RNSG 1301 - Exam 2
A nurse instructs a patient with rheumatoid arthritis who was prescribed prednisone 20 mg PO daily. Which statements by the patient indicate that patient teaching was effective? "I will make sure to have a diet rich in vitamin D and calcium to reduce my risk for osteoporosis. "I will make sure to take the prednisone with food to avoid an upset stomach. "I may experience side effects and adverse effects such as insomnia, weight gain, and mood swings. "If my rheumatoid arthritis symptoms do not improve or get worse, I can take an extra dose of prednisone. "If side effects are bothering me, I will stop taking the prednisone and follow up with my physician later.
"I will make sure to have a diet rich in vitamin D and calcium to reduce my risk for osteoporosis. - "Patients taking corticosteroids chronically are at increased risk for osteoporosis. Therefore encouraging a diet rich in calcium and vitamin D is important. The patient should also be encouraged to maintain health care provider appointments to monitor bone health, which may necessitate the addition of vitamin D and calcium supplementation or possibly bisphosphonate therapy. "I will make sure to take the prednisone with food to avoid an upset stomach. - "To avoid gastrointestinal upset, prednisone should be taken with food. "I may experience side effects and adverse effects such as insomnia, weight gain, and mood swings. - "Side effects and adverse effects associated with prednisone are numerous. Insomnia, weight gain, and mood swings have been commonly reported and should be shared with the patient.
A patient taking insulin has a new prescription for hydrochlorothiazide, a thiazide diuretic to treat hypertension. Which statement by the patient indicates a need for additional teaching about the interactions between the two medications? "My blood pressure should go down." "My insulin dose may need to be increased." "My insulin dose may need to be decreased." "My diet will not need to change if I take thiazide with insulin."
"My insulin dose may need to be decreased." - Thiazide diuretics increase blood sugar, so the insulin dose would need to be increased, not decreased.
A patient with type 1 diabetes, who has been admitted to the hospital for infection, has been taking regular insulin for about 3 months. Which statement made by the patient indicates a need for additional teaching? "My insulin needs will be increased." "My insulin needs will be decreased." "I will need to make sure I stay hydrated." "I will need to make sure I do not skip any meals."
"My insulin needs will be decreased." - Blood glucose levels can be elevated during stressful times, such as during an infection. Insulin doses may need to be increased for a period of time.
A patient diagnosed with type 2 diabetes states, "I did not eat breakfast, but I made sure to take my repaglinide." Which response by the nurse is appropriate? "The best meal to skip is breakfast." "This medicine does not regulate your blood glucose." "Skipping meals can cause your blood glucose to drop." "Your blood glucose level will be maintained as long as you took the medication."
"Skipping meals can cause your blood glucose to drop." - Repaglinide regulates blood glucose, which could drop if the drug is taken without a meal
A patient with glaucoma is prescribed timolol after using other medications for increased intraocular pressure. The patient says, "I think there has been a mistake. Isn't that medicine for heart problems?" Which response by the nurse would be appropriate? "This drug in oral form is prescribed for other health issues." "This diuretic acts on the heart and eye to lower pressure." "You might be correct. Let me contact the health care provider for clarification." "Timolol drops only affect the eye pressure, not the heart directly."
"This drug in oral form is prescribed for other health issues." - Beta blockers are frequently used for hypertension, cardiac dysthymias, and glaucoma.
A patient is scheduled for dental surgery in 1 month and asks the nurse whether to stop taking a regular daily dose of 100 mg of aspirin before surgery. Which response by the nurse is appropriate? "You should continue the dose of aspirin because this type of surgery is associated with a low risk of bleeding. "You should stop taking aspirin 1 to 2 weeks before the surgery because this surgery is a high risk for bleeding. "You should stop taking aspirin 1 to 2 weeks before your surgery because the aspirin significantly increases the risk of bleeding." "You should continue the dose of aspirin because discontinuation of it will increase the risk for bleeding that may occur with surgery."
"You should continue the dose of aspirin because this type of surgery is associated with a low risk of bleeding." - Elective dental surgery is typically considered a low risk for bleeding. As such, the patient should continue to take aspirin, particularly because it is a low, cardioprotective dose of the drug.
Regular insulin is administered at 0730. At which time would the nurse anticipate the insulin to start acting? 0745 0800 0900 1000
0800 - Regular insulin's onset of action is within 30 minutes to 1 hour.
A nurse is administering glargine insulin to a patient. Which time frame describes the onset of action of this medication? 10 minutes 15 to 45 minutes 1 to 2 hours 6 hours
1 to 2 hours - Glargine is a long-acting insulin with an onset of action of 1 to 2 hours.
Which CYP450 isoenzyme metabolizes colchicine? 2C9 2D6 2E1 3A4
3A4 - Colchicine is metabolized by CYP3A4 and is subject to multiple drug interactions because of this.
Because acetaminophen has a short half-life, it can be administered every__hours as needed for pain relief.
4 - The half-life of acetaminophen is approximately 2 hours. For this reason, it can be given up to every 4 hours.
A nurse administering neutral protamine Hagedorn (NPH) insulin would expect peak effect to occur in which time frame? 1 to 2 hours 2 to 4 hours 6 to 12 hours 10 to 12 hours
6 to 12 hours - NPH Insulin is an intermediate-acting insulin and has its peak effect at 6 to 12 hours.
Which patients does a nurse determine cannot safely receive prednisone? A 33-year-old patient with active tuberculosis A 48-year-old patient with hypothyroidism A 55-year-old patient with type 2 diabetes A 59-year-old patient with dyslipidemia A 61-year-old patient with benign prostatic hyperplasia A 78-year-old patient with cataracts
A 33-year-old patient with active tuberculosis - Patients with an active infection like tuberculosis should not receive glucocorticoids. Given prednisone's effect on the immune system, the body may not be able to clear the infection. A 78-year-old patient with cataracts - Patients with cataracts should not receive glucocorticoids because they can worsen the cataracts.
