Pharm Exam 3

A patient who has duodenal ulcers is receiving longterm therapy with ranitidine (Zantac). The nurse includes in the care plan that the patient should be monitored for which adverse effects? 1. Photophobia and skin irritations 2. Neutropenia and thrombocytopenia 3. Dyspnea and productive coughing 4. Urinary hesitation and fluid retention

2 Blood dyscrasias have been reported, especially neutropenia and thrombocytopenia, with long-term use. Periodic blood counts should be performed. Options 1, 3, and 4 are incorrect. Ranitidine does not cause photophobia and skin irritations. Dyspnea and productive cough are not expected adverse effects for this medication. Ranitidine is not known to cause these symptoms.

The patient has developed severe diarrhea following 4 days of self-administered antacid preparation. The nurse suspects that the diarrhea may be caused by which type of antacid? 1. Aluminum compounds 2. Magnesium compounds 3. Calcium compounds 4. Sodium compounds

2 Magnesium compounds, especially in higher doses, often cause diarrhea. Options 1, 3, and 4 are incorrect. Aluminum compounds and calcium compounds may cause constipation. Sodium compounds may cause flatulence.

The nurse determines that the patient understands an important principle in self-administration of fluoxetine (Prozac) when the patient makes which statement? 1. "I should not decrease my sodium or water intake." 2. "This drug can be taken concurrently with a monoamine oxidase inhibitor." 3. "It may take up to 1 month to reach full therapeutic effects." 4. "There are no problems associated with concurrent use of other central nervous system depressants."

3 Full therapeutic effects of fluoxetine may take up to 1 month. Options 1, 2, and 4 are incorrect. Normal water and sodium intake do not affect fluoxetine. The patient cannot take an MAOI or other CNS depressant concurrently. The use of other drugs or CNS depressants such as alcohol could increase the risk of adverse effects or increased depression.

A patient with deep vein thrombosis is being treated with a heparin infusion. The nurse would monitor for therapeutic effectiveness by noting which of the following? 1. Activated partial thromboplastin time (aPTT) 2. Prothrombin time (PT) 3. Platelet counts 4. International normalized ratio (INR)

1 An activated partial thromboplastin time (aPTT) is the appropriate laboratory value to monitor with heparin infusions. When the patient is receiving this drug, the results should be 1.5 to 2 times that patient's baseline, or 60 to 80 seconds. Options 2, 3, and 4 are incorrect. A PT or INR is used to monitor the effectiveness of warfarin. Platelets are not affected by anticoagulants and are therefore not used in the monitoring of these drugs.

The nurse expects that the patient experiencing extrapyramidal symptoms during therapy with phenothiazines will be prescribed: 1. Benztropine (Cogentin). 2. Diazepam (Valium). 3. Haloperidol (Haldol). 4. Lorazepam (Ativan).

1 Benztropine is classified as an autonomic nervous system drug and an anticholinergic. It suppresses tremor and rigidity by decreasing the excess cholinergic effect associated with dopamine deficiency. Options 2, 3, and 4 are incorrect. Diazepam and lorazepam are antianxiety medications that will not improve the patient's symptoms. Haloperidol is an antipsychotic medication that may cause these symptoms.

A patient who is taking clopidogrel (Plavix) to prevent another stroke asks the nurse how the medication works. The nurse's response should be based on an understanding that Plavix: 1. Inhibits platelet aggregation to prevent clot formation. 2. Activates antithrombin III and subsequently inhibits thrombin. 3. Inhibits enzymes involved in the formation of vitamin K. 4. Converts plasminogen to plasmin to dissolve fibrin clots.

1 Clopidogrel is an antiplatelet drug used to prevent blood clots from forming inside arteries by inhibiting platelet aggregation. Options 2, 3, and 4 are incorrect. Heparin is an anticoagulant that blocks the formation of blood clots by activating antithrombin III. Warfarin is a vitamin K antagonist used to prevent the blood from clotting. The drug alteplase is a tissue plasminogen activator that dissolves fibrin clots.

The development of which symptom(s) in a patient taking an antipsychotic must be reported immediately? 1. Fever, tachycardia, stupor, and incontinence 2. Suddenly occurring muscle spasms, especially in the neck and back 3. Sexual dysfunction 4. Leg pains, pacing, an inability to sit still

1 Fever, tachycardia, stupor, and incontinence are symptoms of neuroleptic malignant syndrome (NMS), a potentially fatal adverse effect of antipsychotics that must be diagnosed and treated immediately. Options 2, 3, and 4 are possible adverse reactions, but are not life threatening, and therefore do not need to be reported with the same urgency as symptoms of NMS.

