practice questions

The nurse should assess a patient who is taking loraz- epam (Ativan) for the development of which of these adverse effects? 1. Tachypnea 2. Astigmatism 3. Ataxia 4. Euphoria

3

Which factor is most important for the nurse to assess when evaluating the effectiveness of a patient's drug therapy? 1. The patient's promise to comply with drug therapy 2. The patient's satisfaction with the drug 3. The cost of the medication 4. Evidence of therapeutic benefit from the medication

4

Planning teaching needs for a patient who is to be dis- charged postoperatively with a prescription for oxy- codone with acetaminophen (Percocet) should include which of the following? 1. Refer the patient to a drug treatment center if ad- diction occurs. 2. Encourage increased fluids and fiber in the diet. 3. Monitor for GI bleeding. 4. Teach the patient to self-assess blood pressure.

2

Which of the following patient statements indicates that the levodopa/carbidopa (Sinemet) is effective? 1. "I'm sleeping a lot more, especially during the day." 2. "My appetite has improved." 3. "I'm able to shower by myself." 4. "My skin doesn't itch anymore."

3 Becoming more independent in ADLs shows an improvement in physical abilities.

A 65-year-old patient is prescribed ipratropium (Atrovent) for the treatment of asthma. Which of the following conditions should be reported to the health care provider before giving this patient the ipratropium? 1. A reported allergy to peanuts 2. A history of intolerance to albuterol (Proventil) 3. A history of bronchospasms 4. A reported allergy to chocolate

1 Ipratropium (Atrovent) is contraindicated in patients with hypersensitivity to soya lecithin or related food products such as soybean and peanut.

A 24-year-old patient reports taking acetaminophen (Tylenol) fairly regularly for headaches. The nurse knows that a patient who consumes excessive acetami- nophen per day or regularly consumes alcoholic bev- erages should be observed for what adverse effect? 1. Hepatic toxicity 2. Renal damage 3. Thrombotic effects 4. Pulmonary damage

1

A patient is treated for psychosis with fluphenazine. What drug will the nurse anticipate may be given to prevent the development of acute dystonia? 1. Benztropine (Cogentin) 2. Diazepam (Valium) 3. Haloperidol (Haldol) 4. Lorazepam (Ativan)

1. Benztropine (Cogentin), an anti- cholinergic, may be given to suppress the tremor and rigidity that may be caused by fluphenazine or other phenothiazine antipsychotic drugs.

What health teaching should the nurse provide for the patient receiving nadolol (Corgard)? 1. Increase fluids and fiber to prevent constipation. 2. Report a weight gain of 1 kg per month or more. 3. Immediately stop taking the medication if sexual dysfunction occurs. 4. Rise slowly after prolonged periods of sitting or lying down.

4 Nadolol (Corgard) may increase the risk of orthostatic hypotension, and the patient should be taught to rise slowly to standing from a sitting or lying position.

Which of the following statements by a patient who is undergoing antineoplastic therapy would be of con- cern to the nurse? (Select all that apply.) 1. "I have attended a meeting of a cancer support group." 2. "My husband and I are planning a short trip next week." 3. "I am eating six small meals plus two protein shakes a day." 4. "I am taking my 15-month-old granddaughter to the pediatrician next week for her baby shots." 5. "I am going to go shopping at the mall next week."

4, 5

A 15-year-old adolescent with a history of diabetes is treated in the emergency department for compli- cations related to skipping her medication for dia- betes. She confides in the nurse that she deliberately skipped some of her medication doses because she did not want to gain weight and she is afraid of nee- dle marks. Before establishing a diagnosis of "Non- compliance," what should the nurse assess? 1. Whether the patient received adequate teaching related to her medication and expresses an un- derstanding of that teaching 2. Whether the patient was encouraged to skip her medication by a family member or friend 3. Whether the patient is old enough to understand the consequences of her actions 4. Whether the provider will write another pre- scription because the patient refused to take the medication the first time

1

A patient who is taking an adrenergic-blocker for hy- pertension reports being dizzy when first getting out of bed in the morning. The nurse should advise the patient to: 1. Move slowly from the recumbent to the upright position. 2. Drink a full glass of water before rising to in- crease vascular circulatory volume. 3. Avoid sleeping in a prone position. 4. Stop taking the medication.

1

Following administration of phenylephrine (Neo- Synephrine), the nurse would assess for which of the following adverse drug effects? 1. Insomnia, nervousness, and hypertension 2. Nausea, vomiting, and hypotension 3. Dry mouth, drowsiness, and dyspnea 4. Increased bronchial secretions, hypotension, and bradycardia

1

Simethicone (Gas-X, Mylicon) may be added to some medications or given plain for what therapeutic effect? 1. Decrease the amount of gas associated with GI disorders. 2. Increase the acid-fighting ability of some medications. 3. Prevent constipation associated with gastrointes- tinal drugs. 4. Prevent diarrhea associated with gastrointestinal drugs.

1

The nurse is administering medications and the pa- tient states, "I've never seen that blue pill before." What would be the nurse's most appropriate action? 1. Verify the order and double-check the drug label. 2. Administer the medication in the existing form. 3. Instruct the patient that different brands are fre- quently used and may account for the change of color. 4. Recommend that the patient discuss the medica- tion with the provider and give the medication.

1

The nurse is assisting the older adult diagnosed with a gastric ulcer to schedule her medication administra- tion. What would be the most appropriate time for this patient to take her lansoprazole (Prevacid)? 1. About 30 minutes before her morning meal 2. At night before bed 3. After fasting at least 2 hours 4. 30 minutes after each meal

1

The nurse is caring for a patient with gastroesopha- geal reflux disease and would question an order for which of the following? 1. Amoxicillin (Amoxil) 2. Ranitidine (Zantac) 3. Pantoprazole (Protonix) 4. Calcium carbonate (Tums)

1

The nurse is providing education for a 12-year-old pa- tient with partial seizures currently prescribed valproic acid (Depakene). The nurse will teach the patient and the parents to immediately report which symptom? 1. Increasing or severe abdominal pain 2. Decreased or foul taste in the mouth 3. Pruritus and dry skin 4. Bone and joint pain

1

The patient or family of a patient taking neostigmine (Prostigmin) should be taught to be observant for which of the following adverse effects that may signal that a possible overdose has occurred? 1. Excessive sweating, salivation, and drooling 2. Extreme constipation 3. Hypertension and tachycardia 4. Excessively dry eyes and reddened sclera

1

The provider has ordered atropine, a drug that will prevent the patient's own chemical, acetylcholine, from causing parasympathetic effects. What type of drug would atropine be considered? 1. An antagonist 2. A partial agonist 3. An agonist 4. A protagonist

1

To avoid the first-dose phenomenon, the nurse knows that the initial dose of prazosin (Minipress) should be: 1. Very low and given at bedtime. 2. Doubled and given before breakfast. 3. The usual dose and given before breakfast. 4. The usual dose and given immediately after breakfast.

1

What is the term used to describe the magnitude of maximal response that can be produced from a par- ticular drug? 1. Efficacy 2. Toxicity 3. Potency 4. Comparability

1

A 16-year-old patient has taken an overdosage of cit- alopram (Celexa) and is brought to the emergency de- partment. What symptoms would the nurse expect to be present? 1. Seizures, hypertension, tachycardia, extreme anxiety 2. Hypotension, bradycardia, hypothermia, sedation 3. Miosis, respiratory depression, absent bowel sounds, hypoactive reflexes 4. Manic behavior, paranoia, delusions, tremors

1 An overdose of citalopram (Celexa) causes symptoms similar to serotonin syndrome including seizures, hypertension, tachycardia, and extreme anxiety.

A patient has been diagnosed with tuberculosis and is prescribed Rifater (pyrazinamide with isoniazid and rifampin). While the patient is on this medication, what teaching is essential? (Select all that apply.) 1. "It is critical to continue therapy for at least 6 to 12 months." 2. "Two or more drugs are used to prevent tubercu- losis bacterial resistance." 3. "These drugs may also be used to prevent tuberculosis." 4. "No special precautions are required." 5. "After 1 month of treatment, the medication will be discontinued."

1, 2, 3

The nurse is monitoring the patient for early signs of lithium (Eskalith) toxicity. Which symptoms, if present, may indicate that toxicity is developing? (Select all that apply.) 1. Persistent gastrointestinal upset (e.g., nausea, vomiting) 2. Confusion 3. Increased urination 4. Convulsions 5. Ataxia

1, 2, 3 Persistent GI upset such as nausea, vomiting, and abdominal pain; increased urination; and confusion are signs of elevated lithium levels and may signal the early stages of toxicity.

What patient education should be included for a patient receiving enoxaparin (Lovenox)? (Select all that apply.) 1. Teach the patient or family to give subcutaneous injections at home. 2. Teach the patient or family not to take any over- the-counter drugs without first consulting with the health care provider. 3. Teach the patient to observe for unexplained bleeding such as pink, red, or dark brown urine or bloody gums. 4. Teach the patient to monitor for the development of deep vein thrombosis. 5. Teach the patient about the importance of drink- ing grapefruit juice daily.