Which patients does a nurse determine can safely receive therapy with ibuprofen? A 33-year-old patient who is breastfeeding A 41-year-old patient with an actively bleeding gastrointestinal ulcer A 49-year-old patient receiving azathioprine A 51-year-old patient with type 2 diabetes A 52-year-old patient with a history of uric acid calculus A 53-year-old patient who is in menopause
A 49-year-old patient receiving azathioprine - Azathioprine usage is a concern with patients who are receiving xanthine oxidase inhibitors like allopurinol and febuxostat. It is not a concern for patients receiving ibuprofen and can be safely administered. A 51-year-old patient with type 2 diabetes - Type 2 diabetes is not a concern for patients receiving ibuprofen therapy. A 52-year-old patient with a history of uric acid calculus - Having a history of uric acid calculi is a concern for those who are prescribed probenecid, not ibuprofen. A 53-year-old patient who is in menopause - Menopause does not pose a concern for patients who are receiving ibuprofen.
Which statement correctly identifies the pharmacologic properties of acetaminophen? Acetaminophen is a nonopioid drug and a nonsteroidal antiinflammatory drug (NSAID) Acetaminophen is an opioid drug and an antipyretic Acetaminophen is an opioid drug but is not an NSAID Acetaminophen is a nonopioid drug but is not an NSAID
Acetaminophen is a nonopioid drug but is not an NSAID - Because acetaminophen is a nonopioid analgesic but not an NSAID, it is used for the treatment of mild to moderate pain but cannot be used as an antiinflammatory.
A patient presents to the emergency department with nausea, vomiting, abdominal pain, and yellow sclera. The patient's liver function tests are elevated, and the serum acetaminophen level is 10. Which conclusion will the nurse draw? Acetaminophen is not likely playing a role. The patient is probably an alcoholic with liver disease. The patient most likely took an overdose of acetaminophen. Acetaminophen has likely caused the liver function test elevation.
Acetaminophen is not likely playing a role. - A serum acetaminophen level of 10 is within the normal range of 5 to 25. The nurse can conclude that acetaminophen is not the likely cause of the patient's condition.
A 3-year-old child, who is brought to the clinic with ear pain, nasal congestion, and low-grade fever, is diagnosed with mild otitis media. The parent becomes upset when an antibiotic is not prescribed immediately. Which statements describe the rationale behind withholding antibiotics? Acute otitis media usually resolves within 72 hours. Immediate prescription of antibiotics is limited to infants and children with severe illness. Supportive care for pain and fever is usually sufficient for acute otitis media. Side effects and adverse effects can occur with antibiotics. Antibiotics are not effective against most types of otitis media. An antibiotic prescription would require hospitalization for intravenous therapy.
Acute otitis media usually resolves within 72 hours. - Most cases of acute otitis resolve rather quickly with supportive care. Immediate prescription of antibiotics is limited to infants and children with severe illness. - The American Academy of Pediatrics recommends that antibiotics be prescribed immediately to infants less than 6 months of age or to children with severe illness (fever over 102°F, severe ear pain). In this situation the child is older, and the symptoms are not considered to be severe. Supportive care for pain and fever is usually sufficient for acute otitis media. - Supportive care, including analgesics and decongestants, is recommended first. Side effects and adverse effects can occur with antibiotics. - Antibiotics have not only side effects like diarrhea and vomiting but also more serious adverse effects like anaphylaxis.
A 2-year-old child is diagnosed with acute otitis media. The nurse would anticipate incorporating which antibiotic into the plan of care? Amoxicillin oral suspension Erythromycin capsules Ciprofloxacin drops Carbamide peroxide drops
Amoxicillin oral suspension - Amoxicillin is the drug of choice for acute otitis media.
A parent contacts the clinic regarding a child who is receiving amoxicillin for acute otitis media. The parent states that the child is not eating and has developed white patches in the mouth. Which action would the nurse take? Reassure the parent that this is probably thrush and should resolve on its own. Ask the parent to bring the child to the clinic because this is probably thrush and needs to be treated. Encourage the parent to give the child cold Popsicles to provide pain relief and hydration. Instruct the parent to discontinue amoxicillin immediately because this could be an allergic response.
Ask the parent to bring the child to the clinic because this is probably thrush and needs to be treated. - Asking the parent to bring the child to the clinic is the appropriate action because thrush is very uncomfortable but treatable.
A patient in the emergency department has mild pain and asks for acetaminophen. Which intervention by the nurse is appropriate? Suggest that the patient take intravenous (IV) morphine instead. Ask the patient how many cigarettes he or she smokes every day. Tell the patient that acetaminophen does not help with mild pain. Ask the patient if he or she has taken any acetaminophen earlier in the day.
Ask the patient if he or she has taken any acetaminophen earlier in the day. - Asking a patient about his or her use of acetaminophen earlier in the day is important before administering the drug again, as there is a limit to how much can safely be taken in 1 day.
A patient presents to the emergency department with intense itching, ringing in the ears, changes in breathing pattern, and dizziness. The patient's daughter reports that she believes the patient had a seizure and overdosed on a home medication before the ambulance arrived. Which drug toxicity would the nurse suspect as the cause of these manifestations after reviewing the patient's home medication list? Allopurinol Aspirin Colchicine Ibuprofen
Aspirin - Without any additional information, aspirin toxicity is the most likely presentation for this patient. Aspirin toxicity ranges in severity and can cause tinnitus (ringing in the ears), pruritus, headache, dizziness, seizures, abnormal breathing, hyperthermia, and potentially coma. The patient in the case is exhibiting some of these signs and symptoms (tinnitus, pruritus, dizziness, abnormal breathing, and seizures).
Which information would the nurse include when teaching a patient who is taking enteric-coated aspirin on a scheduled basis for rheumatoid arthritis? If the patient has difficulty swallowing, the aspirin should be crushed and sprinkled on food or can be chewed. Aspirin should be taken with food or milk to avoid gastrointestinal upset. If the product ever smells like vinegar it should be discarded. Avoid grapefruit juice because toxicity may occur when mixed with aspirin. The patient can expect analgesic effects within 30 to 60 minutes; however, antiinflammatory effects may be delayed (occurring in about a week). The patient should avoid alcohol with aspirin because it can increase the risk for bleeding.
