Pharm Final New Content
A nurse explains to a nursing student why opioid antidiarrheal medications are classified as drugs with little or no abuse potential. Which statement by the student indicates a need for further teaching? a. "Formulations for the treatment of diarrhea have very short half-lives." b. "Opioid antidiarrheal drugs contain other drugs with unpleasant side effects at higher doses." c. "Some opioid antidiarrheal drugs do not cross the blood-brain barrier." d. "Some opioid antidiarrheal medications are not water soluble and cannot be given parenterally."
A
A nurse is caring for a patient who has been taking low-dose aspirin for several days. The nurse notes that the patient has copious amounts of watery nasal secretions and an urticarial rash. The nurse will contact the provider to discuss: a. administering epinephrine. b. changing to a first-generation NSAID. c. reducing the dose of aspirin. d. giving an antihistamine.
A
A nurse is discussing glucocorticoids with a group of nursing students. Which statement by a student indicates understanding of the teaching? a. "Glucocorticoids have both endocrine and nonendocrine uses." b. "Patients treated for adrenocortical insufficiency receive pharmacologic doses." c. "Pharmacologic effects are achieved with low doses of glucocorticoids." d. "Physiologic doses are used to treat inflammatory disorders."
A
A nurse is discussing the administration of an intravenous infusion of rituximab (Rituxan) with a nursing student. Which statement by the student indicates a need for further education about the care of a patient receiving this drug? a. "Angioedema and hypersensitivity may occur, but they are usually self-limiting and mild." b. "I should be prepared to administer epinephrine, glucocorticoids, and oxygen if needed." c. "I will administer an antihistamine and acetaminophen before beginning the infusion." d. "I will monitor this patient's blood pressure, respiratory rate, and oxygen saturation closely."
A
A nurse is discussing the role of vitamin D in calcium regulation with a nursing student. Which statement by the student indicates a need for further teaching? a. "Adequate amounts of vitamin D occur naturally in the diet." b. "Vitamin D3 is preferred over vitamin D2." c. "Vitamin D can promote bone decalcification." d. "Vitamin D increases the absorption of calcium and phosphorus from the intestine."
A
A nurse is preparing to administer IV calcium chloride to a patient with a low serum calcium level. Which drug on the patient's medication record, administered concurrently, would require additional patient monitoring by the nurse? a. Digoxin [Lanoxin] b. Furosemide [Lasix] c. Lorazepam [Ativan] d. Pantoprazole [Protonix]
A
A nurse is providing education to a patient who will begin taking alendronate [Fosamax]. Which complication should the patient be instructed to report immediately? a. Difficulty swallowing b. Dizziness c. Drowsiness d. Pallor
A
A nurse is providing teaching for an adult patient with arthritis who has been instructed to take ibuprofen [Motrin] for discomfort. Which statement by the patient indicates a need for further teaching? a. "I may experience tinnitus with higher doses of this medication." b. "I may take up to 800 mg 4 times daily for pain." c. "I should limit alcohol intake to fewer than three drinks a day." d. "I will take this medication with meals to help prevent stomach upset."
A
A nurse is taking a history on a clinic patient who reports being constipated. Upon further questioning, the nurse learns that the patient's last stool was 4 days ago, that it was of normal, soft consistency, and that the patient defecated without straining. The patient's abdomen is not distended, and bowel sounds are present. The patient reports usually having a stool every 1 to 2 days. What will the nurse do? a. Ask about recent food and fluid intake. b. Discuss the use of polyethylene glycol [MiraLax]. c. Recommend a bulk laxative. d. Suggest using a bisacodyl [Dulcolax] suppository.
A
A nurse is teaching a patient who has taken glucocorticoids for over a year about glucocorticoid withdrawal. Which statement by the patient indicates a need for further teaching? a. "I should reduce the dose by half each day until I stop taking the drug." b. "I will need to have cortisol levels monitored during the withdrawal process." c. "The withdrawal schedule may take several months." d. "If I have surgery, I may need to take the drug for a while, even after I have stopped."
A
A nursing student is discussing with a nurse the plan of care for a patient about to undergo a third round of chemotherapy with cisplatin. Which statement by the nursing student about the treatment of CINV is correct? a. "Aprepitant [Emend] will be necessary to treat CINV caused by cisplatin." b. "Antiemetics are most effective if given just as the chemotherapy is finished." c. "Lorazepam probably would not be helpful for this patient." d. "This patient will need intravenous antiemetics for best effects."
A
A patient has been receiving intravenous ketorolac 30 mg every 6 hours for postoperative pain for 4 days. The patient will begin taking oral ketorolac 10 mg every 4 to 6 hours to prepare for discharge in 1 or 2 days. The patient asks the nurse whether this drug will be prescribed for management of pain after discharge. The nurse will respond by telling the patient that the provider will prescribe a(n): a. different nonsteroidal anti-inflammatory drug for home management of pain. b. fixed-dose opioid analgesic/nonsteroidal anti-inflammatory medication. c. lower dose of the oral ketorolac for long-term pain management. d. intranasal preparation of ketorolac for pain management at home.
