final 4, final 3, final 2

A patient is to receive a daily dose of fludarabine (Fludara), 25 mg/m2/day for 5 consecutive days. Each dose is diluted in a 125-mL bag of normal saline and is to infuse over 30 minutes. The nurse will set the infusion pump to what rate in milliliters per hour? _______

250 mL/hour

6. A patient with volume overload begins taking a thiazide diuretic. The nurse will tell the patient to expect which outcome when taking this drug? a. Improved exercise tolerance b. Increased cardiac output c. Prevention of cardiac remodeling d. Prolonged survival

ANS: A Diuretics help reduce fluid volume overload, which, by reducing pulmonary edema, can improve exercise tolerance. Diuretics do not improve cardiac output. ACE inhibitors are used to prevent cardiac remodeling and to improve long-term survival.

Which drugs are used to treat COPD? (Select all that apply.) a. Anticholinergic medications b. Glucocorticoids c. Leukotriene modifiers d. Long-acting beta2 agonists e. Monoclonal antibodies

ANS: A, B, D Anticholinergic drugs, glucocorticoids, and LABAs are used to treat COPD. Leukotriene modifiers and monoclonal antibodies are used only to treat asthma.

The nurse knows that which immunosuppressants are among the most effective? a.Azathioprine [Imuran] and everolimus [Zortress] b.Cyclosporine [Sandimmune] and tacrolimus [Prograf] c.Methotrexate [Rheumatrex] and muromonab-CD3 [Orthoclone OKT3] d.Sirolimus [Rapamune] and methylprednisolone

ANS: B Cyclosporine and tacrolimus are the most effective immunosuppressants available.

A patient is receiving an aluminum-containing antacid. The nurse will inform the patient to watch for which possible adverse effect? a. Diarrhea b. Constipation c. Nausea d. Abdominal cramping

ANS: B Aluminum-based antacids have a constipating effect as well as an acid-neutralizing capacity. The other options are incorrect.

A nurse is discussing the use of immunosuppressants for the treatment of inflammatory bowel disease (IBD) with a group of nursing students. Which statement by a student indicates understanding of the teaching? a."Azathioprine [Imuran] helps induce rapid remission of IBD." b."Cyclosporine [Sandimmune] can be used to induce remission of IBD." c."Cyclosporine [Sandimmune] does not have serious adverse effects." d."Methotrexate is used long term to maintain remission of IBD."

ANS: B Cyclosporine can be given intravenously to induce rapid remission of IBD. Azathioprine has delayed onset of effects up to 6 months and is not used to induce rapid remission. Cyclosporine is a toxic compound that can cause renal impairment, neurotoxicity, and immune suppression. Methotrexate is used to promote short-term remission.

A patient has started azathioprine (Imuran) therapy as part of renal transplant surgery. The nurse will monitor for which expected adverse effect of azathioprine therapy? (Select all that apply.) a. Tremors b. Leukopenia c. Diarrhea d. Thrombocytopenia e. Hepatotoxicity f. Fluid retention

ANS: B, D, E Leukopenia is an expected adverse effect of azathioprine therapy, as are thrombocytopenia and hepatotoxicity. The other options are incorrect.

A patient with non-Hodgkin's lymphoma is about to begin chemotherapy with a massive dose of methotrexate [Rheumatrex]. The nurse will expect to administer which medication concurrently with this drug? a.Dexamethasone b.Folic acid c.Leucovorin d.Vitamin B12

ANS: C Leucovorin is used to protect normal cells when massive doses of methotrexate are given. Dexamethasone, folic acid, and vitamin B12 are not given concurrently with methotrexate

11. Insulin glargine is prescribed for a hospitalized patient who has diabetes. When will the nurse expect to administer this drug? a. Approximately 15 to 30 minutes before each meal b. In the morning and at 4:00 PM c. Once daily at bedtime d. After meals and at bedtime

ANS: C Glargine insulin is indicated for once daily subcutaneous administration to treat adults and children with type 1 diabetes and adults with type 2 diabetes. According to the package labeling, the once-daily injection should be given at bedtime. Glargine insulin should not be given more than once a day, although some patients require bid dosing to achieve a full 24 hours of basal coverage.