1, 2, 3, 4 Enoxaparin is an LMWH. Patients and family can be taught to give subcutaneous injections at home. Teaching should include instructions to not take any other medications without first consulting the health care provider and recognizing the signs and symptoms of bleeding. Enoxaparin is given to prevent development of DVT. Patients should be taught signs and symptoms of DVT to observe for and should contact their health care provider immediately if these develop or worsen while on enoxaparin therapy

Anticholinergics may be ordered for which of the following conditions? (Select all that apply.) 1. Peptic ulcer disease 2. Bradycardia 3. Decreased sexual function 4. Irritable bowel syndrome 5. Urine retention

1, 2, 4

Which of the following medications may be used to treat partial seizures? (Select all that apply.) 1. Phenytoin (Dilantin) 2. Valproic acid (Depakene) 3. Diazepam (Valium) 4. Carbamazepine (Tegretol) 5. Ethosuximide (Zarontin)

1, 2, 4

Metronidazole (Flagyl) is being used to treat a patient's Giardia lamblia infection, a protozoan infection of the intestines. Which of the following are appropri- ate to teach this patient? (Select all that apply.) 1. Metronidazole may leave a metallic taste in the mouth. 2. The urine may turn dark amber brown while on the medication. 3. The metronidazole may be discontinued once the diarrhea subsides to minimize adverse effects. 4. Taking the metronidazole with food reduces GI upset. 5. Current sexual partners do not require treatment for this infection.

1, 2, 4, 5

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

1, 2, 4. Aluminum- and magnesium- based antacids decrease absorption of haloperidol (Haldol). Haldol also has a high incidence of EPS. It is contraindicated in Parkinson's disease, seizure disorders, alcoholism, and severe mental depression.

A patient has been diagnosed with genital herpes and has been started on oral acyclovir (Zovirax). What should be included in the teaching instructions for this patient? (Select all that apply.) 1. Increase fluid intake up to 2 L per day. 2. Report any dizziness, tremors, or confusion. 3. Decrease the amount of fluids taken so that the drug can be more concentrated. 4. Take the drug only when having the most itching or pain from the outbreak. 5. Use barrier methods such as condoms for sexual activity.

1, 2, 5

A patient with cirrhosis of the liver has hepatic im- pairment. This will require what possible changes? (Select all that apply.) 1. A reduction in the dosage of the drugs 2. A change in the timing of medication administration (e.g., lengthening time between doses) 3. An increased dose of prescribed drugs 4. Giving all prescribed drugs by intramuscular injection 5. More frequent monitoring for adverse drug effects

1, 2, 5

A patient has been on long-term therapy with colestipol (Colestid). To prevent adverse effects re- lated to the length of therapy and lack of nutrients, which of the following supplements may be required? (Select all that apply.) 1. Folic acid 2. Vitamins A, D, E, and K 3. Potassium, iodine, and chloride 4. Protein 5. B vitamins

1, 2. Long-term use of bile acid sequestrants such as colestipol (Colestid) may cause depletion or decreased absorption of folic acid and the fat-soluble vitamins

A 2-year-old patient is receiving vincristine (Oncovin) for Wilms' tumor. Which of the following findings will the nurse monitor to prevent or limit the main adverse effect for this patient? (Select all that apply.) 1. Numbness of the hands or feet 2. Angina or dysrhythmias 3. Constipation 4. Diminished reflexes 5. Dyspnea and pleuritis

1, 3, 4

Common adverse effects of antidysrhythmic medica- tions include which of the following? (Select all that apply.) 1. Hypotension 2. Hypertension 3. Dizziness 4. Weakness 5. Panic attacks

1, 3, 4 Because antidysrhythmics can slow the heart rate, the patient may experience hypotension, dizziness, or weakness

The nurse administers a medication to the wrong pa- tient. What are the appropriate nursing actions required? (Select all that apply.) 1. Monitor the patient for adverse reactions. 2. Document the error if the patient has an adverse reaction. 3. Report the error to the health care provider. 4. Notify the hospital legal department of the error. 5. Document the error in a critical incident/occur- rence report.

1, 3, 5

Which of the following assessment findings in a patient who is receiving atenolol (Tenormin) for angina would be cause for the nurse to hold the drug and contact the provider? (Select all that apply.) 1. Heart rate of 50 beats/minute 2. Heart rate of 124 beats/minute 3. Blood pressure 86/56 4. Blood pressure 156/88 5. Tinnitus and vertigo

1, 3. Atenolol (Tenormin) decreases blood pressure and heart rate. The administration of this drug may cause significant hypotension and bradycardia in some patients.

What is the role of the nurse in medication adminis- tration? (Select all that apply.) 1. Ensure that medications are administered and delivered in a safe manner. 2. Be certain that health care provider orders are accurate. 3. Inform the patient that prescribed medications need to be taken only if the patient agrees with the treatment plan. 4. Ensure that the patient understands the use and administration technique for all prescribed medications. 5. Prevent adverse drug reactions by properly ad- ministering all medications.

1, 4

A patient with a congenital coagulation disorder is given aminocaproic acid (Amicar) to stop bleeding following surgery. The nurse will carefully monitor this patient for development of which of the follow- ing adverse effects? (Select all that apply.) 1. Anaphylaxis 2. Hypertension 3. Hemorrhage 4. Headache 5. Hypotension

1, 4, 5 Adverse effects of aminocaproic acid (Amicar) include headache, anaphylaxis, and hypo- tension.

A patient is receiving treatment for asthma with albuterol (Proventil). The nurse teaches the patient that while serious adverse effects are uncommon, the following may occur. (Select all that apply.) 1. Tachycardia 2. Sedation 3. Temporary dyspnea 4. Nervousness 5. Headache

1, 4, 5 Tachycardia, nervousness, and headache may occur with the use of albuterol (Proventil, VoSpire) inhalers.

Lisinopril (Prinivil) is part of the treatment regimen for a patient with heart failure. The nurse moni- tors the patient for the development of which of the following adverse effects of this drug? (Select all that apply.) 1. Hyperkalemia 2. Hypocalcemia 3. Cough 4. Dizziness 5. Heartburn

1,3, 4. Common adverse effects of lisinopril (Prinvil) and other ACE inhibitors include cough, headache, dizziness, change in sensation of taste, vomiting and diarrhea, and hypotension. Hyperkalemia may occur, especially when the drug is taken concurrently with potassium-sparing diuretics.

A male, age 67, reports taking diphenhydramine (Benadryl) for hay fever. Considering this patient's age, the nurse assesses for which of the following findings? 1. A history of prostatic or urinary conditions 2. Any recent weight gain 3. A history of allergic reactions 4. A history of peptic ulcer disease

1. Diphenhydramine (Benadryl) and other anithistamines are contraindicated in patients with BPH or lower urinary tract obstruction because anticholinergic effects may worsen these conditions

The nurse should immediately report the develop- ment of which of the following symptoms in a patient taking antipsychotic medication? 1. Fever, tachycardia, confusion, incontinence 2. Pacing, squirming, or difficulty with gait such as bradykinesia 3. Severe spasms of the muscles of the tongue, face, neck, or back 4. Sexual dysfunction or gynecomastia

1. Fever, tachycardia, confusion, and incontinence are symptoms of the development of NMS and should be immediately reported

When monitoring for therapeutic effect of any anti- dysrhythmic drug, the nurse would be sure to assess which essential parameter? 1. Pulse 2. Blood pressure 3. Drug level 4. Hourly urine output

1. In the absence of ECG monitoring, the nurse would assess the pulse for rate, regularity, quality, and volume, noting any changes. The nurse should also teach the patient to monitor the pulse for rate and regularity before sending the patient home.

A patient is receiving cholestyramine (Questran) for elevated low-density lipoprotein (LDL) levels. As the nurse completes the nursing care plan, which of the following adverse effects will be included for contin- ued monitoring? 1. Abdominal pain 2. Orange-red urine and saliva 3. Decreased capillary refill time 4. Sore throat and fever

1. Obstruction of the GI tract is one of the most serious complications of bile acid sequestrants. Abdominal pain may signal the presence of obstruction

The patient has been prescribed oxymetazoline (Af- rin) nasal spray for seasonal rhinitis. The nurse will provide which of the following instructions? 1. Limit use of this spray to 5 days or less. 2. The drug may be sedating so be cautious with activities requiring alertness. 3. This drug should not be used in conjunction with antihistamines. 4. This is an over-the-counter drug and may be used as needed for congestion.

1. Prolonged use of oxymetazoline (Afrin) causes hypersecretion of mucus and worsening nasal congestion, resulting in increased daily use.