Aspirin should be taken with food or milk to avoid gastrointestinal upset. - It is best to take aspirin with food or milk to avoid any adverse gastrointestinal effects. If the product ever smells like vinegar it should be discarded. - If aspirin smells like vinegar the product has begun to degrade and should be discarded. Avoid grapefruit juice because toxicity may occur when mixed with aspirin. - Grapefruit juice does not pose a concern for patients taking aspirin. This is problematic for patients receiving colchicine. The patient can expect analgesic effects within 30 to 60 minutes; however, antiinflammatory effects may be delayed (occurring in about a week). - Analgesic effects of aspirin are noted within 30 to 60 minutes of receiving the drug. Its antiinflammatory effects are a bit prolonged and may not be noticed until about a week after continuously taking the drug. The patient should avoid alcohol with aspirin because it can increase the risk for bleeding. - Alcohol should be avoided with aspirin because of a risk for increased bleeding.
Which information would a nurse include when teaching a patient about the administration of colchicine for gout? Avoid grapefruit juice while taking colchicine. Take one 0.6-mg tablet by mouth twice daily for an attack Note that nausea, vomiting, and diarrhea may occur with treatment. Report any blood in the urine or muscle pains to the health care provider immediately. Ideally take the medication on an empty stomach. If an upset stomach occurs, it may be taken with food.
Avoid grapefruit juice while taking colchicine. - Patients receiving colchicine should not consume grapefruit juice while taking the drug. Grapefruit juice can lead to increased levels of colchicine, increasing the risk for toxicity. Note that nausea, vomiting, and diarrhea may occur with treatment. - Colchicine is associated with significant gastrointestinal distress, such as nausea, vomiting, and diarrhea. Report any blood in the urine or muscle pains to the health care provider immediately. - Patients should be encouraged to report blood in the urine or muscle pains to a health care provider when receiving colchicine because it may indicate the development of rhabdomyolysis. Ideally take the medication on an empty stomach. If an upset stomach occurs, it may be taken with food. - For maximal absorption, colchicine should be taken on an empty stomach. However, most patients tolerate it better when taken with food.
Glargine insulin is administered at bedtime (2100). When should the peak of action be expected for this medication? Usually within 2 hours of administration. Because it is a basal insulin, is considered "peakless." With long-acting insulin, the peak should be about 12 hours. The duration of glargine is approximately 24 hours.
Because it is a basal insulin, is considered "peakless." - Glargine has a small plateau but is considered to be "peakless."
Match the drug or drug class requiring special monitoring to the condition.
Bladder flow obstruction - Anticholinergics Clotting disorders - Nonsteroidal antiinflammatory drugs (NSAIDs) Hypertension - Over-the-counter cold products Falls - Opioids
A nurse is providing care to a patient who has been newly prescribed lesinurad and allopurinol. The patient is also taking carbamazepine for seizures and atorvastatin for dyslipidemia. The nurse would notify the health care provider of which potential drug interaction? Atorvastatin, because it will increase levels of lesinurad Carbamazepine, because it will increase levels of lesinurad Atorvastatin, because it will increase the risk for myotoxicity Carbamazepine, because it will decrease levels of lesinurad
Carbamazepine, because it will decrease levels of lesinurad - This statement is true. Carbamazepine is an inducer of CYP2C9 and may decrease the levels of lesinurad, minimizing its effects when giving them together.
Match the chemical class to the nonsteroidal antiinflammatory drug (NSAID) that belongs to the class.
Celecoxib - Cyclooxygenase-2 inhibitor Ketorolac - Acetic acid derivative Nabumetone - Enolic acid derivative Ibuprofen - Propionic acid derivative
Which statements describe the pharmacokinetics of celecoxib? Celecoxib is well absorbed after oral administration. The drug is minimally distributed. Celecoxib is minimally protein bound. The drug undergoes metabolism by the CYP450 system. It is excreted in both urine and feces.
Celecoxib is well absorbed after oral administration. - It is accurately stated that celecoxib is well absorbed after oral administration. It is excreted in both urine and feces. - Celecoxib is excreted in both the urine (27%) and the feces (57%).
A child is brought to the clinic with possible otitis externa. Which finding would indicate a contraindication for using antibiotic otic drops? Child less than 6 months of age Nasal congestion and discharge Presence of a cough and fever Otalgia and rubbing the ear
Child less than 6 months of age - Antibiotic drops are contraindicated in children less than 6 months of age.
A patient with nausea and vomiting is not able to tolerate oral medications. The patient has a fever, and the health care provider prescribes acetaminophen to be given rectally. The nurse understands that the medication may not be absorbed properly in a patient with which concurrent condition? Headache Constipation Hypertension Abdominal pain
Constipation - Acetaminophen may be absorbed erratically in a patient with constipation because of the presence of fecal material, which acts as a barrier to absorption into the bloodstream.
A patient is prescribed loteprednol, a corticosteroid, for inflammation after eye surgery. Which information is important to convey to the patient to minimize adverse effects of this drug? Continue this drug only for the length of time specified by your health care provider. Wear an eye shield for 1 hour after instillation of this drug. Rise slowly from a sitting position to reduce dizziness with this drug. Do not use this drug with other ophthalmic drugs because of interactions.
Continue this drug only for the length of time specified by your health care provider. - Glaucoma or cataracts may develop after prolonged use of loteprednol, so the patient should not use the drug for longer than directed by the health care provider.
There is a clinical protocol to hold metformin for 48 hours before and after tests that require intravenous contrast dye. Which statement explains why metformin would be held? Contrast dye will be ineffective in the presence of metformin. Contrast dye can cause kidney dysfunction, which is a metformin contraindication. Hypersensitivity to contrast dye is difficult to detect when metformin is being taken. Contrast dye given on the same day as metformin causes severe nausea and vomiting.
Contrast dye can cause kidney dysfunction, which is a metformin contraindication. - Intravenous contrast dye that contains iodine has the potential to cause acute kidney disease. Because metformin is contraindicated in patients with renal dysfunction, it should be discontinued a day or two prior to the procedure and resumed 48 hours after the procedure, once lab results show normal renal function.
Which statement accurately describes the glucocorticoid that is secreted from the adrenal cortex along with its effect in the body? Cortisol, which impacts carbohydrate metabolism Aldosterone, which impacts carbohydrate metabolism Cortisol, which maintains sodium levels and blood pressure Aldosterone, which maintains sodium levels and blood pressure
Cortisol, which impacts carbohydrate metabolism - Cortisol is a glucocorticoid that is secreted from the adrenal cortex. It affects carbohydrate, fat, and protein metabolism.
