Exam 2 NCLEX

The nurse is teaching a patient prescribed felodipine [Plendil] for the treatment of hypertension. Which statement is the most appropriate for the nurse to include in the teaching session? A. "Avoid grapefruit juice while you are taking this medication." B. "Do not eat foods high in tyramine such as aged cheese." C. "Herbal agents can help this drug work more effectively." D. "This drug is free of dangerous drug interactions."

A. "Avoid grapefruit juice while you are taking this medication."

A nurse is educating a breast-feeding patient about her medications. Which statements by the nurse are true? (Select all that apply.) A. "Drugs taken by lactating women can be excreted in breast milk." B. "If drug concentrations in milk are high enough, a pharmacologic effect can occur in the infant." C. "There is a lot of research regarding drugs taken by lactating women." D. "Most drugs can be detected in milk, but concentrations are usually too low to cause harm." E. "Nearly all drugs can enter breast milk, and the extent of entry is the same for all drugs."

A. "Drugs taken by lactating women can be excreted in breast milk." B. "If drug concentrations in milk are high enough, a pharmacologic effect can occur in the infant." D. "Most drugs can be detected in milk, but concentrations are usually too low to cause harm." Drugs taken by lactating women can be excreted in breast milk. If drug concentrations in milk are high enough, a pharmacologic effect can occur in the infant, raising the possibility of harm. Unfortunately, very little systematic research has been done on this issue. Most drugs can be detected in milk, but concentrations are usually too low to cause harm. Although nearly all drugs can enter breast milk, the extent of entry varies greatly.

The nurse is teaching young parents about medication administration in their child. Which statements are appropriate to include in the teaching plan? (Select all that apply.) A. "Guard against spills and spitting to ensure that your child gets an accurate dose." B. "Do not mix your child's medication with food or drink." C. "This calibrated spoon will help your child get an accurate dose." D. "Keep a medication record to make sure you do not give more than one dose at a time." E. "If your child spits some medication out, give another full dose at that time."

A. "Guard against spills and spitting to ensure that your child gets an accurate dose." C. "This calibrated spoon will help your child get an accurate dose." D. "Keep a medication record to make sure you do not give more than one dose at a time." Spills and spitting are common causes of inaccurate dosing in children. It is often helpful to mix medication with food or juice to mask the taste when allowed. Calibrated spoons and medication records can improve accuracy. To prevent overdosing, parents should estimate the amount a child spits out and replace only that amount.

When administering a medication known to be metabolized by the liver, the nurse will closely monitor for adverse drug reactions in which patient? A. A 3-month-old infant B. A 12-month-old infant C. An 18-month-old toddler D. A 13-year-old adolescent

A. A 3-month-old infant Neonates are especially sensitive to drugs that are eliminated primarily by hepatic metabolism. When these drugs are used, dosages must be reduced. The capacity of the liver to metabolize many drugs increases rapidly about 1 month after birth and approaches adult levels a few months later. The liver has matured completely by 1 year of age.

The nurse is preparing to give a drug that is not classified according to a Pregnancy Risk Category. What should the nurse do? A. Administer the medication, because the nurse knows that it was in use before 1983. B. Notify the healthcare provider before administering the drug, because it should be considered a teratogen. C. Hold the medication, because the drug has a proven risk of fetal harm. D. Return the medication to the pharmacy to be assigned a Pregnancy Risk Category.

A. Administer the medication, because the nurse knows that it was in use before 1983. Many drugs are not classified according to the U.S. Food and Drug Administration (FDA) Pregnancy Risk Categories. These drugs were in use before the classification system came into use in 1983. They are considered safe but may not have been studied in controlled trials. The pharmacy cannot assign a pregnancy risk category to a drug.

The nurse understands drug response varies from one individual to another. What are examples of individual variations? (Select all that apply.) A. Age B. Genetic makeup C. Gender D. Diet E. Failure to take medication as prescribed

A. Age B. Genetic makeup C. Gender D. Diet E. Failure to take medication as prescribed

The nurse is reviewing the laboratory value for a patient prescribed atorvastatin [Lipitor]. Which laboratory value is most useful for monitoring this drug? A. Aspartate aminotransferase (AST) B. Blood urea nitrogen (BUN) C. International normalized ratio (INR) D. C-reactive protein (CRP)

A. Aspartate aminotransferase (AST) Test measures the amount of this enzyme in the blood. AST is normally found in red blood cells, liver, heart, muscle tissue, pancreas, and kidneys.

The nurse reviews all of the patient's prescriptions. Which prescribed medications may cause a detrimental potentiative drug interaction? A. Aspirin and warfarin B. Sulbactam and ampicillin C. Propranolol and albuterol D. Isoniazid and rifampin

A. Aspirin and warfarin

The nurse is caring for a 12-year-old boy who weighs 72 pounds. The healthcare provider should make the most precise dosage adjustments for this patient's medications based on what? A. Body surface area B. Body mass index C. Body weight D. Body fat percentage

A. Body surface area

When a pregnant woman has been exposed to a known teratogen, what is the first step in identifying risks for malformation? (Select all that apply.) A. Determine exactly when the drug was taken. B. Determine exactly when the pregnancy began. C. Determine why the woman was taking the medication. D. Determine who prescribed the medication.

A. Determine exactly when the drug was taken. B. Determine exactly when the pregnancy began. When a pregnant woman has been exposed to a known teratogen, the first step is to determine exactly when the drug was taken and exactly when the pregnancy began. Other information is helpful but not necessary.

Which statement about drug use among older adults is true? A. Drug use among older adults is disproportionately high. B. Older adults consume 20% of the nation's prescribed drugs. C. Older patients are less sensitive to drugs than younger adults. D. Older adults experience fewer adverse drug reactions.

A. Drug use among older adults is disproportionately high. Older adults consume 33% of the nation's prescribed drugs. Older patients are more sensitive to drugs than are younger adults. Older adults experience more adverse drug reactions.

Why is it important for drugs to have ease of administration? A. Fewer administration errors B. Less risk of side effects C. Greater chemical stability D. Greater likelihood of reversibility

A. Fewer administration errors

Which factors may contribute to unintentional nonadherence? (Select all that apply.) A. Forgetfulness B. Failure to comprehend instructions C. Unpleasant side effects D. Inability to pay for medications E. Belief that the drug is not needed

A. Forgetfulness B. Failure to comprehend instructions D. Inability to pay for medications Forgetfulness, failure to comprehend instructions (because of intellectual, visual, or auditory impairment), and inability to pay for medications can contribute to unintentional nonadherence. Unpleasant side effects and the belief that the drug is not needed are factors that contribute to intentional nonadherence.

A patient asks the nurse for a supplement that can be used to prevent motion sickness during a vacation cruise. The nurse suggests which supplement? A. Ginger root (Zingiber officinale) B. Garlic (Allium sativum) C. Coenzyme Q-10 (CoQ-10) D. Feverfew (Tanacetum parthenium)

A. Ginger root (Zingiber officinale) Ginger root is used to suppress nausea and vomiting caused by motion sickness and morning sickness and also for postoperative nausea and vomiting. It may be involved in the blockade of serotonin receptors located in the chemoreceptor trigger zone of the brain. Garlic, coenzyme Q-10, and feverfew are not used to suppress nausea and vomiting.

A child receives a vaccine for measles, mumps, and rubella (MMR). Six hours after the injection, the child's parent reports local soreness, erythema, lethargy, and a fever of 101°F to a nurse. Which action should the nurse take? A. Give instructions on relieving symptoms with acetaminophen (Tylenol). B. Seek emergency help, because these symptoms are signs of an anaphylactic reaction. C. Tell the parent that a live vaccine will cause a mild case of measles. D. Obtain and fill out a Vaccine Adverse Event Report form.

