PrepU Questions Exam 1

During an assessment, a client says, "I am in a great deal of pain but I am afraid of becoming addicted to the medication I'm receiving." Which statements could the nurse use to educate the client on the difference between tolerance and physical dependence? (Select all that apply.)

"Both tolerance and physical dependence develop over time." "When you become tolerant to the medication, you require more to achieve the same result." "The rate at which a person develops a tolerance is dependent upon the individual, the amount of medication the person is receiving, and whether the person is receiving pills or shots." "Tolerance can develop quickly and a person may need larger doses every few weeks in order to experience relief, whereas someone else may experience relief with the same dosage throughout the entire course of the illness."

A nurse is assessing a female client who has been taking NSAIDs. What statement by the client indicates a good understanding of the use of NSAID therapy?

"I asked my provider to check for blood in my stool on a regular basis."

A client is instructed to take diphenhydramine (Benadryl) after an allergic reaction. Which statement by the client indicates successful teaching concerning the administration of diphenhydramine (Benadryl)?

"I should not drive my car after taking this medication."

A female client is crying and states that everyone thinks she is a "drug addict," and that no one will listen to her. She states she has abdominal pain and must have something for the pain. What is the best response of the nurse?

"Tell me more about your pain."

A 72-year-old female client is admitted to the hospital for surgery. After the woman returns to the floor, her daughter tells the nurse she is concerned that her mother will overdose on morphine because she keeps pressing the button on her PCA pump. What would be the nurse's best response?

"The device is preset, so your mother cannot get more than a specific amount."

A client, newly diagnosed with COPD, calls the clinic and asks the nurse why the client has to take the medication if their lungs don't work right. What would be an appropriate response by the nurse?

"The medication that has been ordered for you is to help relieve the inflammation and promote dilation of the bronchi."

The nurse is teaching a 61-year-old client about the narcotic antitussive syrup that the health care provider has prescribed. Which client statement suggests understanding of what the nurse has taught?

"This medication might cause drowsiness, so I will avoid driving while I use it."

A male client presents in the emergency department and states that he is experiencing pain in his shoulder and chest muscles. The health care provider orders a cardiac diagnostic assessment. The client asks the nurse why the health care provider feels that he has cardiac problems if his shoulder hurts. What is the nurse's best response?

"You may have referred pain. Pain of cardiac origin may radiate to the neck, shoulders, chest muscles, and down the arms, often on the left side."

The nurse instructs a patient who is using albuterol for exercise-induced bronchospasm to use the inhaler at which time?

15 minutes prior to exercising

The most serious allergic response is called anaphylaxis. Which clients exhibit possible symptoms of anaphylaxis? (Select all that apply.)

A client showing signs of acute respiratory distress. A client with marked hypotension and experiences convulsions. A client with laryngeal edema and pale, cool skin.

The nurse understands that several physiologic changes are related to normal aging. Which change is the least affected by the pharmacokinetic process during aging?

Absorption

A client is taking a nonsteroidal anti-inflammatory agent. Which instruction should the client be given in regards to administration?

Administer the medication with food.

The nurse has entered the room of a client who is being treated with regular doses of morphine. The client is unresponsive to voice but responsive to touch, with a respiratory rate of 6 breaths per minute. In addition to informing the care team, what is a priority action?

Administration of naloxone as prescribed

When developing the teaching plan for a client receiving an antihistamine, which would the nurse include? (Select all that apply.)

Advising the client to avoid alcohol consumption Using sugarless candies or lozenges to combat dry mouth

A 5-year-old boy is brought to the ED with an asthma exacerbation, including wheezing (a high-pitched, whistling sound caused by turbulent airflow through an obstructed airway). Those who have asthma chronically present with what signs, even when they may appear symptom free? (Select all that apply.)

Airway inflammation Damaged airway mucosa

The parents of a 7-year-old client who has been diagnosed with allergic asthma are being taught about their son's medication regimen. The nurse is teaching about the appropriate use of a "rescue drug" for acute exacerbations. What drug should the nurse suggests the parents to use in these situations?

Albuterol

The client has been diagnosed with asthma and is being treated with two inhalers, albuterol and flunisolide. The nurse teaches the client that the two medications should be administered in what order?

Albuterol first, wait five minutes and then follow with flunisolide

What effects are exerted by aspirin? (Select all that apply.)

Analgesic Antipyretic Anti-inflammatory

A client reports a hacking cough. The client asks if taking an antihistamine would be helpful. The nurse's best response is:

Antihistamines are not recommended because they can dry lower respiratory secretions and worsen secretion retention and cough.