A patient admitted to the intensive care unit after neurosurgery has lost the eye-blink reflex. Which drug would the nurse anticipate administering to protect the eye and minimize drying? Loteprednol Cyclosporine Tetryzoline Olopatadine
Cyclosporine - Cyclosporine, an immunosuppressant, is used to protect the eye that has lost the blink reflex. It works by increasing natural tear production.
Which symptoms, if experienced by a patient taking morphine, should be reported to the health care provider? Fatigue Dizziness Analgesia Headaches Constipation Difficulty breathing
Dizziness - A patient taking morphine should report dizziness to the health care provider. Morphine may cause orthostatic hypotension, causing dizziness, and placing the patient at risk for falls and injury. Headaches - A patient taking morphine should report headaches to the health care provider. Morphine may cause orthostatic hypotension, causing headache, and placing the patient at risk for falls and injury. Difficulty breathing - A patient taking morphine should report difficulty breathing to the health care provider. Although respiratory depression is a potential adverse effect of morphine, difficulty breathing may represent an allergic reaction to the medication.
The school nurse is conducting a health class about preventing "swimmer's ear." Which instructions would be included in the class? Dry the outer ear completely after swimming or bathing. Use a cotton swab to make sure the ear canal is dry. Remove moisture by using a towel-covered finger to wipe the external ear. Tilt the head to the side to drain moisture from the ear. Use a hair dryer to help keep the ear canal dry.
Dry the outer ear completely after swimming or bathing. - Drying the outer ear completely removes some of the moisture that has accumulated in the ear canal. Remove moisture by using a towel-covered finger to wipe the external ear. - Using a towel provides a dry surface to absorb excessive moisture. This action also removes excessive wax without entering further into the ear canal. Tilt the head to the side to drain moisture from the ear. - Tilting the head uses gravity to promote drainage of any excessive moisture from the ear canal. Use a hair dryer to help keep the ear canal dry. - The air and warmth from the hair dryer will reduce moisture in the ear canal.
Which categories can be used for classifying glucocorticoids? Onset of action Duration of action Route of administration Natural versus synthetic analog Potential for sodium and water retention
Duration of action - Duration of action is one way to categorize glucocorticoids. Route of administration - Route of administration, such as oral and intranasal, offers one way to classify glucocorticoids, which represent a large and diverse group of steroids. Natural versus synthetic analog - Glucocorticoids may be classified by whether they are natural or synthetic analogs. Potential for sodium and water retention - Glucocorticoids may be classified by their potential to retain water and salt.
Which statements describe the therapeutic uses of aspirin? Closure of patent ductus arteriosus Dysmenorrhea Fever Inflammation Pain Platelet aggregation inhibition
Dysmenorrhea - Nonsteroidal antiinflammatory drugs (NSAIDs) like aspirin may be useful in the treatment and relief of dysmenorrhea by blocking prostaglandin synthesis in uterine smooth muscle. Fever - Because of its antipyretic effects, aspirin may be useful in reducing fevers. It is only effective against pyrogens, not other causes of fever, and aspirin should not be used to manage fever in children because of a risk for Reye syndrome. Inflammation - Aspirin and other NSAIDs are often used for their effects against inflammation. When used to treat inflammation, aspirin is generally given in higher doses compared with when it is used for fever and analgesia. Pain - Aspirin may be used to treat mild to moderate pain, being most effective against muscle pain, joint pain, and headache. Platelet aggregation inhibition - Aspirin confers beneficial cardioprotective effects against stroke and myocardial infarction through its ability to inhibit platelet aggregation.
Which results are expected when arachidonic acid is metabolized through the prostaglandin pathway? Bronchospasms Edema Pain Vasoconstriction Vasopermeability
Edema - Edema is an anticipated effect of the prostaglandin pathway, specifically noting that bradykinin and histamine cause edema. Pain - Pain is an anticipated effect of the prostaglandin pathway, specifically noting that bradykinin and histamine cause pain. Vasopermeability - Vasopermeability is an anticipated effect of arachidonic acid's metabolism through the prostaglandin pathway.
A patient is recovering from surgery and wishes to avoid taking morphine if possible. Which intervention by the nurse is appropriate? Suggest that the patient use codeine instead. Suggest that the patient use meperidine instead. Encourage nonpharmacologic measures to relieve pain. Tell the patient to take the morphine so his or her pain will not get worse.
Encourage nonpharmacologic measures to relieve pain. - The nurse would encourage all postoperative patients to use nonpharmacologic measures to relieve pain. These may include distraction, repositioning, or music therapy.
Acetaminophen is approved for the treatment of which conditions? Fever Gout Headaches Severe pain Mild to moderate pain
Fever - Acetaminophen may be used for fever. The inhibition of prostaglandin synthesis in the central nervous system (CNS) helps to reduce body temperature. Headaches - Acetaminophen may be used for headaches. Through the inhibition of cyclooxygenase (COX), pain reduction is possible. Mild to moderate pain - Acetaminophen may be used for mild to moderate pain. Through the inhibition of COX, pain reduction is possible.
Which statement about fludrocortisone is accurate? Fludrocortisone is a glucocorticoid that is used in the management of inflammatory conditions such as rheumatoid arthritis. Fludrocortisone possesses both mineralocorticoid and glucocorticoid activity. The anticipated onset of action of fludrocortisone is 1 to 2 hours. When given orally, it is minimally protein bound.
Fludrocortisone possesses both mineralocorticoid and glucocorticoid activity. - Fludrocortisone possesses potent mineralocorticoid activity but also has significant glucocorticoid activity.
A nurse is treating an unconscious adult who is covered in sweat. The person has a history of diabetes. A blood glucose of 20 mg/dL is obtained. Which substance would the nurse administer? Subcutaneous glargine Glucagon injection One-half cup fruit juice Regular insulin intravenously
Glucagon injection - Glucagon should be administered to patients who are unconscious or unable to swallow.
Which family-centered education techniques would the nurse use when teaching the parents of a 12-month-old infant how to administer oral antibiotics? Administer the drug all at once Have parent soothe the 12-month-old patient Disguise the drug taste with grape juice Use an oral syringe to administer the drug Allow the 12-month-old patient to suck on a pacifier
Have parent soothe the 12-month-old patient - The parent should maintain safe and secure positioning of the infant (e.g., holding, rocking, cuddling, soothing). Use an oral syringe to administer the drug - The parents should use a calibrated dropper or an oral syringe. Allow the 12-month-old patient to suck on a pacifier - The parents should allow self-comforting measures as age-appropriate (e.g., use of pacifier or sucking on fingers).