A
A patient is admitted for treatment of gout that has been refractory to treatment with allopurinol and probenecid. The patient is taking colchicine, and the prescriber orders pegloticase [Krystexxa]. Before administering this drug, the nurse will expect to: a. administer an antihistamine and a glucocorticoid. b. discontinue the colchicine. c. increase the dose of colchicine. d. prepare to administer a bronchodilator if needed.
A
A patient is beginning therapy with oral methotrexate [Rheumatrex] for rheumatoid arthritis. The nurse will teach this patient about the importance of: a. having routine renal and hepatic function tests. b. limiting folic acid consumption. c. reporting alopecia and rash. d. taking the medication on a daily basis.
A
A patient is diagnosed with peptic ulcer disease. The patient is otherwise healthy. The nurse learns that the patient does not smoke and that he drinks 1 or 2 glasses of wine with meals each week. The nurse anticipates that the provider will prescribe which drugs? a. Amoxicillin [Amoxil], clarithromycin, and omeprazole [Prilosec] b. Amoxicillin [Amoxil], metronidazole [Flagyl], and cimetidine [Tagamet] c. Clarithromycin, metronidazole [Flagyl], and omeprazole [Prilosec] d. Tetracycline, cimetidine [Tagamet], and lansoprazole [Prevacid]
A
A patient newly diagnosed with PUD reports taking low-dose aspirin (ASA) for prevention of cardiovascular disease. The nurse learns that the patient drinks 2 to 3 cups of coffee each day and has a glass of wine with dinner 3 or 4 nights per week. The patient eats three meals a day. The nurse will counsel this patient to: a. change the meal pattern to five or six smaller meals per day. b. discontinue taking aspirin, because it can irritate the stomach. c. stop drinking wine or any other alcoholic beverage. d. switch to a decaffeinated coffee and reduce the number of servings.
A
A patient taking a glucocorticoid for arthritis reports feeling bloated. The nurse notes edema of the patient's hands and feet. Which action by the nurse is correct? a. Ask the patient about sodium intake. b. Obtain a blood glucose level. c. Suggest the patient limit potassium intake. d. Tell the patient to stop taking the drug.
A
A patient taking high doses of a glucocorticoid develops weakness in the muscles of the upper arms and in the legs. What will the nurse do? a. Contact the provider to ask about reducing the dose. b. Encourage the patient to restrict sodium intake. c. Reassure the patient that this is an expected side effect. d. Tell the patient to stop taking the drug.
A
A patient taking risedronate IR [Actonel] for osteoporosis reports experiencing diarrhea and headaches. What will the nurse tell this patient? a. These are common side effects of this drug. b. These symptoms indicate serious toxicity. c. The patient should discuss taking risedronate DR [Atelvia] with the provider. d. The medication should be taken after a meal to reduce symptoms.
A
A patient who has arthritis has been taking ibuprofen [Motrin] and a glucocorticoid medication. The patient reports having tarry stools but denies gastric pain. Which action by the nurse is correct? a. Contact the provider to discuss ordering an antiulcer medication. b. Counsel the patient to use over-the-counter antacids. c. Reassure the patient not to worry unless there is gastric pain. d. Tell the patient to stop taking the glucocorticoid immediately.
A
A patient who is in her first trimester of pregnancy asks the nurse to recommend nonpharmaceutical therapies for morning sickness. What will the nurse suggest? a. Avoiding fatty and spicy foods b. Consuming extra clear fluids c. Eating three meals daily d. Taking foods later in the day
A
A patient who reports regular consumption of two or three alcoholic beverages per day asks about taking acetaminophen when needed for occasional recurrent pain. What will the nurse tell the patient? a. "Do not take more than 2 gm of acetaminophen a day." b. "Do not take more than 3 gm of acetaminophen a day." c. "Do not take more than 4 gm of acetaminophen a day." d. "Do not take a fixed-dose preparation with opioid analgesics."
A
A patient will begin taking hydroxychloroquine [Plaquenil] for rheumatoid arthritis. The patient is currently taking high-dose NSAIDs and methotrexate. What will the nurse teach the patient? a. That an eye exam is necessary at the beginning of therapy with this drug b. That the dose of NSAIDs may be decreased when beginning hydroxychloroquine c. To obtain tests of renal and hepatic function while taking this drug d. To stop taking methotrexate when starting hydroxychloroquine
A
A patient with chronic gout is admitted to the hospital for treatment for an infection. The patient is receiving allopurinol and ampicillin. The nurse is preparing to administer medications and notes that the patient has a temperature of 101°F and a rash. What will the nurse do? a. Withhold the allopurinol and notify the prescriber of the drug reaction. b. Withhold the ampicillin and contact the provider to request a different antibiotic. c. Request an order for an antihistamine to minimize the drug side effects. d. Suggest giving a lower dose of the allopurinol while giving ampicillin.
