Pharmacology test 3 diueretics, antiemetics

22. With use of direct-acting vasodilators, sodium and water are retained and peripheral edema occurs. Which category of drugs should be given to avoid fluid retention? a. Anticoagulants b. Antidysrhythmics c. Cardiac glycosides d. Diuretics

22. d. Diuretics are frequently given with a variety of antihypertensive agents to decrease fluid retention and peripheral edema.

29. The patient is taking furosemide 80 mg/day. She has a history of hypertension and heart failure. She presents to the emergency department after sustaining a fall at a local sports bar. She has a laceration to her posterior scalp. Vital signs are temperature 38° C, heart rate 98 beats/min, respiratory rate 16 breaths/min, and blood pressure 94/62 mm/Hg. Her electrolytes are within normal limits. Her blood alcohol is 0.06, and her toxicology screen is negative. What does the nurse know about possible drug interactions? a. Furosemide can cause severe hypoglycemia and headache. b. Furosemide can cause hyperkalemia and dizziness. c. Furosemide can cause orthostatic hypotension when consumed with alcohol. d. Furosemide can lead to elevated uric acid levels, causing the patient to faint.

29. c. The combination of furosemide and alcohol can increase orthostatic hypotension.

21. With how many ounces of water should a patient take a liquid antacid for best results? a. 2-4 b. 4-6 c. 6-8 d. 8 or more

a. Taking a liquid antacid with water increases gastric emptying time.

16. What is the classification of furosemide? a. Loop diuretic b. Osmotic diuretic c. Potassium-sparing diuretic d. Thiazide diuretic

A

21. Diphenhydramine blocks histamine receptors. Which histamine receptors does it block? a. H1 b. H2 c. B1 d. B2

A

26. What is the best indication for sodium bicarbonate? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

A

17. An appropriate goal when teaching a patient who has diarrhea is that the patient a. will have less frequent, more formed stools. b. will not have a stool for 1 to 2 days. c. will receive adequate intravenous fluids. d. will receive appropriate antibiotic therapy.

ANS: A An appropriate goal is that patients will have formed, less frequent stools not an absence of stools. Receiving adequate intravenous fluids or antibiotic therapy are interventions not goals.

23. The health teaching plan for a patient taking diphenhydramine should include the side effects of the drug. What might the nurse assess in a patient experiencing a side effect? (Select all that apply.) a. Disturbed coordination b. Drowsiness c. Hypertension d. Nausea e. Urinary retention

A, B, D, E

27. The nurse assesses the patient who is taking hydrochlorothiazide (HCTZ) for hypertension. What might the nurse expect to see if the patient is experiencing undesired side effects? (Select all that apply.) a. Diarrhea b. Dizziness c. Headache d. Hypocalcemia e. Vomiting

A,B

13. A child is brought to the emergency department after ingestion of a toxic substance. The child is alert and conscious and is reported to have ingested kerosene 20 minutes prior. The nurse will anticipate administering a. activated charcoal. b. an anticholinergic antiemetic. c. gastric lavage. d. syrup of ipecac

ANS: A Activated charcoal is used when patients have ingested a caustic substance or a petroleum distillate in a patient who is alert and awake. Gastric lavage is no longer used as therapy. Syrup of ipecac is not recommended.

5. A patient who takes propantheline bromine (Pro-Banthine) and omeprazole (Prilosec) for an ulcer will begin taking an antacid. The nurse will give which instruction to the patient regarding how to take the antacid? a. Take the antacid 2 hours after taking the propantheline. b. Take the antacid along with a meal. c. Take the antacid with milk. d. Take the antacid with the propantheline bromine.

ANS: A Antacids can slow the absorption of anticholinergics and should be taken 2 hours after anticholinergic administration. Antacids should be given 1 to 3 hours after a meal and should not be given with dairy products.

6. The nurse is teaching a group of nursing students about the use of antipsychotic drugs for antiemetic purposes. The nurse will explain that, when given as antiemetics, these drugs are given a. in smaller doses. b. less frequently. c. with anticholinergics. d. with antihistamines.

ANS: A Antipsychotic medications have antiemetic properties in smaller doses.

4. The nurse is teaching a patient who is about to take a long car trip about using dimenhydrinate (Dramamine) to prevent motion sickness. What information is important to include when teaching this patient? a. Do not drive while taking this medication. b. Dry mouth is a sign of toxicity with this mediation. c. Take the medication 1 to 2 hours prior to beginning the trip. d. Take 100 mg up to 6 times daily for best effect.

ANS: A Drowsiness is a common side effect of dimenhydrinate, so patients should be cautioned against driving while taking this drug. Dry mouth is a common side effect and not a sign of toxicity. The drug should be taken 30 minutes prior to travel. The maximum recommended dose is 400 mg per day.

6. A patient begins taking nicotinic acid (Niacin) and reports dizziness and flushing of the skin. The nurse will perform which action? a. Contact the provider to discuss decreasing the dose. b. Counsel the patient to increase fluid intake. c. Request an order for renal function tests. d. Schedule the medication to be taken with meals.

