HESI & Final: EAQs & Practice Q's (GI Drugs, Laxatives, Vitamins, Glucose Regulation, Insulin, Thyroid/Adrenal & AD Meds, Seizure Meds, Anti-psychotics/Antidepressants Sedatives)

A. hypercalcemia ***Watch for signs of hypercalcemia in the patient receiving calcium carbonate.

A patient is taking calcium carbonate for peptic ulcer disease. The nurse should monitor the patient for? A. hypercalcemia B. hypocalcemia C. hyperkalemia D. hypokalemia

D. nausea and vomiting ***Ondansetron is an antiemetic used to treat postoperative nasuea and vomiting, as well as nausea and vomiting associated with chemotherapy. The other options are incorrect reasons for administering this medication.

A client has an as needed prescription for ondansetron. For which condition(s) should the nurse administer this medication? A. paralytic ileus B. incisional pain C. urinary retention D. nausea and vomiting

B. heartburn ***Omeprazole is a proton pump inhibitor classified as an antiulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often called heartburn by clients. Omeprazole is not used to treat the conditions identified in options 1, 3, and 4.

A client has been taking omeprazole for 4 weeks. The ambulatory care nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom? A. diarrhea B. heartburn C. flatulence D. constipation

D. one hour before meals and at bedtime ***Sucralfate is a gastric protectant. The medication should be scheduled for administration 1 hour before meals and at bedtime. The medication is timed to allow it to form a protective coating over the ulcer before food intake stimulates gastric acid production and mechanical irritation. The other options are incorrect.

A client with a gastric ulcer has a prescription for sucralfate 1 gram by mouth 4 times daily. The nurse should schedule the medication for which times? A. with meals and at bedtime B. every 6 hours around the clock C. one hour after meals and at bedtime D. one hour before meals and at bedtime

D. rivastigmine

A drug used to treat mild to moderate dementia. Should be given PO BID or transdermal patch daily. Use cautiously in COPD/ asthma. Common side effects include weakness, dizziness, and nausea. May cause wt. loss. A. donepezil B. memantine C. galantamine D. rivastigmine

A. donepezil

A drug used to treat mild to moderate to severe dementia. Can cause headache, nausea, and dizziness. The nurse should assess for bradycardia and teach the pt. to take right before bed. A. donepezil B. memantine C. galantamine D. rivastigmine

B. memantine

A drug used to treat moderate to severe dementia. Is available in immediate and extended release capsules. Nurse should assess RBCs, hemoglobin, and hematocrit. Administer lower doses if pt. has renal failure. A. donepezil B. memantine C. galantamine D. rivastigmine

B. Help control symptoms during the severe manic episode ***Antipsychotic drugs are given to help control symptoms during severe manic episodes, even if psychotic symptoms are absent. Benzodiazepines are given for their sedating effects. Antidepressants help elevate mood during manic episodes.

A family member of a patient who is experiencing a severe manic episode asks the nurse why the patient is receiving an antipsychotic medication. The nurse informs the family member that antipsychotics are used to do what in the treatment of severe manic episodes? A. Elevate mood during the severe manic episode B. Help control symptoms during the severe manic episode C. Produce sedating effects during the severe manic episode D. Reduce the amount of physical pain the patient experiences during the severe manic episode

B. "Discuss tapering the drug with the provider before conception." ***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 female patient who takes 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."

D. Proton pump inhibitors

Which class of drugs is the most effective for suppressing secretion of gastric acid? A. Beta blockers B. H2-receptor blockers C. Antacids D. Proton pump inhibitors

C. In 6 to 12 hours ***Low-dose (30 mL) milk of magnesia, an osmotic laxative, acts to retain water and soften the feces. Fecal swelling promotes peristalsis in 6 to 12 hours.

A nurse administering 30 mL of magnesium hydroxide (milk of magnesia) tells the patient to expect a bowel movement in which amount of time? A. In 1 to 3 days B. In 2 to 4 hours C. In 6 to 12 hours D. In 15 minutes to 1 hour

A. Omeprazole [Prilosec] ***Omeprazole causes irreversible inhibition of the proton pump, the enzyme that generates gastric acid. It is a powerful suppressant of acid secretion. Famotidine and ranitidine block histamine2 receptors on parietal cells. Misoprostol protects against ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs) by stimulating the secretion of mucus and bicarbonate to maintain submucosal blood flow.

A nurse administers which medication to inhibit an enzyme that makes gastric acid in a patient who has a duodenal ulcer? A. Omeprazole [Prilosec] B. Famotidine [Pepcid] C. Misoprostol [Cytotec] D. Ranitidine [Zantac]

B. Cimetidine [Tagamet] ***Cimetidine binds to androgen receptors, producing receptor blockade, which can cause enlarged breast tissue (gynecomastia), reduced libido, and impotence. All these effects reverse when dosing stops. Amoxicillin, metronidazole, and omeprazole are not associated with gynecomastia.

A nurse assesses a male patient who has developed gynecomastia while receiving treatment for peptic ulcers. Which medication from the patient's history should the nurse recognize as a contributing factor? A. Amoxicillin [Amoxil] B. Cimetidine [Tagamet] C. Metronidazole [Flagyl] D. Omeprazole [Prilosec]

D. Akathisia ***Haloperidol is a traditional antipsychotic medication with the adverse effects of extrapyramidal symptoms. Akathisia, or motor restlessness, is an extrapyramidal symptom. Dystonia manifests as severe spasm of the muscles of the tongue, face, neck, or back and may include upward deviation of the eyes, severe cramping, and impaired respiration. Tardive dyskinesia presents with involuntary twisting, writhing, wormlike movements of the tongue and face, lip smacking, and tongue flicking. Parkinsonism appears with bradykinesia, masklike facies, drooling, tremor, rigidity, shuffling gait, and stooped posture.

A nurse assesses a patient receiving haloperidol [Haldol]. The nurse notices that the patient is shifting in the chair, rocking back and forth, and tapping both feet constantly. What is the most accurate term to document these findings? A. Dystonia B. Tardive dyskinesia C. Parkinsonism D. Akathisia

D. Developed lithium toxicity ***Early lithium toxicity is evidenced by diarrhea, anorexia, muscle weakness, nausea, vomiting, tremors, slurred speech, and drowsiness. Later signs include blurred vision, seizures, trembling, confusion, and ataxia.

A nurse assesses a patient who takes a maintenance dose of lithium carbonate [Lithobid] for bipolar disorder. The patient complains of hand tremor, nausea, vomiting, and diarrhea. The patient's gait is unsteady. The patient most likely has done what? A. Consumed some foods high in tyramine B. Not taken the lithium as directed C. Developed tolerance to the lithium D. Developed lithium toxicity

B. taking alcohol with Ativan may increase sedative effects. ***Alcohol and other CNS depressants should not be taken with benzodiazepines because respiratory depression could result.

A nurse caring for a patient in an outpatient setting notes that the patient is currently taking lorazepam (Ativan) for anxiety and her breath smells of alcohol. The nurse reports this to the health care provider because A. taking alcohol with Ativan can be fatal. B. taking alcohol with Ativan may increase sedative effects. C. all patients using alcohol should be referred for assistance. D. Ativan and alcohol antagonize one another.

A. bulk-forming

Which class of laxatives is preferred? A. bulk-forming B. surfactant C. osmotic D. stimulant

B. Hypothyroidism ***The anterior pituitary increases production of TSH when thyroid hormone levels of T3 and T4 are reduced reflecting primary hypothyroidism. Patients may experience fatigue caused by a lowered basal metabolic rate. Thyrotoxicosis, hyperthyroidism, and Graves' disease are medical conditions indicative of excessive thyroid activity.

A nurse is caring for a patient with decreased triiodothyronine (T3) and thyroxine (T4) and elevated thyroid-stimulating hormone (TSH) levels. The nurse knows the patient is likely suffering from which condition? A. Thyrotoxicosis B. Hypothyroidism C. Graves' disease D. Hyperthyroidism

A. At times of stress, the patient increases the glucocorticoid dose. ***Patients with adrenal insufficiency require lifelong replacement doses of glucocorticoids. Failure to increase the dosage at times of stress and illness can be life-threatening. Wearing a Medic Alert bracelet, carrying injectable and oral forms of glucocorticoid, and dividing the daily glucocorticoid dose are important for a patient taking hydrocortisone, but they are not priorities over understanding the need to increase the dose during stress.

A nurse is developing a plan of care for a patient who has Addison's disease and is taking hydrocortisone [Cortef]. Which of these outcomes should receive priority in the plan? A. At times of stress, the patient increases the glucocorticoid dose. B. The patient wears a Medic Alert bracelet at all times. C. The patient carries an injectable form and an oral form of glucocorticoid. D. The patient divides the daily dose, taking two-thirds of it in the morning and one-third in the afternoon.

B. During times of stress, the patient increases the glucocorticoid dose. ***Patients with adrenal insufficiency require lifelong replacement doses of glucocorticoids. Failure to increase the dosage at times of stress and illness can be life threatening. Wearing a medical ID bracelet, carrying injectable and oral forms of glucocorticoid, and dividing the daily glucocorticoid dose are important for a patient taking hydrocortisone, but they are not priorities over understanding the need to increase the dose during times of stress.

A nurse is developing a plan of care for a patient with Addison's disease who is taking hydrocortisone [Cortef]. Which outcome is of the highest priority for this patient's care plan? A. The patient wears a medical ID bracelet at all times. B. During times of stress, the patient increases the glucocorticoid dose. C. The patient carries an injectable form and an oral form of glucocorticoid. D. The patient divides the daily dose taking two-thirds of it in the morning and one-third in the afternoon.

D. Disruption of the bacterial cell wall, causing lysis and death ***Amoxicillin disrupts the cell wall of H. pylori, which causes lysis and death. Inhibition of an enzyme to block acid secretion is a function of the proton pump inhibitors (PPIs). Coating of the ulcer crater as a barrier to acid is an action of sucralfate [Carafate]. Selective blockade of parietal cell histamine2 receptors is an action of the histamine2 receptor antagonists cimetidine, ranitidine, famotidine, and nizatidine.

A nurse is planning care for a patient who has peptic ulcer disease and is taking amoxicillin [Amoxil]. The nurse is aware that the action of this medication is which of the following? A. Inhibition of an enzyme to block acid secretion B. Coating of the ulcer crater as a barrier to acid C. Selective blockade of parietal cell histamine2 receptors D. Disruption of the bacterial cell wall, causing lysis and death

B. A patient taking warfarin ***Vitamin K is not given to a patient taking warfarin, as this will interfere with the action of the warfarin. There is no contraindication to administering vitamin K for the other patients.

A nurse is reviewing the medication records for vitamin K. The nurse will hold vitamin K and call the provider regarding which patient? A. A newborn infant B. A patient taking warfarin C. A patient with celiac disease D. A patient with megaloblastic anemia

B. Neurologic ***A severe deficiency in cyanocobalamin (vitamin B12) produces neurologic damage. While it is important to assess all systems for vitamin B12 deficiency, assessing the neurologic system is a priority.

A patient has a severe vitamin B12 deficiency. The nurse will make it a priority to assess for alterations in which system? A. Renal B. Neurologic C. Integumentary D. Gastrointestinal

D. "I take a megadose multivitamin daily." ***Because vitamin A is highly teratogenic, it is essential for the nurse to discuss the practice of taking megadoses of vitamins. It is important to discuss vegetarianism to ascertain that the client is obtaining necessary nutrients; however, this is not teratogenic so it is not the priority. Grapefruit juice is only a problem if the client takes drugs metabolized by enzymes inhibited by grapefruit juice. Eating ready-to-eat cereals is not a concern.

A nurse reviews the 24-hour diet and supplement intake of a woman who is in the first trimester of pregnancy. Which information creates the priority concern for the nurse to follow up with the woman? A. "I am a vegetarian." B. "I drink grapefruit juice every morning." C. "I eat a variety of ready-to-eat cereals." D. "I take a megadose multivitamin daily."

C. "It would be better to eat five or six small meals a day instead of three larger ones." ***One optimal nondrug measure, in addition to drug management, to aid patients with peptic ulcers is changing the eating pattern to more frequent, smaller meals to avoid fluctuations in intragastric pH. No evidence indicates that beverages containing caffeine promote ulcer formation or that an "ulcer diet" improves healing. Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the biosynthesis of prostaglandins, which reduce mucosal blood flow and promote the secretion of gastric acid.

A nurse should give which nonmedication instruction to a patient who has peptic ulcers? A. "Reduce your intake of caffeine-containing beverages, such as coffee and colas." B. "Take a nonsteroidal anti-inflammatory drug once a day to help with pain." C. "It would be better to eat five or six small meals a day instead of three larger ones." D. "An ulcer diet of bland foods with milk and cream products will speed healing."

C. Aged cheese and Chianti ***Foods that contain tyramine can produce a hypertensive crisis in individuals taking MAOI antidepressants. Many aged foods, such as cheese, contain tyramines.

A nurse teaches a patient taking a monoamine oxidase inhibitor (MAOI) about important dietary restrictions. Which foods will the nurse caution the patient to avoid? A. Potato and corn chips B. Coffee, colas, and tea C. Aged cheese and Chianti D. Grapefruit and other citrus juices

A. Aged cheese and sherry ***Foods that contain tyramine can produce a hypertensive crisis in individuals taking MAOI antidepressants. Many aged foods contain tyramines.

A nurse teaches a patient who takes an MAOI about important dietary restrictions. Which foods will the nurse caution the patient to avoid? A. Aged cheese and sherry B. Grapefruit and other citrus juices C. Coffee, colas, and tea D. Potato and corn chips

D. Several weeks ***The nurse instructs the patient to adhere to therapy for several weeks to determine whether escitalopram [Lexapro] will be an effective antidepressant. Escitalopram [Lexapro] is a selective serotonin reuptake inhibitor (SSRI), and a delay in therapeutic effectiveness is characteristic of SSRIs. Such drugs do not become effective in 1 week or 2 to 3 days; however, the effect occurs long before 2 to 3 months.

A patient asks the nurse how long it will take for escitalopram [Lexapro] to be completely effective. Which time frame should the nurse include in patient teaching? A. 1 week B. 2 or 3 days C. 2 or 3 months D. Several weeks

C. St. John's wort ***Serotonin syndrome may occur with selective serotonin reuptake inhibitors (SSRIs) when they are combined with herbal products such as ginseng and St. John's wort.

A patient currently prescribed duloxetine [Cymbalta] comes to the health clinic complaining of restlessness, agitation, diaphoresis, and tremors. The nurse suspects serotonin syndrome and questions the patient regarding concurrent use of which substance? A. Gingko B. Ibuprofen C. St. John's wort D. Glucosamine chondroitin

A. "This medication will help you sleep." B. "This medication will decrease irritability." C. "This medication will help decrease anxiety." ***Lorazepam is an adjunctive drug used with patients who have schizophrenia. It serves to suppress anxiety and promote sleep. In patients experiencing an acute psychotic episode, it helps to suppress anxiety and irritability. It does not specifically treat the illness or help the patient cope with the illness.

A patient diagnosed with schizophrenia has been prescribed lorazepam. What should the nurse teach as the reason for this therapy ? Select all that apply A. "This medication will help you sleep." B. "This medication will decrease irritability." C. "This medication will help decrease anxiety." D. "This medication will help you cope with your illness." E. "This medication will relieve positive symptoms of schizophrenia."

B. Take on an empty stomach. ***The medication is to be taken on an empty stomach. There is no specification for it to be taken just before bedtime or immediately upon arising in the morning.

A patient diagnosed with thyroid cancer undergoes a thyroidectomy and is prescribed levothyroxine sodium [Synthroid]. What instructions should the nurse give the patient about taking this medication? A. Take on a full stomach. B. Take on an empty stomach. C. Take immediately after arising. D. Take immediately before bedtime.

C. Red blood cell count ***Deficiency of cyanocobalamin (vitamin B12) manifests as megaloblastic anemia so the nurse would assess the red blood cell count first. It does not affect platelets or white blood cells (a neutrophil is a type of white blood cell).

A patient has a low level of vitamin B12. Which laboratory result should the nurse assess first? A. Platelet count B. Neutrophil count C. Red blood cell count D. White blood cell count

C. Regular insulin [Novolin R] ***This patient has clinical indicators of diabetic ketoacidosis. The patient would require regular insulin [Novolin R] in its intravenous form to reduce the concentration of serum glucose. The nurse should prepare to administer regular insulin [Novolin R] because it is the only insulin that can be administered intravenously. Insulin lispro [Humalog] is a human recombinant rapid-acting insulin analogue. Insulin glargine [Lantus] is a long-acting recombinant DNA-produced insulin analogue, and it provides a constant level of insulin in the body. Insulin isophane suspension, also known as neutral protamine Hagedorn (NPH) insulin [Humulin N], is the only available intermediate-acting insulin product.

