Pharm: Quiz #4

The physician has prescribed salmeterol (Serevent) for a patient with asthma. In reviewing the use of dry powder inhalers (DPIs) with the patient, the nurse should provide which of the following instructions? [5c] A) "Close lips tightly around the mouthpiece and breathe in deeply and quickly." B) "To administer a DPI, you must use a spacer that holds the medicine so that you can inhale it." C) "You will know you have correctly used the DPI when you taste or sense the medicine going into your lungs." D) "Hold the inhaler several inches in front of your mouth and breathe in slowly, holding the medicine as long as possible."

A) "Close lips tightly around the mouthpiece and breathe in deeply and quickly."

The patient has an order for each of the following inhalers. Which of the following should the nurse offer to the patient at the onset of an asthma attack? [5] A) Albuterol (Proventil) B) Salmeterol (Serevent) C) Beclomethasone (Beclovent) D) Ipratropium bromide (Atrovent)

A) Albuterol (Proventil).

The nurse determines that the patient is not experiencing adverse effects of albuterol (Proventil) after noting which of the following patient vital signs? [5a] A) Pulse rate of 76 B) Respiratory rate of 18 C) Temperature of 98.4° F D) Oxygen saturation 96%

A) Pulse rate of 76.

The nurse will monitor the client taking albuterol (Proventil) for which condition? [5b] a. Palpitations b. Hypoglycemia c. Bronchospasm d. Uterine contractions

A. Palpitations

A patient with end-stage renal failure has been admitted to the hospital for severe anemia. She is refusing blood transfusions. The nurse anticipates drug therapy with which drug to stimulate the production of red blood cells? [25c] A. filgrastim (Neupogen) B. oprelvekin [IL-11] (Neumega) C. epoetin alfa (Epogen) D. folic acid

A. epoetin alfa (Epogen)

The client receives antihistamine treatment for a respiratory condition through intranasal route therapy. The nurse explains that the major medication of this type is _______________. [3]

Azelastine (Astelin) Rationale: The medication used is azelastine (Astelin), an intranasal antihistamine.

The nurse determines that a patient is experiencing common adverse effects from the inhaled corticosteroid beclomethasone (Beclovent) after noting which of the following? [6] A) Hypertension and pulmonary edema B) Oropharyngeal candidiasis and hoarseness C) Elevation of blood glucose and calcium levels D) Adrenocortical dysfunction and hyperglycemia

B) Oropharyngeal candidiasis and hoarseness.

A patient has been advised to add a nasal spray (an adrenergic decongestant) to treat a cold. Which instruction by the nurse is correct? [3] A. "Expect the beneficial effects to be delayed at least 1 week". B. "Limit the use of this spray to 3-5 days". C. "Continue the spray until nasal stuffiness has resolved". D. "Avoid use of this spray if a fever develops".

B. "Limit the use of this spray to 3-5 days". Rationale: Frequent, long-term, or excessive use of nasal decongestants may lead to rebound congestion if used beyond the recommended time

The health care provider orders ipratropium bromide (Atrovent), albuterol (Proventil), and beclomethasone (Vanceril) inhalers for a client. What is the nurse's best action? [5] a. Question the order; three inhalers should not be given at one time. b. Administer the albuterol first, wait 5 minutes, and administer ipratropium bromide, followed by beclomethasone several minutes later. c. Administer each inhaler at 30-minute intervals. d. Administer beclomethasone first, wait 2 minutes, and administer ipratropium bromide, followed by the albuterol several minutes later.

B. Administer the albuterol first, wait 5 minutes, and administer ipratropium bromide, followed by beclomethasone several minutes later.

The nurse will monitor for which adverse reaction to aluminum-containing antacids such as aluminum hydroxide (Amphojel)? [8] A) Diarrhea B) Constipation C) Gastrointestinal upset D) Fluid retention

B. Constipation Aluminum- and calcium-containing antacids cause constipation, magnesium-containing antacids cause diarrhea, and sodium-containing antacids cause sodium and fluid retention.