A
A patient with metastatic cancer has had several fractures secondary to bone metastases. The provider orders denosumab [Xgeva]. What will the nurse teach this patient? a. Denosumab may delay healing of these fractures. b. Denosumab should be given subcutaneously every 12 months. c. Denosumab will improve hypocalcemia. d. Unlike bisphosphonates, denosumab does not increase osteonecrosis of the jaw (ONJ).
A
A patient with severe glucocorticoid-induced osteoporosis will start therapy with teriparatide [Forteo]. What will the nurse expect to administer? a. 20 mcg once daily subQ b. 20 mcg twice daily subQ c. 10 mcg once daily subQ d. 10 mcg twice daily subQ
A
A woman who has arthritis is breast-feeding her infant and asks the nurse if it is safe to take NSAIDs while nursing. What will the nurse tell this patient? a. NSAIDs are safe to take while breast-feeding. b. NSAIDs are not safe, even in small amounts. c. She should take only COX-2 inhibitors while breast-feeding. d. She should request a prescription for narcotic analgesics.
A
A woman who is breastfeeding is prescribed a low pharmacologic dose of a glucocorticoid and asks the nurse about potential effects on her infant. What will the nurse tell her about this medication? a. "At this dose, the concentration in your breast milk is safe." b. "Contact your provider to discuss lowering the dose." c. "There will be reversible side effects for your baby." d. "This drug is likely to cause growth retardation in your baby."
A
An adolescent is brought to the emergency department by a parent who reports that the patient took a whole bottle of extended-release acetaminophen tablets somewhere between 8 and 10 hours ago. The nurse will anticipate administering which of the following? a. Acetylcysteine [Mucomyst] b. Activated charcoal c. Hemodialysis d. Respiratory support
A
The nurse is caring for an older adult patient after a right hip open reduction internal fixation (ORIF). The patient is taking an opioid every 6 hours as needed for pain. The nurse discusses obtaining an order from the prescriber for which medication? a. Docusate sodium [Colace] b. GoLYTELY c. Lactulose d. Polyethylene glycol [MiraLax]
A
The nurse is providing education to a patient who has been prescribed both an antacid and cimetidine [Tagamet]. Which instruction should the nurse give the patient about taking the medications? a. "Take the antacid 1 hour after the ranitidine." b. "The antacid and ranitidine should be taken at the same time for better effect." c. "Take the antacid 15 minutes before the ranitidine." d. "Take the antacid 30 minutes after the ranitidine."
A
The prescriber orders 20 mg of hydrocortisone orally once each day. The nurse will make sure the drug is scheduled to be administered at what time? a. 8:00 AM b. 12:00 PM c. 4:00 PM d. 9:00 PM
A
When metronidazole [Flagyl] is a component of the H. pylori treatment regimen, the patient must be instructed to do what? a. Avoid any alcoholic beverages b. Avoid foods containing tyramine c. Take the drug on an empty stomach d. Take the drug with food
A
Which condition would cause the nurse to withhold a PRN order for magnesium hydroxide? a. Chronic renal failure b. Cirrhosis c. Hemorrhoids d. Prostatitis
A
A 60-year-old female patient is about to begin long-term therapy with a glucocorticoid. Which of the following will be important for minimizing the risk of osteoporosis? a. Baseline vitamin D level b. Calcium and vitamin D supplements c. Estrogen therapy d. Skeletal x-rays before treatment
B
A 65-year-old female patient tells a nurse that she has begun taking calcium supplements. The nurse learns that the patient consumes two servings of dairy products and takes 1200 mg in calcium supplements each day. The patient's serum calcium level is 11.1 mg/dL. What will the nurse tell this patient? a. She should increase her dietary calcium in addition to the supplements b. The amount of calcium she takes increases her risk for heart attack and stroke c. To continue taking 1200 mg of calcium supplement since she is over age 50 d. To supplement her calcium with 10,000 units of vitamin D each day
B
A child is to begin long-term glucocorticoid therapy. The parents ask the nurse about the effects of this drug on the child's growth. Which response by the nurse is correct? a. "A smaller dose may be indicated for your child." b. "Ask your provider about every other day dosing." c. "Long-acting glucocorticoid preparations should prevent growth suppression." d. "Oral glucocorticoids rarely cause growth suppression."
B
A nurse is providing medication teaching for a patient who will begin taking diclofenac [Voltaren] gel for osteoarthritis in both knees and elbows. Which statement by the patient indicates understanding of the teaching? a. "Because this is a topical drug, liver toxicity will not occur." b. "I should cover areas where the gel is applied to protect them from sunlight." c. "I will apply equal amounts of gel to all affected areas." d. "The topical formulation has the same toxicity as the oral formulation."
B
A nurse is teaching a group of nursing students about cyclooxygenase (COX) inhibitors. A student asks the nurse about characteristics of COX-1 inhibitors. Which statement by the nurse is true? a. "COX-1 inhibitors protect against colorectal cancer." b. "COX-1 inhibitors protect against myocardial infarction and stroke." c. "COX-1 inhibitors reduce fever." d. "COX-1 inhibitors suppress inflammation."