A patient with type 1 diabetes has a scheduled dose of insulin due. Which action would the nurse take when the fingerstick glucose monitor reads 50 mg/dL? Recheck blood glucose within 5 minutes. Document results. No further intervention is needed. Hold scheduled dose and give fruit juice. Administer scheduled insulin dose and give hard candy.
Hold scheduled dose and give fruit juice. - Blood glucose should be 70 mg/dL or above. If a patient with a blood glucose of less than 60 mg/dL receives insulin, the blood glucose will decrease more. Holding the scheduled dose and giving juice would be the appropriate intervention.
When preparing to administer hydrocortisone ear drops, the nurse finds that the patient has a ruptured tympanic membrane. Which action would the nurse take? Give the ear drops because it was prescribed. Hold the ear drops and notify the health care provider. Use a wick to slowly give the drug. Apply warmth to promote healing.
Hold the ear drops and notify the health care provider. - Based on the assessment, holding the drug and notifying the health care provider should be done.
Which questions would the nurse ask a patient who is taking acetaminophen? Do you take nonsteroidal antiinflammatory drugs (NSAIDs)? How often do you drink alcohol? How often do you smoke cigarettes? Do you have any history of liver disease? Do you have any history of renal disease?
How often do you drink alcohol? - Asking a patient taking acetaminophen about alcohol intake is necessary, as both substances affect the liver. The risk for hepatotoxicity is increased when acetaminophen is combined with alcohol. Do you have any history of liver disease? - Asking a patient taking acetaminophen about a history of liver disease is appropriate given the drug's effect on the liver. Patients with a history of liver disease may require a decreased dose of acetaminophen or an alternative medication.
A patient taking metformin for type II diabetes is prescribed prednisone for a respiratory infection. Which action would the nurse anticipate? Increase metformin dosage during prednisone therapy. Hold metformin until prednisone therapy is complete. Replace metformin with insulin during prednisone therapy. Administer both drugs as currently prescribed.
Increase metformin dosage during prednisone therapy. - Prednisone is a corticosteroid that increases glucose blood levels. As a result, metformin dosage may need increasing depending on patient response and length of prednisone therapy.
The patient's hands are shaking while trying to administer eye drops. To promote self-care for a patient who is having difficulty instilling eye drops, which action would the nurse take? Inquire if patient needs an antianxiety drug to lessen shaking. Suggest that a family member learn to give the drops. Ask the health care provider about switching to an oral medication. Indicate that adaptive eye devices might help with instillation.
Indicate that adaptive eye devices might help with instillation. - Using an adaptive eye device can assist the person to give the medication and also promotes self-care.
A patient is prescribed gatifloxacin drops for an eye infection. Which is the action of this drug? Inhibits DNA synthesis in susceptible gram-positive and some gram-negative bacteria Impedes bacterial protein synthesis primarily in gram-positive and gram-negative organisms Restricts spread of disease by blocking an enzyme and preventing viral multiplication Disrupts the transport system within cell walls and causes cell destruction
Inhibits DNA synthesis in susceptible gram-positive and some gram-negative bacteria - Gatifloxacin, a fluoroquinolone, acts by inhibiting DNA synthesis within the cell primarily in gram-positive and some gram-negative bacteria.
Match the antigout drug with its associated mechanism of action.
Inhibits xanthine oxidase - Febuxostat Inhibits chemotaxis and microtubule assembly - Colchicine Blocks reabsorption and promotes excretion of uric acid - Probenecid Inhibits uric acid transporter proteins required for uric acid reabsorption - Lesinurad
A patient prescribed latanoprost for the treatment of glaucoma calls the nurse to report a headache and intense eye pain. Which action would the nurse take? Reassure the patient that this is an expected response to the drug. Encourage the patient to close his or her eyes and rest for about 1 hour. Instruct the patient to immediately go to the clinic or emergency department. Advise the patient to hold the drug and wait 24 hours before resuming.
Instruct the patient to immediately go to the clinic or emergency department. - Intense eye pain and headache are symptoms of angle-closure glaucoma. This is an urgent situation; therefore the patient should be instructed to seek emergency medical attention.
Which response would the nurse expect to find when assessing a patient 4 weeks after starting timolol, 1 drop daily, for glaucoma? Clouding of the lens has resolved. Intraocular pressure is in normal range. The eye infection has healed. Discharge and tearing are not present.
Intraocular pressure is in normal range. - The goal of glaucoma therapy is normalization of intraocular pressure. A therapeutic response to timolol drops is a change in intraocular pressure from high to a more normal range.
A patient is prescribed timolol drops for glaucoma. Which information would the nurse include when teaching about the pharmacodynamics of this drug? The drug's onset of action is immediate, and it lasts for about 12 hours. Drops should be used frequently due to its short duration of action. It may take a few weeks of taking the drug to get the full effect. Only use the drug when irritation of the eye occurs.
It may take a few weeks of taking the drug to get the full effect. - The onset of action is quick, but the full effect of lowering the intraocular pressure takes from 2 to 4 weeks with this drug.
A patient has been taking morphine frequently after a recent surgery. The nurse would suggest monitoring of which laboratory test? Liver function panel Basic metabolic panel Complete blood count (CBC) Complete metabolic panel
Liver function panel - The transaminases aspartate aminotransferase (AST) and alanine aminotransferase (ALT) may become elevated with morphine use and should be monitored via liver function panel. If liver function is impaired, the metabolism of morphine may be slowed, and the dose would be reduced to avoid toxicity.
Which dietary modifications should be shared with a patient who has gout and is receiving colchicine? Minimize or avoid alcohol. Minimize or avoid caffeine. Increase daily water consumption. Consume a low-carbohydrate, high-protein diet. Increase consumption of sweetened fruit juices.
Minimize or avoid alcohol. - This statement is accurate. Patients with gout should be encouraged to minimize or ideally avoid alcohol intake because this can increase uric acid levels. Minimize or avoid caffeine. - This statement is accurate. Patients with gout should be encouraged to minimize or ideally avoid caffeine intake because this can increase uric acid levels. Increase daily water consumption. - This statement is accurate. The patient should be instructed to increase fluid intake to increase uric acid excretion and prevent the formation of renal calculi.