A patient who has been taking cimetidine, Tagament for hyperacidity calls the clinic to say that the medication has not been effective. The nurse reviews his history and notes what which factor may be influencing the effectiveness of this drug? [9] A. He takes the cimetidine with meals B. He smokes two packs of cigarettes a day C. He avoids caffeine and alcohol D, He takes an antacid 1 hour before or after the cimetidine dose

B. He smokes two packs of cigarettes a day.

What system assessment will the nurse monitor in a patient due to a known common side effect of traditional antihistamines? [2] A.Cardiac status B. Neurologic status C. Respiratory status D. Gastrointestinal status

B. Neurologic status

A patient is taking a xanthine derivative as part of treatment for chronic obstructive pulmonary disease. The nurse will monitor for adverse effects associated with the use of xanthine derivatives, including: [4] A. diarrhea B. palpitations C.bradycardia D. drowsiness

B. Palpitations Rationale: The common adverse effects of the xanthine derivatives include nausea, vomiting, and anorexia. In addition, gastroesophageal reflux has been observed to occur during sleep in patients taking these drugs. Cardiac adverse effects include sinus tachycardia, extrasystole, palpitations, and ventricular dysrhythmias. Transient increased urination and hyperglycemia are other possible adverse effects.

When monitoring a patient who has been on peripheral parenteral nutrition (PPN) for more than 3 weeks, the nurse monitors for which possible complication? [26] a. Diarrhea b. Phlebitis c. Hypokalemia d. Hypoglycemia

B. Phlebitis.

A patient complains of worsening nasal congestion despite the use of oxymetazoline (Afrin) nasal spray every 2 to 4 hours for the past 5 days. The nurse's response is based on knowledge that: [3] A. oxymetazoline is not an effective nasal decongestant. B. sustained use of nasal decongestants over several days may result in rebound congestion. C. oxymetazoline should be administered in an hourly regimen for severe congestion. D. the patient is probably displaying an idiosyncratic reaction to oxymetazoline.

B. sustained use of nasal decongestants over several days may result in rebound congestion.

In addition to the use of multiple antibiotics, what compound may be added to the regimen treatment of Helicobacter pylori? [11]

Bismuth compounds Rationale: Bismuth compounds may be added to the regimen treatment of Helicobacter pylori.

When giving dextromethorphan, the nurse understands that this drug suppresses the cough reflex by: [1] A. Causing depression of the central nervous system. B. anesthetizing the stretch receptors. C.having direct action on the cough center. D. decreasing the viscosity of the bronchial secretions.

C. Having direct action on the cough center. Rationale: Dextromethorphan suppresses the cough reflex through a direct action on the cough center.

What is the most important thing for the nurse to teach the client with a history of diabetes and asthma who has started on albuterol PRN? [5b] a. Take Tylenol for headaches when taking albuterol. b. Monitor for orthostatic hypotension every 2 hours when taking albuterol. c. Monitor blood glucose levels every 4 hours when taking albuterol. d. An antianxiety agent may be prescribed to help with nervousness.

C. Monitor blood glucose levels every 4 hours when taking albuterol.

An asthmatic patient who has a new prescription for Advair Diskus (combined fluticasone and salmeterol) asks the nurse the purpose of using two drugs. The nurse explains that: [7] a. Advair is a combination of long-acting and slow-acting bronchodilators. b. the two drugs work together to block the effects of histamine on the bronchioles. c. one drug decreases inflammation, and the other is a bronchodilator. d. the combination of two drugs works more quickly in an acute asthma attack.

C. One drug decreases inflammation, and the other is a bronchodilator. Rationale: Salmeterol is a long-acting bronchodilator, and fluticasone is a corticosteroid; they work together to prevent asthma attacks. Neither medication is an antihistamine. Advair is not used during an acute attack because the medications do not work rapidly. Cognitive Level: Application Text Reference: pp. 621 Nursing Process: Implementation NCLEX: Physiological Integrity

What statement by the patient, who is using the anticholinergic inhaler ipratropium bromide (Atrovent), indicates to the nurse that teaching has been successful? [5a] A. "I will increase my intake of caffeine." B. "I may gain weight as a result of taking this medication." C. "Nausea and vomiting are common adverse effects of this medication, so I will always take it with meals." D. "This inhaler is not to be used alone to treat an acute asthma attack."