B
A nurse is teaching a group of nursing students why glucocorticoids are preferred over nonsteroidal anti-inflammatory drugs in the treatment of inflammation. Which statement by a student indicates a need for further teaching? a. "Glucocorticoids act by multiple mechanisms and have more anti-inflammatory effects than NSAIDs." b. "Glucocorticoids have fewer side effects than nonsteroidal anti-inflammatory drugs." c. "Glucocorticoids help avert damage to tissues from lysosomal enzymes." d. "Glucocorticoids reduce the immune component of inflammation."
B
A nurse provides teaching for a woman who will begin taking supplemental calcium. Which statement by the woman indicates understanding of the teaching? a. "Chewable calcium tablets are not absorbed well and are not recommended." b. "I should not take more than 600 mg of calcium at one time." c. "I should take enough supplemental calcium to provide my total daily requirements." d. "If I take calcium with green, leafy vegetables, it will increase absorption."
B
A nurse receives an order to administer castor oil to a patient. Which action by the nurse is correct? a. Administer the medication at bedtime. b. Chill the medication and mix it with fruit juice. c. Provide teaching about home use of this medication. d. Teach the patient that the effects will occur slowly.
B
A patient admitted to the hospital has a history of peptic ulcer disease. The patient takes ranitidine [Zantac] and sucralfate [Carafate]. The patient tells the nurse that discomfort is usually controlled but that symptoms occasionally flare up. What will the nurse do? a. Ask the provider about ordering an endoscopic examination. b. Contact the provider to discuss serologic testing and an antibiotic. c. Contact the provider to discuss switching to a proton pump inhibitor. d. Counsel the patient to avoid beverages containing caffeine.
B
A patient is taking bismuth subsalicylate [Pepto-Bismol] to prevent diarrhea. The nurse performing an assessment notes that the patient's tongue is black. What will the nurse do? a. Assess further for signs of gastrointestinal (GI) bleeding. b. Reassure the patient that this is an expected side effect of this drug. c. Request an order for liver function tests to evaluate for hepatotoxicity. d. Withhold the drug, because this is a sign of bismuth overdose.
B
A patient reports taking an oral bisacodyl laxative [Dulcolax] for several years. The provider has suggested discontinuing the laxative, but the patient is unsure how to do this. The nurse will tell the patient to: a. stop taking the oral laxative and use a suppository until normal motility resumes. b. stop taking the laxative immediately and expect no stool for several days. c. switch to a bulk-forming laxative, such as methylcellulose [Metamucil]. d. withdraw from the laxative slowly to avoid a rebound constipation effect.
B
A patient who experiences motion sickness is about to go on a cruise. The prescriber orders transdermal scopolamine [Transderm Scop]. The patient asks the nurse why an oral agent is not ordered. The nurse will explain that the transdermal preparation: a. can be applied as needed at the first sign of nausea. b. has less intense anticholinergic effects than the oral form. c. is less sedating than the oral preparation. d. provides direct effects, because it is placed close to the vestibular apparatus of the ear.
B
A patient who has been diagnosed with rheumatoid arthritis (RA) for 1 month and has generalized symptoms is taking high-dose nonsteroidal anti-inflammatory drugs (NSAIDs) and an oral glucocorticoid. The provider has ordered methotrexate [Rheumatrex]. The patient asks the nurse why methotrexate is necessary since pain and swelling have been well controlled with the other medications. The nurse will tell the patient that: a. a methotrexate regimen can reduce overall costs and side effects of treatment. b. starting methotrexate early can help delay joint degeneration. c. starting methotrexate now will help increase life expectancy. d. with methotrexate, doses of NSAIDs can be reduced to less toxic levels.
B
A patient who has been taking a glucocorticoid for several months arrives in the clinic. The nurse notes that the patient's cheeks appear full and that a prominent hump of fat is present on the upper back. The nurse will ask the provider to order which test(s)? a. Liver function tests b. Serum electrolytes c. Tuberculin skin test d. Vitamin D levels
B
A patient who is a long-distance runner has been diagnosed with rheumatoid arthritis in both knees and will begin glucocorticoid therapy. When teaching the patient about the medication, the nurse will include what information? a. "By reducing inflammation, this drug will slow the progression of your disease." b. "Glucocorticoids are used as adjunctive therapy during acute flare-ups." c. "Oral glucocorticoids cause less toxicity than intra-articular injections." d. "You may resume running when the pain and swelling improve."
B
A patient who is hospitalized for an acute gout attack has received several doses of hourly oral colchicine but still reports moderate to severe pain. As the nurse prepares to administer the next dose, the patient begins vomiting. What will the nurse do? a. Contact the provider to discuss giving a lower dose of colchicine. b. Hold the medication and notify the prescriber. c. Explain that this is a common side effect that will soon stop. d. Request an order for an antiemetic so that the next dose of colchicine may be given.
B
A patient who is taking acetaminophen for pain wants to know why it does not cause gastrointestinal upset, as do other over-the-counter pain medications. The nurse will explain that this is most likely because of which property of acetaminophen? a. It does not inhibit cyclooxygenase. b. It has minimal effects at peripheral sites. c. It is more similar to opioids than to nonsteroidal anti-inflammatory drugs (NSAIDs). d. It is selective for cyclooxygenase-2.