A healthcare provider has ordered imipramine (Tofranil) for four patients. A nurse would question the order for the patient with: 1. Seizure disorders. 2. Depression. 3. Enuresis. 4. Neuropathic pain.

1 Imipramine should not be used by patients with seizure disorders because it lowers the seizure threshold. Options 2, 3, and 4 are incorrect. Imipramine is a drug that is effective in treating depression, and is one of only two drugs approved for enuresis (bedwetting) in children. Like other TCAs, imipramine has a number of off-label indications. These include the adjuvant treatment of cancer or neuropathic pain.

The patient, who is receiving benzodiazepines, is a two-pack-per-day cigarette smoker. The nurse expects to administer a/an _________ dose of this medication. 1. Larger 2. Smaller 3. Extra 4. Half

1 Smoking enhances the metabolism of benzodiazepines, so the medication is broken down and removed from the body more quickly if the client is a smoker. Therefore, a smoker may require a larger dose of a benzodiazepine to get the same effect as that of a nonsmoker. Options 2, 3, and 4 are incorrect. A smaller or half dose, or a single extra dose, may not adequately help relieve the client's symptoms.

A patient will be treated with propylthiouracil (PTU) for hyperthyroidism. While the patient is taking this drug, which symptoms will the nurse teach the patient to report to the healthcare provider? 1. Sore throat, low-grade fever, chills 2. Increase in appetite and caloric intake 3. Tinnitus, altered taste, thickened saliva 4. Insomnia, nightmares, and night sweats

1 Sore throat, low-grade fever, and chills are symptoms of a possible infection. Because propylthiouracil may cause agranulocytosis, these symptoms should be reported to the provider. Options 2, 3, and 4 are incorrect. Increased appetite and caloric intake signal a return to a more euthyroid state. Tinnitus, altered taste, thickened saliva, insomnia, nightmares, and night sweats are not effects usually associated with propylthiouracil and if they occur, other causes should be investigated.

A nurse should question the order for pancrelipase (Pancreaze) for which patient? 1. The patient with allergy to pork products 2. The patient with hypertension 3. The patient with coronary artery disease 4. The patient with hypersensitivity to iodine products

1 The enzymes in pancrelipase come from pork. If the patient is allergic to or has religious restrictions on pork, the drug is contraindicated. Options 2, 3, and 4 are incorrect. Pancrelipase is not contraindicated for individuals with HTN or coronary artery disease. Pancrelipase is not an iodine-based drug. There is no expected cross sensitivity. C

Which statement made by the patient who is taking lithium carbonate (Eskalith) indicates that further teaching is necessary? 1. "I will be sure to remain on a low-sodium diet." 2. "I will have blood levels drawn every 2 to 3 months, even when I have no symptoms." 3. "Lithium has a narrow margin of safety, so toxicity is a very real concern." 4. "I will not be able to breastfeed my baby."

1 The patient taking lithium must be conscious of maintaining normal sodium intake. Because lithium is a salt, if sodium intake is low the body will replace the sodium with lithium, leading to lithium toxicity. Options 2, 3, and 4 are incorrect. The patient taking lithium must have regular blood studies and toxicity is a very real concern; hence the necessity for routine blood studies. Women should refrain from breastfeeding while taking lithium.

The nurse is monitoring the patient for early lithium carbonate (Eskalith) toxicity. Which symptoms, if manifested by the patient, would indicate that toxicity may be developing? (Select all that apply.) 1. Persistent gastrointestinal upset 2. Confusion 3. Polyuria 4. Convulsions 5. Ataxia

1, 2 Persistent GI upset and confusion are signs of elevated lithium levels between 1.5 and 2.0, which signify early toxicity. Options 3, 4, and 5 are incorrect. Polyuria is an adverse effect that may occur in early therapy, but is not associated with early toxicity. Convulsions may occur at serum levels above 2.5, but not in early stages of toxicity. Ataxia is also not a sign of early lithium toxicity.

Which of the following should the nurse include in the teaching plan for a patient receiving subcutaneous heparin? (Select all that apply.) 1. Inject medication in the deep fatty layer of the abdomen. 2. When brushing your teeth, use a soft toothbrush. 3. Hold direct pressure on any puncture sites for 15 minutes. 4. Use dental floss daily after brushing. 5. Take a daily aspirin tablet, 325 mg, to prevent inflammation at the injection site.