A patient is on a continuous infusion of morphine after surgery. Which interventions will the nurse perform? Monitor urinary output Monitor respiratory rate Assess for epigastric pain Auscultate bowel sounds Assess for peripheral edema
Monitor urinary output - Urinary output should be monitored in patients on continuous morphine infusions because urinary retention may occur. Monitor respiratory rate - Respiratory rate should be monitored in patients on continuous morphine infusions because respiratory suppression or distress may occur. Assess for epigastric pain Auscultate bowel sounds - The nurse would auscultate bowel tones in patients on continuous morphine infusions because decreased peristalsis and/or constipation may occur.
A patient in severe pain is unable to swallow and does not have intravenous (IV) access. Which prescription would the nurse request from the health care provider? Morphine by mouth (PO) Morphine by rectum (PR) Acetaminophen PO Acetaminophen PR
Morphine by rectum (PR) - A patient in severe pain with no IV access who is not able to swallow should have morphine administered rectally. This will allow for fast absorption and pain relief while ensuring patient safety.
Which statements regarding nonsteroidal antiinflammatory drugs (NSAIDs) are accurate? Most NSAIDs inhibit both cyclooxygenase (COX)-1 and COX-2 to varying degrees. Celecoxib inhibits both COX-1 and COX-2, which are involved in inflammation. Ibuprofen selectively inhibits COX-1, which is the "bad" COX causing pain and inflammation. NSAIDs are also referred to as leukotriene inhibitors with antipyretic and analgesic effects. Although they possess antipyretic and analgesic effects, NSAIDs are mainly used for antiinflammatory effects.
Most NSAIDs inhibit both cyclooxygenase (COX)-1 and COX-2 to varying degrees. - The majority of NSAIDs inhibit both COX-1 and COX-2 to varying degrees. Celecoxib is the only COX-2 selective NSAID that is currently available in the United States. Although they possess antipyretic and analgesic effects, NSAIDs are mainly used for antiinflammatory effects. - NSAIDs exert antiinflammatory, antipyretic, and analgesic effects. The main use of NSAIDs is for their antiinflammatory effects.
Respiratory depression is a side effect of activation of which central nervous system (CNS) receptors? Mu Beta Alpha Kappa
Mu - Activation of the mu receptors may cause respiratory depression. Activation of these receptors can also cause analgesia, euphoria, and sedation.
Which defects may lead to hyperuricemia? Delayed metabolism of uric acid Enhanced elimination of uric acid Impaired absorption of uric acid Overproduction of uric acid Underexcretion of uric acid
Overproduction of uric acid - Hyperuricemia is generally the result of overproduction of uric acid, underexcretion of uric acid, or both. Underexcretion of uric acid - Underexcretion of uric acid is a potential "defect" that may lead to hyperuricemia.
Which factors increase the incidence of older adults experiencing adverse drug effects (ADEs) from drug therapy? Polypharmacy Cognitive impairment Use of drugs with wide therapeutic index Kidney dysfunction Intact hepatic function
Polypharmacy - Polypharmacy contributes to the increased incidence of ADEs experienced by older adults. Cognitive impairment - Cognitive impairment contributes to the increased incidence of ADEs experienced by older adults. Kidney dysfunction - Altered pharmacokinetics (e.g., decreased kidney function) contributes to the increased incidence of ADEs experienced by older adults.
Which statement accurately describes the pharmacodynamics of probenecid? Probenecid has an onset of action of 2 weeks. The peak concentration of probenecid is reached within 1 hour. Probenecid has a duration of action of 8 hours. Probenecid's elimination half-life is 26.6 to 31.2 hours.
Probenecid has a duration of action of 8 hours. - This statement is accurate. Probenecid's duration of action is 8 hours.
Which phrase describes the unique action of empagliflozin, an SGLT2 inhibitor used for type II diabetes? Stimulates pancreatic beta cell to produce insulin Increases insulin sensitivity in target cells Promotes glucose excretion through the urine Suppresses appetite and slows gastric emptying
Promotes glucose excretion through the urine - SGLT2 inhibitors like empagliflozin help to eliminate glucose in the urine.
A child taking amoxicillin has occasional diarrhea. The parent calls the clinic inquiring if the drug should be stopped. Which response would the nurse provide? Reassure the parent that occasional diarrhea may occur, but the drug should not be stopped because of this response. Tell the parent to stop the drug immediately, and report to the health care provider. Instruct the parent to collect a stool sample, and bring it to the clinic for analysis. Ask the parent to hold the drug for 24 hours and to give oral electrolyte solution.
Reassure the parent that occasional diarrhea may occur, but the drug should not be stopped because of this response. - Occasional diarrhea is a side effect of amoxicillin. Unless the stool is watery or has blood or pus present, the drug should not be stopped.
After the nurse instills ear drops, the patient complains of stinging. Which action would the nurse take? Reassure the patient that this is a typical response. Stop the drug, and notify the health care provider. Dilute the drug with normal saline before giving. Use mineral oil in the ear before giving drops.
Reassure the patient that this is a typical response. - Stinging after administration of ear drops is a typical side effect and will subside quickly.
Which considerations would the nurse use to promote drug adherence in older adults? Recommend simple drug regimens Speak in a sharp tone of voice Use a font with sanserif, or "no feet and tails Recommend keeping a drug list in purse or wallet Ask the pharmacy to provide containers that are easy to open
Recommend simple drug regimens - The nurse would recommend the health care provider simplify the drug regimen for the older adult (i.e., use combination drugs to reduce the number of pills the patient takes or use long-acting formulations to reduce the number of doses per day). Recommend keeping a drug list in purse or wallet - The nurse would instruct the patient to keep a list of all drugs and bring it to all health appointments; the nurse would also advise the older adult to keep a copy of the list in their wallet or purse. Ask the pharmacy to provide containers that are easy to open - The nurse would ask the pharmacist to label drug containers using a large print size and provide containers that are easy to open by patients with impaired strength and dexterity (e.g., those with arthritis).
The nurse would monitor a postoperative ophthalmic surgery patient for which outcome after administering loteprednol? Lowered intraocular pressure in affected eye Reduced postoperative pain and inflammation Promotion of the flow of tears through the lacrimal duct Decreased risk for superficial infection caused by surgery
Reduced postoperative pain and inflammation - Reduction of pain and inflammation is the goal of using loteprednol after surgery.
