Contemporary Pharmacotherapeutics

101. A nurse is assessing a drowsy patient brought to the emergency department by a friend. The patient's eyes are dilated, and his speech is slurred. The friend reports the patient just wanted to experiment and "party" and took Oxycontin. What is the primary source of pain relievers for illicit drug use? A) peer B) drug dealer C) family member D) stranger

C

132. An APN is reviewing the patient information in the state prescription database. The nurse would expect to find records related to which information? A) all prescription medications B) all controlled substance prescriptions C) all narcotic prescription medications D) all schedule C-II and C-III prescriptions

B

134. An APN understands that prescriptive authority and practice are regulated by which entity? A) the state through the Board of Medicine B) the state through legislative authority C) the federal government D) the state through the Board of Nursing

B

14. A patient who has been admitted to the hospital for a mastectomy has stated that she has experienced adverse drug effects at various times during her life. Which of the following strategies should the nurse prioritize in order to minimize the potential of adverse drug effects during the patient's stay in the hospital? A) Administer the patient's drugs in doses that are smaller and more frequent than ordered B) Monitor the patient vigilantly for signs and symptoms of potentially adverse drug effects C) Encourage the patient to bring herbal supplements and complementary remedies with her to the hospital D) Alter the administration of the patient's medications in favor of the intravenous, rather than oral, route.

B

16. A physician has ordered subcutaneous injections of morphine, a narcotic, every 4 hours as needed for pain for a motor vehicle accident victim. The nurse is aware that there is a high abuse potential for this drug and that it is categorized as a A) C-I drug. B) C-II drug. C) C-III drug. D) C-IV drug.

B

18. Which of the following would be the most user-friendly and appropriate source of drug information for a nurse? A) Drug Facts and Comparisons book B) A nurse's drug guide C) A drug package insert D) The Physician's Drug Reference (PDR)

B

24. A nurse is providing a patient with a list of drugs as a part of the patient's plan of care. Which of the following drug nomenclatures should the nurse use to list the drugs? A) The drugs' chemical names B) The drugs' generic names C) The drugs' trade names D) The drugs' biologic name

B

3. In order to promote therapeutic drug effects, the nurse should always encourage patients to A) take their medication with meals. B) take their medication at the prescribed times. C) increase medication dosages if necessary. D) use alternative therapy to increase the effects of their medications.

B

32. On the 1 AM rounds, the nurse finds a patient awake and frustrated that she cannot go to sleep. The nurse administers an ordered hypnotic to help the patient sleep. Two hours later, the nurse finds the patient out of bed, full of energy and cleaning her room. The nurse evaluates the patient's response to the hypnotic as: A) an allergic reaction B) an idiosyncratic response C) a synergistic effect D) a teratogenic effect

B

8. Which of the following activities would the nurse expect to complete during the evaluation phase of the nursing process in drug therapy? A) Compare the outcome expected with the actual patient outcome B) Reconsider core drug knowledge and core patient variables C) Ask questions to prepare an effective patient education program D) Establish a baseline for the patient's treatment and care

A

86. A patient has recently been prescribed a drug that treats his hypertension by blocking the sympathetic receptors in his sympathetic nervous system. This action is characteristic of: A) an adrenergic antagonist B) an adrenergic agonist C) a cardiotonic D) a neurotransmitter

A

90. Which of the following patients is most likely to benefit from the administration of an adrenergic agonist? A) a man who is in cardiogenic shock following a myocardial infarction B) a man who has a diagnosis of primary hypertension C) a woman who has been admitted with a suspected ischemic stroke D) a woman who is in labor and may require a caesarean section

A

1. A nurse has been assigned to care for a 52-year-old attorney who has hypertension and peptic ulcer disease. Before administering his medications, the nurse must complete an initial assessment. Core patient variables will be obtained from which of the following? (Select all that apply.) A) The patient's interview B) The patient's medical history C) The patient's medical record D) The patient's physical examination E) The patient's health insurer

A, B, C, D

22. Which of the following statements best defines how a chemical becomes termed a drug? A) A chemical must have a proven therapeutic value or efficacy without severe toxicity or damaging properties to become a drug. B) A chemical becomes a drug when it is introduced into the body to cause a change. C) A chemical is considered a drug when the Food and Drug Administration (FDA) approves its release to be marketed. D) A chemical must have demonstrated therapeutic value to become a drug.

A

26. A nurse who provides care in a long-term care facility is documenting a new resident's medication regimen on the resident's intake admission. The nurse is documenting the generic, rather than proprietary, names of the resident's current drugs because: A) There is a potential for confusion and miscommunication if proprietary names are used. B) Proprietary names of drugs can vary from state to state. C) Documentation of trade names for drugs requires permission from the manufacturer. D) Drugs with generic names are prescribed and used differently than proprietary drugs.

A

43. A patient with a variety of chronic health problems is being seen by her nurse practitioner, who is currently reviewing the patient's medication regimen. Which of the patient's medications should prompt the nurse to teach her to avoid drinking grapefruit juice? A) Atorvastatin (Lipitor) B) Rabeprazole (Aciphex) C) Vitamin D D) Citalopram (Celexa)

A

79. A priority nursing assessment for a patient who is to receive an alpha- or betaadrenergic antagonist would be to: A) assess heart rate B) check blood glucose level C) measure urine output D) monitor respiratory rate

A

102. Which prescription drug class that is used illicitly will result in increased admissions to publicly funded substance abuse treatment programs and more frequent emergency department admissions? A) pain relievers B) sedatives C) tranquilizers D) stimulants

A

105. When a drug is found to be a look alike/sound alike drug, who is ultimately responsible to approve a name change? A) the Federal Drug Administration B) the manufacturer C) the national pharmacy chain D) national drug distributor

A

108. A nurse is caring for a patient on ASA, warfarin, metpropolol, and acetaminophen. The nurse understands that the utilization of pharmacogenomics is most helpful in managing which medication therapy? Page 30 A) warfarin B) metaprolol C) ibuprofen D) acetaminophen

A

111. Besides seizure type and frequency as well as care plan and treatment goals, which factors are considered when developing a pharmacological treatment plan for epilepsy? A) Patient's insurance status and ability to afford medication therapy. B) Serial CT scans to assess progression or regression of the condition. C) Proposed end date to pharmacotherapy. D) Serial measurements of insulin and thyroid hormone levels.

A

112. A male patient with type 2 diabetes takes metformin for 6 months and lowers his hemoglobin A1c to 7% from 7.8%. Page 31 From a pharmacoeconomic perspective, which type of consequence is this an example of? A) intermediate consequence B) pharmaceutical consequence C) negative consequence D) final consequence

A

113. A nurse practitioner is teaching student nurse how to treat prenatal patients. The student asks why the nurse practitioner did not write a prescription for prenatal vitamins for the newly pregnant patient, and instead told the patient to buy over-the-counter (OTC) prenatal vitamins from any local pharmacy. The nurse practitioner explained that OTC vitamins are the most cost-effective treatment. Which concept of pharmacology is this an example of? A) pharmacoeconomics B) incremental cost C) burden of cost D) pharmacodynamics

A

123. A patient is re-admitted to the ICU with chronic heart failure. The patient has elevated natriuretic peptides and is short of breath at rest. The patient's lungs have crackles bilaterally, and there is 4+ pitting edema in all extremities. The patient takes an ACEi, loop diuretic, digoxin, and nitrates routinely. What are other treatment options for this patient? A) chronic inotropes and heart transplant B) IV potassium and a calcium channel blocker C) hemodialysis D) physical therapy

A

129. What is the best resource for providers to obtain up-to-date information on drug shortages? A) Federal Drug Administration B) mainstream media sources C) physician's desk reference D) Center for Disease Control

A

13. A nurse who provides care on a busy medical unit of a large hospital is constantly faced with new drugs on patients' medication administration records. What strategy should the nurse employ to foster up-to-date information about the nursing management of new or uncommon drugs? A) Focus on learning about a prototype drug that is characteristic of a larger drug class B) Identify similarities between new drugs and older drugs that are commonly used on the unit C) Commit time and energy during each shift to learning about new drugs D) Liaise with pharmacists and pharmacy technicians who work at the hospital

A

15. A surgical patient has been diagnosed with type 2 diabetes during his current admission to the hospital. The nurses and other members of the care team have attempted to engage the patient in education about his new diagnosis, the effects it will have on his lifestyle and the medications that will be necessary to treat it. However, the patient is unwilling to discuss these matters, usually citing fatigue or the desire to watch TV or make phone calls. What potential nursing diagnosis should the nurse prioritize? A) Ineffective coping B) Knowledge deficit C) Acute confusion D) Anxiety

A

2. A 68-year-old female patient who was diagnosed with hypertension 2 weeks ago and was prescribed a new hypertension medication has returned to the clinic for a follow-up visit. The nurse notes that the patient's blood pressure is unchanged from her last clinic visit. When the patient was asked if she was taking the new medication on a regular basis, she stated, "I thought that I was supposed to take the new drug when I had a pounding headache or was in a stressful situation, not all the time." An appropriate nursing diagnosis for this patient would be which of the following? A) Knowledge, deficient due to the lack of understanding of treatment regimen B) Coping, ineffective due to forgetfulness C) Confusion, acute concerning drug administration D) Anxiety due to diagnosis of hypertension Page 4 .