A 17-year-old patient has been prescribed escitalo- pram (Lexapro) for increasing anxiety uncontrolled by other treatment measures. Because of this patient's age, the nurse will ensure that the patient and parents are taught what important information? 1. Cigarette smoking will counteract the effects of the drug. 2. Signs of increasing depression or thoughts of sui- cide should be reported immediately. 3. The drug causes dizziness and alternative school- ing arrangements may be needed for the first two months of use. 4. Anxiety and excitability may increase during the first two weeks of use but then will have signifi- cant improvement.

2

A 32-year-old female has been started on amoxicillin (Amoxil, Trimox) for a severe UTI. Before sending her home with this prescription, the nurse will provide which instruction? 1. Teach her to wear sunscreen. 2. Ask her about oral contraceptive use and recom- mend an alternative method for the duration of the ampicillin course. 3. Assess for hearing loss. 4. Recommend taking the pill with some antacid to prevent gastrointestinal upset.

2

A combination of two different antihypertensive drugs in lower doses has been ordered for a patient whose hypertension has not been controlled by stan- dard doses of either drug alone. The nursing student recognizes the interaction between these two drugs is known as what term? 1. Addition 2. Synergism 3. Antagonism 4. Displacement

2

A patient experiences profound drowsiness when a stimulant drug is given. This is an unusual reaction for this drug, a reaction that has not been associated with this particular drug. What is the term for this type of drug reaction? 1. Allergic reaction 2. Idiosyncratic reaction 3. Enzyme-specific reaction 4. Unaltered reaction

2

A patient has a new medication prescription and the nurse is providing education about the drug. Which statement made by the patient would indicate the need for further medication education? 1. "I can consult my health care provider if I experi- ence adverse effects." 2. "If I take more, I'll have a better response." 3. "Taking this drug with food will decrease how much drug gets into my system." 4. "The liquid form of the drug will absorb faster than the tablets."

2

A patient has been taking phenytoin (Dilantin) for control of generalized seizures, tonic-clonic type. The patient is admitted to the medical unit with symptoms of nystagmus, confusion, and ataxia. What change in the phenytoin dosage does the nurse anticipate will be made based on these symptoms? 1. The dosage will be increased. 2. The dosage will be decreased. 3. The dosage will remain unchanged; these are symptoms unrelated to the phenytoin. 4. The dosage will remain unchanged but an addi- tional antiseizure medication may be adde

2

A patient is started on efavirenz (Sustiva) for HIV. What should the nurse teach the patient about this drug? 1. Efavirenz (Sustiva) will cure the disease over time. 2. Efavirenz (Sustiva) will not cure the disease but may significantly extend the life expectancy. 3. Efavirenz (Sustiva) will be used prior to vaccines. 4. Efavirenz (Sustiva) will prevent the transmission of the disease.

2

A patient who is undergoing cancer chemotherapy asks the nurse why she is taking three different chemotherapy drugs. What is the nurse's best re- sponse? 1. "Your cancer was very advanced and therefore requires more medications." 2. "Each drug attacks the cancer cells in a dif- ferent way, increasing the effectiveness of the therapy." 3. "Several drugs are prescribed to find the right drug for your cancer." 4. "One drug will cancel out the side effects of the other."

2

A patient will be discharged after surgery with a prescription for penicillin. When planning at-home in- structions, what will the nurse include? 1. Penicillins can be taken while breast-feeding. 2. The entire prescription must be finished. 3. All penicillins can be taken without regard to eating. 4. Some possible side effects include abdominal pain and constipation.

2

A patient with a severe systemic fungal infection is to be given amphotericin B (Fungizone). Before starting the amphotericin infusion, the nurse premedicates the patient with acetaminophen (Tylenol), diphen- hydramine (Benadryl), and prednisone (Deltasone). What is the purpose of premedicating the patient prior to the amphotericin? 1. It delays the development of resistant fungal infections. 2. It decreases the risk of hypersensitivity reactions to the amphotericin. 3. It prevents hyperthermia reactions from the amphotericin. 4. It works synergistically with the amphotericin so a lower dose may be given.

2

A patient with type 2 diabetes treated with oral an- tidiabetic medication is receiving oral fluconazole (Diflucan) for treatment of chronic tinea cruris (jock itch). The nurse instructs the patient to monitor blood glucose levels more frequently because of what potential drug effect? 1. Fluconazole (Diflucan) antagonizes the effects of many antidiabetic medications, causing hyper- glycemia. 2. Fluconazole (Diflucan) interacts with certain an- tidiabetic drugs, causing hypoglycemia. 3. Fluconazole (Diflucan) causes hyperglycemia. 4. Fluconazole (Diflucan) causes hypoglycemia.

2

An 8-year-old boy is evaluated and diagnosed with absence seizures. He is started on ethosuximide (Zarontin). Which information should the nurse pro- vide the parents? 1. After-school sports activities will need to be stopped because they will increase the risk of seizures. 2. Monitor height and weight to assess that growth is progressing normally. 3. Fractures may occur, so increase the amount of vitamin D and calcium-rich foods in the diet. 4. Avoid dehydration with activities and increase fluid intake.

2

The health care agency is implementing the use of root- cause analysis (RCA) to reduce the occurrence of medi- cation errors. What areas does RCA analyze in order to prevent errors from recurring? 1. Why the medication was ordered, whether it was the correct medication, and whether the patient experienced therapeutic results 2. What happened, why it happened, and what can be done to prevent it from happening again 3. What the cost of the medication was, whether it was the most appropriate medication to order, or whether there is a better alternative 4. Whether the medication was documented in the provider's orders, medication administration re- cord, and pharmacy

2

The nurse has administered prochlorperazine (Com- pazine) to a patient for postoperative nausea. Before administering this medication, it is essential that the nurse check which of the following? 1. Pain level 2. Blood pressure 3. Breath sounds 4. Temperature

2

The nurse is preparing to administer chemotherapy to an oncology patient who also has an order for on- dansetron (Zofran). When should the nurse adminis- ter the odansetron? 1. Every time the patient complains of nausea 2. 30 to 60 minutes before starting the chemotherapy 3. Only if the patient complains of nausea 4. When the patient begins to experience vomiting during the chemotherapy

2

The nurse is teaching a community health class to a group of young adults who have recently immigrated to the United States about preventing hepatitis B. What is the most effective method of preventing a hepatitis B infection? 1. Peginterferon alfa-2a (Pegasys) 2. Hepatitis B vaccine (Engerix-B) 3. Adefovir dipivoxil (Hepsera) 4. Entecavir (Baraclude)

2

The nurse notes that the patient has reached his nadir. What does this finding signify? 1. The patient is receiving the highest dose possible of the chemotherapy. 2. The patient is experiencing bone marrow suppression and his blood counts are at their lowest point. 3. The patient has peaked on his chemotherapy level and should be going home in a few days. 4. The patient is experiencing extreme depression and will be having a psychiatric consult.

2

The nurse reads that the drug to be given to the patient has a "narrow therapeutic index." The nurse knows that this means that the drug has what properties? 1. It has a narrow range of effectiveness and may not give this patient the desired therapeutic results. 2. It has a narrow safety margin and even a small in- crease in dose may produce adverse or toxic effects. 3. It has a narrow range of conditions or diseases that the drug will be expected to treat successfully. 4. It has a narrow segment of the population for whom the drug will work as desired.

2

The nurse teaches the patient relaxation techniques and guided imagery as an adjunct to medication for treat- ment of pain. What is the main rationale for the use of these techniques as adjuncts to analgesic medication? 1. They are less costly techniques. 2. They may allow lower doses of drugs with fewer adverse effects. 3. They can be used at home. 4. They do not require self-injection.

2

The order reads, "Lasix 40 mg IV STAT." Which of the following actions should the nurse take? 1. Administer the medication within 30 minutes of the order. 2. Administer the medication within 5 minutes of the order. 3. Administer the medication as required by the patient's condition. 4. Assess the patient's ability to tolerate the medica- tion before giving.

2

The patient taking benztropine (Cogentin) should be provided education on methods to manage which common adverse effect? 1. Heartburn 2. Constipation 3. Hypothermia 4. Increased gastric motility

2

Which factor in the patient's history would cause the nurse to question a medication order for atropine? 1. A 32-year-old man with a history of drug abuse 2. A 65-year-old man with benign prostatic hyper- plasia 3. An 8-year-old boy with chronic tonsillitis 4. A 22-year-old woman on the second day of her menstrual cycle

2

Which of the following represents an appropriate outcome established during the planning phase? 1. The nurse will teach the patient to recognize and respond to adverse effects from the medication. 2. The patient will demonstrate self-administration of the medication, using a preloaded syringe into the subcutaneous tissue of the thigh, prior to dis- charge. 3. The nurse will teach the patient to accurately pre- pare the dose of medication. 4. The patient will be able to self-manage his dis- ease and medications.