A. Give instructions on relieving symptoms with acetaminophen (Tylenol). Low-grade fever, malaise, and muscle aches are common reactions to the MMR vaccine. Acetaminophen [Tylenol] usually alleviates these problems. Airway constriction, hives, and itching are signs of an anaphylactic reaction. MMR is a live vaccine, but it is attenuated or completely avirulent and does not cause measles in healthy children. Only immunocompromised children are at risk from live vaccines and should not receive them. A Vaccine Adverse Event Report is used by practitioners to report certain unusual events after vaccination; these symptoms are not unusual events for the MMR vaccine.

Which response would the nurse anticipate when giving two drugs that have a potentiative effect, such as Meperidine and Phenergan? A. Increased pain relief B. Increased nausea and vomiting C. Decreased itching D. Increased alertness

A. Increased pain relief A potentiative effect is the enhancement of one agent by another so that the combined effect is greater than the sum of the effects of each one alone.

What is the ultimate concern for the nurse when administering a drug? A. Intensity of the response B. Dosage C. Route of administration D. Timing of administration

A. Intensity of the response

The nurse is concerned with minimizing adverse drug-drug interactions for the patient. Which drug characteristic could result in the most serious consequences from a drug-drug interaction? A. Low therapeutic range B. High biologic half-life C. Low potency D. First-pass effect

A. Low therapeutic range

Which product did the U.S. Food and Drug Administration (FDA) ban in the United States because of the serious adverse effects of myocardial infarction, stroke, and death? A. Ma huang (Ephedra) B. Valerian (Valeriana officinalis) C. St. John's wort (Hypericum perforatum) D. Saw palmetto (Serenoa repens)

A. Ma huang (Ephedra) Sales of ma huang have been banned in the United States since 2004, making it the first time that a dietary supplement has been ordered off the market. It has been associated with stroke, myocardial infarction, and death. The ban was challenged in 2007, but a rehearing petition was denied. Valerian, St. John's wort, and saw palmetto are currently available for sale in the United States.

The nurse is preparing a staff education inservice about specific safety measures that reduce patient medication errors. Which measure improves safety for patients during care transition? A. Medication Reconciliation B. MEDWATCH Program C. Risk Evaluation and Mitigation Strategy D. Regional Medication Safety Program

A. Medication Reconciliation

The nurse is caring for a group of female patients receiving medication therapy. Which factor is of greatest concern with regard to drug therapy in these patients? A. Most drug research has been carried out exclusively in male subjects. B. Hormonal differences make managing drug therapy more difficult in most women. C. Overall, women tend to be less compliant with medication therapy. D. Women tend to be caregivers and may not take time to care for themselves.

A. Most drug research has been carried out exclusively in male subjects.

The nurse is caring for a patient prescribed Isoniazid for the treatment of tuberculosis. The nurse should assess for which signs and symptoms of drug-induced liver toxicity? (Select all that apply.) A. Nausea B. Malaise C. Jaundice D. Vomiting E. Clear urine

A. Nausea B. Malaise C. Jaundice D. Vomiting

What is the objective of drug therapy? A. Provide maximum benefit with minimal harm B. Provide minimum benefit with maximum harm C. Provide total relief of symptoms regardless of harm D. Provide as much benefit as possible

A. Provide maximum benefit with minimal harm

Which intervention would the nurse choose to minimize the risk of drug toxicity in neonates and infants? A. Reduce the amount of drug given. B. Administer the medication before meals. C. Shorten the interval between doses. D. Administer the medication intravenously

A. Reduce the amount of drug given. The albumin in neonates and infants has a lower binding capacity for medication. A lower binding capacity leaves more of the free drug available for action; therefore, a lower dose is required to prevent toxicity.

A patient who has pellagra is taking niacin. Which outcome would be most appropriate for a nurse to establish with the patient? A. Smooth, intact skin in sun-exposed areas B. Regulation of heart rate and rhythm C. Increased dexterity of fine motor skills D. Improvement in coordination and gait stability

A. Smooth, intact skin in sun-exposed areas Pellagra is a syndrome characterized by scaling and cracking of the skin in areas exposed to the sun; it is caused by niacin deficiency. Niacin has no effect on fine motor skills, cardiovascular regulation, or gait and balance control.

The nurse is reading a genetic research study. The study discusses how genetic variants can directly affect the metabolism of clopidogrel [Plavix], reducing the antiplatelet response. The nurse understands reduced efficacy of clopidogrel can increase the risk of which cardiovascular event? (Select all that apply.) A. Stroke B. Cancer C. Myocardial infarction D. Pulmonary embolism E. Palpitations

A. Stroke C. Myocardial infarction

Older adult patients are at high risk for adverse drug reactions (ADRs). Which measures can reduce the incidence of ADRs? (Select all that apply.) A. Taking a thorough drug history, including over-the-counter (OTC) medications B. Monitoring clinical response and laboratory results to help determine proper dosage C. Using as many drugs as possible to reduce symptoms and improve outcome D. Regularly monitoring patients for drug-drug and drug-nutrient interactions E. Helping patients to avoid prescriptions for drugs on the Beers list

A. Taking a thorough drug history, including over-the-counter (OTC) medications A thorough drug history and careful monitoring can help reduce ADRs. Nurses should help patients use the simplest regimen possible to reduce the risk of ADRs. Monitoring patients for interactions reduces ADRs. The Beers list identifies drugs with a high likelihood of causing adverse effects in the elderly.

For a drug to be a proven teratogen, which criteria must be met? (Select all that apply.) A. The drug must cause a characteristic set of malformations. B. The drug must act only during a specific window of vulnerability. C. The drug should be tested in pregnant women. D. The drug causes malformation in animal testing. E. The incidence of malformations should increase with increasing dosage and duration of drug exposure.

A. The drug must cause a characteristic set of malformations. B. The drug must act only during a specific window of vulnerability. E. The incidence of malformations should increase with increasing dosage and duration of drug exposure. To prove that a drug is a teratogen, three criteria must be met: The drug must cause a characteristic set of malformations; the drug must act only during a specific window of vulnerability (eg, weeks 4 through 7 of gestation); and the incidence of malformations should increase with increasing dosage and duration of exposure. Drugs are not tested in pregnant women. Studies in animals may be of limited value, in part because teratogenicity may be species-specific.

When preparing a teaching session for residents at an assisted living facility, the nurse will include what? A. The importance of avoiding intentional underdosing B. The importance of using multiple pharmacies for cost-effective savings on prescription drugs C. The importance of taking double amounts of missed doses to maintain therapeutic levels of medications D. The importance of reducing protein intake while taking prescription medications

A. The importance of avoiding intentional underdosing Underdosing, with resulting therapeutic failure, is much more common (90%) than overdosing among the elderly. In most cases (75%), the nonadherence is intentional because of the patient's conviction that the drug is simply not needed or because of unpleasant side effects. Using multiple pharmacies should be avoided, as should doubling missed doses. Doubling a dose could result in intentional overdosing. Reducing protein intake can result in decreased drug binding to albumin; consequently, the amount of free drug is increased, which could result in drug toxicity.

Which statements about transdermal absorption are correct? (Select all that apply.) A. The stratum corneum of the infant's skin is very thin. B. Transdermal administration is the safest route of administration. C. Blood flow to the skin is greater in infants than in older patients. D. Infants are at increased risk of toxicity from topical drugs. E. Absorption through the skin is more rapid and complete with infants.

A. The stratum corneum of the infant's skin is very thin. C. Blood flow to the skin is greater in infants than in older patients. D. Infants are at increased risk of toxicity from topical drugs. E. Absorption through the skin is more rapid and complete with infants. Drug absorption through the skin is more rapid and complete with infants than with older children and adults because the stratum corneum of the infant's skin is very thin and blood flow to the skin is greater in infants than in older patients. Because of this enhanced absorption, infants are at increased risk of toxicity from topical drugs.

