16 - 19
Which patient undergoing surgery is at greatest risk for an intensified effect from succinylcholine?
A patient receiving gentamicin [Garamycin] 80 mg IV piggyback every 8 hours
A patient is newly prescribed carbamazepine (Tegretol) for seizure control. Which food should the patient be taught to avoid? A. Tomatoes B. Grapefruit juice C. Spinach D. Kiwi fruit
Answer: B Rationale: Grapefruit juice can inhibit the metabolism of carbamazepine
The physician orders a intravenous infusion of cisatracurium (Nimbex) for a patient receiving mechanical ventilation. It is most important for the nurse to take which action before starting the infusion?
Administer lorazepam (Ativan) intravenously
The nurse teaches a patient about bethanechol (Urecholine). Which statement by the patient requires an intervention by the nurse? "The medication should be taken with meals." "Urgency may occur so I should be near a bathroom." "I should plan to take the drug 3 times each day." "This drug may cause a drop in my blood pressure."
Answer: A Rationale: Bethanechol should be taken 1 hour before or 2 hours after meals; nausea and vomiting and gastric upset may occur if bethanechol is taken with meals.
After an intramuscular injection of penicillin, the patient develops severe difficulty breathing and a swollen tongue. Which medication should the nurse prepare to administer? A. Dopamine (Inotropin) B. Epinephrine (Adrenalin) C. Norepinephrine (Levophed) D. Pseudoephedrine (Sudafed)
Answer: B
A patient with multiple sclerosis is prescribed baclofen (Lioresal). The nurse will observe the patient for which intended effect? A. Decreased strength B. Suppression of spasticity C. Improved muscle tone D. Increased muscle resistance
Answer: B Rationale: Baclofen suppresses hyperactive reflexes involved in regulation of muscle movement. The drug will suppress spasticity, which consists of heightened muscle tone, spasm, and loss of dexterity.
A patient taking levodopa/carbidopa (Sinemet) for Parkinson's disease experiences frequent "on-off" episodes (or abrupt loss of effect). Which action by the nurse is best? A. Administer the medication on an empty stomach. B. Instruct the patient to avoid high-protein foods. C. Have the patient increase intake of vitamin B6. D. Discontinue the drug for 10 days (for a "drug holiday").
Answer: B Rationale: Meals high in protein can reduce therapeutic responses to levodopa
A patient is concerned about developing Alzheimer's disease (AD). What should the nurse include in the teaching plan? A. Estrogen replacement therapy improves cognitive functioning. B. No solid evidence supports the use of drugs to prevent AD. C. Naproxen taken daily after age 50 years decreases the risk of AD. D. Daily doses of gingko biloba can prevent cognitive decline.
Answer: B Rationale: No solid evidence indicates that drugs, nutrients, supplements, exercise, cognitive training, or any other intervention can prevent Alzheimer's disease (AD) or can delay cognitive decline.
The nurse cares for a patient receiving pramipexole (Mirapex). The nurse is most concerned if the patient makes which statement? D. "I now use a patch instead of taking birth control pills." C. "Sometimes I just fall asleep without warning." B. "The pills make me sleepy, so I take a nap in the afternoon." A. "I have noticed that this medicine makes me constipated."
Answer: B Rationale: Pramipexole may cause sleep attacks; patients should inform the prescriber and should avoid potentially hazardous activities.
A patient who takes oxybutynin (Ditropan) for an overactive bladder takes an over-the-counter antihistamine for hay fever symptoms. What symptoms should the nurse watch for that would indicate toxicity? A. Cool, moist skin; confusion; and bradycardia B. Dry mouth, increased temperature, and blurred vision C. Hallucinations, increased salivation, and diaphoresis D. Hypothermia, increased respiratory rate, and pupil constriction
Answer: B Rationale: Symptoms of cholinergic antagonist toxicity include dry mouth; blurred vision; photophobia; hyperthermia; respiratory depression; and hot, dry, and flushed skin.
