR] for ADHD. The nurse knows to assess for all of the following adverse effects except: A. restlessness B. increased appetite C. chest pain D. weight loss

Answer Key: B Feedback: "increased appetite" is correct. Amphetamine/dextroamphetamine [Adderrall XR] adverse effects include weight loss as a result of appetite suppression. (Lehne Ch 36, pg 396)

Pharmaceutical company A would like to develop drugs that reduce the effects of acetylcholine in the body. All of the following drugs would accomplish this goal EXCEPT: A. Muscarinic acetylcholine receptor blocker. B. Alpha 1 receptor blocker. C. Vesicle popper (drug that destroys the vesicles in which acetylcholine is stored) D. Acetylcholinesterase (AChE) inhibitor.

Answer Key: B Feedback: Acetylcholinesterase (AChE) inhibitor prevents the acetylcholinesterase enzyme from breaking down acetylcholine, which will then lower the amount of acetylcholine in the body. Muscarinic acetylcholine receptor blocker and the vesicle popper will reduce the amount of acetylcholine in the body. As acetylcholine builds up, it competes with the antimuscarinic agent for receptor binding. (Lehne ch 14 pg 126)

A patient complains to the nurse that the clonidine [Catapres] recently prescribed for hypertension is causing drowsiness. Which response by the nurse to this concern is appropriate? A. "You may be at risk for addiction if you have central nervous system side effects." B. "Drowsiness is a common side effect initially, but it will lessen with time." C. "You should discontinue the medication and contact your prescriber." D. "You may also experience orthostatic hypotension along with the drowsiness."

Answer Key: B Feedback: An adverse side effect of Clonidine is drowsiness due to CNS depression. About 35% of patients experience drowsiness; an additional 8% experience outright sedation. These responses become less intense with continued drug use. (Lehne ch 19, pg 168)

Many medications list side effects that include dry mouth, constipation, and urinary retention. What kinds of effects are these? A. Alpha adrenergic B. Anticholinergic C. Beta adrenergic D. Somatic.

Answer Key: B Feedback: Anticholinergic denotes blockade of muscarinic receptors. When a drug is characterized as being anticholinergic, you can take this to mean that it produces selective muscarinic blockade—and not blockade of all cholinergic receptors. Effects include: Xerostomia (Dry Mouth), blurred vision and photophobia, elevation of intraocular pressure, urinary retention, constipation, and tachycardia. (Lehne Ch 14, pg 120)

You are caring for a patient in an oral surgeon's practice. The surgeon would like to reduce salivation in a patient prior to surgery. Which of the following strategies would be useful in reducing salivation? A. Activate muscarinic receptors in the salivary glands. B. Block muscarinic receptors in the salivary glands. C. Block nicotinic receptors in the salivary glands. D. Activate nicotic receptors in the salivary glands.

Answer Key: B Feedback: Block muscarinic receptors in the salivary glands is correct. Muscarinic agonists act on exocrine glands to increase salivation. Blockade of muscarinic receptors on salivary glands can inhibit salivation, thereby causing dry mouth. (Lehne Ch 14, pg 116 &120)

Which of the following is a systemic effect of a muscarinic agonist? A. Reduced urinary frequency. B. Bradycardia. C. Increased blood pressure. D. Constipation.

Answer Key: B Feedback: Bradycardia is correct. The principal structures affected by muscarinic activation are the heart, exocrine glands, smooth muscles, and eyes. Muscarinic agonists act on the heart to cause bradycardia (decreased heart rate) and on exocrine glands to increase sweating, salivation, bronchial secretions, and secretion of gastric acid. (Lehne Ch 14, pg 116)

A nurse is administering Digoxin to a heart failure patient and notes that the patient is also receiving furosemide [Lasix]. The nurse anticipates several possible adverse effects. Which is the most concerning potential adverse effect? A. Fatigue B. Cardiac dysrhythmias C. Bradycardia D. Vomiting

Answer Key: B Feedback: Cardiac dysrhythmias is correct. Loop diuretics such as Lasix promote potassium loss, use of these drugs in combination with digoxin can increase the dysrhythmia risk. This interaction is unfortunate in that most patients who take digoxin for heart failure must also take a diuretic as well. (Lehne Ch 41, pg 451). Thiazide diuretics and loop diuretics can cause hypokalemia, and can increase the risk of digoxin-induced dysrhythmias. (Lehne Ch 41, pg 533) and (Lehne Ch 48, pg 519).

You and a classmate are reviewing antipsychotic drugs. Your classmate asks you why 1st generation antipsychotics (FGAs) are more likely to cause extrapyramidal effects than 2nd generation antipsychotics (SGAs). You explain that: A. SGAs have a higher affinity for dopamine receptors than FGAs. B. SGAs have lower affinity for dopamine receptors than FGAs. C. SGAs only block norepinephrine, histamine and acetylcholine receptors. D. SGAs are not dopamine receptor antagonists.

Answer Key: B Feedback: FGAs can decrease psychologic symptoms, but they will also intensify symptoms of PD because they block receptors for dopamine in the striatum. When FGAs are used for schizophrenia, the biggest problem is Parkinsonian side effects, referred to as extrapyramidal symptoms (EPS). SGAs have been used successfully to manage levodopa-induced psychosis. Unlike the first-generation antipsychotic drugs, clozapine and quetiapine cause little or no blockade of dopamine receptors in the striatum, and hence do not cause EPS. (Lehne Ch 21, pg 180)

A patient with benign prostatic hyperplasia (BPH) has a moderately enlarged prostate and is started on finasteride [Proscar]. You would anticipate getting an initial baseline ________ lab value and seeing this value ___________ over time as a positive effect of finasteride. A. Testosterone, decrease B. PSA, decrease C. Dihydrotestosterone, increase D. PSA, increase

Answer Key: B Feedback: Finasteride decreases serum levels of prostate-specific antigen (PSA), a marker for prostate cancer. The expected decline is 30% to 50%. PSA levels should be determined before treatment and 6 months later. If PSA levels do not fall as expected, the patient should be evaluated for cancer of the prostate. (Lehne ch 105, pg 802)

The nurse is aware that anticholinergic adverse effects of drugs commonly cause more problems in older adults than younger adults. Which anticholinergic effect would be a priority to report to the prescriber? A. Dry mouth. B. Has not voided in 16 hours. C. No bowel movement for 48 hours. D. Blurred vision.

Answer Key: B Feedback: Has not voided in 16 hours is correct. Older patients 75 years and over often experience overactive bladder and urinary incontinence more frequently than younger individuals. Anticholinergic agents are indicated. These drugs block muscarinic receptors on the bladder detrusor, and thereby inhibit bladder contractions and the urge to void. Drugs that block muscarinic receptors in the bladder can also block muscarinic receptors elsewhere and cause the typical anticholinergic side effects such as urinary retention. (Lehne Ch 14, pg 121) Urinary retention can lead to bladder rupture and should be reported to the provider.

A female patient who takes a benzodiazepine, lorazepam [Ativan], for anxiety tells the nurse that she plans to become pregnant. What is the best instruction for the nurse to give the patient? A. "Eat a well-balanced diet that includes milk." B. "Discuss tapering the drug with the provider before conception." C. "Stop taking the drug and form another plan to manage anxiety." D. "Visit an obstetrician to determine the correct dose of lorazepam during pregnancy."

Answer Key: B Feedback: Lorazepam is Pregnancy Risk Category D, so the nurse instructs should instruct the patient to taper therapy as a means of avoiding the adverse effects of withdrawal and to prevent fetal harm. Therapy must be stopped before conception because *benzodiazepines are lipid soluble and cross the placenta thereby, increasing the risk of fetal harm.* To promote fetal development, the nurse instructs would instruct the patient to visit an obstetrician for folic acid and prenatal vitamin prescriptions and to eat a well-balanced diet. To help prevent a crisis, the nurse instructs would instruct the patient to develop an alternative plan for managing anxiety with the assistance of a primary health carehealthcare provider.