A deficiency of which vitamin is most likely to result in visual disturbances? A. Vitamin A B. Vitamin D C. Vitamin E D. Vitamin K

A. Vitamin A Answer: A Rationale: Vitamin A deficiency can cause night blindness, xerophthalmia (a dry, thickened condition of the conjunctiva), and keratomalacia (degeneration of the cornea with keratinization of the corneal epithelium). Vitamin D plays a critical role in the regulation of calcium and phosphorus metabolism and may help protect against breast cancer, colorectal cancer, type 1 diabetes, and overall mortality. In children, vitamin D deficiency causes rickets. In adults, deficiency causes osteomalacia. High-dose vitamin E (more than 200 IU/day) increases the risk of hemorrhagic stroke. Vitamin K is required for synthesis of prothrombin and other clotting factors. Vitamin K deficiency causes bleeding tendencies. Severe deficiency can cause spontaneous hemorrhage.

A patient with a malabsorption disease is at risk for low levels of fat-soluble vitamins. The nurse is aware that which vitamins are fat soluble? (Select all that apply.) A. Vitamin A B. Vitamin B12 C. Vitamin C D. Vitamin D E. Vitamin E

A. Vitamin A D. Vitamin D E. Vitamin E Vitamins are divided into two major groups: fat-soluble vitamins (A, D, E, and K) and water-soluble vitamins (vitamin C and members of the vitamin B complex).

A 2-year-old child is prescribed an oral drug that is eliminated by metabolism in the liver. Based on the child's age, the nurse would expect to make which adjustment? A. The drug may need to be administered more frequently. B. The dosage of the drug may need to be decreased. C. The route should be changed from oral to intramuscular. D. The drug should be administered on an empty stomach.

Answer: A Rationale: Children between the ages of 1 and 12 years metabolize drugs faster than adults. They may need an increase in dosage or a reduction in dosing interval for drugs that are eliminated by hepatic metabolism.

A patient is taking a Category A drug during pregnancy. Which statement by the nurse is accurate? A. "The risk of harm to the fetus is remote." B. "The drug is safe to take during pregnancy." C. "This drug has caused congenital birth defects." D. "No controlled studies of this drug have been done in humans."

Answer: A Rationale: Remotes means slight chance. Category A drugs are the least dangerous to the fetus.

The nurse instructs an 82-year-old patient about over-the-counter medications that are generally safe for older adults. The nurse should intervene if the patient makes which of the following statements? A. "I can take chlorpheniramine [Chlor-Trimeton] for a cold." B. "If I have a headache, I should take acetaminophen [Tylenol]." C. "Cetirizine [Zyrtec] would be safe to take for my allergies." D. "I should avoid taking diphenhydramine [Benadryl] for hives."

Answer: A Rationale: The Beers list identifies drugs with a high likelihood of causing adverse effects in older adults. Drugs on this list should generally be avoided. Chlorpheniramine is on the Beers list, and it has anticholinergic effects (for example, constipation, urinary retention, blurred vision).

A nurse is caring for a patient who has an infection. The healthcare provider has ordered an antimicrobial drug for the patient. The nurse understands that which of the following is the most important characteristic of this drug? A. That the drug will kill the microorganism B. That the drug will be administered orally C. That the drug does not have any harmful effects D. That the drug does not interact with other drugs

Answer: A Rationale: The three most important characteristics that any drug can have are effectiveness, safety, and selectivity. Effectiveness is the most important property that a drug can have.

A patient is prescribed a medication to be taken on an empty stomach. Which statement should the nurse include when providing patient teaching? A. "Take the medication 1 hour before eating." B. "Take the medication with a small glass of water." C. "Take the medication before going to bed at night." D. "Take the medication 1 hour after a meal."

Answer: A Rationale: To administer a drug on an empty stomach means to administer it at least 1 hour before or 2 hours after a meal.

A patient is taking two prescription medications that both cause bradycardia. The nurse should monitor the patient for which type of effect? A. An increased therapeutic effect B. An increased adverse effect C. A reduced therapeutic effect D. A reduced adverse effect

Answer: B Rationale: Both of the drugs have an adverse effect of bradycardia.

An older adult patient is taking a new prescription medication. After reviewing the patient's medical record, the nurse is most concerned about an adverse drug reaction if what is documented? A. The patient is currently taking eight prescription medications. B. The patient's urinary creatinine clearance is 70 mL/min/1.73 m2. C. The patient regularly takes herbal and dietary supplements. D. The patient takes a medication with a high therapeutic index.

Answer: B Rationale: Drug accumulation secondary to reduced renal function in older adults is the most important factor in adverse drug reactions. The best indicator of renal function is urinary creatinine clearance. Urinary creatinine clearance of less than 105 to 110 mL/min/1.73 m2 indicates reduced renal function.

A patient is 2 months pregnant and complains of gastric distress. It is most appropriate for the nurse to do what? A. Consult with the healthcare provider about a prescription for misoprostol [Cytotec]. B. Instruct the patient to avoid acidic foods such as orange juice and tomatoes. C. Suggest an over-the-counter medication such as bismuth subsalicylate [Pepto-Bismol]. D. Use an alternative therapy such as valerian as a dietary supplement.

Answer: B Rationale: Lifestyle modifications such as dietary restrictions are safe during pregnancy and will not cause harm to the fetus. Misoprostol, bismuth subsalicylate, and valerian are contraindicated during pregnancy. Medications for gastric distress that may be considered during pregnancy include antacids, histamine2-receptor antagonists, and proton pump inhibitors.

The nurse reviews a patient's admission orders written by the healthcare provider. Which medication order should the nurse question? A. Cyanocobalamin 100 mcg intramuscularly every month B. MSO4 2.0 mg IV every 2 to 4 hours as needed for pain C. Levothyroxine 75 mcg orally every morning D. Enoxaparin 40 mg subQ every day for 7 days

Answer: B Rationale: Miscommunication is a common cause of medication errors. To help reduce errors, a list of abbreviations, symbols, and dose designations that should not be used is available. "MSO4" should be written as "morphine sulfate," and a trailing zero should not be used after a final decimal point. The medication order should be written as "Morphine sulfate 2 mg IV every 2 to 4 hours as needed for pain."

The nurse is assessing an infant delivered by a patient who is suspected of regularly using alcohol and cocaine during her pregnancy. It is most important for the nurse to observe the infant for what? A. Lethargy, hypothermia, and weight gain B. High-pitched cry, vomiting, and jitteriness C. Depressed reflexes, jaundice, and dysphagia D. Hypotonia, absent sucking reflex, and epistaxis (bleeding from the nose)

Answer: B Rationale: Symptoms in an infant who develops withdrawal syndrome (from alcohol, barbiturates, or heroin) may include a shrill cry, vomiting, and extreme irritability.

A patient was discharged from the hospital with instructions to take an antibiotic for 7 days to treat a bladder infection. Twelve days later, a home care nurse visits the patient and finds that the symptoms have not resolved. What is the most important question for the nurse to ask? A. "Do you think you have another bladder infection?" B. "Have you taken all of the antibiotics as directed?" C. "How much water have you been drinking each day?" D. "What antibiotic do you usually take to treat an infection?"

Answer: B Rationale: The failure to take medications as directed is a common cause of persistent infection.

A patient is prescribed a medication that is potentially hepatotoxic. Before administering the medication, it is most important for the nurse to assess what? A. Blood urea nitrogen and serum creatinine B. Aspartate aminotransferase and alanine aminotransferase C. Prolonged QT interval on the electrocardiogram D. Serum potassium, serum sodium, and serum magnesium

Answer: B Rationale: The nurse should assess the liver function tests of patients who are taking hepatotoxic drugs. When liver cells are injured, two liver enzymes (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) will be elevated.

A patient who was prescribed an oral medication to be taken four times per day returns to the clinic for a follow-up visit. The patient tells the nurse that he forgets to take two or three doses of the medication each day. What is the most appropriate action that the nurse can take? A. Arranging for the patient to have a home healthcare nurse B. Re-educating the patient about the medication and how it should be taken C. Determining whether the patient is experiencing any adverse effects D. Telling the patient to set an alarm as a reminder to take the drug

Answer: B Rationale: To help minimize errors caused by poor adherence, patients should receive thorough instruction regarding their medications and how to take them.