1, 2, 3 The patient should be taught proper injection technique, including the need to inject the heparin into the deep subcutaneous fat layer. A soft toothbrush should be used for oral hygiene. Puncture wounds or cuts will require longer than normal pressure held at the site to stop bleeding—15 minutes or longer. Options 4 and 5 are incorrect. Dental flossing should be avoided while the patient is receiving anticoagulants. The flossing can cause gum irritation and excessive bleeding. Aspirin has antiplatelet effects and concurrent use may increase the risk of bleeding or hemorrhage.

A patient has been diagnosed with H. pylori as the causative factor for a gastric ulcer. Which of the following drug orders would be considered first-line therapy? (Select all that apply.) 1. Omeprazole 2. Metronidazole 3. Sucralfate 4. Bismuth subsalicylate 5. Fluconazole

1, 2, 4 First-line therapy for H. pylori includes a combination of a PPI such as omeprazole; antibiotics such as metronidazole, clarithromycin, or amoxicillin; and bismuth subsalicylate. Options 3 and 5 are incorrect. Sucralfate stimulates mucus, bicarbonate, and prostaglandin secretion, and acts locally to produce a thick protective barrier that coats and binds to the ulcer, protecting it against further erosion from acid and pepsin to promote healing. It is not used as a first-line drug in H. pylori infections. Fluconazole is an antifungal drug and is not used to treat a bacterial infection such as H. pylori.

Omeprazole (Prilosec) is prescribed for a patient with gastroesophageal reflux disease. The nurse would monitor a reduction in which symptom to determine if the drug therapy is effective? (Select all that apply.) 1. Dysphagia 2. Dyspepsia 3. Appetite 4. Nausea 5. Belching

1, 2, 4, 5 Symptoms of GERD include dysphagia, dyspepsia, nausea, belching, heartburn, and chest pain. Option 3 is incorrect. The nurse would not expect a decrease in the patient's appetite due to this medication.

A patient asks the nurse about giving an over-the-counter drug, bismuth subsalicylate (Pepto-Bismol), to treat a daughter's diarrhea. On which of the following will the nurse base the recommendation? (Select all that apply.) 1. Cause of diarrhea 2. Normal activity level 3. Age 4. Weight 5. School schedule

1, 3 The nurse should explore possible causes for the diarrhea with the mother before making a recommendation because if diarrhea is caused by infections, slowing motility may allow the infection to increase. Salicylates, including bismuth subsalicylate, are contraindicated in children under the age of 19 because of an increased risk for Reye's syndrome. Options 2, 4, and 5 are incorrect. Activity level and weight are important growth and development parameters to assess but are unrelated to the drug's use. The school schedule would not have a direct impact on which drug is recommended.

A patient will be receiving dabigatran (Pradaxa). Which of the following is true concerning this drug therapy? (Select all that apply.) 1. Ginger, garlic, and green tea may increase the risk of bleeding. 2. Vitamin B12 is used to augment this drug's response. 3. Pradaxa is used for deep vein thrombosis. 4. Activated partial thromboplastin time may be monitored to determine effectiveness. 5. This drug is contraindicated for patients with gastritis.

1, 3, 4, 5 Ginger, garlic, and green tea may all increase the risk of bleeding. Dabigatran may be used for DVT and is monitored by aPTT, similar to heparin. The drug is contraindicated in patients with gastritis because of the increased risk of bleeding. Option 2 is incorrect. Vitamin B12 does not enhance the response of dabigatran.

What should the nurse teach the patient who is to receive alteplase (Activase) as part of the treatment for myocardial infarction? 1. The drug will be given IV, and the patient should be able to go home later today. 2. The patient should remain quiet and lying down during drug administration and for up to 8 hours after infusion. 3. The risk of bleeding returns to normal within 24 hours after the drug has been infused. 4. An increase in vitamin K-rich foods or a supplement will be needed for the week following the treatment.

2 Because of the risk of hemorrhage, dysrhythmias, and hypotension, the patient should remain supine during and for up to 8 hours post-drug infusion. Options 1, 3, and 4 are incorrect. The patient will remain in the hospital for a minimum of 24 hours or longer post-procedure for monitoring per agency protocol. The risk of bleeding remains elevated for 2 to 4 days postinfusion. Oral anticoagulants such as warfarin or antiplatelet drugs will be ordered after the infusion; increasing vitamin K in the diet or by supplement may increase the risk of clotting.