B
A patient who takes teriparatide [Forteo] administers it subcutaneously with a prefilled pen injector. The patient asks why she must use a new pen every 28 days when there are doses left in the syringe. Which is the correct response by the nurse? a. "Go ahead and use the remaining drug; I know it is so expensive." b. "The drug may not be stable after 28 days." c. "You are probably not giving the drug accurately." d. "You should be giving the drug more frequently.
B
A patient who will begin taking colchicine for gout reports taking nonsteroidal anti-inflammatory drugs, simvastatin, amoxicillin, and digoxin. What will the nurse do? a. Contact the provider to discuss using a different antibiotic while this patient is taking colchicine. b. Notify the provider about the potential risk of muscle injury when simvastatin is taken with colchicine. c. Request an order for cardiorespiratory monitoring, because the patient is taking digoxin. d. Suggest that the nonsteroidal anti-inflammatory drugs (NSAIDs) be withdrawn during colchicine therapy.
B
A patient will undergo a colonoscopy, and the provider has ordered sodium phosphate as a bowel cleanser before the procedure. The nurse reviews the patient's chart and notes that the patient's creatinine clearance and blood urea nitrogen are both elevated. What will the nurse do? a. Reduce the amount of fluid given with the laxative to prevent fluid retention. b. Request an order to give polyethylene glycol and electrolytes (PEG-ELS) instead. c. Suggest that the patient reduce the dietary sodium intake. d. Suggest using a suppository laxative instead.
B
A pregnant patient in her third trimester asks the nurse whether she can take aspirin for headaches. Which response by the nurse is correct? a. "Aspirin is safe during the second and third trimesters of pregnancy." b. "Aspirin may cause premature closure of the ductus arteriosus in your baby." c. "Aspirin may induce premature labor and should be avoided in the third trimester." d. "You should use a first-generation nonsteroidal anti-inflammatory medication."
B
A pregnant patient who is taking ondansetron [Zofran] for morning sickness tells the nurse she is experiencing headache and dizziness. What will the nurse tell her? a. It is not safe to take this drug during pregnancy. b. These are common side effects of ondansetron. c. She should stop taking the ondansetron immediately. d. She should report these adverse effects to her provider.
B
A 30-year-old male patient will begin a three-drug regimen to treat peptic ulcer disease. The regimen will consist of bismuth subsalicylate, tetracycline, and cimetidine [Tagamet]. The nurse will include which information when teaching this patient about this drug regimen? a. Black discoloration of the tongue and stools should be reported immediately. b. Central nervous system depression and confusion are likely to occur. c. Decreased libido, impotence, and gynecomastia are reversible side effects. d. Staining of the teeth may occur and is an indication for discontinuation of these drugs.
C
A 55-year-old female patient asks a nurse about calcium supplements. The nurse learns that the patient consumes two servings of dairy products each day. The patient's serum calcium level is 9.5 mg/dL. The serum vitamin D level is 18 ng/mL. The nurse will recommend adding ____ daily and ____ IU of vitamin D3 each day. a. 1200 mg of calcium once; 10,000 b. 1500 mg of calcium twice; 1000 c. 600 mg of calcium once; 10,000 d. 600 mg of calcium twice; 2000
C
A 6-year-old child has frequent constipation. The nurse provides teaching after the parent asks the nurse why the provider recommended using laxatives only when needed. Which statement by the parent indicates a need for further teaching? a. "Children who take laxatives regularly can become dehydrated." b. "Chronic laxative use can cause electrolyte imbalances." c. "Frequent use of laxatives can cause diverticulitis." d. "The normal reflex to defecate can be inhibited with overuse of laxatives."
C
A child who has juvenile idiopathic arthritis and who has been taking methotrexate [Rheumatrex] will begin a course of abatacept [Orencia]. What will the nurse include when teaching the child's family about this drug? a. That abatacept and methotrexate must both be taken to be effective b. To continue getting vaccinations during therapy with abatacept c. That signs of infection may warrant immediate discontinuation of abatacept d. That a tumor necrosis factor (TNF) antagonist may be added if this therapy is not effective
C
A clinic patient who has been taking a glucocorticoid for arthritis for several months remarks to the nurse, "It's a good thing my symptoms are better, because my mother has been quite ill, and I have to take care of her." The patient's blood pressure is 100/60 mm Hg. The nurse will report this to the provider and ask about: a. reducing the patient's dose. b. using every other day dosing. c. increasing the patient's dose. d. tapering the dose.
C
A nurse caring for a patient who is undergoing a third round of chemotherapy is preparing to administer ondansetron [Zofran] 30 minutes before initiation of the chemotherapy. The patient tells the nurse that the ondansetron did not work as well the last time as it had the first time. What will the nurse do? a. Administer the ondansetron at the same time as the chemotherapy. b. Contact the provider to suggest using high-dose intravenous dolasetron [Anzemet]. c. Request an order to administer dexamethasone with the ondansetron. d. Suggest to the provider that loperamide [Lomotil] be given with the ondansetron.