The nurse instructs a patient about taking dantrolene (Dantrium) for muscle spasm. The nurse determines that teaching is successful if the patient makes which statement? A. "It is common to experience insomnia when taking this drug." B. "Prescription muscle relaxants do not cause dependence." C. "I should avoid drinking alcohol while taking this medication." D. "This medication may cause increased saliva and diarrhea."
Answer: C Rationale: Adverse effects of centrally acting muscle relaxants such as orphenadrine include central nervous system (CNS) depression; patients should avoid alcohol and all other CNS depressants.
An elderly patient with skin cancer and hypertension is prescribed levodopa/carbidopa (Sinemet) to treat Parkinson's disease. Which action by the nurse is best? A. Give the medication if the blood pressure is normal. B. Administer the medication as prescribed. C. Ask the patient about the type of skin cancer. D. Hold the medication if the patient is older than 65 years.
Answer: C Rationale: Levodopa can activate malignant melanoma
A patient is prescribed phenytoin (Dilantin) for epileptic seizures. What is a priority nursing action? A. Warn the patient against using alcoholic beverages. B. Tell the patient to take the medication with meals. C. Inform the patient about prevention of gingival hyperplasia. D. Teach the patient to avoid abrupt cessation of treatment.
Answer: D Rationale: All of the interventions should be included in patient teaching; however, the most important is to avoid abrupt cessation of treatment. This could lead to a life-threatening seizure or to status epilepticus.
A patient is prescribed bethanechol (Urecholine) for urinary retention. If the patient exhibits signs of an overdose (e.g., increased salivation and sweating, bradycardia, hypotension), which medication should the nurse administer? A. Acetylcholine (Miochol-E) B. Cevimeline (Evoxac) C. Oxybutynin (Ditropan) D. Atropine (AtroPen)
Answer: D Rationale: Atropine is a selective muscarinic blocking agent that will reverse most signs of toxicity from an overdose of a muscarinic agonist (e.g., bethanechol).
A patient with mild symptoms of Alzheimer's disease is prescribed donepezil (Aricept). Which statement made by the patient indicates a need for further teaching? A. "The drug will improve transmission by neurons in my brain." B. "I may experience an upset stomach while taking this drug." C. "I will take the drug every night at bedtime with a snack." D. "The drug will stop damage to the neurons in my brain."
Answer: D Rationale: Donepezil is a cholinesterase inhibitor that increases the availability of acetylcholine at cholinergic synapses.
A patient is prescribed a dopamine agonist, pramipexole (Mirapex). Which statement made by the patient indicates a need for further teaching? A. "The drug should be taken with food to prevent nausea." B. "I may experience hallucinations while taking this drug." C. "I should rise slowly to prevent dizziness and fainting." D. "This drug will stop the progression of Parkinson's disease."
Answer: D Rationale: Dopamine agonists will improve patients' abilities to complete activities of daily living but are not a cure and will not delay progression of Parkinson's disease.
A patient is receiving dopamine (Inotropin) for treatment of shock. What would indicate to the nurse that the medication is effective? A. Decreased mean arterial pressure B. Gain of 2 kg in 24 hours C. Increased heart rate D. Increased urine output
Answer: D Rationale: Dopamine is used in the treatment of shock
The nurse prepares to administer dantrolene (Dantrium) to a patient. The nurse should assess which value before administration of the medication? A. Serum amylase B. Creatinine clearance C. Blood glucose D. Liver function tests
Answer: D Rationale: Dose-related liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, liver function tests (LFTs) should be performed at baseline and periodically thereafter. LFTs include aspartate and alanine aminotransferases
A nurse is teaching a group of nursing students about neuromuscular blocking agents. For what may these agents be used? (Select all that apply.) a. Analgesia b. Electroshock therapy c. Malignant hyperthermia d. Mechanical ventilation e. Surgery
B D E
Which condition is an indication for the use of succinylcholine [Anectine]?
Facilitation of endotracheal intubation
What is the primary effect of neuromuscular blockers?
Flaccid paralysis
Succinylcholine [Anectine] is contraindicated in a patient with what condition?