ANS: A Flushing of the skin and dizziness are common side effects of nicotinic acid, but with careful drug titration and concomitant use of aspirin, these effects can be minimized. Increasing fluid intake or taking with food does not alter these adverse effects. Nicotinic acid can affect liver enzymes not renal function.

11. The nurse is teaching a group of parents about the use of syrup of ipecac. Which instruction will the nurse provide? a. Do not administer ipecac without consulting a poison control center. b. Expect the onset of emesis to be immediate. c. Give ipecac with a glass of milk to increase its emetic effect. d. Use ipecac fluid extract and not ipecac syrup

ANS: A Ipecac should not be used for caustic substances or petroleum distillates. Ipecac should be given only after determining whether it is safe. The onset of emesis is in 15 to 30 minutes. Ipecac should not be given with milk or carbonated beverages. Ipecac syrup should be used.

18. A patient reports having three to four stools, which are sometimes hard, per week. The nurse will perform which action? a. Recommend increased fluids and dietary fiber. b. Request an order for a laxative as needed. c. Request an order for a stool softener. d. Suggest discussing chronic constipation with the provider.

ANS: A This patient is having stools that are within the normal range for frequency. Nonpharmacologic measures should be used first to help soften stools.

3. A patient is taking esomeprazole (Nexium) 15 mg per day to treat a duodenal ulcer. After 10 days of treatment, the patient reports that the pain has subsided. The nurse will counsel the patient to a. continue the medication for 4 more weeks. b. reduce the medication dose by half. c. stop taking the medication. d. take the medication every other day.

ANS: A With treatment, ulcer pain may subside in 10 days, but the healing process may take 1 to 2 months. Patients should be counseled to take the drug for the length of time prescribed. Reducing the dose or taking less frequently is not indicated

10. The nurse notes a blood pressure of 160/90 mm Hg in a patient taking a thiazide diuretic. The patient reports taking an herbal medication that a friend recommended. Which herbal product is likely, given this patients blood pressure? a. Ginkgo b. Hawthorne c. Licorice d. St. Johns wort

ANS: A Increased blood pressure can result when ginkgo is used in combination with a thiazide diuretic. Hawthorne can potentiate hypotension. Licorice can increase potassium loss, leading to hypokalemia. St. Johns wort is not listed as an herbal alert substance with thiazide diuretics.

3. The nurse is teaching a patient about taking hydrochlorothiazide. Which statement by the patient indicates a need for further teaching? a. I may need extra sodium and calcium while taking this drug. b. I should eat plenty of fruits and vegetables while taking this medication. c. I should take care when rising from a bed or chair when Im on this medication. d. I will take the medication in the morning to minimize certain side effects.

ANS: A Patients do not need extra sodium or calcium while taking thiazide diuretics. Thiazide diuretics can lead to hypokalemia, so patients should be counseled to eat fruits and vegetables that are high in potassium. Patients can develop orthostatic hypotension and should be counseled to rise from sitting or lying down slowly. Taking the medication in the morning helps to prevent nocturia-induced insomnia.

12. A patient has been taking spironolactone (Aldactone) to treat heart failure. The nurse will monitor for a. hyperkalemia. b. hypermagnesemia. c. hypocalcemia. d. hypoglycemia.

ANS: A Spironolactone is a potassium-sparing diuretic and can cause hyperkalemia.

1. A patient who recently began having mild symptoms of GERD is reluctant to take medication. What measures will the nurse recommend to minimize this patients symptoms? (Select all that apply.) a. Avoiding hot, spicy foods b. Avoiding tobacco products c. Drinking a glass of red wine with dinner d. Eating a snack before bedtime e. Taking ibuprofen with food f. Using a small pillow for sleeping g. Wearing well-fitted clothing

ANS: A, B, E Hot, spicy foods aggravate gastric upset, tobacco increases gastric secretions, and ibuprofen on an empty stomach increases gastric secretions, so patients should be taught to avoid these actions. Alcohol should be avoided since it increases gastric secretions. Eating at bedtime increases reflux, as does laying relatively flat to sleep, or wearing fitted clothing.

2. The nurse is caring for a patient who has unexplained, recurrent vomiting and who is unable to keep anything down. Until the cause of the vomiting is determined, the nurse will anticipate administering which medications? a. Antibiotics and antiemetics b. Intravenous fluids and electrolytes c. Non-prescription antiemetics d. Prescription antiemetics

ANS: B Antiemetics can mask the underlying cause of vomiting and should not be used until the cause is determined unless vomiting is so severe that dehydration and electrolyte imbalance occurs. Nonpharmacologic measures, such as fluid and electrolyte replacement, should be used. Antibiotics are only used if an infectious cause is determined.

10. A male patient who has been taking a histamine2 blocker for several months reports decreased libido and breast swelling. What will the nurse do? a. Contact the provider to report possible drug toxicity. b. Reassure the patient that these symptoms will stop when the drug is discontinued. c. Request an order for serum hormone levels. d. Suggest that the patient see an endocrinologist.

ANS: B Drug-induced impotence and gynecomastia are reversible drug side effects. These signs do not indicate drug toxicity. Serum hormone levels and endocrinology evaluation are not indicated.