Prior to discharge, the nurse provides teaching related to adverse effects of aripiprazole (Abilify) to the patient and caregivers. Which of the following should be included? 1. The patient may experience social withdrawal and slowed activity. 2. Avoid grapefruit and grapefruit juice in the diet because it increases stomach acidity. 3. Tardive dyskinesia is likely early in therapy. 4. Additional drugs such as fluoxetine may be needed to prevent adverse effects.

2 Grapefruit and grapefruit juice are known to interact with drugs and may increase drug levels of aripiprazole to potentially toxic concentrations. Options 1, 3, and 4 are incorrect. Social withdrawal is a symptom of the disease, and slowed activity may occur as a result of the medication. Tardive dyskinesia is not commonly noted with aripiprazole. SSRIs such as fluoxetine inhibit CYP2D6, which can cause reduced metabolism of aripiprazole, raising serum levels, and potentially causing toxicity.

A patient with type 1 diabetes will use a combination insulin that includes NPH and regular insulins. The nurse is explaining the importance of knowing the peak times for both insulins. Why is this important information for the patient to know? 1. The patient will be able to estimate the time for the next injection of insulin based on these peaks. 2. The risk of a hypoglycemic reaction is greatest around the peak of insulin activity. 3. It is best to plan activities or exercise around peak insulin times for the best utilization of glucose. 4. Additional insulin may be required at the peak periods to prevent hyperglycemia.

2 Insulin peaks are the times of maximum insulin utilization with the greatest risk of hypoglycemia. Options 1, 3, and 4 are incorrect. Insulin schedules for the patient are developed by the provider and the patient should not self-select a schedule for insulin use. Because the risk for hypoglycemia is highest at peak serum insulin levels, exercise or additional insulin may increase the risk further.

A patient was started on rosiglitazone for type 2 diabetes. He tells the nurse that he has been taking it for 5 days, but his glucose levels are unchanged. What is the nurse's best response? 1. "You should double the dose. That should help." 2. "You need to give the drug more time. It can take several weeks before it becomes fully effective." 3. "You will need to add a second drug since this one has not been effective." 4. "You most likely require insulin now."

2 It can take several weeks for rosiglitazone to provide full therapeutic effects, so the appropriate response would be to give it more time to reach effectiveness. Options 1, 3, and 4 are incorrect. It is not within a nurse's scope of practice to prescribe additional drugs or change the dosage. The healthcare provider should be consulted about any change to the patient's drug regimen.

The patient who is taking sulfasalazine (Azulfidine) develops a sore throat, bruising, and severe fatigue. The nurse determines that the patient is most likely experiencing drug-induced: 1. Stevens-Johnson syndrome. 2. Blood dyscrasias. 3. Idiosyncratic reaction. 4. Hypersensitivity response.

2 One adverse effect of sulfasalazine is blood dyscrasias, which may include anemia, leukopenia, and thrombocytopenia. Fever, an increase in bruising, and sore throat are all possible symptoms of these decreased cell counts. Options 1, 3, and 4 are incorrect. Stevens-Johnson syndrome results in inflammation of the skin and mucous membranes and includes a sunburn-like appearance, blisters, and possible exfoliation of the dermis. Idiosyncratic reactions are aberrant reactions that cannot be explained by the known pharmacologic action of the drug and occur only in a small percentage of the population. This patient's symptoms are well documented as adverse effects. Hypersensitivity responses are due to stimulation of the immune system and are invoked by an antigen or antibody response. The symptoms presented do not reflect hypersensitivity to the drug.

The nurse should question a healthcare provider's order of phenobarbital for the patient with which condition? 1. Seizure disorder 2. Panic disorder 3. Prior to a bronchoscopy 4. Prior to receiving a general anesthetic

2 Panic disorder is not an appropriate use for phenobarbital. Options 1, 3, and 4 are incorrect. Treatment of status epilepticus, use prior to diagnostic testing, and use prior to receiving general anesthesia are all appropriate for phenobarbital.

A patient is taking a solution of 5% iodine and 10% potassium iodide (Lugol's solution) prior to a thyroidectomy. The patient asks why iodine solution is used since iodine is needed to make thyroid hormone. What is the nurse's best answer? 1. "The symptoms you were having indicate you were not receiving enough iodine." 2. "High levels of iodine can temporarily reduce the amount of thyroid hormone your body makes and secretes." 3. "High levels of iodine are always used prior to thyroidectomy to make up for the loss of iodine when the thyroid is removed." 4. "The high levels of iodine help prevent diabetes from developing."