Major burns during the emergent phase
Which are adverse effects of alpha blockade? (Select all that apply.) a. Hypertension b. Reflex tachycardia c. Nasal congestion d. Ejaculation e. Hypernatremia
b c e
A patient receives succinylcholine (Anectine) before endotracheal intubation. What would the nurse expect?
Muscle paralysis for 5 to 10 minutes
A patient with acute renal failure requires continuous NM blockade to facilitate oxygenation and mechanical ventilation. Which agent prescribed by the physician should the nurse question?
Pancuronium [Pavulon]
The nurse is caring for a patient receiving inhalant anesthesia and succinylcholine [Anectine]. The patient develops muscle rigidity and a temperature of 105°F. What nursing action is essential?
Prepare to administer dantrolene [Dantrium].
The nurse in the cardiac care unit is caring for a patient receiving epinephrine. Which assessment criterion takes priority in the monitoring for adverse effects of this drug? a. Cardiac rhythm b. Blood urea nitrogen c. Central nervous system (CNS) tremor d. Lung sounds
a
The nurse administering succinylcholine knows that the paralysis effect only lasts a few minutes because of what pathophysiologic action?
Succinylcholine is rapidly degraded by pseudocholinesterase
The following statements about neuromuscular blockers are true except:
The easily cross the placenta.
What is essential for the nurse to confirm before starting vecuronium [Norcuron] as a continuous intravenous infusion?
The patient has been intubated and is on mechanical ventilation
The nurse understands that tubocurarine and other neuromuscular (NM) blockers cannot be given by mouth. What is the rationale for this statement?
They carry a positive charge.
A male patient is being treated for benign prostatic hyperplasia and has stopped taking his alpha-adrenergic antagonist medication because of ejaculatory difficulties. Which medication does the nurse expect the provider to prescribe? a. Alfuzosin (Uroxatral) b. Prazosin (Minipress) c. Silodosin (Rapaflo) d. Tamsulosin (Flomax)
a
A nurse is reviewing nursing actions for emergency treatment of malignant hyperthermia with a group of nursing students. Which statement by a student indicates a need for further teaching? a. "Analgesics should be given to help with muscle pain." b. "Dantrolene helps to slow the metabolic activity in skeletal muscles." c. "If malignant hyperthermia occurs, the succinylcholine must be stopped immediately." d. "The patient may need an intravenous infusion of cold saline."
a
A nurse is teaching parents how to use an Epi-Pen for their child, who has a peanut allergy. Which statement by the parents indicates understanding of the teaching? a. "After using the Epi-Pen, we must go to the emergency department." b. "The Epi-Pen should be stored in the refrigerator, because epinephrine is sensitive to heat." c. "The teacher should call us when symptoms start so that we can bring the Epi-Pen to school." d. "We should jab the device into the thigh until it is empty of solution."
a
A nursing student asks why albuterol, which is selective for beta2 receptors, causes an increased heart rate in some patients. How does the nurse respond? a. "Adrenergic agonists can lose their selectivity when given at higher doses." b. "Bronchodilation lowers blood pressure, which causes a reflex tachycardia." c. "Some patients metabolize the drug differently and have unusual side effects." d. "Systemic effects are intensified with inhaled doses."
a
A patient will begin taking propranolol (Inderal) for hypertension. Which statement by the nurse is important when teaching this patient about the medication? a. "Check your hands and feet for swelling and report that to your provider." b. "It is safe to take this medication with a calcium channel blocker." c. "Stop taking the drug if you become short of breath." d. "Take your pulse and do not take the medication if your heart rate is fast."
a
A patient with asthma uses albuterol (Ventolin) for wheezing. The nurse assesses the patient and notes vital signs of HR, 96 beats per minute; RR, 18 breaths per minute; and BP, 116/78 mm Hg. The patient has clear breath sounds and hand tremors. What will the nurse do? a. Ask the patient how often the inhaler is used. b. Check the patient's blood glucose level. c. Request an order for isoproterenol (Isuprel) to reduce side effects. d. Stop the medication and report the tremors to the provider.