16. A patient asks the nurse the best way to prevent travelers diarrhea. The nurse will provide which recommendation to the patient? a. Ask your provider for prophylactic antibiotics. b. Drink bottled water and eat only well-cooked meats. c. Eat fresh, raw fruits and vegetables. d. Take loperamide (Imodium) every day.

ANS: B Patients traveling to areas with potential travelers diarrhea should be taught to drink bottled water and eat meats that are well-cooked. Prophylactic antibiotics are not recommended. Patients should eat cooked, washed fruits and vegetables. Loperamide can increase exposure to pathogens by slowing motility.

1. A patient who has been instructed to use a liquid antacid medication to treat gastrointestinal upset asks the nurse about how to take this medication. What information will the nurse include when teaching this patient? a. Take a laxative if constipation occurs. b. Take 60 minutes after meals and at bedtime. c. Take with at least 8 ounces of water to improve absorption. d. Take with milk to improve effectiveness.

ANS: B Since maximum acid secretion occurs after eating and at bedtime, antacids should be taken 1 to 3 hours after eating and at bedtime. Taking antacids before meals slows gastric emptying time and causes increased gastrointestinal (GI) secretions. Patients should not self-treat constipation or diarrhea. Patients should use 2 to 4 ounces of water when taking to ensure that the drug enters the stomach; more than that will increase GI secretions. Antacids should not be taken with milk or foods high in vitamin D.

3. The parent of an 18-month-old toddler calls the clinic to report that the child has vomited 5 times that day. The nurse determines that the child has had three wet diapers in the past 6 hours. What will the nurse recommend for this child? a. Administering an OTC antiemetic medication such as diphenhydramine b. Giving frequent, small amounts of Pedialyte c. Keeping the child NPO until vomiting subsides d. Taking the child to the emergency department for IV fluids

ANS: B The child is not dehydrated as evidenced by adequate wet diapers, so nonpharmacologic measures, such as oral fluids, are recommended. Antiemetics are not recommended unless dehydration occurs. Intravenous fluids are given when dehydration is present.

6. Which antacid is likely to cause acid rebound? a. Aluminum hydroxide b. Calcium carbonate c. Magnesium hydroxide d. Magnesium trisilicate

ANS: B While calcium carbonate is most effective in neutralizing acid, a significant amount can be systemically absorbed and can cause acid rebound. The other antacids do not have significant systemic absorption.

5. The nurse is caring for a patient who develops marked edema and a low urine output as a result of heart failure. Which medication will the nurse expect the provider to order for this patient? a. Digoxin (Lanoxin) b. Furosemide (Lasix) c. Hydrochlorothiazide (HydroDIURIL) d. Spironolactone (Aldactone)

ANS: B Furosemide is a loop diuretic and is given when the patients condition warrants immediate removal of body fluid, as in heart failure. Digoxin improves cardiac function but does not remove fluid quickly. The other diuretics may be used when immediate fluid removal is not necessary.

1. A patient who experiences motion sickness when flying asks the nurse the best time to take the medication prescribed to prevent motion sickness for a 0900 flight. The nurse will instruct the patient to take the medication at which time? a. As needed, at the first sign of nausea b. At 0700, before leaving for the airport c. At 0830, just prior to boarding the plane d. When seated, just prior to takeoff

ANS: C Motion sickness medication has its onset in 30 minutes. The patient should be instructed to take the medication a half hour prior to takeoff. It is not used as needed.

14. A patient reports experiencing flatulence and abdominal distension to the nurse. Which over-the-counter medication will the nurse recommend? a. Alka-Seltzer b. Maalox c. Mylicon d. Tums

ANS: C Mylicon is a brand-name simethicone, which is an anti-gas agent. Maalox Gas contains simethicone, while regular Maalox does not. The other products do not contain simethicone.

8. A woman who is 2 months pregnant reports having morning sickness every day and asks if she can take any medications to treat this problem. The nurse will recommend that the patient take which action first? a. Contact the provider to discuss a possible need for intravenous fluids. b. Contact the provider to discuss a prescription antiemetic. c. Use nonpharmacologic measures such as saltines. d. Take over-the-counter antiemetics such as diphenhydramine

ANS: C Pregnant women should avoid antiemetics during the first trimester of pregnancy because of possible teratogenic effects. The nurse should recommend nonpharmacologic measures such as saltines. If this is not effective, intravenous fluids may become necessary. Pregnant women should consult with their provider before taking prescription or over-the-counter antiemetics.

3. A patient has a blood pressure of 155/95 mm Hg. The nurse understands that this patients risk of cardiovascular disease is _____ greater than normal. a. two times b. three times c. four times d. six times

ANS: C Cardiovascular disease (CVD) risk doubles with each increase of 20/10 mm Hg above normal, starting at 115/75 mm Hg. This patients blood pressure is 40/20 above normal, which increases the risk four times. A blood pressure of 135/85 would be two times greater. The patients risk would still be four times greater with a blood pressure of 155/70 or 130/95, since systolic and diastolic blood hypertension are each powerful predictors of CVD.