2 The high levels of iodine found in potassium iodide solution will inhibit the synthesis and release of thyroid hormone. The effectiveness decreases over time so it is only used short term before more definitive treatment can be accomplished. Options 1, 3, and 4 are incorrect. Iodine deficiency is rare and does not cause symptoms of hyperthyroidism, the indication for the patient's potassium iodide solution. High-dose iodine is not always used prior to thyroid surgery and the thyroidectomy is not related to a loss of iodine. High doses of iodine will not prevent diabetes.

A 17-year-old patient is started on fluoxetine (Prozac) for treatment of depression. When teaching the patient and his family, what would the nurse include? (Select all that apply.) 1. Report any sedation to the provider and exercise caution with activities requiring mental alertness. 2. Fluctuations in weight may be managed with a healthy diet and adequate amounts of exercise. 3. Report any thoughts of suicide to the provider immediately, especially during early initiation of the drug. 4. The drug may be safely stopped if unpleasant side effects occur and reported to the provider at the next scheduled visit. 5. The drug may cause excessive thirst but dramatic increase in fluid intake should be avoided.

2, 3 Fluoxetine causes weight loss in some patients while others experience weight gain or fluctuations in weight. A healthy diet and adequate exercise will help maintain normal weight while on this drug. While rare, an increased risk of suicide has been noted in patients up to age 24, and the patient should be carefully monitored, especially during the early initiation of therapy. Options 1, 4, and 5 are incorrect. Fluoxetine may cause insomnia but not sedation. Abrupt withdrawal of fluoxetine may lead to withdrawal symptoms. If the drug needs to be discontinued, gradually tapering the dose is recommended. Fluoxetine is not known to cause excessive thirst.

Before administering a morning lispro insulin (Humalog) injection, which activity should the nurse perform? (Select all that apply.) 1. Obtain a morning urine sample for glucose and ketones. 2. Check the patient's fingerstick glucose level. 3. Ensure that breakfast trays are present on the unit and the patient may eat. 4. Obtain the patient's pulse and blood pressure. 5. Assess for symptoms of hypoglycemia.

2, 3, 5 The blood glucose level should be checked prior to administering any type of insulin. Because lispro is a rapid-acting insulin, the nurse should ensure that a meal is available and that the patient will be able to eat shortly after receiving a dose. If signs of hypoglycemia are present, the insulin dose should be held and the patient treated for hypoglycemia. The provider should be notified. Options 1 and 4 are incorrect. Urine testing for glucose and ketones does not give exact information, and patients vary on the degree to which glucose and ketones will "spill" into the urine. While a check of the pulse or blood pressure may be included in routine vital signs or to further assess symptoms of hypoglycemia, they do not provide information directly pertinent to the administration of insulin.

Nursing implications of the administration of haloperidol (Haldol) to a patient exhibiting psychotic behavior include which of the following? (Select all that apply.) 1. Take 1 hour before or 2 hours after antacids. 2. The incidence of extrapyramidal symptoms is high. 3. It is therapeutic if ordered on an as-needed basis. 4. Haldol is contraindicated in Parkinson's disease, seizure disorders, alcoholism, and severe mental depression. 5. Crush the sustained release form for easier swallowing.

2, 4 EPS occur frequently, especially at the beginning of therapy with haloperidol. An individual with Parkinson's disease, seizure disorders, alcoholism, or severe mental depression should not take haloperidol because they are all disorders that affect the CNS. Dementia, seizures, depression, and severe CNS depression are known to occur with the use of haloperidol in these patients. Options 1, 3, and 5 are incorrect. Haloperidol and antacids may be given simultaneously; there are no known interactions between these two medications. Haloperidol must be taken as ordered, on a regular schedule. Taking the drug prn will not reduce symptoms of psychosis because it takes several weeks of regular administration before therapeutic levels are reached. Sustained release medications should never be crushed. If the patient cannot take the medication, another form should be used.

Which assessment finding would cause the nurse to withhold a regularly scheduled dose of levothyroxine? 1. A 1-kg (2-lb) weight gain 2. A blood pressure reading of 100/70 mmHg 3. A heart rate of 110 beats/min 4. A temperature of 37.9°C (100.2°F)

3 A heart rate of 110 beats/min would cause the nurse to hold the scheduled dose of levothyroxine, because it could indicate too high a level of thyroid hormone. Options 1, 2, and 4 are incorrect. A low level of thyroid hormone could cause weight gain or decreased blood pressure. These are symptoms of hypothyroidism and would not cause the nurse to hold the medication. An elevated temperature without other signs of hyperthyroidism would not warrant withholding the medication.