A patient has a serum glucose concentration of 375 mg/dL, urine output of 450 mL/hr, and an arterial pH of 7.1. The sliding scale requires intravenous insulin for a blood glucose concentration of more than 350 mg/dL. Which type of insulin is the nurse most likely to administer? A. Insulin lispro [Humalog] B. Insulin glargine [Lantus] C. Regular insulin [Novolin R] D. Neutral protamine Hagedorn (NPH) insulin [Humulin N]

C. Decrease in bleeding tendency ***Vitamin K is an essential nutrient for the synthesis of clotting factors. It also is the antidote for warfarin [Coumadin], an oral anticoagulant. Vitamin K enhances the coagulation process, thus minimizing a patient's risk for excessive bleeding. Increases in RBC indices or mental alertness or a decrease in pulse pressure is unrelated to the therapeutic effects of vitamin K.

A patient has an international normalized ratio [INR] that is elevated to an unsafe level. A nurse administers vitamin K expecting which therapeutic result? A. Decrease in pulse pressure B. Increase in mental alertness C. Decrease in bleeding tendency D. Increase in red blood cell [RBC] indices

A. Dantrolene (Dantrium) ***Treatment of NMS involves immediate withdrawal of antipsychotics, adequate hydration, hypothermic blankets, and administration of antipyretics, benzodiazepines, and muscle relaxants such as dantrolene (Dantrium). Tetrabenazine (Xenazine), used to improve symptoms of Huntington's disease, seems to be effective in treating tardive dyskinesia. Propanolol (Inderal) has been found to be effective in the treatment of akathisia. Acute dystonia may be treated with lorazepam (Ativan).

A patient has been diagnosed with neuroleptic malignant syndrome. The nurse anticipates administration of which medication to treat this patient? A. Dantrolene (Dantrium) B. Tetrabenazine (Xenazine) C. Propranolol (Inderal) D. Lorazepam (Ativan)

A. "I'll take this medication in the morning so as not to interfere with sleep." ***Levothyroxine is used to treat hypothyroidism by increasing the basal metabolism and thus wakefulness. It is administered as a once-daily dose and is a lifelong therapy. It is best taken on an empty stomach to enhance absorption.

A patient has been given instructions about levothyroxine [Synthroid]. Which statement by the patient indicates understanding of these instructions? A. "I'll take this medication in the morning so as not to interfere with sleep." B. "I'll plan to double my dose if I gain more than 1 pound per day." C. "It is best to take the medication with food so I don't have any nausea." D. "I'll be glad when I don't have to take this medication in a few months."

B. Notify the healthcare provider the patient may need to be taken off the drug. ***The primary action is to notify the healthcare provider. Donezepil [Aricept] is known to cause slow heartbeat and fainting. The healthcare provider should be notified because the patient may need to be taken off the medication. The other actions can be performed after the healthcare provider is notified and the nurse is awaiting action.

A patient has been started on donepezil [Aricept]. The patient's family member notifies the nurse that the patient fainted at home. What is the highest priority action on the part of the nurse? A. Instruct the family member not to administer any further doses of the drug. B. Notify the healthcare provider the patient may need to be taken off the drug. C. Reassure the family member that this is an expected side effect of the medication. D. Instruct the family member to call if the patient continues to exhibit fainting episodes.

C. "I only have a bowel movement when I take the medicine." ***Docusate sodium is a surfactant laxative that softens stool by allowing water penetration. Chronic exposure to laxatives can diminish defecation reflexes, leading to further reliance on laxatives. Patient education is the key to reducing laxative abuse. Colon polyps, loss of tooth enamel, and tremors are unrelated to docusate sodium.

A patient has been taking docusate sodium [Colace] daily for 1 year. Which statement by the patient would indicate a complication associated with use of this drug? A. "My doctor says that I've developed colon polyps." B. "I've noticed that I'm having tremors now in my left hand." C. "I only have a bowel movement when I take the medicine." D. "The dental hygienist said I was losing the enamel on my teeth."

D. Flumazenil [Romazicon] ***Oxazepam [Serax] is a benzodiazepine drug. Flumazenil [Romazicon] is an antidote for benzodiazepine overdoses. Naloxone [Narcan], naltrexone [ReVia], and nalmefene [Revex] are not antidotes for benzodiazepine overdoses.

A patient is admitted to the emergency department after an overdose of oxazepam [Serax]. Which antagonist may be used to treat this patient? A. Naloxone [Narcan] B. Naltrexone [ReVia] C. Nalmefene [Revex] D. Flumazenil [Romazicon]

A. vitamin D is fat-soluble.

A patient is admitted to the emergency department after taking high doses of vitamin B and vitamin D. The nurse is more concerned about the vitamin D because A. vitamin D is fat-soluble. B. vitamin D is water-soluble. C. vitamin D in high doses causes bleeding. D. vitamin D in low doses results in scurvy.

B. activated charcoal ***Activated charcoal is a general-purpose antidote that is used for various types of acute oral poisoning.

A patient is admitted to the emergency department with salicylate poisoning. Which drug should the nurse anticipate giving the patient? A. chlorpromazine B. activated charcoal C. magnesium citrate D. docisate

A. The patient is prone to stress ulcers. ***A critically ill patient is prone to stress-related mucosal damage. Therefore, these patients should be prescribed a histamine receptor blocker or a proton pump inhibitor. The patient's stress levels can cause gastrointestinal disorders, but these drugs do not lower stress levels. The general procedures performed on the patients, such as the use of nasal tubes or feeding tubes, only increase the chances of gastrointestinal disorders. Adverse effects are specific to the type of treatment received and can be addressed by specific drugs.

A patient is admitted to the intensive care unit after a myocardial infarction. The provider has ordered drugs to prevent gastrointestinal disorders. Which is a likely reason for administering acid-controlling drugs? A. The patient is prone to stress ulcers. B. The patient's stress levels are treated by these drugs. C. The general procedures for the treatment include these drugs. D. The adverse effects of the treatment are treated by these drugs.

B. Grapefruit juice ***Grapefruit juice can inhibit the metabolism of carbamazepine, thereby causing plasma levels to rise. Grapefruit juice may increase the peak and trough levels of carbamazepine by up to 40%.

A patient is newly prescribed carbamazepine [Tegretol] for seizure control. It is most important for the nurse to teach the patient to avoid which food? A. Tomatoes B. Grapefruit juice C. Spinach D. Kiwi fruit

B. Destroy the bacteria in the stomach that are causing ulceration.

A patient is prescribed amoxicillin and tetracycline to treat peptic ulcer disease. The nurse will instruct the patient that these medications will do what? A. Prevent GI infections that cause gastric bleeding. B. Destroy the bacteria in the stomach that are causing ulceration. C. Reduce gastric acid production and alkalize the stomach fluids. D. Reduce the secretion of pepsin in the stomach.

D. Do not take the bisacodyl with an antacid. ***Instruct patients to take oral bisacodyl no sooner than 1 hour after ingesting milk or antacids. Instruct patients to swallow the tablets intact, without crushing or chewing. Inform patients that bisacodyl suppositories may cause a burning sensation, and warn them that prolonged use can cause proctitis. Senna can cause the patient's urine to turn a harmless yellow-brown or pink.

A patient is prescribed bisacodyl. Which of the following should the nurse include in patient teaching? A. Your urine will turn yellow-brown when taking this medication. B. Crush the bisacodyl tablet and sprinkle it on your food. C. Chew the bisacodyl tablet. D. Do not take the bisacodyl with an antacid.

D. Wait at least 1 hour between administration of the two medications.

A patient is prescribed cimetidine [Tagamet] and aluminum hydroxide [Maalox] for the treatment of peptic ulcer disease. What should the nurse teach the patient to do? A. Drink an 8-ounce glass of water when taking these medications. B. Take the medications together to enhance their effectiveness. C. Take the Tagamet 2 hours before the Maalox. D. Wait at least 1 hour between administration of the two medications.

D. "Take this medication 30 to 60 minutes before meals." ***Omeprazole [Prilosec] and other proton pump inhibitors act directly on the proton pump on parietal cells and decrease acid levels. For the drug to be absorbed and show its action, it should be administered at least 30 to 60 minutes before meals. Crushing and chewing the drug will damage its enteric coating and thus should be avoided. The medication can be given by dissolving in water only when the patient has difficulty swallowing and for patients with a nasogastric tube. The medication will have no effect when taken after meals because of the presence of food.

A patient is prescribed enteric-coated omeprazole [Prilosec] for hyperacidity. What instructions should the nurse provide to the patient regarding medication administration? A. "Take the medication by chewing or crushing it." B. "Take this medication 30 to 60 minutes after meals." C. "Take the medication by dissolving it in water or milk." D. "Take this medication 30 to 60 minutes before meals."

C. Tomatoes D. Orange juice E. Strawberries ***Vitamin C (ascorbic acid) facilitates absorption of dietary iron. The main dietary sources of ascorbic acid are citrus fruits and juices, tomatoes, potatoes, strawberries, melons, spinach, and broccoli. Pasta is usually enriched with folate. Peanuts are high in niacin.

A patient is prescribed iron supplements. Which foods will the nurse encourage the patient to consume to increase iron absorption? Select all that apply. A. Pasta B. Peanuts C. Tomatoes D. Orange juice E. Strawberries

D. Teach the patient to avoid the abrupt cessation of treatment. ***The most important concept is to teach the patient to avoid the abrupt cessation of treatment. This could lead to a life-threatening seizure or to status epilepticus. The patient should not adjust the dose without consulting the prescriber. Although teaching the patient to take the medication with meals and teaching the patient how to avoid gingival hyperplasia are indicated, they are not the priority.

A patient is prescribed phenytoin [Dilantin] for epileptic seizures. Which of the following is the priority for patient teaching? A. Teach the patient to adjust the dose according to the presence of symptoms. B. Tell the patient to take the medication with meals. C. Inform the patient about the prevention of gingival hyperplasia. D. Teach the patient to avoid the abrupt cessation of treatment.

D. Serum creatinine levels ***Assessment of serum creatinine levels is useful for determining the kidney function that is required to prescribe H2 receptor antagonist drugs such as ranitidine [Zantac]. Monitoring blood glucose and blood pressure gives a general idea about the patient's well-being. Serum antibody levels detect possible infections in the patient.

A patient is prescribed ranitidine [Zantac] for the treatment of peptic ulcers. To ensure drug safety, what should the nurse assess before administering the drug? A. Blood glucose levels B. Blood pressure levels C. Serum antibody levels D. Serum creatinine levels

A. Blood glucose control for 24 hours ***Insulin glargine is administered as a once-daily subcutaneous injection for patients with type 1 diabetes. It is used for basal insulin coverage, not mealtime coverage. It has a prolonged duration, up to 24 hours, with no peaks. Blood glucose monitoring is still an essential component to achieve tight glycemic control.

A patient is scheduled to start taking insulin glargine [Lantus]. On the care plan, a nurse should include which of these outcomes related to the therapeutic effects of the medication? A. Blood glucose control for 24 hours B. Mealtime coverage of blood glucose C. Less frequent blood glucose monitoring D. Peak effect achieved in 2 to 4 hours

A. This medication provides blood glucose control for 24 hours. ***Insulin glargine is administered as a once-daily subcutaneous injection for patients with type 1 and type 2 diabetes. It is used for basal insulin coverage, not mealtime coverage. It has a prolonged duration, up to 24 hours, with no peaks. Blood glucose monitoring is still an essential component to achieve tight glycemic control.

A patient is scheduled to start taking insulin glargine [Lantus]. Which information should the nurse give the patient regarding this medication? A. This medication provides blood glucose control for 24 hours. B. The peak effect of this medication is achieved in 2 to 4 hours. C. This medication provides mealtime coverage of blood glucose. D. Less frequent blood glucose monitoring is required when taking this medication

D. Nausea and diarrhea ***Large doses of vitamin C can cause nausea and vomiting, headache, abdominal cramps, and the development of renal stones. Delayed healing, bone and joint pain, and loosening of the teeth are unrelated to the side effects of vitamin C; they actually are symptoms of scurvy, a deficiency of vitamin C.

A patient is scheduled to start taking vitamin C. The nurse should teach the patient to observe for which side effect? A. Delayed healing B. Bone and joint pain C. Loosening of the teeth D. Nausea and diarrhea

C. Nausea and diarrhea ***Large doses of vitamin C can cause nausea and vomiting, headache, abdominal cramps, and the development of renal stones. Delayed healing, bone and joint pain, and loosening of the teeth are unrelated to the side effects of vitamin C; they actually are symptoms of scurvy, a deficiency of vitamin C.

A patient is scheduled to start taking vitamin C. The nurse should teach the patient to observe for which side effect? A. Delayed healing B. Bone and joint pain C. Nausea and diarrhea D. Loosening of the teeth

A. hypercalcemia ***Watch for signs of hypercelemia in the patient receiving calcium carbonate.

A patient is taking calcium carbonate for peptic ulcer disease. The nurse should monitor the patient for: A. hypercalcemia B. hypocalcemia C. hyperkalemia D. hypokalemia

C. Muscle weakness ***Muscle weakness is a sign of hypokalemia, which can occur because fludrocortisone has mineralocorticoid properties, resulting in sodium and fluid retention and potassium excretion. Syncope and weight loss do not occur because of salt and water retention. Numbness and tingling may be associated with another problem but are not related to fludrocortisone.

A patient is taking fludrocortisone [Florinef]. A nurse should recognize that the patient is at risk for developing an electrolyte imbalance if the patient reports which symptom? A. Syncope B. Weight loss C. Muscle weakness D. Numbness and tingling

B. increase fiber and fluid intake to avoid constipation. E. take the iron supplement with orange juice.

A patient is taking iron supplementation. It is most important for the nurse to instruct the patient to: (Select all that Apply) A. increase fluid intake to avoid urinary calculi. B. increase fiber and fluid intake to avoid constipation. C. increase deep breathing to avoid atelectasis. D. use sunscreen to deal with photosensitivity. E. take the iron supplement with orange juice.

D. "It promotes the passage of glucose into cells for energy." ***Insulin promotes the passage of glucose into cells, where it is metabolized for energy. During or after a meal, the glucose that is ingested stimulates the pancreas to secrete insulin. Insulin stimulates the synthesis of proteins and not amino acids. Insulin stimulates the liver to convert glucose to glycogen.

A patient newly diagnosed with diabetes asks, "How does insulin normally work in my body?" Which response by the nurse is correct? A. "It stimulates the pancreas to reabsorb glucose." B. "It promotes synthesis of amino acids into glucose." C. "It stimulates the liver to convert glycogen to glucose." D. "It promotes the passage of glucose into cells for energy."

D. It promotes the passage of glucose into cells for energy. ***The hormone insulin promotes the passage of glucose into cells, where it is metabolized for energy. Insulin does not stimulate the pancreas to reabsorb glucose or synthesize amino acids into glucose. It does not stimulate the liver to convert glycogen into glucose.

A patient newly diagnosed with type 1 diabetes asks a nurse, "How does insulin normally work in my body?" The nurse explains that normal insulin has which action in the body? A. It stimulates the pancreas to reabsorb glucose. B. It promotes the synthesis of amino acids into glucose. C. It stimulates the liver to convert glycogen to glucose. D. It promotes the passage of glucose into cells for energy.

A. It promotes the passage of glucose into cells. ***The hormone insulin promotes the passage of glucose into cells where it is metabolized for energy. Insulin does not stimulate the pancreas to reabsorb glucose or synthesize amino acids into glucose. It does not stimulate the liver to convert glycogen into glucose.

A patient newly diagnosed with type 1 diabetes asks a nurse, "How does insulin normally work in my body?" The nurse should base his or her response on which understanding of the mechanism of insulin? A. It promotes the passage of glucose into cells. B. It stimulates the pancreas to reabsorb glucose. C. It stimulates the liver to convert glycogen to glucose. D. It promotes the synthesis of amino acids into glucose.

A. "This medication has a duration of action of 24 hours." ***Insulin glargine [Lantus] has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas. This medication cannot be mixed with other insulins and is not a short-acting insulin. The patient may need to receive this medication for a long time.

A patient newly diagnosed with type 2 diabetes mellitus has been ordered insulin glargine [Lantus]. Which information is essential for the nurse to teach this patient? A. "This medication has a duration of action of 24 hours." B. "This medication should be mixed with the regular insulin each morning." C. "This medication is very expensive, but you will be receiving it only a short time." D. "This medication is very short-acting. You must be sure you eat after injecting it."

B. increased risk for falls due to orthostatic hypotension. ***Orthostatic hypotension is the most common adverse reaction seen in patients treated with risperidone (Risperdal).

A patient on risperidone (Risperdal) may be at increased risk for injury due to A. increased potential for aspiration due to sedation. B. increased risk for falls due to orthostatic hypotension. C. increased risk for infection due to neutropenia. D. increased risk for suicide due to changes in thought processes.

D. Ask whether the patient is using at least 8 ounces of fluid to prepare the psyllium. ***Bulk-forming laxatives, such as psyllium, must be given with at least 8 ounces (240 mL) of liquid, plus additional liquid each day, to prevent intestinal impaction. Another laxative may not be necessary at this time. A dosage increase and monitoring are appropriate after proper mixing of the medication has been validated.

A patient reports abdominal bloating and infrequent, small, hard stools after taking psyllium [Metamucil] for 2 weeks. Which is the nurse's priority action? A. Consult the physician about another laxative choice. B. Check the dose because an increase may be indicated. C. Ask whether the patient is toileting at the same time every day. D. Ask whether the patient is using at least 8 ounces of fluid to prepare the psyllium.