2

Nifedipine (Procardia) has been ordered for a patient with hypertension. In the care plan, the nurse in- cludes the need to monitor for which adverse effect? 1. Rash and chills 2. Reflex tachycardia 3. Increased urinary output 4. Weight loss

2 Nifedipine (Procardia) may cause hypotension with reflex tachycardia.

While the nurse takes the patient's admission history, the patient describes having a severe allergy to an an- tibiotic. What is the nurse's responsibility to prevent an allergic reaction? (Select all that apply.) 1. Instruct the patient to alert all providers about the allergy. 2. Document the allergy in the medical record. 3. Notify the provider and the pharmacy of the al- lergy and type of allergic reaction. 4. Place an allergy bracelet on the patient. 5. Instruct the patient not to allow anyone to give the antibiotic.

2, 3, 4

The nurse is preparing to administer the first dose of enalapril (Vasotec). Identify the potential adverse ef- fects of this medication. (Select all that apply.) 1. Reflex hypertension 2. Hyperkalemia 3. Persistent cough 4. Angioedema 5. Hypotension

2, 3, 4, 5 Side effects of ACE inhibitors such as enalapril (Vasotec) include persistent cough and postural hypotension. Hyperkalemia may occur and can be a major concern for those patients with renal impairment and in patients who are taking potassium-sparing diuretics. Though rare, the most serious adverse effect of ACE inhibitors is the development of angioedema.

The nurse knows that which of the following are ma- jor disadvantages for the use of donepezil (Aricept) to treat the symptoms of early Alzheimer's disease? (Select all that apply.) 1. It must be administered four times per day. 2. It may causes significant weight loss. 3. It may cause potentially fatal cardiac dysrhythmias. 4. It may cause serious hepatic damage. 5. It results in only modest cognitive improvement and results do not last.

2, 3, 4, 5 Donepezil (Aricept) may cause serious liver damage and potentially fatal dysrhythmias including severe bradycardia and heart block. It may also cause significant weight loss, and the patient's weight should be monitored. While cognitive improvement may be observed in as few as 1 to 4 weeks, patients should receive pharmacotherapy for at least 6 months prior to assessing maximum benefits of drug therapy. Unfortunately, cognitive improvement is only modest and short-term

A patient with HIV has been taking lopinavir with ritonavir (Kaletra) for the past 8 years and has noticed a redistribution of body fat in the arms, legs, and abdomen (lipodystrophy). The nurse will evaluate this patient for what other additional adverse effects associated with this drug? (Select all that apply.) 1. Renal failure 2. Hyperglycemia 3. Pancreatitis 4. Bone marrow suppression 5. Hepatic failure

2, 3, 5

Which of the following medications would not be ad- ministered through a nasogastric tube? (Select all that apply.) 1. Liquids 2. Enteric-coated tablets 3. Sustained-release tablets 4. Finely crushed tablets 5. IV medications

2, 3, 5

The nurse is instructing a patient on home use of nia- cin and will include important instructions on how to take the drug and about its possible adverse effects. Which of the following may be expected adverse effects of this drug? (Select all that apply.) 1. Fever and chills 2. Intense flushing and hot flashes 3. Tingling of the fingers and toes 4. Hypoglycemia 5. Dry mucous membranes

2, 3. : Intense flushing and hot flashes occur in almost every patient who is taking niacin. Tingling of the extremities may also occur.

A 35-year-old male patient has been prescribed ome- prazole (Prilosec) for treatment of gastroesophageal reflux disease. Which of the following assessment findings would assist the nurse to determine whether drug therapy has been effective? (Select all that apply.) 1. Decreased "gnawing" upper abdominal pain on an empty stomach 2. Decreased belching 3. Decreased appetite 4. Decreased nausea 5. Decreased dysphagia

2, 4, 5

A patient with a history of hypertension is to start drug therapy for rheumatoid arthritis. Which of the following drugs would be contraindicated, or used cautiously, for this patient? (Select all that apply.) 1. Aspirin 2. Ibuprofen (Advil, Motrin) 3. Acetaminophen (Tylenol) 4. Naproxen (Aleve) 5. Methylprednisolone (Medrol)

2, 4, 5

The patient is to begin taking atorvastatin (Lipitor) and the nurse is providing education about the drug. Which symptom related to this drug should be re- ported to the health care provider? 1. Constipation 2. Increasing muscle or joint pain 3. Hemorrhoids 4. Flushing or "hot flash"

2. "Statins" (HMG-CoA reductase inhibitors) such as atorvastatin (Lipitor) may cause rhabdomyolysis, a rare but serious adverse effect.

Prior to discharge, the nurse plans for patient teach- ing related to side effects of phenothiazines to the patient, family, or caregiver. Which of the following should be included? 1. The patient may experience withdrawal and slowed activity. 2. Severe muscle spasms may occur early in therapy. 3. Tardive dyskinesia is likely early in therapy. 4. Medications should be taken as prescribed to prevent adverse effects.

2. Acute dystonias, or severe muscle spasms, particularly of the back, neck, face, or tongue, may occur within hours or days of the first dose of a phenothiazine drug and should be reported immediately.

The patient receiving heparin therapy asks how the "blood thinner" works. What is the best response by the nurse? 1. "Heparin makes the blood less thick." 2. "Heparin does not thin the blood but prevents clots from forming as easily in the blood vessels." 3. "Heparin decreases the number of platelets so that blood clots more slowly." 4. "Heparin dissolves the clot."

2. Anticoagulants do not change the viscosity (thickness) of the blood. Instead, anticoagulants modify the mechanisms by which clotting occurs

A patient has started clopidogrel (Plavix) after experi- encing a transient ischemic attack. What is the desired therapeutic effect of this drug? 1. Anti-inflammatory and antipyretic effects 2. To reduce the risk of a stroke from a blood clot 3. Analgesic as well as clot-dissolving effects 4. To stop clots from becoming emboli

2. Antiplatelet drugs such as clopidogrel are given to inhibit platelet aggregation and, thus, reduce the risk of thrombus formation

A 20-year-old man is admitted to the psychiatric unit for treatment of acute schizophrenia and is started on risperidone (Risperdal). Which patient effects should the nurse assess for to determine whether the drug is having therapeutic effects? 1. Restful sleep, elevated mood, and coping abilities 2. Decreased delusional thinking and lessened auditory/visual hallucinations 3. Orthostatic hypotension, reflex tachycardia, and sedation 4. Relief of anxiety and improved sleep and dietary habits

2. Antipsychotic drugs such as risperidone (Risperdal) treat the positive and negative effects of the underlying mental disorder. A decrease in delusional thinking, lessened hallucinations, and over- all improvement in mental thought processes should be noted.

The patient is being discharged with nitroglycerin (Nitrostat) for sublingual use. While planning patient education, what instruction will the nurse include? 1. "Swallow three tablets immediately for pain and call 911." 2. "Put one tablet under your tongue for chest pain. If pain does not subside, call 911." 3. "Call your health care provider when you have chest pain. He will tell you how many tablets to take." 4. "Place three tablets under your tongue and call 911."

2. At the initial onset of chest pain, sublingual nitroglycerin is administered and if the pain persists after the initial dose, the patient should seek emergency medical assistance for more definitive diagnosis and care.

A patient is given a prescription for propranolol (In- deral) 40 mg bid. What is the most important instruc- tion the nurse should give to this patient? 1. Take this medication on an empty stomach, as food interferes with its absorption. 2. Do not stop taking this medication abruptly; the dosage must be decreased gradually if it is discontinued. 3. If the patient experiences any disturbances in hearing, the patient should notify the health care provider immediately. 4. The patient may become very sleepy while taking this medication; do not drive.

2. Beta blockers such as propranolol should never be stopped abruptly because of the possible rebound HTN and increased dysrhythmias that may occur.

Erectile dysfunction drugs such as sildenafil (Viagra) are contraindicated in patients taking nitrates for an- gina. What is the primary concern with concurrent administration of these drugs? 1. They contain nitrates, resulting in an overdose. 2. They also decrease blood pressure through vaso- dilation and may result in prolonged and severe hypotension when combined with nitrates. 3. They will adequately treat the patient's angina as well as erectile dysfunction. 4. They will increase the possibility of nitrate toler- ance developing and should be avoided unless other drugs can be used.

2. Erectile dysfunction drugs such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) decrease BP. When combined with nitrates, severe and prolonged hypotension may result

The nurse reviews laboratory studies of a patient receiving digoxin (Lanoxin). Intervention by the nurse is required if the results include which of the following laboratory values? 1. Serum digoxin level of 1.2 ng/dL 2. Serum potassium level of 3 mEq/L 3. Hemoglobin of 14.4 g/dL 4. Serum sodium level of 140 mEq/L

2. Normal serum potassium level is 3.5 to 5 mEq/L. Hypokalemia may predispose the patient to digitalis toxicity.

The patient asks what can be expected from the levodopa/carbidopa (Sinemet) he is taking for treatment of Parkinson's Disease. What is the best response by the nurse? 1. "A cure can be expected within 6 months." 2. "Symptoms can be reduced and the ability to per- form ADLs can be improved." 3. "Disease progression will be stopped." 4. "Extrapyramidal symptoms will be prevented."

