Pharm Chapters

Which statement should the nurse include when teaching a patient about rifampin (Rifadin)? A "A harmless side effect will be a red-orange discoloration of body fluids." B "Oral contraception is the preferred method of birth control when using rifampin." C "Take vitamin B6 to relieve numbness and tingling in the fingers and toes." D "Treatment length for the medication is 3 times per day for an 8-week period."

A "A harmless side effect will be a red-orange discoloration of body fluids." Red-orange discoloration of body fluids is a common side effect of rifampin, but it is not harmful. Rifampin does not cause peripheral neuropathy. It does reduce the effectiveness of oral contraceptives, so a nonhormonal form of birth control should be considered. All antitubercular agents need to be taken at least 6 to 24 months to eradicate the slow-growing mycobacterium.

Which administration instruction should the nurse give a patient scheduled to start receiving the HIV fusion inhibitor enfuvirtide (Fuzeon)? A "Rotate injection sites in the arm, thigh, and abdomen." B "Take only when you consume low-fat meals." C "Dosing is optimal 30 minutes before meals." D "Injection-site reactions are usually uncommon."

A "Rotate injection sites in the arm, thigh, and abdomen." The primary action of enfuvirtide is to block the entry of HIV into CD4 T cells. It is administered through subcutaneous injection, and the injections should be rotated in the upper arm, thigh, and abdominal areas of the body. Injection-site reactions of pain, tenderness, erythema, and induration occur in almost every patient. Enfuvirtide is not an oral medication; dosing before meals or with low-fat meals is not a relevant instruction.

The selective serotonin reuptake inhibitors (SSRIs) are recommended therapy for a number of psychologic disorders. The nurse identifies the SSRIs as effective for the treatment of patients with which psychologic disorder or disorders? (Select all that apply.) A Depression B Panic disorder C Social anxiety disorder D Post-traumatic stress disorder E Obsessive-compulsive disorder

A Depression B Panic disorder C Social anxiety disorder D Post-traumatic stress disorder E Obsessive-compulsive disorder Neither the SSRIs nor any other drugs, for that matter, have proved effective in the treatment of post-traumatic stress disorder. SSRIs are used to treat the other psychologic disorders listed.

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 in the treatment of severe manic episodes to do what? A Help control symptoms during the severe manic episode B Elevate mood 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

A 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.

Which medications are used in the treatment plan for chemotherapy-induced nausea and vomiting? (Select all that apply.) A Lorazepam (Ativan) B Meclizine (Antivert) C Dolasetron (Anzemet) D Loperamide (Imodium) E Dexamethasone (Decadron)

A Lorazepam (Ativan) C Dolasetron (Anzemet) E Dexamethasone (Decadron) Lorazepam, a benzodiazepine, is used in combination regimens to suppress CINV. Dolasetron and dexamethasone also are used in the treatment of CINV. Meclizine is most often used to treat motion sickness, and loperamide is used to treat diarrhea.

When caring for a patient receiving mafenide (Sulfamylon) for treatment of a severe burn, it is most important for the nurse to monitor which laboratory value? A Blood glucose level B Acid-base status C Sodium level D Peak mafenide level

B Acid-base status Mafenide (Sulfamylon) therapy is associated with the development of acidosis. Peak mafenide levels are not obtained. The blood glucose and sodium levels are not affected by mafenide.

A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse, "Why am I receiving codeine? I don't have any pain." The nurse's response is based on the knowledge that codeine also has which effect? A Immunostimulant B Antitussive C Expectorant D Decongestant

B Antitussive Codeine provides both analgesic and antitussive therapeutic effects.

Which medication does the nurse identify as a monoclonal antibody used to inhibit allograft rejection in transplant recipients? A Mycophenolate mofetil (CellCept) B Basiliximab (Simulect) C Tacrolimus (Prograf) D Sirolimus (Rapamune)

B Basiliximab (Simulect) Basiliximab is a monoclonal antibody that blocks the activation of T cells. It is used in the prophylaxis of organ rejection in the first 6 months after renal transplantation. Mycophenolate mofetil suppresses B- and T-lymphocyte proliferation. Tacrolimus and sirolimus suppress T lymphocytes.

Which are the main families of drugs used to prevent or relieve anginal pain? (Select all that apply.) A Platelet inhibitors B Beta blockers C Nitrates D Calcium channel blockers E Statins

B Beta blockers C Nitrates D Calcium channel blockers The three main families of antianginal agents are organic nitrates, beta blockers, and calcium channel blockers. Platelet inhibitors and statins (unless contraindicated) are incorporated into the treatment plan to reduce the risk of myocardial infarction.

The nurse is caring for a patient who is receiving enteral feedings because of dysphagia. The physician orders isosorbide mononitrate (Imdur) 60 mg daily via the enteral tube. What would be an appropriate action by the nurse? A Have the patient swallow the pill, because it cannot be crushed. B Call the physician about an alternate form of nitrate for administration. C Crush the Imdur into a fine powder, dilute it with water, and administer it via the enteral tube. D Place the nitrate under the patient's tongue and let it dissolve, because the person has dysphagia.

B Call the physician about an alternate form of nitrate for administration. The nurse should contact the prescriber for an alternate form of nitrate, such as a non-sustained release pill, transdermal patch, or topical ointment. Because isosorbide mononitrate is a sustained-release pill, it cannot be crushed. Because the patient has dysphagia, attempting to administer the pill orally could result in aspiration. Sustained-release tablets must be administered whole.

A patient develops hypotension, laryngeal edema, and bronchospasm after eating peanuts. Which medication should the nurse prepare to administer? A Promethazine (Phenergan) B Epinephrine (Adrenalin) C Diphenhydramine (Benadryl) D Hydroxyzine (Vistaril)

B Epinephrine (Adrenalin) The patient is showing signs of anaphylaxis caused by a peanut allergy. Histamine1 activation plays a minor role in anaphylaxis; other substances are the principal mediators. Therefore, the drug of choice for anaphylaxis is epinephrine. The antihistamines promethazine, diphenhydramine, and hydroxyzine are effective only for symptoms of mild allergy; they may be used as adjuncts in the treatment of anaphylaxis, but they will have only limited benefit.

Which aspect of drug therapy indicates to the nurse whether a drug is having a beneficial effect? A Performing a preadministration assessment B Evaluating therapeutic responses C Minimizing adverse effects D Managing toxicity

B Evaluating therapeutic responses Evaluation is one of the most important aspects of drug therapy, because it tells the nurse whether a drug is having its intended effect. The other aspects of drug administration are important but do not give information about a drug's effectiveness.

A nurse is preparing to give a drug that stimulates the parasympathetic nervous system. Which patient response is an expected outcome of this drug? A Wheezing decreases due to bronchodilation. B Heart rate decreases to 60 beats per minute. C Diarrhea stool count decreases. D Oxygenation improves because of bronchodilation.

B Heart rate decreases to 60 beats per minute. Stimulation of the parasympathetic nervous system (PNS) causes slowing of the heart rate. The PNS does not regulate temperature. The PNS would facilitate peristalsis and thus would not decrease diarrhea. The PNS is associated with contraction of bronchial smooth muscle.

A nurse should teach a patient receiving oral pseudoephedrine (Sudafed) to observe for which adverse effects? (Select all that apply.) A Sedation B Irritability C Paranoia D Anxiety E Weight loss

B Irritability D Anxiety Oral pseudoephedrine activates alpha1 receptors on nasal and systemic blood vessels, causing vasoconstriction and central nervous system (CNS) excitation. This results in restlessness, irritability, anxiety, and insomnia. Sedation, paranoia, and weight loss are not adverse effects associated with pseudoephedrine.

A patient is taking daptomycin (Cubicin). The nurse should obtain a creatine phosphokinase (CPK) level when the patient shows what? A Increased urination and urinary urgency B Muscle pain and weakness C Abdominal bloating and diarrhea D Headache and visual disturbances

B Muscle pain and weakness Daptomycin is one of the cyclic lipopeptides, a class of antibiotics that can kill gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). It may pose a small risk of myopathy (muscle injury). Patients should be warned about muscle injury and told to report any pain or weakness. In addition, CPK levels should be measured weekly. Increased urination and urinary urgency, abdominal bloating and diarrhea, and headache and visual disturbances are not associated with daptomycin.

Which physiologic mechanism helps to ensure venous return despite low pressure in the venules? A Positive pressure in the right atrium B Negative pressure in the right atrium C Vasodilation in the periphery D Cardiac muscle relaxation

B Negative pressure in the right atrium The three mechanisms that help ensure venous return are negative pressure in the right atrium, constriction of veins, and the combination of venous valves and contraction of skeletal muscles.

The nurse is caring for a patient with hypertension who is receiving verapamil (Calan). The patient has a healthy heart. What pharmacodynamic effects does the nurse expect from this drug? (Select all that apply.) A Peripheral vasoconstriction B Peripheral vasodilation C Coronary vasodilation D Increased heart rate E Increased force of contraction

B Peripheral vasodilation C Coronary vasodilation Verapamil causes peripheral vasodilation and coronary vasodilation, which lead to decreased blood pressure and improved coronary perfusion. It does not cause vasoconstriction and usually has little effect on the heart rate or contractility in healthy hearts.

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

B 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.

The nurse is caring for a patient receiving amiodarone (Cordarone). Which parameter takes priority when this patient is assessed for serious adverse effects of this drug? A Blood urea nitrogen B Respiratory symptoms C Skin assessment D Neutrophil count

B Respiratory symptoms Pulmonary toxicity is the most serious potential adverse effect of amiodarone. It may manifest as pneumonitis or pulmonary fibrosis, with symptoms such as dyspnea, cough, and chest pain.

Which complaint indicates that a patient is experiencing an adverse effect of beclomethasone (Beconase AQ) nasal spray? A Sneezing B Sore throat C Runny nose D Rebound congestion

B Sore throat Sore throat is an adverse effect associated with intranasal glucocorticoids, such as beclomethasone. More common adverse effects include drying of the nasal mucosa and a burning or itching sensation. Sneezing and runny nose are two of the symptoms of allergic rhinitis for which intranasal glucocorticoids are used. Rebound congestion is an adverse effect of intranasal sympathomimetics.

A patient goes to the emergency department after using organophosphate insecticides improperly. What assessment finding would the nurse expect? A Urinary retention B Stool incontinence C Mydriasis D Flushed, dry skin

B Stool incontinence A toxic condition has been produced, which results in stimulation of the cholinergic nervous system and cholinergic crisis. The symptoms of cholinergic crisis include profuse salivary and bronchial secretions, urinary and stool incontinence, laryngospasm, bronchoconstriction, paralysis, and death. Miosis (pupil constriction), not mydriasis, occurs, as well as diaphoresis.

The nurse is caring for a patient who is experiencing a respiratory rate of 6 breaths per minute as a result of a large dose of pain medication. Which term most accurately describes this reaction? A Side effect B Toxicity C Allergic reaction D Idiosyncratic reaction

B Toxicity Toxicity is an adverse drug reaction caused by excessive dosing. A side effect is a nearly unavoidable secondary drug effect produced at a therapeutic dose. An allergic reaction is an immune response. An idiosyncratic effect is an uncommon drug response resulting from a genetic predisposition.

Natriuretic peptides serve to protect the cardiovascular system under which condition? A Hypovolemia B Volume overload C Myocardial infarction D Hypotension

B Volume overload Natriuretic peptides protect the cardiovascular system in the event of volume overload. They work by reducing blood volume and promoting the dilation of arterioles and veins.

The nurse is teaching a patient with cancer about a new prescription for a fentanyl (Sublimaze) patch, 25 mcg/hr, for chronic back pain. Which statement is the most appropriate to include in the teaching plan? A "You will need to change this patch every day, regardless of your pain level." B "This type of pain medication is not as likely to cause breathing problems." C "With the first patch, it will take about 24 hours before you feel the full effects." D "Use your heating pad for the back pain. It will also improve the patch's effectiveness."

C "With the first patch, it will take about 24 hours before you feel the full effects." Full analgesic effects can take up to 24 hours to develop with fentanyl patches. Most patches are changed every 72 hours. Fentanyl has the same adverse effects as other opioids, including respiratory depression. Patients should avoid exposing the patch to external heat sources, because this may increase the risk of toxicity.

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

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.

A nurse obtains a health history from a patient who has gout and is taking a glucocorticoid. The nurse should follow up on which finding? A Flushing and urticaria B Heart rate of 88 beats per minute C Blood glucose level of 140 mg/dL D 6-kg weight loss

C Blood glucose level of 140 mg/dL Glucocorticoids are very effective in the treatment of acute gout attacks and are preferred for patients who are not candidates for or are unresponsive to NSAIDs. Because of their effects on carbohydrate metabolism, glucocorticoids should be avoided in patients prone to hyperglycemia. Flushing and urticaria are not associated with glucocorticoid use. The heart rate is not affected by glucocorticoids. Glucocorticoids cause weight gain, not weight loss.

A patient who took NPH insulin at 0800 reports feeling weak and tremulous at 1700. Which action should the nurse take? A Take the patient's blood pressure. B Give the patient's PRN dose of insulin. C Check the patient's capillary blood sugar. D Advise the patient to lie down with the legs elevated.

C Check the patient's capillary blood sugar. The patient is showing symptoms of hypoglycemia at 5 PM. NPH has a peak action of 8 to 10 hours after administration. Based on the duration of action of NPH insulin, the patient's hypoglycemic symptoms are from the 8 AM injection of NPH insulin. An injection of NPH insulin at 2 AM, 1 PM, or 3 PM would not cause hypoglycemic symptoms based on the average duration of action of NPH insulin.

Which complaint by a patient taking fingolimod (Gilenya) requires prompt evaluation by the prescriber? A Hair loss B Backache C Dizziness and fatigue D Blue-green tint to the skin

C Dizziness and fatigue Fingolimod slows the heart rate and can cause bradycardia. Dizziness and fatigue may be consequences of bradycardia. Backache is an adverse effect that occurs in 12% of patients taking the medication, but it does not require prompt attention. Reversible hair loss and a blue-green tint to the skin are adverse effects of mitoxantrone (Novantrone).

The nurse should follow up on which finding if it is identified in a patient receiving periodic intravenous infusions of abatacept (Orencia) for rheumatoid arthritis? A Itching and hives B Blurred vision and eye pain C Fever and malaise D Jaundice and dark urine

C Fever and malaise Abatacept suppresses immune function by reducing T-cell proliferation. Therefore, the patient is at greater risk for serious infections of the upper respiratory, gastrointestinal (GI), and urinary tracts. Fever and malaise are symptoms of infection that should be investigated. Itching and hives, blurred vision and eye pain, and jaundice and dark urine are not adverse effects of abatacept.

A nurse is educating a patient about sildenafil (Viagra). The nurse should instruct the patient that which adverse effect would be a priority for the patient to report to his prescriber? A Flushing B Diarrhea C Hearing loss D Dyspepsia

C Hearing loss In rare cases, sildenafil has caused sudden hearing loss, usually in one ear, which may be partial or complete. The medication should be discontinued if it is being taken for erectile dysfunction. Flushing, diarrhea, and dyspepsia are other, less serious adverse effects.

The nurse is caring for a patient prescribed aliskiren (Tekturna). In which way does this medication act to lower blood pressure? A It blocks the conversion of angiotensin I to angiotensin II. B It prevents angiotensin II from binding to its receptors. C It inhibits the conversion of angiotensinogen into angiotensin I. D It selectively blocks aldosterone receptors in the kidneys.

C It inhibits the conversion of angiotensinogen into angiotensin I. Aliskiren is the first direct renin inhibitor on the market. It binds with renin and thus inhibits the conversion of angiotensinogen to angiotensin I. The other items describe ACE inhibitors, ARBs, and selective aldosterone receptor blockers.

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 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.

A patient who is receiving cefotetan (Cefotan) has all of these medications ordered. The nurse monitors the patient for an adverse effect related to an interaction with which medication? A Regular insulin B Ampicillin (Polycillin) C Naproxen (Naprosyn) D Bisacodyl (Dulcolax)

C Naproxen (Naprosyn) Three cephalosporins—cefmetazole (Zefazone), cefoperazone (Cefobid), and cefotetan (Cefotan)—cause bleeding tendencies. Caution should be used during concurrent use of anticoagulants and other nonsteroidal medications. Regular insulin, ampicillin, and bisacodyl are unrelated to adverse effects with cefotetan.

What term is commonly used for nonprescription drugs? A Legend B Generic C Over-the-counter D Pharmaceutical

C Over-the-counter Over-the-counter (OTC) drugs are also known as nonprescription drugs.

A nurse should recognize that a patient who takes an angiotensin-converting enzyme (ACE) inhibitor while also taking high-dose aspirin is at risk of developing what complication? A Congestive heart failure B Liver toxicity C Renal failure D Hemorrhage

C Renal failure High-dose aspirin therapy should be avoided in patients taking ACE inhibitors. In susceptible patients, these medications can impair renal function when they are combined with aspirin. Liver toxicity, congestive heart failure, and hemorrhage are not effects of ACE inhibitor and aspirin interactions.

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 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 identifies tigecycline (Tygacil) as a derivative of what? A Penicillins B Cephalosporins C Tetracyclines D Macrolides

C Tetracyclines Tigecycline is the first representative of a new class of antibiotics, the glycyclines. It is a tetracycline derivative made to overcome drug resistance and is active against many drug-resistant strains. It has adverse effects similar to those of the tetracyclines.

The nurse knows that which neurotransmitter is most commonly found at the synapses of the peripheral nervous system? A Norepinephrine B Epinephrine C Dopamine D Acetylcholine

D Acetylcholine Norepinephrine, epinephrine, dopamine, and acetylcholine all are neurotransmitters for the peripheral nervous system, but acetylcholine is the most abundant. It is released by all preganglionic neurons in both the sympathetic and parasympathetic systems. It also is released by all postganglionic neurons of the parasympathetic nervous system.

Which symptom is the most indicative of muscarinic poisoning? A Constipation B Heart rate of 140 beats per minute C Blood pressure of 180/110 mm Hg D Blurred vision

D Blurred vision Muscarinic poisoning can result from overdose of muscarinic agonists or cholinesterase inhibitors or from ingestion of certain mushrooms. The symptoms include profuse salivation, lacrimation, visual disturbances, bronchospasm, diarrhea, bradycardia, and hypotension.

The nurse is working with a group of patients with hypertension. The nurse understands that which agent works by preventing angiotensin II from binding with its receptors? A Quinapril (Accupril) B Aliskiren (Tekturna) C Eplerenone (Inspra) D Candesartan (Atacand)

D Candesartan (Atacand) Candesartan is an angiotensin II receptor blocker (ARB) and thus prevents the binding of angiotensin II at its receptor sites. Quinapril is an ACE inhibitor; aliskiren is a direct renin inhibitor, and eplerenone is a selective aldosterone receptor blocker.

In which situation is dronedarone (Multaq) contraindicated? A PR intervals of 240 msec B QT intervals less than 500 msec C Resting heart rate of 55 beats per minute D Concomitant administration of amitriptyline (Elavil)

D Concomitant administration of amitriptyline (Elavil) Drugs and supplements that prolong the QT interval (e.g., phenothiazines, tricyclic antidepressants, amitriptyline, class I and class III antidysrhythmics) can intensify dronedarone-induced QT prolongation, thereby increasing the risk of torsades de pointes. These drugs are contraindicated for use with dronedarone. Dronedarone is contraindicated when the PR intervals are greater than 280 msec; the QT interval is greater than 500 msec; and the heart rate is less than 50 beats per minute.

A patient is receiving amphotericin B. It is most important for the nurse to monitor which laboratory result? A Serum pH B Protein level C Glucose level D Creatinine level

D Creatinine level Amphotericin B is toxic to cells of the kidneys. To evaluate renal injury, the plasma creatinine level should be monitored every 3 or 4 days, as well as intake and output. It is not necessary to monitor the serum protein or glucose levels or the serum pH in patients taking amphotericin B.

Which agent is most likely to cause the side effect of constipation? A Nifedipine (Adalat) B Amlodipine (Norvasc) C Isradipine (DynaCirc) D Diltiazem (Cardizem)

D Diltiazem (Cardizem) Nifedipine, amlodipine, and isradipine, which are dihydropyridine calcium channel blockers, cause less risk of constipation than diltiazem and verapamil.

A patient who takes ciprofloxacin (Cipro) and runs 6 miles daily tells a nurse about heel and calf tenderness. The nurse instructs the patient to take which action? A No action is needed, because this is a temporary but expected side effect. B Continue the antibiotic with an anti-inflammatory medication. C Slow the running pace and walk more. D Discontinue the medication, because severe damage can result.

D Discontinue the medication, because severe damage can result. Fluoroquinolones may result in tendinitis and rupture by disrupting the extracellular matrix of cartilage. Because tendon injury is reversible if diagnosed early, fluoroquinolones should be discontinued at the first sign of tendon pain or inflammation.

The nurse caring for a patient taking furosemide (Lasix) is reviewing the patient's most recent laboratory results, which are: sodium, 136 mEq/L; potassium, 3.2 mEq/L; chloride, 100mEq/L; blood urea nitrogen, 15 mg/dL. What is the nurse's best action? A Administer Lasix as ordered B Place the patient on a cardiac monitor C Begin a 24-hour urine collection D Hold the Lasix and notify the physician

D Hold the Lasix and notify the physician The nurse's best action is to hold the Lasix and notify the physician. Loop diuretics, such as furosemide, can cause significant potassium loss. The normal potassium level is 3.5 to 5 mEq/L. The remaining electrolyte levels are normal. Administering the Lasix could result in a critically low potassium level. Effects of low potassium include cardiac dysrhythmias. Placing a patient on a cardiac monitor requires a physician's order and would warrant further assessment first, such as taking vital signs and asking the patient whether he or she is having any cardiac-related symptoms. Collecting a 24-hour urine specimen is not appropriate in this case.

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

D 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.

Which laboratory result should a nurse monitor more frequently when a patient is receiving clarithromycin (Biaxin) and warfarin (Coumadin)? A Activated partial thromboplastin time (aPTT) B Platelet count C Erythrocyte sedimentation rate (ESR) D International normalized ratio (INR)

D International normalized ratio (INR) Clarithromycin is a macrolide similar to erythromycin and can inhibit hepatic metabolism of medications such as warfarin and theophylline. The INR is the blood test used to evaluate warfarin ranges. The aPTT is the blood test used in monitoring heparin. The platelet count and ESR are not affected by clarithromycin.

The cephalosporins are beta-lactam antibiotics similar in structure and actions to the penicillins. They are contraindicated in patients with a history of severe allergic reactions to penicillins. The use of soy products, peanuts, and opioids is unrelated to cephalosporins. A High blood pressure B Cardiotoxicity C Red man syndrome D Seizures

D Seizures Imipenem can reduce blood levels of valproate, a drug used to control seizures, and breakthrough seizures have occurred. If possible, combined use of imipenem and valproate should be avoided. If no other antibiotic will suffice, supplemental antiseizure therapy should be considered. The other responses are not associated with use of imipenem and valproate.

A nurse should recognize that which sulfonamide, applied topically, has the greatest therapeutic benefit for burns? A Sulfadiazine B Trimethoprim (Trimpex) C Sulfacetamide (Isopto Cetamide) D Silver sulfadiazine (Silvadene)

D Silver sulfadiazine (Silvadene) Silver sulfadiazine is a topical anti-infective agent used to treat and prevent infection in second- and third-degree burns. Its effects are due primarily to the release of free silver and not to the sulfonamide portion of the molecule. Sulfadiazine and trimethoprim are sulfonamides used systemically, not topically. Sulfacetamide is used for superficial infections of the eye.

A patient who has a vancomycin-resistant enterococci (VRE) infection is receiving linezolid (Zyvox). Which laboratory result indicates that the patient is having an adverse effect? A White blood cell (WBC) count of 1200 units/L B Hemoglobin (Hgb) level of 18 g/dL C Potassium level of 3.0 mEq/dL D Glucose level of 200 mg/dL

A White blood cell (WBC) count of 1200 units/L Linezolid can cause reversible myelosuppression, manifesting as anemia, leukopenia, or even pancytopenia. The potassium and blood glucose levels are not affected by linezolid.

A patient with Parkinson's disease who takes levodopa/carbidopa (Sinemet) comes to the clinic for a semiannual physical examination. Which question is the most important for the nurse to ask? A "Have you noticed any swelling in your feet?" B "Are you having vivid dreams or visual hallucinations?" C "Have you noticed any changes in your stool?" D "Have you had your flu vaccine?"

B "Are you having vivid dreams or visual hallucinations?" Patients taking levodopa/carbidopa (Sinemet) are at increased risk for the psychiatric side effects of levodopa, including visual hallucinations, vivid dreams, nightmares, and paranoid ideation. The other questions are not directly related to problems that are likely to occur with this drug.

A nurse is administering a daily dose of tobramycin (Nebcin) at 1000. At which time should the nurse obtain the patient's blood sample to determine the trough level? A 0800 B 0900 C 1130 D 1200

B 0900 Trough levels determine the lowest level between doses. Blood is drawn just before the next dose is administered when a divided dose is used or 1 hour before the next dose if a single daily dose is used.

When administering a central nervous system depressant, the nurse should closely observe for drug toxicity in which patient? A A 3-week-old neonate B A 12-year-old boy C A 25-year-old woman D A 15-month-old infant

A A 3-week-old neonate The blood-brain barrier is not fully developed at birth. As a result, newborns are much more sensitive than older children or adults to medicines that act on the brain.

Which medication is indicated for suppression of cough? A Benzonatate (Tessalon) B Guaifenesin (Mucinex) C Acetylcysteine (Mucomyst) D Fluticasone furoate (Flonase)

A Benzonatate (Tessalon) Benzonatate suppresses cough by reducing the sensitivity of respiratory stretch receptors (components of the cough reflex pathway). Acetylcysteine reacts directly with mucus to make it more watery and is administered by inhalation treatment. Guaifenesin is an expectorant. Fluticasone furoate is an intranasal glucocorticoid used to treat the clinical manifestations of allergic rhinitis.

Which drug should be used with caution in a patient with first-degree atrioventricular (AV) heart block? A Lacosamide (Vimpat) B Felbamate (Felbatol) C Tiagabine (Gabitril) D Levetiracetam (Keppra)

A Lacosamide (Vimpat) Lacosamide can prolong the PR interval and should be used with caution in patients with cardiac conduction problems and in those taking other drugs that prolong the PR interval, such as calcium channel and beta blockers. Felbamate, tiagabine, and levetiracetam do not affect the PR interval.

Which receptors below are considered adrenergic receptors? (Select all that apply.) A Alpha1 B Beta2 C Dopamine D Muscarinic1 E Beta1 F Alpha2

A Alpha1 B Beta2 C Dopamine E Beta1 F Alpha2 Alpha, beta, and dopamine receptors are all part of the sympathetic system and therefore are adrenergic receptors. Muscarinic receptors are part of the parasympathetic system and are cholinergic.

Which statements about serum drug levels does the nurse identify as true? (Select all that apply.) A With once-daily dosing, only trough levels need to be drawn. B Peak levels for intramuscular (IM) injections should be drawn 30 minutes after administration of the medication. C The trough level ideally should be close to zero. D For patients receiving once-daily doses, the sample should be drawn 2 hours before the next dose. E For patients receiving divided doses, trough levels should be drawn 1 hour before the next dose.

A With once-daily dosing, only trough levels need to be drawn. B Peak levels for intramuscular (IM) injections should be drawn 30 minutes after administration of the medication. C The trough level ideally should be close to zero. For patients receiving once-daily doses, the sample should be drawn 1 hour before the next dose. For patients receiving divided doses, trough levels should be drawn immediately before the next dose. The other three statements are true.

The nurse is teaching a patient taking felodipine (Plendil), a drug for hypertension, about taking the medication at home. Which statement by the nurse is the most appropriate to include in the teaching session? A "Avoid grapefruit juice while you are taking this medication." B "Citrus juices are an important part of a heart-healthy diet." C "Herbal agents can help this drug work more effectively." D "This drug is free of dangerous drug interactions."

A "Avoid grapefruit juice while you are taking this medication." Grapefruit juice can raise levels of felodipine by as much as 400% because of the effect grapefruit juice has on the CYP3A4 isozyme.

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."

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.

A nursing instructor knows that further instruction about drug selectivity is needed when a nursing student makes which statement? A "Botulinum toxin is very selective and therefore very safe for administration." B "Selective drug action is made possible by many types of receptors in the body." C "The more selective a drug is, the fewer side effects it will produce." D "Even though a drug is selective, it can produce nonselective results."

A "Botulinum toxin is very selective and therefore very safe for administration." Selectivity does not guarantee safety. Botulinum toxin can cause paralysis of respiratory muscles, resulting in respiratory arrest. All of the remaining statements about receptors and selectivity of drug action are correct.

A 68-year-old woman with a history of myocardial infarction is beginning a new prescription for lovastatin (Mevacor). Which statements by the nurse are appropriate to include in the teaching plan? (Select all that apply.) A "Call if you get new prescriptions from other providers, because several medications can interact with lovastatin." B "Return to the clinic every 6 to 12 months so we can run blood tests for possible side effects." C "Take your medication once a day, first thing in the morning, with a full glass of water for best results." D "Take one 325-mg aspirin 30 minutes before your dose to lessen the problem of flushing and itching that can occur with this drug." E "Lower the total fat and saturated fat in your diet by increasing your intake of fresh fruits and vegetables and whole grains."

A "Call if you get new prescriptions from other providers, because several medications can interact with lovastatin." B "Return to the clinic every 6 to 12 months so we can run blood tests for possible side effects." E "Lower the total fat and saturated fat in your diet by increasing your intake of fresh fruits and vegetables and whole grains." Lovastatin, simvastatin, and atorvastatin levels may be elevated when these drugs are combined with other drugs that inhibit CYP3A4. If these drugs are combined, caution is warranted. The manufacturer recommends monitoring of liver function tests every 6 to 12 months to watch for potential hepatotoxicity. The statins are taken once daily. It is recommended that they be taken in the evening, because endogenous cholesterol synthesis increases during the night. The statins do not typically cause flushing and itching; that effect occurs with niacin. A diet low in total fat and saturated fat is recommended when antilipemic drugs are prescribed.

Which instruction should the nurse provide when teaching a patient to mix regular insulin and NPH insulin in the same syringe? A "Draw up the clear regular insulin first, followed by the cloudy NPH insulin." B "It is not necessary to rotate the NPH insulin vial when it is mixed with regular insulin." C "The order of drawing up insulin does not matter as long as the insulin is refrigerated." D "Rotate subcutaneous injection sites each day among the arm, thigh, and abdomen."

A "Draw up the clear regular insulin first, followed by the cloudy NPH insulin." To ensure a consistent response, only NPH insulin is appropriate for mixing with a short-acting insulin. Unopened vials of insulin should be refrigerated; current vials can be kept at room temperature for up to 1 month. Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could alter the pharmacokinetics of subsequent doses taken out of the regular insulin vial. NPH insulin is a cloudy solution, and it should always be rotated gently to disperse the particles evenly before loading the syringe. Subcutaneous injections should be made using one region of the body (e.g., the abdomen or thigh) and rotated within that region for 1 month.

Which instruction should be included in the teaching for a patient for whom fluticasone propionate (Flovent) MDI has been ordered? A "Gargle after using your inhaler." B "Take the medication immediately at the onset of an attack." C "Take your albuterol first, followed by the Flovent 5 minutes later." D "Make sure you monitor your fingerstick blood glucose level each morning."

A "Gargle after using your inhaler." Patients should be taught to gargle after using inhaled glucocorticoids, such as fluticasone propionate, to minimize dysphonia and oropharyngeal candidiasis. The medication is not used to abort an acute attack. Short-acting bronchodilators, such as albuterol, should be administered 5 minutes before inhaled glucocorticoids to enhance delivery to the bronchial tree. Oral glucocorticoids pose a risk of hyperglycemia.

The nurse is teaching a patient about a new prescription for mitoxantrone (Novantrone). Which statement made by the patient indicates a need for further teaching? A "I volunteer at a local day care center once a week." B "I drink grapefruit juice with breakfast each morning." C "I enjoy walking and outdoor activities in the sun." D "I understand this drug may cause my urine to turn blue."

A "I volunteer at a local day care center once a week." Mitoxantrone can cause myelosuppression. Patients taking this drug should be advised to avoid contact with people who have infections, such as children in day care centers. The other statements are appropriate for patients taking this drug.

The nurse is teaching an older adult patient with hypertension who has a new prescription for verapamil (Calan). Which statement or statements by the patient indicate that the teaching was effective? (Select all that apply.) A "I will increase my intake of fluid and foods high in fiber." B "I will avoid exposing my skin to the sun." C "I will call my physician if I notice swelling in my ankles." D "I will avoid salt substitutes and potassium supplements." E "I may notice easy bruising and bleeding with this drug."

A "I will increase my intake of fluid and foods high in fiber." C "I will call my physician if I notice swelling in my ankles." Verapamil often causes constipation and can also cause peripheral edema. Patients should take measures to prevent constipation and should call about new symptoms of peripheral edema. Patients taking verapamil should not experience photosensitivity, hyperkalemia, or increased bruising and bleeding.

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."

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.

Which statement is the most appropriate to include in the teaching plan for a 30-year-old woman beginning a new prescription of clonidine (Catapres)? A "If you stop taking this drug abruptly, your blood pressure might go up very high." B "You will need to have your blood drawn regularly to check for anemia." C "Take this medication first thing in the morning to reduce nighttime wakefulness." D "This medication often is used to manage hypertension during pregnancy."

A "If you stop taking this drug abruptly, your blood pressure might go up very high." Rebound hypertension is a potential adverse effect of clonidine. Patients should be warned against abrupt withdrawal. Clonidine is not associated with anemia. It can cause drowsiness and usually is taken at night. Clonidine is not recommended for pregnant patients.

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."

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 nurse is administering an oral dose of itraconazole (Sporanox) to a patient at 10:00 AM. The nurse should administer a prescribed dose of famotidine (Pepcid) at which time? A 9:00-9:30 AM B 10:00 AM C 10:30 AM D 11:00 AM

A 9:00-9:30 AM Medications that lower gastric acidity, such as famotidine (Pepcid), can reduce absorption of oral itraconazole (Sporanox) Those agents should be given at least 1 hour before itraconazole or 2 hours after. The other time administrations would interfere with absorption of itraconazole.

When teaching the patient and family about clozapine therapy, which statements should the nurse include? (Select all that apply.) A "It is important for you to obtain ordered blood tests when taking this medication." B "Most patients who take this medication lose weight, so you should increase the number of calories you consume each day." C "If you experience increased urination, increased thirst, or increasd appetite, contact your healthcare provider." D "Inform your healthcare provider if you are taking any medications to control seizures." E "Contact your healthcare provider if you experience any unexplained tiredness, shortness of breath, increased respirations, chest pain, or heart palpitations."

A "It is important for you to obtain ordered blood tests when taking this medication." C "If you experience increased urination, increased thirst, or increasd appetite, contact your healthcare provider." D "Inform your healthcare provider if you are taking any medications to control seizures." E "Contact your healthcare provider if you experience any unexplained tiredness, shortness of breath, increased respirations, chest pain, or heart palpitations." Clozapine can cause agranulocytosis. Patients should be taught that clozapine will not be dispensed without repeated proof of blood counts. Patients taking clozapine are at increased risk of weight gain and dyslipidemia; they should be taught about the risk of weight gain and encouraged to control caloric intake and get regular exercise. Patients should be informed about early signs of infection (fever, sore throat, fatigue, mucous membrane ulceration) and instructed to notify their healthcare provider immediately if these should develop. Patients taking clozapine are at increased risk for the development of diabetes mellitus; they should be taught about symptoms of diabetes (e.g., hyperglycemia, polyuria, polydipsia, polyphagia, dehydration) and instructed to contact the prescriber if these occur. Clozapine should be used with caution in patients with seizure disorders. In rare cases, clozapine causes myocarditis; patients should be informed about the signs and symptoms (e.g., unenplained fatigue, dyspnea, tachypnea, chest pain, palpitations) and advised to seek immediate medical attention if these develop. Clozapine should be withheld until myocarditis has been ruled out. If myocarditis is diagnosed, the drug should never be used again.

The nurse is teaching a patient with rheumatoid arthritis who is scheduled to start a treatment regimen that includes nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and glucocorticoids. Which statement by the nurse is correct? A "It will take at least 3 to 5 months for the DMARD to produce effects." B "In large doses, the NSAIDs will stop most of the disease process." C "Remission is achieved quickly, and usually the medications can be stopped." D "The glucocorticoid will need to be taken for at least 2 years."

A "It will take at least 3 to 5 months for the DMARD to produce effects." The treatment for rheumatoid arthritis includes NSAIDs, glucocorticoids, and DMARDs; it is chronic because of the progressive nature of rheumatoid arthritis. A DMARD is started very soon after diagnosis to delay joint destruction. However, effects from the DMARD take months to develop. An NSAID provides quick pain relief but does not prevent joint damage; it is given until the DMARD has had time to take effect. Glucocorticoids are reserved for short-term disease management, not long-term control.