a
A patient with migraines is started on a beta blocker. The nurse explains the benefits of taking the medication for migraines. Which statement by the patient indicates an understanding of the medication's effects? a. "I need to take it every day to reduce the frequency of migraines." b. "I will take it as needed to get relief from migraines." c. "I will take it to shorten the duration of my migraines." d. "I will take this drug when a migraine starts."
a
A patient with pheochromocytoma is admitted for surgery. The surgeon has ordered an alpha- blocking agent to be given preoperatively. What does the nurse understand about this agent? a. It is ordered to prevent perioperative hypertensive crisis. b. It prevents secretion of catecholamines by the adrenal tumor. c. It reduces contraction of smooth muscles in the adrenal medulla. d. It is given chronically after the surgery to prevent hypertension.
a
Because they cause vasoconstriction, alpha1-adrenergic agonists are especially useful for: a. extending the duration of local anesthetics. b. producing mydriasis to facilitate ophthalmic examinations. c. slowing the heart rate in tachycardic patients. d. treating hypertension
a
Small doses of tubocurarine are administered when patients are suspected of having a myasthenia gravis crisis. If the patient develops increased muscle weakness in response to the tubocurarine, the nurse should prepare to administer what kind of drug? a. Cholinesterase inhibitor b. Dopamine agonist c. Ganglionic blocker d. Neuromuscular blocking agent
a
The nurse administering succinylcholine knows that the paralysis effect only lasts a few minutes because of which pathophysiologic action? a. Succinylcholine is rapidly degraded by pseudocholinesterase. b. Succinylcholine is rapidly metabolized by the liver. c. Succinylcholine is rapidly excreted by the kidneys. d. Succinylcholine is rapidly degraded by cholinesterase.
a
The nurse is caring for a patient receiving inhalant anesthesia and succinylcholine [Anectine]. The patient develops muscle rigidity and a temperature of 105°F. Which nursing action is essential? a. Prepare to administer dantrolene [Dantrium]. b. Administer normal saline at 50 mL/hr. c. Administer morphine sulfate to relieve pain. d. Prepare for intubation and mechanical ventilation.
a
The nurse notices significant edema surrounding and proximal to the peripheral intravenous (IV) site where epinephrine is being infused. Which action would the nurse anticipate first? a. Prepare to administer phentolamine [Regitine]. b. Ensure that naloxone [Narcan] is available. c. Institute the protocol for congestive heart failure (CHF). d. Monitor the blood urea nitrogen (BUN), creatinine, and potassium levels.
a
The nurse understands that tubocurarine and other neuromuscular (NM) blockers cannot be given by mouth. What is the rationale for this statement? a. They carry a positive charge. b. They compete with acetylcholine (ACh) for binding sites. c. They cause muscle relaxation. d. They interact with potassium.
a
What is essential for the nurse to confirm before starting vecuronium [Norcuron] as a continuous intravenous infusion? a. The patient has been intubated and is on mechanical ventilation. b. A Foley catheter has been inserted. c. Hourly blood glucose levels have been ordered. d. A nasogastric tube is in place for suction.
a
What is the primary effect of neuromuscular blockers? a. Flaccid paralysis b. Hypotension c. Loss of consciousness d. Reduction in pain
a
A patient is receiving dobutamine (Dobutrex) as a continuous infusion in the immediate postoperative period. The patient also is receiving a diuretic. What adverse drug reactions are possible in this patient? (Select all that apply.) a. Angina b. Dysrhythmias c. Hypotension d. Oliguria e. Tachycardia
a b e
Prior to discharge, the nurse provides teaching related to adverse effects of terazosin [Hytrin] to the patient and caregivers. Which adverse effects should the nurse include in the teaching of this drug? (Select all that apply.) a. Headache b. Hypoglycemia c. Nasal congestion d. Erectile dysfunction e. Orthostatic hypotension
a c d e
A nurse is teaching a nursing student about the two classes of adrenergic agonist drugs. Which statement by the nursing student indicates understanding of the teaching? a. "Catecholamines may be given orally." b. "Catecholamines often require continuous infusion to be effective." c. "Noncatecholamines do not cross the blood-brain barrier." d. "Noncatecholamines undergo rapid degradation by monoamine oxidase."