A. Folic acid ***Folic acid deficiency during early pregnancy can cause neural tube defects (spina bifida). All women with the potential for becoming pregnant should consume folic acid every day. Vitamin B12, riboflavin, and vitamin D are not considered as important as folic acid to supplement before a woman becomes pregnant.

A patient tells the nurse that she is thinking about becoming pregnant. The nurse teaches the patient that which vitamin should be her priority for supplementation before planning a pregnancy? A. Folic acid B. Vitamin D C. Riboflavin D. Vitamin B12

D. Folic acid ***Folic acid deficiency during early pregnancy can cause neural tube defects [spina bifida]. All women with the potential for becoming pregnant should consume folic acid every day. Vitamin B12, riboflavin, and vitamin D are not considered as important as folic acid to supplement before a woman becomes pregnant.

A patient tells the nurse that she is thinking about becoming pregnant. The nurse teaches the patient that which vitamin should be her priority for supplementation before planning a pregnancy? A. Vitamin B12 B. Riboflavin C. Vitamin D D. Folic acid

D. Senna [Senokot] ***Stimulant laxatives are commonly used to treat opioid-induced constipation.

A patient who has been taking a long-acting morphine to treat severe pain for a few months complains of constipation. The nurse anticipates which of the following will be prescribed for the patient? A. Polycarbophil [FiberCon] B. Mineral oil C. Psyllium [Metamucil] D. Senna [Senokot]

A. Alcohol B. Opioids D. Antihistamines E. Muscle relaxants ***Because they are also central nervous system (CNS) depressants, the nurse instructs the patient to avoid alcohol, opioids, antihistamines, and muscle relaxants; when taken together with alprazolam [Xanax] they can cause significant CNS depression, including respiratory depression. Tobacco use is likely to be harmful, but it is unlikely to intensify the adverse effects of a benzodiazepine. Caffeine, a xanthine stimulant, is likely to ameliorate CNS depression associated with benzodiazepines.

A patient who has been taking alprazolam [Xanax] and has been compliant with the therapeutic regimen for 6 weeks is now complaining of adverse effects of the medication. Which substances will the nurse instruct the patient to avoid to help prevent intensification of this medication's adverse effects? Select all that apply. A. Alcohol B. Opioids C. Tobacco D. Antihistamines E. Muscle relaxants F. Caffeinated drinks

A. Neutralized gastric acid ***Antacids work by neutralizing, absorbing, or buffering gastric acid, which raises the gastric pH above 5. For patients with GERD, antacids can produce symptomatic relief. Increased barrier to pepsin is an effect of sucralfate [Carafate]. Reduced stomach motility is not an effect of milk of magnesia.

A patient who has gastroesophageal reflux disease (GERD) is taking magnesium hydroxide (milk of magnesia). Which outcome should a nurse expect if the medication is achieving the desired therapeutic effect? A. Neutralized gastric acid B. Reduced stomach motility C. Increased barrier to pepsin D. Reduced duodenal pH

C. Administer the drug with an aluminum hydroxide antacid. ***Magnesium hydroxide is a rapid-acting antacid with a prominent adverse effect of diarrhea. To compensate, it usually is administered in combination with aluminum hydroxide, which promotes constipation. A reduction in dose might be necessary if the diarrhea is severe, but this is not the priority action. Increasing dietary fiber and keeping a stool count are appropriate actions to implement after adding an antacid to counteract the diarrhea effect.

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 increase dietary fiber. C. Administer the drug with an aluminum hydroxide antacid. D. Instruct the patient to keep an accurate stool count.

D. Administer the drug with an aluminum hydroxide antacid. ***Magnesium hydroxide is a rapid-acting antacid with a prominent adverse effect of diarrhea. To compensate, it usually is administered in combination with aluminum hydroxide, which promotes constipation. A reduction in dose might be necessary if the diarrhea is severe, but this is not the priority action. Increasing dietary fiber and keeping a stool count are appropriate actions to implement after adding an antacid to counteract the diarrhea effect.

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. Encourage the patient to increase dietary fiber. B. Ask the healthcare provider for a reduction in dose. C. Instruct the patient to keep an accurate stool count. D. Administer the drug with an aluminum hydroxide antacid.

D. A therapeutic effect can be expected in another 2 to 4 weeks ***The full therapeutic effects of selective serotonin reuptake inhibitor (SSRI) therapy may take 4 to 6 weeks to occur, so this patient can anticipate experiencing a therapeutic effect in 2 to 4 more weeks. Knowing the time frame to achieve a therapeutic effect offers the patient realistic hope and provides a justification for adherence to therapy. Adverse effects can usually be managed, and relaxation exercises may provide some relief from anxiety. The patient must fulfill these tasks to get the full therapeutic effect of the medication, but it can be difficult for a patient with depression to do so. SSRIs can require considerable titration, but, because of the nature of the patient's illness, this information is unlikely to promote adherence to therapy.

A patient who has taken fluoxetine [Prozac] for 2 weeks to treat an anxiety disorder complains of dissatisfaction with the therapy. What is the best information for the nurse to include in patient education to promote adherence to the therapeutic regimen? A. This medication usually requires titration. B. The adverse effects can be managed well. C. Relaxation exercises can offer some relief. D. A therapeutic effect can be expected in another 2 to 4 weeks

A. Vitamin A D. Vitamin D E. Vitamin E ***Vitamins are divided into two major groups: fat-soluble vitamins (A, D, E, and K) and water-soluble vitamins (vitamin C and members of the vitamin B complex).

A patient with a malabsorption disease is at risk for low levels of fat-soluble vitamins. The nurse anticipates the patient to have a deficiency of which vitamin(s)? Select all that apply. A. Vitamin A B. Vitamin B12 C. Vitamin C D. Vitamin D E. Vitamin E

A. Vitamin A D. Vitamin D E. Vitamin E F. Vitamin K ***Vitamins are divided into two major groups: fat-soluble vitamins (A, D, E, and K) and water-soluble vitamins (vitamin C and members of the vitamin B complex).

A patient with a malabsorption disease is at risk for low levels of fat-soluble vitamins. The nurse is aware that which vitamins are fat soluble? (Select all that apply.) A. Vitamin A B. Vitamin B12 C. Vitamin C D. Vitamin D E. Vitamin E F. Vitamin K

D. Benzodiazepines ***First-line approved choices for generalized anxiety disorder are benzodiazepines, buspirone, and four antidepresssants: venlafaxine, paroxetine, escitalopram, and duloxetine. With the benzodiazepines, onset of relief is rapid, so it will meet the need for immediate symptom relief. In contrast, with buspirone and the antidepressants, onset is delayed.

A patient with generalized anxiety disorder needs immediate relief of symptoms. Which class of medications is the drug of choice? A. Buspirone B. Antipsychotics C. Antidepressants D. Benzodiazepines

B. Reduced ammonia level ***Some practitioners use lactulose to reduce blood ammonia levels by forcing ammonia from the blood into the colon. Lactulose is useful for treating patients with hepatic encephalopathy. It does not result in less ascitic fluid, a normal serum sodium level, or release of glycogen stores.

A patient with hepatic encephalopathy receives lactulose. The nurse expects which therapeutic outcome if the medication is having the desired effect? A. Less ascitic fluid B. Reduced ammonia level C. Release of glycogen stores D. Normal serum sodium level

B. vitamin B12.

A patient with pernicious anemia most likely has a deficiency of A. iron. B. vitamin B12. C. vitamin K. D. selenium.

D. The medication may cause headaches and insomnia. ***Side effects include headache, nervousness, restlessness, insomnia, blurred vision, tremors, GI distress, and sexual dysfunction. The drug takes about 2 to 4 weeks for onset, decreases libido, and has no interaction with grapefruit juice.

A patient with reactive depression is ordered to receive fluoxetine (Prozac). Which information will the nurse include when teaching this patient? A. The medication takes effect in 1 week. B. The medication increases libido. C. The medication should be taken with grapefruit juice. D. The medication may cause headaches and insomnia.

D. Polyethylene glycol-electrolyte solution [GoLYTELY] ***GoLYTELY, an osmotic laxative, produces a watery stool in 2 to 6 hours. It is isosmotic with body fluids so it causes no fluid or electrolyte imbalance and thus can be used safely in patients with an electrolyte impairment. Magnesium salts are contraindicated in patients with renal dysfunction. Mineral oil is more useful when administered by enema for fecal impaction. Docusate sodium produces results in 1 to 3 days.

A patient with renal impairment requires bowel cleansing before a diagnostic procedure. The nurse prepares to administer which laxative? A. Mineral oil B. Docusate sodium [Colace] C. Magnesium salts (magnesium citrate) D. Polyethylene glycol-electrolyte solution [GoLYTELY]

C. "Full effects of this drug may not be seen for 4 weeks or more." ***The patient should not expect the problem to be cured quickly. The patient should be instructed that therapeutic effects may not be seen for 4 weeks or more.

A patient with schizophrenia begins a course of first-generation antipsychotic medications. What should the nurse teach the patient? A. "Assess your weight daily." B. "Your blood pressure may increase significantly. " C. "Full effects of this drug may not be seen for 4 weeks or more." D. "Call the healthcare provider if you do not feel better right away."

D. Make sure the patient eats breakfast immediately. ***Insulin aspart [NovoLog] is a rapid-acting insulin that acts in 15 minutes or less. It is imperative that the patient eat as the insulin starts to work. The patient should have had a fingerstick blood sugar test done before receiving the medication. There is no need to check the urine. This medication is given subcutaneously.

A patient with type 1 diabetes mellitus has been ordered insulin aspart [NovoLog] 10 units at 7:00 AM. Which nursing intervention should the nurse perform after administering this medication? A. Flush the intravenous line. B. Perform a fingerstick blood sugar test. C. Have the patient void and dipstick the urine. D. Make sure the patient eats breakfast immediately.

B. Just before bedtime ***Oral bisacodyl is a stimulant laxative that acts within 6 to 12 hours. When given at bedtime, it produces a response the next morning. Administration at another time might produce a bowel movement at an inconvenient time, such as during a meal or in the middle of the night.

A postoperative patient is scheduled to start taking a daily oral dose of bisacodyl [Dulcolax]. When does the nurse administer the medication? A. After ambulating B. Just before bedtime C. At the evening meal D. Before the morning bath

A. "Inject this insulin with your first bite of food, because it is very fast acting." ***Lispro is a rapid-acting insulin and has an onset of action of 15 to 30 minutes with a peak action of about 2 hours, not 8 to 10 hours. Because of its rapid onset, it is administered immediately before a meal or with meals to control the blood glucose rise after meals. Lispro insulin must be combined with an intermediate- or a long-acting insulin, not regular insulin (which also is a short-duration insulin), for glucose control between meals and at night. To achieve tight glycemic control, patients must combine different types of insulin based on their duration of action.

A teaching plan for a patient who is taking lispro [Humalog] should include which instruction by the nurse? A. "Inject this insulin with your first bite of food, because it is very fast acting." B. "The duration of action for this insulin is about 8 to 10 hours, so you'll need a snack." C. "This insulin needs to be mixed with regular insulin to enhance the effects." D. "To achieve tight glycemic control, this is the only type of insulin you'll need."

B. Facial grimacing and tongue spasms ***Pseudoparkinsonism, which resembles symptoms of Parkinson's disease, is a major side effect of typical antipsychotic drugs such as fluphenazine (Prolixin). Anticholinergic medications may be used to control this side effect.

A young woman is being treated for psychosis with fluphenazine (Prolixin). Which sign would indicate the need to add an anticholinergic to the patient's medication regimen? A. A decrease in pulse and respiratory rate B. Facial grimacing and tongue spasms C. An increase in hallucinations D. A decrease in the patient's level of orientation

D. Gamma-aminobutyric acid (GABA) ***Alprazolam is a benzodiazepine; this class of drugs reduces anxiety by potentiating the action of GABA.

Alprazolam [Xanax] is prescribed for an adult with panic attacks. The nurse recognizes that this drug exerts its therapeutic effect by interacting with which neurotransmitter? A. Norepinephrine B. Acetylcholine C. Serotonin (5-HT) D. Gamma-aminobutyric acid (GABA)

C. New onset of disorientation to time and place ***Effects on the central nervous system are most likely to occur in elderly patients who have renal or hepatic impairment. Patients may experience confusion, hallucinations, lethargy, restlessness, and seizures. The remaining options are not adverse effects of cimetidine.

An 80-year-old patient with a history of renal insufficiency recently was started on cimetidine. Which assessment finding indicates that the patient may be experiencing an adverse effect of the medication? A. +3 pitting edema B. Pain with urination C. New onset of disorientation to time and place D. Heart rate changes from a baseline of 70 to 80 beats per minute (bpm) to 110 to 120 bpm

D. The patient is using a calcium-based antacid. ***Renal stones may occur from the deposition of calcium from milk and calcium-based antacids. The fact that the patient takes an over-the-counter antacid explains the patient's digestive issues and low gastric pH (hyperacidity). A lower dose of antacid would not be effective for treating hyperacidity or cause renal stones. The fact that the patient drinks two glasses of milk every day is an indication that the patient can process milk.

An assessment reveals that a patient has renal calculi. During the assessment, the nurse learns that the patient has taken over-the-counter antacids for a long time. The patient also consumes two glasses of milk every day. What should the nurse infer from this information? A. The patient has high gastric pH. B. The patient is unable to process milk. C. The patient is taking a lower dose of antacid. D. The patient is using a calcium-based antacid.

C. confusion ***Cimetidine is a histamine (H2)-receptor antagonist. Older clients are especially susceptible to central nervous system side effects of cimetidine. The most frequent of these is confusion. Less common central nervous system side effects include headache, dizziness, drowsiness, and hallucinations.

An older client recently has been taking cimetidine. The nurse monitors the client for which MOST frequent central nervous system effect of this medication? A. tremors B. dizziness C. confusion D. hallucinations

A. renal impairment

Antacids should be used with cation in patients with: A. renal impairment B. COPD C. gastric ulcers D. dueodenal ulcers

D. rhabdomyolysis. ***NMS symptoms include muscle rigidity, sudden high fever, altered mental status, blood pressure fluctuations, tachycardia, dysrhythmias, seizures, rhabdomyolysis, acute renal failure, respiratory failure, and coma.

Assessment findings for a patient with neuroleptic malignant syndrome (NMS) include A. bradycardia. B. hypothermia. C. muscle weakness. D. rhabdomyolysis.

C. dietary intake. ***Certain drug and food interactions with MAO inhibitors can be fatal. Foods that contain tyramine have sympathomimetic-like effects and can cause a hypertensive crisis. These types of food must be avoided by MAOI users.

Before administering an MAO inhibitor, it is most important for the nurse to assess the patient's A. sexual history. B. socioeconomic status. C. dietary intake. D. hydration status.

B. By length of time (rapid, short, intermediate, long)

How are different insulins categorized? A. By route B. By length of time (rapid, short, intermediate, long) C. By mechanism of action D. By color

B. Impaired night vision ***Vitamin A plays an important role in adaptation to dim light and night blindness, which often are the first indicators of deficiency. Vitamin A is used primarily for the prevention or correction of vitamin A deficiency. Tender, bleeding gums, disturbed sleep patterns, and excessive sweating are not related to manifestations of vitamin A deficiency.

In assessing a patient with a vitamin A deficiency, the nurse should determine if the patient has which manifestation? A. Excessive sweating B. Impaired night vision C. Tender, bleeding gums D. Disturbed sleep patterns

C. Rapid

Insulin aspart is a ________ acting insulin. A. Intermediate B. Long C. Rapid D. Short

D. Increases sedation, decreases anxiety and has anticonvulsant effects

Intensifying the effect of GABA has what effect on the body? A. Decreases signs of depression in long term use B. Increases sedation, but does decreases seizure threshold C. Increases mental alertness and focus D. Increases sedation, decreases anxiety and has anticonvulsant effects

B. liver failure patients

Lactulose is an osmotic laxative that is also used in: A. renal failure patients B. liver failure patients C. Cushing's disease patients D. Addison's disease patients

A. dry mouth B. blurry vision D. constipation E. difficulty urinating H. sedation ***Cant see, cant pee, cant spit, cant sh**

List some effects of anticholinergic agents: Select all that apply. A. dry mouth B. blurry vision C. diarrhea D. constipation E. difficulty urinating F. incontinence G. hyperactivity H. sedation

B. fracture C. pneumonia E. acid rebound F. intestinal infection w/ C. diff

Proton pump inhibitors can increase the risk of serious adverse effects including: (select all that apply). A. H. pylori infection B. fracture C. pneumonia D. hypothyroidism E. acid rebound F. intestinal infection w/ C. diff

A. sulfonylureas (glyburide) D. biguanides (metformin - glucophage) ***Sulfonylureas are containdicated in sulfa allergy. Metformin should not be given if pt. is scheduled to have contrast dye for CT scan (could cause renal toxicity).