A patient brought to the emergency department requires sutures. The prescriber orders a local anesthetic with epinephrine. The nurse understands that epinephrine is ordered to: A. prevent hypertension induced by the anesthetic. B. prolong effects and allow a reduced dose of the anesthetic. C. reduce anesthetic-induced nausea. D. reduce the pain of an injection.

Answer Key: B Feedback: Prolong effects and allow a reduced dose of the anesthetic is correct. The drug used most frequently to delay anesthetic absorption is epinephrine. Alpha1 agonists are frequently combined with local anesthetics to delay systemic absorption. The delay of anesthetic absorption is beneficial, because keeping the drug at the local site of action prolongs anesthesia, allows a reduction in anesthetic dosage, and reduces the systemic effects that a local anesthetic might produce. (Lehne Ch 17, pg 146)

An elderly man is brought to the hospital after mistakenly ingesting a large quantity of propranolol tablets, a drug that blocks βeta adrenergic receptors. Which of the following effects would you expect in this patient? A. Tachycardia. B. Bradycardia. C. Dilation of the pupils. D. Constipation.

Answer Key: B Feedback: Propranolol blocks both beta1 and beta 2 adrenergic receptors. By blocking cardiac beta1 receptors, propranolol can reduce heart rate. Bradycardia, AV Heart Block, and Heart failure are some adverse effects of this drug. (Lehne Ch 18, pg 161 &163)

A client with the diagnosis of schizophrenia is given halperidol [Haldol] to manage his symptoms. The nurse understands that this antipsychotic drug can cause extrapyramidal symptoms [EPS]. Which EPS is cause for the greatest concern? A. Acute Dystonia B. Tardive dyskinesia C. Parkinsonian syndrome D. Akathisia

Answer Key: B Feedback: Tardive dyskinesia, an extrapyramidal response characterized by vermicular movements and protrusion of the tongue, chewing and puckering movements of the mouth, and puffing of the cheeks, is often irreversible, even when the antipsychotic medication is withdrawn. Akathisia, motor restlessness, usually can be treated with antiparkinsonian or anticholinergic drugs while the antipsychotic medication is continued. Parkinsonian syndrome (a disorder featuring signs and symptoms of Parkinson disease such as resting tremors, muscle weakness, reduced movement, and festinating gait) can usually be treated with antiparkinsonian or anticholinergic drugs while the antipsychotic medication is continued. Dystonia, impairment of muscle tonus, can usually be treated with antiparkinsonian or anticholinergic drugs while the antipsychotic medication is continued.

A nurse is interviewing a client in the mental health clinic. Which statement by the client indicates a potential irreversible adverse response to long-term therapy with an antipsychotic medication? A. "My mouth is always dry." B. "My tongue seems to move by itself." C. "I don't have much of an appetite." D. "I can't seem to sleep at night."

Answer Key: B Feedback: The tongue's moving by itself is characteristic of tardive dyskinesia, an irreversible, antipsychotic, drug-induced neurological disorder. Dry mouth is an anticholinergic-type side effect that is not considered serious. This drug will cause sedation, not insomnia. Lack of an appetite is unrelated to antipsychotic medications

A prescriber has ordered clonidine [Catapres] for a patient who has hypertension. The nurse teaches the patient about side effects of this drug. Which statement by the patient indicates understanding of the teaching? A. "I should not drive as long as I am taking this drug." B. "I should chew sugar-free gum or drink water to reduce dry mouth." C. "I should stop taking this drug if I feel anxious or depressed." D. "I should stand up slowly when taking this medication."

Answer Key: B Feedback: Xerostomia (dry mouth) is a common adverse effect of Clonidine, occurring in about 40% of patients. The reaction usually diminishes over the first 2 to 4 weeks of therapy. Dry mouth can be reduced by chewing gum, sucking hard candy, and taking frequent sips of fluids. (Lehne Ch 19, pg 168)

A patient who takes warfarin is requesting oral contraceptives for birth control. The nurse educates the patient that warfarin can decrease the effectiveness of the oral contraceptives. What strategy will the nurse suggest in this case? A. "Start the oral contraceptives and stop taking warfarin." B. "Oral contraceptives can decrease the effectiveness of warfarin, so your levels should be routinely monitored." C. "Oral contraception isn't for someone taking warfarin, let's discuss how to use the rhythm method." D. "Abstinence is really the best way to prevent pregnancy in this case."

Answer Key: B Feedback: combined oral contraceptives are known to decrease the effectiveness of warfarin. Patients taking warfarin should continue to have their levels monitored and adjustments made to warfarin doses as needed. Warfarin is a teratogenic drug, so women taking warfarin should be educated on the importance of consistent use of contraception.

Mr. Dunn is a patient in the ICU who is receiving many IV medications, one of which is epinephrine. As his nurse, you will monitor Mr. Dunn carefully for which potential adverse effect [select all that apply] A. Increased nasal congestion B. Hypertensive crisis C. Necrosis D. CNS depression

Answer Key: B, C Feedback: Epinephrine is a potent vasoconstrictor with widespread effects. Vasoconstriction secondary to excessive alpha1 activation can produce a dramatic increase in blood pressure, resulting in hypertensive crisis. Because of the potential for severe hypertension, patients receiving parenteral epinephrine must undergo continuous cardiovascular monitoring with frequent assessment of vital signs.(Lehne Ch 17, pg 149) Additionally, because the patient is receiving IV epinephrine, the IV site must be monitored carefully for signs of extravasation that might lead to local necrosis secondary to vasoconstriction.

Which populations are most at risk for laxative abuse? [SELECT ALL THAT APPLY] A. Pregnant women. B. Older adults. C. People with eating disorders. D. Pediatric patients.

Answer Key: B, C Feedback: Older adults and people with eating disorders often abuse laxatives. Laxatives—especially the stimulant type—are commonly misused (abused) by the public. To reduce abuse, educate patients about normal bowel function and about alternatives to laxatives (diet high in fiber and fluids, exercise, establishing regular bowel habits). (Lehne Ch 79, pg 969)

Muscarinic acetylcholinergic stimulation might have this effect(s) on organs if activated [Select all that apply] A. Slowed GI motility B. Sweating C. Decreased heart rate D. Dilation of the eye

Answer Key: B, C Feedback: some effects of stimulation of muscarinic receptors by acetylcholine are: Decreased heart rate, decreased pupil diameter, constriction of bronchi, generalized sweating and vasodilation. (Lehne Ch 13, pg 108)

A patient is newly prescribed clozapine [Clozaril]. Which blood tests does the nurse anticipate being prescribed prior to the start of treatment? [Select all that apply]. A. Troponin I B. Lipid panel C. Complete blood count D. Fasting Blood Glucose

Answer Key: B, C, D Feedback: Prior to beginning clozapine therapy, the patient should have a baseline lipid panel, complete blood count, and fasting blood glucose test. Clozapine and other antipsychotics can cause new-onset or worsened diabetes, dyslipidemia, and agranulocytosis. Troponin I and BMP are not necessary lab tests.

A nurse is obtaining a health history from an older adult patient in an outpatient clinic. The patient reports chronic difficulty falling asleep and staying asleep. The nurse knows that the best treatment for this patient will be: A. benzodiazepines. B. improved sleep hygiene. C. short-term barbiturates. D. hypnotics.