A

46. A nurse is caring for a patient who abuses marijuana. The treatment for marijuana abuse consists mainly of: A) nonpharmacologic interventions combined with an exercise program B) drug therapy with bromocriptine (Parlodel) C) aggressive respiratory assistance D) no nursing action unless the patient experiences a "bad trip"

A

5. A nurse has been assigned the task of preparing educational materials for patients with diabetes. The nurse has included the drug name, the reason the drug was prescribed, the intended effect of the drug, along with important adverse effects that should be reported to the nurse or the health care provider. Which of the following information is essential to include in the educational materials? A) Drug administration method B) Core drug knowledge C) Vital signs of the patient D) Diagnosis and outcome identification mechanism

A

56. A 26-year-old professional began using cocaine recreationally several months ago and has begun using the drug on a daily basis over the past few weeks. He has noticed that he now needs to take larger doses of cocaine in order to enjoy the same high that he used to experience when he first used the drug. A nurse should recognize that this pattern exemplifies: A) drug tolerance B) addiction C) dependence D) withdrawal

A

61. A new immigrant to the United States has come to the clinic. She reports having lived in a crowded, poor urban area. Considering her residence and immigration status, which of the following should the nurse screen for? A) tuberculosis B) malaria C) diabetes D) hypertension

A

62. A traditional Middle Eastern man has type 2 diabetes and is being seen in a primary care clinic with his wife. The nurse would like to provide culturally sensitive education regarding the time of administration of his medication and what he is permitted to eat. The nurse should be careful to: A) direct the conversation to the patient regarding his illness B) educate the patient's wife about his illness C) inform the patient's employer about his illness D) inform the patient's medical insurance provider about his illness

A

68. A 46-year-old white American has been prescribed a drug that binds to acid glycoproteins. The nurse understands that white Americans usually receive: A) a higher-than-normal dose of drugs that bind to acid glycoproteins B) a lower-than-normal dose of drugs that bind to acid glycoproteins C) the recommended normal dose of drugs that bind to acid glycoproteins D) one half the recommended dose of drugs that bind to acid glycoproteins

A

75. A 60-year-old African-American man lives with a number of chronic health problems. Genetic factors are likely to influence his etiology and/or treatment of: A) hypertension B) low bone density C) a seizure disorder D) cardiac arrhythmias

A

76. Which of the following patients should be advised by the nurse to avoid overthe-counter cold and allergy preparations that contain phenylephrine? A) a 47-year-old female with hypertension B) a 52-year-old male with adult-onset diabetes C) a 17-year-old female with symptoms of an upper respiratory infection D) a 62-year-old male with gout

A

94. A 58-year-old female patient with type 2 diabetes and hyperlipidemia schedules an appointment with her primary care provider. Her A1C is 7%, and there are no indications of any complications of diabetes. Her only income is a monthly disability check. She is on the following medications: Metformin 1000 mg PO bid Lisinopril 5 mg PO daily ASA 81 gr PO daily Vitamin D 500/200 1 tab with meals Pravastatin 40 mg. PO hs Niacin 500 mg PO hs Tricor 145 PO hs FeSO4 325 mg. PO daily Sudafed 12 hr. PO bid Cetrizine 10 mg PO daily Bee pollen capsule 1 capsule daily Cinnamon capsule 1 with each meal Which problem could be occurring with this patient related to her medication? A) polypharmacy B) major adverse drug interactions C) overuse of over-the-counter medications D) inappropriate prescriptions

A

54. A nurse is caring for an adolescent who has a history of alcohol abuse. In order to develop a care plan for this patient, the nurse will need to explore and assess which of the following risk factors? (Select all that apply.) A) low self-esteem B) divorced parents C) financial problems D) health concerns E) depression

A, B, E

20. A nurse who is responsible for administering medications should understand that the goals of the MedWatch program are to: (Select all that apply.) A) Provide regular feedback about product safety issues. B) Accredit new medical facilities and hospitals. C) Facilitate the reporting of adverse reactions of drugs. D) Increase awareness of serious reactions caused by drugs or medical devices. E) Report medication errors that occur in hospitals.

A, C, D

163. A 15-year-old adolescent with a history of diabetes is treated in the emergency department for complications related to skipping her medication for diabetes. She confides in the nurse that she deliberately skipped some of her medication doses because she did not want to gain weight and she is afraid of needle marks. Before establishing a diagnosis of "noncompliance," what should the nurse assess? Page 49 A) Whether the patient received adequate teaching related to her medication and expresses an understanding of that teaching. B) Whether the patient was encouraged to skip her medication by a family member or friend. C) Whether the patient is old enough to understand the consequences of her actions. D) Whether the provider will write another prescription because the patient refused to take the medication the first time

Answer: A Rationale: Before establishing a diagnosis of "noncompliance," the nurse must ensure that the client was properly educated about the medication and has made an educated decision not to take it. It is vital to explore all possible factors leading to the noncompliance before establishing this diagnosis. From this client's statements, it is possible that she does not fully understand why the medication was prescribed and the harm of not taking it. Options B, C, and D are incorrect. Although it is not known whether family members or friends had an impact on her decision, an educated client would understand the consequences of a choice to forego medication. Family members should also be included in the client education if there is a concern that the client is not old enough to fully understand.

166. Methyldopa (Aldomet) is being initiated for a client with hypertension. Which health teaching would be most appropriate for this drug? A) Avoid hot baths and showers, and prolonged standing in one position. B) This drug may discolor the urine a pinkish-brown color. C) You may experience bloating and weight gain. D) The tablet should be taken only with food or milk.

Answer: A Rationale: Hot baths and showers, prolonged standing in one position, and strenuous exercise may enhance orthostatic hypotension. Options B, C, and D are incorrect. Methyldopa does not discolor the urine. Bloating and weight gain are not typical adverse effects of methyldopa, and methyldopa can be taken without food

161. A 65-year-old client is prescribed ipratropium (Atrovent) for the treatment of asthma. Which of the following conditions should be reported to the health care provider before giving this client the ipratropium? A) a reported allergy to peanuts B) a history of intolerance to albuterol (Proventil, VoSpire) C) a history of bronchospasms D) a reported allergy to chocolate

Answer: A Rationale: Ipratropium (Atrovent) is contraindicated in patients with hypersensitivity to soya lecithin or related food products such as soybean and peanut. Options B, C, and D are incorrect. A history of intolerance to albuterol or bronchospasms are indications for the ipratropium. A history of allergy to chocolate is not a contraindication for this drug.

143. Clients characterized as slow acetylators may experience what effects related to drug therapy? Page 42 A) They are more prone to drug toxicity. B) They require more time to absorb enteral medications. C) They must be given liquid medications only. D) They should be advised to decrease protein intake.

Answer: A Rationale: Patients classified as slow acetylators do not metabolize drugs as rapidly and increased levels of the drug may accumulate, leading to toxicity. Options B, C, and D are incorrect. Acetylation affects metabolism; it does not affect absorption or protein use.

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

Answer: AC Rationale: Atenolol (Tenormin) decreases blood pressure and heart rate. The administration of this drug may cause significant hypotension and bradycardia in some clients. Options B, D, and E are incorrect. Atenolol is given to treat tachycardia and hypertension as well as angina. Tinnitus and vertigo are not adverse effects associated with atenolol.

154. The client is being discharged with nitroglycerin (Nitrostat) for sublingual use. While planning client education, what instruction will the nurse include? "Swallow three tablets immediately for pain and call 911." "Put one tablet under your tongue for chest pain. If pain does not subside, you may repeat in 5 minutes, taking no more than three tablets." "Call your health care provider when you have chest pain. He will tell you how many tablets to take." "Place three tablets under your tongue and call 911."

Answer: B Rationale: At the initial onset of chest pain, sublingual nitroglycerin is administered and three doses may be taken 5 minutes apart. Pain that persists 5 to 10 minutes after the initial dose may indicate an MI, and the client should seek emergency medical assistance for more definitive diagnosis and care. Options A, C, and D are incorrect. Nitroglycerin sublingual dosing should not be swallowed and no more than one tablet is administered at a time

158. Erectile dysfunction drugs such as sildenafil (Viagra) are contraindicated in clients taking nitrates for angina. What is the primary concern with concurrent administration of these drugs? A) They contain nitrates, resulting in an overdose. B) They decrease blood pressure and may result in prolonged and severe hypotension when combined with nitrates. C) They will adequately treat the patient's angina as well as erectile dysfunction. D) They will increase the possibility of nitrate tolerance developing and should be avoided unless other drugs can be used

Answer: B Rationale: Erectile dysfunction drugs such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) decrease BP. When combined with nitrates, severe and prolonged hypotension may result. Options A, C, and D are incorrect. Erectile dysfunction drugs do not contain nitrates and do not lead to nitrate tolerance. These drugs are not recognized as useful for the treatment of anginal pain

139. The client informs the nurse that he uses herbal compounds given by a family member to treat his hypertension. What is the most appropriate action by the nurse? Inform the client that the herbal treatments will be ineffective. Obtain more information and determine whether the herbs are compatible with medications prescribed. Notify the health care provider immediately. Inform the client that the health care provider will not treat him if he does not accept the use of traditional medicine only.