9. A patient has begun taking spironolactone (Aldactone) in addition to a thiazide diuretic. With the addition of the spironolactone, the nurse will counsel this patient to a. continue taking a potassium supplement daily. b. recognize that abdominal cramping is a transient side effect. c. report decreased urine output to the provider. d. take these medications at bedtime.

ANS: C Caution must be used when giving potassium-sparing diuretics to patients with poor renal function, so patients should be taught to report a decrease in urine output. Patients taking potassium-sparing diuretics are at risk for hyperkalemia, so they should not take potassium supplements. Abdominal cramping should be reported to the provider. The medications should be taken in the morning for patients who sleep during the night.

7. The nurse is caring for an 80-year-old patient who has just begun taking a thiazide diuretic to treat hypertension. What is an important aspect of care for this patient? a. Encouraging increased fluid intake b. Increasing activity and exercise c. Initiating a fall risk protocol d. Providing a low potassium diet

ANS: C Older patients experience a higher risk of orthostatic hypotension when taking antihypertensive medications. Fall risk also increases with a need for increased trips to the bathroom. A fall risk protocol should be implemented. Increasing fluids and activity and limiting potassium are not indicated.

7. The nurse is teaching a patient who will begin taking furosemide. The nurse learns that the patient has just begun a 2-week course of a steroid medication. What will the nurse recommend? a. Consume licorice to prevent excess potassium loss. b. Report a urine output greater than 600 mL/24 hours. c. Obtain an order for a potassium supplement. d. Take the furosemide at bedtime.

ANS: C The interaction of furosemide and a steroid drug can result in an increased loss of potassium. Patients should take a potassium supplement. Patients should avoid licorice while taking furosemide, partially due to the hypokalemic effects of both substances. Urine output greater than 600 mL/24 hours is normal. Patients should take furosemide in the morning to avoid nocturia.

1. The nurse is preparing to administer the first dose of hydrochlorothiazide (HydroDIURIL) 50 mg to a patient who has a blood pressure of 160/95 mm Hg. The nurse notes that the patient had a urine output of 200 mL in the past 12 hours. The nurse will perform which action? a. Administer the medication as ordered. b. Encourage the patient to drink more fluids. c. Hold the medication and request an order for serum BUN and creatinine. d. Request an order for serum electrolytes and administer the medication.

ANS: C Thiazide diuretics are contraindicated in renal failure. This patient has oliguria and should be evaluated for renal failure prior to administration of the diureticespecially in the absence of known renal failure for this patient. Drinking more fluids will not increase urine output in patients with renal failure.

4. The nurse is caring for a patient who is to begin receiving a thiazide diuretic to treat heart failure. When performing a health history on this patient, the nurse will be concerned about a history of which condition? a. Asthma b. Glaucoma c. Gout d. Hypertension

ANS: C Thiazides block uric acid secretion and elevated levels can contribute to gout. Patients with a history of gout should take thiazide diuretics with caution; they may need behavioral and/or pharmacologic changes to their gout treatment.

2. The nurse is preparing to administer doses of hydrochlorothiazide (HydroDIURIL) and digoxin (Lanoxin) to a patient who has heart failure. The patient reports having blurred vision. The nurse notes a heart rate of 60 beats per minute and a blood pressure of 140/78 mm Hg. Which action will the nurse take? a. Administer the medications and request an order for serum electrolytes. b. Give both medications and evaluate serum blood glucose frequently. c. Hold the digoxin and notify the provider. d. Hold the hydrochlorothiazide and notify the provider.

ANS: C When thiazide diuretics are taken with digoxin, patients are at risk of digoxin toxicity because thiazides can cause hypokalemia. The patient has bradycardia and blurred vision, which are both signs of digoxin toxicity. The nurse should hold the digoxin and notify the provider. Serum electrolytes may be ordered, but the digoxin should not be given.

12. A patient has been taking famotidine (Pepcid) 20 mg bid to treat an ulcer but continues to have pain. The provider has ordered lansoprazole (Prevacid) 15 mg per day. The patient asks why the new drug is necessary, since it is more expensive. The nurse will explain that lansoprazole a. can be used for long-term therapy. b. does not interact with other drugs. c. has fewer medication side effects. d. is more potent than famotidine.

ANS: D Famotidine is a histamine2 (H2) blocker. When patients fail therapy with these agents, proton pump inhibitors, which can inhibit gastric acid secretion up to 90% greater than the H2 blockers, are used. Lansoprazole is not for long-term treatment and has drug interactions and drug side effects as do all other medications.

7. An elderly patient reports using Maalox frequently to treat acid reflux. The nurse should notify the patients provider to request an order for which laboratory tests? a. Liver enzymes and serum calcium b. Liver enzymes and serum magnesium c. Renal function tests and serum calcium d. Renal function tests and serum magnesiu

ANS: D Maalox contains magnesium and carries a risk of hypermagnesemia, especially with decreased renal function. Older patients have an increased risk of poor renal function, so this patient should especially be evaluated for hypermagnesemia.