D. "This inhaler is not to be used alone to treat an acute asthma attack."

A patient has been receiving total parenteral nutrition (TPN). Upon assessment, the nurse notes that his blood pressure is elevated, his pulse is weak and elevated, he seems confused, and he has new pitting edema around his ankles. Which condition does the nurse suspect the patient is experiencing? [27] a. Hyperglycemia b. Hypoglycemia c. Infection d. Fluid overload

D. Fluid overload.

The nurse should instruct patients about a possible systemic effect that may occur if excessive amounts of topically applied adrenergic nasal decongestants are used. Which systemic effect may occur? [2] A. Heartburn B. Bradycardia C. Hypotension D. Nervousness

D. Nervousness Rationale: Although a topically applied adrenergic nasal decongestant can be absorbed into the bloodstream, the amount absorbed is usually too small to cause systemic effects at normal dosages. Excessive dosages of these medications, however, are more likely to cause systemic effects elsewhere in the body. These may include cardiovascular effects, such as hypertension and palpitations, and central nervous system effects such as headache, nervousness, and dizziness.

During the night shift, a patients TPN infusion ran out, and there was no TPN solution on hand to continue the infusion. The nurse will have to implement measure to prevent what consequence of abruptly discontinuing TPN infusion? [27] a. Fluid overload b. Hyperglycemia c. Dumping syndrome d. Rebound hypoglycemia

D. Rebound hypoglycemia.

The nurse notes that a patient has excessive and painful gas. The nurse checks the patient's medication orders and prepares to administer which drug for this problem? [10d] a. famotidine (Pepcid) b. aluminum hydroxide and magnesium hydroxide (Maalox or Mylanta) c. calcium carbonate (Tums) d. Simethicone (Mylicon)

D. Simethicone (Mylicon)

The nurse will prepare to give which preparation to a newborn upon arrival in the nursery after delivery? [23] a. Vitamin B3 (Niacin) b. Vitamin D (Calciferol) c. Vitamin A (Aquasol A) d. Vitamin K (AquaMEPHYTON)

D. Vitamin K (AquaMEPHYTON)

The client is prescribed dextromethorphan (Benylin) for treatment of a cold. The nurse teaches that the action of this drug: [1]

Is a non-opioid. Rationale: Dextromethorphan (Benylin) is classified as a non-opioid cold medication

The client is using intranasal sympathomimetics for treatment of nasal congestion. The nurse teaches that the use of this drug: [3]

Is limited to 3-5 days for nasal congestion. Rationale: Beta-adrenergic agonists (sympathomimetics) act by relaxing bronchial smooth muscle, resulting in a bronchodilation that lowers airway resistance and makes breathing easier for the client. Limit the use of intranasal treatment to 3-5 days.

Client teaching for clients on dextromethorphan (Benylin) should include: [1]

Notifying the physician if the drug no longer seems effective. Rationale: Benylin is a drug included in most severe cold and flu preparations; therefore, the client must be instructed to seek medical attention should the drug become less effective with continued use.

The gram-negative bacterium Helicobacter pylori is the primary cause of what type of ulcer development? [11]

Peptic ulcers Rationale: The gram-negative bacterium Helicobacter pylori is the primary cause development of peptic ulcers.

An elderly male client is prescribed ipratropium (Atrovent) for the treatment of asthma. Appropriate nursing intervention includes: [5a]

Teaching the client to report inability to urinate. Rationale: Anticholinergic bronchodilators should be used cautiously in elderly men with benign prostatic hypertrophy, and in all clients with glaucoma.

In the treatment of Helicobacter pylori, the nurse must recognize that the use of two or more antibiotics is essential for what reason? [11]

They lower the potential for bacterial resistance. Rationale: Two or more antibiotics are used in order to lower the potential for bacterial resistance.