Answer Key: B, D Feedback: "improved sleep hygiene" is correct. Research has shown that cognitive behavioral therapy is superior to drug therapy for both short-term and long-term management of chronic insomnia in older adults. Cognitive and behavioral interventions include sleep restriction, control of the bedroom environment, progressive relaxation, and education about sleep hygiene. (Lehne Ch 34, pg 382)

A pregnant patient who is taking ondansetron [Zofran] for morning sickness tells the nurse she is experiencing headache and dizziness. What will the nurse tell her? A. It is not safe to take this drug during pregnancy. B. She should report these adverse effects to her provider. C. These are common side effects of ondansetron. D. She should stop taking the ondansetron immediately.

Answer Key: C

Which patient would be at greatest risk of developing a venous thromboembolism (VTE) if a combination oral contraceptive were prescribed? A. A 29 year-old patient who has used birth control pills for 9 years. B. A 25 year-old patient who drinks 3-4 alcoholic drinks daily. C. A 22 year-old patient who smokes 2 packs of cigarettes per day. D. A 45 year-old patient who has a family history of stroke.

Answer Key: C Feedback: "A 22 year-old patient who smokes 2 packs of cigarettes per day." Is correct, *OCs should not be prescribed for heavy smokers, women with a history of thromboembolism, or women with other risk factors for thrombosis. *(Lehne ch 62, pg 754)

Which best describes the mechanism of action of the drug atomoxetine [Strattera]? A. Atomoxetine acts as an agonist at the cholinergic receptor sites. B. Atomoxetine causes release of norepinephrine and dopamine to increase availability of these transmitters in the synapses. C. Atomoxetine inhibits the reuptake of norepinephrine to increase available norepinephrine in the synapses. D. Atomoxetine prevents the synthesis of dopamine.

Answer Key: C Feedback: "Atomoxetine inhibits the reuptake of norepinephrine to increase available norepinephrine in the synapses." is correct. Several theories implicate dysregulation in neuronal pathways that employ NE, DA, and serotonin as transmitters. These theories would be consistent with the effects of atomoxetine (which blocks NE reuptake). (Lehne Ch 36, pg 400) - its like SSRIs!

A patient reports having occasional periods of tremors, palpitations, nausea, and a sense of fear, which usually dissipate within 30 minutes. To treat this condition, the nurse anticipates the provider will prescribe a drug in which drug class? A. Monoamine oxidase inhibitors B. Tricyclic antidepressants C. Benzodiazepines D. Hypnotics

Answer Key: C Feedback: "Benzodiazepines" is correct. Anxiety is an uncomfortable state that has both psychologic and physical components. The psychologic component can be characterized with terms such as fear, apprehension, dread, and uneasiness. The physical component manifests as tachycardia, palpitations, trembling, dry mouth, sweating, weakness, fatigue, and shortness of breath. Benzodiazepines, along with the newer benzodiazepine receptor agonists, are drugs of first choice for anxiety and insomnia (Lehne Ch 34 pg 373 and Ch 35 pg 388)

A patient's provider has recommended a bulk-forming laxative for occasional constipation. Which statement by the patient indicates understanding of the teaching about this agent? A. "This drug can cause severe diarrhea." B. "I can take this medication long term." C. "I should take each dose with a full glass of water." D. "I should not take this drug if I have diverticulitis."

Answer Key: C Feedback: "I should take each dose with a full glass of water." Is correct. Because the bulk-forming agents are not absorbed, systemic reactions are rare. Esophageal obstruction can occur if they are swallowed in the absence of sufficient fluid. Accordingly, bulk-forming laxatives should be administered with a full glass of water or juice. (Lehne Ch 79, pg 964)

Ezetimibe is a newer drug that may be used alone or in combination with a "statin" to control cholesterol. What is unique about this drug's mechanism of action? A. It promotes the removal of LDL cholesterol from the blood. B. It binds with cholesterol in the intestine promoting cholesterol excretion. C. It blocks cholesterol absorption in the intestine. D. It stimulates the synthesis of HDL cholesterol.

Answer Key: C Feedback: "It blocks cholesterol absorption in the intestine" is correct. Ezetimibe acts on cells of the brush border of the small intestine to inhibit dietary cholesterol absorption. The drug also inhibits reabsorption of cholesterol secreted in the bile. (Lehne Ch 50, pg 573)

A patient started taking atomoxetine [Strattera] one week ago and now complains that it's not working very well. He states that he would like to try a stimulant instead. The nurse would tell him: A. "It takes a while for the drug to start synthesizing norepinephrine." B. "Ask the prescriber to change your prescription to Ritalin." C. "It may take up to 3 weeks for you to feel the maximum benefit of taking Strattera." D. "Maybe you were incorrectly diagnosed with ADHD."

Answer Key: C Feedback: "It may take up to 3 weeks for you to feel the maximum benefit of taking Strattera." Is correct. Strattera therapeutic effects develop slowly: The initial response takes a few days to develop, and the maximal response is seen in 1 to 3 weeks. (Lehne Ch 36, pg 401)

You are studying for your pharmacology exam with a friend and you ask him/her to explain some general characteristics of combined oral contraceptives (OCs). You know your friend may need to spend more time studying if he/she makes which statement? A. "OCs commonly have side effects like nausea and breast tenderness." B. "OCs should not be taken by women who are >35 years old and smoke." C. "OCs are known to cause breast cancer." D. "OCs are contraindicated in women with a history of thromboembolic disorders."

Answer Key: C Feedback: "OCs are known to cause breast cancer." Is correct, oral contraceptives present no known risk of cancer, but can *promote breast cancer growth*. (Lehne ch 2, pg 754)

Ranitidine [Zantac] is prescribed for a client with peptic ulcer disease. The client asks the nurse what this medication does. The nurse responds: A. "Ranitidine neutralizes gastric acidity." B. "Ranitidine facilitates histamine release." C. "Ranitidine inhibits gastric acid secretion." D. "Ranitidine increases gastric motility."

Answer Key: C Feedback: "Ranitidine inhibits gastric acid secretion." is correct Ranitidine suppresses secretion of gastric acid by blocking H2 receptors on gastric parietal cells. (Lehne Ch 78, pg 953)

An ideal hypnotic for a patient with difficulty falling asleep would have which of the following pharmacokinetic properties? A. Active metabolites. B. Long duration of action. C. Rapid onset of action. D. High first-pass metabolism.

Answer Key: C Feedback: "Rapid onset of action" is correct. If a patient needs medication to accelerate falling asleep, a benzodiazepine with a rapid onset would be indicated. (Lehne Ch 34, pg 375)

A patient is taking bismuth subsalicylate [Pepto-Bismol] to prevent diarrhea. The nurse performing an assessment notes that the patient's tongue is black. What will the nurse do? A. Withhold the drug, because this is a sign of bismuth overdose. B. Assess further for signs of gastrointestinal (GI) bleeding. C. Reassure the patient that this is an expected side effect of this drug. D. Request an order for liver function tests to evaluate for hepatotoxicity.

Answer Key: C Feedback: "Reassure the patient that this is an expected side effect of this drug" is correct. Bismuth subsalicylate can impart a harmless black coloration to the tongue and stool. Patients should be forewarned. (Lehne Ch 78, pg 950)

A patient has been taking a progestin-only pill [Micronor] for 3 months and reports spotting and irregular menstrual cycles. The nurse will: A. Question the patient about any possible missed doses of the pill B. Recommend that she take a pregnancy test to rule out pregnancy. C. Reassure the patient that this is normal with this form of contraception. D. Suggest that she use a backup form of contraception until these symptoms resolve.