Answer: B Rationale: Many cultural groups believe in using herbs and other alternative therapies either along with or in place of traditional medicines. The nurse should interpret how these herbal and alternative therapies will affect the desired pharmacotherapeutic outcomes. Options A, C, and D are incorrect. Herbal therapies may be effective in the treatment of disease conditions but may interact with traditional medicines.

149. Nifedipine (Procardia) has been ordered for a client with hypertension. In the care plan, the nurse includes the need to monitor for which adverse effect? A) rash and chills B) reflex tachycardia C) increased urinary output D) weight loss

Answer: B Rationale: Nifedipine (Procardia) may cause hypotension with reflex tachycardia. Options A, C, and D are incorrec

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

Answer: B Rationale: Propranolol (Inderal) and other beta-blocking drugs are used to prevent reflex tachycardia that may occur as a result of treatment with direct-acting vasodilators. Giving two antihypertensive drugs together may also lower blood pressure further; however, the beta-blocking drugs also lower the heart rate and are given in this case to reduce the chance for reflex tachycardia. Options A, C, and D are incorrect

146. The client states that he has been using the herbal product saw palmetto. The nurse recognizes that this supplement is often used to treat which condition? Page 43 A) insomnia B) urinary problems associated with prostate enlargement C) symptoms of menopause D) urinary tract infection

Answer: B Rationale: Saw palmetto is used to relieve urinary problems related to prostate enlargement. Options A, C, and D are incorrect. Saw palmetto is not used to treat insomnia, menopausal symptoms, or urinary tract infections. Soy, evening primrose, and black cohosh are used for menopausal symptoms. Cranberry juice (or the berries) is used to prevent urinary tract infections.

150. The client is taking atenolol (Tenormin) and doxazosin (Cardura). What is the rationale for combining two antihypertensive drugs? A) The blood pressure will decrease faster. B) Lower doses of both drugs may be given with fewer adverse effects. C) There is less daily medication dosing. D) Combination therapy will treat the patient's other medical conditions

Answer: B Rationale: The advantage of using a combination of two drugs such as atenolol (Tenormin; a beta blocker) and doxazosin (Cardura; an alpha-1 antagonist) is that lower doses of each may be used, resulting in fewer side effects. Options A, C, and D are incorrect. With careful dosing, the blood pressure should be gradually lowered to a safe limit. The number of doses per day is dependent on the half-life of the drug, not the combination

162. Which of the following represents an appropriate outcome established during the planning phase? A) The nurse will teach the patient to recognize and respond to adverse effects from the medication. B) The patient will demonstrate self-administration of the medication, using a preloaded syringe into the subcutaneous tissue of the thigh, prior to discharge. C) The nurse will teach the patient to accurately prepare the dose of medication. D) The patient will be able to self-manage his disease and medications

Answer: B Rationale: The outcome statement includes what action the client needs to achieve (self-administration of the medication), the expected performance (using a preloaded syringe into the subcutaneous tissue of the thigh), and when it will be accomplished (by discharge). Options A, C, and D are incorrect.

142. The client informs the nurse that she will decide whether she will accept treatment after she prays with her family and minister. What is the role of spirituality in drug therapy for this client? Irrelevant, because medications act on scientific principles. Important to the client's acceptance of medical treatment and response to treatment. Harmless if it makes the client feel better. Harmful, especially if treatment is delayed

Answer: B Rationale: When clients have strong spiritual or religious beliefs, these may greatly influence their perceptions of illness and their preferred modes of treatment. Ill health and spiritual issues can have an impact on wellness, nursing care, and pharmacotherapy. Options A, C, and D are incorrect. Recognizing the role that spirituality plays in a client's life is important to treating the client holistically. Even if treatment is delayed, it may cause greater harm to force a medication on the client than to wait.

141. The nurse understands that gender issues also influence pharmacotherapy. What are some important considerations for the nurse to remember about these differences? A) Men seek health care earlier than women. B) Women may not seek treatment for cardiac conditions as quickly as men. C) Women are more likely to stop taking medications because of side effects. D) All drug trials are conducted on male subjects.

Answer: B Rationale: Women generally tend to seek health care earlier than men but do not seek treatment for cardiac conditions as quickly as men. The nurse should encourage women to seek prompt treatment for any cardiacrelated symptoms. Options A, C, and D are incorrect. Women tend to seek health care earlier for symptoms and conditions than men but are not more likely to stop taking medications due to side effects.

144. A client undergoing treatment for cancer complains about nausea and fatigue. In approaching this client problem holistically, what actions would the nurse take? (Select all that apply.) A) Give an anti-nausea drug as ordered and place the patient on bed rest. B) Observe for specific instances of nausea or fatigue and report them to the oncologist. C) Take a medication history on the client, noting specific medication or food triggers. D) Talk to the client about the symptoms, the impact they have on daily activities, and techniques that have helped lessen the problem.

Answer: B D Rationale: Taking a holistic approach to pharmacotherapy includes considering environmental, genetic, psychosocial, gender, and cultural influences. Noting any environmental triggers, such as food smells, and asking the client about the effect on lifestyle are holistic approaches that enhance pharmacotherapy. Options A and C are incorrect

152. The nurse is preparing to administer the first dose of enalapril (Vasotec). Identify the potential adverse effects of this medication. (Select all that apply.) A) reflex hypertension B) hyperkalemia C) persistent cough D) angioedema E) hypotension

Answer: BCDE Rationale: Side effects of ACE inhibitors such as enalapril (Vasotec) include persistent cough and postural hypotension. Hyperkalemia may occur and can be a major concern for those clients with renal impairment and in clients who are taking potassium-sparing diuretics. Though rare, the most serious adverse effect of ACE inhibitors is the development of angioedema. Option A is incorrect. Hypotension with reflex tachycardia is a possibility depending on how low or how fast the blood pressure decreases

140. The nurse provides teaching about a drug to an older adult couple. To ensure that the instructions are understood, which of the following actions would be most appropriate for the nurse to take? A) Provide detailed written material about the drug. B) Provide labels and instructions in large print. Page 41 C) Assess the clients' reading levels and have the clients "teach back" the instructions to determine understanding. D) Provide instructions only when family members are present.

Answer: C Rationale: A significant percentage of English-speaking clients do not have the basic ability to read, understand, and act on health information. This rate is even higher among non-English-speaking individuals and older clients. The nurse must be aware of the client's literacy level and take appropriate action to ensure that information is understood. Having the client "teach back" the instruction the nurse has given may ensure that it has been understood.

148. The client has been given a prescription of furosemide (Lasix) as an adjunct to treatment of hypertension and returns for a follow-up check. Which of the following is the most objective data for determining the therapeutic effectiveness of the furosemide? A) absence of edema in lower extremities B) weight loss of 6 lb C) blood pressure log notes blood pressure 120/70 mmHg to 134/88 mmHg since discharge D) frequency of voiding of at least six times per day

Answer: C Rationale: Furosemide (Lasix) was prescribed as an adjunct treatment for hypertension. Blood pressure decrease toward normal limits indicates that the use of this treatment has been effective. Options A, B, and D are incorrect. Although absence of edema, weight loss, and frequency of voiding are related to fluid status and are other effects of furosemide, they are not related to the primary reason this drug was given (adjunctive therapy in hypertension).

155. Nitroglycerin patches have been ordered for a client with a history of angina. What teaching will the nurse give to this client? A) Keep the patches in the refrigerator. B) Use the patches only if the chest pain is severe. C) Remove the old patch before applying a new one. D) Apply the patch only to the upper arm or thigh areas.

Answer: C Rationale: To prevent the development of nitrate tolerance, nitroglycerin patches are often removed at night for 6 to 12 hours. Options A, B, and D are incorrect. The patches should not be kept in the refrigerator unless excessive room temperatures are anticipated and then only under the direction of the pharmacist or health care provider. Nitroglycerin patches provide long-term control of angina and should not be used only when the chest pain is severe.

159. A client with asthma has a prescription for two inhalers, albuterol (Proventil, VoSpire) and beclomethasone (Qvar). How should the nurse instruct this client on the proper use of the inhalers? A) Use the albuterol inhaler, and use the beclomethasone only if symptoms are not relieved. B) Use the beclomethasone inhaler, and use the albuterol only if symptoms are not relieved. C) Use the albuterol inhaler, wait 5-10 minutes, then use the beclomethasone inhaler. D) Use the beclomethasone inhaler, wait 5-10 minutes, then use the albuterol inhaler

Answer: C Rationale: Using a bronchodilating inhaler such as albuterol (Proventil, VoSpire) first, then waiting 5-10 minutes before using an ICS inhaler such as beclomethasone (Qvar), will allow the corticosteroid to reach deeper into the lungs following bronchodilation. Options A, B, and D are incorrect. The two inhalers have been prescribed together to maximize therapeutic effects. Using the beclomethasone before the albuterol may not allow the drug to reach deeply into the lungs for best effects

165. Which method may offer the best opportunity for patient teaching? A) Providing detailed written information when the client is discharged. B) Providing the patient with Internet links to conduct research on drugs. C) Referring the patient to external health care groups that provide patient education, such as the American Heart Association. D) Providing education about the patient's medications each time the nurse administers the drugs.