Prototype for oral antidiabetic drugs, is used to treat type 2 diabetes: select all that apply. A. sulfonylureas (glyburide) B. aspirin NSAIDs C. insulin D. biguanides (metformin - glucophage)

B. decreased TSH, increased T3 & T4 D. intolerance to heat E. goiter F. weight loss and muscle wasting F. restlessness and anxiety

Signs of hyperthyroidism: select all that apply. A. increased TSH, decreased T3 & T4 B. decreased TSH, increased T3 & T4 C. brittle hair and nails D. intolerance to heat E. goiter F. weight loss and muscle wasting G. lethargy and fatigue F. restlessness and anxiety

A. increased TSH, decreased T3 & T4 C. brittle hair and nails D. lethargy and fatigue F. intolerance to cold

Signs of hypothyroidism: select all that apply. A. increased TSH, decreased T3 & T4 B. increase secretion of thyroid hormone C. brittle hair and nails D. lethargy and fatigue E. restlessness and anxiety F. intolerance to cold

A. Hold the medication ***A therapeutic drug level for phenytoin is 10 to 20 mcg/mL. The nurse should hold the medication and then call the healthcare provider.

The client's serum phenytoin [Dilantin] level is 31 mcg/mL. What is the nurse's best action? A. Hold the medication B. Increase the medication dose C. Administer the medication intravenously D. Have the client continue the current regimen

B. "Thyroid drugs should not be taken to treat obesity." ***Thyroid drugs should not be taken to treat obesity. Thyroid drugs may increase the activity of oral anticoagulants. Thyroid drugs may decrease serum digitalis levels when administered concurrently. Cholestyramine decreases the absorption of thyroid drugs by binding to thyroid hormone in the gastrointestinal tract. This may reduce the absorption of both drugs.

The clinical instructor asks the nursing student about various drug interactions of thyroid drugs. Which statement by the nursing student indicates effective learning? A. "Thyroid drugs may increase serum digitalis levels." B. "Thyroid drugs should not be taken to treat obesity." C. "Thyroid drug absorption is increased by cholestyramine." D. "Thyroid drugs may decrease the activity of oral anticoagulants."

B. A different drug may be ordered instead. C. The dosage of the drug may be reduced. ***Due to the reduction in kidney function, the healthcare provider may choose to reduce the dosage of the medication to prevent toxicity or may put the patient on a completely different drug. There would be no reason to stop all drug therapy due to a potential problem with one drug.

The healthcare provider is considering placing the patient on memantine [Namenda]. The patient's family member tells the nurse that the patient has a history of kidney disease. Based on this information, the nurse should anticipate which action on the part of the healthcare provider? Select all that apply. A. All drug therapy will be stopped. B. A different drug may be ordered instead. C. The dosage of the drug may be reduced. D. The dosage of the drug may be increased

C. 750 mg ***The patient taking a medication every 8 hours will take it three times in a 24-hour period: 250 mg times 3 equals 750 mg for a 24-hour period.

The healthcare provider ordered lithium 250 mg PO every 8 hours for a patient experiencing acute mania. What will the patient's total dose be in 24 hours? A. 250 mg B. 500 mg C. 750 mg D. 1000 mg

30 minutes ***The medication is 100 mg in 50 mL and is ordered to run at 100 mL per hour. Since the medication is only 50 mL, the infusion would be complete in 30 minutes.

The healthcare provider ordered thiamine solution 100 mg in 50 mL IV piggyback for a patient with a history of alcohol abuse. The dose is ordered to run at 100 mL per hour. The nurse knows that the infusion will require how much time? Record your answer using a whole number. _____ minutes

C. 2 ***The ordered dose is 150 mcg. The available tablets are 75 mcg. 75 multiplied by 2 equals 150. Therefore, 2 tablets is the correct dose.

The healthcare provider orders 150 mcg of levothyroxine [Synthroid] PO every morning. The medication available is levothyroxine [Synthroid] 75 mcg tablets. How many tablets will the nurse administer? A. 0.5 B. 1 C. 2 D. 4

B. 5 mL *** Each dose will be 5 mL. The total of 20 mg is divided into two doses of 10 mg. The concentration is 2 mg/mL. Divide 10 mg by 2 mg to equal 5 mL.

The healthcare provider orders Namenda syrup 20 mg PO daily in two divided doses. The concentration available is Namenda 2 mg/mL. How many mL will the patient receive for each dose? A. 2 mL B. 5 mL C. 10 mL D. 20 mL

A. It is a synthetic steroid identical to cortisol. C. It has glucocorticoid and mineralocorticoid actions. D. It is a preferred drug for adrenocortical insufficiency. ***Hydrocortisone is a synthetic steroid with a structure identical to that of cortisol. Hydrocortisone is a preferred drug for all forms of adrenocortical insufficiency. Oral hydrocortisone is ideal for chronic replacement therapy. Parenteral administration is used for acute adrenal insufficiency and to supplement oral doses during times of stress. Despite being classified as a glucocorticoid, hydrocortisone also has mineralocorticoid actions.

The nurse administering hydrocortisone to a patient recognizes which statement(s) as true regarding the medication? Select all that apply. A. It is a synthetic steroid identical to cortisol. B. It should not be given during times of stress. C. It has glucocorticoid and mineralocorticoid actions. D. It is a preferred drug for adrenocortical insufficiency. E. It is given intravenously for chronic replacement therapy.

A. "I will take the cimetidine with my meals." B. "I'll know the medication is working if my diarrhea stops." D. "Taking the cimetidine with an antacid will increase its effectiveness." ***Cimetidine, a histamine (H2)-receptor antagonist, helps to alleviate the symptom of heartburn, not diarrhea. Because cimetidine crosses the blood-brain barrier, central nervous system side and adverse effects, such as mental confusion, agitation, depression, and anxiety, can occur. Food reduces the rate of absorption, so if cimetidine is taken with meals, absorption will be slowed. Antacids decrease the absorption of cimetidine and should be taken at least 1 hour apart. If cimetidine is concomitantly administered with warfarin therapy, warfarin doses may need to be reduced, so prothrombin and international normalized ratio results may be followed.

The nurse determines the client needs further instruction on cimetidine if which statements were made? Select all that apply. A. "I will take the cimetidine with my meals." B. "I'll know the medication is working if my diarrhea stops." C. "My episodes of heartburn will decrease if the medication is effective." D. "Taking the cimetidine with an antacid will increase its effectiveness." E. "I will notify my health care provider if I become depressed or anxious." F. "Some of my blood levels will need to be monitored closely since I also take warfarin for atrial fibrillation."

A. A patient with chronic pain D. A patient who recently delivered a child E. A patient recovering from cardiac surgery ***Laxatives are used for correcting constipation associated with certain drugs, especially opioid analgesics, which would probably be used for chronic pain. By softening the stool, laxatives can reduce the painful elimination that can be associated with episiotomy and hemorrhoids associated with childbirth. In patients with cardiovascular diseases (eg, aneurysm, myocardial infarction, disease of the cerebral or cardiac vasculature), softening the stool decreases the amount of strain needed to defecate, thereby avoiding dangerous elevation of blood pressure.

The nurse expects laxatives to be ordered for which patient(s)? Select all that apply. A. A patient with chronic pain B. A patient with no bowel sounds C. A patient with acute food poisoning D. A patient who recently delivered a child E. A patient recovering from cardiac surgery

B. Temperature of 101°F ***Sudden high fever is a symptom of neuroleptic malignant syndrome, a rare but serious complication of high-potency, first-generation antipsychotics, such as haloperidol. The other findings are potential side effects of the drug but would not necessarily need to be reported to the healthcare provider.

The nurse has just administered the first dose of haloperidol [Haldol] to a patient with schizophrenia. Which finding, if present, is the most important for the nurse to report to the healthcare provider before administering the next dose of medication? A. Dry mouth B. Temperature of 101°F C. BP of 104/72 mm Hg D. Drowsiness

A. Lithium C. Carbamazepine E. Divalproex sodium [Depakote] ***Lithium, divalproex sodium [Valproate], and carbamazepine are the principal mood stabilizers used in the treatment of bipolar disorder. Risperidone is an antipsychotic used in the management of bipolar disorder. Venlafaxine [Effexor] is an antidepressant used in the treatment of bipolar disorder.

The nurse identifies which drug(s) as the principal mood stabilizers used in the treatment of bipolar disorder? Select all that apply. A. Lithium B. Risperidone C. Carbamazepine D. Venlafaxine [Effexor] E. Divalproex sodium [Depakote]

A. Lithium C. Divalproex sodium [Depakote] D. Carbamazepine ***Lithium, divalproex sodium [Valproate], and carbamazepine are the principal mood stabilizers used in the treatment of bipolar disorder. Risperidone is an antipsychotic used in the management of bipolar disorder. Venlafaxine [Effexor] is an antidepressant used in the treatment of bipolar disorder.

The nurse identifies which drugs as the principal mood stabilizers used in the treatment of bipolar disorder? (Select all that apply.) A. Lithium B. Risperidone C. Divalproex sodium [Depakote] D. Carbamazepine E. Venlafaxine [Effexor]

B. Orthostatic hypotension ***Orthostatic hypotension is the most common adverse effect of tricyclic antidepressant therapy.

The nurse identifies which most common serious adverse effect of TCA therapy? A. Excitation B. Orthostatic hypotension C. Skin rash D. Sexual dysfunction

C. Bisacodyl [Dulcolax] ***Stimulant laxatives (bisacodyl, senna, castor oil) are most commonly abused by the general public. The nurse should discourage use of these drugs for occasional relief of constipation.

The nurse identifies which of the following as the most common type of laxative abused by the general public? A. Magnesium hydroxide [Milk of Magnesia] B. Docusate sodium [Colace] C. Bisacodyl [Dulcolax] D. Polyethylene glycol [MiraLax]

B. Lactulose ***In addition to its laxative action, lactulose can enhance intestinal excretion of ammonia. This property has been exploited to lower blood ammonia content in patients with portal hypertension and hepatic encephalopathy secondary to chronic liver disease.

The nurse identifies which of the following laxatives as having the added response of ridding the body of ammonia? A. Polyethylene glycol B. Lactulose C. Lubiprostone D. Mineral oil

B. Flumazenil [Romazicon] ***Flumazenil [Romazicon], a benzodiazepine receptor antagonist, is the treatment of choice for overdose of the benzodiazepine diazepam [Valium]. Naloxone [Narcan] is used to reverse opioid overdose. Acetylcysteine [Mucomyst] is used to reverse acetaminophen [Tylenol] overdose. Vitamin K is used to reverse warfarin toxicity.

The nurse in the emergency department is caring for a patient with a suspected overdose of diazepam [Valium]. Which agent is most likely to be administered to reverse the effects of diazepam? A. Naloxone [Narcan] B. Flumazenil [Romazicon] C. Acetylcysteine [Mucomyst] D. Vitamin K

C. The nurse administers carbamazepine with grapefruit juice. ***Carbamazepine is not to be given with grapefruit juice as this can lead to increased toxicity of the drug. Dilantin is adminstered IV with a filter. Gabapentin can safely be given without regard to meals. Phenobarbital elixir can be administered with fruit juice, but the oral pill form of the drug should be given with water.

The nurse is administering morning medications. Which administration technique is an error? A. The nurse administers intravenous Dilantin with a filter. B. The nurse adminsters phenobarbital elixir with fruit juice. C. The nurse administers carbamazepine with grapefruit juice. D. The nurse administers gabapentin without checking when the patient ate

C. Administer the medication no faster than 50 mg/min ***Intravenous phenytoin should be given no faster than 50 mg/min into a 20-gauge or larger catheter. It can only be mixed or diluted in normal saline for infusion. The medication should not be given with dextrose or given quickly through a central line.

The nurse is administering phenytoin [Dilantin] intravenously. What intervention is essential? A. Push the medication quickly through a central line B. Mix the medication in 5% dextrose with 0.9% saline C. Administer the medication no faster than 50 mg/min D. Administer the medication in a 22-gauge or smaller catheter

D. The patient is experiencing adverse effects of the thyroid drugs. ***Anxiety, tachycardia, and insomnia are among the adverse effects of levothyroxine [Synthroid]. These adverse effects may be due to accumulation of the drug in the body; thus, they appear as symptoms of hyperthyroidism. These are not signs and symptoms of an allergic (hypersensitivity) reaction. Anxiety, tachycardia, and insomnia are not anticipated age-related symptoms. If the patient was not responding to the medication, then the patient would have decreased thyroid hormone levels, which would more likely be manifested by bradycardia and increased drowsiness or sleep.

The nurse is assessing an elderly patient who has been taking levothyroxine [Synthroid] for 6 months. The nurse finds that the patient has anxiety, tachycardia, and insomnia. What should the nurse interpret from these findings? A. The patient is hypersensitive to thyroid drugs. B. The patient has common age-related symptoms. C. The patient is not responding to the thyroid drugs. D. The patient is experiencing adverse effects of the thyroid drugs.

C. Diverticulitis D. Abdominal pain E. Bowel obstruction ***Laxatives are contraindicated for individuals with abdominal pain, nausea, cramps, and other symptoms of appendicitis, regional enteritis, diverticulitis, and obstruction of the bowel. Laxatives should be used with caution during pregnancy and lactation. Laxatives are used to treat constipation.

The nurse is aware that laxatives are contraindicated in patients with which condition(s)? Select all that apply. A. Pregnancy B. Constipation C. Diverticulitis D. Abdominal pain E. Bowel obstruction

A. Abdominal pain B. Diverticulitis D. Bowel obstruction ***Laxatives are contraindicated for individuals with abdominal pain, nausea, cramps, and other symptoms of appendicitis, regional enteritis, diverticulitis, and obstruction of the bowel. Laxatives should be used with caution during pregnancy and lactation. Laxatives are used to treat constipation.

The nurse is aware that laxatives are contraindicated in patients with which of the following? (Select all that apply.) A. Abdominal pain B. Diverticulitis C. Constipation D. Bowel obstruction E. Pregnancy

C. To reduce the risk of suicide with overdose ***The SSRIs may be chosen because they have fewer side effects and are safer if an overdose occurs. However, the SSRIs can cause sexual dysfunction and weight gain, and they carry a risk of serotonin syndrome.

The nurse is caring for a group of patients being treated for depression. Why might a selective serotonin reuptake inhibitor (SSRI) be chosen over a tricyclic antidepressant (TCA)? A. To help prevent sexual dysfunction B. To prevent the risk of serotonin syndrome C. To reduce the risk of suicide with overdose D. To avoid weight gain and other gastrointestinal (GI) effects

A. To reduce the risk of suicide with overdose ***The SSRIs may be chosen because they have fewer side effects and are safer with overdose. However, the SSRIs can cause sexual dysfunction and weight gain, and they carry a risk of serotonin syndrome.

The nurse is caring for a group of patients being treated for depression. Why might an SSRI be chosen over a TCA? A. To reduce the risk of suicide with overdose B. To avoid weight gain and other gastrointestinal (GI) effects C. To help prevent sexual dysfunction D. To prevent the risk of serotonin syndrome

C. Acetylcholine ***Acetylcholine (ACh) levels naturally decline by a small percentage with age. Patients with severe AD may have ACh levels that are as much as 90% below normal. This is likely part of the explanation for the pathophysiology of AD.

The nurse is caring for a group of patients diagnosed with Alzheimer's disease (AD). Which neurotransmitter level is decreased by as much as 90% in patients with severe AD? A. Norepinephrine B. Serotonin C. Acetylcholine D. Dopamine

C. Acetylcholine ***Acetylcholine (ACh) levels naturally decline by a small percentage with age. Patients with severe AD may have ACh levels that are as much as 90% below normal. This is likely part of the explanation for the pathophysiology of AD.

The nurse is caring for a group of patients diagnosed with Alzheimer's disease (AD). Which neurotransmitter level is decreased by as much as 90% in patients with severe AD? A. Serotonin B. Dopamine C. Acetylcholine D. Norepinephrine

B. Serotonin syndrome ***Serotonin syndrome can occur within 2 to 72 hours after initiation of treatment with a selective serotonin reuptake inhibitor (SSRI). The symptoms include altered mental status, incoordination, myoclonus, hyperreflexia, excessive sweating, tremor, and fever.

The nurse is caring for a patient in the emergency department who reports the onset of agitation, confusion, muscle twitching, diaphoresis, and fever about 12 hours after beginning a new prescription for escitalopram [Lexapro]. Which is the most likely explanation for these symptoms? A. Cholinergic crisis B. Serotonin syndrome C. Depressive psychosis D. Escitalopram overdose

B. Serotonin syndrome ***Serotonin syndrome can occur within 2 to 72 hours after initiation of treatment with an SSRI. The symptoms include altered mental status, incoordination, myoclonus, hyperreflexia, excessive sweating, tremor, and fever.

The nurse is caring for a patient in the emergency department who reports the onset of agitation, confusion, muscle twitching, diaphoresis, and fever about 12 hours after beginning a new prescription for escitalopram [Lexapro]. Which is the most likely explanation for these symptoms? A. Depressive psychosis B. Serotonin syndrome C. Escitalopram overdose D. Cholinergic crisis

C. Dizziness ***Buspirone is an antianxiety medication with few side effects. The most common effects are dizziness, nausea, headache, nervousness, lightheadedness, and excitement. Buspirone does not cause drowsiness, risk for abuse, or weight gain.