When teaching a patient about tuberculosis, the nurse will include which statements? (Select all that apply.) A "Most people infected with M. tuberculosis are asymptomatic." B "Most people infected with M. tuberculosis harbor dormant bacteria for life if they do not receive drug therapy." C "Treatment of tuberculosis lasts 3 months." D "Isoniazid can cause peripheral neuropathy by depleting vitamin B12." E "Rifampin can cause optic neuritis."

A "Most people infected with M. tuberculosis are asymptomatic." B "Most people infected with M. tuberculosis harbor dormant bacteria for life if they do not receive drug therapy." Treatment for tuberculosis usually lasts 6 months to 2 years. Isoniazid can cause peripheral neuropathy by depleting vitamin B6. Ethambutol, not rifampin, can cause optic neuritis. The other two statements are true and can be included in patient teaching.

Which instructions will the nurse include when teaching a patient about cephalosporin therapy? (Select all that apply.) A "Notify your healthcare provider if you develop diarrhea." B "Take aspirin if you develop a headache." C "Notify your healthcare provider if you develop a rash." D "Cephalosporins may not be taken with food." E "Do not take cephalosporins if you have lactose intolerance."

A "Notify your healthcare provider if you develop diarrhea." C "Notify your healthcare provider if you develop a rash." Cephalosporins may enhance bleeding tendencies, so drugs such as aspirin that may promote bleeding should be avoided. Cephalosporins may be taken with food, and they are safe to take if a patient has lactose intolerance. Severe diarrhea should be reported, because it may indicate the development of C. difficile infection. Any indication of an allergic reaction, including a rash, should be reported to the healthcare provider.

Teaching for a patient with angina who is being discharged with a prescription for nitroglycerin sublingual tablets should include which instruction? A "Store the tablets in their original dark container." B "The tablets are only good for 1 month after the container is opened." C "Sublingual nitroglycerin tablets are also effective when swallowed whole." D "Effects of sublingual nitroglycerin begin in 5 to 10 minutes."

A "Store the tablets in their original dark container." Sublingual nitroglycerin tablets should be stored moisture free at room temperature in their original container, which should be closed tightly after use. If stored correctly, the tablets should remain effective until the expiration date on the container. Sublingual nitroglycerin tablets are ineffective when swallowed whole. Effects of nitroglycerin begin in 1 to 3 minutes.

The nurse should instruct a patient complaining of pain to do what to reduce fluctuations in drug levels? A "Take pain medication around the clock at specified intervals and doses." B "Take pain medication when the pain level reaches an 8 or 9 on a 1 to 10 scale." C "Take pain medication at night before bed and avoid daytime dosing because of drowsiness." D "Take pain medication after breakfast and dinner to reduce stomach upset."

A "Take pain medication around the clock at specified intervals and doses." One technique to reduce drug level fluctuations is to take a specified dose at reduced dosing intervals. A patient who waits for the pain to peak will have to wait longer for the pain medicine to reach a plateau level of pain control. Avoiding daytime dosing because of drowsiness and avoiding stomach upset does not address the question of how to reduce fluctuations in drug levels.

Which statements will the nurse include when teaching a patient about isoniazid therapy for the treatment of tuberculosis? (Select all that apply.) A "Take the isoniazid on an empty stomach." B "Notify your healthcare provider if your skin starts to turn yellow." C "Numbness or tingling in your extremities is a normal response when taking this drug." D "You urine will turn reddish orange because of the effects of this drug." E "Use of this drug is associated with vision problems."

A "Take the isoniazid on an empty stomach." B "Notify your healthcare provider if your skin starts to turn yellow." Numbness and tingling in the extremities is associated with the development of peripheral neuropathy and should be reported to the healthcare provider. Rifampin, not isoniazid, causes discoloration of body fluids. Ethambutol, not isoniazid, is associated with optic neuritis. The other two statements are true and can be included in patient teaching.

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."

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.

A patient with nonvalvular atrial fibrillation is to be discharged on dabigatran etexilate (Pradaxa). Which statement should the nurse include in the discharge teaching? A "The medication must be stored in the manufacturer-supplied bottle." B "Once a new bottle is opened, the capsules maintain efficacy for 90 days." C "If you have difficulty swallowing the capsule, you can open it and mix it with food." D "You will need to learn how to give yourself a subcutaneous injection in your abdomen."

A "The medication must be stored in the manufacturer-supplied bottle." Dabigatran is unstable, especially when exposed to moisture, and should be stored in the manufacturer-supplied bottle, which has a desiccant cap. Current labeling of the pill bottle indicates that once the bottle is opened, the pills should be used within 30 days. However, recent evidence indicates that they maintain efficacy for 60 days, provided they have been stored in the original container. Capsules should be swallowed intact, because chewing, crushing, or opening enhances absorption by 75% and increases the risk of bleeding. The medication is administered orally, not subcutaneously.

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 "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 should include which instructions when teaching a patient about tigecycline therapy? (Select all that apply.) A "Use sunscreen when you are outside." B "If you have diarrhea more than five times a day, notify your healthcare provider." C "Avoid using this drug if you are pregnant." D "Stop taking the drug if you experience nausea." E "Stop taking the drug if you experience vomiting."

A "Use sunscreen when you are outside." B "If you have diarrhea more than five times a day, notify your healthcare provider." C "Avoid using this drug if you are pregnant." Nausea and vomiting may occur. The patient should not stop taking the medication; rather, the healthcare provider should be notified so that an alternative plan can be discussed. The other three instructions should be included in the patient teaching.

A nurse instructs a female patient with peptic ulcer disease who is to start a treatment regimen that includes ranitidine (Zantac) and bismuth subsalicylate (Pepto-Bismol). Which statement by the patient indicates that the teaching has been effective? A "While I'm taking these medications, my bowel movements could look black." B "I have a medicine at home to take when I start having some loose diarrhea stools." C "I'm so glad that my allergies will be helped while I'm taking these medications." D "I'll include more calcium and vitamin D in my diet to prevent osteoporosis."

A "While I'm taking these medications, my bowel movements could look black." Regimens for eradicating H. pylori include using two or three antibacterials with an antisecretory agent or histamine2 receptor antagonist. Bismuth acts topically to disrupt the cell wall of H. pylori. It can cause a harmless black stool discoloration. Loose stools are an adverse effect of systemic antibacterials such as amoxicillin (Amoxil). Ranitidine (Zantac) produces selective blockade of H2 receptors, which inhibits gastric acid secretion only, not allergy symptoms. Osteoporosis is an adverse effect of omeprazole, a PPI.

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 "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.

A nurse assesses the urine output of a patient receiving oxytocin (Pitocin). Which finding would require immediate follow-up by the nurse? A 80 mL in the past 4 hours B 250 mL in the past 8 hours C 150 mL in the past hour D 400 mL in the past 12 hours

A 80 mL in the past 4 hours Oxytocin exerts an antidiuretic effect similar to the effect of antidiuretic hormone (ADH) on the renal tubules to reduce the excretion of water. At least 30 mL of urine per hour is considered an adequate measure of kidney function. Values of 250 mL in 8 hours, 150 mL in 1 hour, or 400 mL in 12 hours all indicate adequate urine output.

The nurse is caring for a group of patients taking warfarin (Coumadin). Which patient or patients is/are at moderate to high risk for harm as a result of warfarin therapy? (Select all that apply.) A A 79-year-old man with variant genes that code for VKORC1 and CYP2CP B A 50-year-old woman with a current INR of 2.2 treated for deep vein thrombosis C A 26-year-old pregnant woman with new onset of symptoms of a pulmonary embolus D A 65-year-old man on day 4 after hip replacement with a new order for warfarin E A young adult with a prosthetic heart valve, for whom an interacting drug is being deleted from the regimen.

A A 79-year-old man with variant genes that code for VKORC1 and CYP2CP C A 26-year-old pregnant woman with new onset of symptoms of a pulmonary embolus E A young adult with a prosthetic heart valve, for whom an interacting drug is being deleted from the regimen. Patients with genetic alterations in VKORC1 and CYP2CP are at increased risk of warfarin-induced bleeding. An INR of 2.2 indicates a therapeutic warfarin level. Warfarin can cause fetal hemorrhage and is listed as Pregnancy Risk Category X. Warfarin could be prescribed for the prevention of deep vein thrombosis after hip replacement surgery. The day of prescription would not likely be a day to expect a dangerous adverse effect from warfarin, because its half-life is 1.5 to 2 days. Warfarin interacts with many other agents. The greatest risk for harm is when an interacting drug is being added to or deleted from the regimen.

The nurse knows that which statements about postpartum depression are true? (Select all that apply.) A About 80% of women experience depressive symptoms after giving birth. B Thyroid insufficiency has been indicated as a contributing factor in postpartum depression. C Monoamine oxidase inhibitors are the first-line agents of choice for the treatment of postpartum depression. D Once a woman has had postpartum depression, it will not recur with future deliveries. E Sertraline (Zoloft) is the drug of choice for treating postpartum depression in breast-feeding mothers.

A About 80% of women experience depressive symptoms after giving birth. B Thyroid insufficiency has been indicated as a contributing factor in postpartum depression. E Sertraline (Zoloft) is the drug of choice for treating postpartum depression in breast-feeding mothers. The drug of choice for postpartum depression is an SSRI, such as sertraline (Zoloft), because these drugs are effective, well tolerated, and present little risk of toxicity if taken in overdose. If a woman has responded to another antidepressant in the past, that drug should be used first. The risk of relapse is high, as is the risk of postpartum depression with subsequent pregnancies. The statements in options C and D are false.

After administering acetylcysteine (Mucomyst) to a patient who overdosed on acetaminophen (Tylenol), a nurse should recognize which outcome as an indicator of the therapeutic effects of acetylcysteine? A Absence of jaundice B Clear breath sounds C Increased bowel sounds D Palpable pedal pulses

A Absence of jaundice Acetylcysteine (Mucomyst) substitutes for depleted glutathione in the reaction that removes the toxic metabolite of acetaminophen (Tylenol) (which accumulates with acetaminophen poisoning) and thereby minimizes liver damage. Severe hepatic injury may occur with acetaminophen (Tylenol) poisoning, which is manifested by jaundiced sclera and skin. The assessment of bowel sounds, breath sounds, and pedal pulses is not used to determine the therapeutic effects of acetylcysteine (Mucomyst) for the treatment of acetaminophen overdose.

A nurse should establish which outcomes on the care plan for a patient taking oral terbutaline (Brethine)? (Select all that apply.) A Absence of tachycardia B No reports of chest pain C Less irritation of gum tissue D Decrease in bronchospasm E No jaundice or dark urine

A Absence of tachycardia B No reports of chest pain D Decrease in bronchospasm Terbutaline is an oral beta2 agonist. It promotes bronchodilation through activation of beta2 receptors in the lung, which relieves bronchospasm. It also stimulates the beta receptors of the heart and can result in tachycardia and chest pain if dosing is excessive. Irritated mucosal tissue of the gums, jaundice, and dark urine are not adverse effects of the medication.

A patient is receiving local applications of mafenide (Sulfamylon) to burn areas. Before application, it is most important for the nurse to do what? A Administer a pain medication. B Obtain a set of vital signs. C Auscultate the lung fields. D Obtain a signed consent form.

A Administer a pain medication. The sulfonamide mafenide (Sulfamylon) is used to suppress bacterial colonization in patients with burns. Local application frequently is painful. It is important to administer a pain medication before applying mafenide (Sulfamylon). Obtaining vital signs and a signed informed consent form and auscultating lung fields are not essential actions for mafenide application.

What does the nurse identify as a possible adverse effect of long-term glucocorticoid therapy? (Select all that apply.) A Adrenal insufficiency B Osteoporosis C Hypoglycemia D Hyperkalemia E Cataracts

A Adrenal insufficiency B Osteoporosis E Cataracts Adverse effects of long-term glucocorticoid therapy include adrenal insufficiency, osteoporosis, hyperglycemia, hypokalemia, and cataracts.

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

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 provides discharge instructions for a patient who is taking acetaminophen (Tylenol) after surgery. The nurse should instruct the patient to avoid which product while taking acetaminophen? A Alcoholic drinks B Leafy green foods C Bananas D Dairy products

A Alcoholic drinks Through several mechanisms, regular alcohol consumption while taking acetaminophen (Tylenol) increases the risk of liver injury when dosages are excessive. Therapeutic doses of acetaminophen (Tylenol) may be safe for patients who drink alcohol; however, the U.S. Food and Drug Administration (FDA) requires that acetaminophen (Tylenol) labels state an alcohol warning for patients who consume three or more drinks a day to consult their prescriber to determine whether acetaminophen (Tylenol) can be taken safely. It is not necessary to avoid leafy green foods, bananas, or dairy products when taking acetaminophen.

A patient is taking rifampin (Rifadin) for active tuberculosis. Which assessment does the nurse identify as an adverse effect of the drug? A Jaundice B Blood glucose level of 60 mg/dL C Absent deep tendon reflexes D Moon face

A Jaundice Rifampin is toxic to the liver, which increases the patient's risk of hepatitis. Jaundice is a sign of liver dysfunction and should be monitored. Rifampin has no effect on the blood glucose level or deep tendon reflexes, nor does it cause a moon face.

Which statements about medication administration would the nurse identify as true? (Select all that apply.) A All drugs have the potential to produce undesired effects. B Drug therapy often can be enhanced by nonpharmacologic measures. C Patients taking two drugs are not likely to have a drug interaction. D Nurses' knowledge of pharmacology is more important for standing orders than for PRN medications. E Patient adherence is essential in achieving the therapeutic objective of medications.

A All drugs have the potential to produce undesired effects. B Drug therapy often can be enhanced by nonpharmacologic measures. E Patient adherence is essential in achieving the therapeutic objective of medications. All drugs have the potential to produce undesired effects. Drug therapy often can be enhanced by nonpharmacologic measures, such as physical therapy or dietary changes. Patient adherence is the extent to which a patient's behavior coincides with medical advice. This is especially important for patients taking medications at home. Patients taking two drugs are at risk for drug interactions. PRN medications require a high level of nursing discretion, judgment, and knowledge and are not less important than standing orders.

Which statement about the Family Smoking Prevention and Tobacco Control Act (2009) would the nurse identify as true? (Select all that apply.) A All ingredients in tobacco products must be listed on the warning label. B A gradual reduction of nicotine to nonaddictive levels is required. C Marketing to youth is prohibited. D Harmful additives are restricted. E Purchasers of tobacco products must be age 21 years or older.

A All ingredients in tobacco products must be listed on the warning label. B A gradual reduction of nicotine to nonaddictive levels is required. C Marketing to youth is prohibited. D Harmful additives are restricted. All of the statements about the Family Smoking Prevention and Tobacco Control Act (2009) are true except option E. The legal age for purchasing tobacco products, as set by the act, is 18 years.

Before administering celecoxib (Celebrex), it is most important for the nurse to assess the patient for a history of what? A Allergy to sulfonamides B History of hepatitis C C Hypothyroidism D Diabetes mellitus

A Allergy to sulfonamides Celecoxib contains a sulfur molecule and therefore can precipitate an allergic reaction in patients allergic to sulfonamides. Accordingly, the drug should be avoided by patients with a sulfa allergy. The other conditions listed should be part of the nurse's assessment but are not the most important.

A patient is scheduled to start taking sildenafil (Viagra). A nurse should recognize that the patient is at risk for developing an adverse cardiac event if the patient's history reveals which of these conditions? A Angina B Hypertension C Varicose veins D Prosthetic mitral valve

A Angina Sildenafil is used in the treatment of erectile dysfunction. It should be used with caution by men with coronary heart disease (CHD), which may be manifested by angina. Research has suggested that in men with CHD, sexual activity, not sildenafil, is the likely cause of adverse cardiac events. Sildenafil is not contraindicated in patients with hypertension, varicose veins, or a prosthetic mitral valve.

The nurse prepares to give a drug that will prevent receptor activation. Which term would describe this drug? A Antagonist B Selective C Agonist D Potent

A Antagonist An antagonist is a drug that prevents receptor activation. An agonist is a molecule that activates receptors. A selective drug has only the desired response but may not activate receptors. A potent drug requires a lower dose to achieve its effect.

The nurse is reviewing the laboratory work for a patient who is taking atorvastatin (Lipitor). Which laboratory value is most useful for monitoring this drug? A Aspartate aminotransferase (AST) B Blood urea nitrogen (BUN) C International normalized ratio (INR) D C-reactive protein (CRP)

A Aspartate aminotransferase (AST) AST is a liver enzyme that is helpful for monitoring liver function (hepatotoxicity). Lipitor, a lipid-lowering drug, is a commonly prescribed example of a hepatotoxic drug. The BUN is a measure of kidney function. The INR is a comparative rating of prothrombin time ratios that is used to monitor patients taking the anticoagulant agent warfarin. The CRP is elevated in inflammatory and neoplastic disease, myocardial infarction, and the third trimester of pregnancy. It is used as a cardiac risk marker.

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.

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.

Which agent is in the category of drugs considered most effective for lowering LDL cholesterol? A Atorvastatin (Lipitor) B Cholestyramine (Questran) C Gemfibrozil (Lopid) D Ezetimibe (Zetia)

A Atorvastatin (Lipitor) The statin drugs, such as atorvastatin, are the most effective drugs available for lowering LDL cholesterol. They are better tolerated, have fewer adverse effects, and produce better clinical outcomes than any other agents available for lowering LDL.

Which systems are the primary regulators of arterial pressure? (Select all that apply.) A Autonomic nervous system B Renin-angiotensin-aldosterone system C Renal system D Pulmonary system E P450 enzyme system

A Autonomic nervous system B Renin-angiotensin-aldosterone system C Renal system Arterial pressure is regulated primarily by the autonomic nervous system (provides short-term tone and control), the renin-angiotensin-aldosterone system (constriction and volume), and the renal system (long-term volume control).

When assessing a patient for adverse effects of cyclosporine (Sandimmune), it is most important for the nurse to review which laboratory findings? (Select all that apply.) A Creatinine level B Hemoglobin level C Platelet count D Bilirubin level E White blood cell (WBC) count

A Creatinine level D Bilirubin level E White blood cell (WBC) count Cyclosporine is an immunosuppressant medication used to prevent organ rejection. Adverse effects include significant neurotoxicity, renal toxicity, hepatotoxicity, and infection risk. The hemoglobin level and the platelet count are not adversely affected by cyclosporine.

A nurse administers metoclopramide (Reglan) to a patient who is having nausea and vomiting postoperatively. The nurse should expect which therapeutic action if the medication is having the desired result? A Blocking of serotonin and dopamine receptors B Inactivation of histaminergic (H1) receptors C Activation of chloride channels in the intestine D Reduced motility in the small intestine

A Blocking of serotonin and dopamine receptors Metoclopramide works by blocking serotonin and dopamine receptors in the chemoreceptor trigger zone (CTZ) and by increasing motility in the small intestine. This action minimizes gastric distention and the accompanying stimulation of the vomiting center. Metoclopramide does not block H1 receptors or activate chloride channels in the intestine.

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 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.

The laboratory calls the nursing unit to report a drop in the platelet count to 90,000/mm3 for a patient receiving heparin for the treatment of postoperative deep vein thrombosis. Which action by the nurse is the most appropriate? A Call the healthcare provider to discuss the reduction or withdrawal of heparin. B Call the healthcare provider to discuss increasing the heparin dose to achieve a therapeutic level. C Obtain vitamin K and prepare to administer it by intramuscular (IM) injection. D Observe the patient and monitor the activated partial thromboplastin time (aPTT) as indicated.

A Call the healthcare provider to discuss the reduction or withdrawal of heparin. Heparin-induced thrombocytopenia (HIT) is a potential immune-mediated adverse effect of heparin infusions that can prove fatal. HIT is suspected when the platelet counts fall significantly. A platelet count below 100,000/mm3 would warrant discontinuation of the heparin.

The nurse in the cardiac care unit is caring for a patient receiving epinephrine. Which assessment criterion takes priority in the monitoring for adverse effects of this drug? A Cardiac rhythm B Blood urea nitrogen C Central nervous system (CNS) tremor D Lung sounds

A Cardiac rhythm Epinephrine can cause a number of adverse effects, including hypertensive crisis, dysrhythmias, angina, necrosis after extravasation, and hyperglycemia. Monitoring of the heart rhythm is essential to assess the patient for dysrhythmias.

A patient is receiving penicillin G (Bicillin C-R). Which assessment should the nurse monitor as an indicator of an undesired effect? A Cardiac rhythm B Serum sodium level C Lung sounds D Red blood cell (RBC) count

A Cardiac rhythm Penicillin G in high IV doses may cause hyperkalemia, which can result in dysrhythmias or cardiac arrest. Hypernatremia occurs with high IV doses of ticarcillin. Lung sounds and the RBC count are unrelated to the administration of penicillin G.

A nurse instills 1% silver nitrate topically into the eyes of a neonate on delivery to prevent conjunctivitis caused by what? (Select all that apply.) A Chlamydia spp. B Gonorrhea C Syphilis D Bacterial vaginosis E Herpes simplex type 2

A Chlamydia spp. B Gonorrhea Neonatal gonococcal infection is acquired through contact with infected cervical exudates during delivery and can cause blindness. A topical antibiotic should be instilled into both eyes after delivery. Infants born to women with a cervical chlamydial infection can acquire the infection during the birth process. These infants are at risk for conjunctivitis and pneumonia. Syphilis, bacterial vaginosis, and herpes simplex type 2 are not associated with neonatal conjunctivitis.

An adult patient in a physician's office reports severe diarrhea after returning from a trip to Mexico. Which medication might be prescribed for this patient? A Ciprofloxacin (Cipro) 500 mg twice daily B Sulfasalazine (Azulfidine) 500 mg daily C Metoclopramide (Reglan) 10 mg three times daily 30 minutes before meals and at bedtime D Ondansetron (Zofran) 8 mg three times daily

A Ciprofloxacin (Cipro) 500 mg twice daily Traveler's diarrhea, when severe, can be treated with ciprofloxacin, levofloxacin, or norfloxacin. Sulfasalazine is indicated for the treatment of mild to moderate ulcerative colitis; it is not used for the treatment of infection. Oral metoclopramide, a prokinetic agent, is administered for the treatment of diabetic gastroparesis and suppression of gastroesophageal reflux. Ondansetron is used for the treatment of emesis related to chemotherapy, radiation, and anesthetic agents.

The nurse knows that diuretics mostly affect which function of the kidneys? A Cleansing and maintenance of extracellular fluid volume B Maintenance of acid-base balance C Excretion of metabolic waste D Elimination of foreign substances

A Cleansing and maintenance of extracellular fluid volume Most diuretics block sodium and chloride reabsorption, thus affecting the maintenance of extracellular fluid volume.

Which side effect of morphine (Duramorph) does not subside over time? A Constipation B Sedation C Respiratory depression D Nausea and vomiting

A Constipation Over time, tolerance to sedation, respiratory depression, nausea, and vomiting develops. However, constipation is a long-term problem with opioids.

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.

Before administering metformin (Glucophage), the nurse should notify the prescriber about which laboratory value? A Creatinine (Cr) level of 2.1 mg/dL B Hemoglobin (Hgb) level of 9.5 gm/dL C Sodium (Na) level of 131 mEq/dL D Platelet count of 120,000/mm3

A Creatinine (Cr) level of 2.1 mg/dL Metformin can reach toxic levels in individuals with renal impairment, which is indicated by a rise in the serum creatinine level. The prescriber may need to be notified of the hemoglobin, sodium, and platelet values, but they would not affect the administration of metformin.

Which outcome would a nurse establish for a patient with trichomoniasis who is receiving metronidazole (Flagyl)? A Decrease in yellow-green, odorous vaginal discharge B Absence of painful urination and watery discharge C Improvement in pain in the back of the testicles D Resolution of genital and perianal warts

A Decrease in yellow-green, odorous vaginal discharge In women, trichomoniasis may be asymptomatic or may cause a diffuse, malodorous, yellow-green vaginal discharge, along with burning and itching sensations. Painful urination and watery discharge are associated with infection with herpes simplex virus type 2. Pain in the back of the testicles is the primary symptom of acute epididymitis, which is caused by gonorrhea or Chlamydia organisms. Genital and perianal warts are caused by human papilloma viruses (HPVs).

The nurse should monitor for which adverse effect after administering hydrochlorothiazide (HydroDIURIL) and digoxin (Lanoxin) to a patient? A Digoxin toxicity B Decreased diuretic effect C Dehydration D Heart failure

A Digoxin toxicity Digoxin levels have an inverse relationship with potassium levels. Because hydrochlorothiazide can lower potassium levels, combined use of hydrochlorothiazide and digoxin poses a risk for elevated digoxin levels and ensuing digoxin toxicity.

Both IV ampicillin/sulbactam (Unasyn) and gentamicin (Garamycin) are ordered for a patient. When administering these medications, the nurse will do what? A Ensure that separate IV solutions are used. B Use two different peripheral IV sites. C Administer the gentamicin first. D There are no necessary precautions.

A Ensure that separate IV solutions are used. When penicillins are present in high concentrations, they interact chemically with aminoglycosides, causing inactivation of the aminoglycoside. Therefore, penicillins and aminoglycosides should not be mixed in the same IV solution. Rather, these drugs should be administered separately. Two different peripheral IV sites are not necessary. Administering the gentamicin first does not ensure separation of the two medications.

Which drug would not be included in the pretreatment plan for a patient who is to receive an infusion of infliximab (Remicade)? A Epinephrine B Acetaminophen C Diphenhydramine D Methylprednisolone

A Epinephrine Infusion reactions are common with infliximab and manifest themselves as flulike symptoms—headache, fever, chills, dyspnea, hypotension, skin reactions, and gastrointestinal (GI) disturbances. These symptoms can be reduced by pretreatment with antihistamines (diphenhydramine), acetaminophen, and glucocorticoids (methylprednisolone). Epinephrine is administered for anaphylaxis, which is rare with infliximab.

The nurse is preparing to administer a daily dose of digoxin (Lanoxin). Which assessment receives priority at this time? A Evaluating for a change in the heart rhythm B Assessing for Homans' sign C Checking the blood pressure D Palpating the pedal pulses

A Evaluating for a change in the heart rhythm Before giving digoxin, the nurse will assess the heart rate and rhythm. The dosage will be held and the prescriber notified if the heart rate is below 60 beats per minute or if the cardiac rhythm has changed. Digoxin can cause bradycardia and electrical changes in the heart.

In addition to local joint pain and limited range of motion, a nurse should recognize which findings as systemic manifestations of rheumatoid arthritis? (Select all that apply.) A Fatigue B Hyperglycemia C Osteoporosis D Vasculitis E Corneal ulcers

A Fatigue D Vasculitis E Corneal ulcers Rheumatoid arthritis is manifested by joint stiffness and pain secondary to an autoimmune disorder in which damaging compounds attack the articular cartilage. In addition, systemic manifestations of fatigue, corneal ulcers, and vasculitis may occur.

The nurse is working with a patient who has a UTI. Because patient adherence to a medication regimen is a concern, the nurse anticipates use of which medication? A Fosfomycin B Amoxicillin C Cephalexin D Trimethoprim

A Fosfomycin When adherence is a concern, fosfomycin, which requires just one dose, is an attractive choice. As a rule, amoxicillin and cephalexin are avoided, because they are less effective than the alternatives and are less well tolerated. Trimethoprim requires a longer course of therapy than fosfomycin.

Which medication or medications should be used with caution in a hypertensive diabetic patient? (Select all that apply.) A Furosemide (Lasix) B Metoprolol (Lopressor) C Diltiazem (Cardizem) D Hydrochlorothiazide (HCTZ) E Enalapril (Vasotec)

A Furosemide (Lasix) B Metoprolol (Lopressor) D Hydrochlorothiazide (HCTZ) Hydrochlorothiazide and furosemide promote hyperglycemia, and metoprolol suppresses glycogenolysis and can mask signs of hypoglycemia. Therefore, these medications should be administered with caution to patients with diabetes. Diltiazem and enalapril do not cause either of these effects.

Which organs are controlled primarily by the parasympathetic system? (Select all that apply.) A Gastrointestinal tract B Respiratory tract C Cardiovascular system D Skin E Salivary glands

A Gastrointestinal tract B Respiratory tract D Skin E Salivary glands The sympathetic nervous system provides the dominant tone for the cardiovascular system.

Which approach should a nurse take when administering an oral dose of levofloxacin (Levaquin)? A Give the medication with or without food. B Administer the drug with an oral dose of a magnesium-based antacid. C Premedicate the patient with diphenhydramine (Benadryl). D Administer the drug with milk products.

A Give the medication with or without food. Levofloxacin should not be administered with milk products or antacids containing magnesium or aluminum, because this reduces absorption from the gastrointestinal (GI) tract. However, this does not happen with most foods. Premedicating with diphenhydramine is unnecessary.

Patients receiving nitroglycerin are at risk for which adverse effects? (Select all that apply.) A Headache B Wheezing C Dizziness D Tachycardia E Bradycardia

A Headache C Dizziness D Tachycardia The primary adverse effects of nitroglycerin are headache; orthostatic hypotension, which can lead to dizziness; and reflex tachycardia.

A nurse teaches a patient who takes daily low-dose aspirin for protection against myocardial infarction and stroke to avoid also taking which medication? A Ibuprofen (Motrin) B Zolpidem (Ambien) C Loratadine (Claritin) D Diphenhydramine (Benadryl)

A Ibuprofen (Motrin) Ibuprofen (Motrin) can block the antiplatelet effects of aspirin; therefore, patients who take low-dose aspirin to protect against myocardial infarction and thrombosis should avoid taking ibuprofen (Motrin). It is not necessary to avoid taking zolpidem (Ambien), loratadine (Claritin), or diphenhydramine (Benadryl) while taking aspirin.

What does the nurse identify as possible complications of glucocorticoid therapy? (Select all that apply.) A Impaired carbohydrate and glucose tolerance B Increased production of glucocorticoids from the adrenals C Predisposition to gastrointestinal ulceration D Decrease in serum sodium and glucose levels E Increase in plaque development in coronary arteries

A Impaired carbohydrate and glucose tolerance C Predisposition to gastrointestinal ulceration Adverse effects of glucocorticoids occur in response to pharmacologic doses; they include suppression of adrenal glucocorticoids; glucose and carbohydrate intolerance, elevated blood glucose level; water and sodium retention; and increased gastric acid secretion. Plaque development in arteries is not affected.

The nurse is administering warfarin, an anticoagulant, to a patient with a low albumin level. As a result, the nurse can expect to observe which effect of this medication? A Increased PT/INR levels B Deep vein thromboses C Reduced risk of bruising D Increased platelet aggregation

A Increased PT/INR levels Warfarin is an anticoagulant with a high affinity for binding with albumin. If the albumin level is low, more free drug is available for action, resulting in an increased prothrombin time/international normalized ratio (PT/INR). Deep vein thromboses can be prevented with warfarin. An increased risk of bruising and bleeding would occur with more free drug available. Warfarin acts on vitamin K, not on platelets. Aspirin is an example of an antiplatelet aggregator

The nurse is administering isoproterenol, a beta1 and beta2 agonist. The nurse expects the patient to show which effects of this drug? (Select all that apply.) A Increased heart rate B Excessive drowsiness C Increased force of heart contraction D Decreased cardiac output E Bronchial dilation F Decreased glucose levels

A Increased heart rate C Increased force of heart contraction E Bronchial dilation Activation of beta1 and beta2 receptors results in (1) increased cardiac output (by increasing the heart rate and force of contraction); (2) dilation of the bronchi; and (3) elevation of the blood glucose level.

The drug dobutamine acts as an agonist of norepinephrine (NE) receptors. Which effect is the nurse likely to observe in a patient receiving this medication? A Increased heart rate B Atrioventricular heart block C Decreased force of heart contraction D Reduced cardiac output

A Increased heart rate Dobutamine mimics the action of NE at receptors on the heart, thereby causing and increase in the heart's rate and force of contraction.

Which response would the nurse anticipate when giving two drugs that have a potentiative effect, such as meperidine and Phenergan? A Increased pain relief B Increased nausea and vomiting C Decreased itching D Increased alertness

A Increased pain relief A potentiative effect occurs when one drug intensifies the effects of another. An inhibitory effect would cause reduced therapeutic effects or reduced adverse effects. Potentiative effects are not unique responses. Meperidine is a morphine derivative for pain relief. Phenergan is an antiemetic that potentiates the effect of meperidine. The patient should experience decreased pain and also may be drowsy.

The human immunodeficiency virus (HIV) uses which enzymes to replicate and infect a host cell? (Select all that apply.) A Integrase B Dihydrofolate reductase C Reverse transcriptase D Carbonic anhydrase E Protease

A Integrase C Reverse transcriptase E Protease HIV is a retrovirus that replicates itself in a host cell by transcribing RNA into DNA. The enzyme used for this process is viral RNA-dependent DNA polymerase, commonly known as reverse transcriptase. HIV DNA becomes integrated into the host's DNA under the influence of a viral enzyme called integrase. Final maturation of HIV depends on protease, which breaks large HIV polyproteins into smaller, functional forms. Dihydrofolate reductase and carbonic anhydrase are other enzymes used to catalyze chemical cellular reactions, but they are not participants in HIV replication.

What must be in place before alosetron (Lotronex) can be prescribed for a patient with IBS-D? (Select all that apply.) A Intestinal obstruction has been ruled out. B The patient is aware of the signs and symptoms of ischemic colitis. C The physician is enrolled in a prescriber program for alosetron. D The patient has signed a Patient-Physician Agreement. E The patient's IBS-D has lasted at least 2 months and has not responded to conventional treatment.

A Intestinal obstruction has been ruled out. B The patient is aware of the signs and symptoms of ischemic colitis. C The physician is enrolled in a prescriber program for alosetron. D The patient has signed a Patient-Physician Agreement. To ensure the best possible benefit/risk ratio, the manufacturer of alosetron and the FDA have established a risk management program that involves the active participation of the patient, prescriber, and pharmacist. The prescriber must be qualified to make an accurate diagnosis and to manage complications of therapy. Each patient must sign a Patient-Physician Agreement indicating that she or he understands the risks and benefits, agrees to treatment, will contact the prescriber if constipation or ischemic colitis develops, and will report to the prescriber if symptoms are not controlled after 4 weeks. Alosetron is contraindicated in patients with intestinal obstruction. The drug is approved for use in female patients only with severe IBS-D that has lasted for 6 months or longer and has not responded to conventional treatment.

Which statement about aripiprazole would the nurse identify as true? A It is the first representative of a unique class of antipsychotic drugs called dopamine system stabilizers. B It must be administered on an empty stomach. C Gynecomastia is a common adverse effect. D It is safe to use in older adult patients with dementia-related psychosis.

A It is the first representative of a unique class of antipsychotic drugs called dopamine system stabilizers. Aripiprazole is well absorbed in the presence and absence of food, and gynecomastia is not a side effect. Increased mortality is seen when aripiprazole is used in the treatment of older adult patients with dementia-related psychosis.

The nurse is preparing to administer a dose of clonidine (Catapres). Which is the best description of the action of this drug? A It selectively activates alpha2 receptors in the central nervous system (CNS). B It causes peripheral activation of alpha1 and alpha2 receptors. C It depletes sympathetic neurons of norepinephrine. D It directly blocks alpha and beta receptors in the periphery.

A It selectively activates alpha2 receptors in the central nervous system (CNS). Clonidine is an alpha2-adrenergic agonist that causes selective activation of alpha2 receptors in the CNS. This in turn reduces sympathetic outflow to the blood vessels and the heart. Although the body's responses are similar to those from a peripheral adrenergic blocker, clonidine's action occurs in the CNS.

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

A 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 nurse monitors a patient who takes azathioprine (Imuran) for which adverse effects? (Select all that apply.) A Leukopenia B Thrombocytopenia C Alopecia D Nephrotoxicity E Red urine color

A Leukopenia B Thrombocytopenia C Alopecia Azathioprine is a cytotoxic medication used to suppress the immune response. It is toxic to all proliferating cells. Cytotoxic medications usually are reserved for patients who have not responded to safer immunosuppressants. Nephrotoxicity and red-colored urine are not adverse reactions associated with azathioprine.

The nurse knows that which drug acts by suppressing axonal conduction? A Lidocaine (Xylocaine), a local anesthetic B Citalopram (Celexa), an antidepressant C Morphine (Duramorph), a pain reliever D Halothane (Fluothane), a general anesthetic

A Lidocaine (Xylocaine), a local anesthetic Local anesthetics are the only neuropharmacologic agents that act by suppressing axonal conduction. Most neuropharmacologic agents act by altering synaptic transmission. Only a few alter axonal conduction. Drugs that alter synaptic transmission can produce effects that are much more selective than those produced by drugs that alter axonal conduction.