Opioids primarily activate the mu receptors, causing which effects? Itching Nausea Sedation Euphoria Analgesia Bradycardia
Sedation - Activation of mu receptors causes sedation. Patients should be instructed to avoid alcohol or other sedating medications while taking morphine. Euphoria - Activation of mu receptors causes euphoria. This leads to the potential for abuse, making morphine a controlled substance. Analgesia - Activation of mu receptors causes analgesia. This is the primary indication of morphine, to treat moderate to severe pain.
To reduce the incidence of polypharmacy, on which factors would the nurse educate an older adult? Side effects of their drugs Interactions of each drug The name and appearance of their drugs Therapeutic effects of their drugs Altering drug therapy based on symptoms
Side effects of their drugs - Older adults should be educated on the name, appearance, therapeutic effects, and side effects of each drug. Interactions of each drug - Older adults should be educated on potential adverse effects and interactions of each drug. The name and appearance of their drugs - Older adults should be educated about the name and appearance of their drugs. Therapeutic effects of their drugs - Older adults should be educated on the name, appearance, therapeutic effects, and side effects of each drug.
A 59-year-old patient is prescribed colchicine 0.6 mg PO BID to manage gouty symptoms. In addition to colchicine, the patient has been taking pantoprazole for gastroesophageal reflux disease (GERD), lithium for bipolar disorder, theophylline for asthma, and simvastatin for dyslipidemia, with no changes for over 5 years. Which of the patient's current drugs would cause the nurse to report a potentially serious drug interaction should it be administered with colchicine? Lithium Pantoprazole Simvastatin Theophylline
Simvastatin - Statins like simvastatin can increase the risk for myotoxicity when given with colchicine. Ideally this combination should be avoided. Perhaps the health care provider can consider another antigout therapy that does not interact with the statin.
A patient comes to the emergency department complaining of eye pain and excessive tearing. The nurse suspects eye trauma and secures fluorescein sodium drops. Which is the rationale for using fluorescein? Stains the eye for better visualization Dilates the pupil for clear internal analysis Anesthetizes the eye to decrease sensitivity Lubricates and provides eye moisture
Stains the eye for better visualization - This dye temporarily stains the eye yellow-green. Under a slit lamp, a scratch or foreign object can be readily seen.
Which action of sulfonylurea drugs lowers the elevated blood glucose levels in patient with type II diabetes? Stimulates release of insulin from pancreas Suppresses glucose output from liver Lowers the postprandial production of glucagon Facilitates glucose elimination in the urine
Stimulates release of insulin from pancreas - Sulfonylureas act primarily on the release of insulin from the pancreas, which lowers blood glucose levels.
Which statements accurately describe the actions glucocorticoids exert in the inflammatory process? Stimulation of erythroid cells Maintenance of sodium levels in the blood Reduction of interleukin-1 release from white blood cells Promotion of protein metabolism, glycogen production, and fat redistribution Stabilization of lysosomal cell membranes to reduce capillary permeability and leukocyte migration
Stimulation of erythroid cells - Glucocorticoids are able to stimulate the erythroid cells that eventually become red blood cells. Reduction of interleukin-1 release from white blood cells - Glucocorticoids modulate the inflammatory response by reducing interleukin-1 release from white cells to decrease fever. Promotion of protein metabolism, glycogen production, and fat redistribution - They promote protein metabolism, glycogen production, and fat redistribution from peripheral to central areas of the body. Stabilization of lysosomal cell membranes to reduce capillary permeability and leukocyte migration - Glucocorticoids stabilize the cell membranes of lysosomes to reduce capillary permeability and cell migration.
A home health nurse is visiting a patient who uses prefilled insulin syringes. Which instruction would the nurse provide regarding the storage of the insulin syringes? Keep insulins syringes in the freezer for long-term use. Place on the kitchen window sill with other medications. Store insulin syringes in refrigerator with needles pointing up. Store upright on the kitchen countertop.
Store insulin syringes in refrigerator with needles pointing up. - Prefilled syringes can be stored in a refrigerator for up to 2 weeks. Keeping the syringe vertical with needle point up will keep medication from clotting in the needle.
Which side/adverse effects and/or laboratory results would a nurse monitor for while a patient is receiving fludrocortisone? Symptoms of Cushing syndrome Swelling in the extremities Increased blood sugars Hypertension Decreased bone mineral density
Swelling in the extremities - Edema is an anticipated side effect of fludrocortisone. Increased blood sugars - Hyperglycemia may occur in patients receiving fludrocortisone and should be monitored more closely. Hypertension - Hypertension may occur with fludrocortisone because it is involved in the regulation of sodium. Decreased bone mineral density - Osteoporosis, which is characterized by decreased bone mineral density, is an anticipated adverse effect associated with fludrocortisone.
A parent calls the health care provider and reports that her 5-year-old daughter took several acetaminophen tablets. Which intervention is appropriate? Tell the parent to administer ibuprofen rather than acetaminophen for the next 48 hours. Tell the parent to schedule an appointment with her pediatrician. Tell the parent to take her daughter to the emergency department. Tell the parent that an overdose would be impossible unless her daughter took several bottles of pills.
Tell the parent to take her daughter to the emergency department. - A child who has taken an overdose of acetaminophen should be evaluated at the emergency department because of the drug's possible toxic effects on the liver.
A patient presents to the emergency department reporting heart palpitations. The patient is flushed, smells of alcohol, and is taking glyburide, a sulfonylurea. Which situation might the nurse suspect based on this clinical presentation? The alcohol is reacting with the glyburide. The patient is having acute coronary syndrome. The patient is having a hypertensive crisis. The alcohol has caused high blood glucose levels.
The alcohol is reacting with the glyburide. - When alcohol is combined with a sulfonylurea medication such as glyburide, a disulfiram-like reaction may occur or potentiate the hypoglycemic effects of the sulfonylurea. Symptoms of the disulfiram-like reaction include flushing, palpitations, and nausea.
A nurse is providing care to a patient with chronic kidney disease (CKD) who has been prescribed methylprednisolone. Which statement describes the appropriate nursing action for this patient and the rationale for this action? The nurse should administer methylprednisolone because there are no concerns about this drug. The nurse should monitor for side effects because methylprednisolone is renally excreted. The nurse should monitor for side effects because methylprednisolone undergoes biliary excretion. The nurse should call the health care provider because the presence of CKD is a contraindication to treatment with methylprednisolone.