The nurse is caring for a patient receiving buspirone [BuSpar] for the treatment of anxiety. Which symptom is most likely explained as an adverse effect of this drug? A. Diarrhea B. Risk for abuse C. Dizziness D. Weight gain

D. White blood cell (WBC) count of 2000/mm3 ***Clozapine, an atypical antipsychotic, carries a risk of fatal agranulocytosis. For this reason, the WBC count should be monitored and should be greater than 3500/mm3. Renal function (blood urea nitrogen) should not be affected by clozapine. Clozapine may cause metabolic effects, including diabetes, that would result in an increased blood glucose level (greater than 110 mg/dL). Elevated bilirubin indicates liver disease and is not commonly an adverse effect of clozapine.

The nurse is caring for a patient receiving clozapine [Clozaril]. Which assessment finding is most indicative of an adverse effect of this drug? A. Blood urea nitrogen level of 25 mg/dL B. Blood glucose level of 60 mg/dL C. Bilirubin level of 2.5 mg/dL D. White blood cell (WBC) count of 2000/mm3

C. Sexual dysfunction ***Fluoxetine [Prozac], a selective serotonin reuptake inhibitor (SSRI), does not cause anticholinergic effects, orthostatic hypotension, or cardiotoxicity, as do the tricyclic antidepressants. The most common adverse effects are sexual dysfunction, nausea, headache, and central nervous system stimulation.

The nurse is caring for a patient receiving fluoxetine [Prozac] for depression. Which adverse effect is most likely associated with this drug? A. Dry mouth B. Bradycardia C. Sexual dysfunction D. Orthostatic hypotension

A. Sexual dysfunction ***Fluoxetine [Prozac], a selective serotonin reuptake inhibitor (SSRI), does not cause anticholinergic effects, orthostatic hypotension, or cardiotoxicity, as do the tricyclic antidepressants. The most common adverse effects are sexual dysfunction, nausea, headache, and central nervous system stimulation.

The nurse is caring for a patient receiving fluoxetine [Prozac] for depression. Which adverse effect is most likely associated with this drug? A. Sexual dysfunction B. Dry mouth C. Orthostatic hypotension D. Bradycardia

A. Swollen, tender gums B. Measles-like rash D. Unusual hair growth ***Adverse effects associated with phenytoin at therapeutic doses include mild sedation, gingival hyperplasia (swollen, tender gums), morbilliform (measles-like) rash, cardiovascular effects, and other effects, such as hirsutism (unusual hair growth) and interference with vitamin D metabolism.

The nurse is caring for a patient receiving phenytoin [Dilantin] for treatment of tonic-clonic seizures. Which symptoms, if present, would indicate an adverse effect of this drug? (Select all that apply.) A. Swollen, tender gums B. Measles-like rash C. Productive cough D. Unusual hair growth E. Nausea and vomiting

C. "I will drink grapefruit juice instead of coffee with breakfast." ***Grapefruit juice can greatly increase buspirone levels and should be avoided. The other statements are appropriate.

The nurse is caring for a patient taking buspirone [BuSpar]. Which statement by the patient indicates a need for further teaching about this drug? A. "This medication should not make me feel drowsy." B. "This medication should help me feel less anxious." C. "I will drink grapefruit juice instead of coffee with breakfast." D. "I will take my medication three times per day."

C. Aspirin (ASA) for mild headache ***Aspirin is safe to use as an analgesic with lithium. Other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can increase lithium levels by as much as 60%. Diuretics increase lithium levels by reducing the serum sodium level. Diphenhydramine has anticholinergic properties and can aggravate lithium-induced polyuria by causing urinary hesitancy.

The nurse is caring for a patient taking lithium [Lithobid]. The nurse understands that many drugs interact with lithium. Which agent is safe to administer with lithium? A. Ibuprofen [Motrin] for muscle pain B. Hydrochlorothiazide (HCTZ) for edema C. Aspirin (ASA) for mild headache D. Diphenhydramine [Benadryl] for cold symptoms

A. Cimetidine [Tagamet] ***Cimetidine will elevate phenytoin levels by reducing the rate at which phenytoin is metabolized. Phenytoin levels may increase to toxic levels. The use of cimetidine should generally be avoided in patients who are treated with phenytoin, because safer alternatives are available.

The nurse is caring for a patient who is taking phenytoin [Dilantin]. Which medication, if ordered by the physician, should the nurse question? A. Cimetidine [Tagamet] B. Captopril [Capoten] C. Pantoprazole [Protonix] D. Ondansetron [Zofran]

D. The patient should have effective relief from the manic symptoms. ***There is a narrow therapeutic window between the therapeutic and toxic serum levels of lithium. A serum lithium level of 1 to 1.4 mEq/L is optimum for the treatment of acute mania. Therefore, a serum lithium level of 1.2 mEq/L indicates that the patient will have effective relief from the manic symptoms. If the serum lithium level is less than 1 mEq/L, then the patient may have persistent manic symptoms. If the lithium serum level is more than 1.5 mEq/L, then the patient may have lithium toxicity, which is characterized by impaired liver and renal functioning. The adverse effects of lithium toxicity include cardiac dysrhythmia and tremors.

The nurse is caring for a patient with acute mania who has been prescribed lithium carbonate [Lithobid]. The blood tests of the patient indicate the serum lithium level to be 1.2 mEq/L. What does the nurse interpret from this? A. The patient will have persistent manic symptoms. B. The patient may have cardiac dysrhythmia and tremors. C. The patient may have impaired liver and renal functioning. D. The patient should have effective relief from the manic symptoms.

A. Sodium level of 128 mEq/L ***The sodium level is well below the normal range of 135 to 145 mEq/L. When the serum sodium level is reduced, lithium excretion also is reduced, and lithium accumulates. Because lithium has a narrow therapeutic index, this is a dangerous situation that can result in symptoms of toxicity and even death.

The nurse is caring for a patient with bipolar disorder (BPD) who is taking lithium [Lithobid]. Which abnormal laboratory value is most essential for the nurse to communicate to the healthcare provider because this patient is taking lithium? A. Sodium level of 128 mEq/L B. Prothrombin time of 8 seconds C. Potassium level of 5.6 mEq/L D. Blood urea nitrogen level of 25 mg/dL

A. Sodium level of 128 mEq/L ***The sodium level is well below the normal range of 135 to 145 mEq/L. When the serum sodium level is reduced, lithium excretion also is reduced, and lithium accumulates. Because lithium has a narrow therapeutic index, this is a dangerous situation, which can result in symptoms of toxicity and even death.

The nurse is caring for a patient with bipolar disorder (BPD) who is taking lithium [Lithobid]. Which abnormal laboratory value is most essential for the nurse to communicate to the healthcare provider because this patient is taking lithium? A. Sodium level of 128 mEq/L B. Prothrombin time of 8 seconds C. Blood urea nitrogen level of 25 mg/dL D. Potassium level of 5.6 mEq/L

A. "Be sure to call the clinic if you or your family notice increased anxiety or agitation." B. "You may have some mild sedation. Do not drive until you know how this drug will affect you." D. "It is very important to have good oral hygiene and to visit your dentist regularly." ***Patients taking an antiepileptic drug are at increased risk for suicidal thoughts and behavior beginning early in their treatment. The U.S. Food and Drug Administration (FDA) advises that patients, families, and caregivers be informed of the signs that may precede suicidal behavior and be encouraged to report these immediately. Mild sedation can occur in patients taking phenytoin, even at therapeutic levels. Carbamazepine, not phenytoin, increases the risk for hematologic effects, such as easy bruising. Phenytoin causes gingival hyperplasia in about 20% of patients who take it; dental hygiene is important. Patients receiving phenytoin should avoid alcohol and other central nervous system depressants, because they have an additive depressant effect.

The nurse is conducting discharge teaching related to a new prescription for phenytoin [Dilantin]. Which statements are appropriate to include in the teaching for this patient and family? (Select all that apply.) A. "Be sure to call the clinic if you or your family notice increased anxiety or agitation." B. "You may have some mild sedation. Do not drive until you know how this drug will affect you." C. "This drug may cause easy bruising. If you notice this, call the clinic immediately." D. "It is very important to have good oral hygiene and to visit your dentist regularly." E. "You may continue to have wine with your evening meals, but only in moderation."

D. "Have you had any changes in your mood or anxiety level?" ***In the early phase of treatment for depression, suicide risk may increase. Patients should be monitored closely for worsening mood, unusual changes in behavior, and suicide risk. The other questions would be useful in assessing the patient for adverse effects of amitriptyline [Elavil], but assessing suicide risk is the most important intervention.

The nurse is monitoring a patient with depression in the early phase of treatment with amitriptyline [Elavil]. Which question is most important for the nurse to ask the patient? A. "Have you noticed dry mouth or blurred vision?" B. "Have you had any changes in your urine function?" C. "When was your last bowel movement?" D. "Have you had any changes in your mood or anxiety level?"

C. Sedation and dry mouth ***Anticholinergic effects (dry mouth, blurred vision, constipation, tachycardia, urinary retention) and sedation are potential adverse effects of the tricyclic antidepressants (TCAs), such as imipramine [Tofranil]. The most serious common adverse effect is orthostatic hypotension; therefore, a blood pressure of 160/90 mm Hg probably is not caused by this drug. Respiratory problems are not commonly associated with the TCAs.

The nurse is planning care for a patient taking imipramine [Tofranil]. Which finding, if present, would most likely be an adverse effect of this drug? A. Blood pressure of 160/90 mm Hg B. Insomnia and diarrhea C. Sedation and dry mouth D. Tachypnea and wheezing

C. Fluid volume deficit ***Acute adrenal insufficiency (adrenal crisis) is characterized by hypotension, dehydration, weakness, lethargy, and gastrointestinal (GI) symptoms of nausea and vomiting. Rapid replacement of fluid, salt, and glucocorticoids is essential to prevent shock and death. Comfort, nutrition, and activity are important to address once fluid balance has been restored.

The nurse is planning care for a patient with signs of acute adrenal insufficiency. What is the priority nursing diagnosis? A. Altered comfort B. Altered nutrition C. Fluid volume deficit D. Activity intolerance

D. It has more hazardous side effects and drug interactions. ***Phenelzine [Nardil], a monoamine oxidase inhibitor (MAOI), is considered a second- or third-line treatment because of the risk of triggering hypertensive crisis when the patient eats foods high in tyramine. Also, an increased incidence of drug-drug interactions is seen with phenelzine. Phenelzine does not pose an increased risk for suicide, psychoses, or parkinsonism, and it is as effective as the tricyclic and selective serotonin reuptake inhibitor (SSRI) antidepressants.

The nurse is preparing to administer phenelzine [Nardil] to a patient with depression. Why is this drug considered a second- or third-line agent in the treatment of depression? A. It increases the risk of suicide in the early phase. B. It is less effective than the tricyclic antidepressants. C. It increases the risk of psychoses and parkinsonism. D. It has more hazardous side effects and drug interactions.

D. It has more side effects and drug interactions. ***Phenelzine [Nardil], a monoamine oxidase inhibitor (MAOI), is considered a second- or third-line treatment because of the risk of triggering hypertensive crisis when the patient eats foods high in tyramine. Also, an increased incidence of drug-drug interactions is seen with phenelzine. Phenelzine does not pose an increased risk for suicide, psychoses, or parkinsonism, and it is as effective as the tricyclic and SSRI antidepressants.

The nurse is preparing to administer phenelzine [Nardil] to a patient with depression. Why is this drug considered a second- or third-line agent in the treatment of depression? A. It increases the risk of suicide in the early phase. B. It is less effective than the tricyclic antidepressants. C. It increases the risk of psychoses and parkinsonism. D. It has more side effects and drug interactions.

C. 2 ***The ordered dose is 400 mg, and the available tablets are 200 mg. 200 mg × 2 tablets equals the 400-mg ordered dose.

The nurse is preparing to administer quetiapine extended release 400 mg PO every day as ordered. The available medication is quetiapine 200-mg extended-release tablets. How many tablets should the nurse administer? A. 0.5 B. 1 C. 2 D. 4

B. Assessing lithium levels every other week

The nurse is reviewing a patient's medication history and notes that the patient recently began taking lithium (Lithibid). What intervention is a priority for this patient? A. Monitoring for the recurrence of seizure activity B. Assessing lithium levels every other week C. Asking the patient if they have ringing in the ears D. Monitoring the patient's intake and output

B. Clopidogrel [Plavix] 75 mg daily ***For patients who lack risk factors for GI bleeding, combined use of clopidogrel with a PPI, such as omeprazole, may reduce the effects of clopidogrel without offering any real benefits and thus should be avoided. This is due to inhibition of CYP2C19, which converts the drug to its active form. Nothing in the question indicates that the patient is at risk for GI bleeding. The other options are not cause for concern.

The nurse is reviewing the prescriber's orders and notes that omeprazole [Prilosec] has been ordered for a patient admitted with acute coronary syndrome (ACS). The nurse should be concerned if this medication is combined with which medication noted on the patient's record? A. Aspirin 81 mg daily B. Clopidogrel [Plavix] 75 mg daily C. Heparin 5000 units subQ every 12 hours D. Metoprolol 50 mg every 8 hours

B. A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L ***Lithium levels above 1.5 mEq/L should be reported, because this level may indicate impending serious toxicity. The other findings may be side effects of the drugs the patients are taking, but they are not priority problems.

The nurse is seeing several patients in the outpatient clinic today. Which patient most requires the nurse's immediate attention? A. A female patient with BPD who takes valproic acid [Depakene] and who reports nausea and vomiting B. A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L C. A male patient with depression who takes fluoxetine [Prozac] and who reports sexual dysfunction D. A female patient with schizophrenia who takes haloperidol [Haldol] and who has a blood pressure of 102/72 mm Hg

A. A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L ***Lithium levels above 1.5 mEq/L should be reported because this level may indicate impending, serious toxicity. The other findings may be side effects of the drugs the patients are taking, but they are not priority problems.

The nurse is seeing several patients in the outpatient clinic. Which patient most requires the nurse's immediate attention? A. A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L B. A male patient with depression who takes fluoxetine [Prozac] and who reports sexual dysfunction C. A female patient with schizophrenia who takes haloperidol [Haldol] and who has a blood pressure of 102/72 mm Hg D. A female patient with bipolar disorder (BPD) who takes valproic acid [Depakene] and who reports nausea and vomiting

B. "Our goal is to reduce your seizures to an extent that helps you live a normal life." ***Epilepsy is treated successfully with medication in most patients. However, the dosages needed to completely eliminate seizures may cause intolerable side effects. Neurosurgery is indicated only for patients in whom medication therapy is unsuccessful.

The nurse is teaching a patient newly diagnosed with epilepsy about her disease. Which statement made by the nurse best describes the goals of therapy with antiepilepsy medication? A. "With proper treatment, we can completely eliminate your seizures." B. "Our goal is to reduce your seizures to an extent that helps you live a normal life." C. "Epilepsy medication does not reduce seizures in most patients." D. "These drugs will help control your seizures until you have surgery."

A. "This medication may cause some sexual side effects. Let your healthcare provider know about this if it occurs." B. "When you stop taking this medication, you should not withdraw it abruptly." E. "Let your family or your healthcare provider know if you experience a worsening mood, agitation, or increased anxiety." ***Citalopram [Celexa] and other SSRIs can cause sexual side effects that patients may be hesitant to report. SSRIs should be withdrawn slowly to prevent dizziness, headache, dysphoria, and/or other symptoms of withdrawal. The SSRIs do not generally cause orthostatic hypotension or drowsiness. All antidepressants initially increase the risk of suicide, and patients should be monitored for worsening mood and other signs of suicide risk.

The nurse is teaching a patient who has a new prescription for citalopram [Celexa]. Which statement is appropriate to include in the teaching plan? (Select all that apply.) A. "This medication may cause some sexual side effects. Let your healthcare provider know about this if it occurs." B. "When you stop taking this medication, you should not withdraw it abruptly." C. "You will need to move slowly from a sitting to a standing position to prevent dizziness from low blood pressure." D. "This medication often causes drowsiness. You should take it at bedtime." E. "Let your family or your healthcare provider know if you experience a worsening mood, agitation, or increased anxiety."

A. Sweating B. Headache F. Tachycardia ***The effects of hypoglycemia are largely attributable to stimulation of the central nervous system because low blood glucose stresses the body. When hypoglycemia occurs, the sympathetic nervous system responds in an attempt to increase blood glucose. Clinical indicators of hypoglycemia mimic sympathetic nervous system stimulation; they include headaches, diaphoresis (sweating), tachycardia, palpitations, and anxiety.

The nurse is teaching a patient who has type 1 diabetes mellitus how to prevent hypoglycemia. Which clinical indicators of hypoglycemia should the nurse identify for the patient and family? Select all that apply. A. Sweating B. Headache C. Polyphagia D. Weight loss E. Dehydration F. Tachycardia

A. "When it is time to discontinue this drug, you will need to taper it off slowly." ***Alprazolam [Xanax] is a benzodiazepine for which abrupt discontinuation can precipitate withdrawal symptoms. Patients should withdraw the drug gradually over several weeks. The other statements are not related to alprazolam [Xanax].

The nurse is teaching a patient with a new prescription for alprazolam [Xanax]. Which statement is the most appropriate to include in the teaching plan? A. "When it is time to discontinue this drug, you will need to taper it off slowly." B. "Protect your skin from the sun to prevent rash and exaggerated sunburn." C. "Increase your intake of fluid and high-fiber foods to prevent constipation." D. "Take this medication on an empty stomach at least 2 hours after meals."