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

A Lithium C Divalproex sodium (Valproate) 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.

A patient is having high-volume output from a new ileostomy. A nurse develops a plan that includes teaching the patient to take which antidiarrheal agent? A Loperamide (Imodium) B Alosetron (Lotronex) C Bismuth subsalicylate (Pepto-Bismol) D Paregoric (camphorated opium tincture)

A Loperamide (Imodium) Opioids are the most effective antidiarrheal agents that activate opioid receptors in the gastrointestinal tract, thus slowing intestinal transit. This action allows more time for fluid and electrolyte absorption in the colon. Loperamide, a structural analog of meperidine, is used to reduce the volume of discharge from ileostomies. Alosetron is a dangerous medication that is approved only for irritable bowel syndrome-diarrhea (IBS-D). Paregoric is not appropriate as an antidiarrheal for longer term use, because it has moderate potential for abuse. Bismuth subsalicylate is effective only for mild diarrhea.

The nurse is concerned with minimizing adverse drug-drug interactions for the patient. Which drug characteristic could result in the most serious consequences from a drug-drug interaction? A Low therapeutic index B High biologic half-life C Low potency D First-pass effect

A Low therapeutic index Interactions are especially important with drugs that have a low therapeutic index, because an interaction that produces a modest increase in drug levels can cause toxicity.

Which outcomes should a nurse establish when planning care for a patient taking methenamine (Mandelamine)? (Select all that apply.) A Maintains a urine pH of 5.5 or lower B Consumes 3000 mL of liquid daily C Uses an enteric-coated formulation D Avoids sulfonamide medications E No elevation in liver enzymes

A Maintains a urine pH of 5.5 or lower C Uses an enteric-coated formulation D Avoids sulfonamide medications Under acidic conditions, methenamine makes formaldehyde, which causes bacterial cell death. Formaldehyde requires an acid urine to be released. To prevent the dose from being converted to formaldehyde in an acidic stomach, an enteric-coated formula may be used. Ingestion of large volumes of fluid dilutes methenamine and raises the urinary pH. Hepatotoxicity is not associated with methenamine (Mandelamine).

The nurse is caring for a pregnant patient who is experiencing a new episode of hypertension. Which agent does the nurse anticipate will be prescribed for this patient? A Methyldopa (Aldomet) B Propranolol (Inderal) C Captopril (Capoten) D Valsartan (Diovan)

A Methyldopa (Aldomet) Hypertension is the most common complication of pregnancy, occurring in about 10% of pregnant patients. When drug therapy is initiated during pregnancy, methyldopa is the traditional agent of choice because of its limited effects on the fetus. Patients with pre-existing hypertension typically can continue taking the antihypertensives they previously were prescribed except for angiotensin-converting enzyme (ACE) inhibitors, such as captopril; angiotensin II receptor blockers (ARBs), such as valsartan; and direct renin inhibitors, such as aliskiren.

The nurse is preparing to administer the first dose of intravenous muromonab-CD3 (Orthoclone). Which premedication will the nurse administer? A Methylprednisolone sodium (Solu-Medrol) B Diphenhydramine (Benadryl) C Acetaminophen (Tylenol) D Meperidine (Demerol)

A Methylprednisolone sodium (Solu-Medrol) Methylprednisolone sodium, a glucocorticoid, is administered intravenously 30 minutes before injection of muromonab-CD3 to prevent or minimize a first-dose adverse reaction. Diphenhydramine or acetaminophen would not be as effective as a steroid to minimize an adverse immune system reaction. Meperidine is a pain medication.

Which medication can be used to manage fatigue associated with multiple sclerosis? (Select all that apply.) A Modafinil (Provigil) B Clonazepam (Klonopin) C Amantadine (Symmetrel) D Carbamazepine (Tegretol) E Dalfampridine (Ampyra)

A Modafinil (Provigil) C Amantadine (Symmetrel) Fatigue develops in about 90% of patients with multiple sclerosis, and the drugs most commonly used to manage this symptom include modafinil and amantadine. Clonazepam may be useful for alleviating tremor and ataxia associated with the disease. Carbamazepine, an antiepileptic drug, may be helpful for alleviating neuropathic pain. Dalfampridine may be given to improve walking.

A nurse should teach a patient to observe for which side effect when taking ampicillin (Polycillin)? A Skin rash and loose stool B Reddened tongue and gums C Digit numbness and tingling D Bruising and petechiae

A Skin rash and loose stool Ampicillin's most common side effects are rash and diarrhea; both reactions occur more frequently with ampicillin than with any other penicillin. Reddened tongue and gums, digit numbness and tingling, and bruising and petechiae are not associated side effects of ampicillin.

The nurse is administering lidocaine (Xylocaine) to a patient with a ventricular dysrhythmia. What action should the nurse take to prevent a complication with this drug? A Monitor the ECG B Obtain a complete blood count frequently C Administer the drug with meals D Keep naloxone (Narcan) on hand

A Monitor the ECG Continuous ECG monitoring is required during lidocaine infusions so that the cardiac response can be evaluated and the dosage adjusted accordingly. Blood counts are not necessary, because lidocaine is not linked to blood dyscrasias. Lidocaine preferably is given intravenously (IV) rather than intramuscularly (IM). Timing with meals is not necessary. Naloxone is a reversal agent for opioids and is not used with lidocaine.

The nurse has just administered the initial dose of enalapril (Vasotec) to a newly admitted patient. Which nursing intervention takes priority over the next several hours? A Monitoring the blood pressure B Measuring the heart rate C Auscultating the lungs D Drawing blood for potassium levels

A Monitoring the blood pressure First-dose hypotension is a serious potential adverse effect of ACE inhibitors, such as enalapril. Monitoring the blood pressure is the priority nursing intervention. If hypotension develops, the nurse will place the patient in the supine position and possibly increase intravenous fluids. The other interventions may be appropriate for this patient; however, in the hours immediately after the first dose of an ACE inhibitor, monitoring of the blood pressure is most important.

Which statement or statements about the treatment of bipolar disorder does the nurse identify as true? (Select all that apply.) A Mood stabilizers are used to prevent recurrent manic-depressive episodes. B Antipsychotics are used to treat depressive episodes. C Antidepressants should be used with mood stabilizers in the treatment of patients with bipolar depression. D Lithium and valproate are the preferred mood stabilizers for BPD. E A lithium level of 2.0 mEq/L is considered therapeutic

A Mood stabilizers are used to prevent recurrent manic-depressive episodes. C Antidepressants should be used with mood stabilizers in the treatment of patients with bipolar depression. D Lithium and valproate are the preferred mood stabilizers for BPD. The statements in options A, C, and D are true. Antipsychotics are used to treat manic episodes. A lithium level above 1.5 mEq/L is considered to be above the therapeutic index.

Which are advantages of a dry-powder inhaler (DPI) over a metered-dose inhaler (MDI)? . (Select all that apply.) A More of the drug is delivered to the lungs and less to the oropharynx. B Use of a spacer is not necessary. C Less propellant is needed to deliver the medication. D Less hand-lung coordination is required. E DPIs pose no environmental risk.

A More of the drug is delivered to the lungs and less to the oropharynx. B Use of a spacer is not necessary. D Less hand-lung coordination is required. E DPIs pose no environmental risk. DPIs deliver more drug to the lungs (20% of the total released, compared to 10% for MDIs). Spacers are not necessary with DPIs; they are recommended for use with MDIs to increase the delivery of drug to the lungs rather than the oropharyngeal mucosa. DPIs do not require the hand-lung coordination needed with MDIs. DPIs present no environmental hazard, because no propellant is required for delivery.

Which agent is most likely to cause serious respiratory depression as a potential adverse reaction? A Morphine (Duramorph) B Pentazocine (Talwin) C Hydrocodone (Lortab) D Nalmefene (Revex)

A Morphine (Duramorph) Morphine is a strong opioid agonist and as such has the highest likelihood of causing respiratory depression. Pentazocine, a partial agonist, and hydrocodone, a moderate to strong agonist, may cause respiratory depression, but they do not do so as often or as seriously as morphine. Nalmefene, an opioid antagonist, would be used to reverse respiratory depression with opioids.

Which statement about over-the-counter (OTC) drugs would the nurse identify as true? (Select all that apply.) A Most illnesses initially are treated with an OTC agent. B More prescription drugs than OTC agents are administered each year in the United States. C The average home medicine cabinet contains eight OTC preparations. D Forty percent of Americans take at least one OTC drug every 2 days. E Some drugs that originally were sold by prescription are now OTC.

A Most illnesses initially are treated with an OTC agent. D Forty percent of Americans take at least one OTC drug every 2 days. E Some drugs that originally were sold by prescription are now OTC. Most illnesses are initially treated with an OTC agent. OTC drugs account for 60% of all doses administered. The average home medicine cabinet contains 24 OTC preparations

Before administering an aminoglycoside, it is most important for the nurse to assess the patient for a history of what? A Myasthenia gravis B Asthma C Hypertension D Diabetes mellitus

A Myasthenia gravis Aminoglycosides can inhibit neuromuscular transmission, causing flaccid paralysis and potentially fatal respiratory depression. These drugs should be used with extreme caution in patients with myasthenia gravis.

A postoperative patient has an epidural infusion of morphine sulfate (Astramorph). The patient's respiratory rate declines to 8 breaths per minute. Which medication would the nurse anticipate administering? A Naloxone (Narcan) B Acetylcysteine (Mucomyst) C Methylprednisolone (Solu-Medrol) D Protamine sulfate

A Naloxone (Narcan) Naloxone is a narcotic antagonist that can reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.

The nurse teaches a patient with gout that naproxen (Naprosyn) is an agent of first choice for treatment over colchicine. The nurse should use which rationale for the teaching? A Naproxen achieves more predicable pain relief with fewer side effects. B Treatment with naproxen must continue over a long period to restore joint function. C Naproxen causes less impairment of carbohydrate metabolism and less risk of hyperglycemia. D Naproxen reduces uric acid levels sooner and with less risk to the kidneys.

A Naproxen achieves more predicable pain relief with fewer side effects. Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) that is used to suppress inflammation in gout. Compared with colchicine, NSAIDs are better tolerated and have more predictable effects. Because safe, effective alternatives are available, the use of colchicine has declined. The treatment time with NSAIDs is brief, because pain relief occurs within 24 hours and swelling subsides over a few days. Hyperglycemia is more of a concern when glucocorticoids are used. NSAIDs do not affect uric acid levels.

A history of allergy to which substance is a contraindication to the use of ipratropium/albuterol (Combivent)? A Mold B Peanuts C Penicillin D Dairy products

B Peanuts Patients with peanut allergy should avoid Combivent, which contains soya lethicin as a carrier. Soya is in the same plant family as peanuts, and about 10% of people with peanut allergy are cross-allergic to soya. Allergy to the remainder of the options is not a contraindication.

The nurse is caring for a patient with a suspected overdose of pancuronium, which was used during surgery. Which drug does the nurse anticipate will be used as a reversal agent? A Neostigmine (Prostigmin) B Atropine (Sal-Tropine) C Pralidoxime (DuoDote) D Dobutamine (Dobutrex)

A Neostigmine (Prostigmin) Because neostigmine inhibits cholinesterase, it allows acetylcholine to accumulate at synapses. This action can help reverse neuromuscular blockade in postoperative patients, especially when a nondepolarizing neuromuscular blocker, such as pancuronium, has been used.

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

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.

What is a result of the Prescription Drug User Fee Act (PDUFA) of 1992? A New drugs reach the market sooner than ever before. B Controlled substances are categorized into schedules. C Drugs for acquired immunodeficiency syndrome (AIDS) receive accelerated approval. D More research is conducted on drug safety in children.

A New drugs reach the market sooner than ever before. PDUFA was a response to complaints about the length of time required for approval of new drugs by the U.S. Food and Drug Administration (FDA). Under this act, drug sponsors pay fees to the FDA that are used to fund additional reviewers. The FDA then must adhere to strict turnaround times for drug review processes

A nurse is preparing to give bethanechol (Urecholine). What is an expected outcome of this drug? A Nondistended bladder B Increased heart rate and blood pressure C Improved pulse oximetry reading D Relief of cardiac rhythm problems

A Nondistended bladder Bethanechol is a muscarinic agonist and therefore activates muscarinic receptors. This can lead to relaxation of the urinary sphincter muscles and increased voiding pressure. It also can cause bradycardia and hypotension, bronchoconstriction, and dysrhythmias in hyperthyroid patients.

A patient who has tuberculosis is treated with isoniazid. The nurse should monitor for which symptoms, which could indicate a vitamin B6 deficiency caused by the medication? A Numbness and tingling in the fingers and toes B Alopecia and flaking scalp C Dry skin and brittle nails D Oral ulcers and tongue fissures

A Numbness and tingling in the fingers and toes Dose-related peripheral neuropathy is the most common adverse effect of isoniazid. It results from a vitamin B6 deficiency, which is corrected by taking oral supplements. Symptoms include numbness and tingling in the fingers and toes. Alopecia and flaking scalp, oral ulcers and tongue fissures, and dry skin and brittle nails are not adverse effects of isoniazid-induced vitamin B6 deficiency.

A patient in a hypertensive crisis is being started on a continuous sodium nitroprusside (Nipride) infusion. Which activities should the nurse implement? (Select all that apply.) A Obtain a baseline weight and weigh daily. B Collaborate with the physician on insertion of an arterial line. C Discontinue the infusion when the blood pressure is at an acceptable level. D Observe for signs of hypertrichosis during the infusion. E Cover the IV bottle containing the medication with an opaque bag.

A Obtain a baseline weight and weigh daily. B Collaborate with the physician on insertion of an arterial line. E Cover the IV bottle containing the medication with an opaque bag. A Nipride infusion is ordered in micrograms/kilogram/minute. Knowing the patient's weight is essential for calculating the appropriate dose. Also, tracking daily weights and comparing them with the baseline values helps the nurse determine whether the adverse effect of fluid retention has developed. An arterial line allows for continuous and accurate measurement of blood pressure. Because light degrades nitroprusside, the infusion bottle should be covered. The infusion should not be discontinued abruptly, because the blood pressure will return to the pretreatment levels within minutes. Hypertrichosis (excessive hair growth) is a side effect of minoxidil.

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)

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.

The nurse identifies terbinafine (Lamisil) as useful for treating which conditions? (Select all that apply.) A Onychomycosis B Tinea corporis C Oropharyngeal candidiasis D Vulvovaginal candidiasis E Tinea pedis

A Onychomycosis B Tinea corporis E Tinea pedis Terbinafine (Lamisil) is highly active against dermatophytes and is used to eradicate fungal infection of the nails (onychomycosis) and as topical therapy for ringworm infections (tinea corporis, tinea pedis). It is not effective against oropharyngeal and vulvovaginal candidiasis.

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 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.

A distraught patient is admitted to the emergency department with symptoms of palpitations, tachycardia, chest pain, and shortness of breath. The physical examination reveals no physiologic basis for the symptoms. Which diagnosis therefore is most likely? A Panic disorder B Bipolar disorder C Generalized anxiety disorder D Clinical depression

A Panic disorder Panic disorder is characterized by symptoms similar to those of a myocardial infarction (MI). Patients often fear losing control and dying and also may experience dizziness, nausea, depersonalization, and tingling or numbness in the hands. Generalized anxiety disorder is characterized by excessive worrying about events, but it also can include trembling, muscle tension, restlessness, palpitations, tachycardia, sweating, and clammy hands. Bipolar disorder is characterized by mood swings with periods of mania and depression.

A nurse gives a medication that inhibits acetylcholinesterase. How would this drug affect autonomic activity? A Parasympathetic activity would increase. B Parasympathetic signals would be depressed. C Sympathetic activity would increase. D Respiratory centers would be depressed.

A Parasympathetic activity would increase. Acetylcholinesterase is an enzyme that metabolizes acetylcholine. When acetylcholine is not broken down, it continues to send its message. Acetylcholine is associated mostly with the parasympathetic nervous system; therefore, this system would be stimulated by acetylcholine-inhibiting drugs.

The nurse identifies which statements about Stevens-Johnson syndrome as true? (Select all that apply.) A Patients with Stevens-Johnson syndrome have a mortality rate of about 25%. B Toxemia is associated with Stevens-Johnson syndrome. C Short-acting sulfonamides do not induce Stevens-Johnson syndrome. D Patients with Stevens-Johnson syndrome usually are hypothermic. E Lesions of the mucous membranes are a characteristic of Stevens-Johnson syndrome.

A Patients with Stevens-Johnson syndrome have a mortality rate of about 25%. B Toxemia is associated with Stevens-Johnson syndrome. E Lesions of the mucous membranes are a characteristic of Stevens-Johnson syndrome. Short-acting sulfonamides do induce Stevens-Johnson syndrome on rare occasions, and patients with Stevens-Johnson syndrome usually are hyperthermic. The other three statements are true.

The nurse identifies which statements about penicillins as true? (Select all that apply.) A Penicillins are the safest antibiotics available. B The principal adverse effect of penicillins is allergic reaction. C A patient who is allergic to penicillin always has a cross-allergy to cephalosporins. D A patient who is allergic to penicillin is also allergic to vancomycin, erythromycin, and clindamycin. E Penicillins are normally eliminated rapidly by the kidneys but can accumulate to harmful levels if renal function is severely impaired.

A Penicillins are the safest antibiotics available. B The principal adverse effect of penicillins is allergic reaction. E Penicillins are normally eliminated rapidly by the kidneys but can accumulate to harmful levels if renal function is severely impaired. A patient who is allergic to penicillin has a 1% chance of also being allergic to cephalosporins. Patients who are allergic to penicillin are safely able to take vancomycin, erythromycin, and clindamycin. The other three statements are true.

A patient is receiving the protease inhibitor (PI) amprenavir (Agenerase). Which laboratory results would the nurse evaluate as indicators of adverse effects of this medication? (Select all that apply.) A Plasma cholesterol level B Serum transaminases C Cardiac enzymes D Blood glucose level E Creatinine level

A Plasma cholesterol level B Serum transaminases D Blood glucose level All PIs cause hyperglycemia and diabetes, and patients should be instructed to report symptoms of polydipsia, polyphagia, and polyuria. In addition, PIs can increase serum levels of transaminases and should be used with caution in patients with chronic liver disease. Cholesterol should be measured for elevation caused by the use of PIs that results in a risk of cardiovascular events. Altered cardiac enzymes and serum creatinine levels are not associated with adverse effects of PIs.

A patient is admitted to the hospital with a medical diagnosis of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). When taking the patient's history, a nurse recognizes which information as the most important? A Plays a contact sport and is an athlete B Currently resides in a long-term care facility C Did not complete the last course of antibiotics D Had gallbladder surgery in the previous month

A Plays a contact sport and is an athlete CA-MRSA is transmitted by skin-to-skin contact and by contact with contaminated objects, such as sports equipment and personal items. It is seen in young, healthy people without recent exposure to healthcare facilities, which is one of the biggest risk factors for CA-MRSA. Not completing an antibiotic course is unrelated.

A nurse should associate which factors with the pathophysiology of peptic ulcer disease? (Select all that apply.) A Poor submucosal gastric blood flow B Presence of Zollinger-Ellison syndrome C Reduced stomach production of bicarbonate D Increased synthesis of prostaglandins E Gastrointestinal (GI) tract colonized with Haemophilus influenzae

A Poor submucosal gastric blood flow B Presence of Zollinger-Ellison syndrome C Reduced stomach production of bicarbonate Peptic ulcers develop when an imbalance exists between mucosal defensive factors and aggressive factors. Sufficient blood flow to cells of the GI mucosa is needed to maintain integrity. In Zollinger-Ellison syndrome, hypersecretion of acid alone causes ulcers by overcoming mucosal defenses. Bicarbonate is needed to neutralize hydrogen ions. Prostaglandins are needed to stimulate mucus and bicarbonate to maintain mucosal blood flow. Helicobacter pylori, not Haemophilus influenzae, is a bacillus that can disrupt the protective mucosal layer when colonized in the GI tract.

Which assessment is essential before a patient receives a second dose of mitoxantrone (Novantrone)? (Select all that apply.) A Pregnancy test B Echocardiogram C Complete blood count D T3, T4, and TSH levels E Ophthalmic examination F Magnetic resonance imaging (MRI)

A Pregnancy test B Echocardiogram C Complete blood count Mitoxantrone (Novantrone) can cause a variety of adverse effects. Myelosuppression, cardiotoxicity, and fetal injury are the greatest concerns. Consequently, a pregnancy test and a complete blood count should be done, as well as an echocardiogram to determine the left ventricular ejection fraction. Thyroid function studies and MRI are not necessary. Ophthalmic examinations are necessary when the patient is experiencing macular edema, an adverse effect of fingolimod.

The nurse is caring for a patient receiving inhalant anesthesia and succinylcholine (Anectine). The patient develops muscle rigidity and a temperature of 105°F. What nursing action is essential? A Prepare to administer dantrolene (Dantrium) B Administer normal saline at 50 mL/hr C Administer morphine sulfate to relieve pain D Prepare for intubation and mechanical ventilation

A Prepare to administer dantrolene (Dantrium) The patient is showing symptoms of malignant hyperthermia, a rare and potentially fatal complication of succinylcholine and inhalation anesthesia. Treatment includes discontinuation of succinylcholine and anesthesia; application of cooling blankets and ice packs; and IV administration of dantrolene, a muscle relaxant.

A patient who has pellagra is taking niacin. Which outcome would be most appropriate for a nurse to establish with the patient? A Smooth, intact skin in sun-exposed areas B Regulation of heart rate and rhythm C Increased dexterity of fine motor skills D Improvement in coordination and gait stability

A Smooth, intact skin in sun-exposed areas Pellagra is a syndrome characterized by scaling and cracking of the skin in areas exposed to the sun; it is caused by niacin deficiency. Niacin has no effect on fine motor skills, cardiovascular regulation, or gait and balance control.

The nurse notices significant edema surrounding and proximal to the peripheral intravenous (IV) site where epinephrine is being infused. Which action would the nurse anticipate first? A Prepare to administer phentolamine (Regitine) B Ensure that naloxone (Narcan) is available C Institute the protocol for congestive heart failure (CHF) D Monitor the blood urea nitrogen (BUN), creatinine, and potassium levels

A Prepare to administer phentolamine (Regitine) Phentolamine, an adrenergic antagonist, is used to prevent tissue necrosis after extravasation of a vasoconstrictor, such as epinephrine. The edema surrounding the peripheral IV suggests infiltration of the IV, not CHF. Naloxone is an opioid antagonist.

A nurse should monitor more frequently the blood pressure of a patient with a history of hypertension who takes which medication for allergic rhinitis? A Pseudoephedrine (Sudafed) B Montelukast (Singulair) C Mometasone (Nasonex spray) D Oxymetazoline (Afrin spray)

A Pseudoephedrine (Sudafed) Pseudoephedrine is a sympathomimetic that activates alpha1 receptors and causes vasoconstriction. Only oral agents cause widespread vasoconstriction that warrants caution in patients with hypertension. Montelukast blocks leukotrienes and has no adverse effects. Oxymetazoline spray is a topical sympathomimetic that causes rebound congestion with prolonged use. Mometasone spray is a glucocorticoid intranasal spray for which systemic side effects are rare.

A patient develops flushing, rash, and pruritus during an IV infusion of vancomycin (Vancocin). Which action should a nurse take? A Reduce the infusion rate. B Administer diphenhydramine (Benadryl). C Change the IV tubing. D Check the patency of the IV.

A Reduce the infusion rate. When vancomycin is infused too rapidly, histamine release may cause the patient to develop hypotension accompanied by flushing and warmth of the neck and face; this phenomenon is called red man syndrome. Diphenhydramine is not necessary if the infusion is administered slowly over at least 60 minutes. Changing the IV tubing would not help the symptoms. The patency of the IV needs to be checked before the administration is started.

Which are beneficial effects that can be derived from simvastatin (Zocor) and other agents in this class? (Select all that apply.) A Reduction of LDLs B Elevation of HDLs C Stabilization of the plaque in coronary arteries D Reduction of risk of cardiovascular events E Improvement of liver function

A Reduction of LDLs B Elevation of HDLs C Stabilization of the plaque in coronary arteries D Reduction of risk of cardiovascular events The statin drugs have many benefits, the most important being reduction of LDLs. They also promote an increase in HDLs, stabilization of atherosclerotic plaque, and reduced inflammation at the plaque site. Among other benefits, they also slow progression of coronary artery calcification. The statins reduce the overall risk of cardiovascular events. They can have adverse effects on the liver.

A patient who has type 2 diabetes has a glycated hemoglobin A1c (HbA1c) of 10%. The nurse should make which change to the nursing care plan? A Refer the patient to a diabetes educator because the result reflects poor glycemic control. B Glycemic control is adequate; no changes are needed. C Hypoglycemia is a risk; teach the patient the symptoms. D Instruct the patient to limit activity and weekly exercise.

A Refer the patient to a diabetes educator because the result reflects poor glycemic control. Glycated hemoglobin (HbA1c) is a measure of plasma glucose levels on average over the previous 2- to 3-month period. The target value is 7% or lower. If it is greater than 7%, a diabetes educator is an additional resource who can facilitate lifestyle, exercise, and medication changes. Hypoglycemia is not a concern, because elevated HbA1c levels indicate poor glycemic control. Exercise should be part of an overall management program, because it counteracts insulin resistance.

The nurse identifies which statements about frequent urinary tract reinfections as true? (Select all that apply.) A Reinfections are considered frequent if the individual has three or more a year. B Prophylactic therapy should continue for at least 2 months. C If reinfection is associated with sexual intercourse, the risk can be reduced by instructing the patient to void after intercourse. D Single-dose nitrofurantoin 50 mg taken 1 hour before intercourse has been found to reduce the rate of reinfection. E If a symptomatic episode occurs, the standard therapy for acute cystitis should be used.

A Reinfections are considered frequent if the individual has three or more a year. C If reinfection is associated with sexual intercourse, the risk can be reduced by instructing the patient to void after intercourse. E If a symptomatic episode occurs, the standard therapy for acute cystitis should be used. Prophylactic therapy should continue for at least 6 months. Single-dose trimethoprim/sulfamethoxazole, taken after intercourse, has been found to reduce the risk of reinfection. The other three statements are true.

Which action should a nurse take when a pregnant patient develops uterine contractions after receiving dinoprostone (Cervidil) into the vaginal system? A Remove the insert using the long tape. B Keep the patient supine for 2 hours. C Prepare for immediate delivery. D Administer a tocolytic agent.

A Remove the insert using the long tape. Dinoprostone is used to promote cervical softening and dilation before induction of labor. It is delivered by way of a pouch with an attached long tape that is used for removal when active labor and contractions occur. Keeping the patient supine is done only after insertion of the pouch. Immediate delivery is not a therapeutic effect. A tocolytic agent suppresses labor.

When ceftriaxone is administered intravenously, it is most important for the nurse to avoid mixing it with what? A Ringer's lactate B Normal saline C Sterile water D D5 0.45% NS

A Ringer's lactate Mixing ceftriaxone with calcium causes precipitates to form. Ringer's lactate contains calcium; therefore it should not be mixed with ceftriaxone. It is safe to mix normal saline, sterile water, and D5 0.45% NS with ceftriaxone.

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 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 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 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.

A patient is receiving an aminoglycoside (tobramycin) antibiotic. A nurse asks the patient to choose daily meal selections, to which the patient responds, "Oh, dear, I don't want another IV." The nurse makes which assessment about the patient's response? A Some hearing loss may have occurred. B The confusion is due to the hospital stay. C A nutrition consult most likely is needed. D The patient has a family history of dementia.

A Some hearing loss may have occurred. The patient's comment suggests that the person did not hear the instructions. Aminoglycoside antibiotics can cause ototoxicity. The first sign may be tinnitus (ringing in the ears), progressing to loss of high-frequency sounds. Audiometric testing is needed to detect it. Nutrition, confusion, and a family history of dementia do not address the problem of possible hearing loss associated with aminoglycosides.

A patient is experiencing symptoms of the fight-or-flight response. Which autonomic process orchestrates this response? A Stimulation of the sympathetic system B Stimulation of the predominant tone of the organs C Stimulation of the baroreceptor reflex D Stimulation of the parasympathetic system

A Stimulation of the sympathetic system Stimulation of the sympathetic nervous system produces the fight-or-flight response. The baroreceptor reflex regulates blood pressure.

The nurse identifies which drug as a short-acting tetracycline? A Sumycin B Declomycin C Vibramycin D Minocin

A Sumycin Sumycin is a short-acting tetracycline. Declomycin is an intermediate-acting tetracycline, and Vibramycin and Minocin are long-acting tetracyclines.

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

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 should question an order for glucocorticoids in the treatment of a patient with what? A Systemic fungal infection B Diabetes mellitus C Myasthenia gravis D Glaucoma

A Systemic fungal infection Glucocorticoids are contraindicated in the treatment of a patient with a systemic fungal infection or in patients receiving live vaccines. Glucocorticoids should be used with caution in patients with diabetes mellitus, myasthenia gravis, and glaucoma.

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

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.

In the failing heart, arterial pressure falls, stimulating the baroreceptor reflex to increase sympathetic nervous system activity. Which finding is an expected outcome of increased sympathetic activity? A Tachycardia B Bradypnea C Hypotension D Hypoglycemia

A Tachycardia Increased sympathetic activity results in an increased heart rate (tachycardia), increased contractility, increased venous tone, and increased arteriolar tone (elevated blood pressure). Sympathetic stimulation also causes bronchodilation (not bradypnea) and possibly hyperglycemia.

What is essential for the nurse to confirm before starting vecuronium (Norcuron) as a continuous intravenous infusion? A The patient has been intubated and is on mechanical ventilation. B A Foley catheter has been inserted. C Hourly blood glucose levels have been ordered. D A nasogastric tube is in place for suction.

A The patient has been intubated and is on mechanical ventilation. Vecuronium (Norcuron), an NM blocking agent, can cause respiratory arrest. Therefore the nurse must ensure that the patient has an established airway and assisted oxygenation and ventilation before starting the continuous IV infusion. A Foley catheter would help prevent incontinence but is not necessary. Hourly blood glucose levels are unnecessary, because hyperglycemia and hypoglycemia are not adverse effects. A nasogastric tube is not essential before initiation of the continuous infusion, but insertion may be considered afterward for gastric suctioning or feeding.

After completing a course of ciprofloxacin (Cipro) for a skin infection, the patient says, "I took the whole bottle of pills, but my infection hasn't gotten any better." Which additional information should the nurse recognize as most significant? A The patient takes antacids on a daily basis. B The medication was stored in a cool, dry area. C The patient did not use sunscreen while taking the ciprofloxacin (Cipro). D The patient took two doses of diphenhydramine (Benadryl) while on ciprofloxacin (Cipro) therapy.

A The patient takes antacids on a daily basis. Antacids interfere with the absorption of quinolone antibiotics, such as ciprofloxacin (Cipro), and many other drugs; therefore, this patient has not received the full dosing regimen, which is required if ciprofloxacin is to be effective against the infection. Storing the drug in a cool, dry area and using sunscreen or diphenhydramine would not disrupt the effectiveness of ciprofloxacin.

The nurse understands that tubocurarine and other neuromuscular (NM) blockers cannot be given by mouth. What is the rationale for this statement? A They carry a positive charge. B They compete with acetylcholine (ACh) for binding sites. C They cause muscle relaxation. D They interact with potassium.

A They carry a positive charge. All NM blockers have a quaternary nitrogen atom and therefore always carry a positive charge, making it difficult for them to cross membranes. The inability to cross membranes makes parenteral administration necessary. NM blockers do compete with ACh, cause muscle relaxation, and interact with potassium, but these factors do not necessitate oral administration.

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

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.

A nurse should teach a patient who has Pneumocystis pneumonia (PCP) about the dosing and therapeutic effects of which medication? A Trimethoprim/sulfamethoxazole (Bactrim) B Azithromycin (Zithromax) C Acyclovir (Zovirax) D Ganciclovir (Cytovene)

A Trimethoprim/sulfamethoxazole (Bactrim) PCP is a potentially fatal infection caused by Pneumocystis jiroveci. Among people with advanced HIV infection, it is the most common opportunistic infection. The preferred regimen for treatment and prophylaxis of PCP is trimethoprim/sulfamethoxazole. Azithromycin is used in the treatment of Mycobacterium avium infection. Cytomegalovirus (CMV) retinitis is treated with ganciclovir. Acyclovir is the preferred treatment of varicella-zoster virus, which causes chickenpox and herpes zoster.

The nurse identifies rifampin as useful in the treatment of which disorders? (Select all that apply.) A Tuberculosis B Active meningococcal infection C Leprosy D Prophylaxis of meningitis caused by Haemophilus influenzae E C. difficile infection

A Tuberculosis C Leprosy D Prophylaxis of meningitis caused by Haemophilus influenzae Rifampin is useful in the treatment of tuberculosis and can be used for prophylaxis of meningitis caused by H. influenzae. The treatment of leprosy is an unlabeled use. Rifampin is indicated for treatment of carriers of meningococcal infection, but not for active meningococcal infection. Rifampin is not indicated for the treatment of C. difficile infection.

A nurse prepares to administer acetaminophen (Tylenol) to a patient with an oral temperature of 101.7°F. Which preparation would the nurse expect to have the most rapid onset of action? A Tylenol elixir B Tylenol tablets C Tylenol capsules D Tylenol gel caps

A Tylenol elixir A liquid does not have to dissolve first to allow absorption; therefore, the onset of action occurs more quickly than with capsules, tablets, or gel caps

When evaluating the effects of probenecid, the nurse should monitor which laboratory result? A Uric acid level B Sodium level C Hemoglobin D Blood pH

A Uric acid level Probenecid acts on the renal tubules to increase uric acid excretion, and plasma urate levels are reduced as a result. The sodium level, hemoglobin, and blood pH are not affected by probenecid.

The nurse is caring for a patient receiving atropine (Sal-Tropine). Which is a therapeutic indication for giving this drug? A Use as a preanesthesia medication B Treatment of tachycardias C Prevention of urinary retention D Reduction of intraocular pressure in glaucoma

A Use as a pre anesthesia medication Atropine is a muscarinic antagonist and can help prevent dangerous bradycardia during surgery. It often is administered before the induction of anesthesia. Its side effects may include urinary retention, constipation, and tachycardia.

The nurse is obtaining a drug history for a patient admitted to the unit. The nurse obtains information about past and present health histories, currently used prescription drugs, behavioral factors, and use of over-the-counter (OTC) drugs. What other information does the nurse need to obtain? (Select all that apply.) A Use of recreational drugs and substances B Usual sleep patterns and disturbances C Highest level of education completed D Use of home remedies Correct E Self-treatment with complementary and alternative drugs

A Use of recreational drugs and substances D Use of home remedies E Self-treatment with complementary and alternative drugs All drugs have the potential to produce undesired effects. Drug therapy often can be enhanced by nonpharmacologic measures, such as physical therapy or dietary changes. Patient adherence is the extent to which a patient's behavior coincides with medical advice. This is especially important for patients taking medications at home. Patients taking two drugs are at risk for drug interactions. PRN medications require a high level of nursing discretion, judgment, and knowledge and are not less important than standing orders

Which statements about vancomycin (Vancocin) does the nurse identify as true? (Select all that apply.) A Vancomycin is the most widely used antibiotic in U.S. hospitals. B Vancomycin is effective in the treatment of Clostridium difficile infection. C Vancomycin is effective in the treatment of MRSA infections. D Patients who are allergic to penicillin are also allergic to vancomycin. E The major toxicity of vancomycin therapy is liver failure.

A Vancomycin is the most widely used antibiotic in U.S. hospitals. B Vancomycin is effective in the treatment of Clostridium difficile infection. C Vancomycin is effective in the treatment of MRSA infections. Patients who are allergic to penicillin are able to take vancomycin. The major toxicity of vancomycin therapy is kidney failure. The other three statements are true.

When educating patients about their medications, the nurse includes information about which topics? (Select all that apply.) A What to do if a dose is missed B The duration of treatment C Prescription drug coverage D The method of drug storage E Symptoms of adverse effects

A What to do if a dose is missed B The duration of treatment D The method of drug storage E Symptoms of adverse effects Prescription drug coverage is not considered part of essential patient drug information. The remaining options are topics the nurse would include in patient education.

Using a stepwise approach to managing asthma, a nurse teaches a patient who is at step 1 to use albuterol MDI (Proventil) at which of these times? A Whenever needed (PRN) as a quick-relief agent B Twice daily combined with an inhaled glucocorticoid C Only with a long-acting beta2 agonist (LABA) D If night time awakenings occur more than 2 days a week

A Whenever needed (PRN) as a quick-relief agent For patients at step 1 in the stepwise approach to managing asthma, albuterol is a short-acting beta2 agonist (SABA) used only PRN to relieve ongoing asthma attacks and prevent exercise-induced bronchospasm. For patients at step 1, no long-term control medications are taken. A patient is at a higher step than 1 in the stepwise approach if the patient requires a daily inhaled glucocorticoid or LABA or awakens at night more often than 2 days a week. For patients at steps 2 to 6, albuterol is considered a quick-relief medication taken PRN.