A 15-month-old patient develops chemotherapy-induced nausea and vomiting. Which medication, if ordered by the healthcare provider, should the nurse question? A. Ondansetron [Zofran] B. Dexamethasone [Decadron] C. Promethazine [Phenergan] D. Metoclopramide [Reglan]

Answer: C Rationale: Certain drugs can cause unique adverse effects in pediatric patients of various ages. These drugs should be avoided in patients whose age puts them at risk. Promethazine is contraindicated in children younger than 2 years old because pronounced respiratory depression may occur.

A toddler has been prescribed a medication that does not have an established pediatric dose. To calculate the appropriate dose for the child, the nurse should consider what information? A. The child's weight is 26 pounds. B. The child's height is 32 inches. C. The child's body surface area is 0.52 kg/m2. D. The child's age is 24 months.

Answer: C Rationale: For drugs without an established pediatric dose, the dose is based on the child's body surface area. The most commonly used formula is as follows: Approximate child's dose = (Body surface area of the child × Adult dose)/1.73 m2.

The nurse cares for a patient who is taking a calcium channel blocker for hypertension. The nurse should be most concerned if the patient makes which statement? A. "I take my medication with a glass of water." B. "I eat foods high in fiber to prevent constipation." C. "I drink a glass of grapefruit juice each evening." D. "I avoid foods such as broccoli and cabbage."

Answer: C Rationale: Grapefruit juice can inhibit the metabolism of certain drugs, thereby raising their blood levels. The effect is sometimes quite remarkable. In one study, the coadministration of grapefruit juice produced a 406% increase in blood levels of felodipine [Plendil], a calcium channel blocker used for hypertension. In addition to felodipine and other calcium channel blockers, grapefruit juice can increase blood levels of lovastatin [Mevacor], cyclosporine [Sandimmune], midazolam [Versed], and many other drugs. This effect is not seen with other citrus juices, including orange juice.

An older adult patient frequently forgets to take an oral medication that has been prescribed to be taken three times per day. Which action by the nurse is best? A. Assess the patient's ability to swallow the medication. B. Arrange for a neighbor to call the patient three times a day. C. Call the prescriber for a sustained-release form of the drug. D. Give the patient verbal and written instructions about the drug.

Answer: C Rationale: If the patient forgets to take a prescribed medication that is scheduled throughout the day, simplifying the regimen by reducing the number of doses per day may improve adherence. Enlisting the aid of a friend, relative, or visiting healthcare professional three times per day may be helpful, but it is not realistic. In addition, the patient should retain as much independence as possible in his or her self-care. Explaining the treatment plan using clear and concise verbal and written instructions will not directly correct the problem of forgetfulness. Difficulty swallowing may be a reason for nonadherence, but it is not related to the problem of forgetfulness.

Which individual is at the highest risk for a drug-drug interaction? A. A toddler who is prescribed two antibiotics for a serious infection B. An adolescent who takes over-the-counter medications for menstrual cramping C. An adult who takes eight prescription medications for a chronic condition D. An older adult who takes two prescription medications and a dietary supplement for anxiety

Answer: C Rationale: The risk of a serious drug interaction is proportional to the number of drugs that a patient is taking. In other words, the more drugs that the patient receives, the greater the risk for a detrimental interaction.

A patient with cancer is receiving morphine for pain control. The patient calls the nurse to report that the morphine is no longer controlling his pain. What is the most appropriate response by the nurse? A. "Increasing the dose of morphine will make you so sleepy that you will not be able to function." B. "This means that you have developed a psychological addiction to morphine." C. "You have developed a tolerance to morphine and will need a higher dose." D. "It is recommended that we wait to increase the morphine until the pain is more severe."

Answer: C Rationale: Tolerance is a decreased responsiveness to a drug as a result of repeated drug administration. Patients who become tolerant to a drug require higher doses to produce effects equivalent to those that could be achieved with lower doses before the tolerance developed.

Which child should not receive the measles, mumps, and rubella (MMR) virus vaccine? A. A child who is allergic to penicillin and milk B. A child with a fever of 100.6º F (tympanic) C. A child with acute lymphocytic leukemia D. A child with asymptomatic HIV infection

Answer: C Rationale: Measles, mumps, rubella (MMR) is contraindicated in children with severe immunodeficiency conditions, such as leukemia, and these children should not be vaccinated. Children with mild upper respiratory infection and mild fever or asymptomatic HIV infection may be vaccinated. Children who are allergic to eggs, gelatin, or neomycin should not be vaccinated.

Which patient does the nurse identify as being at highest risk for the development of an adverse drug reaction? A. A 1-month-old patient whose mother has allergies to penicillin, aspirin, and codeine B. A 16-year-old patient with multiple traumatic injuries who is taking morphine and an antibiotic C. A 54-year-old patient with multiple sclerosis who has been enrolled in a clinical trial of a new drug D. An 84-year-old patient with diabetes, heart failure, and hypertension who takes seven prescription medications each day

Answer: D Rationale: Adverse events are more common in older adults and the very young, in patients with severe illness, and in those who are taking multiple drugs.

A patient who is breast-feeding her newborn infant is prescribed an antibiotic to take after discharge. Which statement should the nurse include when providing discharge instructions? A. "Drink plenty of fluids to dilute the drug in your breast milk." B. "Take the drug at night with a full glass of water." C. "Pump your breasts, and then discard all of the milk." D. "Take the antibiotic immediately after breast-feeding."

Answer: D Rationale: Dosing immediately after breast-feeding minimizes drug concentration in milk at the next feeding.

The nurse provides teaching for the caregiver of a 2-month-old infant and a 3-year-old child. Both children will be taking oral ampicillin (an acid-labile drug) to treat a bacterial infection. The nurse determines that teaching is successful if the caregiver makes which of the following statements? A. "The dose will not be different, but the baby will take the drug for 7 days instead of 10 days." B. "The dose will be higher for the baby, because the infection is more serious." C. "The dose will be the same, because my children have the same infection." D. "The dose will be smaller for the baby, because the drug will be absorbed better in the stomach."

Answer: D Rationale: Gastric acidity is very low 24 hours after birth and does not reach adult values for 2 years. Because of this low acidity, the absorption of acid-labile drugs such as ampicillin and penicillin is increased.

The nurse is assessing an 82-year-old patient before the administration of medications. Which laboratory result would provide the best index of renal this patient's function? A. Serum creatinine B. Blood urea nitrogen C. Urinalysis D. Creatinine clearance

Answer: D Rationale: In older adults, the proper index of renal function is creatinine clearance. Serum creatinine levels do not reflect kidney function in older adults, because the source of serum creatinine - lean muscle mass - declines in parallel with the decline in kidney function. As a result, creatinine levels may be normal even though renal function is greatly reduced.

The healthcare provider writes a medication order that the nurse cannot read. What should the nurse do? A. Consult with the charge nurse to verify the order. B. Discuss the order with the pharmacist. C. Check with the patient to determine the correct medication. D. Contact the prescriber to clarify the order.

Answer: D Rationale: The nurse should contact the prescriber to clarify the order.

The nurse is preparing to administer warfarin [Coumadin] to a patient. The nurse notes that the patient has altered CYP2D6 genes. It is most important for the nurse to do which of the following? A. Check for signs of a transient ischemic attack. B. Monitor for ST segment elevation or depression. C. Observe the patient's legs for symptoms of a blood clot. D. Examine the patient's stools for the presence of blood.

Answer: D Rationale: Variants in the gene that codes for CYP2C9 can increase the risk of toxicity (i.e., bleeding) when taking warfarin [Coumadin], an anticoagulant with a narrow therapeutic index. The nurse should assess the patient for the presence of bleeding.

The parent of a 6-month-old baby asks about the recommended childhood schedule for varicella vaccine. The nurse should inform the parent that the infant may receive the vaccine at which age? A. 6 months B. 8 months C. 10 months D. 12 months

Answer: D Rationale: The Centers for Disease Control and Prevention (CDC) recommends varicella vaccination between 12 and 18 months of age.