Answer Key: C Feedback: "Reassure the patient that this is normal with this form of contraception." Is correct, progestin-only pills are more likely to cause irregular bleeding (breakthrough bleeding, spotting, amenorrhea, inconsistent cycle length, variations in the volume and duration of monthly flow). (Lehne ch 62, pg 759)

An adolescent has begun using benzoyl peroxide lotion twice daily to treat acne. The patient reports experiencing drying and burning of the skin. What will the you suggest the patient do? A. Apply lotion to the skin after applying the drug B. Request a prescription for a gel formulation of the drug C. Discontinue the medication, because this is likely an allergic reaction D. Reduce the frequency to one application a day

Answer Key: D Feedback: "Reduce the frequency to one application a day", is correct, because benzoyl peroxide may produce drying and peeling of the skin. If signs of severe local irritation occur (eg, burning, blistering, scaling, swelling), the frequency of application should be reduced. (Lehne ch 105, pg 1281)

A client is diagnosed with Parkinson's disease and receives a prescription for levodopa. What does the nurse identify as the drug's mechanism of action? A. Levodopa promotes the production of acetylcholine. B. Levodopa blocks the effects of acetylcholine. C. Levodopa restores the dopamine levels in the brain. D. Levodopa increases the production of dopamine.

Answer Key: C Feedback: "Restores the dopamine levels in the brain," is correct. Levodopa restores dopamine levels, but does not increase production because Parkinson's is a result of the depletion of dopamine producing neurons in the brain and this is irreversible. However, Levodopa converts to active dopamine to restore levels by entering the brain via an active transport system that carries it across the blood-brain barrier. Once in the brain, the drug undergoes uptake into the remaining dopaminergic nerve terminals that remain in the striatum. Following uptake, levodopa is converted to dopamine, its active form. As dopamine, levodopa helps restore a proper balance between dopamine and acetylcholine. (Lehne Ch 21, pg 179)

Which group of laxatives is the most widely "used and abused" laxatives? A. Surfactant laxatives B. Osmotic laxatives C. Stimulant laxatives D. Bulk forming laxatives

Answer Key: C Feedback: "Stimulant laxatives" is correct. Stimulant agents are the laxatives most commonly abused by the general public. Discourage patients from inappropriate use of these drugs. These drugs are commonly—and appropriately—used to manage opioid-induced constipation. (Lehne Ch 79, pg 970)

A nursing student is caring for a patient who is taking sucralfate [Carafate] and ciprofloxacin [Cipro] to treat peptic ulcer disease. The student asks the nurse about the pharmacokinetics of sucralfate. Which statement by the student indicates a need for further teaching? A. "Sucralfate does not cause systemic side effects." B. "Sucralfate adheres to the ulcer and blocks the back-diffusion of hydrogen ions." C. "Sucralfate has a moderate ability to neutralize stomach acid." D. "Sucralfate and ciprofloxacin should be administered 1 hour apart."

Answer Key: C Feedback: "Sucralfate has a moderate ability to neutralize stomach acid" is correct. Sucralfate promotes ulcer healing by creating a protective barrier against acid and pepsin. Sucralfate has no acid-neutralizing capacity and does not decrease acid secretion. (Lehne Ch 78, pg 957)

An adolescent with moderately severe acne has just started taking two antibiotics and oral isotretinoin. Her mother asks, "Does she really need two antibiotics?" Which response is the best answer to this question? A. "That must be a mistake. Let me check with the provider." B. "These two antibiotics have a synergistic effect." C. "Two antibiotics will prevent the bacteria from developing resistance." D. "Two antibiotics will help the acne clear up faster."

Answer Key: C Feedback: "Two antibiotics will prevent the bacteria from developing resistance." Is correct, because when antibiotics are used alone, there can be P. acnes resistance. Therefore, the drug is often combined with clindamycin or erythromycin to protect against resistance, which can occur when antibiotics are used alone. (Lehne ch 105, pg 1281)

A patient who has peptic ulcer disease and is receiving magnesium hydroxide (milk of magnesia) is experiencing an increased number of bowel movements. Which is the nurse's priority action? A. Ask the healthcare provider for a reduction in dose. B. Encourage the patient to decrease dietary fiber. C. request an order to administer the drug with an aluminum hydroxide antacid. D. Instruct the patient to keep an accurate stool count.

Answer Key: C Feedback: "request an order to administer the drug with an aluminum hydroxide antacid." is correct. Most antacids affect the bowel. Some antacids (eg, aluminum hydroxide) promote constipation, whereas others (eg, magnesium hydroxide) promote diarrhea. Effects on the bowel can be minimized by combining an antacid that promotes constipation with one that promotes diarrhea. (Lehne Ch 78, pg 958)

A nurse is administering an adrenergic agonist drug that acts on the adrenergic receptors of the sympathetic nervous system. Which response will the nurse expect to see? A. Pinpoint pupils B. Decreased cardiac output C. Bronchodilation D. Decreased sweating

Answer Key: C Feedback: Adrenergic agonist drug that acts on the adrenergic receptors of the sympathetic nervous system can lead to bronchodilation. Drugs that activate beta2 receptors in the lungs promote bronchodilation. (Lehne Ch 17, pg 148)

our 50 year old patient has high LDLs and has just been prescribed a cholesterol-lowering drug. Which of the following is a first-line agent for lowering LDL? A. Gemfibrozil [Lopid] B. Ezetimibe C. Atorvastatin [Lipitor] D. Nicotinic Acid [Niaspan]

Answer Key: C Feedback: Atorvastatin (statin), is correct. The most effective agents for lowering LDL cholesterol are the HMG-CoA reductase inhibitors (eg, atorvastatin [Lipitor]), usually referred to simply as statins. Atorvastatin is a first-line agent for lowering LDL. (Lehne Ch 50, pg 564)

A classmate asks you how calcium channel blockers (CCBs) work. Which response should you provide? A. CCBs increase arterial pressure. B. CCBs block reabsorption of sodium. C. CCBs relax vascular smooth muscle. D. CCBs have a positive inotropic effect.

Answer Key: C Feedback: By blocking calcium channels, CCBs inhibit muscle contraction in the coronary arteries and peripheral arteries, resulting in relaxed vascular smooth muscle (vasodilation). CCBs have a negative inotropic effect by blocking calcium entry, which decreases the force of contractions. CCBs have no direct role in sodium activity. Vasodilation from CCBs decrease arterial pressure.

A client who has been taking digoxin for 20 years is hospitalized. The client exhibits signs of dehydration, and laboratory results identify the presence of hypokalemia. The nurse should monitor the client for which clinical finding indicating digoxin toxicity A. Constipation B. Decreased urination C. Cardiac dysrhythmias D. Metallic taste in the mouth

Answer Key: C Feedback: Cardiac dysrhythmias is correct. Dehydration can lead to hypokalemia, which is the most common cause of cardiac dysrhythmias in patients receiving digoxin. (Lehne Ch 48, pg 526)

Clonidine reduces blood pressure by: A. Blocking alpha-1 receptors in the peripheral vasculature. B. Stimulating the release of acetylcholine in the brain. C. Reducing outflow of norepinephrine to blood vessels and the heart. D. Decreasing calcium levels in vascular smooth muscle cells.

Answer Key: C Feedback: Clonidine is an alpha2-adrenergic agonist that causes selective activation of alpha2 receptors in the CNS— By activating central alpha2 receptors, clonidine reduces sympathetic outflow (Norepinephrine) to blood vessels and to the heart. By suppressing sympathetic regulation of blood vessels, the drug promotes vasodilation. The net result of cardiac suppression and vasodilation is decreased blood pressure. (Lehne Ch 19, pg 168)

An 18-year-old patient comes to the ER in an intoxicated state after attending a concert. The patient is singing loudly, throws the linens off the bed and urinates on the floor. The patient is not obeying your instructions to calm down. What is the most appropriate action in this scenario? A. Obtain an order for a first-generation antipsychotic drug to calm the patient down. B. Prevent the patient from falling by ensuring the floor is dry and place the patient in a locked room at the end of the unit until they calm down. C. Continue to monitor and communicate with the patient, while ensuring they are safe. D. Ensure all 4 bedrails are up to prevent the patient from urinating on the floor again.