The parent of a pediatric patient with nasal stuffiness and congestion asks a nurse about cold remedies. Which additional information is the priority for the nurse to obtain? A) Age Correct B) Developmental stage C) Body weight D) Swallowing ability

A) Age Correct Cold remedies should not be used for children younger than 2 years because of the risk of harm with little evidence of efficacy. In 2008, the U.S. Food and Drug Administration (FDA) recommended that over-the-counter (OTC) cold remedies no longer be given to children younger than 2 years because of the risk of life-threatening events. Safety is still being reviewed for children ages 2 to 11 years. Developmental stage, body weight, and swallowing ability are secondary considerations with dosing of cold remedies for children.

A nurse obtains a specimen from which body fluid when performing the QuantiFERON-TB Gold (QFT-G) test for latent tuberculosis? A Saliva B Blood C Urine D Sputum

B Blood The specimen for the QFT-G test is obtained from blood, not from saliva, urine, or sputum. It is a new test for latent TB and is as sensitive as the tuberculin skin test and more specific. The results are available within 24 hours, and unlike with the skin test, a follow-up visit to a healthcare provider's office is not required.

Which instructions should a nurse provide to a patient who is to start taking amoxicillin/clavulanate (Augmentin)? A "Take Augmentin once per day and only at bedtime." B "Augmentin may be taken with food or meals." C "Avoid taking Augmentin with grapefruit juice." D "Use a minimal amount of liquid to swallow the Augmentin."

B "Augmentin may be taken with food or meals." Amoxicillin/clavulanate is a broad-spectrum aminopenicillin that may be taken with meals. Most other oral penicillins must be taken with a full glass of water 1 hour before or 2 hours after meals. Taking oral penicillins only at bedtime, avoiding grapefruit juice, and taking the drug with only minimal water are not necessary.

Which statement does the nurse include when teaching a patient about antipsychotic drug therapy? (Select all that apply.) A "Restrict the use of antipsychotic drugs to 3 months to prevent the development of addiction." B "Dilute oral preparations in fruit juice to improve their palatability." C "Store oral preparations in a dark area." D "Do not make skin contact with these drugs; flush the affected area with water if a spill occurs." E "Take an over-the-counter sleep aid if you have trouble falling asleep at night."

B "Dilute oral preparations in fruit juice to improve their palatability." C "Store oral preparations in a dark area." D "Do not make skin contact with these drugs; flush the affected area with water if a spill occurs." Patients should be informed that antipsychotic drugs do not cause addiction and that they should be taken as prescribed. Patients should be instructed to avoid all drugs with anticholinergic properties, including the antihistamines and certain over-the-counter sleep aids to prevent drug interactions. All other statements are appropriate to include in teaching the patient about the use of antipsychotic medications.

Which statement should the nurse include in the teaching for a patient who is to be started on zileuton (Zyflo)? A "Use your zileuton (Zyflo) inhaler every 12 hours." B "Have your blood drawn once a month for the next 3 months so that your liver function can be checked." C "Take the zileuton (Zyflo) 2 hours before eating breakfast each day." D "Take an extra dose of zileuton (Zyflo) if you have an asthmatic attack."

B "Have your blood drawn once a month for the next 3 months so that your liver function can be checked." Zileuton can injure the liver, as evidenced by increased plasma levels of alanine aminotransferase (ALT). Therefore, ALT should be monitored once a month for 3 months, then every 2 to 3 months for the remainder of the first year, and periodically thereafter. Zileuton is an oral, not an inhaled, medication that is rapidly absorbed with or without food. The timing of administration with regard to meals is insignificant. Zileuton is used for asthma prophylaxis and cannot be used to abort an attack.

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 only have a bowel movement when I take the medicine." C "The dental hygienist said I was losing the enamel on my teeth." D "I've noticed that I'm having tremors now in my left hand."

B "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.

Which statement made by a female patient newly diagnosed with complex partial seizures and starting treatment with valproic acid indicates a need for further teaching by the nurse? A "The medication should not make me feel sleepy." B "I should take the medication on an empty stomach." C "I'll need to discuss a reliable form of birth control with my gynecologist." D "I'll call my physician immediately if I develop a yellow tint to my skin or my urine appears tea-colored."

B "I should take the medication on an empty stomach." Gastrointestinal side effects, such as nausea, vomiting, and indigestion, can occur when valproic acid is taken on an empty stomach; this statement indicates that further teaching is needed. Valproic acid has minimal sedative effects, is teratogenic, and can lead to hepatotoxicity. Female patients of child-bearing age must use effective methods of birth control to prevent pregnancy and must be taught the signs of liver failure (abdominal pain, malaise, jaundice), which must be reported immediately.

The nurse is conducting discharge teaching for a patient with a new prescription for transdermal nitroglycerin. Which statement by the patient indicates a need for further teaching? A "I will remove my patch at bedtime each evening." B "I will limit my alcohol to one drink per day." C "I will not use Viagra as long as I am on nitroglycerin." D "I will move slowly when changing positions."

B "I will limit my alcohol to one drink per day." Alcohol can intensify the hypotensive effects of nitrates, so the patient should avoid alcohol. Patients develop tolerance to nitrates rather quickly. Patients receiving transdermal nitrates are recommended to have 10 to 12 hours of patch-free time each evening. Sildenafil (Viagra) and other drugs for erectile dysfunction also can cause significant hypotension with nitroglycerin and are contraindicated. Nitroglycerin causes orthostatic hypotension; therefore, patients should change positions slowly.

Which statement made by the patient indicates the best understanding of teaching related to a new prescription for atenolol (Tenormin)? A "I will increase my fluids to prevent constipation." B "I will not stop taking this medication abruptly." C "I will take the first dose of this medicine at night." D "I will wear sunscreen and a hat when I work in the sun."

B "I will not stop taking this medication abruptly." Atenolol is a beta blocker and can cause rebound cardiac excitation if withdrawn abruptly. Patients should carry an adequate supply when traveling. It does not commonly cause constipation, first-dose hypotension, or photosensitivity.

The nurse is teaching a patient who has just been prescribed a vasodilator. Which statement by the patient indicates that the teaching was effective? A "I will take this medication in the morning to reduce nighttime urination." B "I will rise slowly when changing from a sitting to a standing position." C "My heart rate may slow down with this drug. I will call if my pulse is below 60." D "I will increase my intake of fluids and foods that are high in fiber."

B "I will rise slowly when changing from a sitting to a standing position." Vasodilators may cause postural hypotension and reflex tachycardia. Patients should be taught to move slowly when changing positions to prevent dizziness.

Which instruction does the nurse include when teaching a patient about phenelzine (Nardil) therapy? (Select all that apply.) A "Take the medication as needed when you are feeling depressed." B "If you experience a severe headache, inform your healthcare provider." C "Profuse sweating is an expected side effect of this medication and will diminish with time." D "Ginseng can be used to treat headache, which patients often experience when they first take phenelzine." E "Avoid eating avocados when taking this drug."

B "If you experience a severe headache, inform your healthcare provider." E "Avoid eating avocados when taking this drug." Patients should be instructed to take MAOIs every day as prescribed—not PRN. They should be warned not to discontinue treatment once mood has improved, because doing so may result in relapse. Patients should be informed of the symptoms of hypertensive crisis--severe headache, tachycardia, hypertension, nausea, vomiting, confusion, and profuse sweating—and instructed to seek immediate medical attention if these develop. Patients should be forewarned of the hazard of hypertensive crisis and the need to avoid tyramine-rich foods, such as aged cheese, Chianti, and avocados. (Patients on low-dose transdermal selegiline need not avoid foods containing tyramine.) Patients taking MAOIs should not take ginseng, because headache, tremulousness, and maniclike reactions have occurred.

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."

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.

Which instruction should the nurse include in the teaching for a patient prescribed cetirizine (Zyrtec) for seasonal allergic rhinitis? A "Clean the nasal applicator after use to prevent contamination." B "Take the medication daily throughout the allergy season." C "Expect a decrease in your nasal congestion in a day or two." D "Take a stool softener daily to avoid the side effect of constipation."

B "Take the medication daily throughout the allergy season." For treatment of allergic rhinitis, antihistamines such as cetirizine are most effective when taken prophylactically throughout the allergy season, even when symptoms are absent. The medication is taken orally, not intranasally. Oral antihistamines relieve sneezing, rhinorrhea, and nasal itching but not nasal congestion. Constipation is rare in patients taking second-generation agents, such as cetirizine.

A patient asks a nurse, "Why should I switch to fexofenadine (Allegra) for my allergies when I've taken diphenhydramine (Benadryl) for so long?" Which response should the nurse make? A "You'll have much less risk of cardiac problems." B "There is not nearly as much drowsiness and sedation." C "The biggest benefit is that the cost is so much lower." D "The dosing is more convenient, because you take it once a week."

B "There is not nearly as much drowsiness and sedation." Fexofenadine is a second-generation antihistamine that crosses the blood-brain barrier poorly, thus producing much less sedation than first-generation medications, such as diphenhydramine. Fexofenadine has no associated cardiac risks, and daily dosing is still required. Second-generation antihistamines are not less expensive, but pricing is lower now that they are available over the counter.

Which statement by a patient indicates understanding of a nurse's teaching about fluticasone nasal spray (Flonase)? A "I'll gradually stop taking this so I don't have any problems with withdrawal." B "This drug will help prevent the inflammation and irritation from my allergies." C "I'll have to be more careful about not falling, because my bones may break more easily." D "I realize that I only need to take this when my symptoms are really bad."

B "This drug will help prevent the inflammation and irritation from my allergies." Fluticasone nasal spray is a steroid drug used to prevent the symptoms of allergy. Its effect is localized; therefore, the patient does not have systemic adverse effects with normal use and does not have to wean down the medication, as with oral corticosteroids. Intranasal glucocorticoids are most effective for preventing and treating allergic rhinitis.

Which instruction should a nurse include in the discharge teaching for a patient who is to start taking tetracycline (Sumycin)? A "You may stop taking the pills when you begin to feel better." B "Use sunscreen and protective clothing when outdoors." C "You'll have to come back to the clinic for weekly blood work." D "Take the medication with yogurt or milk so you won't have nausea."

B "Use sunscreen and protective clothing when outdoors." Tetracyclines are bacteriostatic antibiotics; photosensitivity and severe sunburn are common adverse effects. A full course of antibiotics must always be taken. Blood studies are not necessary for therapeutic levels. Absorption decreases after ingestion of chelates, such as calcium and magnesium, so doses should be given 2 hours before or 2 hours after ingestion of milk products.

A nurse is teaching a patient about montelukast (Singulair). Which statement by the patient would indicate that the nurse's teaching was effective? A "I'll take a dose as soon as I feel short of breath and start to cough." B "While taking this medicine, I may be able to reduce my steroid medication." C "This is the priority medication for preventing exercise-induced asthma symptoms." D "If I have nosebleeds or excessive bruising, I'll stop the medication immediately."

B "While taking this medicine, I may be able to reduce my steroid medication." Montelukast is an antileukotriene agent. Combining montelukast with an inhaled glucocorticoid medication can improve asthma symptoms and thus may allow a reduction in the glucocorticoid dosage. The effects of montelukast develop slowly, so it cannot be used as a quick-relief agent. Short-acting beta2 agonists are preferred for exercise-induced asthma. Montelukast does not affect coagulation, so bleeding and bruising do not occur.

A nurse is teaching a patient with chronic tophaceous gout who is scheduled to start taking allopurinol (Zyloprim). Which of these statements should the nurse include in the teaching? A "You'll see the joint swelling reduced in your toe in just a few days." B "You may notice an increase in your pain attacks in the first month." C "We need to collect periodic hair samples to measure uric acid levels." D "It'll be important to minimize fluid intake so the kidneys can rest."

B "You may notice an increase in your pain attacks in the first month." Allopurinol inhibits xanthine oxidase to reduce uric acid levels in chronic tophaceous gout. During the first months of treatment, it may increase the incidence of acute gouty arthritis. Allopurinol lacks anti-inflammatory and analgesic actions and is not useful in an acute gout attack. Plasma levels of uric acid are evaluated. To prevent renal injury, fluid intake should be increased.

Which statement made by the nurse is most important to include in the teaching plan for a patient being discharged from the hospital with a new prescription for prazosin (Minipress)? A "You should increase your intake of fresh fruits and vegetables." B "You should move slowly from a sitting to a standing position." C "Be sure to wear a Medic Alert bracelet while taking this medication." D "Take your first dose of this medication first thing in the morning."

B "You should move slowly from a sitting to a standing position." Orthostatic hypotension is the most serious potential complication of prazosin and other alpha1 blockers. Patients should be taught to change positions slowly to avoid dizziness and prevent falls. Fresh fruits and vegetables are good to include in the dietary teaching, but this is not as important as preventing hypotension. A Medic Alert bracelet should not be needed for this drug. This drug causes significant first-dose hypotension. First doses should be taken at bedtime. Patients should avoid hazardous activities for 12 to 24 hours after the first dose.

The nurse is beginning a heparin infusion for a patient with evolving stroke. The baseline activated partial thromboplastin time (aPTT) is 40 seconds. Which aPTT value indicates that a therapeutic dose has been achieved? A 50 B 70 C 90 D 110

B 70 The therapeutic level of heparin is achieved when the aPTT reaches 1.5 to 2 times normal. Thus, a range of 60 to 80 seconds would be appropriate for this patient.

The nurse is caring for a group of patients who are all receiving anticholinergic drugs. In which patient is an anticholinergic drug contraindicated? A A 60-year-old woman with an overactive bladder (OAB) B A 72-year-old man with glaucoma C A 45-year-old woman with peptic ulcer disease (PUD) D A 26-year-old man being prepared for surgery today

B A 72-year-old man with glaucoma Anticholinergic drugs tend to cause adverse effects of dry mouth, blurred vision, elevation of intraocular pressure, urinary retention, constipation, anhidrosis, tachycardia, and asthma. They are contraindicated in patients with glaucoma because of the potential danger of increased intraocular pressure. Anticholinergics are used to treat OAB and are used as preanesthetic agents. They are not contraindicated in PUD.

A nurse is caring for several patients. In which patient is it appropriate to use the drug chlorpromazine (Thorazine)? (Select all that apply.) A An 85-year-old man with Alzheimer's disease B A 78-year-old man with intractable hiccups C A 76-year-old woman with severe dementia D A 48-year-old woman with schizoaffective disorder E A 30-year-old man with anxiety and depression

B A 78-year-old man with intractable hiccups D A 48-year-old woman with schizoaffective disorder The primary indications for chlorpromazine, a first-generation antipsychotic agent, are schizophrenia and other psychotic disorders. It may also be used for schizoaffective disorder, bipolar disorder, suppression of emesis, and relief of intractable hiccups. Antipsychotics are not used for dementia because of increased mortality. Chlorpromazine is not a primary treatment for Alzheimer's disease or depression.

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.

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.

Which patient undergoing surgery is at greatest risk for an intensified effect from succinylcholine? A A patient who takes aspirin 81 mg orally daily B A patient receiving gentamycin (Garamycin) 80 mg IV piggyback every 8 hours C A patient taking isosorbide mononitrate (Imdur) 60 mg orally daily D A patient receiving a continuous infusion of normal saline solution .

B A patient receiving gentamycin (Garamycin) 80 mg IV piggyback every 8 hours The effects of succinylcholine can be intensified if the drug is administered concomitantly with certain antibiotics, such as aminoglycosides and tetracyclines, as well as other nonpenicillin antibiotics. Gentamycin is an aminoglycoside. Aspirin, Imdur, and normal saline would not intensify the effect of succinylcholine.

The nurse is monitoring a hospitalized patient who is receiving reserpine. Which assessment parameter indicates that this medication is effective? A Decrease in diarrhea B Blood pressure of 118/72 mm Hg C Absence of bladder distention D Improved symptoms of depression

B Blood pressure of 118/72 mm Hg The primary use of reserpine is to control hypertension. It has been used to treat psychosis, but superior drugs now are available for that purpose. Adverse effects of reserpine include severe depression with suicide risk, gastric ulcer formation, and diarrhea. Reserpine is not used to treat urinary retention.

Which scenario would warrant an immediate call to the physician by the nurse? A A patient who takes digoxin 0.125 mg orally daily presents with a serum digoxin level of 0.8 ng/mL. B A patient who takes oral spironolactone (Aldactone) 25 mg daily and enalapril (Vasotec) 5 mg daily presents with a serum potassium level of 5.5 mEq/L. C A patient who takes digoxin 0.25 mg orally daily presents with a serum potassium level of 4.0 mEq/L. D A patient who takes oral lisinopril (Zestril) 5 mg daily and digoxin 0.125 mg daily presents with a serum digoxin level of 0.5 ng/mL.

B A patient who takes oral spironolactone (Aldactone) 25 mg daily and enalapril (Vasotec) 5 mg daily presents with a serum potassium level of 5.5 mEq/L. Patients who take an aldosterone antagonist (spironolactone) are at risk for developing hyperkalemia. The risk is increased if an aldosterone antagonist and an ACE inhibitor (enalapril) are used together. The normal serum potassium level ranges from 3.5 to 5.0 mEq/mL. This patient is hyperkalemic, which increases the risk for electrocardiographic changes. The optimal range for the serum digoxin level is 0.5 to 0.8 ng/mL. The risk of digoxin toxicity increases when hypokalemia is present (potassium level below 3.5 mEq/L).

The nurse is preparing to give ethosuximide (Zarontin). The nurse understands that this drug is only indicated for which seizure type? A Tonic-clonic B Absence C Simple partial D Complex partial

B Absence Absence seizures are the only indication for ethosuximide. The drug effectively eliminates absence seizures in approximately 60% of patients and effectively controls 80% to 90% of cases.

The nurse is caring for a patient whose seizures are characterized by a 10- to 30-second loss of consciousness and mild, symmetric eye blinking. Which seizure type does this most closely illustrate? A Tonic-clonic B Absence C Atonic D Myoclonic

B Absence This scenario accurately describes absence seizures. Tonic-clonic seizures present with convulsions and muscle rigidity followed by muscle jerks. Patients may experience urinary incontinence and loss of consciousness. Atonic seizures cause sudden loss of muscle tone. Myoclonic seizures present with sudden muscle contractions that last but a second.

A patient is receiving glucocorticoids for the treatment of rheumatoid arthritis. The patient complains of having a headache. Which ordered medication should the nurse administer? A Aspirin (Bayer) B Acetaminophen (Tylenol) C Ibuprofen (Advil) D Naproxen sodium (Aleve)

B Acetaminophen (Tylenol) The risk of gastrointestinal irritation and ulceration for a patient taking glucocorticoids is increased by concurrent use of other medications, such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs).

A patient develops supraventricular tachycardia (SVT) and is hypotensive. The nurse anticipates that which medication will be administered? A Lidocaine (Xylocaine) B Adenosine (Adenocard) C Amiodarone (Cordarone) D Phenytoin (Dilantin)

B Adenosine (Adenocard) The drug of choice for terminating SVT is adenosine. Lidocaine is used for ventricular dysrhythmias; amiodarone is used for atrial and ventricular dysrhythmias; and phenytoin is used for digoxin-induced dysrhythmias.

Which approach should a nurse take to administer sucralfate (Carafate) to a patient with a duodenal ulcer? A Crush the tablet into a fine powder before mixing it with water. B Administer the tablet with sips of water 1 hour before meals. C Allow the tablet to dissolve in water before administering it. D Administer the tablet with an antacid for maximum benefit.

B 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 does not dissolve in water when crushed, and crushing it could reduce the effectiveness of the drug. Sucralfate acts under mildly acidic conditions; antacids raise the gastric pH above 4 and may interfere with the effects of sucralfate.

The nurse is caring for a patient receiving tacrine (Cognex). Which laboratory test (or tests) will be most important for assessing the patient for adverse effects of this drug? A Blood urea nitrogen (BUN) and creatinine B Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) C White blood cell (WBC) count with differential D Hemoglobin

B Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) Tacrine can cause hepatotoxicity. Approximately 50% of patients taking this drug experience an increase in ALT, a liver enzyme. Nurses should monitor liver function tests every 2 weeks during early treatment and every 3 months thereafter.

Before administering trimethoprim, it is most important for the nurse to assess the patient for a history of what? A Heart failure B Alcoholism C Diabetes D Emphysema

B Alcoholism Trimethoprim inhibits bacterial synthesis of folic acid. It is avoided in patients when folate deficiency is likely, such as in alcoholism, because bone marrow suppression may occur. Heart failure, diabetes, and emphysema are unrelated to adverse effects with trimethoprim.

A patient is receiving morphine sulfate and promethazine (Phenergan). It is most important for the nurse to assess what? A Heart rate B Alertness C Blood pressure D Bowel sounds

B Alertness Promethazine is a first-generation H1 blocker that binds selectively to H1 receptors, resulting in central nervous system (CNS) effects. The most common adverse effect of first-generation H1 blockers is sedation, and caution is advised, especially when these drugs are used in combination with other CNS depressants. The heart rate, blood pressure, and bowel sounds do not warrant more frequent monitoring.

A nurse caring for a patient who has diabetic ketoacidosis recognizes which characteristics in the patient? (Select all that apply.) A Type 2 diabetes B Altered fat metabolism leading to ketones C Arterial blood pH of 7.35 to 7.45 D Sudden onset, triggered by acute illness E Plasma osmolality of 300 to 320 mOsm/L

B Altered fat metabolism leading to ketones D Sudden onset, triggered by acute illness E Plasma osmolality of 300 to 320 mOsm/L Diabetic ketoacidosis is the most severe manifestation of insulin deficiency in patients with type 1 diabetes. It develops and worsens acutely over several hours to days. Alterations in fat metabolism lead to the production of ketones and ketoacids. Increased ketoacid levels lead to a fall in arterial blood pH below 7.35. Altered glucose metabolism leads to hyperglycemia, water loss, and an elevated plasma osmolality (285 to 295 mOsm/L).

The nurse can best describe what is meant by activation of a receptor with which phrase? A An effect that causes the physiologic process to speed up B An effect that mimics the natural neurotransmitter for that receptor C An effect that improves the function of the receptor D An effect that causes the receptor to be more sensitive

B An effect that mimics the natural neurotransmitter for that receptor Receptor activation is an effect on receptor function equivalent to that produced by the natural neurotransmitter at a particular synapse. Activation of a receptor may slow down or speed up the process, depending on the function of that particular receptor. Activation does not have to do with improving receptor function or sensitivity.

A patient is receiving isosorbide dinitrate (Isordil) 20 mg 3 times/day for management of newly diagnosed stable angina. Which assessment finding requires immediate intervention by the nurse? A A change in blood pressure from 122/70 to 108/66 mm Hg B An increase in the resting heart rate to 110 beats per minute from baseline rates of 68 to 72 beats per minute C A headache the patient rates as a 5 on a pain scale of 1 to 10 D Report of increased frequency of urination

B An increase in the resting heart rate to 110 beats per minute from baseline rates of 68 to 72 beats per minute Because nitrates lower blood pressure, isosorbide dinitrate can activate the baroreceptor reflex, causing sympathetic stimulation of the heart; this negates the benefits of treatment with nitrates, because it increases the cardiac oxygen demand. For these reasons, addressing the tachycardia becomes the nurse's immediate priority. A decrease in blood pressure would be expected, and there is no indication the patient is experiencing side effects of decreased cardiac output. Headache is an adverse effect and should be treated (e.g., with acetaminophen), but it does not require immediate intervention. Increased frequency of urination may be related to the presence of a urinary tract infection and requires follow-up, but it is not the immediate concern.

The renin-angiotensin-aldosterone system plays an important role in maintaining blood pressure. Which compound in this system is most powerful at raising the blood pressure? A Angiotensin I B Angiotensin II C Angiotensin III D Renin

B Angiotensin II Angiotensin II is a potent vasoconstrictor. It participates in all the pathways regulated by the renin-angiotensin-aldosterone system. Angiotensin I is a precursor to angiotensin II; angiotensin III is formed by degradation of angiotensin II and is less potent. Renin catalyzes the conversion of angiotensinogen to angiotensin I.

A nurse should offer which fluid choice to a patient with acute diarrhea? A Low-fat milk B Apple juice C Coffee with cream D Prune juice

B Apple juice Managing fluids and electrolytes is a high priority for patients with acute diarrhea because of the risk for dehydration. Clear liquids, such as apple juice, do not irritate the gastrointestinal (GI) tract. Milk products and other liquids, such as prune juice, which is not considered a clear liquid, could further irritate the GI tract.

Before administering intravenous (IV) penicillin, the nurse should do what? A Flush the IV site with normal saline. B Assess the patient for allergies. C Review the patient's intake and output record. D Determine the latest creatinine clearance result.

B Assess the patient for allergies. The principal adverse effect of penicillins is allergic reaction. Penicillins are contraindicated in patients with a history of severe allergic reactions to penicillins, cephalosporins, or carbapenems. IV patency is important, as is monitoring renal function, because impairment can cause penicillins to reach toxic levels; however, these are not as important as determining allergy status.

A patient has been prescribed efavirenz (Sustiva). The nurse should instruct the patient to use which administration approach to minimize central nervous system (CNS) adverse effects? A The drug should be taken in divided doses throughout the day. B Bedtime dosing is most effective. C The drug should be mixed only with an acidic beverage. D A steroid medication should be used concurrently.

B Bedtime dosing is most effective. Efavirenz frequently causes CNS symptoms of dizziness, impaired consciousness, drowsiness, vivid dreams, and nightmares. Bedtime dosing can minimize CNS effects, which typically resolve in 2 to 4 weeks. Mixing with an acidic beverage, using a steroid medication concurrently, and taking efavirenz in divided doses throughout the day are not effective means of minimizing CNS effects.

Initial therapy for hypertension after a myocardial infarction (MI) includes drugs from which classes? A Diuretic and beta blocker B Beta blocker and ACE inhibitor C ACE inhibitor and calcium channel blocker D Diuretic and calcium channel blocker

B Beta blocker and ACE inhibitor Beta blockers and ACE inhibitors, as well as aldosterone antagonists, are the drug classes recommended for initial therapy of hypertension after an MI. Diuretics and calcium channel blockers are not part of initial therapy for hypertension after an MI.

The nurse is reviewing the care of patients with AD. Which factors are associated with the pathophysiology of this disease? (Select all that apply.) A Dilation and inflammation of cranial blood vessels B Beta-amyloid and neuritic plaques C Neurofibrillary tangles and tau D Autoimmune changes in the myelin sheath E Firing of hyperexcitable neurons throughout the brain F Neuronal degeneration and decreased acetylcholine

B Beta-amyloid and neuritic plaques C Neurofibrillary tangles and tau F Neuronal degeneration and decreased acetylcholine AD is characterized by neuronal degeneration, reduced cholinergic transmission, beta-amyloid and neuritic plaques, and neurofibrillary tangles and tau. Dilation and inflammation of cranial blood vessels are associated with migraine. Multiple sclerosis is characterized by autoimmune changes in the myelin sheath, and epilepsy is associated with hyperexcitability of neurons and firing of those neurons throughout the brain.

What is the primary benefit of spironolactone (Aldactone) in patients with heart failure? A Profound diuresis and fluid loss B Blockage of aldosterone receptors C Inhibition of beta activation by norepinephrine D Stimulation of the renin-angiotensin-aldosterone system

B Blockage of aldosterone receptors Spironolactone is a potassium-sparing diuretic that has been shown to prolong survival in patients with heart failure. It has only weak diuretic properties. The primary benefit of this drug is blockage of aldosterone receptors. It does not inhibit beta receptors, nor does it stimulate the renin-angiotensin-aldosterone system.

A nurse should recognize that which therapies would be beneficial to a patient with BPH? (Select all that apply.) A Saw palmetto B Botulinum (Botox) C Tolterodine (Detrol) D Alfuzosin (Uroxatral) E Sildenafil (Viagra)

B Botulinum (Botox) C Tolterodine (Detrol) D Alfuzosin (Uroxatral) Botulinum (by single injection into the prostate), tolterodine (a muscarinic antagonist), and alfuzosin (an alpha blocker) are newer drug therapies used to relieve urinary symptoms associated with BPH. Viagra is used to treat erectile dysfunction. Saw palmetto, an herbal preparation, has been widely used to treat BPH, but recent research has shown it is not effective.

When administering an aminoglycoside to a patient with myasthenia gravis, it is most important for the nurse to assess what? A Deep tendon reflexes B Breath sounds C Eyelid movement D Muscle strength

B Breath sounds Aminoglycosides can inhibit neuromuscular transmission, causing potentially fatal respiratory depression. Patients with myasthenia gravis (MG) are at an increased risk. Deep tendon reflexes, eyelid movement, and muscle strength are important assessments for a patient who has MG, but they are not as important as airway and breathing ability.

The nurse identifies which symptom as a result of activation of histamine1 (H1) by allergic reaction? A Hypertension B Bronchoconstriction C Sweating D Pupillary dilation

B Bronchoconstriction Activation of H1 receptors in an allergic reaction causes bronchoconstriction. Vasodilation of small blood vessels and increased capillary permeability cause loss of fluid which, if extensive, results in severe hypotension. Histamine has no effect on pupil reaction, nor does it cause sweating.

A nurse should recognize that which laboratory result is used as a major factor in deciding when antiretroviral therapy is indicated for a patient infected with HIV? A Plasma HIV RNA assay B CD4 T-lymphocyte count C Western blot assay D OralQuick Rapid HIV-1 Antibody Test

B CD4 T-lymphocyte count The CD4 T-cell count is the principal indicator of how much immunocompetence remains when a patient is infected with HIV. It is used as a guide in the initiation, discontinuation, and resumption of medications for opportunistic infections. A plasma HIV RNA assay is a measure of viral load that indicates HIV replication and magnitude and accordingly is used to predict clinical outcomes. The Western blot assay and OralQuick Rapid HIV-1 Antibody Test, respectively, are used for initial screening and follow-up confirmation of HIV infection.

Which statement should the nurse include in the teaching plan for a patient being started on levodopa/carbidopa (Sinemet) for newly diagnosed Parkinson's disease? A Take the medication on a full stomach. B Change positions slowly. C The drug may cause the urine to be very dilute. D Carbidopa has many adverse effects.

B Change positions slowly. Postural hypotension is common early in treatment, so the patient should be instructed to change positions slowly. Administration with meals should be avoided, if possible, because food delays the absorption of the levodopa component. If the patient is experiencing side effects of nausea and vomiting, administration with food may need to be considered. The levodopa component in Sinemet may darken the color of the urine. Carbidopa has no adverse effects of its own.

N-acetyl-para-aminophenol is an example of which type of drug name? A Proprietary B Chemical C Generic D Trade

B Chemical The chemical name is a description of a drug using the nomenclature of chemistry. The proprietary or trade name of the drug is the brand name under which the drug is marketed by one or more companies. The generic name is the name assigned by the U.S. Adopted Names Council and is the same regardless of who manufactures the drug.

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)

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.

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 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 caring for a group of patients who take cholesterol-lowering drugs. Which agent is least likely to cause systemic side effects and is considered safer than other lipid-lowering drugs? A Simvastatin (Zocor) B Colesevelam (Welchol) C Nicotinic acid (Niaspan) D Gemfibrozil (Lopid)

B Colesevelam (Welchol) Colesevelam, a bile acid sequestrant, is a nonabsorbable resin that works directly in the gastrointestinal tract. Because it and other bile acid sequestrants (e.g., cholestyramine [Questran] and colestipol [Colestid]) are not absorbed, they do not have systemic effects. The bile acid sequestrants' most common complication is constipation. The other agents have potential systemic adverse effects.

The nurse is caring for a patient with MS who is receiving interferon beta-1a (Rebif) by subcutaneous injection. Which laboratory tests should be performed regularly in this patient to monitor for a potential adverse effect? (Select all that apply.) A Blood urea nitrogen B Complete blood count C Hemoglobin A1c D Alkaline phosphatase E Immunoglobulin G levels

B Complete blood count D Alkaline phosphatase When monitoring a patient receiving interferon, the nurse should watch for potential adverse reactions of hepatotoxicity (alkaline phosphatase) and myelosuppression (complete blood counts). The blood urea nitrogen value is an indicator of renal function, which is not affected by interferon beta-1a. The hemoglobin A1c test is a weighted average of the glucose level over the past several months. Glucose levels are not affected by interferon beta-1a. Immunoglobulin G levels might be assessed when making the diagnosis, but they are not used to monitor for adverse effects of interferon.

A nurse administers dexamethasone (Decadron), 1 mg, at 11:00 PM to a patient who has suspected adrenal dysfunction. The nurse obtains blood for which of these laboratory tests at 8:00 AM the next morning? A Potassium B Cortisol C Glucose D Sodium

B Cortisol The overnight dexamethasone suppression test is used to diagnose Cushing's syndrome. Normally, dexamethasone acts to suppress the release of ACTH, thereby suppressing the release of cortisol. In a patient with Cushing's disease, no cortisol suppression occurs. Potassium, glucose, and sodium are not used as measures of adrenal function.

A nurse planning care for a patient who is receiving nystatin (Mycostatin) should establish which outcome on the care plan? A Relief of nasal congestion B Decrease in mouth pain C Productive cough D Absence of urticaria

B Decrease in mouth pain Nystatin is an antifungal medication that is used for candidiasis of the skin, mouth, esophagus, intestine, and vagina. It can be administered orally and topically and will heal mouth lesions from oral candidiasis. Nystatin has no effect on nasal congestion and cough production. It does not cause urticaria.

Which is a true statement about new drug development? (Select all that apply.) A Preclinical testing of drugs is always performed in healthy, nonpregnant adults. B Drug trials require that those involved not know which subjects are receiving the drug or control. C During preclinical testing, drugs are evaluated for toxicities, kinetic properties, and useful effects. D When a new drug is released, all adverse effects are known.

B Drug trials require that those involved not know which subjects are receiving the drug or control. C During preclinical testing, drugs are evaluated for toxicities, kinetic properties, and useful effects. Preclinical drug testing is not performed in humans; it is done mostly in animals. Because drug testing occurs in a relatively small number of patients, those patients are carefully selected, the drug is taken for a relatively short time, and not all adverse effects are detected during the drug testing process. During the testing process, randomized controlled trials are used, in which the participants are unaware of which subjects are getting drug, placebo, or control. Kinetics, toxicities, and effectiveness are tested during the preclinical phase of drug testing.

A patient going on a vacation cruise is prescribed a scopolamine transdermal patch (Transderm Scôp) for motion sickness. The nurse teaches the patient to recognize which side effect? A Increased heart rate B Dry mouth C Irritability D Urinary frequency

B Dry mouth Scopolamine blocks the binding of acetylcholine with cholinergic receptors in the inner ear, an imbalance that is a common cause of motion sickness. The most common side effects are dry mouth, blurred vision, and drowsiness. Urinary retention occurs less frequently. An increased heart rate and irritability are not associated effects.

A patient with Parkinson's disease is prescribed pramipexole (Mirapex) along with his levodopa/carbidopa (Sinemet). Which symptom is most likely a manifestation of an adverse effect of these drugs when given together? A Diarrhea B Dyskinesia C Wheezing D Headache

B Dyskinesia When pramipexole is combined with the levodopa component in Sinemet, patients are most likely to experience symptoms of dyskinesias, such as dyskinesia (head bobbing) and orthostatic hypotension. The other effects are not common responses to these drugs.

A patient is taking nitrofurantoin (Macrodantin). Which finding should a nurse recognize as an indication that the treatment is having an undesired effect? A Hyperpigmentation of the palms B Dyspnea with chills C Gum irritation with bleeding D Scalp tenderness and thinning hair

B Dyspnea with chills Nitrofurantoin, a urinary tract antiseptic, may induce a pulmonary reaction that manifests with dyspnea, chest pain, and chills. These symptoms, which resolve 2 to 4 days after the drug is stopped, are thought to be hypersensitivity reactions. Hyperpigmentation of the palms, gum irritation with bleeding, and scalp tenderness and thinning hair are not side effects associated with nitrofurantoin.

The nurse is caring for a patient who has diabetes and hypertension. Which agent is most likely to be prescribed to treat this patient's hypertension? A Hydrochlorothiazide (HCTZ) B Enalapril (Vasotec) C Propranolol (Inderal) D Methyldopa (Aldomet)

B Enalapril (Vasotec) Preferred antihypertensives for patients with diabetes include ACE inhibitors (enalapril), ARBs, and calcium channel blockers. ACE inhibitors are particularly useful, because they slow the progression of diabetic nephropathy in addition to lowering blood pressure. Thiazide diuretics promote hyperglycemia and are used with caution.