Which vaccine has been identified as the safest, the one for which no adverse effects have been reported? A. MMR B. Varicella C. Hepatitis B D. Haemophilus influenzae type b

Answer: D Rationale: The Haemophilus influenzae type b conjugate (Hib) vaccine is one of our safest vaccines. No serious adverse events have been reported.

The nurse is caring for a patient with epilepsy who is on anticonvulsant therapy and is also breast-feeding. Which patient teaching instruction should minimize the risk to the baby? A. "Give the dose just before breast-feeding." B. "Avoid drugs that have a long half-life." C. "Discontinue the drug until you have stopped breast-feeding." D. "Increase your fluid intake."

B. "Avoid drugs that have a long half-life." Dosing immediately after breast-feeding minimizes the drug concentration in milk. Drugs with a shorter half-life are excreted by the mother more quickly. If possible, drugs should be avoided during breast-feeding; however, patients with chronic illnesses, such as epilepsy, may require medication for their own health. The maternal fluid intake is not related to medication safety during breast-feeding.

The healthcare provider ordered thiamine solution 100 mg in 50 mL IV piggyback for a patient with a history of alcohol abuse. The dose is ordered to run at 100 mL per hour. The nurse knows that the infusion will require how much time? A. 15 minutes B. 30 minutes C. 50 minutes D. 60 minutes

B. 30 minutes The medication is 100 mg in 50 mL and is ordered to run at 100 mL per hour. Since the medication is only 50 mL, the infusion would be complete in 30 minutes. 50 mL x 1hr x 60 min /100 mL 1 hr

It is most important for the nurse to inform which patient NOT to use ginkgo biloba? A. A patient with Alzheimer's disease and hypertension B. A patient with atrial fibrillation taking warfarin [Coumadin] C. A patient taking sildenafil [Viagra] for erectile dysfunction D. A patient prescribed fluoxetine [Prozac] for depression

B. A patient with atrial fibrillation taking warfarin [Coumadin] Rationale: Gingko biloba suppresses coagulation and should be used with caution in patients taking antiplatelet drugs, anticoagulants (such as warfarin), and heparin.

A nurse prepares to administer a newly prescribed medication to a 22-year-old woman. The insert in the medication package states, "Category X." Select the nurse's best action. A. Ask the patient, "Have you been sexually active during the past year?" B. Ask the patient, "When was your last menstrual period?" C. Inform the patient of the primary actions of the medication. D. Assess the patient for a history of sexually transmitted disease.

B. Ask the patient, "When was your last menstrual period?" Category X means that the drug will be harmful to the fetus if the patient is pregnant. The patient may not know she is pregnant; therefore, asking her when her last menstrual period occurred gives the nurse a better indication of whether the patient might be pregnant.

When studying the effects of drugs in humans, the nurse is learning about what? A. Pharmacology B. Clinical pharmacology C. Therapeutics D. Effectiveness

B. Clinical pharmacology

The nurse will monitor which laboratory result closely when administering medications to an older adult patient while assessing for adverse drug reactions (ADRs)? A. Serum creatinine levels B. Creatinine clearance C. Serum albumin levels D. Liver function tests

B. Creatinine clearance Drug accumulation secondary to reduced renal excretion is the most important cause of ADRs in the elderly. Creatinine clearance, not serum creatinine levels, is the proper index of renal function in older adult patients.

Before administrating the dosage of a prescribed medication, the nurse observes precipitation formation of the intravenous (IV) solution. What is the priority nursing action? A. Verify the prescription. B. Discard the IV solution. C. Prepare another dose to administer. D. Check the expiration date of the drug.

B. Discard the IV solution.

The nurse teaches a patient not to consume alcohol with nitroglycerine, because the blood pressure often drops significantly when nitroglycerine is taken with alcohol. Which drug property does this illustrate? A. Chemical instability B. Drug interaction C. Reversible action D. Drug selectivity

B. Drug interaction

The nurse is caring for a group of very young patients receiving a variety of medications. Which concept guides the nurse's care of these patients? A. Drugs given intravenously (IV) leave the body more quickly in infants than in adults. B. Drugs given subcutaneously (SC) remain in the body longer in infants than in adults. C. Gastric emptying time is shorter in infants than in children and adults. D. The blood-brain barrier protects the infant's brain from toxic drugs.

B. Drugs given subcutaneously (SC) remain in the body longer in infants than in adults. The very young are at risk for drug effects that are more intense and prolonged than those seen in adults. Drugs given by the SC route reach higher levels and remain in the system longer than in adults. Drugs given IV leave the body more slowly in infants than in adults. Gastric emptying time is prolonged in infants. The blood-brain barrier is not fully developed in infants.

What is the Beers list? A. Drugs with a low likelihood of causing adverse effects in older adults Incorrect B. Drugs with a high likelihood of causing adverse effects in older adults C. Drugs with zero likelihood of causing adverse effects in older adults D. Drugs that are recommended to be used for older adults

B. Drugs with a high likelihood of causing adverse effects in older adults The Beers list identifies drugs with a high likelihood of causing adverse effects in older adults.

A patient receives an immunization with an attenuated vaccine. Which response should a nurse expect if the vaccine produces active immunity? A. A mild form of the infectious illness B. Endogenous production of antibodies C. Immediate antibody protection D. A stronger immune system response

B. Endogenous production of antibodies Attenuated vaccines are made from live microbes that cause the immune system to make endogenous antibodies against the microbe from which the vaccine was made. Because attenuated vaccines are avirulent, they do not cause the illness. Active immunity takes weeks or months to develop; passive immunity is conferred immediately and refers to the administration of preformed antibodies. Attenuated vaccines do not cause more potent immune system responses than killed vaccines.

The patient is prescribed warfarin [Coumadin] to treat deep vein thrombosis. The nurse is teaching the patient about dietary supplements that have the potential to interfere with coumadin therapy. What herbs should the nurse include in the teaching? (Select all that apply.) A. Echinacea B. Garlic C. Ginger root D. Gingko biloba E. Valerian

B. Garlic C. Ginger root D. Gingko biloba Garlic, ginger root, and gingko biloba can increase the risk of bleeding in patients receiving anticoagulants or antiplatelet drugs.

The nurse is completing an admission assessment for a patient who requires treatment of an anxiety disorder. The patient states "I take the dietary supplement kava every day to help my anxiety and stress." The nurse understands the patient is at risk for which serious adverse effect? A. Stroke B. Hepatoxicity C. Suicidal behavior D. Acute renal failure

B. Hepatoxicity In the United States, kava is promoted as a natural alternative to benodiazepines to treat anxiety and stress. However, kava has the risk for the serious adverse effect of hepatoxicity, which lead the FDA to issue a public warning in March 2002. Also, in 2002, the Centers for Disease Control and Prevention issued a report on kava-related hepatoxicity.

In assessing a patient with a vitamin A deficiency, the nurse should determine whether the patient has which manifestation? A. Tender, bleeding gums B. Impaired night vision C. Disturbed sleep patterns D. Excessive sweating

B. Impaired night vision Vitamin A plays an important role in adaptation to dim light and night blindness, which often are the first indicators of deficiency. Vitamin A is used primarily for the prevention or correction of vitamin A deficiency. Tender, bleeding gums, disturbed sleep patterns, and excessive sweating are not related to manifestations of vitamin A deficiency.

A patient is taking black cohosh (Cimicifuga racemosa) for relief of menopausal symptoms. The nurse should caution her about adverse interactive effects with which conventional medication? A. Docusate sodium [Colace] B. Insulin C. Furosemide [Lasix] D. Aspirin

B. Insulin Black cohosh may potentiate the hypoglycemic effect of insulin and oral hypoglycemics. In addition, adverse hypotensive effects have been associated with antihypertensive medications. No interactive effects have been reported with docusate sodium, aspirin, or furosemide.