2. Pharmacotherapy does not cure or stop the disease process but does improve the patient's ability to perform ADLs such as eating, bathing, and walking.

The patient is taking atenolol (Tenormin) and doxa- zosin (Cardura). What is the rationale for combining two antihypertensive drugs? 1. The blood pressure will decrease faster. 2. Lower doses of both drugs may be given with fewer adverse effects. 3. There is less daily medication dosing. 4. Combination therapy will treat the patient's oth- er medical conditions.

2. The advantage of using a combination of two drugs such as atenolol (Tenormin; a beta blocker) and doxazosin (Cardura; an alpha-1 antagonist) is that lower doses of each may be used resulting in fewer side effects.

A patient with significant hypertension unresponsive to other medications is given a prescription for hy- dralazine (Apresoline). An additional prescription of propranolol (Inderal) is also given to the patient. The patient inquires why two drugs are needed. What is the nurse's best response? 1. Giving the two drugs together will lower the blood pressure even more than just one alone. 2. The hydralazine may cause tachycardia and the propranolol will help keep the heart rate within normal limits. 3. The propranolol is to prevent lupus erythemato- sus from developing. 4. Direct-acting vasodilators such as hydralazine cause fluid retention and the propranolol will prevent excessive fluid buildup.

2. propranolol (Inderal) and other beta-blocking drugs are used to prevent reflex tachycardia that may occur as a result of treatment with direct- acting vasodilators. Giving two antihypertensive drugs together may also lower BP further; however, the beta- blocking drugs also lower the heart rate and are given in this case to reduce the chance for reflex tachycardia.

A patient has been prescribed fluticasone (Flonase) to use with oxymetazoline (Afrin). How should the pa- tient be taught to use these drugs? 1. Use the fluticasone first, then the oxymetazoline after waiting 5 minutes. 2. Use the oxymetazoline first, then the fluticasone after waiting 5 minutes. 3. The drugs may be used in either order. 4. The fluticasone should be used only if the oxym- etazoline fails to relieve the nasal congestion.

2: The oxymetazoline (Afrin) should be used first, followed by the fluticasone (Flonase) in 5 to 10 minutes. When a decongestant and corticosteroid nasal spray are used together, the decongestant spray should be used first to allow time for the nasal passages to open, allowing the corticosteroid to reach deeper into the nasal passages

A 16-year-old adolescent is 6 weeks pregnant. The pregnancy has exacerbated her acne. She asks the nurse if she can resume taking her isotretinoin pre- scription, a category X drug. What is the most appro- priate response by the nurse? 1. "Since you have a prescription for isotretinoin, it is safe to resume using it." 2. "You should check with your health care provid- er at your next visit." 3. "Isotretinoin is known to cause birth defects and should never be taken during pregnancy." 4. "You should reduce the isotretinoin dosage by half during pregnancy."

3

A 32-year-old female patient has been taking loraz- epam (Ativan) for her anxiety and is brought into the emergency department after taking 30 days' worth at one time. What antagonist for benzodiazepines may be used in this case? 1. Epinephrine 2. Atropine 3. Flumazenil 4. Naloxone

3

A female patient reports using OTC aluminum hydroxide (AlternaGEL) for relief of gastric upset. She is on renal dialysis three times a week. What should the nurse teach this patient? 1. Continue using the antacids but if she needs to continue them beyond a few months, she should consult the health care provider about different therapies. 2. Take the antacid no longer than for two weeks; if it has not worked by then, it will not be effective. 3. Consult with the health care provider about the appropriate amount and type of antacid. 4. Continue to take the antacid; it is OTC and safe.

3

A patient admitted with hepatitis B is prescribed hydroc- odone with acetaminophen (Vicodin) 2 tablets for pain. What is the most appropriate action for the nurse to take? 1. Administer the drug as ordered. 2. Administer 1 tablet only. 3. Recheck the order with the health care provider. 4. Hold the drug until the health care provider arrives.

3

A patient has been diagnosed with a fungal nail infection. The health care provider has prescribed griseofulvin (Fulvicin). The nurse will include which of the following in her teaching to the patient? 1. Drug therapy will be for a very short time, prob- ably 2 to 4 weeks. 2. Carefully inspect all intramuscular injection sites for bruising. 3. Notify the provider if symptoms of infection worsen. 4. Limit fluid intake to approximately 1,000 mL/day.

3

A patient who is in renal failure may have a diminished capacity to excrete medications. The nurse must assess the patient more frequently for what development? 1. Increased risk of allergy 2. Decreased therapeutic drug effects 3. Increased risk for drug toxicity 4. Increased absorption of the drug from the intestines

3

A patient with severe diarrhea has an order for di- phenoxylate with atropine (Lomotil). When assessing for therapeutic effects, which of the following will the nurse expect to find? 1. Increased bowel sounds 2. Decreased belching and flatus 3. Decrease in loose, watery stools 4. Decreased abdominal cramping

3

An older adult patient has arthritis in her hands and takes several prescription drugs. Which statement by this patient requires further assessment by the nurse? 1. "My pharmacist puts my pills in screw-top bot- tles to make it easier for me to take them." 2. "I fill my prescriptions once per month." 3. "I care for my 2-year-old grandson twice a week." 4. "My arthritis medicine helps my stiff hands."

3

Before administering drugs by the enteral route, the nurse should evaluate which of the following? 1. Ability of the patient to lie supine 2. Compatibility of the drug with intravenous fluid 3. Ability of the patient to swallow 4. Patency of the injection port

3

During the evaluation phase of drug administration, the nurse completes which responsibilities? 1. Prepares and administers drugs correctly 2. Establishes goals and outcome criteria related to drug therapy 3. Monitors the patient for therapeutic and adverse effects 4. Gathers data in a drug and dietary history

3

Older adult patients taking bethanechol (Urecholine) need to be assessed more frequently because of which of the following adverse effects? 1. Tachycardia 2. Hypertension 3. Dizziness 4. Urinary retention

3

The nurse is preparing a plan of care for a patient with myasthenia gravis. Which of the following outcome statements would be appropriate for a patient receiv- ing a cholinergic agonist such as pyridostigmine (Mes- tinon) for this condition? The patient will exhibit: 1. An increase in pulse rate, blood pressure, and respiratory rate. 2. Enhanced urinary elimination. 3. A decrease in muscle weakness, ptosis, and diplopia. 4. Prolonged muscle contractions and proprioception.

3

The nurse is preparing to give an oral medication to a 6-month-old infant. How should this drug be admin- istered? 1. By placing the medication in the next bottle of formula 2. By mixing the medication with juice in a bottle 3. By placing the medicine dropper in the inner cheek, allowing time for the infant to swallow 4. By placing the medication toward the back of the mouth to avoid having the infant immediately spit out the medication

3

The nurse is teaching a postoperative patient about the medications ordered for use at home. Because this patient also has a primary care provider in addition to the surgeon, what strategy should the nurse include in this teaching session that might prevent a medica- tion error in the home setting? 1. Encourage the patient to consult the Internet about possible side effects. 2. Delay taking any new medications prescribed by the surgeon until the next health visit with the primary provider. 3. Have all prescriptions filled at one pharmacy. 4. Insist on using only brand-name drugs because they are easier to remember than generic names.

3

The patient has been taking aspirin for several days for headache. During the assessment, the nurse dis- covers that the patient is experiencing ringing in the ears and dizziness. What is the most appropriate ac- tion by the nurse? 1. Question the patient about history of sinus infections. 2. Determine whether the patient has mixed the aspirin with other medications. 3. Tell the patient not to take any more aspirin. 4. Tell the patient to take the aspirin with food or milk.

3

What important information should be included in the patient's education regarding taking ciprofloxacin (Cipro)? 1. The drug can cause discoloration of the teeth. 2. Fluid intake should be decreased to prevent urine retention. 3. Any heel or lower leg pain should be reported immediately. 4. The drug should be taken with an antacid to reduce gastric effects.

3

What is the most appropriate method to ensure adequate pain relief in the immediate postoperative period from an opioid drug? 1. Give the drug only when the family members re- port that the patient is complaining of pain. 2. Give the drug every time the patient complains of acute pain. 3. Give the drug as consistently as possible for the first 24 to 48 hours. 4. Give the drug only when the nurse observes signs and symptoms of pain.

3

What is the most effective treatment method for the nausea and vomiting that accompanies many forms of chemotherapy? 1. Administer an oral antiemetic when the patient complains of nausea and vomiting. 2. Administer an antiemetic by intramuscular injec- tion when the patient complains of nausea and vomiting. 3. Administer an antiemetic prior to the antineo- plastic medication. 4. Encourage additional fluids prior to administer- ing the antineoplastic medication.