A patient who has Cushing's syndrome is taking ketoconazole (Nizoral) as an adjunct treatment to brain radiation. A nurse should expect the patient to have which of these therapeutic responses? A Increased resistance to infection B Enhanced radiation effect to the brain C Suppressed cortisol synthesis D Increased ACTH production

B Enhanced radiation effect to the brain Ketoconazole is an antifungal drug that inhibits glucocorticoid synthesis very effectively. It is used as an adjunct to radiation or surgery in patients with Cushing's syndrome. Increased ACTH production and resistance to infection and suppressed cortisol synthesis are not actions of ketoconazole.

A nurse should recognize that recent research has shown which statement is true about the use of zinc in children with colds? A Efficacy is seen within the first 24 hours of signs and symptoms. B Evidence has been inconclusive, and more research is needed. C Lozenges with the lemon-lime formula are the most effective. D Recovery is accelerated, and symptoms resolve quickly.

B Evidence has been inconclusive, and more research is needed. Studies have shown that zinc can benefit adults with colds. However, the one study done in children showed no beneficial effects. The study left unanswered questions; therefore, more research is required. Conclusions about efficacy, lozenge formula, and time to recovery are open to other possible interpretations in the one study done in children.

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

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.

Why is intramuscular (IM) administration of promethazine (Phenergan) preferred over intravenous (IV) administration? A The risk of respiratory depression is eliminated with IM injection. B Extravasation of IV promethazine can lead to abscess formation or tissue necrosis. C Extrapyramidal reactions do not occur when the drug is administered IM. D IM injection has a more rapid onset of action.

B Extravasation of IV promethazine can lead to abscess formation or tissue necrosis. Extravasation of IV promethazine can lead to abscess formation, tissue necrosis, and gangrene, leading to amputation; therefore, IV administration should be avoided. If it must be done, promethazine should be given through a large-bore IV line. Respiratory depression and extrapyramidal side effects can occur regardless of the route of administration. Drugs administered IM have a longer onset of action than those given IV.

When planning interventions for pain control in a patient with gouty arthritis, the nurse should assess for pain in which joints? A Hands B Feet C Shoulders D Neck

B Feet Gout is characterized by hyperuricemia and episodic pain attacks from urate crystals, which are deposited most commonly in the great toe. The kidneys also can be damaged. When gout is chronic, tophi, or large, gritty deposits, may form in the affected joint. Joints in the hands, shoulders, and neck are not commonly affected by gout.

Which manifestations does the nurse associate with the development of hemolytic anemia? (Select all that apply.) A Urticaria B Fever C Pallor D Jaundice E Diarrhea

B Fever C Pallor D Jaundice Urticaria and diarrhea are not associated with the development of hemolytic anemia. Fever, pallor, and jaundice are associated with the development of hemolytic anemia.

The nurse administers 100 mg of drug X by mouth. After the drug moves through the hepatic system, very little active drug is left in the general circulation as a result of what? A Therapeutic range B First-pass effect C Biologic half-life D Plasma protein binding

B First-pass effect The term first-pass effect refers to the rapid hepatic inactivation of certain oral drugs. Drugs that undergo the first-pass effect often are administered parenterally. The therapeutic range is the range of drug level between the minimum effective concentration (MEC) and the toxic concentration. The biologic half-life is the time required for the amount of drug in the body to decrease by 50%. Plasma protein binding is involved with the transport of drugs through the bloodstream.

What does the nurse identify as an adverse effect of clindamycin (Cleocin) therapy? A Cyanosis and gray discoloration of the skin B Frequent loose, watery stools with mucus and blood C Reduction in all blood cells produced in the bone marrow D Elevated bilirubin, with dark urine and jaundice

B Frequent loose, watery stools with mucus and blood Clostridium difficile-associated diarrhea (CDAD) is the most severe toxicity associated with clindamycin and is characterized by profuse, watery stools. The cause is superinfection of the bowel with Clostridium difficile, an anaerobic gram-positive bacillus. Gray syndrome, which usually occurs in infants and those with aplastic anemia, is an adverse effect of chloramphenicol (Chloromycetin). Hepatotoxicity is associated most closely with telithromycin (Ketek).

A nurse monitors a patient who has peptic ulcer disease and is taking antibacterial medications. If the treatment has been effective, the patient's breath test result should reveal the absence of what? A Bicarbonate B H. pylori C Histamine2 D Prostaglandins

B H. pylori Antibacterial medications should be given to patients who have confirmed infection with H. pylori, a cause of ulcers. A breath test is a noninvasive means of measuring H. pylori levels. The patient is given radiolabeled urea, which converts to carbon dioxide and ammonia if H. pylori is present. Radiolabeled carbon dioxide then can be detected in the breath. Bicarbonate, histamine2, and prostaglandins are not affected by the actions of antibacterial medications for peptic ulcers.

The nurse assesses a patient who takes ibuprofen (Advil) on a regular basis. Which finding does the nurse know is an adverse effect of ibuprofen (Advil) therapy? A Hives B Hematemesis C Dysmenorrhea D Jaundice

B Hematemesis Ibuprofen is a member of the nonaspirin first-generation nonsteroidal anti-inflammatory drugs (NSAIDs). Through inhibition of both cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), ibuprofen poses a risk for gastric ulceration and bleeding, which may lead to hematemesis. Ibuprofen is used to reduce inflammation, fever, and pain and therefore is effective in reducing dysmenorrhea (painful menstrual cramping). It is not known to cause hives or jaundice, which are signs of impaired liver function.

A patient with deep vein thrombosis is receiving an intravenous (IV) heparin infusion. He asks the nurse how this medication will help him. The nurse's response is accurately based on which concept? A Heparin prevents the activation of vitamin K and thus blocks synthesis of some clotting factors. B Heparin suppresses coagulation by helping antithrombin perform its natural functions. C Heparin works by converting plasminogen to plasmin, which in turn dissolves the clot matrix. D Heparin inhibits the enzyme responsible for platelet activation and aggregation within vessels.

B Heparin suppresses coagulation by helping antithrombin perform its natural functions. Heparin is an anticoagulant that works by helping antithrombin inactivate thrombin and factor Xa, reducing the production of fibrin and thus decreasing the formation of clots.

Which of these findings, if identified in a patient receiving ergonovine (Ergotrate), should a nurse report to a physician immediately? A Tremors B Hypertension C Uterine cramping D Hypoglycemia

B Hypertension Ergonovine is used to control postpartum bleeding by increasing uterine tone and decreasing postpartum bleeding. Because of the vascular effects, hypertension can be severe, especially if the drug is administered IV. Cramping occurs as a therapeutic response. Tremors and hypoglycemia are unrelated.

A nurse is monitoring a patient who is receiving an intravenous infusion of rituximab (Rituxan) for severe rheumatoid arthritis. Which finding is a complication of this treatment that would require the nurse to stop the infusion? A Nose bleed B Hypotension C Seizure activity D Hypoglycemia

B Hypotension Rituximab can cause infusion-related hypersensitivity reactions within 30 minutes of initiation. Symptoms include hypotension, bronchospasm, hypoxia, and cardiogenic shock. Nose bleeds, seizure activity, and hypoglycemia are not associated with infusion reactions of rituximab.

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 what? A Thyrotoxicosis B Hypothyroidism C Hyperthyroidism D Graves' disease

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.

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

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.

A nurse assesses the history of a patient who has had multiple complicated UTIs for which risk factors? (Select all that apply.) A Female gender, child-bearing age B Indwelling catheter C Prostate hypertrophy D Fair skin tone E Urinary tract stones

B Indwelling catheter C Prostate hypertrophy E Urinary tract stones Complicated UTIs occur in both males and females and usually are associated with some predisposing factor, such as calculi, prostatic hypertrophy, or catheters. Uncomplicated UTIs occur primarily in women of child-bearing age and are not associated with any specific predisposing factor. Fair skin tone is unrelated to UTI occurrence.

A patient with a history of numbness, weakness, and blurred vision recently was diagnosed with multiple sclerosis (MS). What does the nurse understand to be the underlying pathophysiology for these symptoms? A An imbalance of dopamine and acetylcholine in the central nervous system B Inflammation and myelin destruction in the central nervous system C An inability of serotonin to bind to its receptors in the chemoreceptor trigger zone D High-frequency discharge of neurons from a specific focus area of the brain

B Inflammation and myelin destruction in the central nervous system The underlying pathophysiology of MS is related to myelin destruction and slowing of axonal conduction related to inflammation within the central nervous system. The demyelination leads to the characteristic neurologic symptoms associated with MS.

A patient who takes cyclosporine (Sandimmune) also is receiving ketoconazole (Nizoral). The nurse should expect which therapeutic outcome from the combined medications? A Improved glomerular filtration rate B Inhibition of cyclosporine metabolism C Decreased risk of lymphoma occurrence D Decreased risk of bacterial and viral infections

B Inhibition of cyclosporine metabolism Ketoconazole raises cyclosporine levels and can increase the risk of toxicity. However, some physicians administer ketoconazole with cyclosporine, because this greatly reduces the cost of cyclosporine treatment; the dosage of cyclosporine may be reduced by up to 88%. An improved glomerular filtration rate, decreased risk of lymphoma occurrence, and decreased risk of bacterial and viral infections are not effects of cyclosporine.

The nurse is planning care for a patient receiving morphine sulfate (Duramorph) by means of a patient-controlled analgesia (PCA) pump. Which intervention may be required because of a potential adverse effect of this drug? A Administering cough suppressant B Inserting a Foley catheter C Administering an antidiarrheal D Monitoring liver function tests

B Inserting a Foley catheter Morphine can cause urinary hesitancy and urinary retention. If bladder distention or inability to void is noted, the prescriber should be notified. Urinary catheterization may be required. Morphine acts as a cough suppressant and an antidiarrheal, so neither of those types of drugs would be needed to counteract an adverse effect of morphine. Liver toxicity is not a common adverse effect of morphine.

The nurse develops a care plan for a patient in the continuation phase of treatment for active tuberculosis (TB). The care plan includes teaching about which medication regimen? A Pyrazinamide and ethambutol B Isoniazid and rifampin C Ethambutol and isoniazid D Rifampin and ethambutol

B Isoniazid and rifampin If drug resistance is not a factor, treatment for active TB consists of a four-drug induction phase and a two-drug continuation phase. The continuation phase lasts at least 4 months, and therapy consists of two drugs—isoniazid and rifampin. Pyrazinamide and ethambutol, ethambutol and isoniazid, and rifampin and ethambutol are not the preferred regimens for the continuation phase.

Which statements about CDAD associated with clindamycin therapy does the nurse identify as true? (Select all that apply.) A Leukopenia commonly occurs. B It is a potentially fatal condition. C Patients usually experience abdominal pain. D Anticholinergics are effective in treating the diarrhea. E Clindamycin therapy should be discontinued and vancomycin started.

B It is a potentially fatal condition. C Patients usually experience abdominal pain. E Clindamycin therapy should be discontinued and vancomycin started. CDAD is a potentially fatal condition in which patients experience abdominal pain. If CDAD develops, clindamycin therapy should be stopped and vancomycin or metronidazole therapy started. Leukocytosis, not leukopenia, develops. Anticholinergics can make the diarrhea worse and therefore should be avoided.

The nurse is preparing to give neostigmine (Prostigmin). What best describes the action of this drug? A It inhibits acetylcholine at all cholinergic synapses. B It prevents inactivation of acetylcholine. C It prevents activation of muscarinic receptors. D It stimulates activation of adrenergic receptors.

B It prevents inactivation of acetylcholine. Neostigmine is a cholinesterase inhibitor. As such, it prevents the inactivation of acetylcholine, allowing it to linger at the synapses. It lacks selectivity and thus intensifies transmission at all cholinergic junctions.

The nurse administers naloxone to a patient receiving morphine sulfate who has a respiratory rate of 8 breaths per minute. Why? A Naloxone causes hypersensitivity of the opioid receptors. B Naloxone prevents the activation of opioid receptors. C Naloxone is a partial agonist, requiring a lesser dose to achieve pain relief. D Naloxone is an agonist, leading to desensitization of the opioid receptors.

B Naloxone prevents the activation of opioid receptors. Naloxone is an antagonist, which prevents the activation of opioid receptors, reversing the respiratory depression effects of morphine. Continuous exposure of cells to antagonists can result in hypersensitivity. Continuous exposure of cells to agonists can lead to desensitization, refractoriness, or down-regulation.

A patient admitted with deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) requires immediate anticoagulation. What would be appropriate in this situation, given that the patient has a history of heparin-induced thrombocytopenia (HIT)? A Warfarin (Coumadin) B Lepirudin (Refludan) C Bivalirudin (Angiomax) D Eptifibatide (Integrilin)

B Lepirudin (Refludan) Lepirudin (Refludan) and argatroban are indicated for the treatment of thrombosis in patients with a history of HIT. Because these medications are given as an initial IV bolus followed by a continuous infusion, the desired effect of direct thrombin inhibition is achieved more quickly. Because of warfarin's delayed onset of effects, it is not useful in emergency situations, such as pulmonary embolism (PE). Intravenous bivalirudin given in combination with aspirin helps prevent clot formation in patients undergoing coronary angioplasty. Eptifibatide (Integrilin), a glycoprotein IIb/IIIa receptor inhibitor, is an antiplatelet drug that is used short term to prevent ischemic events in patients who have acute coronary syndrome or who are undergoing percutaneous coronary intervention.

The nurse is caring for a patient with bipolar disorder treated with lithium (Eskalith). The patient has a new prescription for captopril (Capoten) for hypertension. The combination of these two drugs makes which assessment particularly important? A Potassium level B Lithium level C Creatinine level D Blood pressure

B Lithium level ACE inhibitors, such as captopril, can cause lithium accumulation. Lithium levels should be monitored on a regular basis. ACE inhibitors can cause hyperkalemia, renal insufficiency in some patients, and hypotension. However, the combination of lithium and captopril would not increase the risk of these effects.

A patient with end-stage breast cancer is experiencing ineffective pain management. Which statement represents the most likely cause of this problem? (Select all that apply.) A Most cancer pain is neuropathic and quite difficult to relieve. B Many cancer patients are reluctant to take pain medication. C Healthcare professionals often fear patient addiction to pain medication. D Nociceptive pain does not respond well to traditional pain medications. E The healthcare system often places a low priority on pain management.

B Many cancer patients are reluctant to take pain medication. C Healthcare professionals often fear patient addiction to pain medication. E The healthcare system often places a low priority on pain management. Most cancer pain is nociceptive and responds well to opioids and other pain relievers. Cancer pain can be relieved in 90% of patients. Healthcare professionals often fear patient addiction, and the healthcare system itself tends to place a low priority on pain management and control.

The nurse is caring for a patient receiving a nitroprusside (Nipride) intravenous infusion. The patient's wife asks why furosemide (Lasix) is being prescribed along with this drug. The nurse's response is based on which concept? A Furosemide will help reduce reflex tachycardia. B Many vasodilators cause retention of sodium and water. C Thiocyanate may accumulate in patients receiving nitroprusside. D Vasodilators can cause serious orthostatic hypotension.

B Many vasodilators cause retention of sodium and water. Nitroprusside is a potent vasodilator that can cause retention of sodium and water. Furosemide, a diuretic, often is combined with nitroprusside to reduce the risk of edema and fluid retention. Furosemide does not reduce reflex tachycardia. Thiocyanate can accumulate in patients receiving nitroprusside, but furosemide does not help prevent or treat that. Vasodilators can cause serious orthostatic hypotension, but that is not the rationale for adding furosemide to the regimen.

The nurse is caring for a patient hospitalized with an acute episode (relapse) of MS. Which agent is the preferred treatment during relapse? A Interferon beta-1a (Avonex) IM B Methylprednisolone (Solu-Medrol) IV C Glatiramer acetate (Copaxone) subQ D Natalizumab (Tysabri) IV infusion

B Methylprednisolone (Solu-Medrol) IV During an acute relapse episode of MS, the treatment of choice is high-dose IV glucocorticoid, such as methylprednisolone, to reduce the inflammation and diminish symptoms. The other agents are disease-modifying drugs that are used in the long-term management of MS.

Instruction by the nurse regarding alcohol abstinence is essential when a patient will be discharged taking which medication? A Tetracycline B Metronidazole C Bismuth subsalicylate D Clarithromycin

B Metronidazole A disulfiram-like reaction can occur if metronidazole is used with alcohol; therefore, alcohol must be avoided during treatment with this drug. Although the use of alcohol is not promoted in patients who take the other medications, it does not create an adverse reaction.

A patient who takes multiple antibiotics starts to experience diarrheal stools. The nurse anticipates administration of which antibiotic if a stool sample tests positive for Clostridium difficile? A Rifaximin (Xifaxan) B Metronidazole (Flagyl) C Daptomycin (Cubicin) D Gemifloxacin (Factive)

B Metronidazole (Flagyl) Metronidazole is the treatment of choice for antibiotic-associated colitis caused by C. difficile. Rifaximin, daptomycin, and gemifloxacin are not used in the treatment of C. difficile infection.

The nurse is working with the multidisciplinary healthcare team to optimize the care of a patient with schizophrenia. Which concepts will guide the nursing care of this patient? (Select all that apply.) A The second-generation antipsychotics generally are more effective than the first-generation agents. B Most antipsychotic agents increase the risk of mortality in elderly patients with dementia. C Antipsychotic depot preparations carry a greater risk of neuroleptic malignant syndrome. D The lipid levels of patients receiving second-generation antipsychotics should be monitored. E Schizophrenia is characterized by disordered thinking and loss of touch with reality.

B Most antipsychotic agents increase the risk of mortality in elderly patients with dementia. D The lipid levels of patients receiving second-generation antipsychotics should be monitored. E Schizophrenia is characterized by disordered thinking and loss of touch with reality. The first- and second-generation antipsychotics are considered equally effective, even though the second-generation agents are more widely used today. Most antipsychotics should be avoided in elderly patients with dementia because of increased mortality. Antipsychotic depot preparations are effective for the long-term control of schizophrenia and do not have an increased risk of side effects. Second-generation antipsychotics may cause weight gain, diabetes, and dyslipidemia. Schizophrenia is characterized by disordered thinking and loss of touch with reality.

Which label most aptly describes the drug atropine (Sal-Tropine)? A Cholinergic B Parasympatholytic C Muscarinic agonist D Parasympathomimetic

B Parasympatholytic Atropine is a muscarinic antagonist agent. Other terms for this agent are parasympatholytic, antimuscarinic, muscarinic blocker, and anticholinergic.

Which medication used for the management of multiple sclerosis cannot be self-administered? A Fingolimod (Gilenya) B Natalizumab (Tysabri) C Glatiramer acetate (Copaxone) D Interferon beta-1b (Betaseron)

B Natalizumab (Tysabri) Natalizumab (Tysabri) is administered by intravenous infusion over 1 hour. The patient must be observed during the infusion and also must be monitored for 1 hour after the infusion is complete. Before this medication can be prescribed and administered, everyone involved with the drug—patients, physicians, pharmacists, infusion nurses, and infusion centers—must be registered with the TOUCH Prescribing Program. The other medications can be self-administered: fingolimod (oral) and glatiramer acetate and interferon beta-1b (subcutaneous injection).

A patient taking a sulfonamide is breast-feeding an infant. Which complication in the infant would the nurse associate with kernicterus? A Hemolytic anemia B Neurologic deficits C Hepatocellular failure D Ophthalmic infection

B Neurologic deficits Kernicterus is a disorder in newborns caused by deposition of bilirubin in the brain, which leads to severe neurologic deficits and death. Sulfonamides promote kernicterus by displacing protein-bound bilirubin from the proteins, leaving newly freed bilirubin access to brain sites. Sulfonamides are not administered to infants under 2 years old, nor are they given to pregnant patients near term or nursing mothers. Hemolytic anemia, hepatocellular failure, and ophthalmic infection are not associated sulfonamide effects in infants.

According to the 2008 guidelines published by the American College of Physicians and the American Academy of Family Physicians, which statement is/are true about the drugs used to treat AD? (Select all that apply.) A Cholinesterase inhibitors are the first-line agents for the treatment of AD. B None of the five drugs approved is more effective than any of the others. C Memantine (Namenda) is a promising new drug that now is a first-line agent. D All drugs show statistically significant improvement with little clinical significance. E Donepezil (Aricept) has fewer side effects and should be the first-line drug.

B None of the five drugs approved is more effective than any of the others. D All drugs show statistically significant improvement with little clinical significance. According to the 2008 report entitled Effectiveness of Cholinesterase Inhibitors and Memantine for Treating Dementia, the five agents approved for AD show statistically significant improvement in patients, but those changes are very small and are considered clinically insignificant. Furthermore, none of the five drugs is more effective than any of the others. Treatment decisions should be based on individual tolerance, convenience, and cost.

In a patient with a thiamine deficiency, which finding would indicate the development of Wernicke-Korsakoff syndrome? A Pedal edema B Nystagmus C Angular stomatitis D Peripheral neuritis

B Nystagmus Wernicke-Korsakoff syndrome is a disorder of the central nervous system. It produces neurologic and psychologic symptoms, including nystagmus, diplopia, ataxia, and inability to remember the recent past. It occurs in the United States most commonly among alcoholics who have a thiamine deficiency. Pedal edema occurs in wet beriberi, another form of thiamine deficiency. Angular stomatitis occurs in riboflavin (vitamin B2) deficiency as cracks in the skin at the corners of the mouth. Peripheral neuritis occurs in pyridoxine (vitamin B6) deficiency.

When performing a skin test for penicillin allergy, the nurse will do what? (Select all that apply.) A Inject a tiny amount of the allergen subcutaneously. B Observe for a local allergic response. C Have epinephrine readily available. D Have respiratory support readily available. E Administer diphenhydramine (Benadryl) as the first-line agent should anaphylaxis occur.

B Observe for a local allergic response. C Have epinephrine readily available. D Have respiratory support readily available. For a penicillin allergy skin test, a small amount of allergen is injected intradermally. The nurse observes for a local allergic reaction and has epinephrine and respiratory support readily available. Epinephrine is administered as the first-line agent should anaphylaxis occur.

Which nursing action is the priority for a patient in preterm labor who is receiving magnesium sulfate? A Documenting body temperature B Obtaining deep tendon reflexes C Measuring intake and output D Monitoring the intensity of contractions

B Obtaining deep tendon reflexes Magnesium sulfate acts to suppress uterine contractions through inhibition of acetylcholine at the neuromuscular junction in the uterine muscle. Loss of the patellar reflex is an early indicator of high magnesium levels. Assessments of body temperature, intake and output, and contraction intensity are necessary but not as important as deep tendon reflexes.

The nurse is caring for a patient receiving clopidogrel (Plavix) to prevent blockage of coronary artery stents. Which other drug on the patient's medication administration record may reduce the antiplatelet effects of clopidogrel? A Aspirin (Bayer) B Omeprazole (Prilosec) C Acetaminophen (Tylenol) D Warfarin (Coumadin)

B Omeprazole (Prilosec) Omeprazole and other proton pump inhibitors may reduce the antiplatelet effects of clopidogrel. Patients sometimes take them to reduce gastric acidity and the risk of gastrointestinal (GI) bleeding.

To achieve therapeutic effectiveness, a nurse teaches a patient with chronic asthma to use an inhaled glucocorticoid medication according to which schedule? A Only in an emergency B On a continuing, daily basis C To abort an asthma attack D 2 weeks on, 2 weeks off

B On a continuing, daily basis Glucocorticoid medications are first-line therapy for asthma to reduce symptoms of inflammation. They should be taken for prophylaxis on a daily basis. Therapeutic effects develop slowly, so these drugs cannot be taken to abort an asthma attack or in an emergency. They are most effective when administered on a fixed schedule, not PRN.

What assessment is essential before treatment with hydroxychloroquine (Plaquenil) is started for a patient with rheumatoid arthritis (RA)? A T3, T4, TSH B Ophthalmic examination C PPD and chest x-ray D BUN and creatinine

B Ophthalmic examination Patients with RA should have a thorough ophthalmic examination before treatment with hydroxychloroquine is started and also every 6 months thereafter because the drug poses a risk of retinal damage. The medication should be discontinued at the first sign of retinal injury. The remaining options are not indicated before initiating treatment with hydroxychloroquine.

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

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

A nurse teaches a patient who is to start taking infliximab (Remicade) for rheumatoid arthritis. Which of these cardiac findings should the nurse instruct the patient to report as a complication of the treatment? A Calf pain B Pedal edema C Cool, pale toes D Clubbed fingernails

B Pedal edema Infliximab is a tumor necrosis factor (TNF) blocker used for the treatment of rheumatoid arthritis. It should not be used in patients who have heart failure, and it may cause new-onset heart failure in some individuals. Pedal edema is a sign of heart failure, and the patient should report it to the healthcare provider. Cool, pale toes; calf pain; and clubbed fingers are not symptoms related to heart failure.

The nurse is managing the care of a group of patients with cancer who will be receiving chemotherapy. The nurse defines goals, sets priorities, identifies interventions, and establishes criteria for evaluating success. Which phase of the nursing process does this represent? A Assessment B Planning C Implementation D Evaluation

B Planning These activities are all carried out in the planning phase of the nursing process. Assessment is a time of data gathering, implementation begins with carrying out the interventions, and evaluation is performed to determine the degree to which treatment has succeeded

The nurse should be concerned about which finding in a patient on long-term, low-dose colchicine therapy to prevent gout? A White blood cell (WBC) count of 6500/mcL B Platelet count of 200,000/mcL C Complaints of muscle pain and weakness D Complaints of headache

B Platelet count of 200,000/mcL Long-term, low-dose therapy with colchicine can cause rhabdomyolysis, which is manifested by complaints of muscle tenderness, pain, and weakness. Because the drug causes myelosuppression, patients should be monitored for leukopenia and thrombocytopenia. Both the WBC count and platelet count are within normal limits. Headache is not an adverse effect of colchicine.

Which condition should the nurse anticipate when the patient has received an intraspinal opioid medication to control cancer pain? A Reduced risk of nausea, vomiting, and constipation B Potential for delayed respiratory depression and catheter-related infections C Less need for rescue medication to control breakthrough pain D Greater risk of paresthesias and numbness in the lower extremities

B Potential for delayed respiratory depression and catheter-related infections Intraspinal administration of opioids carries the same risk of side effects and tolerance as administration by other routes. However, it also poses a risk of delayed respiratory depression and catheter-related infections. Because breakthrough pain may occur, patients receiving intraspinal opioids may need rescue medication. Paresthesias and numbness are not effects commonly associated with intraspinal opioid administration.

Which cardiovascular finding does the nurse identify as a possible adverse effect of erythromycin (Ery-Tab) therapy? A Heart rate of 52 beats per minute B Prolonged QT interval C Jugular vein distention D Grade III diastolic murmur

B Prolonged QT interval When present in high levels, erythromycin can prolong the QT interval, causing a potentially fatal ventricular dysrhythmia. It should be avoided by patients taking class IA or class III antidysrhythmic medications or others that inhibit metabolism.

A patient who has type 2 diabetes is taking nateglinide (Starlix). Which response should a nurse expect the patient to have if the medication is achieving the desired therapeutic effect? A Inhibition of carbohydrate digestion B Promotion of insulin secretion C Decreased insulin resistance D Inhibition of ketone formation

B Promotion of insulin secretion Nateglinide is a meglitinide medication that acts to increase pancreatic insulin release. It is used as an adjunct to calorie restriction and exercise to maintain glycemic control in patients with type 2 diabetes. It does not act to reduce insulin resistance or inhibit carbohydrate digestion. It should not be used to manage diabetic ketone formation, because its glucose-lowering effects are too slow to be of benefit.

Why does the nurse anticipate administering metoprolol (Lopressor) rather than propranolol (Inderal) for diabetic patients who need a beta-blocking agent? A Metoprolol is less likely to cause diabetic nephropathy. B Propranolol causes both beta1 and beta2 blockade. C Metoprolol helps prevent retinopathy in individuals with diabetes. D Propranolol is associated with a higher incidence of foot ulcers.

B Propranolol causes both beta1 and beta2 blockade. Metoprolol is a second-generation beta blocker and as such is more selective. At therapeutic doses, it causes less bronchoconstriction and suppression of glycogenolysis, which can cause problems in diabetic patients. Propranolol blocks both beta1 and beta2 receptors.

The nurse is preparing to give a medication for pain. The label states that the drug is "lipid soluble." Based on the nurse's knowledge of lipid-soluble drugs, how quickly would the nurse expect to observe the effects of the drug? A Slowly B Rapidly C Unpredictably D Variably

B Rapidly Cell membranes are composed of lipids; therefore, a lipid-soluble drug passes through rapidly. A water-soluble drug passes through more slowly. The nurse would expect to observe the effects of a lipid-soluble drug more quickly, because the drug is absorbed more rapidly

A patient who has rheumatoid arthritis is scheduled to start taking celecoxib (Celebrex). A nurse should recognize which factor from the patient's history as a contraindication to taking this medication? A Hypothyroidism B Recent heart bypass surgery C Positive tuberculin skin test result D Allergy to penicillin

B Recent heart bypass surgery Celecoxib (Celebrex) should be avoided in patients who have undergone recent heart bypass surgery. Because it does not inhibit COX-1, platelet aggregation is not suppressed. It does inhibit COX-2 in blood vessels, which results in increased vasoconstriction. Unimpeded platelet aggregation and increased vasoconstriction pose a higher risk of thrombotic events in patients with certain cardiovascular risk factors. Hypothyroidism, a penicillin allergy, and a positive tuberculin skin test result are not contraindications to taking celecoxib (Celebrex).

A patient who has had a pancreatectomy is taking pancrelipase (Viokase). Which finding would the nurse use to evaluate the effectiveness of this drug? A Increase in flatulence B Reduction in fatty stools C Resolution of jaundice D Decrease in abdominal distention

B Reduction in fatty stools A deficiency of pancreatic enzymes through pancreatectomy or pancreatitis may compromise digestion, especially the digestion of fats. Fatty stools are characteristic of the deficiency. Replacement of pancreatic enzymes with pancrelipase results in a reduction of fat excretion through the stools. An increase in flatulence, resolution of jaundice, and a decrease in abdominal distention are not therapeutic effects of pancrelipase.

A nurse is planning care for a patient who takes fexofenadine (Allegra) for allergic rhinitis. Which outcome should the nurse anticipate? A No complaints of dry mouth B Relief of sneezing and itching C Use limited to allergy season D Absence of rebound congestion

B Relief of sneezing and itching Fexofenadine, a second-generation antihistamine, is prescribed as a first-line medication for allergic rhinitis to relieve sneezing, rhinorrhea, and nasal itching. Anticholinergic effects (dry mouth, constipation) are uncommon with second-generation antihistamines. Antihistamines are most effective when taken prophylactically. Rebound congestion develops in topical sympathomimetic agents.

A patient is taking nalidixic acid (NegGram) and experiencing photophobia and diplopia. Which instruction should a nurse provide the patient? A Wear prescription sunglasses. B Restrict driving temporarily. C Wear nonskid footwear. D Avoid daytime activities.

B Restrict driving temporarily. Nalidixic acid (NegGram) is a second-choice medication for UTIs. It can cause visual disturbances (blurred vision, diplopia, photophobia, altered color perception). Caution with driving is needed. Prescription sunglasses and avoiding daytime activities are not necessary. Nonskid footwear does not help a visual acuity problem.

Which cholinesterase inhibitor has the highest incidence of adverse gastrointestinal (GI) effects? A Donepezil (Aricept) B Rivastigmine (Exelon) C Galantamine (Reminyl) D Tacrine (Cognex)

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.

The nurse is caring for a patient with MS who is having worsening recurrent episodes of neurologic dysfunction followed by periods of partial recovery. How would this subtype be classified? A Relapsing-remitting B Secondary progressive C Primary progressive D Progressive-relapsing

B Secondary progressive Relapsing-remitting MS is marked by defined episodes of neurologic dysfunction separated by periods of partial or full recovery. In secondary progressive MS, the patient with the relapsing-remitting subtype experiences declining function with or without occasional recovery of function. Primary progressive MS presents with progressive decline of function from the onset. Progressive-relapsing MS is rare and is similar to primary progressive but has acute episodes in addition to the progressively worsening dysfunction.

A patient has received a toxic dose of an antihistamine. It is most important for the nurse to assess the patient for what? A Tinnitus B Seizure activity C Lethargy D Visual disturbances

B Seizure activity Toxicity associated with antihistamines can produce CNS stimulation, and seizures may result. Tinnitus, lethargy, and visual disturbances are not associated with increased doses of antihistamines.

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

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 assessing a patient who is receiving a sulfonamide for treatment of a urinary tract infection. To monitor the patient for the most severe response to sulfonamide therapy, the nurse will assess for what? A Diarrhea B Skin rash and lesions C Hypertension D Bleeding

B Skin rash and lesions The nurse's priority is to monitor for hypersensitivity reactions. The most serious response to sulfonamide therapy is Stevens-Johnson syndrome, which manifests as symptoms of the skin and mucous membranes, lesions, fever, and malaise. In rare cases, hematologic effects occur, requiring periodic blood studies.

A nurse is monitoring a patient who takes etanercept (Enbrel) for rheumatoid arthritis. The nurse should obtain the results of which laboratory test when evaluating for adverse effects? A Arterial blood gases (ABGs) B Skin test for tuberculosis C Electrocardiogram (ECG) D 24-hour urine collection for creatinine clearance

B Skin test for tuberculosis Etanercept increases the risk for serious bacterial and fungal infections, as well as tuberculosis. Patients who develop new infections should be monitored frequently. If tuberculosis develops, it often is extrapulmonary. Patients should be tested for latent tuberculosis, and if the test result is positive, they should be treated for TB before starting etanercept. It is not necessary to obtain ABGs, an ECG, or urine for creatinine clearance when a patient is taking etanercept.

A patient is admitted to the emergency department in hypertensive crisis, and examination reveals papilledema. The nurse would expect which IV medications to be administered to achieve rapid, controlled reduction of the patient's blood pressure? A Furosemide (Lasix) B Sodium nitroprusside (Nitropress) C Metoprolol (Lopressor) D Diltiazem (Cardizem)

B Sodium nitroprusside (Nitropress) Hypertensive crisis associated with papilledema, intracranial hemorrhage, myocardial infarction, or acute heart failure is a severe emergency, and the BP must be lowered rapidly (within 1 hour). Intravenous sodium nitroprusside (Nitropress) usually is the drug of choice first used, because its effects begin within seconds of initiation of the continuous IV infusion, and they fade rapidly when the infusion is stopped. Furosemide, metoprolol, and diltiazem are not used for rapid reduction of BP in hypertensive crisis.

A nurse teaches a patient with chronic obstructive pulmonary disease (COPD) about the adverse effects of tiotropium (Spiriva). Which behavior by the patient would indicate that the teaching has been effective? A Combines tiotropium with an antacid B Sucks on sugarless hard candy C Prevents constipation with a stool softener D Wears long sleeves and a wide-brim hat

B Sucks on sugarless hard candy Tiotropium is an anticholinergic medication used to relieve bronchospasm associated with COPD. The most common adverse effect is dry mouth, and patients can suck on sugarless hard candy for symptomatic relief. It is not necessary to take an antacid medication, use a daily stool softener, or wear protective clothing when taking tiotropium.

A nurse assesses a patient who is taking pramlintide (Symlin) with mealtime insulin. Which finding requires immediate follow-up by the nurse? A Skin rash B Sweating C Itching D Pedal edema

B Sweating Pramlintide is a new type of antidiabetic medication used as a supplement to mealtime insulin in patients with type 1 and 2 diabetes. Hypoglycemia, which is manifested by sweating, tremors, and tachycardia, is the adverse reaction of most concern. Skin rash, itching, and edema are not adverse effects of pramlintide.

To promote treatment adherence in a patient with tuberculosis, the nurse will include which interventions? (Select all that apply.) A Use a single medication, to keep the treatment simple. B Teach the patient about intermittent-dose therapy C Teach the patient about the need for long-term treatment. D Use a signed consent form to enhance patient compliance. E Directly watch the patient take the medication.

B Teach the patient about intermittent-dose therapy C Teach the patient about the need for long-term treatment. E Directly watch the patient take the medication. In patients with TB, nonadherence is the most common reason for treatment failure, relapse, and increased medication resistance. Because treatment is necessary for at least 6 months, directly observed therapy (DOT) is a standard of care, as is intermittent dosing. Multiple medication regimens are needed to prevent drug resistance. Education about the length of treatment and the regimen is essential to compliance. A signed consent form does not increase patient compliance.

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

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.

A new graduate nurse, who is preparing to administer medications, knows that what is required for a drug to move through the body? A Selectivity and effectiveness B The ability to cross membranes C Development of an electric charge D A transporter protein

B The ability to cross membranes To move through the body, drugs must cross membranes. They cross membranes to enter the bloodstream, to exit the bloodstream and reach the site of action, and to undergo metabolism and excretion. Selectivity and effectiveness are not related to drug movement. Development of an electric charge (ionization) reduces a drug's ability to be absorbed. Transporter proteins are not required for drugs to move through the body.