The nurse would consider which of the following assessment findings as adverse effects to metformin therapy? 1. Hypoglycemia 2. Gastrointestinal distress 3. Lactic acidosis 4. Weight loss

3 A serious adverse effect of metformin is the risk of developing lactic acidosis. CKD, excess alcohol use, and IV contrast agents increase the risk for lactic acidosis and are contraindications to the use of metformin. Options 1, 2, and 4 are incorrect. Hypoglycemia, GI distress, and weight loss are common adverse effects of most oral antidiabetic drugs and are not specific to metformin.

The patient who has been taking venlafaxine (Effexor) for 2 weeks calls the nurse to report that there is no improvement in the depression. The nurse's best response is: 1. "Call your healthcare provider and see if he or she will change the order to a different medication." 2. "Are you sure that you are taking it as ordered? Perhaps you should consider increasing the dosage gradually." 3. "The medication may take up to 3 weeks or longer to be effective. Continue taking the medication as ordered." 4. "Add an over-the-counter antianxiety agent to your daily medications."

3 An atypical antidepressant such as venlafaxine may take up to 3 weeks or longer to reach full therapeutic effect, so the patient must continue taking the medication as ordered so that therapeutic drug levels can be reached and maintained. Options 1, 2, and 4 are incorrect. It is not within a nurse's scope of practice to suggest changes in medication routine without consulting the prescriber, and these comments are not helpful to maintaining a therapeutic nurse-patient relationship.

The nurse who is caring for a patient with gastroesophageal reflux disease should question the order for which drug? 1. H2-receptor antagonists 2. Proton pump inhibitors 3. Antibiotics 4. Antacids

3 Antibiotics have no role in the treatment of GERD although certain antibiotics are used in treating PUD to eradicate the H. pylori organism. Options 1, 2, and 4 are incorrect. H2-receptor antagonists and PPIs are used routinely to relieve symptoms of GERD. OTC antacids provide intermittent relief for mild cases.

A nurse should advise a patient who is receiving lorazepam (Ativan) about the adverse effects of this medication, which include: 1. Tachypnea. 2. Astigmatism. 3. Ataxia. 4. Euphoria.

3 Ataxia, weakness, restlessness, dizziness, and other motor problems can occur with lorazepam. Options 1, 2, and 4 are incorrect. These are not adverse effects associated with lorazepam.

The nurse is caring for a patient receiving a sedative-hypnotic. Which adverse effect associated with this drug therapy is the highest priority for the nurse? 1. Urinary incontinence 2. Activity intolerance 3. Fall risk 4. Poor nutritional intake

3 Client safety is the major concern with sedative-hypnotics, so prevention of falls is the highest priority. Options 1, 2, and 4 are incorrect. The client may experience urinary incontinence, activity intolerance, or poor nutritional intake related to drug therapy or other reasons. Safety, however, is the priority concern.

The patient is taking diphenoxylate with atropine (Lomotil). What does the nurse assess when monitoring for therapeutic effects? 1. Reduction of abdominal cramping 2. Minimal passage of flatus 3. Decrease in loose, watery stools 4. Increased bowel sounds

3 Diphenoxylate with atropine is given for diarrhea. The patient should report a decrease in the number of loose, watery stools after administration. Options 1, 2, and 4 are incorrect. Although diphenoxylate with atropine may decrease abdominal cramping and gas as a result of slowed peristalsis, it is not the main therapeutic effect desired from this drug. Slowing peristalsis may cause a decrease in bowel sounds rather than an increase.

A patient who is taking warfarin (Coumadin) states, "I wake up every morning with arthritis pain and I always take aspirin or ibuprofen." The nurse's response would be based on which physiologic concepts? 1. Aspirin and ibuprofen (Motrin) will counteract the therapeutic effects of many anticoagulants. 2. Anticoagulants will reduce the half-life of drugs such as aspirin and ibuprofen. 3. Many substances such as aspirin and ibuprofen will increase the risk of bleeding. 4. The combination of aspirin products with anticoagulants will worsen arthritis pain.

3 Many drugs such as aspirin and ibuprofen have strong anticoagulant effects. When the patient on warfarin takes these drugs, the increased risk of bleeding can be hazardous. Options 1, 2, and 4 are incorrect. Drugs such as aspirin and ibuprofen do not neutralize the effect of an anticoagulant. Anticoagulants do not influence the half-life of any drugs. The pain associated with arthritis is not worsened by the combination of these drugs.