Answer: D Rationale: Every nurse-patient interaction can present an opportunity for teaching and each time the nurse administers the client's medications is such an opportunity. Small portions of education given over time are often more effective than large amounts of information given on only one occasion. Options A, B, and C are incorrect.

157. The nurse is caring for a client with chronic stable angina who is receiving isosorbide dinitrate (Isordil). Which of the following are common adverse effects of isosorbide? A) flushing and headache B) tremors and anxiety C) sleepiness and lethargy D) light-headedness and dizziness

Answer: D Rationale: Lightheadedness and dizziness may occur secondary to the hypotensive effects of the isosorbide (Isordil). Options A, B, and C are incorrect. The oral form of isosorbide has a slower onset than the sublingual form and flushing and headache are not usually experienced. Tremors, anxiety, sleepiness, or lethargy are not associated effects from the drug and if they occur, other causes should be investigated.

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

Answer: D Rationale: Nadolol (Corgard) may increase the risk of orthostatic hypotension and the client should be taught to rise slowly to standing from a sitting or lying position. Options A, B, and C are incorrect. The drug does not cause constipation and extra fluids and fiber are not required. A weight gain of over 1 kg per day should be reported but a gain of 1 kg per month may be insignificant or unrelated to the drug.

164. Which factor is most important for the nurse to assess when evaluating the effectiveness of a patient's drug therapy? A) the patient's promise to comply with drug therapy B) the patient's satisfaction with the drug C) the cost of the medication D) evidence of therapeutic benefit from the medication

Answer: D Rationale: Once pharmacotherapy is initiated, ongoing assessment is conducted to determine the presence of therapeutic effects or adverse effects. The lack of therapeutic effects should be cause for a re-evaluation of the medication for appropriateness. Options A, B, and C are incorrect. The client's promise to take the medication may involve many factors that affect the willingness to take medication.

167. A client is receiving hydralazine (Apresoline) for elevated blood pressure levels. The nurse would include in the care plan to monitor the client for which adverse effects? A) atelectasis B) crystalluria C) photosensitivity D) orthostatic hypotension

Answer: D Rationale: Orthostatic hypotension is a common adverse effect of vasodilators such as hydralazine. Options A, B, and C are incorrect. Hydralazine does not typically cause atelectasis. Crystalluria is not an adverse effect of hydralazine and it does not cause photosensitivity.

145. The nurse obtains information during the admission interview that the client is taking herbal supplements in addition to prescribed medications. What is the nurse's primary concern for this client? A) Herbal products are natural and pose no risk to the client but may be costly. B) Herbal products are a welcome supplement to conventional medications but do not always come with instructions. C) The client may be at risk for allergic reactions. D) The herbal products may interact with prescribed medications and affect drug action.

Answer: D Rationale: Some herbal products contain ingredients that may serve as agonists or antagonists to prescription drugs. Herbal supplements should not be taken without discussing their use with the health care provider. Options A, B, and C are incorrect. Herbal products may be natural but not all of them are safe or effective and they may vary greatly in cost. Most herbal products, like medications, come with instructions.

160. A client has been using a fluticasone (Flovent) inhaler as a component of his asthma therapy. He returns to his health care provider's office complaining of a sore mouth. On inspection, the nurse notices white patches in the client's mouth. What is a possible explanation for these findings? Page 48 A) The client has been consuming hot beverages after the use of the inhaler. B) The client has limited his fluid intake, resulting in dry mouth. C) The residue of the inhaler propellant is coating the inside of the mouth. D) The client has developed thrush as a result of the fluticasone.

Answer: D Rationale: The client likely has developed a thrush (Candida) infection of the mouth secondary to the use of the corticosteroid inhaler. After the use of ICS inhalers such as fluticasone (Flovent), clients should be taught to rinse the mouth and spit out the residue. Drinking fluids will also prevent irritation, ulcerations, and thrush infections of the throat. Options A, B, and C are incorrect

168. A client with hypertensive crisis is started on nitroprusside (Nipride) therapy. The nurse would perform what priority intervention during the course of this treatment? A) Monitor for the presence or absence of bowel sounds. B) Obtain urine samples for specific gravity measurements and glucose levels. C) Observe skin pressure points for turgor and integrity. D) Titrate intravenous infusion rate according to the blood pressure response

Answer: D Rationale: The nurse will titrate (adjust) the rate of infusion based on the client's blood pressure. Options A, B, and C are incorrect. Listening for bowel sounds in the client with hypertensive crisis is not a nursing priority. Urine specific gravity and glucose levels may be obtained but are not associated with hypertensive crisis or the administration of this drug. Observing skin pressure points is a nursing intervention that does not directly relate to hypertensive crisis or nitroprusside therapy.

147. An older adult client tells the nurse that she has been using several herbal products recommended by a friend. Why would the nurse be concerned with this statement, given the age of the client? The older adult client may have difficulty reading labels and opening bottles and confuse medications. The older adult client may have difficulty paying for additional medications and stop using prescribed drugs. The older adult client may be more prone to allergic reactions from herbal products. The older adult client may have other disease conditions that could increase the risk for a drug reaction.

Answer: D Rationale: The older adult client is more likely to have chronic ailments such as renal, cardiac, or hepatic disease that could increase the risk for a drug-herb interaction. Options A, B, and C are incorrect. Not all older adult clients have difficulty with reading labels, opening bottles, or financial concerns that would affect the ability to obtain prescribed medication. When these situations occur, the nurse should assess the impact they have on the client's ability to safely take medication.

100. A 56-year-old male morbidly obese patient with a 40-year history of smoking is in a clinic. The patient is short of breath when asking his medication questions and is not able to sit in the patient chair due to body size. What will increase the APN's effectiveness of medication education? A) Utilizing the teach-back method to ensure the patient is understanding you in this situation. Page 28 B) Meeting the needs of the patient before providing education. C) Giving written medication information so the patient can look it over when they feel better. D) Involving family members that are symptom free and who can easily learn about the medications.

B

103. A 72-year-old male develops a rash after one day of treatment with amoxicillin for acute otitis media. What is the next drug that the nurse should consider to treat this patient's acute otitis media? A) Levaquin B) Omnicef C) Bactrim D) Augmentin

B

114. The parent of an 8-year-old female patient being treated for asthma asks a nurse practitioner why Albuterol is the drug covered by her insurance plan when Xopenex has fewer side effects. Her daughter frequently reports tachycardia and tremor following albuterol neublizer treatment. The nurse practitioner explains that Xopenex is significantly more expensive, and it is frequently not covered. What is the most likely reason that Xopenex is not covered by many insurance companies? A) Xopenex is a new drug, and many insurance companies are not familiar with it. B) Outcomes for the two drugs are the same and therefore the increased cost is not justified. C) Insurance companies are concerned with the excessive cost since asthma is very common. D) Xopenex has a higher incidence of allergic reactions, which increases cost of coverage.

B

118. A patient is in the preoperative area for a carpal tunnel release. During the interview, the patient states that he is a past opioid abuser and has a narcotic contract with his primary care physician. What is a treatment option for this patient to avoid the use of intraoperative narcotics? A) hypnotism B) a Bier block and toradol C) defer surgery until patient can be screened for drug abuse D) PO Tylenol

B

120. A 69-year-old patient comes to a clinic with the complaint of increased forgetfulness. In the patient interview, the nurse notices that the patient has a history of falling and poor recall and has been diagnosed with CHF and Parkinson's disease. The patient takes several medications daily and is on a fixed income. Which consideration must be made for this patient and the treatment plan? A) Communication only with the patient is imperative to agree on a plan of care. B) Education, communication, and planning with a designated caregiver are key. C) Institutionalization is the next step to safely manage this patient's disorder and medications. D) The patient's medications need to be discontinued because of the patient's poor memory and increased risk of overdose.

B

121. A patient with a BMI of 42 has an allergy to insect bites and a history of anaphylactic shock. The nurse prescribes an EpiPen for the patient to carry at all times. Which consideration should be made in this treatment plan? Page 34 A) If the patient has a fast heart rate and trembling after an injection, the patient should consider epinephrine as an allergy. B) Two doses of the EpiPen should be used. C) The patient should never self-administer the EpiPen. D) The EpiPen should be used even if it is expired.

B

124. The nurse is reviewing discharge papers for a patient who is hospitalized because of a life-threatening adverse drug event. The nurse understands that this is a qualifying event for MedWatch, the FDA adverse drug report monitoring system. Which additional information does the nurse also understand? A) The prescriber does not have to report the adverse event to MedWatch since no permanent damage or death resulted. B) No specific member of the healthcare team is responsible to report, as participation in MedWatch is voluntary. C) The prescriber is legally responsible to report the adverse event to MedWatch. D) Any licensed practitioner who cares for the patient is legally responsible to verify that the event was reported to MedWatch.