In a patient with a thiamine deficiency, which finding would indicate the development of Wernicke-Korsakoff syndrome? A. Pedal edema Incorrect B. Nystagmus C. Angular stomatitis D. Peripheral neuritis

B. Nystagmus Wernicke-Korsakoff syndrome is a disorder of the central nervous system. It produces neurologic and psychologic symptoms, including nystagmus, diplopia, ataxia, and inability to remember the recent past. It occurs in the United States most commonly among alcoholics who have a thiamine deficiency. Pedal edema occurs in wet beriberi, another form of thiamine deficiency. Angular stomatitis occurs in riboflavin (vitamin B2) deficiency as cracks in the skin at the corners of the mouth. Peripheral neuritis occurs in pyridoxine (vitamin B6) deficiency.

A patient plans to take saw palmetto. Which statement should the nurse include when teaching the patient about this supplement? A. Saw palmetto has numerous serious adverse effects. B. Saw palmetto should be used with caution in patients taking antiplatelet drugs. C. Saw palmetto is used to treat hot flashes associated with menopause. D. Beneficial effects of saw palmetto usually occur within 1 week.

B. Saw palmetto should be used with caution in patients taking antiplatelet drugs. Rationale: Saw palmetto should be used with caution in patients taking antiplatelet drugs (such as aspirin) or anticoagulants (for example, warfarin or heparin). Saw palmetto is very well tolerated. Significant adverse effects have not been reported. In rare cases, saw palmetto causes nausea or headache. Although antiandrogenic effects (for example, gynecomastia) have not been reported, it may be wise to monitor for them. Saw palmetto may have antiplatelet actions, but increased bleeding has not been reported. Saw palmetto (Serenoa repens, Sabal serrulata) is taken to relieve urinary symptoms associated with benign prostatic hypertrophy (BPH). Benefits of saw palmetto take at least 1 or 2 months to develop.

The nurse is caring for a patient who is experiencing a respiratory rate of 6 breaths per minute as a result of a large dose of pain medication. Which term most accurately describes this reaction? A. Side effect B. Toxicity C. Allergic reaction D. Idiosyncratic effect

B. Toxicity

A nurse is preparing a class on vitamin supplementation. What statement will be included in the class content? A. Vitamin B12 supplements during pregnancy reduce the risk of neural tube defects. B. Vitamin K is required to prevent bleeding. C. Vitamin E supplementation reduces the risk of cancer. D. Taking a daily multivitamin prevents the development of chronic disease.

B. Vitamin K is required to prevent bleeding. Answer: B Rationale: Vitamin K is required for the synthesis of prothrombin and other clotting factors. Antioxidants such as vitamins E and C do not reduce the risk of cancer. Folic acid supplements during pregnancy reduce the risk of neural tube defects. No evidence supports the use of multivitamins to prevent chronic diseases.

The nurse is preparing a discharge teaching plan to a patient prescribed phenobarbital and oral contraceptives which are known to induce CYP isoenzymes. What patient teaching should the nurse include in the discharge plan? A. "Continue taking your medications as prescribed." B. "Condoms are not necessary while taking phenobarbital. It is not an antibiotic." C. "Plan to use another form of birth control while taking phenobarbital." D. "Your dose of birth control pills will be reduced while you are taking phenobarbital."

C. "Plan to use another form of birth control while taking phenobarbital."

The nurse is working in an immunization clinic. Which patient will the nurse identify as not eligible to receive routine immunizations? A. An 8-year-old experiencing diarrhea B. A 2-year-old with a history of premature birth C. A 4-year-old with a fever and upper respiratory infection D. A 6-year-old who has recently been exposed to a classmate with chickenpox

C. A 4-year-old with a fever and upper respiratory infection The only true contraindications to receiving vaccines are an anaphylactic reaction to a specific vaccine or vaccine component and moderate or severe illness with or without a fever.

In which patient will the nurse suspect a thiamin deficiency? A. A 14-year-old whose diet is deficient in citrus fruits and juices B. A 26-year-old who is pregnant and is not taking prenatal vitamins C. A 42-year-old with alcoholism who has diplopia, ataxia, and memory loss D. A 76-year-old with lung cancer who is undergoing chemotherapy

C. A 42-year-old with alcoholism who has diplopia, ataxia, and memory loss Rationale: Thiamin deficiency occurs most often in alcoholic patients with symptoms of neurologic and motor deficits.

The nurse is monitoring for adverse drug reactions (ADRs) of assigned patients. Which patient is most at risk for the development of drug toxicity? A. A 30-year-old man admitted for altered mental status B. A 55-year-old woman with abnormal arterial blood gas values C. A 70-year-old woman with an elevated creatinine level D. A laboring 25-year-old woman with a positive Homans' sign

C. A 70-year-old woman with an elevated creatinine level

Which statement about renal excretion in infants is true? A. Renal blood flow is high during infancy. B. Renal drug excretion is significantly increased at birth. C. Adult levels of renal function are achieved by 1 year. D. Drugs that are eliminated primarily by renal excretion must be given in higher doses.

C. Adult levels of renal function are achieved by 1 year. Adult levels of renal function are achieved by 1 year. Renal blood flow, glomerular filtration, and active tubular secretion are low during infancy. Renal drug excretion is significantly reduced at birth. Drugs that are eliminated primarily by renal excretion must be given in reduced dosage and/or at longer dosing intervals.

Which factor in a patient's history is most likely related to the development of thiamine (vitamin B1) deficiency? A. Exposure to asbestos B. Heart transplant recipient C. Chronic alcohol abuse D. Gastric resection surgery

C. Chronic alcohol abuse Thiamine deficiency is common in individuals who abuse alcohol. Thiamine requirements are related to caloric intake, and principal dietary sources are enriched, fortified, or whole-grain products, such as breads and cereals. Exposure to asbestos, heart transplantation, and gastric resection surgery are situations unrelated to thiamine deficiency.

A patient has an international normalized ratio [INR] that is elevated to an unsafe level. A nurse administers vitamin K, expecting which therapeutic result? A. Increase in red blood cell [RBC] indices B. Decrease in pulse pressure C. Decrease in bleeding tendency D. Increase in mental alertness

C. Decrease in bleeding tendency Vitamin K is an essential nutrient for the synthesis of clotting factors. It also is the antidote for warfarin [Coumadin], an oral anticoagulant. Vitamin K enhances the coagulation process, thus minimizing a patient's risk for excessive bleeding. Increases in RBC indices or mental alertness or a decrease in pulse pressure is unrelated to the therapeutic effects of vitamin K.

The healthcare provider prescribes a medication that is renally eliminated for a patient with acute renal failure. The nurse recognizes the patient is at risk for which altered drug response? A. Increased drug excretion B. Decreased drug levels in the blood C. Development of drug toxicity D. Increased tolerance to the medication

C. Development of drug toxicity

The nurse is caring for a patient who has jaundice, dark urine, malaise, light-colored stools, nausea, and vomiting. What is this patient most likely experiencing? A. An idiosyncratic drug effect on the bone marrow B. Iatrogenic disease of the kidneys C. Drug toxicity of the liver D. An allergic reaction

C. Drug toxicity of the liver

Which statement by a new nurse indicates that further study is indicated? A. Effectiveness is the most important property a drug can have. B. There is no such thing as a safe drug. C. Drugs are defined as illegal substances. D. There is no such thing as a selective drug; all medications cause side effects.

C. Drugs are defined as illegal substances.

A patient who is in the early stages of Wernicke-Korsakoff syndrome has been admitted to the health care facility. Upon assessment of the patient, the nurse expects to find all but which manifestation? A. Nystagmus (involuntary eye movement) B. Diplopia (double-vision) C. Fixed, dilated pupils D. Ataxia (the loss of full control of bodily movements)

C. Fixed, dilated pupils Rationale: Fixed, dilated pupils are associated with severe neurologic damage or opiate drug overdose. Wernicke-Korsakoff syndrome is a serious disorder of the central nervous system, caused by thiamin deficiency, that has neurologic and psychologic manifestations. Symptoms include nystagmus, diplopia, ataxia, and inability to remember the recent past. Failure to correct the deficiency may result in irreversible brain damage.