b
A patient brought to the emergency department requires sutures. The prescriber orders a local anesthetic with epinephrine. The nurse understands that epinephrine is ordered to: a. prevent hypertension induced by the anesthetic. b. prolong absorption of the anesthetic. c. reduce anesthetic-induced nausea. d. reduce the pain of an injection.
b
A patient is receiving a drug that blocks alpha1-adrenergic receptors. Which adverse effect, if experienced by the patient, is of most concern to the nurse? a. Nasal congestion b. Orthostatic hypotension c. Inhibition of ejaculation d. Reflex tachycardia
b
A patient is taking a beta-adrenergic antagonist medication for angina pectoris and asks the nurse how the drug works to relieve the discomfort associated with this condition. Which statement by the patient after the nurse's teaching indicates understanding of the drug's effects? a. "It causes bronchodilation, which increases oxygen flow." b. "It helps reduce the heart's oxygen needs." c. "It improves blood flow to the heart." d. "It increases cardiac output."
b
A patient is to be discharged home with a new prescription for prazosin [Minipress]. Which statement is most important for the nurse to include in the teaching plan? a. "You should increase your intake of fresh fruits and vegetables." b. "You should move slowly from a sitting to a standing position." c. "Be sure to wear a Medic Alert bracelet while taking this medication." d. "Take your first dose of this medication first thing in the morning."
b
A patient taking a beta blocker complains of shortness of breath. The patient has respirations of 28 breaths per minute, a blood pressure of 162/90 mm Hg, and a pulse of 88 beats per minute. The nurse auscultates crackles in all lung fields. The nurse understands that these assessments are consistent with: a. bronchoconstriction. b. left-sided heart failure. c. rebound cardiac excitation. d. sinus bradycardia
b
A patient with hepatitis requires endotracheal intubation. Which agent does the nurse expect to be administered to facilitate this procedure? a. Atropine b. Cisatracurium (Nimbex) c. Rocuronium (Zemuron) d. Vecuronium (Norcuron)
b
A patient with type 2 diabetes mellitus is diagnosed with stable angina. Which beta blocker, if prescribed by the physician, would the nurse question? a. Metoprolol [Lopressor] b. Nadolol [Corgard] c. Bisoprolol [Zebeta] d. Atenolol [Tenormin]
b
After an intramuscular injection of penicillin, a patient develops severe difficulty breathing and a swollen tongue. Which medication should the nurse prepare to administer? a. Dopamine [Inotropin] b. Epinephrine [Adrenalin] c. Norepinephrine [Levophed] d. Pseudoephedrine [Sudafed]
b
Dopamine is administered to a patient who has been experiencing hypotensive episodes. Other than an increase in blood pressure, which indicator would the nurse use to evaluate a successful response? a. Decrease in pulse b. Increase in urine output c. Weight gain d. Improved gastric motility
b
The following statements about neuromuscular blockers are true except: a. they cannot be absorbed by the GI tract. b. they easily cross the placenta. c. they cannot cross the blood-brain barrier. d. they have no effect on the CNS.
b
The nurse cares for a patient with asthma who uses an albuterol (Ventolin) metered-dose inhaler. The nurse is most concerned if the patient makes which of the following statements? a. "The medicine in the inhaler helps me to breathe." b. "I can use the inhaler as often as needed." c. "My hand starts to shake after I use the inhaler." d. "If the inhaler doesn't work, I should dial 911."
b
The nurse identifies which patient as being most at risk for developing complications if succinylcholine [Nimbex] is used? a. A patient with a recent history of malignant hypertension b. A patient with full-thickness burns to the chest and legs c. A patient with multiple sclerosis and severe depression d. A patient with sepsis who is receiving gentamicin [Garamycin]
b
The nurse is caring for a patient receiving propranolol [Inderal]. Which clinical finding is most indicative of an adverse effect of this drug? a. A heart rate of 100 beats/min b. Wheezing c. A glucose level of 180 mg/dL d. Urinary urgency
b
The physician orders a intravenous infusion of cisatracurium [Nimbex] for a patient receiving mechanical ventilation. It is most important for the nurse to take which action before starting the infusion? a. Teach the patient relaxation exercises. b. Administer lorazepam [Ativan] intravenously. c. Assess the patient for the presence of a gag reflex. d. Check if the patient is allergic to aminoglycosides.