B

127. What is the role of the Center for Drug Evaluation and Research (CDER)? A) To inform patients about purchasing their own supply of drugs in short supply. B) To address drug shortages that have a significant impact on public health. C) To oversee manufacturing and storage of drugs made in the United States. D) To oversee pricing of drugs being manufactured and sold in the United States

B

35. A nurse is instructing a patient concerning a newly prescribed drug. Which of the following should be included to help improve patient compliance and safety? A) A list of pharmacies where the drug can be obtained. B) Measures to alleviate any discomfort associated with adverse effects. C) The cost of the brand drug compared with the generic form. D) Statistics related to phase III of testing for the prescribed drug

B

36. A nurse is caring for a patient who is experiencing nausea and vomiting from chemotherapy. Which of the following would be an appropriate nursing diagnosis for this patient? A) Infection: Risk for related to drug-induced bone marrow suppression. B) Nutrition: Imbalanced: Less Than Body Requirement related to adverse effects of drug. C) Poisoning: Risk for related to use of a drug with a narrow therapeutic index. D) Nutrition, Imbalanced: More Than Body Requirement related to adverse effects of drug.

B

38. A home health nurse notes that there have been changes to a patient's oral drug regimen. The nurse will closely monitor the new drug regimen to: A) Track the exact route of metabolism as a research project. B) Identify any changes in drug absorption that would change the drug effect. C) Monitor only for the adverse effect of immunotoxicity. D) Determine the speed of chelation

B

42. A nurse who provides care for older adults is aware of the high incidence of drug interactions in this population. When educating a group of seniors about the prevention of drug interactions, the nurse should encourage them to: A) Take their medications with food unless otherwise instructed. B) Consult their care provider before taking new over-the-counter medications. C) Maintain a healthy, high-fluid diet, and high levels of physical activity. D) Ensure that there is at least 90 minutes between doses of different drugs

B

47. A nurse is working in the emergency department and is assigned to a patient brought in by family members. The family thinks that the patient is on methamphetamine. Which of the following will the nurse assess for? A) increased appetite B) hypertension C) bradycardia D) stupor

B

49. A patient has been admitted to the hospital with acute cocaine intoxication. Family members are present and are observing prolonged seizure activity. The family is upset and asks the nurse how long the patient will experience the seizures. An appropriate response by the nurse would be: A) "Not long, he should be fine in a few minutes." B) "It's very hard to tell, but the seizure activity might not end right away." C) "It is possible that the seizure activity could last a week or more." D) "Once a person has had a seizure there is always a possibility of other seizures."

B

53. A patient is suffering from acute inhalant intoxication. The priority nursing intervention will be to: A) administer epinephrine B) administer oxygen therapy C) provide an emesis basin D) assess the patient's psychosocial status

B

55. A patient has been hospitalized for treatment of substance abuse after being arrested and jailed for the past 24 hours. The patient is experiencing severe muscle and abdominal cramps, seizures, and acute psychosis due to abrupt withdrawal. Which of the following drug classes is the most likely cause of these severe and potentially fatal withdrawal symptoms? A) amphetamines B) sedative-hypnotic drugs C) benzodiazepines D) opioids

B

57. A 33-year-old man has been a chronic abuser of alcohol for several years and has been admitted to the emergency department many times because of the consequences of his alcohol use. Most recently, he has been brought in by emergency medical services after being found unconscious outside a local mall. The nurse who is admitting the patient should prioritize what assessments? A) Assessing the patient's patterns of dependence and coping strategies. B) Assessing neurological status and assessing for electrolyte imbalances. C) Assessing for impaired nutrition. D) Assessing for possible interactions between alcohol and other drugs.

B

64. A nurse is caring for a 46-year-old patient of Chinese origin who has bipolar disorder. The physician has prescribed lithium carbonate (Eskalith) to treat the disorder. The nurse is aware that the lithium dose will likely be given in a: A) higher-than-normal dose B) lower-than-normal dose C) child's dose D) weight-based protocol dose

B

7. The nurse has been assigned a 49-year-old patient who has acute colitis, and the nurse just completed gathering data concerning core drug knowledge and core patient variables. To implement nursing management of drug therapy for this patient, the nurse will then A) evaluate the outcome of the drug therapy. B) devise strategies to maximize the therapeutic effects of the drug. C) implement planned nursing actions. D) assess for data that will indicate interactions between core drug knowledge and core patient variables.

B

71. A nurse is providing care for a 71-year-old woman who was sponsored to emigrate from Mexico to the United States 6 months ago. Earlier this week, the woman slipped while getting off a bus and fractured her hip. How should the woman's nurse best exemplify cultural competence in the care of this patient? A) Ensure that the woman receives care solely from Spanish-speaking caregivers. B) Consider dimensions of the woman's cultural background when planning care. C) Integrate teaching about American culture when interacting with the patient. D) Address the woman's children first when explaining her care and changes in her health status.

B

78. A nurse is caring for a patient who is taking metoprolol (Lopressor). Which of the following statements would indicate that teaching by the nurse concerning the betaadrenergic antagonist has been effective? A) "I may have a very dry mouth while taking this drug." B) "I should never stop taking this drug abruptly." C) "I can stop walking a mile a day." D) "Since I am taking this drug, I no longer need to worry about my diet."

B

83. A patient is prescribed regular doses of epinephrine. Which of the following nursing diagnoses is related to comfort and would be most appropriate for this patient? A) Imbalanced Nutrition: Less Than Body Requirements B) Disturbed Sleep Pattern, Insomnia Related to CNS Excitation C) Disturbed Sensory Perception D) Ineffective Tissue Perfusion

B

85. A nurse is caring for a patient in the critical care unit. Phentolamine (Regitine, OraVerse) has been ordered for the management of tissue necrosis caused by extravasation of parenterally administered drugs. Before administering this drug, the nurse will check the patient's chart for indications of: A) peptic ulcer disease B) history of acute myocardial infarction C) diabetes mellitus D) obesity

B

88. A 73-year-old man was diagnosed with Parkinson disease earlier this year and has begun taking carbidopa-levodopa four times daily in an effort to control the signs and symptoms of the disease. The nurse should recognize that this therapeutic effect is achieved by influencing the: A) uptake of acetylcholine B) dopamine receptors in the brain C) synthesis of epinephrine D) sensitivity of beta-2 receptors

B

89. A resident of a long-term care facility receives 12.5 mg metoprolol (Lopressor) at 8 AM and 8 PM daily. Before administering this drug, the nurse should perform and document what assessments? A) oxygen saturation and respiratory rate B) heart rate and blood pressure C) level of consciousness and pain level D) temperature and respiratory rate

B

96. A nurse practitioner is heading a committee to help decrease drug misuse and abuse in the free clinic where she works. Patients who are "drug seeking" for narcotics are the most prevalent problem. The nurse practitioner knows that the prevalence of drug seeking in clinics is likely a result of which act that prohibits internet sales of narcotics? A) Alger Hiss Act B) Ryan Haight Act C) James Zardroga Act D) Volstead Act

B

117. A 14-year-old patient is brought to the emergency department unconscious by her friend's mother. The patient's medical records show previous labs indicating beta cell destruction and a previous admission with ketoacidosis. The patient's blood glucose is 743. Which three drug therapies are appropriate? A) one amp of D50 B) IV normal saline bolus C) lactated ringers IV bolus D) glucagon E) insulin F) Kayexalate G) potassium

B, E, G

116. A 3-year-old patient presents symptoms of a sinus infection, coughing, and wheezing. The patient's mother states that immune deficiencies run in the family. Which two medications may be helpful for this patient's condition? A) over-the-counter cold medication B) antibiotic for sinus infection C) albuterol SVN D) daily fiber supplements E) racemic epi SVN

B,C

106. A 69-year-old female patient is being discharged from the hospital with instructions to continue her previous medications of ASA, furosemide, potassium, and lisinopril. She is instructed to add lanoxin 0.25 mg daily and aceteminophen 500 mg 1-2 tablets every six to eight hours as needed for pain. The APN calls the prescribing healthcare provider to verify the dose of acetominophen. This scenario exemplifies which type of action? A) Identifying potential and actual drug-related problem. B) Resolving actual drug-related problem. C) Preventing potential drug-related problem. D) Monitoring drug-related problem.

C

107. What is an example of how medication shortages affect patients? A) A patient has to purchase generic ibuprofen because Advil is unavailable. B) A patient dies from sepsis since there is no antibiotic sensitive to an identified pathogen. C) A woman has a miscarriage because Rhogam is unavailable. D) Lisinopril is substituted for Prinivil because Prinivil is unavailable from any manufacturer.