The nurse is scheduling the patient's daily medication. When would be the most appropriate time for the patient to receive proton pump inhibitors? 1. At night 2. After fasting at least 2 hours 3. About 1/2 hour before a meal 4. About 2 to 3 hours after eating

3 The proton pump is activated by food intake. Thus, administering it about 20 to 30 minutes before the first major meal of the day allows peak serum levels to coincide with when the maximum levels of pumps are activated, allowing maximum efficiency of the PPI. Options 1, 2, and 4 are incorrect. The proton pumps are less active at night, in the fasting state, or between meals.

Which of these statements, if made by a patient, would indicate that further instruction is needed about alprazolam (Xanax)? 1. "I will stop smoking by undergoing hypnosis." 2. "I will not drive immediately after I take this medication." 3. "I will stop the medicine when I feel less anxious." 4. "I will take my medication with food if my stomach feels upset."

3 This medication must be gradually reduced, not abruptly terminated. Abrupt termination may cause withdrawal symptoms (nausea, vomiting, abdominal cramps, diaphoresis, confusion, tremors, seizures). Options 1, 2, and 4 are incorrect. These are appropriate statements, and indicate that the client understands the teaching.

What should the nurse teach the patient who is newly diagnosed with hypothyroidism and will start taking levothyroxine (Synthroid)? 1. Take the pill in the afternoon with a high-fiber snack to prevent stomach upset. 2. Eat plenty of fruits and vegetables such as strawberries, spinach, and kale to replace vital nutrients. 3. Take the dose in the morning before breakfast, as close to the same time each day as possible. 4. The drug may be taken every other day if diarrhea occurs.

3 To closely approximate the body's own hormone levels, levothyroxine should be taken in the morning, ideally at the same time each day. Options 1, 2, and 4 are incorrect. Taking levothyroxine along with food or meals containing high fiber may affect the absorption of the drug. Foods such as strawberries, spinach, and kale may inhibit thyroid secretion, reducing the effectiveness of the levothyroxine. If diarrhea occurs, the provider should be notified to determine the need to alter the dose.

Which of the following assessment findings would the nurse expect to observe in an adult patient experiencing therapeutic effects from levothyroxine (Synthroid)? (Select all that apply.) 1. Constipation and weight gain 2. Decreased blinking and exophthalmos 3. Decreased reports of fatigue 4. Decreased blood cholesterol levels 5. Pulse rate between 60 and 100 beats/minute

3, 4, 5 A euthyroid (normal) state is indicated by a return to normal performance of ADLs without fatigue, normalizing cholesterol levels, and vital signs within normal limits with a pulse rate between 60 and 100 beats/min. Options 1 and 2 are incorrect. Constipation and weight gain are symptoms of hypothyroidism. Decreased blinking and exophthalmos are symptoms of hyperthyroidism.

The patient states that he has not taken his antipsychotic drug for the past 2 weeks because it was causing sexual dysfunction. The nurse is aware that the name antipsychotic indicates that continuing the medication as prescribed is important because: 1. Hypertensive crisis may occur with abrupt withdrawal. 2. Muscle twitching may occur with abrupt withdrawal. 3. Parkinson-like symptoms will occur with withdrawal. 4. Symptoms of psychosis are likely to return if the medication is withdrawn.

4 Antipsychotic medications treat the symptoms associated with mental illness but do not cure these disorders. Without the medication, the symptoms will return. Options 1, 2, and 3 are incorrect. These are not symptoms associated with abrupt withdrawal of an antipsychotic medication.

A healthcare provider orders magnesium hydroxide (Milk of Magnesia) for a patient with constipation, secondary to postoperative opioid use. Before administering the drug, the nurse would assess: 1. Blood pressure. 2. Dosage of the opioid drug prescribed. 3. The patient's ability to ambulate to the bathroom. 4. Bowel sounds.

4 Because magnesium hydroxide will stimulate peristalsis, it is important for the nurse to assess for bowel sounds before giving the drug. If blockage or an ileus is suspected, the drug should be held and the provider notified. Options 1, 2, and 3 are incorrect. Blood pressure is an important vital sign to monitor postoperatively, but the magnesium hydroxide should not have direct effects. The dosage of the opioid drug and the patient's ability to ambulate to the bathroom will not impact the drug's use or action.