A student nurse is researching the charts of 25 patients with a diagnosis of chronic pharyngitis and what medication is most commonly prescribed. What type of medication would the nurse expect to find in the majority of the chart audits?

Antitussives

A client asks, "What is the difference between antitussive medications and expectorants?" What information should the nurse's response be based upon?

Antitussives suppress coughing while expectorants loosen bronchial secretions.

The client reports to the nurse that the client is having ringing in the ears. The nurse questions the client on use of what medication?

Aspirin

To decrease the risk of injury to a client taking an opioid, what should the nurse do? (Select all that apply.)

Assist client from their bed to the toilet. Assist client with rising from a lying position. Assist client with hall-walking activities.

A nurse caring for a client in the hospital is being discharged today with a prescription for benzonatate (Tessalon Perles) 200 mg one capsule 3 times daily. What would the nurse tell the client about this prescription during discharge counseling? (Select all that apply.)

Benzonatate can cause GI upset and sedation. The client should drink plenty fluids.

A patient with arthritis is on NSAID therapy. What should be evaluated by the nurse to determine the effectiveness of NSAID therapy?

Better mobility

Which would the nurse include as possible adverse effects when teaching a patient about albuterol? (Select all that apply.)

Bronchospasm Nervousness Sweating

A 71-year-old man with a history of heart disease and diabetes has had an antihistamine prescribed. The nurse is concerned with this prescription because of the risk for:

Cardiac arrhythmias

The nurse should complete which of the following during acute breathing distress before initiation of a broncodilator? Select all that apply

Check blood pressure. Check pulse. Check respiratory rate

There are two types of antitussives, centrally acting and peripherally acting. Which are centrally acting antitussives? (Select all that apply.)

Codeine Dextromethorphan

The nurse works in a long-term care facility. When administering narcotics to clients, the nurse must monitor for which side effect?

Constipation

In clinical practice, measurement of serum drug levels is useful in what circumstances? (Select all that apply.)

Correct response: When drugs with a narrow margin of safety are given, because their therapeutic doses are close to their toxic doses To document the serum drug levels associated with particular drug dosages, therapeutic effects, or possible adverse effects To monitor unexpected responses to a drug dose, such as decreased therapeutic effects or increased adverse effects When a drug overdose is suspected

The client has difficulty swallowing and requests the nurse to crush all the medications. The nurse notes a client prescribed an extended-release opioid requests that all medications be crushed to facilitate the administration. What information about this form of opioid presents a problem respecting the client's request?

Crushing the medication may precipitate an overdose.

A client comes to the clinic with what appears to be a cold. What group of upper respiratory drugs cause local vasoconstriction, which decreases blood flow and shrinks swollen membranes to improve air flow?

Decongestants

A 57-year-old client is given morphine for myocardial ischemic pain. The nurse needs to monitor the client frequently for which adverse effect?

Decreased respiratory rate

A 45-year-old female client is being seen in the health care provider's office for a dry, hacking cough that is keeping her up at night. The provider prescribes dextromethorphan for the cough. Which statement is true about dextromethorphan?

Dextromethorphan works in the medulla to suppress the cough reflex.

A 76-year-old client has been prescribed an oral antihistamine. What adverse effect presents a priority safety concern for older adult clients?

Drowsiness

How does knowledge of a drug's adverse effects impact the care provided by the nurse? (Select all that apply.)

Drug teaching can address signs and symptoms the client should be alert for. Assessments include monitoring for expected or common adverse effects. Baseline can be established to help identify adverse effects that occur.

A patient with allergic rhinitis is prescribed an antihistamine. The nurse instructs the patient to suck on a sugarless hard candy to prevent which condition?

Dryness of the oral mucosa and the throat

A 27-year-old athlete with newly diagnosed asthma presents for patient education regarding situations that could precipitate an asthma attack. The nurse teaches that acute episodes of asthma may last minutes to hours. In this teaching, which precipitants would the nurse state may cause the asthma? (Select all that apply.)

Exercise Allergens Pollutants

A client's past experience with pain has little impact on the patient's perception of pain. (true or false)

False

Second generation antihistamines are associated with a higher risk of sedation than first generation antihistamines. (True or False)

False

The first step in treating obstructive pulmonary disorders involves medication therapy. (True or False)

False

A nurse is caring for a client with low back pain, who has self-administered large doses of ibuprofen for several consecutive days. The nurse should caution the client that overuse of ibuprofen may lead to which?