The nurse should monitor for side effects because methylprednisolone is renally excreted. - This patient can cautiously receive methylprednisolone; however, the patient should be monitored for the emergence of side effects from the glucocorticoid because the drug undergoes renal excretion.
The nurse is observing a nursing student administer eye ointment. In which situation would the nurse intervene? The lower eyelid is pulled forward to instill the ointment. Ointment is instilled in the lower cul-de-sac starting from inner canthus to outer eye. The student asks the patient to look up while ointment is inserted. The patient is instructed to keep the eye open for 1 minute.
The patient is instructed to keep the eye open for 1 minute. - Closing the eye, not keeping it open, allows ointment to cover the eye surface. The nurse needs to intervene in this situation.
A patient has been prescribed prednisone 10 mg PO daily for worsening systemic lupus erythematous (SLE). The patient is also on hydroxychloroquine (for SLE) and warfarin (for venous thromboembolism). Which effect does the nurse anticipate will occur if prednisone is administered to this patient? The prednisone will interact with warfarin, increasing the effects of warfarin. The prednisone will interact with warfarin, decreasing the effects of warfarin. The prednisone will interact with hydroxychloroquine, increasing the effects of hydroxychloroquine. The prednisone will interact with hydroxychloroquine, decreasing the effects of hydroxychloroquine.
The prednisone will interact with warfarin, increasing the effects of warfarin. - When prednisone is given with warfarin, it will likely increase the effects of warfarin, increasing the risk for bleeding in this patient. The patient's warfarin will need to be monitored more closely.
Following administration of a nonantidiabetic drug, the patient develops new responses. Which response indicates an urgent need for nursing intervention? The presence of itching and rash Low appetite and fatigue The occurrence of diarrhea and abdominal pain A nonproductive cough and chills
The presence of itching and rash - Itching and rash may indicate a hypersensitivity reaction to the medication and a potential anaphylaxis reaction. The patient with these symptoms would be given the highest priority.
An 18-month-old patient has been started on chemotherapy. Which means are used to adjust the drug dosages? Therapeutic response Drug dosage calculator Plasma drug concentrations Body surface area calculation Extrapolated from adult dosage
Therapeutic response - Drug therapy must be adjusted based on therapeutic response to chemotherapy. Plasma drug concentrations - Drug therapy must be adjusted based on plasma drug concentrations.
Which pharmacokinetic trait is important to consider with oral morphine administration? Has a long half-life Does not cross the placenta Undergoes first hepatic pass Does not cross the blood-brain barrier
Undergoes first hepatic pass - Oral morphine undergoes first hepatic pass, meaning it must be metabolized by the liver before it becomes available to the rest of the body. This results in a higher dose for oral administration compared with parenteral administration.
Which statements regarding aspirin's pharmacokinetics are accurate? Upon oral administration, aspirin is readily absorbed, with 80% to 100% of the drug absorbed. Rectal absorption of aspirin may be delayed if fecal material is present or blood supply is reduced. Aspirin distributes to all body fluids and tissues. It is minimally (25%) protein bound in the body. Aspirin undergoes deacetylation to salicylic acid. Excretion is independent of urinary pH.
Upon oral administration, aspirin is readily absorbed, with 80% to 100% of the drug absorbed. - After oral administration, aspirin is readily absorbed in the small intestines with 80% to 100% of the drug absorbed. Rectal absorption of aspirin may be delayed if fecal material is present or blood supply is reduced. - The presence of fecal material and a reduced blood supply to the rectum may delay absorption, resulting in a week or longer for the therapeutic effects to occur. It is minimally (25%) protein bound in the body. - Aspirin is highly protein bound with 80% to 90% being bound. Aspirin undergoes deacetylation to salicylic acid. - Aspirin's metabolism involves deacetylation to salicylic acid. This undergoes glucuronidation, conjugation, and oxidation.
After administering ophthalmic drops, which instructions would the nurse give the patient? Keep the eyes open for 1 minute. Blink rapidly to distribute the drug. Squeeze the eyes tightly shut. Use punctual pressure for 2 to 3 minutes.
Use punctual pressure for 2 to 3 minutes. - Punctual pressure keeps the drug in the eyes rather than draining through the nasal lacrimal duct.
Which parameters would be assessed in a patient who has been prescribed prednisone? Vital signs Glucose levels Potassium levels Testosterone levels Presence of preexisting edema Skin color, turgor, and temperature
Vital signs - Vital signs are important to assess, particularly blood pressure, because hypertension may occur with glucocorticoid therapy. Glucose levels - Glucose levels should be monitored because of a risk for hyperglycemia with prednisone. Potassium levels Potassium levels should be closely followed when receiving prednisone because of a risk for potassium depletion. Testosterone levels - Testosterone levels are not typically assessed in patients receiving prednisone. Presence of preexisting edema - Determining whether a patient has preexisting edema before glucocorticoid initiation is critical because prednisone may cause or worsen edema. Skin color, turgor, and temperature - Skin color, turgor, and temperature should be assessed because glucocorticoids can cause thinning of the skin.
The nurse is teaching a patient about using timolol for glaucoma. Which safety concerns would the nurse emphasize? When moving from a light room to a dark room, pause a few minutes to allow vision to adjust. Report any drooling or sweating (symptoms of drug overdose) to the health care provider. Use caution when driving because vision may be blurred with this drug. Dizziness may occur with this drug. Move slowly from a sitting to a standing position. Be aware that this drug may cause dry, itchy, or red eyes after use. Development of brown discoloration of the pupil may impair vision.
When moving from a light room to a dark room, pause a few minutes to allow vision to adjust. - Because timolol is a beta-adrenergic blocker, adjustment of the pupil to light is slowed. Use caution when driving because vision may be blurred with this drug. - Blurred vision is a safety concern for the person driving. Using caution and driving at a slower speed may be recommended. Dizziness may occur with this drug. Move slowly from a sitting to a standing position. - Because dizziness is a side effect of timolol, it is important for the nurse to instruct the patient to move slowly from a sitting position to a standing position.
After taking metformin at 0800, in which time frame should the patient expect to take another dose? Within 4 hours Within 12 hours Within 18 hours Within 24 hours
Within 24 hours - Metformin's duration of action is 24 hours, allowing for one daily dosage.