The nurse is working on a postoperative unit in which pain management is part of routine care. Which statement is the most helpful in guiding clinical practice in this setting? A At least 30% of the U.S. population is prone to drug addiction and abuse. B The development of opioid dependence is rare when opioids are used for acute pain. C Morphine is a common drug of abuse in the general population. D The use of PRN (as needed) dosing provides the most consistent pain relief without risk of addiction.

B The development of opioid dependence is rare when opioids are used for acute pain. The development of dependence on or addiction to opioids as a result of clinical exposure is extremely rare. In fact, some estimate that only 25% of patients receive doses of opioids that are sufficient to relieve suffering. Only about 8% of the population is estimated to be prone to drug abuse. Morphine is a drug of abuse, but this fact is not helpful in guiding clinical practice. A patient-controlled analgesia (PCA) pump provides the most consistent pain relief, better than PRN and fixed-dosing schedules.

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 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.

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, all other options are incorrect.

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.

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.

Which statement or statements accurately reflect Starling's law as applied to a healthy heart? (Select all that apply.) A When venous return increases, stroke volume decreases. B The right and left ventricles pump the same amount of blood. C Cardiac output is equal to the volume of blood delivered by the veins. D When venous return increases, cardiac output increases. E As cardiac muscle fibers increase in length, their contractile force decreases.

B The right and left ventricles pump the same amount of blood. C Cardiac output is equal to the volume of blood delivered by the veins. D When venous return increases, cardiac output increases. Starling's law states that the force of ventricular contraction is proportional to muscle fiber length. Therefore, as muscle fibers increase in length, the force of the heart contraction increases. In this situation, the right and left ventricles pump the same amount of blood, and overall cardiac output is equivalent to the volume delivered by the veins. As venous return increases, stroke volume increases accordingly.

A patient is scheduled to receive intravenous amphotericin B. Which medication should a nurse administer as pretreatment before the infusion? A 10 units of regular insulin intravenously B 20 mg famotidine (Pepcid) in 50 mL of 5% dextrose C 50 mg of diphenhydramine (Benadryl) and 650 mg of acetaminophen D 1 g of calcium gluconate in 100 mL of normal saline

C 50 mg of diphenhydramine (Benadryl) and 650 mg of acetaminophen Almost all patients given intravenous amphotericin B develop fever, chills, and nausea. Pretreatment with diphenhydramine and an analgesic, such as acetaminophen, can minimize or prevent these adverse effects. It is not beneficial to administer calcium gluconate, insulin, or famotidine as pretreatment.

The nurse is preparing to give terbutaline (Brethine) to prevent preterm labor. Which concepts are important to keep in mind when working with this drug? (Select all that apply.) A Terbutaline must be given by a parenteral route. B The selectivity of terbutaline is dose dependent. C The patient may experience tremor with terbutaline. D Terbutaline is a sympathomimetic drug. E Bronchoconstriction is a potential adverse effect of terbutaline.

B The selectivity of terbutaline is dose dependent. C The patient may experience tremor with terbutaline. D Terbutaline is a sympathomimetic drug. Terbutaline is a noncatecholamine adrenergic agonist (sympathomimetic) drug. It can be given orally, because it is not a catecholamine. Tremor and tachycardia are potential adverse effects. It can be used to treat asthma and does not typically cause bronchoconstriction. When given at low therapeutic doses, it is selective for beta2 receptors.

The nurse knows that there is an increased risk of ototoxicity in a patient receiving an aminoglycoside if which level is high? A Concentration B Trough C Peak D Dose

B Trough When trough levels remain elevated, aminoglycosides are unable to diffuse out of inner ear cells, thus exposing the cells to the medication for an extended time. Prolonged exposure (i.e., high trough levels), rather than brief exposure to high levels, underlies cellular injury.

The nurse identifies which antidepressant as effective in the treatment of generalized anxiety disorder (GAD)? (Select all that apply.) A Fluoxetine (Prozac) B Venlafaxine (Effexor XR) C Paroxetine (Paxil) D Escitalopram (Lexapro) E Duloxetine (Cymbalta)

B Venlafaxine (Effexor XR) C Paroxetine (Paxil) D Escitalopram (Lexapro) E Duloxetine (Cymbalta) Fluoxetine (Prozac) is not approved for the treatment of generalized anxiety disorder. All the other medications listed are approved for the treatment of GAD.

The heart undergoes cardiac remodeling during the early phase of heart failure. Which finding describes the geometric changes that occur during heart failure? A Ventricular constriction B Ventricular wall thickening C Ventricular atrophy D Ventricles become more cylindric

B Ventricular wall thickening An increase in ventricular wall thickness, also called ventricular hypertrophy, is characteristic of the remodeling process during early heart failure. The ventricles also dilate and become more spherical (less cylindric). This change in cardiac shape typically occurs after cardiac injury under the influence of the neurohormonal systems, such as the sympathetic nervous system and renin-angiotensin-aldosterone system.

The nurse is caring for a patient receiving propranolol (Inderal). Which finding is most indicative of an adverse effect of this drug? A A heart rate of 100 beats per minute B Wheezing C A glucose level of 180 mg/dL D Urinary urgency

B Wheezing Beta blockers, such as propranolol, are known to cause bronchoconstriction, which could manifest as wheezing. Other adverse effects could include bradycardia, atrioventricular (AV) heart block, heart failure, rebound cardiac excitation, inhibition of glycogenolysis, and potential central nervous system (CNS) effects.

A patient diagnosed with a pulmonary embolism is receiving a continuous heparin infusion at 1000 units/hr. Which situation would warrant a call to the physician? (Select all that apply.) A aPTT of 65 seconds B aPTT of 40 seconds C Nosebleeds D aPTT of 100 seconds E platelet count of 300, 000/mcL

B aPTT of 40 seconds C Nosebleeds D aPTT of 100 seconds Measurement of the aPTT is essential to determine whether the heparin infusion is having the desired effect. If the normal value of the aPTT is 40 seconds, the goal is to achieve a therapeutic range of a factor of 1.5 to 2 (60 to 80 seconds). Because 40 seconds is too short (increases the risk for clotting) and 100 seconds is too long (increases the risk for bleeding), the physician requires notification for adjustment of the infusion rate. Evidence of bleeding, such as nosebleeds, hematuria, and red or tarry stools, warrant a call to the physician. An aPTT of 65 seconds indicates that a therapeutic effect has been achieved, and a platelet count of 300,000/mcL is within normal limits, indicating no evidence of thrombocytopenia.

Which needle length and gauge should the nurse choose to administer subcutaneous heparin? A ½ inch; 20 gauge B ⅝ inch; 25 gauge C 1½ inch; 18 gauge D 1 inch; 26 gauge

B ⅝ inch; 25 gauge Heparin should be administered subcutaneously into the fatty layer of the abdomen with a ½- to ⅝-inch needle, 25 or 26 gauge. The only appropriate option for injection in the list shown is the ⅝-inch, 25-gauge needle.

Which instruction about clopidogrel (Plavix) should be included in the discharge teaching for a patient who has received a drug-eluting coronary stent? A "Constipation is a common side effect of clopidogrel, so take a stool softener daily." B "If you see blood in your urine or black stools, stop the clopidogrel immediately." C "Check with your healthcare provider before taking any over-the-counter medications for gastric acidity." D "Keep the amounts of foods containing vitamin K, such as mayonnaise, canola and soybean oil, and green, leafy vegetables, consistent in your diet."

C "Check with your healthcare provider before taking any over-the-counter medications for gastric acidity." Proton pump inhibitors (PPIs), such as omeprazole (Prilosec), and CYP2C1 inhibitors, such as cimetidine (Tagamet), can be purchased over the counter to treat heartburn. However, patients taking clopidogrel should consult their healthcare provider before using them. PPIs and CYP2C1 inhibitors can reduce the antiplatelet effects of clopidogrel. Diarrhea (5% incidence), not constipation, is a side effect of clopidogrel. Patients should immediately contact the healthcare provider if signs of bleeding occur, such as bloody urine, stool, or emesis. The drug should not be stopped until the prescriber advises it, because this could lead to coronary stent restenosis. Consistency of vitamin K intake is indicated while taking warfarin (Coumadin).

Which statement made by a patient indicates a need for further teaching by the nurse about reducing injection site reactions from interferon beta?"I need to rotate my injection sites, so I'll need to keep a record of them." A "I will apply hydrocortisone ointment to the injection site if it is itchy." B "Applying a warm compress before giving the injection will reduce the risk of pain at the site." C "I can take over-the-counter Benadryl if the injection site itches and is red."

C "I can take over-the-counter Benadryl if the injection site itches and is red."

When administering an IV medication, the nurse injects the medicine in what minimum amount of time to reduce the risk of injury to the patient? A 10 seconds B 30 seconds C 60 seconds D 30 minutes

C 60 seconds IV drugs should be injected over at least 1 minute or longer, because all the blood in the body is circulated about once every minute. This allows the drug to be diluted in the largest volume of blood possible

The nurse is teaching a patient who has a new prescription for spironolactone (Aldactone). Which statement by the patient indicates that the teaching was effective? A "I will use salt substitutes to lower my sodium intake." B "I will increase my intake of foods that are high in potassium." C "I will call my doctor if I begin having menstrual irregularities." D "I will take this medication at bedtime each evening."

C "I will call my doctor if I begin having menstrual irregularities." Spironolactone is a potassium-sparing, aldosterone-blocking diuretic. As such, it can cause endocrine effects, such as gynecomastia, menstrual irregularities, impotence, hirsutism, and deepening of the voice. Patients taking spironolactone should avoid salt substitutes because they contain potassium, and high-potassium foods should be avoided with this drug. Ideally, all diuretics should be taken in the morning to prevent nocturia.

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 "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 evaluating the teaching done with a patient who has a new prescription for fosinopril (Monopril). Which statement by the patient indicates a need for further teaching? A "I can take this medicine with breakfast each morning." B "I will call if I notice a rash or wheals on my skin." C "I will use a salt substitute to lower my sodium intake." D "I will call if I develop a bothersome cough."

C "I will use a salt substitute to lower my sodium intake." Salt substitutes contain potassium and may increase the risk of hyperkalemia with ACE inhibitors, such as fosinopril. The patient should not take potassium supplements or use salt substitutes. The other statements are appropriate for this patient.

Which statement by a patient indicates understanding of teaching about leflunomide (ARAVA)? A "I'll need to learn how to give myself injections." B "Constipation is a common side effect, so I'll need to take a stool softener." C "I'll need to be extremely conscientious about taking my birth control pills." D "I'll need to have routine eye examinations to make sure I'm not having any side effects of the medication."

C "I'll need to be extremely conscientious about taking my birth control pills." Leflunomide is contraindicated during pregnancy and has been classified by the U.S. Food and Drug Administration (FDA) as Pregnancy Risk Category X. Women of child-bearing age must use a reliable form of contraception. Leflunomide is administered orally, not by injection. Diarrhea, not constipation, is a common adverse effect. Eye examinations are not essential.

A nurse teaches a patient who has ulcerative colitis about the side effects of the treatment medication, sulfasalazine (Azulfidine). Which statement by the patient would indicate understanding of the information? A "My tongue may become discolored and my taste altered." B "I may have constipation, so I'll increase my fluid intake." C "I'll report any fatigue or sore throat and fever to my doctor." D "I'll immediately report any chest pain or shortness of breath."

C "I'll report any fatigue or sore throat and fever to my doctor." Sulfasalazine is used to treat ulcerative colitis by suppressing inflammation. It has the adverse hematologic effects of agranulocytosis, hemolytic anemia, and macrocytic anemia. Patients should report any signs of infection and/or fatigue. Altered taste, tongue discoloration, constipation, chest pain, and shortness of breath are not effects associated with sulfasalazine.

Which statement by a patient taking ethambutol (Myambutol) indicates understanding of adverse effects of the drug? A "I will get up slowly when sitting to prevent me from getting dizzy." B "I'll increase the fiber and liquids in my diet to prevent constipation." C "I'll report any problems with blurred vision or determining colors." D "I'll immediately report any red-orange urine to my healthcare provider."

C "I'll report any problems with blurred vision or determining colors." Ethambutol can cause optic neuritis, resulting in disturbance of color discrimination and blurred vision. Symptoms resolve when the medication is discontinued. Orthostatic hypotension, constipation, and discoloration of urine are not known adverse effects of ethambutol.

A patient with Graves' disease is treated with iodine-131 (Iodope) therapy. Which statement by the patient would indicate understanding of the treatment's effects? A "I'll have to isolate myself from my family so I don't expose them to radiation." B "I'm looking forward to feeling better immediately after this treatment." C "I'll tell my doctor if I have fatigue, hair loss, or cold intolerance." D "I'll need to take this drug on a daily basis for at least 1 year."

C "I'll tell my doctor if I have fatigue, hair loss, or cold intolerance." Iodine-131 usually is given as a single treatment to produce remission of Graves' disease. Fatigue, hair loss, and cold intolerance are signs of hypothyroidism, which is a complication of the treatment. Iodine-131 has a quick radioactive decay and half-life; therefore, isolation is not needed, but it can take up to 2 months for the desired response to develop.

A nurse is teaching a patient who is to start taking an expectorant. The nurse provides the patient with which of these instructions? A "Restrict cold fluids to promote reduced mucus production." B "Take the medication once a day only, usually at bedtime." C "Increase your fluid intake to reduce the viscosity of secretions." D "Increase your fiber and fluid intake to prevent constipation."

C "Increase your fluid intake to reduce the viscosity of secretions." Expectorant drugs are used to reduce the viscosity of secretions, allowing them to be more easily expectorated. Reduction of mucus production is unrelated to an expectorant. Expectorants may be taken several times a day and do not cause constipation.

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 "It would be better to eat five or six small meals a day instead of three larger ones." Some optimal nondrug measures, in addition to drug management, to aid patients with peptic ulcers include 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.

An adult male patient has taken medication for management of hypertension for 3 years. He says to the nurse, "I'm not going to take these drugs anymore, because they are interfering with my sex life." Which response by the nurse would be most helpful? A "It is unfortunate that these drugs can cause erectile dysfunction, but managing your blood pressure is more important than your sexual performance." B "I understand how discouraging it must be to live with this adverse effect, but you could have a stroke if you do not take your blood pressure medicines." C "Let's discuss this effect with your prescriber. There are other drugs available to manage your blood pressure that may not have the same adverse effect." D "I am glad you told me about your experience with this adverse effect. Sexual performance can be a difficult subject to discuss."

C "Let's discuss this effect with your prescriber. There are other drugs available to manage your blood pressure that may not have the same adverse effect." Many antihypertensive medications can produce adverse sexual side effects, including impotence. It is important for the nurse to listen to the patient's concerns and to avoid making value judgments. Other antihypertensive medications may manage this patient's blood pressure without causing adverse sexual effects. Reducing the undesired effects of antihypertensive medication will improve the patient's adherence.

The nurse will include which statements when teaching a patient about the use of acetaminophen (Tylenol)? (Select all that apply.) A "Acetaminophen is a useful drug for the treatment of inflammation, such as a rheumatoid arthritis." B "The most common side effect of treatment with the drug is kidney failure." C "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." D "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." E "Use of this drug can prevent heart attack and stroke."

C "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." D "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." Acetaminophen (Tylenol) is used to treat fever and pain. It is not an anti-inflammatory drug. The most serious side effect of acetaminophen therapy is liver failure; therefore, the healthcare provider should be notified if indications of jaundice are seen, such as yellowing of the skin or sclera. Acetaminophen therapy has no antiplatelet activity; therefore, it is not used to prevent heart attack or stroke. Routine use of acetaminophen may blunt the immune response to vaccines; therefore, it should be avoided as routine treatment for vaccine-associated fever and pain.

The nurse is preparing to begin giving phenobarbital, which is known to induce CYP isozymes, to a patient on oral contraceptives. What patient teaching will the nurse expect to provide for this patient? A "Continue taking your medications as prescribed." B "Condoms are not necessary while taking phenobarbital. It is not an antibiotic." C "Plan to use another form of birth control while taking phenobarbital." D "Your dose of birth control pills will be reduced while you are taking phenobarbital."

C "Plan to use another form of birth control while taking phenobarbital." Phenobarbital induces CYP isozymes; therefore, it will increase the metabolism of other drugs. Because phenobarbital is an inducer, it will increase the metabolism of oral contraceptives. The nurse would anticipate that this would likely reduce the blood levels of birth control pills. The patient should use another form of birth control while taking phenobarbital.

The nurse is teaching a group of patients about dietary approaches to reduce cholesterol levels. Which statement is most important to include in the teaching? A "Lower your cholesterol to 300 mg/day." B "Eliminate red meat and pork from your diet." C "Read food labels and reduce your intake of saturated fats." D "Reduce salt consumption to keep your sodium intake to 2400 mg/day."

C "Read food labels and reduce your intake of saturated fats." An increase in dietary cholesterol intake does not produce a large increase in blood cholesterol because of the body's feedback system. When cholesterol intake increases, endogenous production decreases. However, because the body uses dietary saturated fats to make cholesterol, an increase in saturated fat intake can produce a significant increase in blood cholesterol levels. To lower blood cholesterol, it is most important to lower saturated fat intake. Although red meat and pork should be limited, it is not necessary to eliminate them from the diet. Sodium intake is not directly related to lowering cholesterol levels.

Which instruction by the nurse should be the priority for a patient scheduled to start intranasal cromolyn (NasalCrom)? A "It is only moderately effective." B "There are few adverse reactions." C "Relief may take a week or two." D "It suppresses histamine release."

C "Relief may take a week or two." Cromolyn is best suited for prophylaxis and should be given before symptoms start, because responses may take a week or 2 to develop. It is important for the patient to know about cromolyn's moderate effectiveness, few adverse reactions, and suppression of histamine release, but it is more important that the patient be informed of the delay in response.

The nurse is caring for a 60-year-old woman who has been prescribed oxybutynin (Ditropan) for the treatment of overactive bladder (OAB). Which statement by the nurse will be the most helpful to include in the teaching plan? A "You may experience a slower heart rate. Call your doctor if it is below 60." B "Ditropan is very effective. Most patients experience significant relief." C "Sip on water and hard candy to help with the problem of dry mouth." D "Antihistamines, such as Benadryl, can help with some of the side effects of Ditropan."

C "Sip on water and hard candy to help with the problem of dry mouth." Oxybutynin is an anticholinergic drug that commonly causes dry mouth. Other side effects include constipation, tachycardia, urinary hesitancy, urinary retention, and visual disturbances. Oxybutynin is only moderately effective (30% better than placebo). It should not be taken with other drugs with anticholinergic properties, such as antihistamines, because of the additive anticholinergic effects.

Which instruction should the nurse give a patient who is to take bismuth subsalicylate for eradication of H. pylori? A "Nausea and diarrhea are common side effects." B "Do not drink alcohol while taking this medication." C "The drug can cause your bowel movements to be black." D "Take the medication through a straw to prevent staining of your teeth."

C "The drug can cause your bowel movements to be black." Bismuth may impart a harmless black coloration to the tongue and the stool, and patients should be forewarned of this effect. Nausea and diarrhea are the most common side effects of clarithromycin (Biaxin), which also is used to treat H. pylori. Alcohol must be avoided when the patient is treated with metronidazole (Flagyl) for H. pylori infection, because it may cause a disulfiram-like reaction. Tetracycline, which is also highly active against H. pylori, can cause staining of developing teeth.

A patient newly diagnosed with MS asks the nurse how a person gets this disease. Which response by the nurse is most accurate and appropriate? A "Multiple sclerosis is a congenital condition that typically manifests itself in late adulthood." B "Multiple sclerosis is a disease believed to be caused by exposure to drugs during a mother's pregnancy." C "This is an autoimmune disease that occurs in people with certain genetic traits when they are exposed to some environmental trigger factor." D "This disease is most often caused by an increase of rapidly dividing cells in the central nervous system."

C "This is an autoimmune disease that occurs in people with certain genetic traits when they are exposed to some environmental trigger factor." Although the exact cause is unknown, MS is believed to have a genetic link. Susceptible individuals have an autoimmune response when exposed to environmental or microbial factors. It is more common among first-degree relatives of individuals who have the disease and is more prevalent among Caucasians. It also is more common in cooler climates, with increased incidence moving away from the equator. MS may also be associated with the Epstein-Barr virus, human herpesvirus 6, and Chlamydia pneumonia.

A patient with Parkinson's disease who has been positively responding to drug treatment with levodopa/carbidopa (Sinemet) suddenly develops a relapse of symptoms. Which explanation by the nurse is appropriate? A "You have apparently developed resistance to your current medication and will have to change to another drug." B "This is an atypical response. Unfortunately, there are no other options of drug therapy to treat your disease." C "This is called the 'on-off' phenomenon. Your healthcare provider can change your medication regimen to help diminish this effect." D "You should try to keep taking your medication at the current dose. These effects will go away with time."

C "This is called the 'on-off' phenomenon. Your healthcare provider can change your medication regimen to help diminish this effect." Patients who have been taking levodopa/carbidopa for a period of time may experience episodes of symptom return. Adding other medications to the drug regimen can help minimize this phenomenon.

A patient with asthma is scheduled to start taking a glucocorticoid medication with a metered-dose inhaler (MDI). The nurse should give the patient which instruction about correct use of the inhaler? A "After you inhale the medication once, repeat until you obtain symptomatic relief." B "Wait no longer than 30 seconds after the first puff before taking the second one." C "Use a spacer with the inhaler and rinse your mouth after each dose administration." D "Breathe in through the nose and hold for 2 seconds just before activating the inhaler."

C "Use a spacer with the inhaler and rinse your mouth after each dose administration." Spacers are available for use with MDIs to prevent the patient from swallowing the dose and to allow for maximum delivery of medication to the lungs. Rinsing the mouth after administration is important for inhaled glucocorticoids to prevent candidiasis. Glucocorticoid inhalers are used for long-term prophylaxis of asthma, not for symptomatic relief. When 2 puffs are needed, an interval of at least 1 minute should separate the first puff from the second. Inhaling through the mouth just before activating the MDI is the proper technique.

Discharge teaching about amiodarone should include which statements? (Select all that apply.) A "Take amiodarone with grapefruit juice." B "Take the medication on an empty stomach." C "Wear sunblock and protective clothing when you are outdoors." D "Check your pulse daily and report excessive slowing to your prescriber immediately." E "Report new onset of dyspnea, cough, and chest pain immediately to your prescriber."

C "Wear sunblock and protective clothing when you are outdoors." D "Check your pulse daily and report excessive slowing to your prescriber immediately." E "Report new onset of dyspnea, cough, and chest pain immediately to your prescriber." Patients frequently experience photosensitivity reactions while taking amiodarone. To reduce this risk, patients should avoid sunlamps and wear sunblock and protective clothing when outdoors. Excessive slowing of the heart rate may indicate that the patient is experiencing sinus bradycardia or an AV block. Dyspnea, cough, and chest pain may indicate pulmonary toxicity. Grapefruit juice should be avoided, because it may increase amiodarone levels and thus the risk of toxicity. Gastrointestinal side effects of amiodarone can be reduced by taking the drug on a full stomach.

Which instruction should be included in the teaching for a patient being started on the antihistamine azelastine (Astelin)? A "Take the pill in the morning before breakfast." B "Headache may be a side effect of the medication." C "You may experience an unpleasant taste in your mouth when using azelastine." D "You will experience a decrease in nasal congestion if the medication is working."

C "You may experience an unpleasant taste in your mouth when using azelastine." With both formulations of azelastine (Astelin and Astepro), patients often complain of an unpleasant taste. Azelastine is administered as an intranasal metered spray. Headache is a side effect of the intranasal antihistamine olopatadine. Antihistamines do not reduce nasal congestion.

Which instruction should be the priority for the nurse to teach a patient scheduled to start taking sirolimus (Rapamune)? A "A lipid-lowering medication can be given to lower cholesterol levels." B "There might be some joint pain, diarrhea, and rash with this medicine." C "You'll need to notify your doctor if you experience any sore throat or fever." D "Take this medication with food, but you'll need to avoid taking it with grapefruit juice."

C "You'll need to notify your doctor if you experience any sore throat or fever." Sirolimus is an immunosuppressant approved only for preventing renal transplant rejection. It raises the risk of infection, and patients need to take precautions to avoid sources of contagion. Side effects include rash, joint pain, diarrhea, and increased levels of cholesterol, and taking sirolimus with grapefruit juice inhibits the drug's metabolism; these are lower levels of priority than the infection risk.

When providing teaching for a patient starting flucytosine (Ancobon) therapy, the nurse identifies what as the priority concern? A "You will have weekly blood draws to monitor your liver function." B "Another very strong medication may be needed in addition to this one." C "You'll need to report any symptoms of bruising, fever, and fatigue." D "The dose is 10 pills, so take a few at a time over a 15-minute interval."

C "You'll need to report any symptoms of bruising, fever, and fatigue." Flucytosine (Ancobon) is used for serious infections caused by Candida and Cryptococcus neoformans. Bone marrow suppression may cause fatal agranulocytosis, so symptoms of bruising, fever, and fatigue could indicate life-threatening conditions. The other statements are true; however, they are not the priority concern. Flucytosine (Ancobon) is usually combined with amphotericin B. Treatment may require ingestion of 10 capsules 4 times per day. Taking these pills for a short time helps to reduce nausea. Hepatotoxicity is mild and reversible; liver function is monitored while the patient is receiving treatment.

The nurse is caring for several patients. For which patient is propranolol (Inderal) most likely to be contraindicated? A A 30-year-old woman with cardiac dysrhythmias B A 48-year-old man with hypertension C A 60-year-old woman with diabetes D A 72-year-old man with angina

C A 60-year-old woman with diabetes Propranolol inhibits glycogenolysis and thus can produce hypoglycemia, which can cause problems in patients with diabetes. It also suppresses tachycardia, which is an important warning sign of hypoglycemia in diabetic patients. It is safe to use propranolol in dysrhythmias, hypertension, and angina.

The nurse is monitoring a group of patients for adverse drug reactions (ADRs). Which patient is most at risk for developing drug toxicity? A A 30-year-old man admitted for altered mental status B A 55-year-old woman with abnormal arterial blood gas values C A 70-year-old woman with an elevated creatinine level D A laboring 25-year-old woman with a positive Homans' sign

C A 70-year-old woman with an elevated creatinine level The liver, kidneys, and bone marrow are important sites of drug toxicity. Creatinine is a measure of kidney function and would be the most helpful for monitoring for ADRs. In addition, patients over age 60 are at greater risk for ADRs. Mental status is a measure of central nervous system (CNS) function, which may be affected by drugs but is not one of the most important and common sites of drug toxicity. Arterial blood gas measurements reflect respiratory and acid-base function. Homans' sign is used to detect deep vein thromboses.

The nurse is caring for several patients. For which patient would a prescription for nifedipine (Adalat) be least appropriate? A A 60-year-old man with angina and hypertension B A 48-year-old woman with primary hypertension C A 78-year-old man with atrial fibrillation D A 55-year-old woman with vasospastic angina

C A 78-year-old man with atrial fibrillation Nifedipine produces very little blockade of the calcium channels of the heart; therefore, it is ineffective for treating dysrhythmias, such as atrial fibrillation. Therapeutic uses for nifedipine include the treatment of angina pectoris and essential hypertension.

The nurse demonstrates the concept of maximal efficacy by administering which drug for a headache that the patient describes as a "mild dullness" and a 2 and on a 1-10 scale? A Meperidine (Demerol) B Pentazocine (Talwin) C Acetaminophen (Tylenol) D Morphine sulfate

C Acetaminophen (Tylenol) Maximal efficacy is the greatest effect a drug can produce. Potency is the amount of drug that must be given to elicit an effect. Maximal efficacy illustrates the fact that all drugs have a maximal effect, and dosages beyond this do not increase the effect. The goal is to match the intensity of the response to the patient's needs; therefore, a drug with high maximal efficacy is not always most desirable. Demerol, Talwin, and morphine all have a higher maximal efficacy than Tylenol; therefore, Tylenol is the most desirable drug for a headache rated as "mild."

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.

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.

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 60-year-old man with an elevated triglyceride level is prescribed a pharmacologic dose of an extended-release form of nicotinic acid (Slo-Niacin). Which laboratory value takes priority for assessment when this patient is seen in the clinic? A Blood urea nitrogen (BUN) B Complete blood count (CBC) C Alanine aminotransferase (ALT) D Creatine kinase (CK)

C Alanine aminotransferase (ALT) The alanine aminotransferase (ALT or SGPT) would receive priority, because nicotinic acid is hepatotoxic and severe liver injury has been reported. Hepatotoxicity is more common with the extended-release formulation.

The nurse understands that the dose-response relationship is graded and therefore would expect to observe what? A Once a drug is given, the response is predictably all-or-nothing. B The response is maintained at a specific level when the therapeutic objective is achieved. C As the dosage increases, the response becomes progressively greater. D A graded response is based on relative potency and maximal efficacy.

C As the dosage increases, the response becomes progressively greater. If drug responses were all-or-nothing instead of graded, drugs could produce only one intensity level of response. The response may be maintained at a specific level when the therapeutic objective is achieved, but that option does not pertain to a dose-response relationship that is graded.

The nurse is preparing to give epinephrine by the IV push route. Which actions are essential before giving this drug? (Select all that apply.) A Check the blood urea nitrogen (BUN) and creatinine levels B Obtain insulin from the medication cart C Assess the patency of the IV line D Review the allergy history E Assess the vital signs

C Assess the patency of the IV line D Review the allergy history E Assess the vital signs All of the actions mentioned might be appropriate for this patient. However, because epinephrine can cause necrosis with extravasation, the first priority is to assess the patency of the IV line before beginning administration. Reviewing the patient's allergy history is essential, as is assessing the vital signs, particularly the heart rate and blood pressure. Epinephrine is a vasoconstrictor and can cause a dramatic increase in the heart rate and blood pressure.

The nurse identifies which medication as posing a significant risk of causing confusion, somnolence, psychosis, and visual disturbances in elderly patients? A Metronidazole (Flagyl) B Rifampin (Rifadin) C Ciprofloxacin (Cipro) D Daptomycin (Cubicin)

C Ciprofloxacin (Cipro) In elderly patients, ciprofloxacin (Cipro) poses a significant risk of confusion, somnolence, psychosis, and visual disturbances. Metronidazole, rifampin, and daptomycin are not associated with confusion in elderly patients.

The nurse is caring for a patient with myasthenia gravis who is beginning a new prescription of neostigmine (Prostigmin), 75 mg PO twice daily. What is the most important initial nursing action? A Obtain a measurement of the plasma level of neostigmine B Teach the patient to wear a Medic Alert bracelet C Assess the patient's ability to swallow D Check the patient's deep tendon reflexes (DTRs)

C Assess the patient's ability to swallow Patients with myasthenia gravis have decreased muscle strength and may have impaired swallowing. If swallowing is insufficient, the medication must be given by the parenteral route. Plasma levels are not as important when beginning medication. Neostigmine typically is dosed to symptoms. The patient should be taught to wear a Medic Alert bracelet and may need to have DTRs monitored, but assessing swallowing is a higher priority.

A nurse should consider which diagnostic test a priority to obtain before a patient receives iodine-131 (Iodotope)? A White blood cell (WBC) count B Electrocardiogram (ECG) C Beta human chorionic gonadotropin (hCG) test D Creatinine level

C Beta human chorionic gonadotropin (hCG) test Any female patient of reproductive age requires a negative result on a beta hCG (pregnancy hormone) test before iodine-131 (131I) can be administered. 131I is a radioactive isotope used to treat hyperthyroidism and is contraindicated in pregnancy and lactation. A WBC count, ECG, and creatinine level are not indicated before treatment with iodine-131.

Calcium channel blockers work by reducing calcium influx into the cells of the heart and blood vessels. Calcium channels are coupled to which type of autonomic nervous system receptors? A Alpha1 B Alpha2 C Beta1 D Beta2

C Beta1 Calcium channels are coupled to beta1-adrenergic receptors in the heart. For that reason, calcium channel blockers affect the heart in ways similar to the beta blockers. Both types of drugs cause a decrease in the force of contraction, heart rate, and cardiac impulse conduction.

When providing patient teaching for oral sulfonamide therapy, the nurse should instruct the patient to take the sulfonamide in what way? A At mealtime, when food is available B With soy or nonmilk products C Between meals with a full cup of water D On awakening before breakfast

C Between meals with a full cup of water Oral sulfonamides should be taken on an empty stomach and with a full glass of water. To minimize the risk of renal damage, adults should maintain a daily urine output of 1200 mL. Sulfonamides should not be taken with soy or nonmilk products or food or before breakfast without liquids.

Which statements about the care of a patient with aspirin poisoning does the nurse identify as true? (Select all that apply.) A Warming blankets are routinely used to raise the patient's temperature. B Diuretics and fluid restrictions are needed to correct the fluid overload commonly seen with aspirin poisoning. C Bicarbonate infusions are used to reverse acidosis and promote renal excretion of salicylates. D Activated charcoal is contraindicated in the treatment of aspirin poisoning. E Hemodialysis or peritoneal dialysis can accelerate salicylate removal.

C Bicarbonate infusions are used to reverse acidosis and promote renal excretion of salicylates. E Hemodialysis or peritoneal dialysis can accelerate salicylate removal. Aspirin poisoning is an acute medical emergency that requires hospitalization. Treatment is largely supportive and consists of external cooling (e.g., sponging with tepid water), infusion of fluids (to correct dehydration and electrolyte loss), infusion of bicarbonate (to reverse acidosis and promote renal excretion of salicylates), and mechanical ventilation (if respiration is severely depressed). Absorption of aspirin can be reduced by gastric lavage and by giving activated charcoal. If necessary, hemodialysis or peritoneal dialysis can accelerate salicylate removal.

The nurse is administering diphenhydramine (Benadryl), a neuropharmacologic agent that works by doing what? A Preventing mast cells from releasing histamine B Preventing axonal conduction C Binding to histamine receptors, preventing receptor activation D Acting as an agonist to H1 histamine receptors

C Binding to histamine receptors, preventing receptor activation Drugs that bind to receptors and prevent their activation include naloxone (used to treat overdose with morphinelike drugs), antihistamines (used to treat allergic disorders), and propranolol (used to treat hypertension, angina pectoris, and cardiac dysrhythmias).

Which assessment should a nurse monitor more frequently in a patient who takes both an alpha blocker for BPH and metoprolol (Lopressor)? A Blood glucose level B Hemoglobin level C Blood pressure D Urine output

C Blood pressure Caution must be exercised in combining an alpha blocker (terazosin [Hytrin], doxazosin [Cardura], Tamsulosin [Flomax], alfuzosin [Uroxatral]) with an antihypertensive medication such as metoprolol, because severe hypotension could result. Blood glucose, hemoglobin, and urine output are not affected by combining an alpha blocker and a hypertensive medication.

Before administering hydralazine (Apresoline), it is most important for the nurse to obtain which assessment? A Peripheral pulses B Homans' sign C Blood pressure D Capillary refill

C Blood pressure Hydralazine is a vasodilator that causes arteriolar dilation, decreased resistance, and decreased blood pressure. Monitoring of the blood pressure and heart rate is the highest assessment priority.

Before amiodarone therapy for atrial fibrillation is initiated, what should take place? A An ophthalmic examination should be performed. B A dermatologic evaluation should be performed. C Blood should be drawn for baseline serum thyroid and liver function studies. D Transesophageal echocardiogram (TEE) should be performed to rule out mural thrombus.

C Blood should be drawn for baseline serum thyroid and liver function studies. Amiodarone may cause hypothyroidism or hyperthyroidism and may also injure the liver. Serum thyroid and liver function levels should be assessed before treatment with amiodarone is started and periodically during treatment. Patients who develop changes in visual acuity or peripheral vision while taking amiodarone should have an ophthalmologic evaluation, but this is not necessary before starting therapy. A dermatologic examination and TEE are not necessary before initiation of amiodarone therapy. Although patients with atrial fibrillation are at risk for mural thrombus, amiodarone therapy itself does not pose a risk of systemic embolization.

Which factor in a patient's history is most likely related to the development of thiamine (vitamin B1) deficiency? A Exposure to asbestos B Heart transplant recipient C Chronic alcohol abuse D Gastric resection surgery

C Chronic alcohol abuse Thiamine deficiency is common in individuals who abuse alcohol. Thiamine requirements are related to caloric intake, and principal dietary sources are enriched, fortified, or whole-grain products, such as breads and cereals. Exposure to asbestos, heart transplantation, and gastric resection surgery are situations unrelated to thiamine deficiency.

Why are trade names much easier to say and remember than generic names? A The FDA assigns every drug's generic name. B Trade names must be the same regardless of which drug company manufactures the drug. C Companies have a marketing advantage when the trade name is easier to recognize. D Trade names improve oral and written communication in the healthcare system.