GI irritation

A female client presents at the clinic with a dry, nonproductive cough. The client is diagnosed with bronchitis, and it is determined that she will need help thinning sputum so that the cough can become productive. What does the nurse expect will be prescribed for the client?

Guaifenesin

A patient is admitted to the emergency department with a suspected overdose of acetaminophen (Tylenol). What adverse effect is most common in acute or chronic overdose of acetaminophen (Tylenol)?

Hepatotoxicity

Which factors will decrease the rate of drug absorption? Select all that apply.

Higher drug concentration in the circulatory system Drug given by a subcutaneous route versus an intramuscular route A disease that alters the stomach and small intestine lining

When teaching a patient to use a dry powder inhaler, which of the following is true? Select all that apply:

Hold breath for 10 seconds. Inhale quickly.

A client has been experiencing severe pain and is being treated with narcotics. What should the nurse include in the plan of care as a desirable and measurable outcome for this client?

Increased independence with AM care

A 60-year-old patient with rheumatoid arthritis visits the health care facility for a regular checkup. The patient informs the nurse that the patient has been using an over-the-counter NSAID for the last few days. Why should the nurse caution the patient against the use of NSAIDs on a long-term basis?

Increased risk of GI bleeding

The triage nurse in the emergency department has a 42-year-old client with asthma present for treatment. The client's respiratory rate is 40 breaths per minute. Based on this objective data, what is the correct nursing diagnosis for this client?

Ineffective breathing pattern

How do inhaled corticosteroid agents assist in the treatment of asthma?

Inhaled corticosteroid agents will reduce airway inflammation.

The client is taking NSAIDs for pain. The nurse explains to the client that NSAIDs act by which actions?

Inhibiting the synthesis of prostaglandins

A patient has an important presentation to make in 4 hours and needs relief from the congestion of seasonal rhinitis. The patient calls the nurse, explains the situation, and tells the nurse that he cannot afford to be drowsy. Which antihistamine would be a good choice for this patient?

Loratadine (Claritin)

What should be observed during ongoing assessment of a client taking an antitussive? (Select all that apply.)

Lung sounds Frequency of cough Therapeutic effect Pain assessment

The client is receiving an opioid medication for pain. During an assessment, the nurse notes respiratory depression in the client. Which actions should the nurse perform next? Select all that apply.

Make an effort to arouse the client to change his breathing pattern if possible. Review the medical record for which drug could be causing the symptom. Review the allergy and health histories and current treatment modalities.

The nurse is obtaining a list of the medications that an elderly client is taking. The client is known to be taking 14 different medications. What is the greastest risk for the client?

Morbidity and mortality.

A client with cystic fibrosis may use which type of medication to reduce the viscosity of respiratory secretions?

Mucolytic

Chronic use of nasal decongestants may cause which condition?

Mucosal ulcerations

A nurse is caring for a client in the early stage of rheumatoid arthritis. The nurse would expect which medication classification to be used in the treatment of this client?

NSAIDs

The client returns to the unit following surgery. The client reports being in pain. After checking the medication administration record in the client's chart, the nurse sees that the client has not received the morphine the health care provider has ordered for over an hour. As the order reads q 1-2 hours, the nurse administers the low dose of the morphine. The PACU nurse calls to tell the floor nurse that the nurse forgot to chart the last dose of morphine the client had received just before the client was transferred to the floor. What drug would the floor nurse be sure to have on the unit that is used to reverse the effects of opioids?

Naloxone hydrochloride (Narcan) tartrate

The client uses his sympathomimetic inhaler frequently. The nurse evaluates the client for which of the following symptoms related to frequent use of the sympathomimetic inhaler?

Nervousness

Pseudoephedrine (Sudafed) is prescribed for a client suffering from nasal and sinus congestion. What is the most important assessment the nurse should complete before the client leaves the clinic to purchase the medication?

Obtain the client's blood pressure.

Decongestants are available in which dosage forms? (Select all that apply.)

Oral tablets Nasal sprays Nasal drops

Which patients are at a greater risk for liver failure during administration of acetaminophen?

Patients who consume alcohol habitually

A hospital client began taking a newly prescribed antihypertensive 12 hours ago and has developed a full body rash with edema and pruritis. What is the nurse's best action?

Promptly inform the prescriber of the client's status.

A geriatric client received a narcotic analgesic before leaving the post-anesthesia care unit to return to the regular unit. What is the priority nursing intervention for the nurse receiving the client on the regular unit?

Put side rails up and place bed in low position.

The instructor is discussing adverse effects associated with nasal decongestants. What is an effect of excessive use of these products when admnistered correctly?