A young woman calls the clinic and reports that her mother had an insulin reaction and was found unconscious. The young woman gave her a glucagon injection 20 minutes ago, and her mother woke up but is still groggy and "does not make sense." What should the nurse tell the daughter? 1. "Let her wake up on her own, then give her something to eat." 2. "Place some hard candies in her mouth." 3. "Just let her sleep. People are sleepy after hypoglycemic episodes." 4. "Give her another injection and call the paramedics."

4 Glucagon injections can be repeated if one dose is not effective. Hypoglycemia is a medical emergency, and because this woman has not fully recovered, medical attention is needed. Options 1, 2, and 3 are incorrect. The patient is still experiencing symptoms of hypoglycemia, and continued treatment is indicated. Because she is still groggy and disoriented, it would not be safe to give this patient anything by mouth.

The nurse explains the benefit of using the long-acting insulin glargine (Lantus) over other insulins. What will the nurse tell the patient about this insulin? 1. It does not need to be administered by injection. 2. It can be given by intramuscular or subcutaneous injection. 3. It does not require blood glucose monitoring. 4. It has no definite peak but maintains a steady state of insulin in the body.

4 Insulin glargine has no definite peak, so the risk of a hypoglycemic reaction is minimal. Options 1, 2, and 3 are incorrect. Insulin glargine must be given by subcutaneous injection, it cannot be given by IM injection, and blood glucose monitoring is required for all patients taking any insulin.

Ondansetron (Zofran) has been ordered prior to chemotherapy for a patient receiving treatment for lymphoma. Prior to administering this drug, the nurse will review the patient's past medical history for what condition? 1. Allergy to soy or soy products 2. History of chronic constipation 3. Glaucoma 4. Cardiac dysrhythmias

4 Ondansetron is known to prolong the QT interval and may cause cardiac dysrhythmias. Options 1, 2, and 3 are incorrect. An allergy to soy or soy products, chronic constipation, or glaucoma does not present contraindications to the drugs.

The patient on replacement therapy with levothyroxine (Synthroid) reports feeling nervous and is having occasional palpitations and tremors. The nurse recognizes that these symptoms may indicate what effect is occurring? 1. The patient is still experiencing hypothyroidism and the dose may need to be increased. 2. The patient now has normal thyroid function and the levothyroxine (Synthroid) is no longer needed. 3. The patient has developed diabetes and needs further evaluation. 4. The patient is experiencing symptoms of hyperthyroidism and the drug dosage may need to be decreased.

4 The administration of too much levothyroxine may cause hyperthyroidism, characterized by nervousness, palpitations, weight loss, diarrhea, and muscle tremors. Before altering the dosage, thyroid function studies will be performed to verify this condition. Options 1, 2, and 3 are incorrect. Nervousness, palpitations, and tremors are not symptoms of hypothyroidism or normal thyroid states. While these symptoms may occur with diabetes and hyperglycemia, other symptoms would dominate and would be noted before these symptoms occurred.

Which statement made by the patient who is taking risperidone (Risperdal) indicates that further teaching is necessary? 1. "I'll monitor my weight every month." 2. "I can increase my intake of fluids and fiber if I have any gastrointestinal problems." 3. "I'll have my blood pressure monitored regularly." 4. "There is no problem if I want to drink alcohol on the weekends."

4 The patient taking risperidone or any antipsychotic medication should refrain from consuming alcohol. Concurrent use of alcohol with antipsychotic medications will increase CNS depression. Because there is an increased risk of hyperglycemia or diabetes in patients taking risperidone, alcohol should also be avoided because it may affect blood sugar levels. Options 1, 2, and 3 are incorrect. Weight gain may occur, and obtaining a weekly weight will help the patient track any gain. Increasing fluids and fiber may help to limit GI adverse effects. Hypotension is related to adverse reactions the patient may experience and must be monitored and reported if it occurs.

The patient with insomnia is being treated with temazepam (Restoril). The nurse monitors for therapeutic effectiveness by noting which of the following? 1. Sleeping in 3-hour intervals, awaking for a short time, and then returning to sleep 2. Feeling less anxiety during activities of daily living 3. Having fewer episodes of panic attacks when stressed 4. Sleeping 7 hours without awakening

4 leeping for 7 h is the desired effect of temazepam. Options 1, 2, and 3 are incorrect. The client should experience periods of sleep lasting longer than 3 h and should obtain a full night's sleep. The client will be taking temazepam to assist with insomnia, not to treat anxiety related to everyday stress or to help control panic attacks.