C
A nurse is providing teaching for a patient with osteoporosis who has just switched from alendronate [Fosamax] to zoledronate [Reclast]. Which statement by the patient indicates a need for further teaching? a. "I will need to have blood tests periodically while taking this drug." b. "I will only need a dose of this medication every 1 to 2 years." c. "This drug is less likely to cause osteonecrosis of the jaw." d. "This drug is only given intravenously."
C
A nurse is teaching a nursing student who wants to know how aspirin and nonaspirin first-generation NSAIDs differ. Which statement by the student indicates a need for further teaching? a. "Unlike aspirin, first-generation NSAIDs cause reversible inhibition of cyclooxygenase." b. "NSAIDs do not increase the risk of myocardial infarction and stroke; however, unlike ASA, they do not provide protective benefits against those conditions." c. "Unlike aspirin, first-generation NSAIDs do not carry a risk of hypersensitivity reactions." d. "Unlike aspirin, first-generation NSAIDs cause little or no suppression of platelet aggregation."
C
A nurse tells a nursing student that the glucocorticoids given for rheumatoid arthritis are nearly identical to substances produced naturally by the body. The student remarks that the drug must be very safe. Which response by the nurse is correct? a. "As long as the drug is taken as prescribed, side effects usually do not occur." b. "By interrupting the inflammatory process, these drugs inhibit side effects." c. "Side effects can occur and are dependent on the dose and duration of treatment." d. "The negative feedback loop prevents side effects."
C
A patient has severe Paget's disease of the bone. The patient asks the nurse what can be done to alleviate the pain. The nurse will suggest that the patient discuss the use of which medication with the provider? a. Alendronate [Fosamax] b. Calcifediol [25-Hydroxy-D3] c. Calcitonin-salmon [Miacalcin] d. Long-acting NSAIDs
C
A patient is admitted with lower abdominal pain and nausea. The nurse performing the initial assessment notes that the patient's abdomen is distended and firm, and hypoactive bowel sounds are present. The patient has not had a stool for 3 days. The nurse will contact the provider, who will: a. order a bulk-forming laxative. b. order extra fluids and fiber. c. perform diagnostic tests. d. prescribe a cathartic laxative.
C
A patient is being treated for chemotherapy-induced nausea and vomiting (CINV) with ondansetron [Zofran] and dexamethasone. The patient reports getting relief during and immediately after chemotherapy but has significant nausea and vomiting several days after each chemotherapy treatment. What will the nurse do? a. Contact the provider to discuss increasing the dose of ondansetron. b. Suggest giving prolonged doses of dexamethasone. c. Suggest adding aprepitant [Emend] to the medication regimen. d. Tell the patient to ask the provider about changing the ondansetron to aprepitant.
C
A patient is diagnosed with Zollinger-Ellison syndrome. Which medication does the nurse expect the provider to order for this patient? a. Cimetidine [Tagamet] b. Esomeprazole [Nexium] c. Ranitidine [Zantac] d. Sucralfate [Carafate]
C
A patient is receiving intravenous promethazine [Phenergan] 25 mg for postoperative nausea and vomiting. What is an important nursing action when giving this drug? a. Giving the dose as an IV push over 3 to 5 minutes b. Infusing the dose with microbore tubing and an infusion pump c. Observing the IV insertion site frequently for patency d. Telling the patient to report dry mouth and sedation
C
A patient tells the nurse that she takes aspirin for menstrual cramps, but she does not feel that it works well. What will the nurse suggest? a. The patient should avoid any type of COX inhibitor because of the risk of Reye's syndrome. b. The patient should increase the dose to a level that suppresses inflammation. c. The patient should use a first-generation nonsteroidal anti-inflammatory medication instead. d. The patient should use acetaminophen because of its selective effects on uterine smooth muscle.
C
A patient who has developed postmenopausal osteoporosis will begin taking alendronate [Fosamax]. The nurse will teach this patient to take the drug: a. at bedtime to minimize adverse effects. b. for a maximum of 1 to 2 years. c. while sitting upright with plenty of water. d. with coffee or orange juice to increase absorption.
C
A patient who takes daily doses of aspirin is scheduled for surgery next week. The nurse should advise the patient to: a. continue to use aspirin as scheduled. b. reduce the aspirin dosage by half until after surgery. c. stop using aspirin immediately. d. stop using aspirin 3 days before surgery.