5. The nurse is caring for a patient who has postoperative nausea and vomiting. The surgeon has ordered promethazine HCl (Phenergan). Which aspect of this patients health history would be of concern? a. Asthma b. Diabetes c. GERD d. Glaucoma

ANS: D Promethazine is contraindicated in patients with glaucoma since it is an anticholinergic medication. It should be used with caution in patients with asthma. The other two conditions are not concerning with this medication

13. The nurse is caring for a patient who will begin taking omeprazole (Prevacid) 20 mg per day for 4 to 8 weeks to treat gastroesophageal reflux disease esophagitis. The nurse learns that the patient takes digoxin. The nurse will contact the provider for orders to a. decrease the dose of omeprazole. b. increase the dose of digoxin. c. increase the omeprazole to 60 mg per day. d. monitor for digoxin toxicity.

ANS: D Proton pump inhibitors can enhance the effects of digoxin, so patients should be monitored for digoxin toxicity. Changing the dose of either medication is not indicated prior to obtaining lab results that are positive for digoxin toxicity.

2. A patient who has symptoms of peptic ulcer disease will undergo a test that requires drinking a liquid containing 13C urea and breathing into a container. The nurse will explain to the patient that this test is performed to a. assess the level of hydrochloric acid. b. detect H. pylori antibodies. c. measure the pH of gastric secretions. d. test for the presence of 13CO2.

ANS: D When H. pylori is suspected, a noninvasive test is performed by administering 13C urea which, in the presence of H. pylori, will release 13CO2. The test does not measure the amount of HCl acid or the pH and does not detect H. pylori antibodies.

2. A patient has a blood pressure of 135/85 mm Hg on three separate occasions. The nurse understands that this patient should be treated with a. a beta blocker. b. a diuretic and a beta blocker. c. a diuretic. d. lifestyle changes.

ANS: D Prehypertension is defined as a systolic pressure of 120 to 139 and a diastolic pressure between 80 and 89. Drug therapy is recommended if the blood pressure is greater than 20/10 over the goal, which would be140/90. Prehypertension is generally treated first with lifestyle changes

6. The nurse is caring for a patient who is receiving furosemide (Lasix) and an aminoglycoside antibiotic. The nurse will be most concerned if the patient reports which symptom? a. Dizziness b. Dysuria c. Nausea d. Tinnitus

ANS: D The interaction of furosemide and an aminoglycoside can produce ototoxicity in the patient. Tinnitus is a sign of ototoxicity. Dizziness can occur as a result of diuretic therapy but not necessarily as a result of this combination. Dysuria and nausea are not common signs of these drugs interacting.

11. The nurse is caring for a patient who is taking hydrochlorothiazide (HydroDIURIL) and digoxin (Lanoxin). Which potential electrolyte imbalance will the nurse monitor for in this patient? a. Hypermagnesemia b. Hypernatremia c. Hypocalcemia d. Hypokalemia

ANS: D Thiazide diuretics can cause hypokalemia, which enhances the effects of digoxin and can lead to digoxin toxicity. Thiazides can cause hypercalcemia.

1. A patient is diagnosed with borderline hypertension and states a desire to make lifestyle changes to avoid needing to take medication. The nurse will recommend which changes? a. Changing from weight bearing exercise to yoga b. Decreased fluid intake and increased potassium intake c. Stress reduction and increased protein intake d. Weight reduction and decreased sodium intake

ANS: D Weight loss decreases the stress on the heart and the afterload. Decreasing salt intake decreases the amount of retained fluid. Changing to yoga from weight-bearing exercise, limiting fluids, and increasing potassium are not indicated. Stress reduction is recommended, but increasing protein is not.

14. The patient has been prescribed hydrochlorothiazide (HCTZ) for her hypertension. When she comes to the office for a follow-up appointment, the nurse observes her drinking an energy drink. Which herb, commonly found in some energy drinks, can increase blood pressure when taken with thiazide diuretics? a. Ginger b. Ginkgo c. Licorice d. St. John's wort

B

15. What is the pharmacologic action of spironolac-tone? a. Increase potassium and sodium excretion b. Promote potassium retention c. Promote potassium and calcium retention d. Promote potassium excretion and sodium retention

B

24. An ARB can be combined with the thiazide diuretic hydrochlorothiazide. What is the purpose of combining these two drugs? a. To decrease rapid blood pressure drop b. To enhance the antihypertensive effect by promoting sodium and water loss c. To increase sodium and water retention for controlling blood pressure d. To promote potassium retention

B

26. What is the optimal time to administer diuretics? a. At bedtime b. After arising for the day c. On an empty stomach d. With meals

B

28. Which drug-lab value interaction is caused by thiazide diuretics? a. Decreased blood glucose level b. Elevated lithium level c. Elevated BUN d. Decreased calcium level

B

12. Which group(s) of diuretics is/are frequently prescribed to treat hypertension and congestive heart failure? (Select all that apply.) a. Carbonic anhydrase inhibitors b. Loop diuretics c. Osmotic diuretics d. Potassium-sparing diuretics e. Thiazide diuretics