Answer Key: C Feedback: Correct answer "Continue to monitor and communicate with the patient, while ensuring they are safe." As a nurse, your goal is to ensure that your patient is safe and being monitored frequently. Any form of restraints should be a last resort; after all other non-invasive interventions have failed.

Epinephrine is not administered orally because: A. Oral epinephrine has a very bitter taste and patients refuse to take it. B. There is an increased risk for extravasation. C. Epinephrine undergoes rapid destruction by enzymes before it reaches systemic circulation. D. Oral administration would cause immediate vasoconstriction in the GI system, preventing absorption.

Answer Key: C Feedback: Epinephrine can be administered topically or by injection and not orally. Epinephrine and other catecholamines undergo destruction by MAO and COMT before reaching the systemic circulation and have a short half-life. MAO and COMT refer to the actions of two enzymes—monoamine oxidase and catechol-O-methyltransferase. (Lehne Ch 17 pg 144 & 149)

A patient is to receive a beta 1 adrenergic agonist. Before administration of this medication, which assessment finding would most concern the nurse? A. Blood pressure of 100/60 mm Hg B. Respiratory rate of 22 breaths per minute C. Heart rate of 110 bpm D. Pulse oximetry reading of 88%

Answer Key: C Feedback: Heart rate of 110 bpm. Rationale: A beta agonist will bind with the beta 1 receptors of the heart to further increase heart rate. This patient is already tachycardic and further increase could lead to a cardiac event.

A nurse is administering intravenous epinephrine to a patient in the intensive care unit. Which assessment finding would cause the most concern? A. Headache B. Blood pressure of 100/70 mm Hg C. Edema and redness at the IV insertion site D. Increased urine output

Answer Key: C Feedback: If an IV line containing epinephrine becomes extravasated, the ensuing localized vasoconstriction may result in necrosis. Because of this possibility, the IV site should be monitored closely. If extravasation occurs, injury can be minimized by local injection of phentolamine, an alpha-adrenergic antagonist. (Lehne Ch 17, pg 149)

Dopamine is administered to a patient who has been experiencing hypotensive episodes. Other than an increase in blood pressure, which indicator would the nurse use to evaluate a successful response? A. Improved gastric motility B. Weight gain C. Increase in urine output D. Decrease in pulse

Answer Key: C Feedback: Increase in urine output is correct. Dopamine is used to improve hemodynamic status in patients with shock or heart failure. Benefits derive from enhanced cardiac performance and increased renal perfusion. Increased urine output is one index of success. Diuretics may complement the beneficial effects of dopamine on the kidney. (Lehne Ch 17, pg 154)

When is it most appropriate for a nurse to consider implementing an order for chemical restraint? A. When a patient is refusing to obey the orders of both the healthcare team and security. B. When the patient already has a prn order. C. If the patient is causing harm to themselves and others around them and is delirious. D. When the patient is found to be confused and has high ammonia levels.

Answer Key: C Feedback: One must consider the competency of the patient, which is defined as "the capacity or ability to understand the nature and effects of one's actions or decisions." A patient can be restrained if they are a harm to themselves and others and found to be incompetent to make decisions for themselves.

A patient is prescribed a new medication for hypertension, Prazosin [Minipress]. It is most important for the nurse to educate the patient about what? A. Xerostomia B. Rebound hypertension C. Orthostatic hypotension D. Increased urination

Answer Key: C Feedback: Orthostatic hypotension (adverse side effect) is correct. Blockade of alpha1 receptors can cause orthostatic hypotension, reflex tachycardia, and nasal congestion. The most serious of these is hypotension. Patients should be educated about the symptoms of orthostatic hypotension and be advised to sit or lie down if they occur. Also, patients should be informed that orthostatic hypotension can be minimized by moving slowly when changing from a supine or sitting position to an upright position. (Lehne Ch 18, pg 158)

Epinephrine, dopamine, and norepinephrine are called catecholamines. These neurotransmitters are metabolized to inactive metabolites by: A. Acetylcholinesterase (AChE). B. a and b C. Monoamine oxidase (MAO) and catechol-o-methyl transferase (COMT). D. Kinase.

Answer Key: C Feedback: The actions of two enzymes—monoamine oxidase and catechol-O-methyltransferase (COMT)—causes catecholamines to have short half-lives and cannot be used orally. MAO and COMT are located in the liver and in the intestinal wall. Both enzymes are very active and quickly destroy catecholamines administered by any route. (Lehne Ch 17, pg 144)

What information should you include when teaching about hormone-associated cancer risks in postmenopausal women? A. Estrogen monotherapy increases the risk of breast cancer. B. Monotherapy with a progestin increases breast cancer risk. C. Risk for breast cancer increases with age and prolonged use of hormone therapy. D. Estradiol with progestin increases the risk of endometrial cancer.

Answer Key: C Feedback: The prolonged use of estrogen alone is associated with an increased risk of endometrial cancer. Estrogens used alone are not associated with increased risk of breast cancer. Estrogen in combination with progestin is associated with an increased risk of breast cancer. When estrogen is combined with progestin, the risk of endometrial cancer diminishes.

Methylphenidate [Ritalin] has been prescribed for a 7-year-old child diagnosed with ADHD and the nurse suggests it is to be taken with meals. What rationale should the nurse provide for the parents about the timing of medication administration? A. It is an oral mucous membrane irritant. B. This will ensure proper absorption. C. Children tend to forget to take it before meals. D. Ritalin depresses the appetite.

Answer Key: D Feedback: "Ritalin depresses the appetite." Is Correct. Principal adverse effect of Ritalin is weight loss (from appetite suppression). (Lehne Ch 36, pg 397)

The high risk for fetal abnormalities associated with the use of isotretinoin requires that the patient follow a very specific protocol in order to receive the drug. Which of the following is true about this protocol? [Select all that apply] A. The patient must consent to one pregnancy test prior to the initial prescription. B. If a female patient is using isotretinoin, both she and her partner must sign a contract agreeing to both use contraception. C. The patient, pharmacist and prescriber must all participate in protocol. D. The patient must use two forms of birth control while taking isotretinoin.

Answer Key: C, D Feedback: "The patient, pharmacist and prescriber must all participate in protocol." "The patient must use *two forms of birth control* while taking isotretinoin." are both correct. Patients taking isotretinoin must be registered with *iPLEDGE*, which is a protocol involving the patient, provider, and pharmacist. Under the protocol, each patient must use two effective forms of birth control, due to the drugs teratogenic effects. (Lehne ch 105, pg 1283)

Cardiotoxicity is a potential ADR (Adverse Drug Reaction) associated with taking tricyclic antidepressants. While this ADR is not common, patients with underlying cardiac conditions are at higher risk for cardiotoxicity. What two pharmacologic effects of TCAs are responsible for cardiotoxicity? [Select two that apply] A. Nonselective blockade of the reuptake of norepinephrine resulting in vasoconstriction. B. Nonselective blockade of the reuptake of serotonin resulting in tremors. C. Nonselective blockade of muscarinic receptors resulting in reduced parasympathetic response. D. Nonselective blockade of adrenergic receptors resulting in decreased conduction.