The drug of choice in the H2-receptor antagonists, ranitidine (Zantac), is preferable to the use of cimetidine (Tagamet) for what reason? [12a]

Zantac (ranitidine) has a higher potency than cimetidine, and can be administered once daily. Rationale: Development of GERD (gastroesophageal reflux disease) is often associated with obesity.

The nurse is caring for a client who is taking a first-generation antihistamine. What is the most important fact for the nurse to teach the client? [2] a. "Do not drive after taking this medication." b. "Make sure you drink a lot of liquids while on this medication." c. "Take this medication on an empty stomach." d. "Do not take this medication for more than 2 days."

a. "Do not drive after taking this medication."

When administering mineral, oil, the nurse recognizes that it can interfere with the absorption of which substance? [13] a. Vitamin A b. Vitamin C c. Iron D. Potassium

a. Vitamin A

The nurse is reviewing conditions caused by nutrients deficiencies. Conditions such as infantile rickets, tetany, and osteomalcia are caused by a deficiency in which vitamin or mineral? [24b] a. Vitamin D b. Vitamin K c. Magnesium D. Cyanocobalamin (Vitamin B12)

a. Vitamin D

A client complains of worsening nasal congestion despite the use of oxymetazoline (Afrin) nasal spray every 2 hours. What is the nurse's best response? [3] a. "Oxymetazoline is not an effective nasal decongestant." b. "Overuse of nasal decongestants results in rebound congestion." c. "Oxymetazoline should be administered every hour for severe congestion." d. "You are probably displaying an idiosyncratic reaction to oxymetazoline."

b. "Overuse of nasal decongestants results in rebound congestion."

A client tells the nurse that he has started to take an OTC antihistamine, diphenhydramine. In teaching him about side effects, what is most important for the nurse to tell the client? [2] a. Do not to take this drug at bedtime to avoid insomnia. b. Avoid driving a motor vehicle until stabilized on the drug. c. Nightmares and nervousness are more likely in an adult. d. Limit use to 1 to 2 puffs/sprays 4 to 6 times per day to avoid rebound congestion.

b. Avoid driving a motor vehicle until stabilized on the drug.

A client is taking famotidine (Pepcid) to inhibit gastric secretions. What are the side effects of famotidine? (Select all that apply.) [10a] a. Diarrhea b. Dizziness c. Dry mouth d. Headaches e. Blurred vision f. Decreased libido

b. Dizziness d. Headaches f. Decreased libido

The nurse is caring for a client in the clinic who states that he is afraid of taking antihistamines because he is a truck driver. What is the best information for the nurse to give this client? [2] a. "Take the medication only when you are not driving." b. "Take a lower dose than normal when you have to drive." c. "You are correct, you should not take antihistamines." d. "You may be able to safely take a second-generation antihistamine."

d. "You may be able to safely take a second-generation antihistamine."

A client is prescribed the decongestant oxymetazoline (Afrin) nasal spray. What should the nurse teach the client? [3] a. Take this drug at bedtime as a sleep aid. b. Directly spray away from the nasal septum and gently sniff. c. This drug may be used in maintenance treatment for asthma. d. Limit the drug to 5 days of use to prevent rebound nasal congestion.

d. Limit the drug to 5 days of use to prevent rebound nasal congestion.

When educating a patient recently placed on inhaled corticosteroids, the nurse will discuss which potential adverse effects? [6] a. fatigue and depression b. anxiety and peripheral vasoconstriction c. headache and rapid heart rate d. oral candidiasis and dry mouth

d. Oral candidiasis and dry mouth.

The nurse is instructing a client about the advantages of salmeterol (Serevent) over other beta2 agonists such as albuterol (Proventil). How will the nurse explain to the client the difference in these two medications? [5b,c] a. Salmeterol has a shorter onset of action. b. Salmeterol does not have any side effects. c. Albuterol has a longer onset of action. d. Salmeterol has a longer duration of action.

d. Salmeterol has a longer duration of action.

A patient will be taking bismuth subsalicylate (Pepto-Bismol) to control his diarrhea. When reviewing the patient's other ordered medication, the nurse recognizes that which medication will interact significantly with the Pepto-Bismol? [Maalox 10b]

digoxin (Lanoxin).