C

109. An APN orders a non-formulary medication for a patient. What is a possible problem with ordering non-formulary drugs? A) medication that is non-FDA approved B) receiving substandard medication C) delay in receiving medications D) increased possibility of counterfeit medication

C

115. Which scenario best supports the use of a pharmacoeconomic evaluation when comparing the following options? An APN is asked by a physician in the same practice to research the quality of life measures for two of the most popular drugs prescribed for rheumatoid arthritis. The A) physician would like to know how Drug A compares to Drug B from anecdotal evidence of patients who have used each, specifically qualitative measures regarding how much the patients' quality of life has improved after 6 months of therapy on each Page 32 drug. An APN is asked by a physician in the same practice to research the biochemical B) method by which a certain antiemetic drug (Drug A) works, compared to another drug (Drug B) whose off-label use would be as an anti-nausea medication. The APN is asked to provide a side-by-side comparison of all possible contraindications of each drug. An APN is collaborating with hospital administrators to help decide what C) chemotherapy drug should be on the formulary. Drug A is well-tolerated, effective, and expensive. Drug B is also effective, but has more side effects, and is significantly less expensive. The administrators have asked the APN to research data supporting the additional cost of Drug A. An APN is asked by a patient for a comparison of Birth Control Pill A with Birth D) Control Pill B. Specifically, the patient would like to know the side-effects of each pill, as well as how often each must be taken, and the efficacy of each at preventing pregnancy.

C

119. A 44-year-old male patient presents with shortness of breath, diaphoresis, and tachycardia. During the patient interview, the nurse finds that the patient has smoked a pack of cigarettes per day for 30 years. The nurse notices clubbing on the patient's fingers. The patient states that his last doctor put him on a long-acting bronchodilator, but that he is still short of breath with daily activities. Which intervention with this diagnosis can reduce mortality? A) Metoprolol B) niacin C) oxygen therapy D) incentive spirometry

C

12. The nurse's assessment of a community-dwelling adult suggests that the client may have drug allergies that have not been previously documented. What statement by the client would confirm this? A) "I tend to get sick in the stomach when I take antibiotics." B) "I've been told that aspirin might have caused my stomach bleed a few years back." C) "I broke out in hives and got terribly itchy when I started a new prescription last year." D) "When I fell last year, the doctor said that it might have been because of my blood pressure pills."

C

122. A 26-year-old male patient was in a motorcycle accident one year earlier, resulting in a traumatic brain injury. He is now living at home with constant care from his family. This patient arrives in the emergency department via ambulance with massive muscle spasms alternating with muscle relaxation, loss of consciousness, and incontinence. What is the FIRST appropriate pharmacological intervention for this patient? A) ehenytoin or fosphenytoin IV B) epinephrine IV C) lorazepam or diazepam IV D) atropine IV

C

125. Which action should a nurse take as a provider at a large oncology infusion unit when made aware that there is a shortage of the drug Doxil that is currently received from Janssen Products? A) Alert the FDA so legal action can be taken against Janssen. B) Alert the FDA and begin to dilute the concentration of Doxil on hand so the supply will last longer. C) Report the shortage to the FDA so the underlying cause for shortage can be addressed. D) Alert the FDA so production of the drug can be increased.

C

126. Which type of communication is imperative to decrease drug shortage-related issues? A) communication between patients and providers B) communication between the FDA and the White House C) communication between the public and the FDA D) communication between the Surgeon General and the FDA

C

133. Which measure has the federal government taken in an effort to reduce prescription drug abuse? A) defers the decision for monitoring controlled substances to pharmacists B) defers the decision for monitoring controlled substances to individual prescribers C) defers the decision for monitoring controlled substances to each state D) requires each state to have a controlled substance monitoring program

C

135. Which objective is the American Academy of Nurse Practitioners seeking to achieve by encouraging all states to provide unrestricted prescriptive authority to nurse practitioners? A) To acknowledge the advanced training and education of nurse practitioners. B) To allow nurse practitioners to practice in a variety of settings. C) To provide comprehensive healthcare services. D) To encourage equality with physician counterparts.

C

60. A 22-year-old woman has given birth to an infant who exhibits the signs and symptoms of maternal cocaine use during pregnancy. These signs and symptoms are a result of what pathophysiological effect of cocaine use during pregnancy? A) Changes in blood chemistry as a result of nephrotoxicity and hepatotoxicity. B) Impaired maternal nutrition as a result of drug use. C) Vasoconstriction leading to reduced placental blood flow. D) Hypoxia as a result of a prolonged second stage of labor

C

137. A nurse is doing clinical rotations at a family health clinic that has a large population of adolescent patients. What is the nurse's role as the healthcare provider in regards to substance abuse when performing assessments on adolescents? A) The nurse should tell the patient that you will detect any drugs in the system at the next physical to prevent the patient from experimenting with them. B) The nurse should not approach the subject of substance abuse unless the patient has physical signs of abuse. C) The nurse should try to elicit information from all school-aged patients regardless of the patient's age or appearance. D) The nurse should instruct the school guidance counselor to address the topic as it is not the role of the provider to discuss substance abuse.

C

138. A 50-yr-old male patient complains of frequent heartburn after dinner and states that he "eats Tums all night long" most nights. The antacid does not appear to be effective as his heartburn continues to interfere with his sleep. He has begun to take Benadryl each night to help him sleep better. What is a potential adverse effect of these two drugs being taken together that could explain the patient's condition? A) The combination of the drugs can have a drug effect opposite of the desired effect, creating worse heartburn. B) The Tums speed up the rate of digestion preventing the body from absorbing the Benadryl. C) The Tums increase the pH in the stomach, which decreases the ionization of base drugs, resulting in a decreased drug effect. D The Tums lower the pH in the stomach and increase ionization of base drugs, resulting in a decreased drug effect

C

17. A nurse working for a drug company is involved in phase III drug evaluation studies. Which of the following might the nurse be responsible for during this stage of drug development? A) Working with animals who are given experimental drugs B) Monitoring drug effects in patients who are selected to participate in a study, who have the disease that the drug is meant to treat C) Administering investigational drugs to patients D) Informing healthy, young volunteer participants of possible risks that could occur from taking an experimental drug

C

19. A nurse works in a private hospital and needs to administer some narcotic drugs to one of her patients. Which of the following should the nurse consider when administering narcotics to patients in a hospital setting? A) Narcotics are banned in private settings and cannot be used. B) Narcotics can be used in the hospital after obtaining written approval from the Joint Commission for Accreditation of Hospitals and Healthcare Organizations (JCAHO). C) Narcotics to be used in the hospital are dispensed only with a written prescription. D) Narcotics can be used in the hospital according to patient preferences.

C

25. The medication nurse is in charge of transcribing drug orders and administering drugs to assigned patients. While preparing the drugs for administration, the nurse should always check: A) For drug composition. B) The chemical, generic, and trade name of each drug. C) The drug name at least three times—before, during, and after obtaining each drug. D) The cost of each drug.

C

28. A nurse at a large, university hospital has been informed that a drug trial will be taking place that may involve several patients in the hospital over the next several months. What is the nurse's most likely role in this drug testing process? A) Determining the clinical efficacy and safety of the drug. B) Suggesting potential improvements to the testing process. C) Administering the investigational drug to patients. D) Consulting on the methodology that has been chosen for testing the drug.

C

29. A nurse is performing discharge teaching with a patient who will be returning home shortly after being diagnosed with type 2 diabetes. The patient has stated that his intention to purchase his medications from an online pharmacy in an effort to save money. How should the nurse best respond to the patient's statement? A) "Using an online pharmacy is an excellent way to reduce your drug costs." B) "If you do this, make sure that the pharmacy is physically located in the United States." C) "Be very careful when doing this, and make sure you're in close contact with your physician." D) "Actually, obtaining prescription drugs via the Internet has recently been made illegal."

C

33. The nurse is caring for a patient receiving an aminoglycoside (antibiotic) that can be nephrotoxic. Which of the following will alert the nurse that the patient may be experiencing nephrotoxicity? A) visual disturbances B) yellowing of the skin C) a decrease in urine output D) ringing noise in the ears

C

65. A nurse is caring for a middle-aged man of Navajo Indian origin who has type 2 diabetes and who is living a traditional Navajo lifestyle. The nurse will be sure to discuss the adverse effects of drug therapy with which of the following family members? A) the patient's father B) the patient's spouse C) the patient's grandmother D) the patient's grandfather

C

34. A nurse is caring for a patient who has recently moved from Vermont to south Florida. The patient has been on the same antihypertensive drug for 6 years and has had stable blood pressures and no adverse effects. Since her move, however, she reports "dizzy spells and weakness" and feels that the drug is no longer effective. The nurse suspects that the change in the effectiveness of the drug is related to: A) The impact of the placebo effect on the patient's response. B) The accumulative effect of the drug if it has been taken for many years. C) The impact of the warmer climate on the patient's physical state. D) Problems with patient compliance with the drug regimen due to the move.

C

37. A nurse has administered a medication to a patient with hypertension. The prescribed drug is supposed to decrease cardiac output. A decrease in cardiac output would most likely: A) Increase the serum creatinine level. B) Decrease drug absorption in the blood. C) Decrease the amount of circulating blood sent through the kidneys. D) Increase the synergistic effect of the drug.

C

39. Which of the following affects drug distribution throughout the body? A) presence of food in the gastrointestinal tract B) increase in hepatic enzymes C) protein binding D) high blood levels

C

4. A patient is treated with an antibiotic for an infection in his leg. After 2 days of taking the antibiotic, the patient calls the clinic and reports that he has a rash all over his body. The nurse is aware that a rash can be an adverse effect of an antibiotic and can be either a biologic, chemical, or physiologic action of the drug, which is an example of A) pharmacotherapeutics. B) pharmacokinetics. C) pharmacodynamics. D) pharmacogenetics.