3

Which of the following findings would suggest that myelosuppression is occurring in a patient who is taking zidovudine (Retrovir)? 1. Increase in serum blood urea nitrogen (BUN) levels 2. Increase in white blood cell (WBC) count 3. Decrease in platelet count 4. Decrease in blood pressure

3

A patient has a prescription for fluticasone (Flonase). Place the following instructions in the order in which the nurse will instruct the patient to use the drug. 1. Instill one spray directed high into the nasal cavity. 2. Clear the nose by blowing. 3. Prime the inhaler prior to first use. 4. Spit out any excess liquid that drains into the mouth.

3 2 1 4

Verapamil (Calan, Covera-HS, Verelan) should be used with extra caution or is contraindicated in patients with which cardiovascular condition? 1. Hypertension 2. Tachycardia 3. Heart failure 4. Angina

3 CCBs such as verapamil (Calan) are used cautiously or are contraindicated in patients with HF because they may cause decreased contractility, which may precipitate or worsen HF.

The parents of a young patient receiving methylpheni- date (Ritalin) express concern that the health care pro- vider has suggested the child have a "holiday" from the drug. What is the purpose of a drug-free period? 1. To reduce or eliminate the risk of drug toxicity 2. To allow the child's "normal" behavior to return 3. To decrease drug dependence and assess the pa- tient's status 4. To prevent the occurrence of a hypertensive crisis

3 Methylphenidate (Ritalin) is a Schedule II drug with potential to cause drug dependence when used over an extended period. The drug holiday helps to decrease the risk of dependence. It is also useful to evaluate current behavior; if improvement is noted, the drug dosage may be lowered or the drug stopped.

Place the following nursing interventions in order for a patient who is experiencing chest pain. 1. Administer nitroglycerin sublingually. 2. Assess heart rate and blood pressure. 3. Assess the location, quality, and intensity of pain. 4. Document interventions and outcomes. 5. Evaluate the location, quality, and intensity of pain.

3, 2, 1, 5, 4

Which of the following are correct statements regard- ing nursing diagnoses? (Select all that apply.) 1. They identify the medical problem experienced by the patient. 2. They are identified for the patient by the nurse. 3. They identify the patient's response to a health condition or life process. 4. They assist in determining nursing interventions. 5. They remain the same throughout the patient's health care encounter to ensure continuity of care.

3, 4

The nurse administers morphine 4 mg IV to a patient for treatment of severe pain. Which of the following assessments require immediate nursing interven- tions? (Select all that apply.) 1. The patient's blood pressure is 110/70 mmHg. 2. The patient is drowsy. 3. The patient's pain is unrelieved in 15 minutes. 4. The patient's respiratory rate is 10 breaths per minute. 5. The patient becomes unresponsive.

3, 4, 5

To reduce the chance of duplicate medication orders for the older adult returning home after surgery, what actions should the nurse take? (Select all that apply.) 1. Call in all prescriptions to the patient's pharma- cies rather than relying on paper copies of pre- scriptions. 2. Give all prescriptions to the patient's family member. 3. Take a medication history, including all OTC and prescription medications and a pharmacy history with each patient visit. 4. Work with the patient's health care provider to limit the number of prescriptions. 5. Perform a medication reconciliation before send- ing the patient home.

3, 5

Zolpidem (Ambien, Edluar, Intermezzo) has been ordered for a patient for the treatment of insomnia. What information will the nurse provide for this pa- tient? (Select all that apply.) 1. Be cautious when performing morning activities because it may cause a significant "hangover" effect with drowsiness and dizziness. 2. Take the drug with food; this enhances the ab- sorption for quicker effects. 3. Take the drug immediately before going to bed; it has a quick onset of action. 4. If the insomnia is long-lasting, this drug may safely be used for up to one year. 5. Alcohol and other drugs that cause CNS depres- sion (e.g., antihistamines) should be avoided while taking this drug.

3, 5

A patient with heart failure has an order for lisinopril (Prinivil, Zestril). Which of the following conditions in the patient's history would lead the nurse to con- firm the order with the provider? 1. A history of hypertension previously treated with diuretic therapy 2. A history of seasonal allergies currently treated with antihistamines 3. A history of angioedema after taking enalapril (Vasotec) 4. A history of alcoholism, currently abstaining

3. Angioedema is a rare but potentially serious adverse effect of ACE inhibitors; because this patient has had a previous reaction to another drug within the same group (enalapril/Vasotec), the nurse should confirm the order with the provider.

Which of the following drugs is most immediately helpful in treating a severe acute asthma attack? 1. Beclomethasone (Qvar) 2. Zileuton (Zyflo CR) 3. Albuterol (Proventil, Ventolin) 4. Salmeterol (Serevent Diskus)

3. Beta-adrenergic drugs such as albuterol (Proventil, Ventolin) are most often used for rapid bronchodilation.

An early sign(s) of levodopa toxicity is (are) which of the following? 1. Orthostatic hypotension 2. Drooling 3. Spasmodic eye winking and muscle twitching 4. Nausea, vomiting, and diarrhea

3. Blepharospasm (spasmodic eye winking) and muscle twitching are early signs of potential overdose or toxicity.

The patient is prescribed digoxin (Lanoxin) for treat- ment of HF. Which of the following statements by the patient indicates the need for further teaching? 1. "I may notice my heart rate decrease." 2. "I may feel tired during early treatment." 3. "This drug should cure my heart failure." 4. "My energy level should gradually improve."

3. Digoxin helps increase the contractility of the heart, thus increasing cardiac output. But it is not a cure for HF, only a treatment option.

The patient who has not responded well to other ther- apies has been prescribed milrinone (Primacor) for treatment of his heart failure. What essential assess- ment must the nurse make before starting this drug? 1. Weight and presence of edema 2. Dietary intake of sodium 3. Electrolytes, especially potassium 4. History of sleep patterns and presence of sleep apnea

3. Electrolytes, especially potassium for the presence of hypokalemia, should be assessed before beginning milrinone (Primacor) or any phosphodiesterase inhibitory. Hypokalemia should be corrected before administering phosphodiesterase inhibitors because this can increase the likelihood of dysrhythmias.

A patient has been ordered gemfibrozil (Lopid) for hyperlipidemia. The nurse will first validate the order with the health care provider if the patient reports a history of which disorder? 1. Hypertension 2. Angina 3. Gallbladder disease 4. Tuberculosis

3. Fibric acid agents (fibrates) may cause or worsen gallbladder disease and the order should be checked with the provider before giving

The patient has been given a prescription of furosem- ide (Lasix) as an adjunct to treatment of hypertension and returns for a follow-up check. Which of the fol- lowing is the most objective data for determining the therapeutic effectiveness of the furosemide? 1. Absence of edema in lower extremities 2. Weight loss of 13 kg (6 lb) 3. Blood pressure log notes blood pressure 120/70 mmHg to 134/88 mmHg since discharge 4. Frequency of voiding of at least six times per day

3. Furosemide (Lasix) was prescribed as an adjunct treatment for HTN. Blood pressure de- crease toward normal limits indicates that the use of this treatment has been effective.

A patient who received a prescription for montelukast (Singulair) returns to his provider's office after three days, complaining that "the drug is not working." She reports mild but continued dyspnea and has had to maintain consistent use of her bronchodilator inhaler, albuterol (Proventil). What does the nurse suspect is the cause of the failure of the montelukast? 1. The patient is not taking the drug correctly. 2. The patient is not responding to the drug and will need to be switched to another formulation. 3. The drug has not had sufficient time of use to have full effects. 4. The albuterol inhaler is interacting with the montelukast.

3. Leukotriene modifiers such as montelukast (Singulair) take up to 1 week or longer to develop full effects. The patient should continue to use her bronchodilator as needed while the drug reaches full therapeutic effects. If no change in effects is noted after 7-10 days, the therapy should be re-evaluated.

Which of the following would be a priority compo- nent of the teaching plan for a patient prescribed phenelzine (Nardil) for treatment of depression? 1. Headaches may occur. Over-the-counter medica- tions will usually be effective. 2. Hyperglycemia may occur and any unusual thirst, hunger, or urination should be reported. 3. Read labels of food and over-the-counter drugs to avoid those with substances that should be avoided as directed. 4. Monitor blood pressure for hypotension and re- port any blood pressure below 90/60.

3. Phenelzine (Nardil) is an MAOI. This class of drugs has many drug and food interactions that may cause a hypertensive crisis. A list of foods, beverages, and medications to avoid should also be given to the patient.

The nurse determines that the teaching plan for a pa- tient prescribed sertraline (Zoloft) has been effective when the patient makes which statement? 1. "I should not decrease my sodium or water intake." 2. "The drug can be taken concurrently with the phenelzine (Nardil) that I'm taking." 3. "It may take up to a month for the drug to reach full therapeutic effects and I'm feeling better." 4. "There are no other drugs I need to worry about; Zoloft doesn't react with them."

3. SSRI antidepressant drugs such as sertraline (Zoloft) may not have full effects for a month or longer, but some improvement in mood and depression should be noticeable after beginning therapy.