Answer Key: C, D Feedback: The most serious adverse effect is cardiotoxicity. These effects occur because, in addition to blocking reuptake of NE and 5-HT, TCAs cause direct blockade of receptors for histamine, acetylcholine, and NE. The TCAs affect the heart by decreasing vagal influence on the heart (secondary to muscarinic blockade), they also block muscarinic cholinergic receptors, and can thereby cause an array of anticholinergic effects. (Lehne Ch 32, pg 349 - 351)

A client with a history of hypertension comes to the emergency department with double vision and a blood pressure of 260/120 mm Hg. The healthcare provider prescribes a nitroprusside [Nipride] infusion. The nurse recalls that nitroprusside [Nipride] decreases blood pressure by what mechanism? A. Decreasing the heart rate B. Increasing cardiac output C. Increasing peripheral resistance D. Relaxing arterial smooth muscles

Answer Key: D

A health care provider prescribes antipsychotic medication, and the nurse teaches the client about the possible side effects of the drug. The nurse concludes that the client needs further teaching about these side effects when he states that he should call the clinic if he experiences: A. Tremors B. Bradykinesia C. Rigidity D. photosensitivity

Answer Key: D Feedback: Signs of pseudoparkinsonism (e.g., tremors, rigidity, and bradykinesia) are common side effects of antipsychotics, but could become more severe so should be reported to the provider. Vision changes and photosensitivity are common side effects of antipsychotic medications.

A patient takes zolpidem [Ambien] for insomnia. The patient tells the nurse that recently he noticed multiple texts in his phone that were sent in the middle of the night but he didn't remember sending them. What should the nurse do? A. Contact the prescriber to request an order for a benzodiazepine instead. B. Reassure the patient that this is most likely caused by a paradoxical reaction to the zolpidem. C. Tell the patient that this is an example of anterograde amnesia, which is an expected effect of a hypnotic. D. Ask the patient about any alcohol consumption in conjunction with the zolpidem.

Answer Key: D Feedback: "Ask the patient about any alcohol consumption in conjunction with the zolpidem." Is Correct. Patients taking benzodiazepines in sleep-inducing doses may carry out complex behaviors, and then have no memory of their actions. Although these events can occur with normal doses, they are more likely when doses are excessive, and when benzodiazepines are combined with alcohol and other CNS depressants. As a result, patients should be warned against combining zolpidem with alcohol and all other drugs that depress CNS function. (Lehne Ch 34, pg 375, 376 and 378)

A patient being treated for generalized anxiety disorder has taken alprazolam [Xanax] daily for 4 weeks. The patient reports stopping the medication yesterday because the symptoms have improved but reports having feelings of panic and paranoia. Which initial action by the nurse is correct? A. Instruct the patient to resume taking the alprazolam. B. Notify the provider that the patient is experiencing a relapse. C. Suggest that the patient discuss taking buspirone [Buspar] with the provider. D. Ask the patient if the medication was stopped abruptly.

Answer Key: D Feedback: "Ask the patient if the medication was stopped abruptly" is correct. When benzodiazepines are discontinued following short-term use at therapeutic doses, the resulting withdrawal syndrome is generally mild and often goes unrecognized. Symptoms include anxiety, insomnia, sweating, tremors, and dizziness. Withdrawal from long-term, high-dose therapy can cause more serious reactions, such as panic, paranoia, delirium, hypertension, muscle twitches, and outright convulsions. The intensity of withdrawal symptoms can be minimized by discontinuing treatment gradually. Doses should be slowly tapered over several weeks or months. Substituting a benzodiazepine with a long half-life for one with a short half-life is also helpful. Patients should be warned against abrupt cessation of treatment. (Lehne Ch 34, pg 376)

A patient receiving clozapine [Clozaril] is complaining of increased urination and thirst. What nursing intervention is essential for this patient? A. Holding the medication. B. Assessing blood pressure. C. Measuring potassium levels. D. Assessing blood glucose levels.

Answer Key: D Feedback: "Assessing blood glucose levels. " Is correct. Clozapine and all other SGAs can cause new-onset diabetes. Patients taking these drugs have developed typical diabetes symptoms, including hyperglycemia, polyuria, polydipsia, polyphagia, and dehydration. In extreme cases, hyperglycemia has led to ketoacidosis, hyperosmolar coma, and even death. Because of diabetes risk, fasting blood sugar should be measured before starting clozapine. (Lehne Ch 31, pg 327)

A patient returns to her health care provider for routine monitoring 3 months after her hypertension regimen was modified. Labs reveal that her serum potassium is elevated. Which is likely responsible for this hyperkalemia? A. Furosemide B. Nifedipine C. Clonidine D. Captopril

Answer Key: D Feedback: "Captopril" is correct. ACE inhibitors such as Captopril can cause hyperkalemia, which is an adverse effect secondary to suppression of aldosterone release. Combined use with potassium supplements or potassium-sparing diuretics is generally avoided. (Lehne Ch 47, pg 508)

Your patient asks you why the provider changed their Parkinson's medication from levodopa [Dopar] to the combination drug carbidopa/levodopa [Sinemet]. You tell your patient that a possible explanation for this change is: A. Carbidopa is sedating so it promotes restful sleep B. Carbidopa can be taken with high protein foods reducing dietary restrictions associated with the medication C. Carbidopa works better to delay the progression of Parkinson's Disease D. Carbidopa increases the availability of levodopa in the CNS, reducing the required dose of levodopa and side effects

Answer Key: D Feedback: "Carbidopa increases the availability of levodopa in the CNS, reducing the required dose of levodopa," is correct. The combination of levodopa plus carbidopa is the most effective therapy for PD. Carbidopa is used to enhance the effects of levodopa.By increasing the fraction of levodopa available for actions in the CNS, carbidopa allows the dosage of levodopa to be reduced by about 75%. (Lehne Ch 21, pages 181 & 182)

An adolescent patient with moderate acne has begun a regimen consisting of combination of clindamycin/benzoyl peroxide [BenzaClin] and tretinoin [Retin-A]. Which statement by the patient indicates understanding of this medication regimen? A. "I should apply the Retin-A twice daily." B. "I should apply the Retin-A immediately after bathing." C. "I should augment this therapy with an abrasive soap." D. "I should use sunscreen every day."

Answer Key: D Feedback: "I should use sunscreen every day." Is Correct. Tretinoin increases susceptibility to sunburn. Therefore, a sunscreen with a sun protection factor [SPF] of 15 or greater should be used in addition to protective clothing. Patients with existing sunburn should not use the drug. (Lehne Ch 105, pg 1282)

Your patient complains of having recent episodes of insomnia and would like a prescription for a hypnotic drug such as Ambien. Which statement made by the patient would concern you the least? A. "I generally have 2-3 glasses of wine before bed to help me sleep." B. "I'm pregnant and getting up to use the bathroom several times a night." C. "I recently was diagnosed with sleep apnea and just started using a CPAP machine at night." D. "In the past, I've experienced some day-time drowsiness after taking Ambien."

Answer Key: D Feedback: "In the past, I've experienced some day-time drowsiness after taking Ambien." Is correct. Ambien has a side effect profile like that of the benzodiazepines. Daytime drowsiness and dizziness are most common, and these occur in only 1% to 2% of patients. (Lehne Ch 34, pg 377)

A 20-year-old woman comes into the clinic after missing her menstrual period 2 weeks ago and says that she suspects that she is pregnant. As you review her medications, the patient says that she is taking isotretinoin. You are most concerned because: A. It is used to treat migraines associated with hormonal changes and is not safe. B. Isotretinoin is used to suppress progesterone and can harm the pregnancy. C. Isotretinoin is a suspected teratogenic and should be used with caution in pregnancy. D. Isotretinoin is a known teratogenic and is contraindicated in pregnancy.

Answer Key: D Feedback: "Isotretinoin is a known teratogenic and is contraindicated in pregnancy." Is correct, Isotretinoin is highly teratogenic and is associated with fetal malformations and therefore should not be used during pregnancy. (Lehne ch 105, pg 1283)

You are educating your patient about the risks of using a topical glucocorticoid ointment. You recognize your patient needs additional education when he makes which statement: A. "This ointment may cause some mild irritation to my skin." B. "If I notice excessive hair growth, I should contact my provider." C. "If I use this for a long time it may start to damage my skin." D. "It will work faster if I apply a lot of ointment to the area."