C Companies have a marketing advantage when the trade name is easier to recognize. The U.S. Adopted Names Council assigns a drug's generic name. Generic names, not trade names, are the same regardless of which company manufactures the drug. Trade names do not contribute to ease and clarity of communication in the healthcare system, because healthcare professionals do not always know what compound is described by the trade name.

Which finding in a patient taking oxymetazoline (Afrin) nasal spray every 2 hours would indicate that the patient has developed an adverse effect? A Dry mouth and constipation B Drowsiness and sedation C Congestion and stuffiness D Itching and skin rash

C Congestion and stuffiness Oxymetazoline is an effective nasal decongestant, but overuse results in worsening, or rebound, congestion. It should not be used more often than every 4 hours for several days. Dry mouth and constipation, drowsiness and sedation, and itching and skin rash are not adverse effects of oxymetazoline.

Which legislation set rules for the manufacture and distribution of drugs considered to have the potential for abuse? A Food, Drug, and Cosmetic Act of 1938 B Harris-Kefauver Amendments of 1962 C Controlled Substances Act of 1970 D Food and Drug Administration Modernization Act of 1997

C Controlled Substances Act of 1970 The Controlled Substances Act of 1970 set rules covering drugs of abuse and defined categories of controlled substances.

A patient is prescribed lisinopril (Prinvil) as part of the treatment plan for heart failure. Which finding indicates that the patient is experiencing the therapeutic effect of the drug? A + 2 edema of the lower extremities B Potassium level of 3.5 mEq/L C Crackles in the lungs are no longer heard D Jugular vein distention

C Crackles in the lungs are no longer heard Because ACE inhibitors promote venous dilation, they provide the therapeutic effect of reducing pulmonary congestion and peripheral edema. Absence of previously heard crackles would be an indicator of effectiveness. Edema and jugular vein distention are manifestations of heart failure. A potassium level of 3.5 mEq/L is a normal value.

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 Increase in red blood cell (RBC) indices B Decrease in pulse pressure C Decrease in bleeding tendency D Increase in mental alertness

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.

The nurse plans to closely monitor for which clinical manifestation after administering Furosemide (Lasix)? A Decreased pulse B Decreased temperature C Decreased blood pressure D Decreased respiratory rate

C Decreased blood pressure High-ceiling loop diuretics, such as furosemide, are the most effective diuretic agents. They produce more loss of fluid and electrolytes than any others. A sudden loss of fluid can result in decreased blood pressure. When blood pressure drops, the pulse probably will increase rather than decrease. Lasix should not affect respirations or temperature. The nurse should also closely monitor the patient's potassium level.

A 52-year-old male patient presents to the emergency department with symptoms of acute myocardial infarction. After a diagnostic workup, the healthcare provider prescribes a 15-mg IV bolus of alteplase (tPA), followed by 50 mg infused over 30 minutes. In monitoring this patient, the nurse understands that which symptom, if present, indicates the most likely adverse reaction to this drug? A Urticaria, itching, and flushing B Blood pressure of 90/50 mm Hg C Decreasing level of consciousness D Potassium level of 5.5 mEq/L

C Decreasing level of consciousness Unlike streptokinase, alteplase does not cause an allergic reaction or hypotension. The greatest risk with this drug is bleeding, with intracranial bleeding being the greatest concern. A decreasing level of consciousness indicates intracranial bleeding. Thrombolytic agents, such as alteplase, do not typically cause an elevated potassium level.

A nurse develops a plan of care for a pregnant patient receiving nifedipine (Procardia). Which outcome should be included? A Cervix shows softening and dilation. B Whole blood glucose is 110 mg/dL or less. C Delivery is postponed for at least 24 hours. D Breasts are soft with no evidence of engorgement.

C Delivery is postponed for at least 24 hours. Nifedipine acts to block the entry of calcium into myometrial cells, thus suppressing preterm labor for at least 24 hours. Cervical ripening and breast engorgement are not affected. Procardia has no effect on blood glucose.

The nurse is caring for a patient who takes quinidine (Quinaglute) for a supraventricular dysrhythmia. What is a common adverse effect of this drug? A Constipation B Urinary retention C Diarrhea D Blurred vision

C Diarrhea Diarrhea and other gastrointestinal problems occur in approximately one-third of patients who take quinidine. This is the most common reason patients stop taking the drug.

Which medication is not associated with prolongation of the QT interval? A Dofetilide (Tikosyn) B Sotalol (Betapace) C Diltiazem (Cardizem) D Dronedarone (Multaq)

C Diltiazem (Cardizem) Diltiazem does not prolong the QT interval. Dofetilide, sotalol, and dronedarone all prolong the QT interval, putting the patient at risk for torsades de pointes.

Which medication combination is useful in the treatment of variant angina? A Metoprolol (Lopressor) and ranozaline (Ranexa) B Isosorbide dinitrate (Isordil) and metoprolol (Lopressor) C Diltiazem (Cardizem) and isosorbide mononitrate (Imdur) D Propranolol (Inderal) and diltiazem (Cardizem)

C Diltiazem (Cardizem) and isosorbide mononitrate (Imdur) Variant angina, also known as Prinzmetal's or vasospastic angina, is a result of coronary artery vasospasm. Drug combinations used to prevent and/or relax the coronary artery are calcium channel blockers (e.g., diltiazem) and organic nitrates (e.g., isosorbide mononitrate). Beta blockers (metoprolol and propranolol) and ranozaline, although effective in stable angina, are ineffective for treating variant angina.

A 63-year-old male patient has been receiving a heparin infusion for 2 days for treatment of pulmonary embolism. Which symptom most clearly relates to an adverse effect of heparin? A Heart rate of 60 beats per minute B Blood pressure of 160/88 mm Hg C Discolored urine D Wheezing

C Discolored urine The primary and most serious adverse effect of heparin is bleeding. Bleeding can occur from any site and may be manifested in various ways, including reduced blood pressure, increased heart rate, bruises, petechiae, hematomas, red or black stools, cloudy or discolored urine, pelvic pain, headache, and lumbar pain.

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 Drowsiness B Risk for abuse C Dizziness D Weight gain

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.

Which medication is useful for stimulating the appetite in patients with acquired immunodeficiency syndrome (AIDS)? A Aprepitant (Amend) B Ondansetron (Zofran) C Dronabinol (Marinol) D Metoclopramide (Reglan)

C Dronabinol (Marinol) Dronabinol is used to stimulate the appetite in patients with AIDS. It is administered before lunch and dinner. Aprepitant, ondansetron, and metoclopramide are used to prevent and treat emesis.

The nurse is assessing a patient in a clinic who has been taking clonidine (Catapres) for hypertension. Which findings are most indicative of an adverse effect of this drug? A Cough and wheezing B Epigastric pain and diarrhea C Drowsiness and dry mouth D Positive Coombs' test result and anemia

C Drowsiness and dry mouth Drowsiness and dry mouth are common adverse effects (35% to 40%) associated with clonidine. The other effects are not commonly associated with clonidine.

The nurse is caring for a patient who has jaundice, dark urine, malaise, light-colored stools, nausea, and vomiting. This patient is most likely experiencing what? A An idiosyncratic drug effect on the bone marrow B Iatrogenic disease of the kidneys C Drug toxicity of the liver D An allergic reaction

C Drug toxicity of the liver Drug toxicity is an adverse drug reaction in which certain drugs are toxic to specific organs. Signs and symptoms of liver toxicity include jaundice, dark urine, light-colored stools, nausea, vomiting, malaise, abdominal discomfort, and loss of appetite.

When assessing a patient who takes finasteride (Proscar), a nurse should monitor for which adverse effect? A Hair loss B Increased libido C Ejaculatory dysfunction D Muscle weakness

C Ejaculatory dysfunction Common adverse effects of finasteride include impotence, decreased libido, and decreased volume of ejaculate. The drug also is used to treat male pattern baldness; therefore, it would cause hair growth, not hair loss. Muscle weakness is unrelated.

When administering prednisone to a patient, the nurse will do what? A Administer the prednisone in the evening to coincide with the natural secretion pattern of the adrenal cortex. B Instruct the patient to stop taking the prednisone immediately if diarrhea develops. C Ensure that meals are at bedside so that administration with food reduces gastric irritation. D Avoid intravenous delivery to prevent adverse effects.

C Ensure that meals are at bedside so that administration with food reduces gastric irritation. Glucocorticoids given in larger pharmacologic doses for nonendocrine causes produce many adverse effects, including gastric irritation and ulcers. They should be given with food. Doses should be administered before 9 AM to maximize endocrine function. Prednisone should not be stopped abruptly; the patient should contact the healthcare provider before discontinuing the medication. The drug may be administered by many routes, including the parenteral route.

A nurse instructs a patient that which nonprescription medication requires patient identification and a signature for purchase? A Chlorpheniramine (Chlor-Trimeton) B Cetirizine (Zyrtec) C Ephedrine D Ipratropium bromide (Atrovent)

C Ephedrine Ephedrine is a sympathomimetic agent associated with abuse, because it can be converted to methamphetamine. Legal availability has been reduced by having the product behind the counter, and patients must present identification and sign a log for purchase. Chlorpheniramine and cetirizine are first- and second-generation antihistamines that are available without legal constraints. Ipratropium bromide, an anticholinergic intranasal agent for allergic rhinitis, also does not require patient identification.

Which condition is an indication for the use of succinylcholine (Anectine)? A Pain relief after major surgery B Loss of consciousness during surgery C Facilitation of endotracheal intubation D Relief of status epilepticus

C Facilitation of endotracheal intubation Succinylcholine is an ultra-short-acting NM blocker used to facilitate insertion of an endotracheal tube for mechanical ventilation. Because an intact gag reflex can fight tube insertion past the glottis and into the trachea, reflexes can be suppressed temporarily by this short-acting agent. It does not provide pain relief or loss of consciousness. It is not indicated for the treatment of status epilepticus.

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

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.

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)

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).

The Seventh Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7 report), released in 2003, is the guiding document for treatment of hypertension in the United States. Which principles are included in these guidelines? (Select all that apply.) A People with blood pressure above 120 to 139 systolic and 80 to 89 diastolic should receive medication treatment. B In people older than 50 years, an elevated diastolic blood pressure is more dangerous than an elevated systolic pressure. C For most patients, thiazide diuretics should be used as the initial medication therapy. D Blood pressure should be measured twice at a clinic visit, with the patient seated in a chair with feet on the floor. E The diagnosis of hypertension typically is made after several elevated readings at more than one clinic visit.

C For most patients, thiazide diuretics should be used as the initial medication therapy. D Blood pressure should be measured twice at a clinic visit, with the patient seated in a chair with feet on the floor. E The diagnosis of hypertension typically is made after several elevated readings at more than one clinic visit. Patients with prehypertension (120 to 139/80 to 89) should adopt lifestyle changes. Medication therapy is not indicated until the blood pressure (BP) is higher than 140 systolic or 90 diastolic. In people older than age 50 years, an elevated systolic BP is more dangerous than an elevated diastolic BP. Thiazide diuretics lower BP by reducing blood volume and arterial resistance. They are considered the initial first-line therapy for most patients. Hypertension generally is diagnosed after repeated elevated measurements. The BP should be measured twice, 5 minutes apart, with the patient seated in a chair with the feet on the floor.

A nurse monitors a patient who is receiving an aminoglycoside (gentamicin) for symptoms of vestibular damage. Which finding should the nurse expect the patient to have first? A Unsteadiness B Vertigo C Headache D Dizziness

C Headache Gentamicin causes irreversible ototoxicity, which results in both impaired hearing and disruption of balance. Headache is the first sign of impending vestibular damage (balance) and may last 1 to 2 days. Unsteadiness, vertigo, and dizziness appear after headache.

The nurse knows that the advantage of patients having multiple types of receptors to regulate bodily functions is what? A Improved maximal efficacy B Reduction of side effects and toxicity C Higher degree of selectivity D Lower therapeutic index

C Higher degree of selectivity Selectivity is one of the most desirable qualities a drug can have. Many neuropharmacologic drugs are highly selective, because the nervous system works through multiple receptors to regulate processes under its control.

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)

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.

A nurse administers naloxone (Narcan) to a postoperative patient experiencing respiratory sedation. What undesirable effect would the nurse anticipate after giving this medication? A Drowsiness B Tics and tremors C Increased pain D Nausea and vomiting

C Increased pain Naloxone reverses the effects of narcotics. Although the patient's respiratory status will improve after administration of naloxone, the pain will be more acute.

The nurse is reviewing drugs on the emergency cart with regard to their therapeutic action. Which medications can help initiate heart contraction during a cardiac arrest? A Topical phenylephrine B Subcutaneous terbutaline C Intravenous epinephrine D Inhaled albuterol

C Intravenous epinephrine When beta1 receptors are activated, cardiac contraction is stimulated. When a beta1 agonist is indicated, epinephrine (given IV) is the preferred drug. Beta1 agonist drugs (e.g., epinephrine), which are kept on the emergency cart, may be injected directly into the heart during an arrest. Alpha1 activation causes hemostasis, nasal decongestion, vasoconstriction, and mydriasis. Alpha2 activation reduces sympathetic outflow to the heart and blood vessels and relieves severe pain. Beta2 activation causes bronchodilation and relaxation of uterine smooth muscle. Topical phenylephrine is helpful for nasal congestion. Terbutaline is indicated for preterm labor and/or asthma. Albuterol is indicated for asthma.

The antiretroviral medication raltegravir (Isentress) achieves therapeutic effectiveness through which action when administered to a patient infected with HIV? A It blocks the entry of HIV into CD4 T cells. B It increases protease enzyme activity. C It inhibits the enzyme integrase. D It destroys reverse transcriptase.

C It inhibits the enzyme integrate. Raltegravir is the first and only member of a new class of antiretroviral medications, the HIV integrase inhibitors. Integrase is one of three viral enzymes needed for HIV-derived DNA insertion into DNA of CD4 T cells. Raltegravir effectively blocks HIV replication. It does not increase protease enzyme activity or destroy reverse transcriptase. Blocking HIV entry into CD4 T cells is an action of other antiretroviral medications, not raltegravir.

The nurse knows that which statement is accurate for enoxaparin (Lovenox)? A It equally reduces the activity of thrombin and factor Xa. B It has selective inhibition of factor Xa and no effect on thrombin. C It reduces the activity of factor Xa more than the activity of thrombin. D It has a lower bioavailability and shorter half-life than unfractionated heparin.

C It reduces the activity of factor Xa more than the activity of thrombin. Enoxaparin acts primarily on factor Xa and also but to a lesser degree on thrombin. Unfractionated heparin equally reduces the action of thrombin and factor Xa. Fondaparinux (Arixtra) causes selective inhibition of factor Xa. Low-molecular-weight (LMW) heparins, such as enoxaparin, have greater bioavailability and a longer half-life than those of unfractionated heparin.

A patient with acute renal failure requires continuous NM blockade to facilitate oxygenation and mechanical ventilation. Which agent prescribed by the physician should the nurse question? A Atracurium (Tracrium) B Cisatracurium (Nimbex) C Pancuronium (Pavulon) D Vecuronium (Norcuron)

C Pancuronium (Pavulon) The order for pancuronium should be questioned, because elimination of this drug is primarily renal. Atracurium is eliminated primarily by plasma cholinesterase; cisatracurium is eliminated through spontaneous degradation; and vecuronium is excreted primarily through the bile.

A patient who takes cromolyn (Intal) for exercise-induced bronchospasm should follow which approach for maximum therapeutic effectiveness? A It should be used infrequently because of systemic adverse effects. B One 10-mg tablet should be taken at least 2 hours before exercising. C It should be administered by inhalation 15 minutes before anticipated exertion. D It should be used as a quick-relief agent if exercise triggers asthma symptoms.

C It should be administered by inhalation 15 minutes before anticipated exertion. Cromolyn suppresses inflammation through inhibition of histamine release. It must be administered at least 15 minutes before exertion to prevent exercise-induced bronchospasm. It is administered by inhalation only. It is not a bronchodilator and cannot abort an ongoing attack. It is one of the safest antiasthma medications and has no systemic adverse effects.

Which medication requires screening for tuberculosis before treatment is started? A Celecoxib (Celebrex) B Minocycline (Minocin) C Leflunomide (ARAVA) D Sulfasalazine (Azulfidine)

C Leflunomide (ARAVA) Screening for tuberculosis is necessary before treatment with leflunomide is started, because this medication can increase the risk for severe infection, including tuberculosis. The other medications do not require tuberculosis screening.

A nurse administers palifermin to reduce oral mucositis from chemotherapy in a patient with which type of malignancy? A Brain B Breast C Leukemia D Lung

C Leukemia In the treatment of oral mucositis, palifermin acts through keratinocyte growth factor (KGF) receptors to stimulate the proliferation and migration of epithelial cells. Because these receptors are not found on cells of hematopoietic origin, palifermin is used only in hematologic malignancies. Palifermin is not indicated for oral mucositis treatment in patients with solid tumors of the brain or breast or for lung cancer.

The nurse understands that cholesterol is carried through the blood by means of lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis? A Very-low-density lipoprotein (VLDL) B Apolipoprotein B-100 C Low-density lipoprotein (LDL) D High-density lipoprotein (HDL)

C Low-density lipoprotein (LDL) Cholesterol is the primary core lipid of LDLs, which are responsible for carrying cholesterol to tissues outside the liver. Of all the lipoproteins, LDLs are the most significant contributors to coronary atherosclerosis. When pharmacologic agents are used to lower cholesterol, the primary goal is to reduce elevated LDL levels.

A patient with a history of Parkinson's disease treated with selegiline (Eldepryl) has returned from the operating room after an open reduction of the femur. Which physician order should the nurse question? A Decaffeinated tea, gelatin cubes, and ginger ale when alert B Docusate 100 mg orally daily C Meperidine 50 mg IM every 4 hours as needed for pain D Acetaminophen 650 mg every 6 hours as needed for temperature

C Meperidine 50 mg IM every 4 hours as needed for pain Selegiline can have a dangerous interaction with meperidine, leading to stupor, rigidity, agitation and hyperthermia; therefore, this order should be questioned. Foods that contain tyramine should be restricted, but there is no contraindication to the fluids that have been ordered. Docusate and acetaminophen are not contraindicated for use with selegiline.

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

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.

The nurse is assessing a patient receiving valproic acid (Depakene) for potential adverse effects associated with this drug. What is the most common problem with this drug? A Increased risk of infection B Reddened, swollen gums C Nausea, vomiting, and indigestion D Central nervous system depression

C Nausea, vomiting, and indigestion Valproic acid is generally well tolerated. Gastrointestinal effects, which include nausea, vomiting, and indigestion, are the most common problems but tend to subside with use and can be lessened by taking the medication with food. Valproic acid does not cause hematologic effects resulting in an increased risk of infection, nor does it cause gingival hyperplasia. It causes minimal sedation.

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

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.

A patient admitted with atrial fibrillation is receiving a continuous heparin infusion as well as . daily warfarin (Coumadin). What is an appropriate action by the nurse? A Contact the healthcare provider for an order to stop the heparin, because the aPTT is 60 seconds. B Contact the healthcare provider to request discontinuation of the heparin, because the patient is receiving Coumadin. C Notify the healthcare provider that the INR is 3 and anticipate that the heparin will be discontinued. D Prepare to administer protamine sulfate, because the patient has received two anticoagulants at the same time.

C Notify the healthcare provider that the INR is 3 and anticipate that the heparin will be discontinued. The INR is within a therapeutic range (2 to 3), so the nurse should call the health care provider to get the heparin infusion discontinued. An aPTT of 60 indicates the heparin is therapeutic with no indication that the patient has achieved the therapeutic effect of warfarin. The patient will be on a combination of heparin and warfarin until the therapeutic effect of warfarin has been achieved, and this may take several days. The patient will have no protective effect against clotting if the heparin is reversed with protamine sulfate and the INR is not within a therapeutic range.

A patient is scheduled to start taking aspirin for the treatment of rheumatoid arthritis. The nurse anticipates that which medication most likely will be prescribed? A Docusate sodium (Colace) B Ascorbic acid (vitamin C) C Pantoprazole (Protonix) D Furosemide (Lasix)

C Pantoprazole (Protonix) Aspirin inhibits COX-2 and thus suppresses inflammation and reduces moderate pain and fever. It also suppresses COX-1, which increases the risk for gastric ulceration and bleeding. This risk can be reduced through administration of a proton pump inhibitor, such as pantoprazole (Protonix). It is not necessary for a patient to take vitamin C or docusate sodium while taking aspirin. Although aspirin may cause sodium and water retention in patients who have pre-existing renal dysfunction, it is not necessary for all patients to take furosemide (Lasix) with aspirin.

The nurse is conducting a pain assessment for a patient with cancer. Which data will be the most helpful in assessing the patient's current level of pain? A Vital signs and surgical history B Pain pump attempt history C Patient's description of pain D Patient's nonverbal behavior

C Patient's description of pain The patient is the expert on his or her pain experience. The patient's description is the most accurate and useful information. The other data may help with the assessment, but no information is more important than the patient's description.

It is most important for the nurse to assess a patient taking itraconazole (Sporanox) for the development of what? A Hair loss B Skin rash C Pedal edema D Joint pain

C Pedal edema Itraconazole (Sporanox) has negative inotropic actions and may cause a transient decrease in the ventricular ejection fraction, thus precipitating heart failure. Pedal edema is a symptom of heart failure, and the nurse should assess for it. Skin rash, hair loss, and joint pain are unrelated to the use of itraconazole.

Before administering a cephalosporin to a patient, it is most important for the nurse to assess the patient for an allergy history to what? A Soy products B Peanuts C Penicillins D Opioids

C Penicillins The cephalosporins are beta-lactam antibiotics similar in structure and actions to the penicillins. They are contraindicated in patients with a history of severe allergic reactions to penicillins. The use of soy products, peanuts, and opioids is unrelated to cephalosporins.

A nurse observes a red streak and palpates the vein as hard and cordlike at the intravenous (IV) site of a patient receiving cefepime (Maxipime). Which assessment should the nurse make about the IV site? A An allergic reaction has developed to the drug solution. B The drug has infiltrated the extravascular tissues. C Phlebitis of the vein used for the antibiotic has developed. D Local infection from bacterial contamination has occurred.

C Phlebitis of the vein used for the antibiotic has developed. IV cephalosporins may cause thrombophlebitis. To minimize this, the injection site should be rotated and a dilute solution should be administered slowly. An allergic response would be shown as itching, redness, and swelling. Infiltration would show as a pale, cool, and puffy IV site. Infection would show as pus, tenderness, and redness.

The nurse is caring for a patient who takes spironolactone (Aldactone) and quinapril (Accupril) for treatment of heart failure. Which symptom, if found, would indicate a potential interaction between these two drugs? A Elevated serum quinapril level B Heart rate of 58 beats per minute C Potassium level of 5.7 mEq/L D Glucose level of 180 mg/dL

C Potassium level of 5.7 mEq/L Both spironolactone, a potassium-sparing diuretic, and quinapril, an angiotensin-converting enzyme (ACE) inhibitor, can increase potassium levels. These agents together do not increase quinapril levels, lower the heart rate, or raise the blood glucose level.

A nurse should take which action when administering an intravenous piggyback (IVPB) of pantoprazole (Protonix) 40 mg? A Administer the infusion at least 1 hour before a meal B Avoid giving the infusion within 30 minutes of an antibacterial agent C Prevent precipitates by using an in-line filter D After reconstitution of the drug, administer the infusion over 5 minutes

C Prevent precipitates by using an in-line filter Pantoprazole is a PPI given to treat peptic ulcer disease. For IV therapy, an in-line filter must be used to remove any precipitate. The infusion may be given without regard to food. IVPB infusions are done over 15 minutes. Giving an antibacterial agent is unrelated to IV administration.

A patient has been diagnosed with performance anxiety. The nurse anticipates use of which drug to treat this psychologic disorder? A Clonazepam (Klonopin) B Alprazolam (Xanax) C Propranolol (Inderal) D Sertraline (Zoloft)

C Propranolol (Inderal) Propranolol (Inderal) and other beta blockers can benefit patients with performance anxiety. When taken 1 to 2 hours before a scheduled performance, beta blockers can reduce symptoms caused by autonomic hyperactivity (e.g., tremors, sweating, tachycardia, palpitations). Doses are relatively small (e.g., only 10 to 80 mg for propranolol).

The nurse is monitoring a patient receiving ranolazine (Ranexa) for angina. Which finding indicates an adverse effect of this drug? A Blood pressure of 90/50 mm Hg B Frequent bloody stools C QT prolongation on the electrocardiogram D Respiratory rate of 11 breaths per minute

C QT prolongation on the electrocardiogram Ranolazine can cause an increase in the QT interval on the electrocardiogram (ECG), mostly with increased doses. Other adverse effects include elevated blood pressure, headache, nausea, dizziness, and constipation.

Which is a true statement about new drug development in the United States? A Development and testing of new drugs take about 3 to 5 years. B About 50% of drugs undergoing clinical trials gain approval. C Randomized controlled trials are the best way to assess drug therapy. D The cost of developing a new drug is usually around $1 million.

C Randomized controlled trials are the best way to assess drug therapy. New drug development takes about 6 to 12 years, and costs can exceed $ 1 billion. Only about 1 in 5 drugs undergoing clinical trials gains approval. Randomized controlled trials are the most reliable way to objectively assess drug therapies and are used to evaluate all new drugs.

The drug the nurse is about to give induces P-glycoprotein (PGP). What outcome might the nurse expect when this drug is given with other drugs? A Increased levels of other drugs B Increased side effects of other drugs C Reduced absorption of other drugs D Reduced drug elimination

C Reduced absorption of other drugs Drugs that induce PGP can cause reduced absorption of other drugs, which would reduce their levels. A PGP inducer would not increase the side effects of other drugs and could increase elimination of other drugs.

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

C 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 is receiving vancomycin (Vancocin). The nurse identifies what as the most common toxic effect of vancomycin therapy? A Ototoxicity B Hepatotoxicity C Renal toxicity D Cardiac toxicity

C Renal toxicity The most common toxic effect of vancomycin (Vancocin) therapy is renal toxicity. Although ototoxicity may occur, it is rare. The liver and heart are not affected when vancomycin is used.

A patient who has acquired immunodeficiency syndrome (AIDS) is receiving trimethoprim/sulfamethoxazole (Bactrim). Which response should a nurse expect if the medication is achieving the desired effect? A Increase in CD4 T cells B Increased appetite and weight gain C Resolution of pneumonia D Decrease in joint pain

C Resolution of pneumonia Trimethoprim/sulfamethoxazole is the treatment of choice for Pneumocystis pneumonia (PCP), an infection caused by Pneumocystis jiroveci (formerly thought to be Pneumocystis carinii). PCP is an opportunistic pneumonia caused by a fungus that thrives in immunocompromised hosts. It does not increase the number of CD4 T cells, the targeted cells of the human immunodeficiency virus (HIV), nor does it affect joint pain. Increased appetite and weight gain are not therapeutic actions of trimethoprim/sulfamethoxazole.

Which outcome would be most appropriate for a nurse to establish for a patient with a cough who takes an antitussive with codeine? A Warm, dry, pink skin B Oriented to time, place, and person C Respiratory rate of 12 to 24 breaths per minute D Effective productive cough

C Respiratory rate of 12 to 24 breaths per minute Codeine, an opioid analgesic that acts through the CNS, effectively suppresses the frequency and intensity of cough. However, it also can suppress respiration, and overdose can be fatal. Doses are small (one-tenth those needed to relieve pain), so orientation and peripheral effects are minimal.

Which drug property is most enhanced by the presence of many different types of receptors throughout the body? A Potency B Safety C Selectivity D Convenience

C Selectivity Because each receptor regulates just a few processes, selective drug action is possible. Multiple types of receptors do not have as much effect on potency, safety, or convenience.

The nurse is caring for an adult male with renal artery stenosis who has been prescribed benazepril (Lotensin). Which symptom, if found, indicates an adverse effect of this drug? A Potassium level of 3.2 mEq/L B Blood glucose level of 180 mg/dL C Serum creatinine level of 2.3 mg/dL D Uric acid level of 10 mg/dL

C Serum creatinine level of 2.3 mg/dL Patients with bilateral renal artery stenosis are at increased risk for renal insufficiency and failure with angiotensin-converting enzyme (ACE) inhibitors, such as benazepril. ACE inhibitors do not typically cause hypokalemia, hyperglycemia, or hyperuricemia.

The nurse is caring for a patient with heart failure who needs a diuretic. Which agent is likely to be chosen, because it has been shown to greatly reduce mortality in patients with heart failure? A Furosemide (Lasix) B Hydrochlorothiazide (HydroDIURIL) C Spironolactone (Aldactone) D Mannitol (Osmitrol)

C Spironolactone (Aldactone) Spironolactone is a potassium-sparing diuretic used to treat both hypertension and edema. It is a preferred drug in heart failure, because it has been shown to have a cardioprotective effect, reducing mortality in patients with heart failure.

A patient who is near term gestation is receiving oxytocin (Pitocin). Which response should the nurse expect if the medication is having the desired therapeutic effect? A Decreased force of uterine contraction B Promotion of cervical ripening C Stimulation of uterine smooth muscle D Inhibition of milk ejection reflex

C Stimulation of uterine smooth muscle Oxytocin is a hormone used in labor induction to promote the force, frequency, and duration of uterine contractions and to stimulate the milk ejection reflex. Cervical ripening needs to have occurred before oxytocin is used, but this is not an effect of oxytocin.

Which outcome should a nurse establish as a priority for a patient taking an oral glucocorticoid for long-term treatment of asthma? A Increases the daily intake of vitamin D and calcium. B Records daily peak expiratory flow rates. C Supplements additional doses at times of stress. D Uses alternate-day therapy to reduce adverse effects.

C Supplements additional doses at times of stress. Adrenal suppression can be profound with oral glucocorticoid use. It is a priority that patients take supplemental oral or intravenous doses at times of stress; failure to do so can be fatal. Alternate-day dosing, using a peak flowmeter, and minimizing bone loss with vitamin D and calcium intake are important; however, they are not as important as supplemental doses of glucocorticoid at times of stress.

A transplant recipient is receiving cyclosporine (Sandimmune). Which response should a nurse expect if the medication is having the desired effect? A Increased antibody response B Increased natural killer (NK) cellular activity C Suppression of T lymphocytes D Suppression of hepatic metabolism of steroids

C Suppression of T lymphocytes Immunosuppressants inhibit T-lymphocyte synthesis through inhibition of calcineurin, thus reducing the immune response to organ transplants. Increased antibody response, increased NK cellular activity, and suppression of hepatic metabolism of steroids are not actions of cyclosporine.

A patient is taking glipizide (Glucotrol) and a beta-adrenergic medication. A nurse is teaching hypoglycemia awareness and should warn the patient about the absence of which symptom? A Vomiting B Muscle cramps C Tachycardia D Chills

C Tachycardia Glipizide is a sulfonylurea oral hypoglycemic medication that acts to promote insulin release from the pancreas. Beta-adrenergic blockers can mask early signs of sympathetic system responses to hypoglycemia; the most important of these is tachycardia, which is the most common adverse effect of glipizide. Vomiting, muscle cramps, and chills are not symptoms of activation of the sympathetic nervous system that arise when glucose levels fall.

The nurse is administering a drug with a low therapeutic index and monitors the patient closely. Why? A The average lethal dose of the drug is much higher than the therapeutic dose. B The dose required to produce a therapeutic response in 50% of patients is low. C The highest dose needed to produce a therapeutic effect is close to the lethal dose. D There is a low variability of responses to this drug.

C The highest dose needed to produce a therapeutic effect is close to the lethal dose. A low therapeutic index indicates that the high doses needed to produce therapeutic effects in some people may be large enough to cause death. A high therapeutic index is more desirable, because the average lethal dose is higher than the therapeutic dose. Low variability of responses to a drug is not the definition of a low therapeutic index.

An immunocompromised patient who is receiving piperacillin/tazobactam (Zosyn) develops oozing and bleeding from the gums. Which additional data should the nurse determine? A Whether the patient has a fever above 100.5°F B Whether the patient reports any painful teeth C The most recent platelet count D The last time mouth care was given

C The most recent platelet count Piperacillin/tazobactam (Zosyn) is an extended-spectrum penicillin used primarily for infections caused by Pseudomonas aeruginosa in immunocompromised hosts. It can cause bleeding secondary to disrupting platelet function; therefore, the platelet count may be altered. High fever, painful teeth, and mouth care do not address the patient's bleeding gums.

What is the goal of pharmacologic therapy in the treatment of Parkinson's disease? A To increase the amount of acetylcholine at the presynaptic neurons B To reduce the amount of dopamine available in the substantia nigra C To balance cholinergic and dopaminergic activity in the brain D To block dopamine receptors in both presynaptic and postsynaptic neurons

C To balance cholinergic and dopaminergic activity in the brain Parkinson's disease results from a decrease in dopaminergic (inhibitory) activity, leaving an imbalance with too much cholinergic (excitatory) activity. With an increase in dopamine, the neurotransmitter activity becomes more balanced, and symptoms are controlled.

The nurse is caring for a patient receiving nitrates for relief of angina. What pharmacodynamic action is responsible for the relief of anginal pain with nitrates? A Vasoconstriction leads to improved cardiac output. B Decreased force of contraction leads to decreased oxygen demand. C Vasodilation leads to decreased preload, which decreases oxygen demand. D Influx of calcium ions leads to relaxation of vascular smooth muscle.

C Vasodilation leads to decreased preload, which decreases oxygen demand. The primary action of nitroglycerin is vasodilation, which leads to decreased venous return, decreased ventricular filling, and decreased preload, thus reducing oxygen demand on the heart.

The nurse is preparing to administer a medication with the following order: "Aldomet 250 mg daily." What should the nurse do? A)Administer the medication as it was given last time. B)Administer the medication by mouth. C)Verify the order with the prescriber. D)Ask the patient how this medication is usually given.

C Verify the order with the prescriber. This order does not include a drug route. The nurse should clarify any questionable orders with the prescriber. The other responses are incorrect.

The nurse is caring for a patient with heart failure who takes digoxin (Lanoxin). Which finding would require immediate attention by the nurse? A Potassium level of 3.7 mEq/L B Digoxin level of 0.7 ng/mL C Vomiting and diarrhea D Heart rate of 68 beats per minute

C Vomiting and diarrhea Vomiting and diarrhea can lead to hypokalemia, which increases the risk of digoxin toxicity. These symptoms, along with nausea, fatigue, and visual disturbances, also may precede digoxin toxicity and warrant further attention. The heart rate, potassium level, and digoxin level are all within normal range.

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?"

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 teaching a patient with a history of anaphylaxis how to use an EpiPen. Which statement made by the patient indicates that he understands the proper use of this drug? A "I will keep my medication in the refrigerator when I'm not using it." B "I should take this medication within 30 minutes of the onset of symptoms." C "I must remove my pants before injecting the medication into the leg." D "I will jab this medication firmly into my outer thigh if needed."

D "I will jab this medication firmly into my outer thigh if needed." The EpiPen should be stored in a cool, dark place, but refrigeration can damage the injection mechanism. The medication should be taken at the first sign of symptoms. Anaphylaxis can develop within minutes after allergen exposure. To use the EpiPen, the patient should form a fist around the unit with the black tip pointing down, remove the activation cap, jab the device firmly into the outer thigh, wait 10 seconds, remove the unit, and massage the area for 10 seconds. The medication can be given directly through clothing if necessary.

A patient is prescribed Calan SR 120 mg daily. Which statement by the patient indicates understanding of the medication? A "I will take the medication with grapefruit juice each morning." B "I should expect occasional loose stools from this medication." C "I'll need to reduce the amount of fiber in my diet." D "I will swallow the pill whole."

D "I will swallow the pill whole." "SR" indicates that the drug is sustained release; therefore, the patient must swallow the pill intact, without chewing or crushing, which would result in a bolus effect. Grapefruit juice should be avoided, because it can inhibit intestinal and hepatic metabolism of the drug, thereby raising the drug level. Constipation, not loose stools is a common side effect of Calan; increasing fluids and dietary fiber can help prevent this adverse effect.

A nurse is teaching a patient who is scheduled to start taking itraconazole (Sporanox). Which statement by the patient would indicate understanding of the teaching? A "I'll take diphenhydramine (Benadryl) before this medication so I don't have a reaction." B "It's important to remember to wear sunscreen while taking this medicine." C "I'll avoid citrus foods, such as oranges and grapefruits, while taking this medication." D "If I notice my skin turning yellow or feel any nausea, I'll notify my healthcare provider."

D "If I notice my skin turning yellow or feel any nausea, I'll notify my healthcare provider." Itraconazole may cause liver injury, and although a causal link has not been identified, patients need to be informed about symptoms to report. These include jaundice, nausea, and right upper abdominal pain. It is not necessary to take diphenhydramine, wear sunscreen, or avoid citrus products while taking itraconazole.