Rebound nasal congestion

An opioid naïve patient experiences acute pain after surgery and is put on opioid therapy. Which severe adverse reactions of opioid treatment should the nurse monitor for in the patient?

Respiratory depression

An opioid antagonist will reverse which opioid effects? (Select all that apply.)

Respiratory depression Constipation Analgesia Hypotension Bradycardia

The nurse is working with a chronically ill client who is being administered opioid analgesics for pain management. While caring for this client, the nurse needs to keep which of the following in mind? Select all that apply.

Respiratory depression can occur, but tolerance can build over time. Tolerance to the medication may develop quickly, requiring larger doses to achieve the same level of pain control. Administering naloxone (Narcan) to clients to increase respiratory rate may lead to the client experiencing intense pain and/or withdrawal symptoms. Morphine sulfate (MS Contin) is the most widely used medication for management of chronic severe pain.

Antipyretic drugs, such as aspirin, ibuprofen, and acetaminophen, often are used to alleviate the discomforts of fever and protect vulnerable organs, such as the brain, from extreme elevations in body temperature. However, the use of aspirin in children is limited due to the possibility of what disease?

Reye syndrome

The client with asthma has been ordered an inhaler and the nurse is teaching how to prevent Candida infections. Which would the nurse include in the instructions?

Rinse mouth with water after each use.

A patient enters the emergency room with reports of visual changes, drowsiness, and tinnitus. The patient is confused and hyperventilating. These symptoms may be attributable to:

Salicylate intoxication.

Opioid analgesics are used primarily for the treatment of what issues? (Select all that apply.)

Severe acute pain Moderate chronic pain Opioid dependence

A nurse is providing health teaching to a newly diagnosed asthmatic client. The client has been prescribed theophylline. The nurse should encourage this client to stop:

Smoking cigarettes

All drugs have adverse reactions when taken. Organ and tissue damage is one such adverse reaction. Which is an example of organ and tissue damage caused by a drug?

Stevens-Johnson syndrome

The nurse caring for a 38-year-old client started on albuterol (Proventil) should advise the client that the client may experience what adverse effect?

Tachycardia

While assessing clients receiving opioid analgesics for pain management, what finding would allert the nurse and require healthcare provider notification?

The client with a pulse of 118, a respiratory rate of 8, and a BP of 80/60

After teaching a group of students about inhaled steroids, the instructor determines that the teaching was successful when the students state:

The drugs are not for use during an acute attack.

Why are inhaled steroids used to treat asthma and COPD?

They act locally to decrease release of inflammatory mediators

Expectorants elicit their effect by which mechanism?

Thinning respiratory secretions

A nurse is presenting an educational event for a group of new parents. One factor that the nurse addresses is the overuse of acetaminophen, which can cause liver toxicity. What would the nurse tell the parents it is important to do?

To check the label of OTC medications carefully to watch for inclusions of acetaminophen

A therapeutic theophylline level ranges from 10 to 20 mcg/mL. (True or False)

True

Expectorants are indicated for patients who have a dry, nonproductive cough. (True or False)

True

Leukotriene receptor antagonists are administered orally. (True or False)

True

Mucolytics are often used for patients with cystic fibrosis, COPD, or tuberculosis. (True or False)

True

A female client states that her pain is unbearable. The nurse has an order for one or two tablets of an opioid analgesic for pain relief. What is the best method that the nurse may use to assess the intensity of the pain?

Use a numerical scale of 0 to 10, with 0 being the least amount of pain.

A nurse is caring for two clients who are status postoperative for abdominal surgery. What is the best way to evaluate pain response after administering analgesia?

Use a pain assessment tool before and 30 minutes after medication administration.

An inhaled sympathomimetic drug has been ordered for a teenage athlete who has exercise-induced asthma. What should the patient be instructed to do?

Use the inhaler 30 to 60 minutes before exercising to ensure peak therapeutic levels when needed

What types of medication can pass through the blood-brain barrier or the placenta? (Select all that apply.)

Water-soluble medications Lipophilic medications Medications unbound to protein

A child prescribed an inhaled corticosteroid agent to decrease respiratory inflammation is now receiving high doses of the drug after only 2 days of treatment. What adverse reaction is the client at risk for developing?

adrenal insufficiency

The nurse should question the health care provider's IV morphine prescription for which client?

an 88-year-old female with failure to thrive

What is an example of a secondary action?

an antihistamine causes the client to experience drowsiness

What is the most common first-line therapy for relief of an acute asthma attack?

beta2-adrenergic agonist

Many drugs, if taken during pregnancy, can cause adverse effects to the fetus. It is important for nurses to teach women the potential risks of fetal drug exposure. What are some potential risks? (Select all that apply.)

blindness central nervous system defects heart anomalies limb deformities facial defects

A trauma client has been receiving frequent doses of morphine in the 6 days since his accident. This pattern of analgesic administration should prompt the nurse to carefully monitor the client's what?

bowel patterns.