A 77-year-old female patient is diagnosed with de- pression and anxiety and is started on imipramine. Because of this patient's age, which adverse effects would take priority when planning care? 1. Dry mouth and photosensitivity 2. Anxiety, headaches, insomnia 3. Drowsiness and sedation 4. Urinary frequency

3. TCAs such as imipramine (Tofranil) may cause drowsiness and sedation. Because of this patient's age, these effects may increase the risk of falls.

Levodopa is prescribed for a patient with Parkinson's disease. At discharge, which of the following teach- ing points should the nurse include? 1. Monitor blood pressure every 2 hours for the first 2 weeks. 2. Report the development of diarrhea. 3. Take the pill on an empty stomach or 2 hours after a meal containing protein. 4. If tremors seem to worsen, take a double dose for two doses and call the provider.

3. Taking dopamine replacement drugs such as levodopa with meals containing protein significantly impairs absorption. The drug should be taken on an empty stomach or 2 or more hours after a meal containing protein.

A patient with deep vein thrombosis is receiving an infusion of heparin and will be started on warfarin (Coumadin) soon. While the patient is receiving hep- arin, what laboratory test will provide the nurse with information about its therapeutic effects? 1. Prothrombin time (PT) 2. International Normalized Ratio (INR) 3. Activated partial thromboplastin time (aPTT) 4. Platelet count

3. Therapeutic effects of heparin are monitored by the aPTT. While the patient is receiving heparin, the aPTT should be 1.5 to 2 times the patient's baseline, or 60 to 80 seconds.

A patient is receiving a thrombolytic drug, alteplase (Activase), following an acute myocardial infarction. Which of the following effects is most likely attrib- uted to this drug? 1. Skin rash with urticaria 2. Wheezing with labored respirations 3. Bruising and epistaxis 4. Temperature elevation of 38.2°C (100.8°F)

3. Thrombolytic agents such as alteplase (Activase) dissolve existing clots rapidly and continue to have effects for 2 to 4 days. All forms of bleeding must be monitored and reported immediately

Nitroglycerin patches have been ordered for a patient with a history of angina. What teaching will the nurse give to this patient? 1. Keep the patches in the refrigerator. 2. Use the patches only if the chest pain is severe. 3. Remove the old patch and wait 6-12 hours before applying a new one. 4. Apply the patch only to the upper arm or thigh areas.

3. To prevent the development of nitrate tolerance, nitroglycerin patches are often removed at night for 6 to 12 hours.

A patient with asthma has a prescription for two inhalers, albuterol (Proventil) and beclomethasone (Qvar). How should the nurse instruct this patient on the proper use of the inhalers? 1. Use the albuterol inhaler, and use the beclometh- asone only if symptoms are not relieved. 2. Use the beclomethasone inhaler, and use the al- buterol only if symptoms are not relieved. 3. Use the albuterol inhaler, wait 5-10 minutes, then use the beclomethasone inhaler. 4. Use the beclomethasone inhaler, wait 5-10 minutes, then use the albuterol inhaler.

3. Using a bronchodilating inhaler such as albuterol (Proventil, VoSpire) first, then waiting 5-10 minutes before using an ICS inhaler such as beclomethasone (Qvar), will allow the corticosteroid to reach deeper into the lungs following bronchodilation.

In taking a new patient's history, the nurse notices that he has been taking omeprazole (Prilosec) consis- tently over the past 6 months for treatment of epigas- tric pain. Which recommendation would be the best for the nurse to give this patient? 1. Try switching to a different form of the drug. 2. Try a drug like cimetidine (Tagamet) or famoti- dine (Pepcid). 3. Try taking the drug after meals instead of before meals. 4. Check with his health care provider about his continued discomfort.

4

Which of the following is the best advice that the nurse can give a patient with viral rhinitis who in- tends to purchase an over-the-counter combination cold remedy? 1. Dosages in these remedies provide precise dos- ing for each symptom that you are experiencing. 2. These drugs are best used in conjunction with an antibiotic. 3. It is safer to use a single-drug preparation if you are experiencing only one symptom. 4. Since these drugs are available over the counter, it is safe to use any of them as long as needed.

3: Single-symptom OTC preparations are preferred over multiuse preparations to avoid additional drugs that are not needed for symptom relief and to decrease risk of additional adverse effects

A 32-year-old female patient is started on metronida- zole (Flagyl) for treatment of a trichomonas vaginal infection. What must the patient eliminate from her diet for the duration she is on this medication? 1. Caffeine 2. Acidic juices 3. Antacids 4. Alcohol

4

A health care provider has written an order for digox- in for the patient but the nurse cannot read whether the order is for 0.25 mg, 0.125 mg, or 125 mg because there is no "zero" and the decimal point may be a "one." What action would be the best to prevent a medication error? 1. Check the dosage with a more experienced nurse. 2. Consult a drug handbook and administer the normal dose. 3. Contact the hospital pharmacist about the order. 4. Contact the health care provider to clarify the il- legible order.

4

A patient has been prescribed tetracycline. When providing information regarding this drug, the nurse should include what information about tetracycline? 1. It is classified as a narrow-spectrum antibiotic with minimal adverse effects. 2. It is used to treat a wide variety of disease processes. 3. It has been identified to be safe during pregnancy. 4. It is contraindicated in children younger than 8 years.

4

A patient has received a prescription for zanamivir (Relenza) for flulike symptoms. The patient states, "I think I'll hold off on starting this. I don't feel that bad yet." What is the nurse's best response? 1. "The drug has a stable shelf life so you can save it for later infections." 2. "It can be saved for later but you will also require an antibiotic to treat your symptoms if you wait." 3. "It can be started within two weeks after the on- set of symptoms." 4. "To be effective, it must be started within 48 hours after the onset of symptoms."

4

A patient is receiving temazepam (Restoril). Which of these responses should a nurse expect the patient to have if the medication is achieving the desired effect? 1. The patient sleeps in 3-hour intervals, awakens for a short time, and then falls back to sleep. 2. The patient reports feeling less anxiety during ac- tivities of daily living. 3. The patient reports having fewer episodes of panic attacks when stressed. 4. The patient reports sleeping 7 hours without awakening.

4

A patient with constipation is prescribed psyllium (Metamucil) by his health care provider. What essen- tial teaching will the nurse provide to the patient? 1. Take the drug with meals and at bedtime. 2. Take the drug with minimal water so that it will not be diluted in the GI tract. 3. Avoid caffeine and chocolate while taking this drug. 4. Mix the product in a full glass of water and drink another glassful after taking the drug.

4

A patient with diabetes has been NPO (nothing by mouth) since midnight for surgery in the morning. He usually takes an oral type 2 antidiabetic drug to con- trol his diabetes. What would be the best action for the nurse to take concerning the administration of his medication? 1. Hold all medications as ordered. 2. Give him the medication with a sip of water. 3. Give him half the original dose. 4. Contact the provider for further orders.

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As the nurse enters a room to administer medications, the patient states, "I'm in the bathroom. Just leave my pills on the table and I'll take them when I come out." What is the nurse's best response? 1. Leave them on the table as requested and check back with the patient later to verify they were taken. 2. Leave the medications with the patient's visitors so they can verify that they were taken. 3. Inform the patient that the medications must be taken now; otherwise they must be documented as "refused." 4. Inform the patient that the nurse will return in a few minutes when the patient is available to take the medications.

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Education given to patients about the use of all drugs to treat insomnia should include an emphasis on what important issue? 1. They will be required long-term to achieve last- ing effects. 2. They require frequent blood counts to avoid ad- verse effects. 3. They are among the safest drugs available and have few adverse effects. 4. Long-term use may increase the risk of adverse effects, create a "sleep debt," and cause rebound insomnia when stopped.

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Propranolol (Inderal) has been ordered for a patient with hypertension. Because of adverse effects related to this drug, the nurse would carefully monitor for which adverse effect? 1. Bronchodilation 2. Tachycardia 3. Edema 4. Bradycardia

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Superinfections are an adverse effect common to all antibiotic therapy. Which of the following best de- scribes a superinfection? 1. An initial infection so overwhelming that it re- quires multiple antimicrobial drugs to treat successfully 2. Bacterial resistance that creates infections that are difficult to treat and are often resistant to multi- ple drugs 3. Infections requiring high-dose antimicrobial therapy with increased chance of organ toxicity 4. The overgrowth of normal body flora or of op- portunistic organisms such as viruses and yeast no longer held in check by normal, beneficial flora

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Teaching for a patient receiving carbamazepine (Tegretol) should include instructions that the patient should immediately report which symptom? 1. Leg cramping 2. Blurred vision 3. Lethargy 4. Blister-like rash

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The emergency department nurse is caring for a patient with a migraine. Which drug would the nurse anticipate administering to abort the patient's migraine attack? 1. Morphine 2. Propranolol (Inderal) 3. Ibuprofen (Motrin) 4. Sumatriptan (Imitrex)

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The health care provider prescribes epinephrine (adrenalin) for a patient who was stung by several wasps 30 minutes ago and is experiencing an allergic reaction. The nurse knows that the primary purpose of this medication for this patient is to: 1. Stop the systemic release of histamine produced by the mast cells. 2. Counteract the formation of antibodies in re- sponse to an invading antigen. 3. Increase the number of white blood cells pro- duced to fight the primary invader. 4. Increase a declining blood pressure and dilate constricting bronchi associated with anaphylaxis.