C
A patient who takes nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis asks a nurse what can be done to prevent ulcers. The nurse will recommend asking the provider about using which medication? a. Antibiotics b. Histamine-2 receptor antagonists c. Proton pump inhibitors d. Mucosal protectants
C
A patient will begin taking etanercept [Enbrel] for severe rheumatoid arthritis. The patient has been taking methotrexate [Rheumatrex]. The patient asks if the etanercept is stronger than the methotrexate. The nurse will tell the patient that etanercept ____ methotrexate. a. has synergistic effects with b. helps reduce adverse effects associated with c. is better at delaying progression of joint damage than d. has fewer adverse effects than
C
A patient with a history of chronic alcohol abuse has been admitted to the unit with cirrhosis. Upon review of the patient's laboratory test results, the nurse notes that the patient's ammonia level is elevated at 218 mcg/dL. What medication should the nurse prepare to administer? a. 0.9% NS b. Docusate sodium [Colace] c. Lactulose d. Polyethylene glycol [MiraLax]
C
A patient with renal disease is scheduled for a colonoscopy. Before the procedure, the nurse will anticipate administering: a. glycerin suppository. b. magnesium hydroxide (MOM). c. polyethylene glycol and electrolytes. d. sodium phosphate.
C
A patient with rheumatoid arthritis is taking leflunomide [Arava] and an oral contraceptive. She tells the nurse she would like to get pregnant. What will the nurse tell her? a. That leflunomide is not dangerous during the first trimester of pregnancy b. That plasma levels of leflunomide will drop rapidly when she stops taking it c. To ask her provider about an 11-day course of cholestyramine d. To stop taking leflunomide when she stops using contraception
C
A patient's provider has recommended a bulk-forming laxative for occasional constipation. Which statement by the patient indicates understanding of the teaching about this agent? a. "I can take this medication long term." b. "I should not take this drug if I have diverticulitis." c. "I should take each dose with a full glass of water." d. "This drug can cause severe diarrhea."
C
A postmenopausal patient develops osteoporosis. The patient asks the nurse about medications to treat this condition. The nurse learns that the patient has a family history of breast cancer. The nurse will suggest discussing which medication with the provider? a. Estrogen estradiol b. Pamidronate [Aredia] c. Raloxifene [Evista] d. Teriparatide [Forteo]
C
An older adult patient with severe gastroesophageal reflux disease (GERD) has had only minimal relief using a histamine2-receptor antagonist (H2RA). The patient is to begin taking omeprazole [Prilosec]. What will the nurse teach this patient? a. A complete cure is expected with this medication. b. Lifestyle changes can be as effective as medication therapy. c. Long-term therapy may be needed. d. The medication will be used until surgery can be performed.
C
A nursing student is caring for a patient who is taking sucralfate [Carafate] and ciprofloxacin [Cipro] to treat peptic ulcer disease. The student asks the nurse about the pharmacokinetics of sucralfate. Which statement by the student indicates a need for further teaching? a. "Sucralfate adheres to the ulcer and blocks the back-diffusion of hydrogen ions." b. "Sucralfate and ciprofloxacin should be administered 1 hour apart." c. "Sucralfate does not cause systemic side effects." d. "Sucralfate has a moderate acid-neutralizing capacity."
D
A patient about to begin therapy with etanercept has a positive tuberculin skin test. A chest radiograph is negative. The nurse will expect this patient to: a. begin taking antituberculosis drugs at the beginning of treatment with etanercept. b. have periodic chest radiographs during treatment with etanercept. c. have regular monitoring of symptoms to detect active tuberculosis. d. undergo tuberculosis treatment prior to beginning etanercept treatment.
D
A patient has been taking psyllium [Metamucil] two to three times daily for several days. The patient complains of stomach pain but has not had a stool. What will the nurse do? a. Ask the patient to drink a full glass of water. b. Give another dose of the psyllium. c. Request an order for a bisacodyl [Dulcolax] suppository. d. Palpate the patient's abdomen and auscultate for bowel sounds.
D
A patient has been taking senna [Senokot] for several days, and the nurse notes that the urine is yellowish-brown. What does the nurse know about this symptom? a. It indicates that renal failure has occurred. b. It is caused by dehydration, which is a laxative side effect. c. It is a sign of toxicity, indicating immediate withdrawal of the drug. d. It is an expected, harmless effect of senna.
D
A patient has had three gouty flare-ups in the past year. Which drug class will the nurse expect the provider to order for this patient? a. Colchicine b. Glucocorticoids c. Nonsteroidal anti-inflammatory drugs d. Urate-lowering drugs
D
A patient is about to receive prednisone for tendonitis. The nurse reviewing the chart would be concerned about which of the following in the patient's medical history? a. Asthma and allergic rhinitis b. Gouty arthritis c. Seborrheic dermatitis d. Systemic fungal infection
D
A patient is being treated with warfarin [Coumadin] to prevent thrombus. The patient develops hyperuricemia, and the provider orders allopurinol [Zyloprim]. The nurse will contact the provider to discuss ____ the ____ dose. a. increasing; allopurinol b. increasing; warfarin c. reducing; allopurinol d. reducing; warfarin
D
A patient is preparing to travel to perform missionary work in a region with poor drinking water. The provider gives the patient a prescription for ciprofloxacin [Cipro] to take on the trip. What will the nurse instruct this patient to do? a. Combine the antibiotic with an antidiarrheal medication, such as loperamide. b. Start taking the ciprofloxacin 1 week before traveling. c. Take 1 tablet of ciprofloxacin with each meal for best results. d. Use the drug if symptoms are severe or do not improve in a few days.