B, D, E

13. When compared with thiazides, how do loop (high-ceiling) diuretics differ? a. They are more effective as antihypertensives. b. They promote potassium absorption. c. They cause calcium reabsorption. d. They are more potent as diuretics

D

20. What is one of the effects of diphenhydramine? a. Anticoagulant b. Anticonvulsant c. Antihypertensive d. Antitussive

D

28. The 16-year-old patient has been vomiting since last night. His mother calls the health care provider for an appointment but will be unable to come in for several hours. What nonpharmacologic method(s) can the nurse suggest to decrease nausea and vomiting? (Select all that apply.) a. "Drink weak tea." b. "Takes sips of flat soda." c. "Eat small amounts of gelatin if tolerated." d. "Crackers may be helpful." e. "Breathe deeply in and out through your nose."

a, b, c, d. Drinking weak tea and sodas that have gone flat may help with nausea. Open a can or bottle of soda and let it sit for several hours to remove its carbonation. Unsweetened gelatin may also be helpful. Crackers and dry toast may provide something to stay in the stomach. Relaxed breathing may help with the feeling of nausea, but it is usually more beneficial to breathe in through the nose and out through the mouth as is used in relaxation techniques.

26. Of the following groups of drugs, which can be used as antiemetics? (Select all that apply.) a. Anticholinergics b. Antihistamines c. Cannabinoids d. Opioids e. Phenothiazines

a, b, c, e. All but the opioids can be used as antiemetics. Opioids can cause constipation that can decrease intestinal motility, thereby decreasing peristalsis; opioids can be used as antidiarrheals

30. Which drug(s) will concern the nurse if prescribed for a patient who is taking esomeprazole? (Select all that apply.) a. Ampicillin b. Digoxin c. Ketoconazole d. Lisinopril e. Propranolol

a, b, c. There are no documented interactions between esomeprazole and either lisinopril or propranolol. Esomeprazole interferes with the absorption of ampicillin, digoxin, and ketoconazole.

29. Which side effect(s) of ranitidine will the nurse monitor in the patient? (Select all that apply.) a. Confusion b. Headache c. Hypertension d. Loss of libido e. Nausea

a, b, d, e. Side effects of ranitidine and other H2 blockers include confusion, headache, decreased libido, and nausea. Other side effects include dizziness, constipation, abdominal pain, diarrhea, vomiting, blurred vision, malaise, and weakness.

24. What priority information regarding nonpharmacologic treatment can the nurse provide in the health education plan to a patient who has been diagnosed with GERD? (Select all that apply.) a. Decrease or stop smoking. b. Elevate the head of the bed. c. Increase fluid intake. d. NSAIDs should be taken with food. e. Spicy foods should be avoided

a, b, d, e. There are various nonpharmacologic methods to help prevent the discomfort associated with gastroesophageal reflux disease (GERD). Nicotine relaxes the lower esophageal sphincter so acid can reflux back into the esophagus. Elevating the head of the bed will allow the body to work with gravity instead of against it to keep acid in the stomach. NSAIDs can cause gastric ulcers. Spicy foods are irritating to the lining of the esophagus.

19. Which lab value(s) should a nurse monitor for a patient receiving chlorothiazide? (Select all that apply.) a. Potassium b. Sodium c. Bicarbonate d. Calcium e. AST/ALT

a, b, d. Hypokalemia, or low serum potassium level, is a risk for patients taking thiazides. This could be a life-threatening condition. Sodium is also lost, causing hyponatremia. Calcium level is elevated because thiazides block calcium excretion. There is minimal effect on bicarbonate levels. Cautious use in hepatic failure patients is recommended, but trending of AST/ALT levels is not always indicated. Baseline values may be beneficial.

42. The patient has been prescribed promethazine 25 mg PO for nausea that accompanies her migraines. What side effect(s) should be included in the patient teaching? (Select all that apply.) a. Blurred vision b. Diarrhea c. Drowsiness d. Dry mouth e. Hypotension

a, c, d, e. Promethazine is an antihistamine given for nausea and/or vomiting. Antihistamines inhibit histamine-mediated responses and have anticholinergic effects, which include blurred vision, drowsiness, dry mouth, and hypotension

25. Which area(s) in the brain cause(s) vomiting when stimulated? (Select all that apply.) a. Chemoreceptor trigger zone b. Nausea center c. Medulla d. Vertigo center e. Vomiting center

a, e. The CTZ lies near the medulla, and the vomiting center is in the medulla. These two areas, when stimulated, can cause vomiting. The medulla is an organ that contains the two areas.

28. A patient has been diagnosed with erosive GERD. Which drug is likely to have the highest success rate? a. Esomeprazole b. Lansoprazole c. Omeprazole d. Rabeprazole

a. All the drugs are PPIs that are effective in treating GERD and ulcers; however, esomeprazole has the highest success rate for erosive GERD.

24. The patient has a complicated medical history including heart failure, cardiac arrhythmias, arthritis, and depression. He is taking furosemide for his heart failure. Which of his other medications would be of major concern to the nurse? a. Amiodarone b. Acetaminophen c. Amitriptyline d. Zolpidem

a. Furosemide will cause an increased loss of potassium (hypokalemia) when given with amiodarone, which may predispose the patient to ventricular arrhythmias.