A patient who is receiving vancomycin (Vancocin) IV for a methicillin-resistant Staphylococcus aureus (MRSA) infection asks a nurse, "Why can't I take this medicine in a pill?" Which response should the nurse make? A "The prescription could be changed, because vancomycin comes in two forms." B "You're allergic to penicillin, and this is the only way this medication can be given." C "It will cause too much loss of appetite and nausea if given in the oral form." D "It is more effective by IV, because the pill form will stay in the digestive tract."

D "It is more effective by IV, because the pill form will stay in the digestive tract." Because of its chemical size and weight, vancomycin is absorbed poorly in the gastrointestinal (GI) tract and is given parenterally for most infections. It is used for serious infections caused by organisms such as MRSA and in patients with susceptible organisms allergic to penicillins. Oral administration is used only for infections of the intestine. It is not associated with loss of appetite or nausea.

A patient taking sildenafil (Viagra) asks a nurse what action to take if priapism occurs. Which response should the nurse make? A "Take an additional half-strength dose of sildenafil." B "The condition usually resolves in 12 hours or less." C "Wait until the following day and notify the doctor." D "Seek emergency help, because permanent damage can occur."

D "Seek emergency help, because permanent damage can occur." Sildenafil is a phosphodiesterase type 5 (PDE5) inhibitor that can cause priapism. Patients are advised to seek medical attention for an erection that lasts longer than 4 hours, because left untreated, priapism can damage penile tissue, causing permanent loss of potency. Increasing the dose or waiting to seek help would do more harm.

The nurse should provide which teaching point when administering an enteric-coated oral tablet to a patient? A "Chew the tablet before swallowing." B "Break the tablet in half before swallowing." C "Allow the tablet to be absorbed under the tongue." D "Swallow the tablet whole after double-checking the dose."

D "Swallow the tablet whole after double-checking the dose." Enteric-coated tablets are covered with a material designed to dissolve in the intestine instead of the stomach. They should not be chewed or broken before administration. Sublingual tablets are placed under the tongue for absorption and are not enteric coated.

When teaching a patient who has genital herpes about treatment with valacyclovir (Valtrex), the nurse includes which statement? A "A condom needs to be worn only when symptoms of the virus are present." B "Although it is costly, continuous daily medication administration will eliminate the virus." C "Once the painful blisters heal, the infection has been cured and will not return." D "The intensity of infection episodes is reduced when the medication is taken daily."

D "The intensity of infection episodes is reduced when the medication is taken daily." Valacyclovir (Valtrex) can reduce symptoms and shorten the duration of pain and viral shedding. Valacyclovir does not eliminate genital herpes entirely; therefore, patients must continue to use condoms and abstain from sex at times when the infection is active. Continuous daily administration of valacyclovir (Valtrex) has been found to reduce the frequency and intensity of episodes, whereas episodic treatment simply reduces symptoms once an episode has begun.

Which statement by a patient indicates understanding of treatment with doxazosin? A "I may experience an increase in hair growth as a side effect." B "I'll notify the healthcare provider if I develop a persistent cough." C "I'll make sure I include extra sources of potassium in my diet, such as bananas and baked potatoes." D "When getting out of bed in the morning, I will sit on the side of the bed for several minutes before standing."

D "When getting out of bed in the morning, I will sit on the side of the bed for several minutes before standing." The most disturbing side effect of alpha blockers, such as doxazosin, is orthostatic hypotension, because it can affect the patient's safety. Patients should change positions slowly and carefully. Excessive hair growth is a side effect of minoxidil. Persistent cough is an adverse effect of ACE inhibitors. Hypokalemia is a side effect of thiazide and loop diuretics, so additional sources of potassium should be incorporated into the diet.

Which statement should a nurse include when providing teaching to a patient who is scheduled to start taking dutasteride (Avodart)? A "Protect yourself from sun exposure to avoid any skin sensitivity." B "You may notice immediate relief of your urinary symptoms." C "Dutasteride will increase both ejaculatory volume and libido over time." D "You cannot donate blood while on this medication or for 6 months after stopping it."

D "You cannot donate blood while on this medication or for 6 months after stopping it." Dutasteride is harmful to a developing male fetus. To avoid transmission to women by way of infusion, men should avoid donating blood while using it and for 6 months after stopping it. Beneficial effects on the symptoms of benign prostatic hyperplasia (BPH) occur over time. Dutasteride reduces ejaculate volume and libido. Photosensitivity is unrelated.

A patient who has human immunodeficiency virus (HIV) infection has a tuberculin skin test (TST) for latent tuberculosis. The nurse assesses the result 48 hours after the injection. An induration of what size indicates that the patient needs to be treated for latent tuberculosis? A 1 mm B 2 mm C 3 mm D 5 mm

D 5 mm A positive reaction on the TST is indicated by an area of induration (hardness) around the injection site. The decision to treat latent tuberculosis is based on the risk category and size of the induration area. Treatment is recommended in high-risk individuals, such as those with HIV infection, for an induration of 5 mm. An induration of 10 mm is required to treat moderate-risk individuals. An induration of more than 15 mm is required to treat low-risk individuals.

The nurse is caring for patients who have been prescribed gemfibrozil (Lopid). For which patient should the nurse question the use of this drug? A A 78-year-old man with cardiovascular disease and elevated triglycerides B A 50-year-old woman with elevated very-low-density lipoprotein (VLDL) levels C A 68-year-old man with elevated triglycerides who has not responded to dietary changes D A 58-year-old woman with history of gallstones and elevated triglycerides

D A 58-year-old woman with history of gallstones and elevated triglycerides Gemfibrozil is indicated to reduce elevated triglycerides and very-low-density lipoprotein levels primarily in patients who have not responded adequately to diet modification. It can also raise HDL but does not reduce LDL to a significant degree. Gemfibrozil increases the risk of gallstone formation and should not be used in patients with pre-existing gallbladder disease.

A nurse instructs the parent of a child with influenza that which medication or medications may be used safely to reduce fever? (Select all that apply.) A Ibuprofen (Advil) B Naproxen (Aleve) C Aspirin (Bayer) D Acetaminophen (Tylenol) E Indomethacin (Indocin)

D Acetaminophen (Tylenol) The use of NSAIDs, which include ibuprofen (Advil), naproxen (Aleve), indomethacin (Indocin), and especially aspirin (Bayer), by children with influenza or chickenpox may precipitate Reye's syndrome. This is a potentially fatal multisystem organ disease. Acetaminophen (Tylenol) may be used safely to reduce fever in children with influenza.

Thirty minutes after receiving an intramuscular (IM) injection of penicillin G (Pfizerpen), a patient reports itching and redness at the injection site. Which action should the nurse take first? A Elevate the lower legs. B Place an ice pack on the site. C Make sure the patient stays calm. D Administer subcutaneous epinephrine.

D Administer subcutaneous epinephrine. Itching and redness at the IM injection site indicate an allergy to penicillin. The primary treatment is epinephrine (subcutaneous, IM, or IV) plus respiratory support. Elevation, ice packs, and calming the patient are done once epinephrine has been administered.

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 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 patient who has active TB is to start a medication regimen that includes pyrazinamide. The nurse identifies a risk for complications if the patient also has which medical condition? A Parkinson's disease B Rheumatoid arthritis C Glaucoma D Alcoholism

D Alcoholism Pyrazinamide is contraindicated in patients with both liver dysfunction and gout. It should be used with caution in patients who abuse alcohol, and liver function studies should be done every 2 weeks. It is not known to cause complications in patients who have Parkinson's disease, rheumatoid arthritis, or glaucoma.

The nurse is caring for a patient with severe generalized anxiety disorder. Which agent would be most effective for immediate stabilization? A Venlafaxine (Effexor) B Buspirone (BuSpar) C Paroxetine (Paxil) D Alprazolam (Xanax)

D Alprazolam (Xanax) Alprazolam, a benzodiazepine, would provide the most rapid onset of relief. Buspirone, paroxetine, and venlafaxine are also first-line agents for the treatment of generalized anxiety disorder, but their onset is delayed. They are preferred for long-term management.

A nurse is planning care for a patient undergoing chemotherapy. The care plan includes medications to reduce chemotherapy-induced nausea and vomiting (CINV). Which regimen should the nurse recognize as effective? A Scopolamine (Transderm Scôp) and lorazepam (Ativan) B Prochlorperazine (Compazine) and diphenhydramine (Benadryl) C Ondansetron (Zofran) and dimenhydrinate (Dramamine) D Aprepitant (Emend) and ondansetron (Zofran)

D Aprepitant (Emend) and ondansetron (Zofran) Regimens for preventing CINV may include medications such as a serotonin receptor antagonist (ondansetron); the substance P/neurokinin1 antagonist aprepitant; and a benzodiazepine (lorazepam). Scopolamine and dimenhydrinate are indicated for motion sickness, not CINV; diphenhydramine is an antihistamine indicated for allergic reactions.

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.

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 nurse prepares to administer a new prescription for bethanechol (Urecholine). Which information in the patient's history should prompt the nurse to consult with the prescriber before giving the drug? A Constipation B Hypertension C Psoriasis D Asthma

D Asthma Muscarinic agonists induce bronchospasm, which would cause problems for a patient with a history of asthma.

A patient in the emergency department reports taking sildenafil (Viagra) and nitroglycerin 1 hour before sexual activity. Which finding should the nurse immediately report to the physician? A White blood cell (WBC) count of 3200 units/L B Respiratory rate of 26 breaths per minute C Body temperature of 100.4°F (38°C) D Blood pressure (BP) of 70/50 mm Hg

D Blood pressure (BP) of 70/50 mm Hg When taken in conjunction with nitroglycerin, sildenafil can cause severe hypotension that is unresponsive to treatment. At least 24 hours should elapse between the last dose of sildenafil and a nitrate. A WBC count of 3200 units/L, a respiratory rate of 26 breaths per minute, and a body temperature of 100.4°F are all abnormal findings and need to be reported. However, they are not as important to report as the BP of 70/50 mm Hg, which is directly related to sildenafil and nitroglycerin.

A nurse is preparing to give a medication that stimulates the beta2 receptors. What response will the nurse expect from this drug? A Increased peristalsis B Constriction of the pupil C Hypoglycemia D Bronchodilation

D Bronchodilation Activation of beta2 receptors leads to bronchodilation; decreased uterine contractions; hyperglycemia; and vasodilation of the heart, lungs, and skeletal muscle. It does not produce increased peristalsis, constriction of the pupil, or hypoglycemia.

A patient is taking oral theophylline for maintenance therapy of stable asthma. A nurse instructs the patient to avoid using which substance to prevent a complication? A Echinacea B Cimetidine (Tagamet) C Sunscreen products D Caffeine

D Caffeine Theophylline is a methylxanthine that provides benefits through bronchodilation. It is used to reduce the frequency and severity of asthma attacks, especially those occurring at night. Caffeine also is a methylxanthine, and its pharmacologic actions may intensify the adverse effects of theophylline on the central nervous system (CNS) and heart. Sources of caffeine should be avoided. It is not necessary to avoid taking cimetidine or echinacea or using sunscreen products while taking theophylline.

A patient who is receiving an aminoglycoside develops flaccid paralysis and impaired breathing. Which medication does the nurse anticipate administering? A Magnesium sulfate (Epsom salt) B Potassium chloride (K-Dur) C Sodium bicarbonate (Citrocarbonate) D Calcium gluconate (Kalcinate)

D Calcium gluconate (Kalcinate) Flaccid paralysis and impaired breathing are signs of impaired neuromuscular transmission, which may occur with aminoglycosides, especially if they are administered concurrently with a neuromuscular blocking agent. Impaired transmission can be reversed with intravenous infusion of a calcium salt (calcium gluconate). Magnesium sulfate, potassium chloride, and sodium bicarbonate do not reverse impaired neuromuscular transmission caused by aminoglycosides.

The nurse is caring for a patient who takes warfarin (Coumadin) for prevention of deep vein thrombosis. The patient has an international normalized ratio (INR) of 1.2. Which action by the nurse is most appropriate? A Prepare to administer protamine sulfate. B Continue with the current prescription. C Prepare to administer vitamin K. D Call the healthcare provider to increase the dose.

D Call the healthcare provider to increase the dose. An INR in the range of 2 to 3 is considered the level for warfarin therapy. For a level of 1.2, the nurse should contact the healthcare provider to discuss an order for an increased dose.

A nurse instructs a patient to discontinue the scheduled use of high-dose aspirin before undergoing which procedures? (Select all that apply.) A Routine dental cleaning B Removal of a skin mole C Cataract surgery D Cholecystectomy E Hysterectomy

D Cholecystectomy E Hysterectomy Aspirin promotes bleeding by causing irreversible suppression of platelet aggregation. High-dose aspirin should be discontinued 1 week before elective surgery (cholecystectomy, hysterectomy). There is no need to stop aspirin before procedures with a low risk of bleeding, such as dental cleaning or dermatologic or cataract surgery.

A nurse should teach a patient who takes alosetron (Lotronex) for diarrhea-prominent irritable bowel syndrome (IBS-D) to stop the medication immediately if the patient develops which condition? A Blurred vision B Heart palpitations C Bruising D Constipation

D Constipation Alosetron selectively blocks serotonin receptors on neurons that innervate the viscera, thereby reducing the symptoms associated with IBS-D. Serious complications of constipation and ischemic colitis can be life-threatening. According to the risk management program established by the manufacturer and the U.S. Food and Drug Administration (FDA), treatment with alosetron should be stopped immediately if either of these conditions develops. Blurred vision, heart palpitations, and bruising are not adverse effects of alosetron.

When evaluating the effects of ergonovine (Ergotrate), the nurse expects which assessment finding? A Suppressed milk reflex B Decreased blood pressure C Decreased uterine tone D Decreased vaginal bleeding

D Decreased vaginal bleeding Ergonovine is a uterine stimulant that causes contractions and may be used in the postpartum period to increase uterine tone and reduce bleeding. It can cause hypertension with intravenous (IV) administration. The milk reflex is not affected.

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

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.

It is most important for the nurse to assess a patient receiving a cephalosporin for the development of which manifestation of antibiotic-associated pseudomembranous colitis (AAPMC)? A Rigidity B Ileus C Ascites D Diarrhea

D Diarrhea AAPMC, which is manifested initially by diarrhea and abdominal cramping, especially may develop with the use of broad-spectrum cephalosporins. Rigidity, ileus, and ascites are unrelated to cephalosporin use.

A nurse assessing a patient who is 12 years old should associate which complication with the patient's receiving tetracycline (Sumycin) as a younger child? A Delay in long bone growth B Early onset of puberty C Severe face and body acne D Discoloration of the teeth

D Discoloration of the teeth Tetracycline is contraindicated in children younger than 8 years of age, because it binds to calcium in developing teeth, resulting in permanent discoloration of the teeth. Delay in long bone growth, early onset of puberty, and severe face and body acne are not adverse effects associated with tetracyclines.

A nurse is planning care for a patient who has peptic ulcer disease and is taking amoxicillin (Amoxil). Which of these should the nurse establish as a therapeutic outcome? 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

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 patient is taking a first-generation H1 blocker for the treatment of allergic rhinitis. It is most important for the nurse to assess for which adverse effect? A Skin flushing B Wheezing C Insomnia D Dry mouth

D Dry mouth First-generation H1 blockers produce adverse effects that include atropine-like properties (i.e., drying of mucous membranes) and gastrointestinal effects (e.g., nausea). Sedation is a pronounced side effect. H1 blockade results in the inhibition of dilator action of histamine in the periphery, which reduces flushing. Wheezing is not an adverse effect.

A female patient who is originally from Thailand is seen in the clinic for seizure control. She receives a new prescription for carbamazepine (Tegretol). Before the patient takes the drug, which is the most appropriate initial nursing intervention? A Warn her not to withdraw this drug abruptly. B Recommend that she take this medication at bedtime with meals. C Teach her family to assist with maintaining a seizure frequency chart. D Ensure that genetic testing for HLA-B*1502 is performed.

D Ensure that genetic testing for HLA-B*1502 is performed. Although all these interventions are appropriate for this patient, the initial nursing intervention would be to ensure that genetic testing is performed. Carbamazepine is associated with several dermatologic effects, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Patients of Asian descent are at higher risk for serious dermatologic reactions with this drug because of a genetic variation known as HLA-B*1502. The FDA now recommends that before taking carbamazepine, patients of Asian descent undergo genetic testing.

Which antifungal agent is used as a one-time oral dose to treat vaginal yeast infections? A Nystatin (Mycostatin) B Caspofungin (Cancidas) C Voriconazole (Vfend) D Fluconazole (Diflucan)

D Fluconazole (Diflucan) Fluconazole (Diflucan) has almost 100% bioavailability and therefore is often sufficient as a single dose to treat vaginal yeast infections. Caspofungin (Cancidas) cannot be administered orally. It is used in patients unresponsive to amphotericin B. Nystatin (Mycostatin) is administered as an oral or topical application for candidiasis. Voriconazole (Vfend) is used in the treatment of aspergillosis.

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 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.

Complete the equation: Cardiac output = Volume of blood ejected at each heartbeat × ____. A Stroke volume B Preload C Afterload D Heart rate

D Heart rate The amount of blood ejected with each heartbeat is known as the stroke volume. To determine the cardiac output, multiply the stroke volume by the number of beats per minute.

The nurse is caring for a patient receiving methyldopa (Aldomet). Which laboratory test is the most important to obtain before treatment? A Creatinine level B Serum glucose level C White blood cell count D Hematocrit

D Hematocrit Methyldopa causes a positive Coombs' test result in about 10% to 20% of patients. A few of those patients develop hemolytic anemia. Coombs' test and blood cell counts (hematocrit, hemoglobin, or red cell count) should be done to establish a baseline and periodically throughout long-term treatment.

A patient is admitted to the emergency department with acute severe exacerbation of asthma. Which drug should the nurse anticipate will be included in the treatment plan? A Oral theophylline (Elixophyllin) B Subcutaneous omalizumab (Xolair) C In haled mometasone furoate (Asmanex) D High-dose albuterol (Proventil) via nebulizer treatment

D High-dose albuterol (Proventil) via nebulizer treatment Nebulized high-dose SABAs, such as albuterol, are administered to relieve airflow obstruction. Oral theophylline is used for maintenance therapy of chronic stable asthma, not for treatment of exacerbation. Omalizumab is a second-line agent indicated for allergy-related asthma and only when preferred options have failed. Inhaled glucocorticoids, such as mometasone furoate, are not used to abort an acute attack. During an exacerbation they are administered systemically.

The nurse should strictly follow safety precautions when administering intravenous (IV) medications for which reason? A The IV route can result in delayed absorption of the medication. B The IV route results in a delayed onset of action. C Control over the levels of drug in the body is unpredictable. D IV administration is irreversible.

D IV administration is irreversible. The IV route allows precise control over levels of drug in the blood and a rapid onset of action. Absorption of IV medication is instantaneous and complete. Once a drug has been injected, there is no turning back; the drug is in the body and cannot be retrieved.

The nurse is preparing to administer a dose of penicillin. Before administering the medication, the nurse assesses the patient's allergy history. Which aspect of drug therapy does this represent? A)Making PRN (as needed) decisions B)Evaluating therapeutic effects C)Ensuring proper dosage D)Identifying high-risk patients

D Identifying high-risk patients Patients receiving penicillin are at high risk for dangerous allergic reactions. This intervention represents the nurse's role in identifying situations with high risk. This situation does not represent the remaining responses

The nurse is developing a plan to minimize the risk of adrenal insufficiency for a patient who is receiving long-term glucocorticoid therapy. Which outcome should be included? A Increases daily intake of sodium for vascular expansion B Tapers blood pressure medications to avoid hypotension C Obtains periodic ultrasound scans of adrenal glands D Increases or supplements dosage of glucocorticoid at times of stress

D Increases or supplements dosage of glucocorticoid at times of stress Exogenous steroids inhibit the synthesis and release of endogenous steroids by the adrenals, and recovery is variable, taking from days to a year. Failure to increase or supplement doses at times of stress may be life-threatening. Increasing sodium intake and tapering blood pressure medications could cause harm. Adrenal gland ultrasound scans are not a valid way to minimize adrenal insufficiency.

The nurse is caring for a patient receiving glatiramer acetate (Copaxone) for MS. Which finding, if present in this patient, could be considered a potential adverse effect of this drug? A Flulike symptoms with fever B Decreased neutrophil count C Jaundice and elevated bilirubin D Injection site pain and redness

D Injection site pain and redness Injection site reactions, such as pain, erythema, pruritus, and induration, are the most common adverse effects of glatiramer. Unlike interferon, glatiramer does not cause flulike symptoms, myelosuppression, or hepatotoxicity, which would be indicated in the other responses.

Which class of drugs is most effective in preventing and treating seasonal and perennial rhinitis? A Antitussives B Oral antihistamines C Oral sympathomimetics D Intranasal glucocorticoids

D Intranasal glucocorticoids Intranasal glucocorticoids are the most effective drugs for preventing and treating seasonal and perennial rhinitis. They reduce nasal congestion, rhinorrhea, sneezing, nasal itching, and erythema. Antihistamines are less effective than glucocorticoids, because histamine is only one of several mediators of allergic rhinitis. Sympathomimetics relieve only nasal congestion. Antitussives are used to suppress cough.

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.

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.

What best describes the rationale for using neostigmine (Prostigmin) in the treatment of myasthenia gravis? A It promotes neuromuscular blockade in the periphery. B It promotes emptying of the bladder and sphincter relaxation. C It reduces intraocular pressure and protects the optic nerve. D It increases the force of skeletal muscle contraction.

D It increases the force of skeletal muscle contraction. Neostigmine is a cholinesterase inhibitor; therefore, at therapeutic doses it increases the force of contraction of skeletal muscles. Myasthenia gravis is a neuromuscular disease characterized by muscle weakness.

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.

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.

Succinylcholine (Anectine) is contraindicated in a patient with what condition? A Diabetes mellitus B Hyperthyroidism C Chronic obstructive pulmonary disease (COPD) D Major burns during the emergent phase

D Major burns during the emergent phase Succinylcholine promotes the release of potassium from tissues. Significant hyperkalemia is most likely to develop in patients with major burns during the emergent phase, multiple trauma, denervation of skeletal muscle, or upper neuron injury.

Which prescription would be the most appropriate for treating persistent cancer pain? A Morphine (Duramorph) 10 mg orally (PO) as needed (PRN) B Meperidine (Demerol) 100 mg PO every 4 hours C Pentazocine (Talwin) 75 mg intramuscularly (IM) every 3 to 4 hours PRN D Morphine (Duramorph) 30 mg every 3 to 4 hours

D Morphine (Duramorph) 30 mg every 3 to 4 hours For persistent pain, medication should be given on a fixed schedule to prevent opioid levels from becoming subtherapeutic. Meperidine causes accumulation of a toxic metabolite when used on a long-term basis. Pentazocine produces a limited amount of analgesia, and IM injections generally should be avoided. Morphine 30 mg is an appropriate dose and should be given as indicated around-the-clock.

A 79-year-old man with cardiovascular disease is taking rosuvastatin (Crestor). The nurse is monitoring for potential adverse effects. Which symptom, if found, indicates a potential adverse effect of this drug? A Blood pressure of 140/90 mm Hg B Wheezing and shortness of breath C Platelet count of 100 × 103/mm3 D Muscle pain and tenderness

D Muscle pain and tenderness The statins typically are well tolerated; however, in rare cases they can cause the serious adverse effect of myopathy and rhabdomyolysis. If unexplained muscle pain and tenderness develop, the prescriber should be notified. The other effects would not likely be caused by rosuvastatin.

A patient is to begin taking nitrofurantoin (Macrodantin). The nurse should teach the patient that which manifestation should be the priority to report to the healthcare provider? A Headache and drowsiness B Brown-colored urine C Nausea and vomiting D Muscle weakness and tingling

D Muscle weakness and tingling Nitrofurantoin is used in acute infections of the lower urinary tract only. Muscle weakness and tingling may indicate irreversible damage to sensory and motor nerves caused by demyelinization of nerves. Patients should be informed of these symptoms and taught to report them immediately. Gastrointestinal (GI) effects may be minimized by taking the drug with milk or food. Brown-colored urine is a harmless effect of the urinary excretion of the medication. Headache and drowsiness are less common adverse effects that are readily reversible.

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

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.

Which enteral aminoglycoside would the nurse expect to be ordered preoperatively for a patient having intestinal surgery? A Gentamicin B Tobramycin C Amikacin D Neomycin

D Neomycin In general, aminoglycosides are poorly absorbed in the gastrointestinal (GI) tract. Neomycin is given orally to suppress bowel flora before surgery of the intestine and is not used parenterally because of its high nephrotoxicity and ototoxicity. Gentamicin, tobramycin, and amikacin are administered parenterally only.

Which clinical manifestation in a patient taking etanercept (Enbrel) requires a prompt call by the nurse to the prescriber? A Swollen, tender joints B Itching and erythema at the injection sites C Tenting of the skin and dry mucous membranes D New onset of an S3 heart sound and crackles in the lower third of the lungs

D New onset of an S3 heart sound and crackles in the lower third of the lungs Etanercept may pose a risk for the development or worsening of heart failure. A new-onset S3 heart sound and crackles are consistent with heart failure and should be reported immediately. Etanercept is administered to relieve swollen, tender joints associated with rheumatoid arthritis. Itching and erythema are associated with injections and usually subside in a few days. Tenting of the skin and dry mucous membranes are a consequence of dehydration, which is not associated with this medication.

A patient who has an infection with Mycobacterium leprae (leprosy) has been prescribed rifampin (Rifadin). The nurse identifies which dosing schedule as most effective for this drug? A Two times per day B Every other day C Once every 2 weeks D Once per month

D Once per month Rifampin is the most effective agent for treating leprosy. A single dose kills more than 99.9% of viable M. leprae. Monthly administration is effective, and this dosing schedule minimizes adverse effects.

Which statements about ototoxicity and aminoglycosides does the nurse identify as true? (Select all that apply.) A The risk of ototoxicity is related primarily to excessive peak levels. B The first sign of impending cochlear damage is headache. C The first sign of impending vestibular damage is tinnitus . D Ototoxicity is largely irreversible. E Use of aminoglycosides for less than 10 days is recommended to avoid ototoxicity.

D Ototoxicity is largely irreversible. E Use of aminoglycosides for less than 10 days is recommended to avoid ototoxicity. The risk of ototoxicity with aminoglycoside use is related primarily to excessive trough levels. The first sign of impending vestibular damage is headache. The first sign of cochlear damage is tinnitus. The other two statements are true.

A patient takes glucocorticoids and digoxin (Lanoxin). It is most important for the nurse to monitor which electrolyte? A Calcium B Magnesium C Sodium D Potassium

D Potassium Because of the mineralocorticoid activity of sodium and water retention and potassium loss, glucocorticoids can increase the risk of toxicity from digoxin. They also can exacerbate hypokalemia caused by thiazide and loop diuretics. Calcium, magnesium, and sodium do not require more frequent monitoring as a result of digoxin and glucocorticoids use.

A patient is receiving amphotericin B. The nurse identifies which medication as useful in preventing adverse effects of amphotericin B? A Furosemide (Lasix) B Insulin C Vitamin K D Potassium

D Potassium Renal injury from amphotericin B may cause severe hypokalemia. Serum potassium levels should be monitored more frequently and potassium supplements given to correct low plasma levels. Furosemide, insulin, and vitamin K do not prevent any adverse effects of amphotericin B.

Fondaparinux (Arixtra) is not approved for use in which circumstance? A Prevention of deep vein thrombosis (DVT) after knee replacement B Treatment of acute pulmonary embolism (PE) (in conjunction with warfarin) C Prevention of deep vein thrombosis (DVT) after abdominal surgery D Prevention of ischemic complications in patients with unstable angina

D Prevention of ischemic complications in patients with unstable angina Enoxaparin (Lovenox), not Arixtra, is approved for use in preventing ischemic complications in patients with unstable angina, non-Q-wave myocardial infarction (MI), and ST-segment elevation myocardial infarction (STEMI). Arixtra is approved for (1) preventing DVT after hip surgery, knee replacement, and abdominal surgery; and (2) treating acute PE and acute DVT in conjunction with warfarin.

The nurse identifies what as the goal of drug therapy in the treatment of patients? A Cure of the disease B Follow-up with the prescriber C Correct administration technique D Production of maximum benefit with minimum harm

D Production of maximum benefit with minimum harm The goal of drug therapy in the treatment of patients is the production of maximum benefit with minimum harm. The other options are not the main goal of drug therapy.

A patient who is receiving an aminoglycoside (gentamicin) has a urinalysis result with all of these findings. Which finding should a nurse associate most clearly with an adverse effect of gentamicin? A White blood cells (WBCs) B Glucose C Ketones D Protein

D Protein Aminoglycoside-induced nephrotoxicity usually presents as acute tubular necrosis. Symptoms of concern are protein in the urine, dilute urine, and elevation of the serum creatinine and blood urea nitrogen (BUN) levels. WBCs, glucose, and ketones are not specifically related to gentamicin use.

Antimuscarinic poisoning can result from overdose of antihistamines, phenothiazines, and tricyclic antidepressants. Differential diagnosis is important, because antimuscarinic poisoning resembles which other condition? A Epilepsy B Diabetic coma C Meningitis D Psychosis

D Psychosis Antimuscarinic poisoning often resembles psychosis and psychotic episodes. It is important to differentiate, because antipsychotic drugs have antimuscarinic properties and could intensify the symptoms of poisoning.

Natalizumab (Tysabri) is a very effective agent for treating MS. Which problem is associated with the administration of this drug, making it a second-line agent? A Increased risk of sudden cardiac death B Documented reports of necrotizing colitis C Increased risk of Stevens-Johnson syndrome D Rare cases of dangerous brain infections

D Rare cases of dangerous brain infections Soon after natalizumab was released on the market, there were three reports of progressive, multifocal leukoencephalopathy. All patients who developed this problem were taking natalizumab in combination with another immunosuppressant. The drug now is available only through a specialized, carefully controlled prescribing program.

Which laboratory abnormality may be a consequence of therapy with a thiazide diuretic? A Serum glucose level of 58 mg/dL B Serum potassium level of 5.3 mEq/L C Serum sodium level of 135 mEq/L D Serum uric acid level of 10.4 mg/dL

D Serum uric acid level of 10.4 mg/dL Hyperuricemia is a side effect of thiazide diuretics. Normal uric acid levels typically range from 3.6 to 8.5 mg/dL. Hyperglycemia, not hypoglycemia, and hypokalemia, not hyperkalemia, are side effects of thiazides. A serum sodium of 135 mEq/L is a normal value.

Which is the only cardiovascular indication for minoxidil (Rogaine)? A Heart failure B Myocardial infarction C Mild hypertension D Severe hypertension

D Severe hypertension Because of its serious adverse effects, minoxidil is reserved for patients who have failed to respond to safer drugs. The only cardiovascular indication for minoxidil is severe hypertension.

A patient is taking methotrexate (Rheumatrex) for rheumatoid arthritis. Which therapeutic action should a nurse expect if the medication is having the desired effect? A Selective inhibition of cyclooxygenase B Neutralization of tumor necrosis factor C Inhibition of T-cell activation D Suppression of T and B lymphocytes

D Suppression of T and B lymphocytes Methotrexate is a nonbiologic DMARD that suppresses the immune system by reducing the activity of B and T lymphocytes. It is highly effective and considered a first-choice medication. Inhibition of cyclooxygenase, neutralization of tumor necrosis factor, and inhibition of T-cell activation are not actions of methotrexate.

Which finding suggests that a patient is experiencing an adverse effect of metoprolol (Lopressor)? A The patient complains of headaches. B The patient's potassium level is 3.3 mEq/L. C The patient's resting heart rate is 58 beats per minute on the cardiac monitor. D The PR interval on the patient's cardiac rhythm strip is 0.32 seconds.

D The PR interval on the patient's cardiac rhythm strip is 0.32 seconds. Beta blockers, such as metoprolol, can reduce conduction through the atrioventricular (AV) node, as demonstrated by prolongation of the PR interval. The normal PR interval is 0.12 to 0.20 seconds. The dosing goal with beta blockers is to reduce the resting heart rate to 50 to 60 beats per minute so that the patient has an acceptable heart rate. Headaches and potassium depletion are unrelated to metoprolol administration.

A patient is receiving dronedarone (Multaq) for treatment of atrial fibrillation. When previous and present ECGs are compared, which change indicates an adverse effect? A Previously upright T waves now are inverted. B Previously rounded, upright P waves now are notched. C ST segments previously on the baseline now are depressed. D The QT-interval measurement changes from 400 msec to 520 msec.

D The QT-interval measurement changes from 400 msec to 520 msec. Dronedarone prolongs the QT interval by about 10 msec. A QT-interval measurement of 400 msec in a normal heart rate (60 to 100 beats per minute) is normal. Prolongation to 520 msec would increase the risk of torsades de pointes. Newly inverted T waves and ST-segment depression can be signs of ischemia or infarction and warrant further investigation through analysis of troponin levels. Notched P waves can be a sign of valvular heart disease and are unrelated to treatment with dronedarone.

A new medication becomes available for treatment of a debilitating neurologic disease. What would the nurse expect about the safety of the drug? A The drug is safe for administration to children. B The drug has been tested in pregnant women. C All possible adverse effects have been identified by animal testing. D The drug has passed the FDA approval process.

D The drug has passed the FDA approval process. A new medication must meet the FDA's stringent requirements before it comes to market. Most drugs have not been tested in women (including pregnant women) or children. Animal testing cannot identify all possible adverse effects.

Which activity noted by the home care nurse indicates that the patient needs further teaching about topical nitroglycerin ointment? A The patient rotates the application sites to minimize skin irritation. B The patient uses the applicator paper to measure the prescribed dose. C The patient removes ointment from a previous dose before applying the next dose. D The patient applies the prescribed ribbon of ointment to the applicator paper and places it on the chest.

D The patient applies the prescribed ribbon of ointment to the applicator paper and places it on the chest. Once the prescribed ribbon of ointment has been squeezed onto the applicator paper provided, the paper is used to spread the ointment over an area at least 2.5 by 3.5 inches. It is then covered with plastic wrap to prevent the ointment from being absorbed into the clothing. There is no mechanistic advantage to applying the ointment on the chest (over the heart). The ointment can be applied to the back, abdomen, or anterior thigh, as well as the chest. Sites should be rotated to minimize skin irritation.

A patient takes oxycodone (OxyContin) 40 mg PO twice daily for the management of chronic pain. Which intervention should be added to the plan of care to minimize the gastrointestinal adverse effects? A The patient should take an antacid with each dose. B The patient should eat foods high in lactobacilli. C The patient should take the medication on an empty stomach. D The patient should increase fluid and fiber in the diet.

D The patient should increase fluid and fiber in the diet. Narcotic analgesics reduce intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can help manage this adverse effect. If increased fluid and fiber is not sufficiently effective, use of a laxative may be considered.

The nurse is caring for a patient receiving hydralazine (Apresoline). The primary care provider prescribes propranolol (Inderal). The nurse knows that a drug such as propranolol often is combined with hydralazine for what purpose? A To reduce the risk of headache B To improve hypotensive effects C To prevent heart failure D To protect against reflex tachycardia

D To protect against reflex tachycardia Hydralazine is a vasodilator that lowers blood pressure, but it also can trigger reflex tachycardia. Beta blockers, such as propranolol, are added to the regimen to normalize the heart rate.

Which medication can cause this acid-base disturbance: pH 7.32, paCO2 33, HCO3 20? A Primidone (Mysoline) B Lamotrigine (Lamictal) C Lacosamide (Vimpat) D Topiramate (Topamax)

D Topiramate (Topamax) The arterial blood gas results reflect metabolic acidosis with partial respiratory compensation. Topiramate can cause metabolic acidosis, because it inhibits carbonic anhydrase; this increases renal excretion of bicarbonate, causing the plasma pH to fall. Hyperventilation is the most characteristic symptom. Primidone, lamotrigine, and lacosamide do not cause metabolic acidosis.

Which finding in a patient receiving an oxytocin (Pitocin) infusion should be reported to the physician immediately? A Resting uterine pressure below 15 mm Hg B Absence of change in the baseline fetal heart rate C Maternal heart rate of 90 to 110 beats per minute D Uterine contractions lasting longer than 1 minute

D Uterine contractions lasting longer than 1 minute Oxytocin is a uterine stimulant used in the induction of labor. During infusion, constant maternal and fetal monitoring is needed, because elevation of uterine pressure above 15 to 20 mm Hg and contractions longer than 1 minute require the infusion to be stopped. Absence of a change in the baseline fetal heart rate and a maternal heart rate of 90 to 110 beats per minute are not evidence of pronounced alterations that indicate an adverse event.

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

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.