C

45. A hospital patient has been prescribed an antiemetic and an antibiotic, both of which are to be administered intravenously. What action should the nurse prioritize before administering the drugs using the same tubing? A) Warn the patient about the possibility of idiosyncratic drug effects. B) Assess the possibility that the antibiotic is causing the patient's nausea. C) Check the compatibility of the two drugs. D) Review the patient's most recent blood work

C

48. A patient comes to the clinic asking for help to quit drinking alcohol. She has a 21-year history of heavy drinking and is worried about developing cirrhosis of the liver. The patient agrees to take disulfiram (Antabuse). The nurse will teach the patient that the combination of alcohol and Antabuse will cause which of the following? A) bradycardia B) diarrhea C) nausea D) slight headache

C

52. A nurse is caring for a patient with cancer who has been prescribed dronabinol (Marinol) to help reduce nausea and vomiting from chemotherapy. The nurse will inform the patient that he or she is taking an oral form of: A) methamphetamine B) cocaine C) marijuana D) nicotine

C

6. A 56-year-old female patient has been admitted to the hospital with chronic muscle spasms and has been prescribed a new medication to treat the spasms. She has a poorly documented allergy to eggs, synthetic clothes, and perfumes. What is the priority action of the nurse to ensure that prescribed medication does not experience an allergic reaction? A) Call the prescriber immediately regarding her allergic reactions B) Hold the medication for her muscle spasms until she can be treated for a possible allergic reaction C) Post an allergies notice on the front of the chart and document the allergies in the appropriate area of the patient's record D) Call the dietary staff and make sure that the patient is not served eggs for breakfast Page 5

C

66. A 32-year-old Asian female who has just arrived in the United States has been diagnosed with hypertension. She has come to the clinic for an office visit and states that she has always used "traditional healing preparations" when ill. In discussing her new antihypertensive drug, the nurse will assess her use of: A) analgesics B) diuretics C) ginseng D) antidepressants

C

69. A nurse is admitting a Mexican woman to the hospital who cannot speak or understand English. The patient is alone, and there is no interpreter available. When trying to communicate with the patient the nurse will: A) speak loudly B) exaggerate her mouth movements C) use nonverbal language D) speak fast

C

70. A Native American man who lives a traditional lifestyle is scheduled to have heart surgery. The tribal chief has requested that the tribe's medicine man perform a ritual before the patient goes to surgery. The nurse's response to this request should be: A) "I'm sorry, but that will not be possible." B) "I will need to inform the doctor and see if he will allow this." C) "As long as the ritual does not interfere with the patient's preoperative care, it will be okay." D) "I don't think that will help, but you have the right to perform the ritual."

C

74. Genetic testing has revealed that woman of European origin lacks CYP2D6 activity. This fact is likely to have an influence on which aspect of pharmacokinetics? A) excretion B) distribution C) metabolism D) absorption

C

77. A nurse receives an order for clonidine (Catapres) for a man who has been diagnosed with secondary hypertension. Which of the following would be the most appropriate action by the nurse? A) Weigh the patient to get the correct body surface area. B) Have a second nurse check the dose before administering the drug. C) Question the order because the patient is not receiving any other antihypertensives. D) Make sure the patient is on a cardiac monitor.

C

82. A nurse in the intensive care unit is caring for a patient in shock and has started IV administration of dopamine (Intropin). For a patient in shock, dopamine helps to: A) decrease heart rate B) decrease blood pressure C) increase blood pressure D) increase body temperature

C

93. A male patient is prescribed oral morphine for chronic degenerative disc disease until his scheduled back surgery the following week. Which combination with morphine could be fatal because of the synergistic effect of CNS depression? A) morphine and antidepressants B) morphine and Pepcid C) morphine and Percocet D) morphine and tobacco use

C

95. A 58-year-old female patient with type 2 diabetes and hyperlipidemia schedules an appointment with her primary care provider (PCP). Her A1C is 7%, and there are no indications of any complications of diabetes. Her only income is a monthly disability check. She is on the following medications: Metformin 1000 mg PO bid Lisinopril 5 mg PO daily ASA 81 gr PO daily Vitamin D 500/200 1 tab with meals Pravastatin 40 mg. PO hs Niacin 500 mg PO hs Tricor 145 PO hs FeSO4 325 mg. PO daily Sudafed 12 hr. PO bid Cetrizine 10 mg PO daily Bee pollen capsule 1 capsule daily Cinnamon capsule 1 with each meal The PCP notes that the patient's blood pressure is 130/90 and orders Accuretic 10/12.5 mg PO daily. The PCP gives the prescription to the nurse. Which action should the nurse take? A) Reassess the blood pressure before giving the prescription. B) Instruct the patient that the medication is for blood pressure. C) Question the order that the patient takes her medications. D) Teach the patient to take the medication in the morning since it contains a diuretic.

C

97. A nursing student caring for a patient in the ICU asks a nurse practitioner what dose of Dobutamine to give the patient as the order was confusing. The nurse practitioner recognizes that the order was for dopamine and corrects the student. The nurse practitioner wants to implement a way to Page 27 help prevent look-a-like drug name errors. Which system does the Joint Commission recommend to help prevent misuse among look a like drug names? A) Removing one of the similar sounding drugs from hospital formulary. B) Always writing both brand and generic on all correspondences. C) Using tall man letters to highlight differences. D) Using only brand names of drugs to avoid the problem

C

98. An 82-year-old patient presents to the clinic today for a routine appointment and prescription refills. She states that she has been having dry mouth and constipation since adding Ditropan to regimen including Benadryl and several other medications. What role does polypharmacy have in this patients complaints? A) The patient is not following the dosing, which is causing the side effects. B) The patient is purchasing drugs from two different pharmacies and getting different concentrations. C) The drugs are interacting and potentiating the anticholinergic side effects. D) The drugs should not be prescribed simultaneously and are counteracting each other.

C

99. A 56-year-old female patient is in the clinic because she needs some prescription refills. The patient mentions that she would also like to take garlic and St. John's wort to improve her health. What should the nurse teach the patient about herbals? A) Education about herbals is not within the scope of the APN. B) Herbals are harmless and safe to use because they are made from plants. C) Herbals can have interactions with prescribed medications. D) Herbals are researched and approved by the FDA

C

10. A patient has been prescribed several drugs and fluids to be given intravenously. Before the nurse starts the intravenous administration, a priority assessment of the patient will be to note the A) heart rate. B) body weight and height. C) blood pressure. D) skin surrounding the potential IV site

D

104. In an interview regarding his individual drug therapy, a 56-year-old male asks if there are any side effects to a particular medication. What is the best response for the APN to give the patient? A) "Yes, but the healthcare team will monitor for any side Page 29 effects." B) "Yes, all medications have side effects." C) "Yes, let me talk with you about those side effects." D) "Why do you ask?"

D

11. A nurse is performing an admission assessment of an elderly patient who is being admitted to a medical ward from the emergency department. Which of the following is an open-ended assessment question? A) "Have you ever had a bad response to a drug that you've taken?" B) "Does anyone in your immediate family have a history of drug allergies?" C) "Are you comfortable with receiving needles?" D) "What kind of reactions have you had to medications?"

D

110. A 55-year-old male diabetic patient is currently taking Actos, among other medications, with good glycemic control. During his office visit, he states that he has a new employer and therefore, new insurance coverage as well. His new insurance company requires prior authorization for this medication. What does the nurse explain to the patient? A) He is responsible to pay for the Actos out of pocket. B) He should be switched from Actos to Actiq since it is less expensive and more efficacious. C) There is no change in medication usage because Medicare Part D covers his prescriptions. D) He must wait for approval from his insurance company before filling his prescription.

D

128. A new drug's adverse effects are often not seen until it is administered to a large number of individuals outside of well-regulated guidelines. In which phase of drug development does this occur? A) Phase I B) Phase II C) Phase III D) Phase IV E) Phase V

D

131. Many states have passed or are considering legislation to allow access to marijuana for medicinal use. Which trend does this fact exemplify? A) termination of the war on illicit drugs B) escalation of the war on illicit drugs C) maintenance of the war on illicit drugs D) de-escalation of the war on illicit drugs

D

136. A 15-year-old male patient comes to a clinic for a sports physical. He has an odor, dilated blood vessels in the eyes, and is tachycardic. The nurse suspects marijuana abuse. What is the nurse's role as a care provider in this situation? A) Inquire to the parent of the patient about a possible source of the marijuana. B) Discourage the patient from participating in sports until he is a non-user. C) Recommend inpatient treatment to prevent further substance abuse. D) Know the Youth Prevention-Related Measures to decrease the risk of escalation of abuse.

D

21. A nurse is a member of a research team that is exploring unique differences in responses to drugs that each individual possesses, based on genetic make-up. This area of study is called: A) pharmacotherapeutics. B) pharmacodynamics. C) pharmacoeconomics. D) pharmacogenomics.