Answer Key: D Feedback: "It will work faster if I apply a lot of ointment to the area." Is correct, the drug should be applied using a thin layer in order to prevent adverse effects /systemic toxicity due to applying a high dose/amount of the drug. (Lehne ch 105, pg 1279)

A client is receiving a monoamine oxidase inhibitor (MAOI). What should the nurse teach the client? A. It is necessary to avoid the sun. B. Drowsiness is an expected side effect of this medication. C. The therapeutic and toxic levels of the drug are very close. D. Many prescribed and over-the-counter drugs cannot be taken with this medication.

Answer Key: D Feedback: "Many prescribed and over-the-counter drugs cannot be taken with this medication" is correct. MAOIs can interact with many drugs to cause potentially harmful results. Accordingly, patients should be instructed to avoid all medications—prescription drugs and over-the-counter drugs—that have not been specifically approved by the prescriber. (Lehne Ch 21, pg 354)

Which of the following medications for gastrointestinal problems is contraindicated in pregnancy? A. Bismuth subsalicylate. B. Magnesium hydroxide. C. Calcium carbonate. D. Misoprostol.

Answer Key: D Feedback: "Misoprostol" is correct. Misoprostol is contraindicated during pregnancy. The drug is classified in FDA Pregnancy Risk Category X: the risk of use by pregnant women clearly outweighs any possible benefits. Because prostaglandins stimulate uterine contractions, use of misoprostol during pregnancy has caused partial or complete expulsion of the developing fetus. (Lehne Ch 78, pg 957)

Which is the most important benefit of a parenteral formulation of an antipsychotic medication? A. Patient consent for treatment is avoided. B. Parenteral administration is faster than oral administration. C. Parenteral formulation is more effective than oral formulations. D. Parenteral formulation improves adherence for acutely psychotic patients

Answer Key: D Feedback: "Parenteral formulation improves adherence for acutely psychotic patients." Is correct. Parenteral therapy is indicated for acutely psychotic, hospitalized patients. Intramuscular administration is preferred to IV administration. Once symptoms are controlled, oral therapy should be substituted for parenteral therapy. (Lehne Ch 31, pg 325)

A 40 year-old woman with Type II diabetes mellitus has been given a new prescription for metoprolol to treat her newly diagnosed hypertension. The patient says her husband takes propranolol and wonders why she isn't given the same medication. As a nursing student you know metoprolol is likely the better choice because: A. Propranolol will interfere with the patient's diabetic medications. B. Metoprolol is known to be more effective in women. C. Metoprolol is a second generation beta-blocker and is more effective than propranolol. D. Propranolol blocks beta 1 and beta 2 receptors, masking the signs of hypoglycemia.

Answer Key: D Feedback: "Propranolol non-selectively blocks beta 1 and beta 2 receptors, masking the signs of hypoglycemia" is correct. A Beta1-selective agent, such as metoprolol should be used because it is selective. Beta blockers can mask signs of hypoglycemia, and therefore must be used with caution in patients with diabetes. (Lehne Ch 51, pg 587)

A patient has been taking high doses of diazepam [Valium], for several months for an anxiety disorder. The nurse assessing the patient observes that the patient is agitated, euphoric, and anxious. The nurse will: A. Request an order for a longer-acting benzodiazepine. B. Withhold the next dose until a drug level can be drawn. C. Double-check the chart to make sure the last dose was given. D. Suspect a possible paradoxical reaction to the diazepam [Valium].

Answer Key: D Feedback: "Suspect a possible paradoxical reaction to the diazepam [Valium]" is correct. When employed to treat anxiety, benzodiazepines such as diazepam can sometimes cause paradoxical responses, including insomnia, excitation, euphoria, heightened anxiety, and rage. If these occur, the benzodiazepine should be withdrawn. (Lehne Ch 34, pg 376)

Carbidopa/levodopa [Sinemet] is prescribed for a client with Parkinson's disease. What should the nurse teach the client about this medication? A. "Take this medication with meals." B. "Blood levels of the drug should be monitored weekly." C. "It can cause happy feelings followed by feelings of depression." D. "You may experience dizziness when moving from sitting to standing."

Answer Key: D Feedback: "You may experience dizziness when moving from sitting to standing," is correct. The patient may experience dizziness when moving from a sitting to standing position due to postural hypotension, which is common early in treatment. Hypotension can be reduced by increasing intake of salt and water. (Lehne Ch 21, pg 180)

A 25-year-old patient has been newly diagnosed with Parkinson's disease, and the prescriber is considering using pramipexole [Mirapex]. Before beginning therapy with this drug, the nurse will ask the patient about: A. any previous history of hypertension. B. whether any family members have experienced psychoses C. difficulty falling asleep or staying asleep. D. any history of alcohol abuse or compulsive behaviors.

Answer Key: D Feedback: "any history of alcohol abuse or compulsive behaviors," is correct. Pramipexole has been associated with impulse control disorders. These behaviors are dose related, begin about 9 months after starting pramipexole, and reverse when the drug is discontinued. Risk factors include younger adulthood, a family or personal history of alcohol abuse, and a personality trait called novelty seeking, characterized by impulsivity. (Lehne Ch 21, pg 183)

Topical glucocorticoids vary in concentration and potential absorption. You would expect higher absorption of a topical glucocorticoid when applied to all of the following except: A. Axilla B. Eyelids C. Face D. forearms

Answer Key: D Feedback: "forearms" is correct, since absorption is higher from regions where the skin is especially permeable (axilla, face, eyelids, neck, perineum, genitalia) and lower from regions where penetrability is poor (palms, soles). Absorption through intact skin is lower than through inflamed skin. (Lehne chh105, pg 1279)

A patient has been diagnosed with Parkinson's disease (PD) and begins treatment with carbidopa/levodopa [Sinemet]. After several months of therapy, the patient reports no change in symptoms. The nurse will expect the provider to: A. add a dopamine agonist. B. discuss the "on-off" phenomenon. C. increase the dose of Sinemet. D. re-evaluate the diagnosis.

Answer Key: D Feedback: "re-evaluate the diagnosis," is correct. The primary goal of Sinemet is to improve the patient's ability to carry out activities of daily living. The drug is very effective, therefore, if a patient fails to respond to the drug, a diagnosis of PD should be questioned. (Lehne Ch 21, pg 178)

A patient stops taking Omeprazole [Prilosec] after 6 weeks of therapy for treatment of peptic ulcer disease. The patient reports symptoms of dyspepsia to the nurse. The nurse will tell this patient to: A. come to the clinic to be tested for Clostridium difficile. B. resume taking the PPI until symptoms resolve completely. C. resume taking the PPI, because long-term therapy is necessary. D. try an antacid to see whether it relieves these symptoms.

Answer Key: D Feedback: "try an antacid to see whether it relieves these symptoms." is correct. When patients stop taking PPIs such as Omeprazole, they often experience dyspepsia brought on by rebound hypersecretion of gastric acid. Acid rebound can be minimized by using PPIs in the lowest effective dose for the shortest time needed, and by tapering the dose when stopping treatment. Dyspepsia can be managed with an antacid. (Lehne Ch 78, pg 954)

Which of the following statements is correct regarding the sympathetic and parasympathetic systems? A. Acetylcholine activates adrenergic receptors. B. Activation of the sympathetic nervous system causes a drop in blood pressure. C. Norepinephrine activates muscarinic receptors. D. Acetylcholine activates muscarinic receptors.