Which action should a nurse take when preparing to administer vitamin D to a patient diagnosed with hyperparathyroidism? A. Assess deep tendon reflexes. B. Give the vitamin with 8 ounces of milk. C. Hold the vitamin and consult the prescriber. D. Determine whether the patient takes nonsteroidal anti-inflammatory drugs (NSAIDs).

C. Hold the vitamin and consult the prescriber. Vitamin D is contraindicated in patients with hypercalcemia, a clinical manifestation of hyperparathyroidism. The prescriber should be consulted about the patient's most recent calcium level and clinical symptoms. Checking deep tendon reflexes, giving milk, and asking about NSAID use are unnecessary actions to take in the administration of vitamin D.

The nurse is preparing the discharge teaching plan for a patient who had a mechanical valve replacement and has been prescribed coumadin. The nurse reviews the patient's medication history and notes the patient is taking the herbal supplement glucosamine to treat osteoarthritis. Which instructions should the nurse give to this patient? A. Increase consumption of foods high in vitamin K. B. Do not take any dietary or herbal supplements. C. Notify the healthcare provider immediately if you experience any signs of bleeding. D. Research studies have shown there is no benefit in using herbs to treat medical conditions.

C. Notify the healthcare provider immediately if you experience any signs of bleeding. Glucosamine may increase the risk of bleeding in patients taking anticoagulants such as coumadin. The nurse should educate the patient about the signs of bleeding. Glucosamine is widely used to treat osteoarthritis of the knee, hip, and wrist. Increasing vitamin K intake may decrease the effect of Coumadin.

A nurse administers Gardasil, the human papillomavirus (HPV) vaccine, to an 11-year-old girl. The nurse informs the parent that routine screening with which diagnostic test is needed? A. Beta hCG B. Chlamydia test C. Pap test D. Mammogram

C. Pap test C. Routine screening with a Pap test is still necessary, because Gardasil protects against four types of HPV, which may leave those vaccinated at risk for cervical cancer from other types of HPV. In addition, Gardasil does not eliminate preexisting HPV infection, which is a risk for cancer from an infection that was present before the vaccine was given. Screening tests for beta hCG or chlamydia and a mammogram are not needed in this situation, because Gardasil does not provide protection against pregnancy, chlamydia, or breast cancer.

The drug the nurse is about to give induces P-glycoprotein (PGP). What outcome should the nurse expect when this drug is given with other drugs? A. Increased levels of other drugs B. Increased side effects of other drugs C. Reduced absorption of other drugs D. Reduced drug elimination

C. Reduced absorption of other drugs

A nurse is preparing to give an oral dose of drug X to treat a patient's high blood pressure. After giving the drug, the nurse finds that it reduces the blood pressure without serious harmful effects, but it also causes the patient to have nausea and a headache. Based on this information, which property of an ideal drug is this drug lacking? A. Effectiveness B. Safety C. Selectivity D. Ease of administration

C. Selectivity

Which information on the product label of an herbal supplement would comply with the regulations established by the Dietary Supplement Health and Education Act (DSHEA)? A. Lowers cholesterol B. Relieves menopausal hot flashes C. Supports the immune system D. Reduces pain of arthritis

C. Supports the immune system The DSHEA restricts the wording of labels on product packaging. A label cannot claim to diagnose, treat, cure, or prevent disease. However, the label is allowed to state the product's ability to favorably influence body function or structure. Statements on a label such as "reduces the pain of arthritis," "lowers cholesterol," and "relieves menopausal hot flashes" would not be in compliance with DSHEA regulations.

A 3-year-old child is scheduled to receive pneumococcal vaccine (PCV). Which condition should the nurse recognize as a contraindication to the vaccine in this child? A. Autism B. Premature birth C. Temperature of 103°F D. The child's mother is pregnant

C. Temperature of 103°F PCV is a type of killed vaccine that is composed of killed microbes or microbial components. PCV vaccination is recommended for children younger than 5 years. Certain contraindications apply to all vaccines, including PCV. A vaccine should not be administered to a child with moderate to severe illness with or without a fever. Autism, premature birth, and pregnancy of the child's mother are not contraindications for PCV vaccination.

Why are infants especially sensitive to drugs that affect CNS function? A. The blood-brain barrier is especially strong in infants. B. The blood-brain barrier does not exist until 1 year of age. C. The blood-brain barrier is not fully developed at birth. D. The blood-brain barrier is weakened by the birth process.

C. The blood-brain barrier is not fully developed at birth. The blood-brain barrier is not fully developed at birth. The other statements are not true.

When studying the impact a drug has on the body, the nurse is reviewing what? A. The drug's pharmacokinetics B. The drug's selectivity C. The drug's pharmacodynamics D. The drug's predictability

C. The drug's pharmacodynamics

Which statement about the percentage of oral drug absorption is true? A. The percentage absorbed increases with age. B. The percentage absorbed decreases with age. C. The percentage absorbed does not usually change with age. D. The percentage absorbed severely declines with age.

C. The percentage absorbed does not usually change with age. As a rule, the percentage of an oral dose that becomes absorbed does not usually change with age.

A patient with diabetes mellitus type 2 is taking an oral hypoglycemic agent. The patient tells the nurse that he wants to start taking garlic supplements. It is most important for the nurse to do what? A. Inform the patient that garlic may interfere with absorption of the oral hypoglycemic agent B. Caution the patient against taking any herbal supplement C. Warn the patient that garlic can potentiate the effects of the oral hypoglycemic agent D. Teach the patient that ingestion of garlic with oral hypoglycemic agents can cause hyperglycemia

C. Warn the patient that garlic can potentiate the effects of the oral hypoglycemic agent Rationale: Garlic can increase insulin levels and thus potentiate the hypoglycemic effects of drugs for diabetes. Potentiate means to increase the power, effect, or likelihood of (something, especially a drug or physiological reaction).

A nursing student is caring for a patient who has been taking morphine sulfate for pain for 2 weeks. The nursing student shows an understanding of pharmacodynamic tolerance by describing it to the instructor in what way? A. "It is a form of tolerance that is a reduction in drug responsiveness brought on by repeated dosing over a short period." B. "It affects the minimum effective concentration." C. "It is a drug response caused by psychologic factors, not by biochemical or physiological properties." D. "It is a condition in which the patient requires increased doses of morphine sulfate to achieve pain relief."

D. "It is a condition in which the patient requires increased doses of morphine sulfate to achieve pain relief."

Which statement about intramuscular (IM) administration is incorrect? A. Drug absorption following IM injection in the neonate is slow and erratic. B. Absorption of IM drugs becomes more rapid in infancy than in neonates. C. Neonates experience low blood flow through muscle during the first days of postnatal life. D. Absorption of IM drugs becomes slower and more erratic in infancy than in neonates.

D. Absorption of IM drugs becomes slower and more erratic in infancy than in neonates. Drug absorption following IM injection in the neonate is slow and erratic. Delayed absorption is due in part to low blood flow through muscle during the first days of postnatal life. By early infancy, absorption of IM drugs becomes more rapid than in neonates and adults.

A nurse administers varicella vaccine [Varivax] to a child. The nurse then instructs the parent to avoid giving the child which product for 6 weeks? A. Foods with citric acid (orange juice) B. Acetaminophen [Tylenol] C. Foods fortified with vitamin D D. Acetylsalicylic acid (aspirin)

D. Acetylsalicylic acid (aspirin) Three percent of children may develop a mild, local, varicella-like rash in response to the varicella vaccine; concurrent use of aspirin increases their risk of also developing Reye's syndrome, a serious childhood illness. It is not necessary to avoid foods fortified with vitamin D or foods with citric acid, such as orange juice. Tylenol is recommended for use in children with chickenpox.

Which nursing action results in the most common cause of fatal medication errors? A. Miscalculation of dosage B. Miscommunication of drug orders C. Misreads the healthcare provider's handwriting D. Administers a drug intravenously (IV) instead of intramuscular (IM)

D. Administers a drug intravenously (IV) instead of intramuscular (IM)

The nurse is caring for a pregnant patient who has chronic asthma. When administering medications to this patient, the nurse should do what? A. Give the medications as ordered, because most drugs do not cross the placenta. B. First assess the creatinine level, because renal blood flow decreases during pregnancy. C. Hold the medications and notify the ordering physician, because drugs that are not known teratogens may not be safe during pregnancy. D. Advise the patient that taking asthma medications during pregnancy improves fetal outcomes.