D. "Take this medicine on an empty stomach in the morning, at least 30 to 60 minutes before eating." ***Patients who are prescribed thyroid replacements or antithyroid drugs should be advised to take the medicine on an empty stomach in the morning, at least 30 to 60 minutes before eating. This helps enhance the absorption of the drug. Taking the medication twice a day after meals may reduce the therapeutic effectiveness of the medication and cause adverse effects. A patient needs to avoid eating foods that may reduce thyroid hormone production and reduce the effectiveness of the medication. Therefore, the nurse should not give false information that the patient need not follow dietary restrictions. This medication should be taken with water rather than orange juice, as it helps enhance the disintegration and absorption of the drug.

The nurse is teaching safe administration of medication to a patient who has been prescribed levothyroxine [Levoxyl]. Which statement should the nurse include in the teaching session? A. "Take this medication with 250 mL of orange juice." B. "Always take the medication three times a day, after meals." C. "There are no dietary restrictions while taking this medication." D. "Take this medicine on an empty stomach in the morning, at least 30 to 60 minutes before eating."

B. "When I am traveling for work I will take lower doses." ***To mimic normal cortisol secretion, patients can take the entire daily dose in the morning immediately after waking. If this schedule results in afternoon or evening fatigue, patients may split the dosage, taking two-thirds in the morning and one-third around 4:00 in the afternoon. Stress, such as travel for work, may require an increase in medication.

The nurse is teaching the patient about oral steroid therapy for chronic adrenal insufficiency. Which statement by the patient indicates a need for further teaching? A. "I can take my full dose in the morning." B. "When I am traveling for work I will take lower doses." C. "I understand that I shouldn't experience many adverse effects." D. "I can break up my dose and take some in the afternoon if I get tired."

D. "When I am traveling for work I will take lower doses." ***To mimic normal cortisol secretion, patients can take the entire daily dose in the morning, immediately after waking. If this schedule results in afternoon or evening fatigue, patients may split the dosage, taking two-thirds in the morning and one-third around 4:00 in the afternoon. Stress, such as travel for work, may require an increase in medication.

The nurse is teaching the patient about oral steroid therapy. Which statement by the patient indicates a need for further teaching? A. "I can take my full dose in the morning." B. "I can break up my dose and take some in the afternoon if I get tired." C. "I understand that I shouldn't experience many adverse effects." D. "When I am traveling for work I will take lower doses."

B. Diazepam [Valium] ***Diazepam [Valium] is known for being used to treat anxiety and muscle spasm and spasticity. Temazepam [Restoril] and quazepam [Doral] are used to treat insomnia. Clonazepam [Klonopin] is used to treat seizures and anxiety.

The nurse is working with a patient who asks for medication for anxiety and a drug to relieve muscle spasms. Which benzodiazepine does the nurse anticipate will be ordered for the patient? A. Quazepam [Doral] B. Diazepam [Valium] C. Temazepam [Restoril] D. Clonazepam [Klonopin]

C. "Cholinesterase inhibitors do not cure AD or slow the progression of the disease." ***Cholinesterase inhibitors do not cure AD or slow the progression of the disease. There are three cholinesterase inhibitor medications. Memantine is not a cholinesterase inhibitor. Cholinesterase inhibitors are not very effective. Unlike donepezil, which cause reversible inhibition of AChE, rivastigmine causes irreversible inhibition.

The nurse is working with a student in the care of a patient with AD. Which statement by the student demonstrates an understanding of the cholinesterase inhibitor medications used for AD? A. "There are four cholinesterase inhibitor medications available to treat AD. They are galantamine, rivastigmine, donepezil, and memantine." B. "Cholinesterase inhibitors are very effective in treating AD." C. "Cholinesterase inhibitors do not cure AD or slow the progression of the disease." D. "All of the cholinesterase inhibitors cause reversible inhibition of AChE."

C. "Cholinesterase inhibitors do not cure AD or slow the progression of the disease." ***Cholinesterase inhibitors do not cure AD or slow the progression of the disease. There are three cholinesterase inhibitor medications. Memantine is not a cholinesterase inhibitor. Cholinesterase inhibitors are not very effective. Unlike donepezil, which causes reversible inhibition of AChE, rivastigmine causes irreversible inhibition.

The nurse is working with a student in the care of a patient with Alzheimer's disease (AD). Which statement by the student demonstrates an understanding of the cholinesterase inhibitor medications used for AD? A. "Cholinesterase inhibitors are very effective in treating AD." B. "All of the cholinesterase inhibitors cause reversible inhibition of AChE." C. "Cholinesterase inhibitors do not cure AD or slow the progression of the disease." D. "There are four cholinesterase inhibitor medications available to treat AD. They are galantamine, rivastigmine, donepezil, and memantine."

A. Dystonia ***Dystonia, an impairment of muscle tone, is the only extrapyramidal side effect listed. The other side effects also occur but are not extrapyramidal effects.

The nurse monitors a patient taking an antipsychotic medication for extrapyramidal side effects. What should the nurse assess for in the patient? A. Dystonia B. Orthostatic hypotension C. Dry mouth and constipation D. Neuroleptic malignant syndrome

8 minutes ***The nurse administers IV phenytoin no faster than 50 mg/min to reduce the risk of cardiovascular collapse. Calculation: (1 min/50 mg) × 400 mg = 400 ÷ 50 = 8 minutes.

The nurse needs to administer phenytoin [Dilantin] 400 mg IV bolus to a patient. At a minimum, over how many minutes should the nurse administer this dose? Record your answer using a whole number. _____ minutes

A. Metabolic syndrome ***Olanzapine [Zyprexa] is approved for monotherapy of acute mania in patients with bipolar disorder. This drug has a high risk of metabolic effects, and patients should be taught about assessing for potential weight gain, diabetes, and dyslipidemia.

The nurse notes olanzapine [Zyprexa] on a patient's drug history upon admission. The nurse should plan to teach the patient about which disorder? A. Metabolic syndrome B. Paranoid schizophrenia C. Obsessive-compulsive disorder D. Schizophrenia positive symptoms

C. Erythromycin ***Erythromycin increases the levels of buspirone 5- to 13-fold. Garlic, ginseng, and St. John's wort are not included in the medications that increase the effects of buspirone.

The nurse obtains a medication history from a patient diagnosed with generalized anxiety disorder who is prescribed buspirone. The nurse recognizes that teaching is needed when the nurse notes that the patient is taking which medication with buspirone? A. Garlic B. Ginseng C. Erythromycin D. St. John's wort

C. In the morning after breakfast ***Bisacodyl suppositories act rapidly (in 15 to 60 minutes). They can be given at any time, but for patient convenience, they should not be given at bed time to avoid disrupting sleep. For convenience and patient ease, a fast acting laxative should not be given before a meal, which could cause the urge to have a bowel movement during the meal.

The nurse prepares to administer a bisacodyl suppository to a patient who has not had a bowel movement in several days. When should the nurse administer the PRN medication? A. In the evening before bed B. In the afternoon before lunch C. In the morning after breakfast D. In the morning before breakfast

A. Calcium-containing antacids cause constipation. C. Aluminum-containing antacids cause constipation. D. Antacids neutralize the acid present in the stomach. ***Both calcium- and aluminum-containing antacids cause constipation as an adverse effect. Antacids neutralize the excess acid secreted in the stomach by forming salts. Agents protective against ulcers, such as sucralfate [Carafate], form a mucous barrier in the stomach; the antacids do not. Antacids can only neutralize the acid secreted in the stomach; they cannot influence the secretion of acids. Magnesium-containing antacids reduce the effect of constipation resulting from aluminum- and calcium-containing antacids.

The nurse provides a patient with educational materials about antacids. Which statements about antacids are appropriate? Select all that apply. A. Calcium-containing antacids cause constipation. B. Antacids form a protective barrier in the stomach. C. Aluminum-containing antacids cause constipation. D. Antacids neutralize the acid present in the stomach. E. Magnesium-containing antacids cause constipation. F. Antacids decrease the secretion of acid in the stomach.

B. "I can stop this drug after 3 weeks if I feel better." ***Lorazepam should not be discontinued abruptly, but gradually, over a period of several days. Caffeine and alcohol should be avoided when taking lorazepam, a benzodiazepine. This drug should not be taken during pregnancy because of possible teratogenic effects.

The nurse realizes more medication teaching is necessary when the 30-year-old patient taking lorazepam (Ativan) states A. "I must stop drinking coffee and colas." B. "I can stop this drug after 3 weeks if I feel better." C. "I must stop drinking alcoholic beverages." D. "I should not become pregnant while taking this drug."

A. Continue as planned, because the level is within normal limits. ***The therapeutic range for phenytoin is 10 to 20 mcg/mL. Because this level is within normal limits, the nurse would continue with the routine plan of care.

The nurse receives a laboratory report indicating that the phenytoin [Dilantin] level for the patient seen in the clinic yesterday is 16 mcg/mL. Which intervention is most appropriate? A. Continue as planned, because the level is within normal limits. B. Tell the patient to hold today's dose and return to the clinic. C. Consult the prescriber to recommend an increased dose. D. Have the patient call 911 and meet the patient in the emergency department.

A. Continue as planned, because the level is within normal limits. ***The therapeutic range for phenytoin is 10 to 20 mcg/mL. Because this level is within normal limits, the nurse would continue with the routine plan of care.

The nurse receives a laboratory report indicating that the phenytoin [Dilantin] level for the patient seen in the clinic yesterday is 16 mcg/mL. Which intervention is most appropriate? A. Continue as planned, because the level is within normal limits. B. Tell the patient to hold today's dose and return to the clinic. C. Consult the prescriber to recommend an increased dose. D. Have the patient call 911 and meet the patient in the emergency department.

B. The nurse should obtain a prescriber order to administer the phenytoin at 9:30 AM daily. ***Sucralfate can impede the absorption of phenytoin; therefore, a period of 2 hours should separate these drugs. The nurse should consult the prescriber for a time administration change. Based on this information, it is not appropriate to administer the drugs as ordered, switch the phenytoin to the IV form, or administer the phenytoin with the sucralfate.

The nurse reviews the patient's medication record and notes the following: sucralfate [Carafate] 1 gram orally four times daily before meals (7:30 AM, 11:30 AM, and 4:30 PM) and at bedtime (10:00 PM); phenytoin [Dilantin] 200 mg orally daily at 8:00 AM. Which modifications, if any, should be made to the medication regimen? A. The medications can be administered as ordered. B. The nurse should obtain a prescriber order to administer the phenytoin at 9:30 AM daily. C. The nurse should obtain a prescriber order for intravenous phenytoin to avoid a drug interaction. D. The nurse should administer the phenytoin with the 7:30 AM dose of sucralfate [Carafate], because this is more time efficient.

A. "You cannot mix this insulin with any other insulin in the same syringe." ***Insulin glargine [Lantus] is a long-acting insulin with a duration of action up to 24 hours. It should not be mixed with any other insulins. The insulin is not fast acting.

The nurse should include which statement when teaching a patient about insulin glargine [Lantus]? A. "You cannot mix this insulin with any other insulin in the same syringe." B. "You should inject this insulin just before meals because it is very fast acting." C. "You can mix this insulin with neutral protamine Hagedorn (NPH) insulin to enhance its effects." D. "The duration of action for this insulin is approximately 8 to 10 hours, so you will need to take it twice a day."

B. Benzodiazepines ***Neuroleptics cause central nervous system depression that can be intensified with benzodiazepines.

The nurse should teach a patient who is prescribed a neuroleptic to avoid what other medications? A. Aspirin B. Benzodiazepines C. Antidiarrheal medications D. Non-steroidal anti-inflammatory drugs

B. The patient is walking with a staggering gait. D. The patient complains of double vision. E. The nurse observes rapid back-and-forth movement of the patient's eyes. ***Manifestations of phenytoin toxicity can occur when plasma levels are higher than 20 mcg/mL. Nystagmus (back-and-forth movement of the eyes) is a common indicator of toxicity, as are ataxia (staggering gait), diplopia (double vision), sedation, and cognitive impairment. Hirsutism (excess hair growth in unusual places) and gingival hyperplasia (swollen, tender, bleeding gums) are adverse effects of phenytoin.

The nurse suspects that a female patient is experiencing phenytoin toxicity if which manifestation is noted? (Select all that apply.) A. The patient complains of excessive facial hair growth. B. The patient is walking with a staggering gait. C. The patient's gums are swollen, tender, and bleed easily. D. The patient complains of double vision. E. The nurse observes rapid back-and-forth movement of the patient's eyes.

D. oral anticoagulants ***Cimetidine may increase the blood levels of oral anticoagulants by reducing their metabolism in the liver and excretion.

The nurse understands that which drug or drug type may interact with the H2-receptor antagonist cimetidine? A. hormonal contraceptives B. antilipemic agents C. digoxin D. oral anticoagulants

D. oral anticoagulants ***Cimetidine may increase the blood levels of oral anticoagulants by reducing their metabolism in the liver and excretion.

The nurse understands that which drug or drug type may interact with the H2-receptor antagonist cimetidine? A. hormonal contraceptives B. antilipemic agents C. digoxin D. oral anticoagulants

C. prevention of gastric ulcers caused by long-term NSAIDs therapy

The only approved GI indication for Misoprostol is: A. GERD B. PUD C. prevention of gastric ulcers caused by long-term NSAIDs therapy D. prevention of gastric ulcers caused by chemotherapy

C. Preparation before a colonoscopy ***Magnesium oxide/anhydrous citric acid/sodium picosulfate [Prepopik] is approved for preparation of colonoscopy in adults. Sodium picosulfate is a stimulant laxative and the magnesium oxide and citric acid combine to form magnesium citrate, an osmotic laxative. Prepopik is given in a split dose regimen. The first dose is taken the evening before the colonoscopy and the second dose the next morning prior to the procedure.

The patient has an order for magnesium oxide/anhydrous citric acid/sodium picosulfate [Prepopik] to be given in two doses. The nurse knows that this medication is used for which indication? A. Prevention of constipation B. Treatment of constipation C. Preparation before a colonoscopy D. Preparation before an abdominal surgery

A. "Inject this insulin with meals because it is very fast acting." ***Lispro is a fast-acting insulin and has an onset action of 15 to 30 minutes with a peak action of about 2 hours, not 8 to 10 hours. Because of its rapid onset, it is administered immediately before a meal or with meals to control the blood glucose rise after meals. Lispro insulin must be combined with an intermediate- or a long-acting insulin, not regular insulin (which also is a short-duration insulin), for glucose control between meals and at night. To achieve tight glycemic control, patients must combine different types of insulin based on their duration of action.

The patient has been prescribed lispro [Humalog] for treatment of type 1 diabetes mellitus. The nurse should give the patient which instruction? A. "Inject this insulin with meals because it is very fast acting." B. "This insulin needs to be mixed with regular insulin to enhance the effects." C. "To achieve tight glycemic control, this is the only type of insulin you'll need." D. "The duration of action for this insulin is about 8 to 10 hours, so you'll need a snack."

D. Analyze the patient's serum thyroid-stimulating hormone levels. ***Drug efficacy is assessed by monitoring the thyroid-stimulating hormone [1] [2] (TSH) levels. The nurse will also monitor other thyroid tests, if ordered, and will assess for symptom improvement. Anxiety and palpitations would indicate a hyperthyroid state, which could occur with drug accumulation or excess. The other items, while important, do not address monitoring for a euthyroid (normal) state.

The primary healthcare provider prescribes a thyroid replacement drug to a patient with hypothyroidism. How should the nurse monitor for return to a euthyroid state? A. Assess for anxiety and palpitations. B. Verify the medication history of patient and family. C. Evaluate the patient's knowledge of thyroid therapy. D. Analyze the patient's serum thyroid-stimulating hormone levels.

A. 2-3 weeks

To avoid the occurrence of serotonin syndrome, how long should patients wait when switching antidepressant meds? A. 2-3 weeks B. 6-8 weeks C. 48 hours D. 6 hours

True

True or False: If a patient has used benzodiazepines consistently for a long period of time and suddenly stops, they will most likely experience withdrawal symptoms or a paradoxical response.

True

True or False: SSRI's work by preventing reuptake of serotonin into presynaptic nerve terminals.

B. Increased intake of vitamin E ***High-dose vitamin E inhibits platelet aggregation, which can promote bleeding. Biotin appears devoid of toxicity; subjects given large doses experienced no adverse effects. Decreased intake of folic acid and vitamin B12 can lead to anemia.