30. In which patient are loop diuretics contraindicated? a. The patient with anuria b. The patient with asthma c. The patient with allergy to ceftriaxone d. The patient with gastric ulcers

a. Loop diuretics are contraindicated in patients with anuria. Giving diuretics to a patient without any urine output will not force urine production

What is a priority nursing action after administration of a total IV lidocaine dose of 3 mg/kg to an adult and the dysrhythmia has been suppressed? a. A continuous infusion of lidocaine must be initiated to maintain a therapeutic serum level. b. A therapeutic serum level will be achieved and maintained. c. Additional bolus doses must be administered to achieve a therapeutic serum level. d. 3 mg/kg is too much, and the patient has been overdosed.

a. Once the dysrhythmia has been suppressed, as long as a total of 3 mg/kg has not been exceeded, a maintenance drip of lidocaine at a rate of 1-4 mg/min is started.

20. A patient who has had an acute myocardial infarction has been started on spironolactone 50 mg/day. When evaluating routine laboratory work, the nurse discovers the patient has a potassium level of 5.8 mEq/L. What is the priority intervention to be implemented? a. The spironolactone dose should be held and the intake of foods rich in potassium should be restricted. b. The spironolactone dose should be continued and the patient should be encouraged to eat fruits and vegetables. c. The spironolactone dose should be increased and the patient instructed to decrease foods rich in potassium. d. Instruct the patient to continue with the current dose of spironolactone and report any signs or symptoms of hypokalemia.

a. The normal range for serum potassium level is 3.5-5 mEq/L. A level of 5.8 mEq/L is considered hyperkalemia. The dose of spironolactone may be held or decreased, and the patient should decrease intake of potassium-rich foods such as bananas, apricots, leafy greens, and salmon.

32. What is the goal behind giving activated charcoal? a. Absorb poison b. Cause diarrhea c. Promote vomiting d. Stop nausea

a. When poison is ingested, vomiting should not be induced because regurgitating these substances can cause esophageal injury. Instead, activated charcoal is administered to absorb the poison.

22. Which drug(s) may be used in the prevention of ulcers? (Select all that apply.) a. Antibiotics b. Anticholinergics c. Antacids d. Histamine2 blockers e. Opiates f. Proton pump inhibitors

b, c, d, f. Antiulcer drugs include anticholinergics, antacids, H2 blockers, and PPIs. Other antiulcer drugs include tranquilizers, pepsin inhibitors, and prostaglandin E1 analogues.

20. The patient has started taking an OTC antacid for "heartburn." He asks the nurse what is the best time to take it so it is the most effective. What is the best answer? a. 1 hour before meals b. 1-3 hours before meals and at bedtime c. With meals and at bedtime d. With meals and 1 hour after

b. Antacids neutralize hydrochloric acid and should be taken 1−3 hours before meals and at bedtime. They should not be taken with meals because of the delayed gastric emptying time, which can increase acid production.

31. Which nonprescription drugs are most commonly used to treat motion sickness? a. Anticholinergics b. Antihistamines c. Cannibinoids d. Osmotics

b. Antihistamines, such as diphenhydramine, are frequently used to treat motion sickness. They are available OTC. Anticholinergics and cannabinoids, while they can be used as antiemetics, are not generally used for motion sickness. Osmotics are considered laxatives.

27. The patient has severe nausea and vomiting and has been prescribed promethazine 25 mg PO q4-6h. The patient asks how the drug works. What is the nurse's best response? a. "It stimulates the dopamine receptors in the brain associated with vomiting." b. "It blocks the histamine receptor sites and inhibits the CTZ." c. "It blocks the acetylcholine receptors associated with vomiting." d. "It prohibits the muscle contraction in the abdominal wall, preventing vomiting."

b. Promethazine is a phenothiazine that blocks H1- receptor sites on effector cells, impedes histamine-mediated responses, and inhibits the CTZ

45. The patient is experiencing diarrhea. Which food(s) will the nurse advise the patient to avoid? (Select all that apply.) a. Bottled water b. Clear liquids c. Fried foods d. Milk products e. Gelatin

c, d. A patient with diarrhea should avoid "heavy" fried foods and milk products. Promoting fluid intake and replacing electrolytes are priority interventions when the patient is experiencing diarrhea.

30. The nurse is taking care of a newly pregnant patient who is complaining of morning sickness. She asks the nurse what she can do to help stop the nausea. How will the nurse respond? (Select all that apply.) a. "Ask your health care provider for a prescription for hydroxyzine." b. "Take over-the-counter antiemetics like bismuth subsalicylate." c. "Try drinking flat soda or weak tea." d. "Consider some dry toast or crackers." e. "This will just go away in a few months. There is nothing to do."

c, d. Nonpharmacologic measures are now recommended for morning sickness. Some prescription antiemetics can be taken during pregnancy, but they are classified as pregnancy category C. Hydroxyzine is classified as pregnancy category X. OTC antiemetics are no longer considered safe. Some herbals are used during pregnancy, but they are not FDA approved. Telling the patient it will just go away in a few months, while this may or may not be true, negates the patient's feelings.