b
Which patient undergoing surgery is at greatest risk for an intensified effect from succinylcholine? a. A patient who takes aspirin 81 mg orally daily b. A patient receiving gentamicin [Garamycin] 80 mg IV piggyback every 8 hours c. A patient taking isosorbide mononitrate [Imdur] 60 mg orally daily d. A patient receiving a continuous infusion of normal saline solution
b
Which statement made by the patient indicates understanding of teaching related to a new prescription for atenolol [Tenormin]? a. "I will increase my fluids to prevent constipation." b. "I will not stop taking this medication abruptly." c. "I will take the first dose of this medicine at night." d. "I will wear sunscreen and a hat when I work in the sun."
b
Why does the nurse anticipate administering metoprolol [Lopressor] rather than propranolol [Inderal] for diabetic patients who need a beta-blocking agent? a. Metoprolol is less likely to cause diabetic nephropathy. b. Propranolol causes both beta1 and beta2 blockade. c. Metoprolol helps prevent retinopathy in individuals with diabetes. d. Propranolol is associated with a higher incidence of foot ulcers.
b
The nurse is preparing to give terbutaline [Brethine] to prevent preterm labor. Which concepts are important to keep in mind when working with this drug? (Select all that apply.) a. Terbutaline must be given by a parenteral route. b. The selectivity of terbutaline is dose dependent. c. The patient may experience tremor with terbutaline. d. Terbutaline is a sympathomimetic drug. e. Bronchoconstriction is a potential adverse effect of terbutaline.
b c d
A nurse is administering intravenous dopamine (Intropin) to a patient in the intensive care unit. Which assessment finding would cause the most concern? a. Blood pressure of 100/70 mm Hg b. Increased urine output c. Edema at the IV insertion site d. Headache
c
A nurse is caring for a newborn 1 day after delivery. The infant's mother used betaxolol during pregnancy. The nurse will expect to monitor this infant for which condition? a. Hyperglycemia b. Hyperthyroidism c. Respiratory distress d. Tachycardia
c
A nurse is discussing phentolamine (OraVerse) with a nursing student. Which statement by the student indicates the need for further teaching? a. "Phentolamine can be used to block both epinephrine- and norepinephrine- mediated vasoconstriction." b. "Phentolamine can be used to treat pheochromocytoma." c. "Phentolamine is a competitive adrenergic agonist that acts selectively on alpha1 receptors." d. "Side effects of phentolamine may include tachycardia and hypotension."
c
A nurse is teaching nursing students about the use of alpha-adrenergic antagonists. Which statement by the student indicates the need for further teaching? a. "Alpha-adrenergic antagonists block alpha1 receptors on arterioles and veins." b. "Dilation of arterioles has a direct effect on arterial pressure." c. "Dilation of veins by alpha-adrenergic antagonists improves cardiac output." d. "Venous dilation by alpha-adrenergic antagonists indirectly lowers arterial pressure.
c
A patient is admitted to the intensive care unit for treatment of shock. The prescriber orders isoproterenol (Isuprel). The nurse expects this drug to increase tissue perfusion in this patient by activating: a. alpha1 receptors to cause vasoconstriction. b. alpha1 receptors to increase blood pressure. c. beta1 receptors to cause a positive inotropic effect. d. beta2 receptors to cause bronchodilation.
c
A patient receives a neuromuscular blocking agent before a procedure. The patient's eyes close. The nurse knows this is a sign that the patient: a. has fallen asleep. b. has received a toxic dose of the medication. c. is beginning to feel the drug's effects. d. may need mechanical ventilation.