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The nurse is admitting a patient with rheumatoid ar- thritis. The patient has been taking prednisone (Ora- sone) for an extended time. During the assessment, the nurse observes that the patient has a very round moon-shaped face, bruising, and an abnormal con- tour of the shoulders. What does the nurse conclude based on these findings? 1. These are normal reactions with the illness. 2. These are probably birth defects. 3. These are symptoms of myasthenia gravis. 4. These are symptoms of adverse drug effects from the prednisone.

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The nurse is caring for a 72-year-old patient taking gabapentin (Gralise, Horizant, Neurontin) for a sei- zure disorder. Because of this patient's age, the nurse would establish which nursing diagnosis related to the drug's common adverse effects? 1. Risk for Deficient Fluid Volume 2. Risk for Impaired Verbal Communication 3. Risk for Constipation 4. Risk for Falls

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The nurse is counseling a mother regarding antipy- retic choices for her 8-year-old daughter. When asked why aspirin is not a good drug to use, what should the nurse tell the mother? 1. It is not as good an antipyretic as is acetaminophen. 2. It may increase fever in children under age 10. 3. It may produce nausea and vomiting. 4. It increases the risk of Reye's syndrome in children under 19 with viral infections.

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The nurse looks up butorphanol (Stadol) in a drug reference guide prior to administering the drug and notes that it is a partial agonist. What does this term tell the nurse about the drug? 1. It is a drug that produces the same type of re- sponse as the endogenous substance. 2. It is a drug that will occupy a receptor and pre- vent the endogenous chemical from acting. 3. It is a drug that causes unpredictable and unex- plained drug reactions. 4. It is a drug that produces a weaker, or less effica- cious, response than an agonist drug.

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The patient requires a drug that is known to be com- pletely metabolized by the first-pass effect. What change will be needed when this drug is administered? 1. The drug must be given more frequently. 2. The drug must be given in higher doses. 3. The drug must be given in a lipid-soluble form. 4. The drug must be given by a non-oral route such as parenterally.

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To reduce the effect of a prescribed medication on the infant of a breast-feeding mother, how should the nurse teach the mother to take the medication? 1. At night 2. Immediately before the next feeding 3. In divided doses at regular intervals around the clock 4. Immediately after breast-feeding

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What is the rationale for the administration of a load- ing dose of a drug? 1. It decreases the number of doses that must be given. 2. It results in lower dosages being required to achieve therapeutic effects. 3. It decreases the risk of drug toxicity. 4. It more rapidly builds plasma drug levels to a plateau level.

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Which method may offer the best opportunity for pa- tient teaching? 1. Providing detailed written information when the patient is discharged 2. Providing the patient with Internet links to con- duct research on drugs 3. Referring the patient to external health care groups that provide patient education, such as the American Heart Association 4. Providing education about the patient's medica- tions each time the nurse administers the drugs

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While educating the patient about hydrocortisone (Cortef), the nurse would instruct the patient to con- tact the health care provider immediately if which of the following occurs? 1. There is a decrease of 1 kg (2 lb) in weight. 2. There is an increase in appetite. 3. There is tearing of the eyes. 4. There is any difficulty breathing.

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The patient states that he has not taken his antipsy- chotic drug for the past 2 weeks because it was caus- ing sexual dysfunction. What is the nurse's primary concern at this time? 1. A hypertensive crisis may occur with such abrupt withdrawal of the drug. 2. Significant muscle twitching may occur, increas- ing fall risk. 3. Extrapyramidal symptoms such as secondary parkinsonism are likely to occur. 4. Symptoms of psychosis are likely to return.

4. Antipsychotic medications treat the symptoms associated with mental illness but do not cure the underlying disorder. Without the medication, symptoms of the disorder are likely to return.

A patient with type 1 diabetes on insulin therapy reports that he takes propranolol (Inderal) for hyper- tension. The nurse will teach the patient to check glu- cose levels more frequently because of what concern? 1. The propranolol can produce insulin resistance. 2. The two drugs used together will increase the risk of ketoacidosis. 3. Propranolol will increase insulin requirements by antagonizing the effects at the receptors. 4. The propranolol may mask symptoms of hypo- glycemia.

4. Beta blockers such as propranolol decrease the body's adrenergic "fight-or-flight" responses and may diminish or mask the symptoms and signals of hypoglycemia that a patient with diabetes normally perceives as blood glucose drops

The community health nurse is working with a pa- tient taking simvastatin (Zocor). Which patient state- ment may indicate the need for further teaching about this drug? 1. "I'm trying to reach my ideal body weight by in- creasing my exercise." 2. "I didn't have any symptoms even though I had high lipid levels. I hear that's common." 3. "I've been taking my pill before my dinner." 4. "I take my pill with grapefruit juice. I've always taken my medications that way."

4. Grapefruit juice inhibits the metabolism of statins such as simvastatin (Zocor) allowing them to reach higher serum levels and increasing the risk of adverse effects

The teaching plan for a patient receiving hydralazine (Apresoline) should include which of the following points? 1. Returning for monthly urinalysis testing 2. Including citrus fruits, melons, and vegetables in the diet 3. Decreasing potassium-rich food in the diet 4. Rising slowly to standing from a lying or sitting position

4. Hydralazine (Apresoline) commonly causes orthostatic hypotension, and the patient should be taught to rise slowly from a lying or sitting position to standing.

The nurse is caring for a patient with chronic stable angina who is receiving isosorbide dinitrate (Isordil). Which of the following are common adverse effects of isosorbide? 1. Flushing and headache 2. Tremors and anxiety 3. Sleepiness and lethargy 4. Light-headedness and dizziness

4. Lightheadedness and dizziness may occur secondary to the hypotensive effects of the isosorbide (Isordil).

A patient was admitted from the emergency depart- ment after receiving treatment for dysrhythmias. He will be started on amiodarone (Cordarone, Pacerone) due to the lack of therapeutic effects from his other antidysrhythmic therapy. When the nurse checks with him in the afternoon, he complains of feeling light-headed and dizzy. What will the nurse assess first? 1. Whether there is the possibility of sleep depriva- tion from the stress of admission to the hospital 2. Whether an allergic reaction is occurring with anticholinergic-like symptoms 3. Whether the amiodarone level is not yet thera- peutic enough to treat the dysrhythmias 4. Whether the patient's pulse and blood pressure are within normal limits

4. Potassium channel blockers such as amiodarone, like other antidysrhythmics, may cause significant bradycardia and hypotension. The lightheadedness and dizziness may be associated with a drop in cardiac output due to bradycardia and hypotension

A patient has been using a fluticasone (Flovent) inhaler as a component of his asthma therapy. He returns to his health care provider's office complain- ing of a sore mouth. On inspection, the nurse notices white patches in the patient's mouth. What is a pos- sible explanation for these findings? 1. The patient has been consuming hot beverages after the use of the inhaler. 2. The patient has limited his fluid intake, resulting in dry mouth. 3. The residue of the inhaler propellant is coating the inside of the mouth. 4. The patient has developed thrush as a result of the fluticasone.

4. The patient likely has developed a thrush (Candida) infection of the mouth secondary to the use of the corticosteroid inhaler. After the use of ICS inhalers such as fluticasone (Flovent), patients should be taught to rinse the mouth and spit out the residue. Drinking fluids will also prevent irritation, ulcerations, and thrush infections of the throat

The nurse is teaching a patient about the use of dextromethorphan with guaifenesin (Robitussin-DM) syrup for a cough accompanied by thick mucus. Which instruction should be included in the patient's teaching? 1. Lie supine for 30 minutes after taking the liquid. 2. Drink minimal fluids to avoid stimulating the cough reflex. 3. Take the drug with food for best results. 4. Avoid drinking fluids immediately after the syr- up but increase overall fluid intake throughout the day.

4. The syrup base of dextromethorphan will help soothe throat irritation, and fluids should be avoided immediately following administration. Overall fluid intake should be increased throughout the day.

A nurse is administering a liquid medication to a 15-month-old child. What is the most appropriate ap- proach to medication administration by the nurse? (Select all that apply.) 1. Tell the child that the medication tastes just like candy. 2. Mix the medication in 8 oz of orange juice. 3. Ask the child if she would like to take her medi- cation now. 4. Sit the child up, hold the medicine cup to her lips, and kindly instruct her to drink. 5. Offer the child a choice of cup in which to take the medicine.

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