23. The patient presents to the clinic with a sore throat. He tells the nurse, "I just feel like a fire-breathing dragon. It is awful when I go to bed." He has been diagnosed with gastroesophageal reflux disease (GERD). What drug(s) does the nurse know is/are most commonly used to treat GERD? (Select all that apply.) a. a. Antacids b. Anticholinergics c. Histamine2 blockers d. Pepsin inhibitors e. Proton pump inhibitors

c, e. Commonly used drugs to treat GERD include H2 blockers and PPIs. Anticholinergics and pepsin inhibitors are commonly used to treat ulcers. Antacids are used to prevent ulcers.

27. The patient is admitted to the critical care unit after sustaining a severe closed head injury in a motorcycle collision. Mannitol is ordered to decrease intracranial pressure. Through which mechanism does mannitol exert its pharmacologic effects? a. Cerebral vasoconstriction b. Loop diuresis c. Osmotic diuresis d. Peripheral vasodilation

c. Mannitol is an osmotic diuretic to treat increased intracranial pressure.

The patient has recently had surgery and has been taking opioids for pain control. He has become constipated and has been prescribed a laxative. When providing health care teaching for this patient, what type of stool should the nurse tell the patient to expect? a. Hard and dry b. Liquid c. Soft d. Soft with hard pieces

c. Soft

17. The 65-year-old patient had an acute myocardial infarction 6 months ago and has been prescribed spironolactone 100 mg/day to treat an irregular heart rate. What statement by the patient indicates that he understands the medication teaching the nurse has provided? a. "I need sodium so my heart beats regularly." b. "This drug is dangerous if you have had a heart attack." c. "It helps keep potassium so my heart does not get irregular." d. "I need to take it with lots of bananas to keep my potassium up."

c. Spironolactone blocks the action of aldosterone and inhibits the sodium-potassium pump, so potassium is retained. This is important in maintaining a regular cardiac rhythm. It is frequently prescribed by cardiologists and is not contraindicated in patients who have had a myocardial infarction. Sodium is excreted with this drug. Patients should be advised not to overindulge in foods rich in potassium such as bananas, because this could cause above-normal levels of potassium (hyperkalemia).

23. The 70-year-old patient has heart failure and has been prescribed hydrochlorothiazide. What statement by the patient indicates understanding of the dosing regimen? a. "I need to take it on an empty stomach for it to work." b. "I really only need to take my medicine when I am having a hard time breathing." c. "It may take several weeks before it starts to work." d. "I should take it in the morning so I don't have to go to the bathroom at night."

d. Because the onset of action is 2 hours, it may be best to take the drug when the patient will be awake for several hours so sleep is not disturbed. Hydrochlorothiazide can be taken with food to prevent GI upset. The drug needs to be taken consistently, even if the patient is not having symptoms.

44. The nurse will question an order for antidiarrheal drug for which patient? a. 46-year-old with diabetes b. 36-year-old with COPD c. 60-year-old with heart failure d. 65-year-old with hepatitis C

d. Certain antidiarrheals, including those containing diphenoxylate, difenoxin, or loperamide, are contraindicated in patients with severe hepatic disease

31. The patient has been diagnosed with hypertension and diabetes and has been started on hydrochlorothiazide. What statement by the patient indicates understanding of the drug teaching the nurse has provided? a. "It will start working within minutes." b. "I don't need to monitor my blood sugar." c. "I should take my drug on an empty stomach so it works better." d. "I need to keep track of my weight and blood pressure at home."

d. Daily weights and vital signs need to be trended at home on a daily basis. The patient and family should be educated on how to take these measurements or arrangements should be made for assessment by home health services, at least initially. The onset of action for hydrochlorothiazide is 2 hours. Hyperglycemia is a side effect of hydrochlorothiazide, so blood sugar level should be monitored. This medication can be taken with food to prevent nausea.

41. A 35-year-old female with heart failure has now developed pulmonary edema. Furosemide 60 mg IVP was ordered. Furosemide exerts its effects on pulmonary edema through which mechanisms? a. Bronchodilation and diuresis b. Bronchodilation and antiinflammatory actions c. Vasoconstriction and diuresis d. Vasodilation and diuresis

d. Furosemide is a loop diuretic that inhibits reabsorption and promotes renal excretion of water, sodium, potassium, magnesium, calcium, and hydrogen. It also promotes vasodilation and diuresis, which can lower blood pressure

18. The nurse has received an order to administer 40 mg of furosemide IV to the patient. What does the nurse know about how this drug should be administered? a. It must be mixed in 50 mL of normal saline. b. It can only be given in a central line. c. The patient must be on a cardiac monitor. d. It should be given over 1-2 minutes.

d. To prevent hearing loss, furosemide must be administered slow IV push over at least 1-2 minutes. It does not need to be diluted and does not require a central line for administration. Cardiac monitoring is not essential, because furosemide does not cause arrhythmias