Upon completing the patient history, which finding will cause the nurse to monitor for bleeding? A. Increased intake of biotin B. Increased intake of vitamin E C. Decreased intake of folic acid D. Decreased intake of vitamin B12

B. Confusion, fever, muscle rigidity, and increase serum creatinine

What are some signs and symptoms of the rare, yet fatal and very serious, side effect of atypical antipsychotic called neuroletic malignant syndrome? A. Insomnia, muscular flaccidity, hyperactivity B. Confusion, fever, muscle rigidity, and increase serum creatinine C. Hypothermia and hyperkalemia D. Thrombocytopenia, anemia, fever

B. Odd facial and tongue movements (like lip smacking or puffing of cheeks)

What are symptoms of tardive dyskinesia? A. Shuffling gait B. Odd facial and tongue movements (like lip smacking or puffing of cheeks) C. An overall muscular rigidity; this is a medical emergency D. Contractures of the arms or legs

A. Cloudy

What color is NPH? A. Cloudy B. Clear / yellow C. Clear D. Amber

C. Dopamine melatonin, and serotonin

What do antipsychotics block in the brain? A. Dopamine, serotonin and the adrenergic receptors B. Melatonin C. Dopamine melatonin, and serotonin D. The adrenergic receptors

B. Muscle coordination/movements

What does dopamine affect / address in relation to antipsychotic meds? A. The sleep-wake cycle B. Muscle coordination/movements C. Water absorption / reabsorption D. Your pain threshold

B. After 5 hours

When do you need look for signs/symptoms of hypoglycemia after giving regular insulin? A. 1 hour later B. After 5 hours C. Within 15 minutes D. 24 hours later

A. Yogurt ***When taking monamine oxidase inhibitors (MAOIs), patients should avoid cheese, red wine, beer, liver, bananas, yogurt, and sausage.

When providing dietary teaching for a patient taking monamine oxidase inhibitors (MAOIs), the nurse should teach the patient to avoid which food? A. Yogurt B. Avocado C. Grapefruit D. Potato chips

D. "There is a good chance that you will become seizure free on this one medication." ***About 70% of clients become seizure free on one medication. Most clients are on the medications for life. The client should not stop the medication as increased seizures can result. If a client has seizures while on a medication, then that medication can be decreased and another one tried. It does not mean they will always have seizures.

What information is essential to teach the client who will begin taking an antiepileptic drug? A. "You will most likely not be on this medication very long." B. "If you develop seizures while on this medication, you will always have seizures." C. "If you find you cannot tolerate the drug, stop it and call your healthcare provider." D. "There is a good chance that you will become seizure free on this one medication."

B. "Use birth control while on this medication." ***The nurse should tell the young woman to use birth control while on the medication as an increased incidence of fetal defects occurred in those who took phenytoin while pregnant.

What information should the nurse include in the care plan of a young woman who has been prescribed phenytoin [Dilantin]? A. "Take your blood pressure daily." B. "Use birth control while on this medication." C. "Do not take this medication with grapefruit juice." D. "If your weight increases, call your healthcare provider."

A. Hypertensive crisis

What is a major side effect of MAOI's? A. Hypertensive crisis B. Guillan-Barre Syndrome C. Hypoxia D. Ischemic bowel

D. The inability to rest or relax

What is akathisia (an extrapyramidal symptom)? A. Spasms of the facial muscles B. Shuffling gait C. Spasms of the back muscles D. The inability to rest or relax

C. constipation

What is an adverse effect of sucralfate? A. diarrhea B. infection C. constipation D. insomnia

A. They are more prone for suicide tendencies

What is an essential thing to remember when a patient is started on any antidepressant? A. They are more prone for suicide tendencies B. It drastically decreases their appetite C. If they notice worsening symptoms, it is okay to take an additional tablet prior to notifying the physician D. They may have severe periods of mania

B. Sexual dysfunction

What is the main side effect of SSRI? A. Weight gain B. Sexual dysfunction C. Kidney failure D. Hypertensive crisis

D. Helicobacter pylori ***AKA H. pylori.

What is the most common cause of peptic ulcers? A. parasite's B. surgical C. food being digested D. Helicobacter pylori

A. NSAIDs

What is the second most common causes of peptic ulcers? A. NSAIDs B. H. pylori C. virus D. food being digested

B. -tidine ***Examples: Ranitidine, Famotidine, Cimetidine

What is the suffix for H2-receptor antagonists? A. -pril B. -tidine C. -olol D. -prazole

D. -prazole ***Examples: Omeprazole, Esomeprazole, Lansoprazole, Pantoprazole

What is the suffix for Proton Pump Inhibitors? A. -tidine B. -olol C. -pril D. -prazole

B. Alprazolam [Xanax] ***The approved first-line choices are benzodiazepines, and alprazolam [Xanax] is a benzodiazepine. Trazodone and phenelzine are monoamine oxidase inhibitors (MAOIs). Amoxapine is a tricyclic antidepressant.

What medication would the nurse anticipate a provider prescribing for treatment of generalized anxiety disorder? A. Phenelzine [Nardil] B. Alprazolam [Xanax] C. Trazodone [Desyrel] D. Amoxapine [Asendin]

B. GABA

What neurotrasmitter to benzodiazepines intensify the action of? A. Melatonin B. GABA C. Endorphin D. Histamine

B. benzodiazipines or cogentin ***Signs of extrapyrdaminal syndrome: acute dystonia, akathisa (can stay still), pseudoparkinsonism syndrome (ridgid), tardive dyskinesia (rolling of tongue).

What should extrapyramidal syndrome be treated with? A. chlorpromazine B. benzodiazipines or cogentin C. lithium or phenytoin

C. Renal function ***As metformin [Glucophage] is excreted by the kidneys, it is necessary to assess the patient's renal function. If the patient's kidneys are not able to excrete the drug, it will accumulate in the patient's system, thereby causing lactic acidosis. One of the adverse effects of metformin [Glucophage] is weight loss, not weight gain. Headaches are not caused by metformin [Glucophage]. Cholesterol levels may be high in some diabetic patients but can be treated with medications and lifestyle changes.

What should the nurse assess in a patient who is prescribed metformin [Glucophage] for treatment of type 2 diabetes? A. Headache B. Weight gain C. Renal function D. Cholesterol level

A. Osteoporosis B. Moon face C. Glycosuria E. Mood swings ***Cushing's syndrome results from excess secretion of adrenocorticotropic hormone (ACTH), and these effects result in manifestations such as redistribution of fat to the face and belly, excess blood sugar, mood changes, and calcium loss from bone. Ketoacidosis does not occur.

When assessing a patient who has Cushing's syndrome, a nurse associates which clinical manifestations with this disorder? (Select all that apply.) A. Osteoporosis B. Moon face C. Glycosuria D. Ketonuria E. Mood swings

A. When SSRIs are taken with MAOI's and TCAs

When can Serotonin Syndrome occur? A. When SSRIs are taken with MAOI's and TCAs B. When SSRIs are taken with green leafy vegetables C. When SSRI's are taken on an empty stomach D. When SSRIs are suddenly stopped

A. Common side effects can be relieved by increasing fluid and fiber intake and sucking hard candy.

When teaching a patient about the use of tricyclic antidepressants, what will the nurse emphasize? A. Common side effects can be relieved by increasing fluid and fiber intake and sucking hard candy. B. The patient should notify the health care provider if therapeutic effects are not noted within 10 days. C. The drugs are often given with monoamine oxidase inhibitors (MAOIs) for synergistic effect. D. Dietary restrictions of beer and chocolate are needed to prevent a hypertensive crisis

A. Clear / regular

When you mix regular insulin and NPH, which do you draw up first? A. Clear / regular B. Cloudy / NPH

B. Cloudy / NPH

When you mix regular insulin and NPH, which do you draw up second? A. Clear / regular B. Cloudy / NPH

C. Hold the vitamin and consult the prescriber. ***Vitamin D is contraindicated in patients with hypercalcemia, a clinical manifestation of hyperparathyroidism. The prescriber should be consulted about the patient's most recent calcium level and clinical symptoms. Checking deep tendon reflexes, giving milk, and asking about NSAID use are unnecessary actions to take in the administration of vitamin D.

Which action should a nurse take when preparing to administer vitamin D to a patient diagnosed with hyperparathyroidism? A. Assess deep tendon reflexes. B. Give the vitamin with 8 ounces of milk. C. Hold the vitamin and consult the prescriber. D. Determine whether the patient takes nonsteroidal anti-inflammatory drugs (NSAIDs).

A. Eating aged cheese ***Eating foods high in tyramine, including aged cheese, can cause a hypertensive crisis in patients taking MAO inhibitors.

Which activity should the patient be cautioned to avoid while taking an monoamine oxidase inhibitor (MAOI)? A. Eating aged cheese B. Sunbathing at the pool C. Participating in a bowling league D. Smoking a low-nicotine cigarette

A. Break the tablet in half so it is easier to swallow. C. Allow the tablet to dissolve in water before administering it. D. Administer the tablet with sips of water 1 hour before meals. ***Sucralfate acts through a compound that is a sticky gel, which adheres to an ulcer crater, creating a barrier to back-diffusion. The drug is best taken on an empty stomach. The tablet form should not be crushed because crushing it could reduce the effectiveness of the drug. Sucralfate tablets are large and difficult to swallow but can be broken or dissolved in water prior to ingestion. Sucralfate acts under mildly acidic conditions; antacids raise the gastric pH above 4 and may interfere with the effects of sucralfate.

Which administration technique(s) would be appropriate when giving a sucralfate [Carafate] tablet to a patient with a duodenal ulcer? Select all that apply. A. Break the tablet in half so it is easier to swallow. B. Administer the tablet with an antacid for maximum benefit. C. Allow the tablet to dissolve in water before administering it. D. Administer the tablet with sips of water 1 hour before meals. E. Crush the tablet into a fine powder before mixing it with water.

D. It may take 1 to 2 weeks before you have any benefits from taking the medication. ***The effectiveness of lithium may not be evident until 1 to 2 weeks after the start of therapy. The patient should be taught to maintain adequate sodium intake and to avoid crash diets that affect physical and mental health. Lithium levels are maintained by taking the drug on a daily basis. The patient should be taught to take lithium with meals to decrease gastric irritation.

Which advice will the nurse include when teaching the patient about lithium therapy? A. Take the drug on an empty stomach. B. Eliminate all sodium from your diet. C. Stop taking the lithium when you feel better. D. It may take 1 to 2 weeks before you have any benefits from taking the medication.

B. Na HCO3

Which antacid is useful in the treatment of acidosis and elevated pH to promote excretion of acidic drugs after overdose? A. Ca carbonate B. Na HCO3 C. Al hydroxide D. Mg hyrdoxide

A. Lispro [Humalog] B. Aspart [NovoLog] C. Glulisine [Apidra] ***Lispro [Humalog], Aspart [NovoLog], and Glulisine [Apidra] are rapid-acting insulins that have an onset of action of 15 minutes. Regular insulin [Humulin R] is a short-acting insulin that has an onset of action of 30 to 60 minutes. Glargine [Lantus] is a long-acting insulin, which is dosed every 12 hours depending on the patient's glycemic response.

Which are rapid-acting insulins that can be administered to patients with diabetes mellitus? Select all that apply. A. Lispro [Humalog] B. Aspart [NovoLog] C. Glulisine [Apidra] D. Glargine [Lantus] E. Regular insulin [Humulin R]

A. lorazepam ***Benzodiazepines used to treat anziety include lorazepam, alprazolam, chlordiazepoxide, hydrochloride, clonazepam, clorazepate dipotassium, diazepam, halazepam, and oxazepam.

Which benzodiazepine is used primarily to treat anxiety? A. lorazepam B. estazolam C. triazolam D. flurazepam

B. Rivastigmine [Exelon] ***All these drugs have the potential to cause GI distress, including nausea, vomiting, anorexia, and weight loss. Rivastigmine is thought to have the highest probability of producing these effects. Memantine (NMDA) is not a cholinesterase inhibitor.

Which cholinesterase inhibitor has the highest incidence of adverse gastrointestinal (GI) effects? A. Donepezil [Aricept] B. Rivastigmine [Exelon] C. Galantamine [Reminyl] D. Memantine [NMDA]

D. H2-receptor antagonists ***This class of meds promotes healing by suppressing secretion of gastric acid.

Which class of antiulcer drugs are the first-choice drugs in the treatment of gastric and duodenal ulcers? A. antacids B. PPIs C. NSAIDs D. H2-receptor antagonists

C. Fluoxetine [Prozac] E. Sertraline [Zoloft] ***Fluoxetine [Prozac] and sertraline [Zoloft] are selective serotonin reuptake inhibitors. Bupropion [Wellbutrin] is an atypical antidepressant. Imipramine [Tofranil] is a tricyclic antidepressant. Desvenlafaxine [Pristiq] is a serotonin/norepinephrine reuptake inhibitor (SNRI).

Which drug does the nurse identify as a selective serotonin reuptake inhibitor? (Select all that apply.) A. Bupropion [Wellbutrin] B. Imipramine [Tofranil] C. Fluoxetine [Prozac] D. Desvenlafaxine [Pristiq] E. Sertraline [Zoloft]

D. Beta-adrenergic blocker ***Beta-adrenergic blockers block the initial sympathetic response to hypoglycemia; therefore, the patient may not exhibit the initial symptoms of nervousness, diaphoresis, and sweating that typically alert the patient to the onset of hypoglycemia. Aspirin increases glucose tolerance by stimulating insulin secretion. Thiazide diuretics worsen insulin sensitivity. There are no known interactions of codeine and insulin.

Which drug interacts with insulin and increases the risk for unrecognized hypoglycemia in a patient? A. Aspirin B. Codeine C. Thiazide diuretics D. Beta-adrenergic blocker

D. thiazide diuretics ***Hyperglycemia may occur if glyburide is taken with a thiazide diuretic.

Which drug or drug type would likely cause hyperglycemia if taken with glyburide? A. procainamide B. cimetidine C. warfarin D. thiazide diuretics

B. Tremor C. Irritability D. Sweating E. Confusion ***Early symptoms of hypoglycemia involve the central nervous system, as the brain needs a constant supply of glucose to function. Hence confusion, irritability, tremors, and sweating are symptoms seen in patients. When these symptoms occur, the family should have the patient immediately ingest a fast-acting carbohydrate source such as glucagon, milk, or juice. Coma occurs if the patient's glucose levels are not restored.

Which early symptoms of hypoglycemia should the nurse instruct a patient's family to treat with a fast-acting carbohydrate source? Select all that apply. A. Coma B. Tremor C. Irritability D. Sweating E. Confusion

D. Monoamine oxidase enzyme

Which enzyme in the brain do MAOI's inhibit? A. Protease B. Acetylcholinerterase C. Catalase D. Monoamine oxidase enzyme

B. Excessive bruising ***Levothyroxine intensifies the effect of warfarin, an anticoagulant that increases the patient's risk for bleeding. The warfarin dose may need to be reduced. Bruising, weight loss, and shortness of breath are not effects associated with interactions of levothyroxine and warfarin.

Which finding in a patient taking levothyroxine [Synthroid] and warfarin [Coumadin] would require follow-up by a nurse? A. Cardiac dysrhythmias B. Excessive bruising C. Weight loss of 5 kg D. Shortness of breath

A. Excessive bruising ***Levothyroxine intensifies the effect of warfarin, an anticoagulant that increases the patient's risk for bleeding. The warfarin dose may need to be reduced if there is excessive bruising. Cardiac dysrhythmias, weight loss, and shortness of breath are not effects associated with interactions of levothyroxine and warfarin.

Which finding in a patient taking levothyroxine [Synthroid] and warfarin [Coumadin] would require follow-up by a nurse? A. Excessive bruising B. Weight loss of 5 kg C. Shortness of breath D. Cardiac dysrhythmias

A. Cheese ***Certain foods can interact with MAO inhibitors and produce serve reactions. The most serious reactions involve tyamine-rich foods, such as red wine, aged cheese, smoked meats, and fave beans.

Which food should the patient taking an MAO inhibitor avoid? A. Cheese B. Apples C. Carrots D. Beer

A. Hypersecretion of parietal cells ***Hydrochloric acid, which is necessary for digestion, is secreted by the parietal cells lining the stomach. Hypersecretion of these cells causes acidity or more severe disorders. Inhibition of the proton pump reduces the hypersecretion of acid. Proteolytic enzymes such as pepsinogen, which is activated by hydrochloric acid, are secreted by the chief cells of the stomach and are responsible for the cleaving of proteins. Acetylcholine receptors also mediate the proton pump, and inhibition of these receptors helps to prevent the effects caused by a highly acidic environment.

Which increases the concentration of gastric acids? A. Hypersecretion of parietal cells B. Inhibition of proton pump activity C. Inhibition of acetylcholine receptors D. Hypersecretion of proteolytic enzymes

C. "Do not take your metformin on the day of the test." ***Angiography uses iodinated (iodine-containing) radiologic contrast media, which interact with metformin [Glucophage] and may cause acute renal failure or lactic acidosis. Hence, the nurse should instruct the patient to discontinue the drug on the day of the test. To prevent any adverse effects, metformin [Glucophage] can be taken 48 hours after the test. Chances of renal failure after the test only occur if metformin is taken during the test. Blood glucose levels are regularly evaluated in diabetic patients, but it is not a priority in this case.

Which instruction should the nurse give when a patient receiving metformin [Glucophage] therapy will undergo angiography? A. "There are chances of renal failure after the test." B. "Your blood glucose levels need to be reevaluated." C. "Do not take your metformin on the day of the test." D. "You can take the medication an hour after the test."

A. "Take the medication with a glass of grapefruit juice each morning." ***Grapefruit juice can inhibit the metabolism of carbamazepine, possibly leading to increased plasma drug levels; therefore, it should be avoided. Carbamazepine can inhibit renal excretion of water by promoting increased secretion of antidiuretic hormone. Weight gain and swollen extremities can be a sign of water retention and should be reported to the physician. Nausea, vomiting, and indigestion are common adverse effects of valproic acid, and the patient should be made aware of them. Liver function studies are monitored for patients taking valproic acid because of the risk of liver toxicity.