c
A patient receives succinylcholine [Anectine] before endotracheal intubation. What would the nurse expect? a. Lethargy and confusion for 30 minutes b. Hypothermia-related seizure activity c. Muscle paralysis for 5 to 10 minutes d. Transient QT interval prolongation
c
A patient will receive atracurium (Tracrium) during surgery for neuromuscular blockade. The nurse caring for this patient will correctly perform which of the following actions? a. Assess the patient for signs of CNS depression. b. Ensure that dantrolene is available in case of a serious adverse reaction. c. Monitor the patient's blood pressure closely. d. Review the preprocedure laboratory values related to renal and hepatic function.
c
A patient with acute renal failure requires continuous NM blockade to facilitate oxygenation and mechanical ventilation. Which agent prescribed by the physician should the nurse question? a. Atracurium [Tracrium] b. Cisatracurium [Nimbex] c. Pancuronium [Pavulon] d. Vecuronium [Norcuron]
c
A patient with type I diabetes is taking NPH insulin, 30 units every day. A nurse notes that the patient is also taking metoprolol (Lopressor). What education should the nurse provide to the patient? a. "Metoprolol has no effect on diabetes mellitus or on your insulin requirements." b. "Metoprolol interferes with the effects of insulin, so you may need to increase your insulin dose." c. "Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely." d. "Metoprolol may potentiate the effects of the insulin, so the dose should be reduced."
c
A pregnant patient with diabetes and hypertension is given isoproterenol (Isuprel) to delay preterm labor. Which side effect might the nurse expect? a. Bronchospasm b. Decreased urine output c. Hyperglycemia d. Hypotension
c
The nurse instructs a patient about doxazosin [Cardura]. Which statement by the patient to the nurse indicates an understanding of the instructions? a. "It is common to have nightmares and insomnia." b. "I need to take the medication on an empty stomach." c. "The medication should be taken tonight before I go to bed." d. "I should stop taking the medication if I feel lightheaded."
c
The nurse is caring for several patients prescribed propranolol [Inderal]. In which patient condition is propranolol [Inderal] contraindicated? a. Cardiac dysrhythmias b. Hypertension c. Diabetes d. Angina
c
The nurse is discussing home management with a patient who will begin taking an alpha- adrenergic antagonist for hypertension. Which statement by the patient indicates understanding of the teaching? a. "I need to stop the medication if my heart rate increases." b. "I should not drive while taking this medication." c. "I should take the first dose at bedtime." d. "I will stop taking the medication if I feel dizzy."
c
The nurse is preparing to administer diltiazem and atenolol. What is the priority nursing intervention before administering these two medications to the patient? a. Obtain blood glucose. b. Observe for lower leg edema. c. Assess the heart rate. d. Apply a pulse oximeter.
c
The nurse is reviewing drugs on the emergency cart with regard to their therapeutic action. Which medications can help initiate heart contraction during a cardiac arrest? a. Topical phenylephrine b. Subcutaneous terbutaline c. Intravenous epinephrine d. Inhaled albuterol
c
Which condition is an indication for the use of succinylcholine [Anectine]? a. Pain relief after major surgery b. Loss of consciousness during surgery c. Facilitation of endotracheal intubation d. Relief of status epilepticus
c
The nurse is preparing to give epinephrine by the IV push route. Which actions are essential before giving this drug? (Select all that apply.) a. Check the blood urea nitrogen (BUN) and creatinine levels. b. Obtain insulin from the medication cart. c. Assess the patency of the IV line. d. Review the allergy history. e. Assess the vital signs.
c d e
A nurse is caring for a patient prescribed doxazosin [Cardura] for hypertension. Safety is a priority because of which associated adverse effect? a. Reflex tachycardia b. Heart palpitations c. Cardiac dysrhythmias d. Orthostatic hypotension
d
A nurse is caring for an intubated patient who is receiving pancuronium for neuromuscular blockade. The patient's eyes are closed, and the patient is not moving any extremities. The heart rate is 76 beats per minute, and the blood pressure is 110/70 mm Hg. The nurse caring for this patient will do what? a. Request an order for an antihistamine to prevent a further drop in blood pressure. b. Request an order for serum electrolytes to evaluate for hyperkalemia. c. Review the patient's chart for a history of myasthenia gravis (MG). d. Talk to the patient while giving care and explain all procedures.