Pain may be classified according to what factors? Select all that apply

cause origin duration

A client presents to the Emergency Department (ED) having an acute asthma attack. An ED health care provider has ordered a sympathomimetic (epinephrine). The nurse is aware that this classification of drug will:

cause dilation of the bronchi with increased rate and depth of respiration.

Opioids have adverse effects on what body systems that are potentially life threatening? Select all that apply.

central nervous (CNS) respiratory

A nurse is administering medications to a 70-year-old female client. What normal physiologic changes that occur with aging will affect the absorption of medications? (Select all that apply.)

chronic illness decreased blood flow to the GI system decreased body surface area

The nurse administers a specific medication to an older adult client every 4 hours. The client has a history of chronic renal failure. The nurse should assess for indications of:

cumulative drug effects.

A client began a new medication 4 days ago and has been reporting increasing malaise for the past 72 hours. The nurse is reviewing the client's most recent laboratory findings. What findings should suggest the possibility of a cytotoxic reaction? (Select all that apply.)

decreased hematocrit decreased leukocytes increased liver enzymes

The nurse administers a medication and the client has an immediate anaphylactic reaction following injection. What symptoms assessed by the nurse would indicate anaphylaxis? (Select all that apply.)

difficulty breathing increased blood pressure diaphoresis

A nurse administrating an opioid medication should assess for what related side effect?

drowsiness

What would be a key element associated with pharmacodynamics?

enzyme systems

What is the most reliable measure to evaluate renal function?

glomerular filtration rate

A patient with a recent diagnosis of acute renal failure has a long-standing seizure disorder which has been successfully controlled for several years with antiseizure medications. The nurse should recognize that the patient's compromised renal function will likely

increase the half-life of medications that are metabolized by the kidneys.

Immediate administration of what drug should be anticipated when a postanesthesia client is noted as having a respiratory rate of 6 breaths per minute?

naloxone

Opioid antagonists may produce withdrawal symptoms in clients physically dependent on which substance?

opioids

A nurse has looked up a new drug in a drug guide and is reviewing characteristics of its absorption. Which processes may be involved in this drug's absorption? (Select all that apply.)

passive diffusion active transport filtration

A nurse is caring for a 49-year-old client in the intensive care unit. The client was in a motor vehicle accident and is in severe pain. The client has been given morphine. After 2 days in the unit, the nurse can detect nasal congestion when the client speaks to her. The nurse will monitor for which?

pneumonia.

A hospital nurse works on a unit specializing in neurological problems and frequently provides care to elderly clients who have undergone spinal surgery. The nurse assesses that the client at highest risk for a medication-related problem:

prescribed metoprolol, pantoprazole, and docusate.

A high school student was diagnosed with asthma when he was in elementary school and has become accustomed to carrying and using his "puffers". In recent months, he has become more involved in sports and has developed a habit of administering albuterol up to 10 times daily. The nurse should teach the student that overuse of albuterol can lead to

rebound brochoconstriction

A client experiencing cancer pain is receiving morphine every 2 hours. What assessment should the family be taught to make while caring for this client at home?

respiratory depression

Morphine has been prescribed for a 28-year-old man with severe pain due to a back injury. The nurse is teaching the client upon discharge to avoid alcohol while taking this medication because it can cause which?

respiratory depression

What factors does the nurse take into account that may influence the rate of absorption of medication? (Select all that apply.)

route of administration solubility of the medication condition of the body tissues

A student asks the study group how to define a drug allergy. What would be the peer group's best response?

the formation of antibodies to a drug protein causing an immune response when the person is next exposed to that drug

The nurse is caring for a client who is exhibiting adverse medication effects. The nurse should recognize that adverse effects can be extensions of:

the primary action of a drug

The nurse teaches a client with rheumatic disease who is being prescribed salicylate therapy to monitor for:

tinnitus.

When assessing a client for possible factors that may affect the pharmacokinetics of a drug, a client with a history of what disease would lead the nurse to suspect that the client may experience an alteration in the distribution of a drug?

vascular disease

Which conditions would occur due to the administration of an opioid antagonist in a client who is physically dependent on opioids?

withdrawal symptoms