Which instruction would be inappropriate to include in the teaching plan for a patient being started on carbamazepine [Tegretol]? A. "Take the medication with a glass of grapefruit juice each morning." B. "Notify the physician if you are gaining weight or your legs are swollen." C. "Nausea, vomiting, and indigestion are common side effects of carbamazepine." D. "Have liver function tests performed on a routine basis."

C. Administering it by slow IV push ***The priority is to administer Dilantin slowly to prevent irritation to veins. Monitoring side effects, flushing the tubing, and monitoring serum drug levels are all interventions that are done after administering the drug. The priority is the first intervention, which is proper administration of the medication.

Which intervention is a priority in the administration of intravenous (IV) Dilantin therapy? A. Monitoring for side effects B. Monitoring serum drug levels C. Administering it by slow IV push D. Flushing the tubing after administration

B. Hypotension

Which is not a symptom of serotonin syndrome? A. Confusion B. Hypotension C. Tremors D. Anxiety

D. Parenteral formulation improves adherence for acutely psychotic patients. ***The primary benefit of administering a parenteral form of an antipsychotic agent is that patient adherence to therapy improves because fewer doses are required to achieve therapeutic effectiveness. It is very effective when used for acutely psychotic patients. Parenteral antipsychotic agents are long-acting medications. Route of administration does not have much effect on the drug's effectiveness or duration of action.

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.

B. Administer intravenous glucose. ***This patient is showing signs of hypoglycemia. In the hospital setting or when the patient is unconscious, intravenous glucose is an obvious option to treat hypoglycemia.

Which is the nurse's best action when finding a patient with type 1 diabetes mellitus unresponsive, cold, and clammy? A. Start an insulin drip. B. Administer intravenous glucose. C. Draw blood glucose level and send to the laboratory. D. Administer subcutaneous regular insulin immediately.

C. Serum electrolytes ***Serum sodium levels need to be monitored in patients taking lithium. Lithium tends to deplete sodium. Lithium must be used with caution, if at all, by patients taking diuretics.

Which laboratory test is most important for the nurse to monitor when a patient is receiving lithium (Lithobid)? A. Urinalysis B. Serum glucose C. Serum electrolytes D. Complete blood count

B. "Reduce the amount of alcohol you consume." D. "Incorporate daily physical exercise into your life." E. "Decrease the amount of carbohydrates in your diet." ***Alcohol is limited because it is broken down into simple carbohydrates and can elevate the patient's blood glucose levels. The patient should perform physical exercises every day to help lower glucose levels. The nurse should advise the patient to decrease the amount of carbohydrates in the diet to lower blood glucose levels. Potassium and sodium are restricted in cardiac patients. Adequate rest is required for respiratory patients to prevent respiratory complications due to physical activity.

Which lifestyle changes should the nurse instruct a patient to implement in order to successfully manage diabetes mellitus? Select all that apply. A. "Restrict potassium and sodium in your diet." B. "Reduce the amount of alcohol you consume." C. "Include rest periods between physical activities." D. "Incorporate daily physical exercise into your life." E. "Decrease the amount of carbohydrates in your diet."

A. Insulin glargine [Lantus] ***Insulin glargine [Lantus] has a duration of action of 24 hours with no peaks, mimicking natural, basal insulin secretion by the pancreas. Insulin aspart [NovoLog] is a rapid-acting human insulin analog used to lower blood glucose, which has a different dosage. Regular insulin [Humulin R] has its duration of action of 6 to 10 hours, with a peak plasma concentration of 2.5 hours. Ultralente insulin [Humulin U] has an active duration of 28 hours.

Which long-acting insulin mimics natural, basal insulin with its duration of 24 hours? A. Insulin glargine [Lantus] B. Insulin aspart [NovoLog] C. Regular insulin [Humulin R] D. Ultralente insulin [Humulin U]

B. Unstable body temperature ***One function of the hypothalamus is the regulation of body temperature, and a tumor that compresses the hypothalamus would impair this function. Regulation of mood swings, respiratory rate, and heart rate are not functions of the hypothalamus.

Which manifestation would the nurse most clearly associate with a tumor of the hypothalamus? A. Mood swings B. Unstable body temperature C. Irregular respirations D. Increased heart rate

A. Tachycardia ***High doses of levothyroxine may cause thyrotoxicosis, a condition of profound excessive thyroid activity. Tachycardia is the priority assessment, because it can lead to severe cardiac dysfunction. Tremors, insomnia, and irritability are other symptoms of thyrotoxicosis and should be assessed after tachycardia.

Which manifestations should a nurse investigate first when monitoring a patient who is taking levothyroxine [Synthroid]? A. Tachycardia B. Tremors C. Insomnia D. Irritability

D. Sucralfate

Which medication is used to promote gastric ulcer healing by providing a protective barrier? A. Cimetidine B. Misoprostol C. Omeprazole D. Sucralfate

C. Lorazepam [Ativan] 0.1 mg/kg IV at a rate of 2 mg/min ***Intravenous benzodiazepines, such as lorazepam or diazepam, are used for abrupt termination of convulsive seizure activity. Lorazepam is preferred over diazepam because of its longer effects. Once seizures have been stopped with a benzodiazepine, phenytoin may be administered for long-term suppression. Phenytoin and valproic acid are not benzodiazepines.

Which medication should the nurse anticipate administering to a patient in convulsive status epilepticus to halt seizure activity? A. Phenytoin [Dilantin] 200 mg IV over 4 minutes B. Phenobarbital 30 mg IM C. Lorazepam [Ativan] 0.1 mg/kg IV at a rate of 2 mg/min D. Valproic acid [Depacon] 250 mg in 100 mL of normal saline infused IV over 60 minutes

C. Norepinephrine and serotonin

Which neurotransmitter(s) do tricyclic antidepressants prevent reuptake of? A. Histamine B. Melatonin C. Norepinephrine and serotonin D. Epinephrine

A. Risk for falls ***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.

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

B. donepezil C. memantine D. galantamine E. rivastigmine

Which of the following are Alzheimer's drugs? Select all that apply. A. hydrocoritsone B. donepezil C. memantine D. galantamine E. rivastigmine

A. milk of magnesia C. miralax

Which of the following are examples of osmotic laxatives? Select all that apply. A. milk of magnesia B. Bisacodyl [Dulcolax] C. miralax D. docusate sodium

A. Attention deficit hyperactivity disorder

Which of the following is NOT an indication for benzodiazepines? A. Attention deficit hyperactivity disorder B. Anxiety C. Alcohol withdrawal D. Seizures

C. bisacodyl [dulcolax] ***Works in 6-12 hours if given my mouth. As a suppository, can work within minutes. Stimulates peristalsis and increases water and electrolyte absorption in GI tract.

Which of the following is an example of a stimulant laxative? A. milk of magnesia B. lactulose C. bisacodyl [dulcolax] D. docusate sodium

D. hydrocoritsone E. fludrocortisone

Which of the following is given during adrenal insufficiency? Select all that apply. A. calcitonin B. levothyroxine C. vitamin D D. hydrocoritsone E. fludrocortisone

A. calcitonin ***Calcitonin is a hormone that decreases plasma levels of Ca+.

Which of the following is given during hyperparathyroidism? A. calcitonin B. levothyroxine C. vitamin D D. hydrocoritsone E. fludrocortisone

C. vitamin D ***Vitamin D is a hormone that increases plasma Ca+ levels.

Which of the following is given during hypoparathyroidism? A. calcitonin B. levothyroxine C. vitamin D D. hydrocoritsone E. fludrocortisone

B. levothyroxine ***But side effects look like hyperthyroidism.

Which of the following is given during hypothyroidism? A. calcitonin B. levothyroxine C. vitamin D D. hydrocoritsone E. fludrocortisone

C. None

Which other insulin can you mix glargine with? A. NPH B. Levamir C. None D. Novolin R / Regular

A. Hallucinations C. Restless activity D. Chaotic thinking E. Defective insight ***Positive symptoms of schizophrenia include psychotic behaviors such as hallucinations. They also include conceptual disorganization such as chaotic thinking and poor insight. Agitation or restless activity is also a positive symptom. Negative symptoms include catatonia characterized by agitation and muscle rigidity and social withdrawal.

Which phenomena should the nurse recognize as positive symptoms of schizophrenia? Select all that apply. A. Hallucinations B. Muscle rigidity C. Restless activity D. Chaotic thinking E. Defective insight F. Social withdrawal

D. Parenteral thiamine to a patient with suspected Wernicke-Korsakoff syndrome ***If Wernicke-Korsakoff syndrome (thiamine deficiency) is suspected, parenteral thiamine should be administered immediately. Taking high-dose folic acid to reduce cancer risk is ineffective and should be discouraged. High doses of beta-carotene (vitamin A) were associated with an increase in lung cancer for smokers, and high doses of vitamin E were associated with an increase in prostate cancer and stroke.

Which prescription will the nurse recognize as appropriate? A. Parenteral vitamin E for a patient with prostate cancer B. Folate supplements orally to a patient for cancer prevention C. Vitamin A supplements orally to a patient who smokes three packs a day D. Parenteral thiamine to a patient with suspected Wernicke-Korsakoff syndrome

A. Weight B. Lipid profile C. Fasting blood glucose ***Risperidone [Risperdal] can cause metabolic effects such as weight gain, diabetes, and dyslipidemia. The nurse should assess weight, blood glucose levels, and lipid levels.

Which should the nurse assess to determine whether a patient has metabolic effects from risperidone [Risperdal] therapy? Select all that apply. A. Weight B. Lipid profile C. Fasting blood glucose D. Complete blood count E. Kidney function studies

B. Abdomen ***The abdomen has the most consistent absorption capacity because muscular movements do not affect the blood flow to subcutaneous tissue as much. The deltoid is used for immunization of children and adults. The vastus lateralis is used for immunization of infants. The gluteus maximus is not recommended for injections because of its close proximity to the sciatic nerve and major blood vessels.

Which site should be used for injecting insulin for the most consistent absorption? A. Deltoid B. Abdomen C. Vastus lateralis D. Gluteus maximus

B. The drug should be discontinued slowly. ***When discontinuing TCAs such as amitriptyline (Elavil), the drug should be gradually decreased to avoid withdrawal symptoms such as nausea, vomiting, anxiety, and akathisia. TCAs are given at night to minimize problems caused by their sedative action. The onset of the antidepressant effect of amitriptyline is 1 to 4 weeks. Orthostatic hypotension is a common side effect of amitriptyline (Elavil).

Which statement about amitriptyline (Elavil) does the nurse identify as being true? A. The drug is administered first thing in the morning. B. The drug should be discontinued slowly. C. The onset of antidepressant effect is 48 hours. D. Hypertension is a frequent side effect of this drug.

C. "When I start to feel better, I will cut the dose of my medication in half." ***The drug should be taken exactly as ordered. Antipsychotics do not cure the mental illness but do alleviate symptoms. Compliance with drug regimen is extremely important.

Which statement by a patient indicates that more teaching on phenothiazine therapy for the treatment of psychosis is needed? A. "It might take 6 weeks or more for the drug to take effect." B. "I will get up slowly from a seated position." C. "When I start to feel better, I will cut the dose of my medication in half." D. "I will avoid exposure to direct sunlight."

C. "I will take the medication only when I need it." ***Oral hypoglycemic agents must be taken on a daily scheduled basis to maintain euglycemia and prevent long-term complications of diabetes. When alcohol is ingested with certain oral hypoglycemic drugs, the hypoglycemic effect can be intensified. The patient may experience fatigue and loss of appetite as side effects of the medication, and these should be reported to the healthcare provider. The patient needs to closely monitor blood sugar.

Which statement indicates that the patient needs additional teaching on oral hypoglycemic agents? A. "I will monitor my blood sugar daily." B. "I will limit my alcohol consumption." C. "I will take the medication only when I need it." D. "I will report symptoms of fatigue and loss of appetite.

A. "You need to notify your doctor if you have a sore throat and fever." ***Agranulocytosis (the absence of granulocytes to fight infection) is the most serious toxicity associated with methimazole. Sore throat and fever may be the earliest signs. Nausea, muscle soreness, and headache and dizziness are other adverse effects of methimazole that are not as serious as agranulocytosis.

Which statement is the most important for a nurse to make to a patient who is taking methimazole? A. "You need to notify your doctor if you have a sore throat and fever." B. "Another medication can be given if you experience any nausea." C. "You may experience some muscle soreness with this medicine." D. "Headache and dizziness may occur but not very frequently."

A. "I need to change positions slowly to prevent dizziness." C. "I will need to wear sunscreen and protective clothing when outdoors." E. "I should call my provider if I notice any uncontrollable movements of my tongue." ***Phenothiazines have the risk for several adverse effects, such as early extrapyramidal reactions, acute dystonia, parkinsonism, and akathisia. In addition, sedation, orthostatic hypotension, anticholinergic effects, gynecomastia, galactorrhea, and menstrual irregularities can result. Tardive dyskinesia (TD), neuroleptic malignant syndrome (NMS), convulsions, and agranulocytosis are side effects that are rarer. Patients should change position slowly to prevent dizziness, wear sunscreen and protective clothing due to dermatologic side effects with the sun, and notify their healthcare provider if they notice uncontrolled movements. Alcohol should not be taken with these medications. While some of these drugs are older, they have quite a few potential side effects.

Which statement made by a patient demonstrates understanding of patient teaching regarding phenothiazine drug therapy? Select all that apply. A. "I need to change positions slowly to prevent dizziness." B. "This is an older drug and has very few risks of side effects." C. "I will need to wear sunscreen and protective clothing when outdoors." D. "It is okay to take this drug with a small glass of wine to help me relax." E. "I should call my provider if I notice any uncontrollable movements of my tongue."

A. It is a synthetic steroid identical to cortisol. B. It is a preferred drug for adrenocortical insufficiency. C. It has glucocorticoid and mineralocorticoid actions. ***Hydrocortisone is a synthetic steroid with a structure identical to that of cortisol. Hydrocortisone is a preferred drug for all forms of adrenocortical insufficiency. Oral hydrocortisone is ideal for chronic replacement therapy. Parenteral administration is used for acute adrenal insufficiency and to supplement oral doses at times of stress. Despite being classified as a glucocorticoid, hydrocortisone also has mineralocorticoid actions.

Which statements about hydrocortisone are correct? (Select all that apply.) A. It is a synthetic steroid identical to cortisol. B. It is a preferred drug for adrenocortical insufficiency. C. It has glucocorticoid and mineralocorticoid actions. D. It is given IV for chronic replacement therapy. E. It should not be given during times of stress.

B. Levothyroxine can be given by IV but is usually taken orally. C. Levothyroxine brands should not be changed if possible. E. Levothyroxine can affect the metabolism of other medications. ***Levothyroxine is almost always administered by mouth. Oral doses should be taken once daily on an empty stomach (to enhance absorption). Dosing is usually done in the morning, at least 30 to 60 minutes before breakfast. Maintain patients on the same brand-name levothyroxine product. Intravenous administration is used for myxedema coma and for patients who cannot take levothyroxine orally. Levothyroxine affects the metabolism of other medications, including warfarin.

Which statements about levothyroxine [Synthroid] are correct? (Select all that apply.) A. Levothyroxine should be taken with food. B. Levothyroxine can be given by IV but is usually taken orally. C. Levothyroxine brands should not be changed if possible. D. Levothyroxine should be taken at night to avoid adverse effects. E. Levothyroxine can affect the metabolism of other medications.

C. Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. ***Drawing up the regular insulin into the syringe first prevents accidental mixture of neutral protamine Hagedorn (NPH) insulin into the vial of regular insulin, which could cause an alteration in the onset of action of the regular insulin. The medications do not have to be in separate syringes and can be administered together. The Z-track method is an intramuscular technique that is not used with insulin.

Which technique is most appropriate regarding mixing insulin when a patient must administer 30 units regular insulin and 70 units neutral protamine Hagedorn (NPH) insulin in the morning? A. Use the Z-track method for administration. B. Draw the medication into two separate syringes but inject into the same spot. C. Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. D. Administer these insulins at least 10 minutes apart, so you will know when they are working

A. regular ***Use regular insulin in a patient with circulatory collapse, DKA, or hyperkalemia.

Which type of insulin would the nurse expect to administer to a patient with DKA? A. regular B. intermediate-acting C. long-acting D. ultra-long-acting

C. They act directly on the proton pump. ***Erosive esophagitis is a condition in which irritation is caused by acid in the esophagus. PPIs directly inhibit the hydrogen-potassium-ATPase pump, thus reducing the release of hydrogen ions that form acid. Food digestion and absorption are unaltered by these drugs. About 90% of acid secretion is stopped within 24 hours of administration, bringing relief to the patient. PPIs inhibit only the proton pump of parietal cells and reduce only gastric acids.

Why are proton pump inhibitors (PPIs) used in the treatment of patients with bleeding due to erosive esophagitis? A. They affect the absorption of food. B. They do not alter the levels of acid. C. They act directly on the proton pump. D. They inhibit the proton pumps in all cells of the digestive system.