d
A nurse prepares to administer propranolol (Inderal) to a patient recovering from acute myocardial infarction. The patient's heart rate is 52 beats per minute, and the rhythm is regular. What action should the nurse take next? a. Administer the drug as prescribed. b. Request an order for atropine. c. Withhold the dose and document the pulse rate. d. Withhold the dose and notify the prescriber.
d
A nursing student asks the nurse about receptor specificity of adrenergic agonist medications. What will the nurse say? a. "As the dosage of these medications increases, drugs in this class are more selective." b. "Dopamine is selective for dopamine receptors and has no effects on alpha or beta receptors." c. "Epinephrine is the most selective alpha-adrenergic agonist medication." d. "Specificity is relative and is dose dependent."
d
A patient has benign prostatic hyperplasia (BPH) and will receive alfuzosin (Uroxatral). What is an important nursing action when administering this drug? a. Administer the first dose at bedtime to minimize the first-dose effect. b. Prepare the patient for potential ejaculatory dysfunction. c. Request an order for a diuretic to counter the effects of sodium retention. d. Review the patient's chart for liver function tests (LFTs).
d
A patient is receiving dopamine [Inotropin] for the treatment of shock. What would indicate to the nurse that the medication is effective? a. Decreased mean arterial pressure b. Gain of 2 kg in 24 hours c. Increased heart rate d. Increased urine output
d
A patient receives vecuronium [Norcuron] to facilitate mechanical ventilation. Which medication would the nurse administer to reverse muscle paralysis? a. Diazepam [Valium] b. Pralidoxime [Protopam] c. Acetylcysteine [Mucomyst] d. Neostigmine [Prostigmin]
d
Succinylcholine [Anectine] is contraindicated in a patient with which condition? a. Diabetes mellitus b. Hyperthyroidism c. Chronic obstructive pulmonary disease (COPD) d. Major burns during the emergent phase.
d
The nurse is teaching a patient with a history of anaphylaxis how to use an EpiPen. Which statement made by the patient indicates that he understands the proper use of this drug? a. "I will keep my medication in the refrigerator when I'm not using it." b. "I should take this medication within 30 minutes of the onset of symptoms." c. "I must remove my pants before injecting the medication into the leg." d. "I will jab this medication firmly into my outer thigh if needed."
d
The nurse is teaching the patient about atenolol [Tenormin]. Which statement by the patient indicates a correct understanding of the nurse's instruction? a. "I will need to wait for 6 months and then stop this medication." b. "One missed dose will not affect my blood pressure." c. "I may experience occasional chest pain and discomfort." d. "I will not stop taking this drug without the approval of my healthcare provider."
d
The nurse prepares to administer metoprolol [Lopressor] to a patient with chronic stable angina. What is a priority assessment to make before the administration of this medication? a. Temperature b. Urinary function c. Respiratory rate d. Heart rate
d
Which of the following areas of the body shows the effects of tubocurarine last? a. Levator muscle of the eyelids and the muscles of mastication b. Muscles in the lower extremities c. Muscles controlling the glottis d. Muscles of respiration and the diaphragm
d
While preparing a patient for a procedure in which a neuromuscular blocking agent will be used, the nurse reviews the patient's preprocedure laboratory values. Which abnormality would cause the most concern? a. Hyponatremia b. Hypercalcemia c. Hypomagnesemia d. Hypokalemia
d
While preparing a patient for a second esophageal dilation procedure, the nurse explains that succinylcholine (Anectine) will be used for muscle relaxation. The patient is anxious and reports not being able to swallow for several hours after the previous procedure. What will the nurse do? a. Be prepared to provide mechanical ventilation after the procedure. b. Have dantrolene available, because this patient is at increased risk for side effects. c. Reassure the patient that this is expected after neuromuscular blockade. d. Request an order for a pseudocholinesterase level.
d