D

23. Which of the following serves to protect the public by ensuring the purity of a drug and its contents? A) American Pharmaceutical Association B) United States Adopted Names Council C) Nursing drug guides D) Federal legislation

D

27. Federal legislation dictates a lengthy and rigorous process of testing for new drugs. What is the primary purpose of this testing process? A) To protect state and federal departments from legal liability. B) To maximize autonomy and treatment options for citizens. C) To facilitate the efficiency of health care delivery. D) To ensure the safety of the public.

D

30. A patient with a recent history of acute pain has been transferred to the intensive care unit after the nurse mistakenly administered hydromorphone rather than morphine. Which of the following statements best describes the legal responsibility of nurses when administering drugs? A) Liability insurance protects nurses from litigation related to drug errors. B) Physicians are ultimately responsible for drug errors that occur in hospital settings. C) Nurses have an ethical, but not legal, responsibility to give drugs safely. D) Nurses are legally responsible for safe drug administration

D

31. Talwin given in combination with Vistaril diminishes the adverse effects of nausea caused by the Talwin. This drug interaction affecting the pharmacodynamics of the Talwin is: A) an additive effect B) a synergistic effect C) a potentiated effect D) an antagonistic effect

D

40. A patient is being seen in the emergency department for a sprained ankle and is given a drug to relieve pain. When a second dose of the pain medication is given, the patient develops redness of the skin, itching, and swelling at the site of injection of the drug. The most likely cause of this response is: A) a hepatotoxic response B) an idiosyncratic response C) a paradoxical response D) an allergic response

D

41. A 70-year-old man who enjoys good health began taking low-dose aspirin several months ago based on recommendations that he read in a magazine article. During the man's most recent visit to his care provider, routine blood work was ordered and the results indicated an unprecedented rise in the man's serum creatinine and blood urea nitrogen (BUN) levels. How should a nurse best interpret these findings? A) The man may be experiencing a paradoxical effect of aspirin. B) The man may be allergic to aspirin. C) The man may be experiencing liver toxicity from the aspirin. D) The man may be experiencing nephrotoxic effects of aspirin.

D

44. In light of her recent high blood pressure readings, a patient has been started on a thiazide diuretic and metoprolol (Lopressor), which is a beta-adrenergic blocker. What is the most likely rationale for using two medications to address the patient's hypertension? A) The adverse effects of each drug may cancel each other out. B) Using two drugs for a health problem tends to increase patient compliance with the drug regimen. C) Using lower doses of two separate drugs may lessen the risk of adverse reactions. D) Using the two drugs to treat a health problem may create a synergistic effect.

D

50. A Native-American man is admitted to the emergency department exhibiting a reddened face and an increased heart rate. He reports that he does not normally drink alcohol but at a party had punch that contained vodka. The nurse recognizes that this reaction may be related to the ethanol exposure and caused by: A) retarded absorption from the small intestine B) immediate distribution at the rate proportional to blood flow and water content C) metabolism using the enzyme alcohol dehydrogenase D) deficiency in the enzyme aldehyde dehydrogenase

D

51. A nurse is caring for a patient who has been admitted with acute cocaine intoxication. Which of the following vital signs would the nurse expect to find initially when assessing the patient? A) Blood pressure (BP): 98/50, pulse (P): 120, respirations (R): 40 B) BP: 130/88, P: 92, R: 28 C) BP: 150/90, P: 80, R: 16 D) BP: 170/98, P:110, R: 20

D

58. Paramedics have brought a patient to the emergency department with a suspected heroin overdose. The nurse should recognize that the patient's most acute threat to health at this time is: A) hypokalemia or hyponatremia B) acute gastrointestinal bleed C) increased intracranial pressure D) respiratory depression

D

59. A school nurse has been teaching high school students about the risks associated with marijuana use. However, the nurse has been met with considerable skepticism on the part of students, most of whom believe that marijuana is a benign drug. Which of the following teaching points should the nurse provide? A) "Most people don't know that marijuana can be just as addictive as heroin or cocaine over time." B) "Marijuana can easily interact with other drugs and cause potentially fatal reactions." C) "Every year, thousands of Americans end up in emergency departments with marijuana overdoses." D) "Smoking marijuana is just as bad, or worse, for your lungs as smoking cigarettes."

D

63. A nurse is assigned to a Caucasian patient who has a phenotype in which the CYP2D6 gene is duplicated. In order to plan appropriate care with regard to drug therapy, the nurse is aware that the patient would: A) exhibit no change in metabolic activity through the CYP2D6 pathway B) metabolize drugs poorly through the CYP2D6 pathway C) exhibit reduced CYP2D6 activity D) exhibit ultra-rapid metabolism through the CYP2D6 pathway

D

67. A Hispanic woman is hospitalized for complications of type 1 diabetes. The nurse speaks only English; the patient understands only Spanish. The patient is being discharged from the hospital, and the nurse needs to provide education related to her diabetes. However, the discharge instructions are in English. The nurse should use: A) body language to educate her and then give her the discharge instructions B) an interpreter to educate her and then give her the English version of the discharge instructions, so she can begin to learn the language C) a translator to translate the materials and give them to her D) an interpreter to review the discharge instructions with the patient and then give her the printed material translated into Spanish

D

72. A nurse who is employed by a large, multinational pharmaceutical company is a member of an interdisciplinary research team that is focused on pharmacogenomic research. What research question is most closely aligned to this team's probable mandate? A) "How can we integrate cultural beliefs and preferences into drug therapy?" B) "How can we use pharmaceuticals in an effort to improve the human genome?" C) "How can we best treat the diseases that are known to be more prevalent in certain groups?" D) "How can we customize drugs to be especially effective for particular individuals and groups?"

D

73. A nurse is aware that the concepts of genotype and phenotype must be included in any consideration of pharmacogenetics. Which of the following statements is true of these concepts? A) Genotype is an expression of DNA, but phenotype is a cultural concept. B) Genotype is easily modifiable, but phenotype is not modifiable. C) Genotype is a consequence of the genetic makeup of an individual's parents while phenotype is unique to every individual. D) Genotype is the composition of person's DNA, but phenotype is the manifestation of these genes

D

80. A 70-year-old man with diabetes mellitus is taking metoprolol (Lopressor) to manage his hypertension. The nurse would be sure to instruct the patient to: A) take his pulse at least four times a day B) weigh himself once a week at the same time of the day C) avoid smoke-filled rooms D) understand the signs and symptoms of hypoglycemia

D

81. A patient experiencing a serious allergic reaction to a bee sting is brought to the emergency department. The patient's right hand is swollen, red, and painful. She is extremely upset, short of breath, and the nurse detects wheezing and stridor. The nurse is ordered to administer epinephrine to relieve the patient's: A) pain and swelling around the sting site B) discoloration in her hand C) acute anxiety D) acute bronchospasm

D

84. A man with a history of cardiac arrhythmias is taking metoprolol (Lopressor) 25 mg, three times a day. He calls the clinic at 11 AM and reports that he failed to take his 8 AM dose and his next dose is at 2 PM. What should the nurse instruct him to do? A) Take two doses when the next dose is due at 2 PM. B) Take two doses as soon as possible. C) Take the missed dose as soon as possible. D) Skip the missed dose and return to the regular dose at 2 PM.

D

87. A 21-year-old man experienced massive trauma and blood loss during a motorcycle accident and has been started on a dopamine infusion upon his arrival at the hospital. In light of this drug treatment, what assessment should the care team prioritize? A) respiratory assessment B) arterial blood gases C) monitoring of intracranial pressure D) cardiac monitoring

D

9. A nurse is caring for a postsurgical patient who has small tortuous veins and had a difficult IV insertion. The patient is now receiving IV medications on a regular basis. What is the best nursing intervention to minimize the adverse effects of this drug therapy? A) Monitor the patient's bleeding time B) Check the patient's blood glucose levels C) Record baseline vital signs D) Monitor the IV site for redness, swelling, or pain

D

91. A patient is on the surgical floor and is NPO with a TPN infusion and is scheduled for abdominal surgery later in the day. A pre-operative antibiotic is ordered. To save time, the nurse adds the antibiotic solution to the premixed bag of TPN that is infusing. Which complication may result from this drug mixture? A) a cloudy appearance in the IV line with infusion B) burning and redness at the IV site C) increased blood loss intraoperatively D) a pH change and inactivation of the antibiotic

D

92. A male patient states that the medications for his blood sugar do not seem to be working. The patient reports that he always takes his medications with food each night because it makes him have nausea without food. Page 25 Which advice can the nurse provide this patient about taking pills with a full stomach? A) Every medication should be taken with food to reduce adverse effects from the drug. B) Gastric emptying can occur as soon as 10 minutes after a meal, and he can take the medications then. C). Many medications are inactive if the pH in the stomach is too high and prevents excretion. D) Food can delay or reduce the absorption of oral drugs, and some require an empty stomach to facilitate absorption.

D

130. A nurse is caring for a patient who requires an overdose of MS04 requiring administration of Narcan. Which medication error index would this be considered? A) Category A B) Category B C) Category C D) Category D E) Category E

E