D. Advise the patient that taking asthma medications during pregnancy improves fetal outcomes. Essentially all drugs can cross the placenta. Renal blood flow increases during pregnancy, which increases the clearance of some drugs, such as lithium. Lack of proof of teratogenicity does not mean that a drug is safe; it only means that the available data are insufficient to make a definitive judgment. Uncontrolled maternal asthma is more dangerous to the fetus than the drugs used to treat.

For medications that do not have established pediatric doses, the most common method of extrapolating the appropriate dose is based on which measurement? A. Age B. Weight C. Height/length D. Body surface area

D. Body surface area Pediatric doses have been established for a few drugs but not for most. For drugs that do not have an established pediatric dose, dosage can be extrapolated from adult doses. The method of conversion employed most commonly is based on body surface area.

When assessing for drug effects in the older adult, which phase of pharmacokinetics is the greatest concern? A. Absorption B. Distribution C. Metabolism D. Excretion

D. Excretion Although pharmacokinetic changes in older adults affect all phases of kinetics, drug accumulation secondary to reduced renal excretion is the most important cause of ADRs in the older adult.

A patient tells the nurse that she is thinking about becoming pregnant. The nurse teaches the patient that which vitamin should be her priority for supplementation before planning a pregnancy? A. Vitamin B12 B. Riboflavin C. Vitamin D D. Folic acid

D. Folic acid Folic acid deficiency during early pregnancy can cause neural tube defects [spina bifida]. All women with the potential for becoming pregnant should consume folic acid every day. Vitamin B12, riboflavin, and vitamin D are not considered as important as folic acid to supplement before a woman becomes pregnant.

The nurse is caring for a patient prescribed abacavir [Ziagen] to treat human immunodeficiency virus (HIV) infection. To reduce the potential fatal hypersensitivity reaction, which recommendation is suggested prior to initiating abacavir drug therapy? A. Administer a test dose B. Obtain liver function studies C. Drug skin testing D. Genetic screening

D. Genetic screening

A patient is scheduled to start taking vitamin C. The nurse should teach the patient to observe for which side effect? A. Delayed healing B. Bone and joint pain C. Loosening of the teeth D. Nausea and diarrhea

D. Nausea and diarrhea Large doses of vitamin C can cause nausea and vomiting, headache, abdominal cramps, and the development of renal stones. Delayed healing, bone and joint pain, and loosening of the teeth are unrelated to the side effects of vitamin C; they actually are symptoms of scurvy, a deficiency of vitamin C.

Which statement regarding adverse reactions during pregnancy is false? A. Not only are pregnant women subject to the same adverse effects as everyone else, but they may also suffer effects unique to pregnancy. B. Drugs taken during pregnancy can adversely affect the patient as well as the fetus. C. The drug effect of greatest concern is teratogenesis. This is the production of birth defects in the fetus. D. One in five children is born with a malformation related to drug use during pregnancy.

D. One in five children is born with a malformation related to drug use during pregnancy. Less than 1% of all birth defects are caused by drugs. All of the other statements are true.

Which is not a reason for the decline in hepatic drug metabolism with age? A. Reduced hepatic blood flow B. Reduced liver mass C. Decreased activity of some hepatic enzymes D. Poor diet

D. Poor diet Rates of hepatic drug metabolism tend to decline with age. Principal reasons are reduced hepatic blood flow, reduced liver mass, and decreased activity of some hepatic enzymes. Diet is important but is not a principal reason for reduced hepatic drug metabolism.

The nurse is caring for a group of older adult patients who are all receiving multiple medications. The nurse understands that it is essential to individualize each patient's therapy. Which is the best rationale for this practice? A. The percentage of drug absorbed often is decreased in older adults. B. Most older adults have decreased body fat and increased lean mass. C. Hepatic metabolism tends to increase in older adults, resulting in decreased drug levels. D. Renal function declines with age, leading to decreased drug excretion.

D. Renal function declines with age, leading to decreased drug excretion. Renal function declines in older adults, leading to decreased excretion and potential drug accumulation. Although absorption may be delayed in older adults, the percentage absorbed does not change. Most older adult patients have increased body fat and decreased lean mass. Hepatic metabolism tends to decline with age.

A teratogenic drug, such as methotrexate, is most likely to cause learning deficits during which phase of fetal development? A. Conception through week 2 B. Weeks 3 to 8 C. First trimester D. Second and third trimesters

D. Second and third trimesters Exposure to teratogens during the second and third trimesters usually disrupts function rather than producing obvious anatomic abnormalities. Exposure to teratogens during the first 2 weeks of pregnancy usually results in an "all-or-nothing" response that may result in fetal death. Exposure during the remainder of the first trimester may result in anatomic malformation

Which statement about St. John's wort does the nurse identify as true? A. St. John's wort is often used in combination with other antidepressants for a more rapid response to treatment. B. Use of St. John's wort in patients taking digoxin results in increased digoxin levels. C. St. John's wort has been found to be effective in the treatment of severe depression. D. Serotonin syndrome is a potential adverse effect of therapy with St. John's wort.

D. Serotonin syndrome is a potential adverse effect of therapy with St. John's wort. Rationale: Combining St. John's wort with certain drugs can intensify serotonergic transmission to a degree sufficient to cause potentially fatal serotonin syndrome. Although St. John's wort can enhance serotonergic transmission by itself, its effect is relatively weak; when used alone, the herb poses little risk. However, if St. John's wort is combined with other serotonin-enhancing agents, the risk is greatly increased; therefore, St. John's wort should not be combined with such drugs. Also, because St. John's wort has a variety of known adverse interactions and is likely to have more that are as yet unknown, caution is clearly advised. St. John's wort is not recommended for treating depression in patients taking other medications. St. John's wort greatly reduces levels of digoxin, a drug for heart failure. For patients with mild to moderate major depression, St. John's wort appears superior to placebo and equal to tricyclic antidepressants. For patients with severe depression, there is no convincing proof of efficacy.

The nurse is preparing to give a drug with certain properties. Which property of the drug is the most compelling indication that it should not be given? A. The drug produces an unwanted side effect. B. The drug is difficult to administer. C. The drug's effects are reversible. D. The drug is not effective for its intended purpose.

D. The drug is not effective for its intended purpose.

Which of the following is not an example of age-related adverse drug effects? A. Growth suppression B. Discoloration of developing teeth C. Kernicterus D. Toxicity

D. Toxicity Like adults, pediatric patients are subject to adverse reactions when drug levels rise too high. In addition, pediatric patients are vulnerable to unique adverse effects related to organ system immaturity and to ongoing growth and development. Among these age-related effects are growth suppression (caused by glucocorticoids), discoloration of developing teeth (caused by tetracyclines), and kernicterus (caused by sulfonamides).

The nurse recognizes that the supplement echinacea (Echinacea angustifolia) should not be taken as prolonged therapy for patients with which condition? A. Peptic ulcer disease B. Diabetes C. Glaucoma Incorrect D. Tuberculosis

D. Tuberculosis When taken on a short-term basis to suppress inflammation and stimulate the immune system, echinacea has few adverse effects. However, if taken as long-term therapy, it can suppress immune function. It should be avoided in patients with chronic infections, such as tuberculosis, that require optimal immune function. Patients with diabetes, peptic ulcer disease, or glaucoma need not avoid taking echinacea.

According to the FDA Pregnancy Risk categories, which category represents the greatest risk for fetal harm? A. A B. B C. D D. X

D. X Drugs in Category X are the most dangerous; these drugs are known to cause human fetal harm, and their risk to the fetus outweighs any possible therapeutic benefit. Drugs in Categories B, C, and D are progressively more dangerous than drugs in Category A and less dangerous than drugs in Category X.