D
A patient is taking alendronate [Fosamax] to treat Paget's disease. The patient asks the nurse why calcium supplements are necessary. The nurse will tell the patient that calcium supplements are necessary to: a. reduce the likelihood of atrial fibrillation. b. maximize bone resorption of calcium. c. minimize the risk of esophageal cancer. d. prevent hyperparathyroidism.
D
A patient reports experiencing weakness, fatigue, nausea, vomiting, constipation, and nocturia. Total serum calcium is 10.5 mg/dL. A dipstick urinalysis shows a positive result for protein. When questioned, the patient reports taking vitamin D and calcium supplements. The nurse will counsel the patient to: a. reduce the amount of vitamin D and stop taking the calcium. b. discuss taking calcitonin-salmon [Fortical] with the provider. c. stop both supplements and discuss the use of a diuretic with the provider. d. stop taking vitamin D, reduce the amount of calcium, and increase the fluid intake.
D
A patient stops taking a proton pump inhibitor (PPI) after 6 weeks of therapy for treatment of peptic ulcer disease. The patient reports symptoms of dyspepsia to the nurse. The nurse will tell this patient to: a. come to the clinic to be tested for Clostridium difficile. b. resume taking the PPI, because long-term therapy is necessary. c. resume taking the PPI until symptoms resolve completely. d. try an antacid to see whether it relieves these symptoms.
D
A patient who has gastroesophageal reflux disease (GERD) receives a prescription for a proton pump inhibitor (PPI) medication. What will the nurse include when teaching the patient about this drug? a. "The FDA has determined that there is a gastric cancer risk with this drug." b. "This drug will be given on a short-term basis only." c. "You may experience hypermagnesemia when taking this drug." d. "You should report any fever and cough to your provider."
D
A patient who has gout will begin taking febuxostat [Uloric] and colchicine. What will the nurse include when teaching this patient about this drug regimen? a. "You are taking both drugs in order to prevent hepatic side effects." b. "You may stop taking the febuxostat after your uric acid levels decrease." c. "You will have to take both drugs indefinitely to treat your symptoms." d. "You will stop taking the colchicine within 6 months after starting therapy."
D
A patient who takes aspirin for rheumatoid arthritis is admitted to the hospital complaining of headache and ringing in the ears. The plasma salicylate level is 300 mcg/mL, and the urine pH is 6.0. What will the nurse do? a. Increase the aspirin dose to treat the patient's headache. b. Notify the provider of possible renal toxicity. c. Prepare to provide respiratory support, because the patient shows signs of overdose. d. Withhold the aspirin until the patient's symptoms have subsided.
D
A patient with chronic gout has an acute gouty episode and is admitted to the hospital. The patient has been taking nonsteroidal anti-inflammatory drugs for several months. The prescriber plans to begin therapy with probenecid. What will the nurse do? a. Give the medication as ordered and observe the patient closely for gastrointestinal side effects. b. Request an order to lower the dose of the nonsteroidal antiinflammatory drug. c. Restrict the patient's fluid intake to minimize the risk of renal injury. d. Suggest delaying the probenecid therapy until the acute episode has subsided.
D
A patient with gout who has increasingly frequent acute gouty attacks will begin receiving allopurinol [Zyloprim] and colchicine. The nurse will include which statement when teaching the patient about this drug regimen? a. "Allopurinol helps reduce the gastrointestinal side effects of colchicine." b. "Allopurinol reduces the likelihood of gouty episodes that usually occur with initial colchicine therapy." c. "The colchicine is given to enhance the effects of the allopurinol." d. "You will take both drugs initially and then stop taking the colchicine."
D
A postmenopausal patient is at high risk for developing osteoporosis. The patient's prescriber orders raloxifene [Evista], and the nurse provides teaching about this drug. Which statement by the patient indicates understanding of the teaching? a. "I may experience breast tenderness while taking this drug." b. "I may experience fewer hot flashes while taking this drug." c. "I should discontinue this drug several weeks before any surgery." d. "I should walk as much as possible during long airline flights."
D
An older male patient with an increased risk of MI is taking furosemide [Lasix] and low-dose aspirin. The patient is admitted to the hospital, and the nurse notes an initial blood pressure of 140/80 mm Hg. The patient has had a 10-pound weight gain since a previous admission 3 months earlier. The patient has voided only a small amount of concentrated urine. The serum creatinine and blood urea nitrogen (BUN) levels are elevated. The nurse will contact the provider to discuss: a. adding an antihypertensive medication. b. obtaining serum electrolytes. c. ordering a potassium-sparing diuretic. d. withdrawing the aspirin.
D
The parent of a child with cerebral palsy reports that the child has pebble-like stools most of the time and seems uncomfortable if several days have passed between stools. The nurse will suggest that the parent discuss which medication with the child's provider? a. Bisacodyl [Dulcolax] suppositories b. Magnesium citrate c. Methylcellulose [Citrucel] d. Polyethylene glycol [MiraLax]
D