Answer Key: D Feedback: Acetylcholine activates muscarinic receptors, is correct. Acetylcholine is the transmitter released by (1) all preganglionic neurons of the parasympathetic nervous system, (2) all preganglionic neurons of the sympathetic nervous system, (3) all postganglionic neurons of the parasympathetic nervous system, (4) all motor neurons to skeletal muscles, and (5) most postganglionic neurons of the sympathetic nervous system that go to sweat glands. ACh binds to receptors (nicotinicN, nicotinicM, or muscarinic) located on the postjunctional cell. (Lehne ch 13, pg 106 &112)

The nurse is working with a 27-year-old female patient who has recently been started on a conventional antipsychotic. The nurse educates the patient about the drug causing potential menstrual cycle irregularities. The nurse explains that these irregularities are caused by an increase in which of the following? A. Calcium. B. Dopamine. C. Estrogen. D. Prolactin.

Answer Key: D Feedback: Conventional antipsychotics are known to cause neuroendocrine effects such as menstrual irregularities, galactorrhea and gynecomastia-even in males. This is because first generation antipsychotics block dopamanine, which acts as an inhibitory transmitter for prolactin. This allows higher levels of prolactin to circulate, stimulating breast growth, lactation and menstrual irregularities.

You are educating high school students about the menstrual cycle. You asks the students to describe the primary effects of estrogen on the female reproductive organs during the follicular phase. Which answer given by a student is correct? A. "Estrogen causes rupture of the follicle." B. "Estrogen causes the ovarian follicle to ripen." C. "Estrogen causes maturation of the corpus luteum." D. "Estrogen causes proliferation of the endometrium."

Answer Key: D Feedback: During the first half of the menstrual cycle, called the follicular phase, estrogen released from maturing ovarian follicles causes the endometrial lining to proliferate. Follicle-stimulating hormone (FSH) acts on the developing ovarian follicles, causing them to ripen and release estrogens in the first half of the cycle. Luteinizing hormone (LH) levels rise at midcycle, causing rupture of the follicle, which evolves into a corpus luteum. At the end of the cycle, without fertilization, the corpus luteum atrophies, leading to menstrual bleeding as the endometrial lining is shed.

When used in combination with certain foods and drugs, monoamine oxidase inhibitors (MAOIs) can cause serious side effects. Which condition could occur in clients treated with MAOIs for depression? A. A serious drop in blood pressure B. A significant increase in cholesterol levels C. A significant increase in liver enzymes D. A serious increase in blood pressure

Answer Key: D Feedback: MAOIs can be the cause of severe hypertension if the patient eats food that is rich in tyramine, a substance that promotes the release of NE from sympathetic neurons. Hypertensive crisis is characterized by severe headache, tachycardia, hypertension, nausea, vomiting, confusion, and profuse sweating—possibly leading to stroke and death. (Lehne Ch 32, pg 353)

A nursing student is caring for a pregnant patient who has just been diagnosed with hypertension and given a prescription for methyldopa. The nursing student asks the nurse why this drug was chosen instead of clonidine. Which statement by the nurse explains the answer? A. "There is no specific reason that methyldopa was chosen." B. "Clonidine is too strong for a pregnant patient." C. "Clonidine will cause dry mouth and sedation in pregnant patients." D. "Methyldopa is safer because it has shown decreased embryonic teratogenicity ."

Answer Key: D Feedback: Methyldopa works much like clonidine. Like clonidine, methyldopa inhibits sympathetic outflow from the CNS by causing alpha2 activation in the brain. However, methyldopa differs from clonidine in that methyldopa itself is not an alpha2 agonist. Studies regarding methyldopa use in pregnant patients have shown improved outcomes without fetal harm, so the American Congress of Obstetricians and Gynecologists has designated methyldopa as a preferred drug in management of hypertension during pregnancy. (Lehne ch 19, pg 169)

Recently, you've begun experiencing difficulty seeing the powerpoint slides during pharmacology. You go to see an ophthalmologist who wants to dilate your eyes for examination. Which of the following drug classes would the ophthalmologist theoretically use? A. Alpha 2 agonist B. Beta 1 antagonist C. Muscarinic receptor agonist. D. Muscarinic receptor antagonist

Answer Key: D Feedback: Muscarinic receptor antagonist is correct. Activation of muscarinic receptors in the eyes has two effects: (1) miosis (pupillary constriction); and (2) contraction of the ciliary muscle, resulting in accommodation for near vision. An antagonist will have the opposite effect and result in pupil dilation. Blockade of muscarinic receptors on the iris sphincter causes mydriasis (dilation of the pupil). (Lehne Ch 14, pg 116 and 119)

A patient has been prescribed a progestin medication as a part of menopausal hormone therapy. You know this medication is intended to have which desired therapeutic effect? A. To reduce urogenital atrophy B. To relieve vasomotor symptoms C. To prevent adverse cardiac events D. To suppress endometrial proliferation

Answer Key: D Feedback: Progestin is prescribed in hormone therapy to provide a counterbalance to estrogen-mediated stimulation of the endometrium, which can lead to endometrial hyperplasia and cancer. However, it is omitted in women who do not have a uterus. Progestins appear to increase the risk of adverse cardiac events. Estrogens relieve the vasomotor symptoms of menopause and prevent urogenital atrophy (manifesting as vaginal dryness and itching).

You are providing teaching regarding a combination drug containing conjugated estrogens/medroxyprogesterone acetate [Prempro]. Which statement by the patient indicates that your teaching was effective? A. "I am prepared to take this medication for the rest of my life." B. "I know this decreases my risk for coronary heart disease." C. "I know I am at an additional risk for increased growth of my uterus lining." D. "I understand that the combination product should help protect me from the side effects of the estrogen.

Answer Key: D Feedback: The progestin component of Prempro reduces the risk of excessive growth of the lining of the uterus that can occur with the estrogen component.

A nurse is teaching a patient about a medication that alters sympathetic nervous system functions. To evaluate understanding, the nurse asks the patient to describe which functions the sympathetic nervous system regulates. Which answer indicates the need for further teaching? A. "The cardiovascular system." B. "Body temperature." C. "The fight-or-flight response." D. "The digestive functions of the body."

Answer Key: D Feedback: The sympathetic nervous system has three main functions: Regulating the cardiovascular system, Regulating body temperature and Implementing the acute stress response ("fight-or-flight" response). (Lehne Ch 13, pg 102)

Which of the following statements concerning the sympathetic nervous system is correct? A. The sympathetic system only uses norepinephrine as a neurotransmitter. B. The sympathetic system is involved in accommodation of near vision, movement of food and urination. C. The sympathetic system does not control the sweat glands. D. The sympathetic system often discharges as a single, functional system.

Answer Key: D Feedback: The sympathetic system often discharges as a single, functional system. Parasympathetic system functions as a unit and often discharges as a complete system. During a fight or flight response, sympathetic activation occurs by stimulation of adrenal medulla to release epinephrine & less norepinephrine. (Lehne ch 13, pg 103)

_______ is a catecholamine release agent that plays a significant role in hypertensive crisis among patients taking monoamine oxidase inhibitors.

Answer Key: Tyramine Feedback: Tyramine MAOIs can be the cause of severe hypertension if the patient eats food that is rich in tyramine, a substance that promotes the release of NE from sympathetic neurons. (Lehne Ch 32, pg 353)

A patient begins taking nifedipine [Procardia] to treat hypertension. Her provider also prescribes metoprolol [Lopressor] and the patient asks why she needs both medications. The nurse explains that metoprolol is used to treat which of the following effect induced by nifedipine [Lopressor]? A. Constipation. B. Reflex tachycardia. C. Gingival hyperplasia. D. Flushing.

B Feedback: "prevent reflex tachycardia" is correct. Reflex tachycardia is an adverse effect of nifedipine. Lehne Ch 45, pg 490). To help prevent vasodilator-induced reflex tachycardia, patients can be pretreated with a beta blocker (eg, metoprolol), which will block sympathetic stimulation of the heart. (Lehne Ch 46, pg 490).