The nurse is reviewing the medication administration record of a patient who is taking isoniazid (INH). Which drug or drug class has a significant drug interaction with isoniazid? a. Pyridoxine (vitamin B6) b. Penicillins c. Phenytoin (Dilantin) d. Benzodiazepines

ANS: C Taking INH with phenytoin will cause decreased metabolism of the phenytoin, leading to increased drug effects. Pyridoxine is often given with isoniazid to prevent peripheral neuropathy. The other options are incorrect.

A patient on an oncology unit has been receiving ifosfamide [Ifex] for a few days. Before administering the next dose, the nurse reviews the patient's laboratory test results. Which finding would cause the nurse to hold the dose? a.Elevated white blood cell count b.Low hemoglobin and hematocrit levels c.Low levels of ketones in the urine d.Microscopic hematuria

ANS: D The nurse should hold the dose for microscopic hematuria, because this may indicate hemorrhagic cystitis. An elevated white blood cell count is not an indication to hold the dose. Low hemoglobin and hematocrit levels are expected for a patient undergoing chemotherapy. Ketones may reveal some other problem, but they are not associated with ifosfamide

An infant has been hospitalized with a severe lung infection caused by the respiratory syncytial virus (RSV) and will be receiving medication via the inhalation route. The nurse expects which drug to be used? a. Acyclovir (Zovirax) b. Ganciclovir (Cytovene) c. Amantadine (Symmetrel) d. Ribavirin (Virazole)

ANS: D The inhalational form of ribavirin (Virazole) is used primarily in the treatment of hospitalized infants with severe lower respiratory tract infections caused by RSV. The other drugs listed are not used for the treatment of RSV.

The nurse is monitoring drug levels for a patient who is receiving theophylline. The most recent theophylline level was 22 mcg/mL, and the nurse evaluates this level to be: A. below the therapeutic level. B. at a therapeutic level. C. above the therapeutic level. D. A t a toxic level.

C. Above the therapeutic level Rationale: Although the optimal level may vary from patient to patient, most standard references have suggested that the therapeutic range for theophylline blood level is 10 to 20 mcg/mL. However, most clinicians now advise levels between 5 and 15 mcg/mL.

When educating a patient recently placed on inhaled corticosteroids, the nurse will discuss which potential adverse effects? A. Fatigue and depression B. Anxiety and palpitations C. Headache and rapid heart rate D. Oral candidiasis and dry mouth

D. Oral candidiasis and dry mouth Rationale: Oral candidiasis and dry mouth are two possible adverse effects of inhaled corticosteroids. The other responses are incorrect.

A patient who is morbidly obese is admitted for treatment. The prescriber orders lisdexamfetamine [Vyvanse]. The nurse will be concerned if this patient shows signs of: a. anorexia. b. dyspnea. c. insomnia. d. loquaciousness.

b. dyspnea.

A nurse is performing a physical assessment on a patient with tuberculosis who takes rifampin [Rifadin]. What would be an expected finding? a. Crystalluria b. Myopathy c. Peripheral neuropathy d. Red-orange-tinged urine

d. Red-orange-tinged urine

A pregnant patient who is taking ondansetron [Zofran] for morning sickness tells the nurse she is experiencing headache and dizziness. What will the nurse tell her? a.It is not safe to take this drug during pregnancy. b.These are common side effects of ondansetron. c.She should stop taking the ondansetron immediately. d.She should report these adverse effects to her provider.

ANS: B The most common side effects of ondansetron are headache, diarrhea, and dizziness. Ondansetron is used off-label to treat morning sickness. These side effects do not indicate a need to stop taking the drug or to report the side effects to the provider.

13. A nurse is preparing to administer digoxin [Lanoxin] to a patient. The patient's heart rate is 62 beats per minute, and the blood pressure is 120/60 mm Hg. The last serum electrolyte value showed a potassium level of 5.2 mEq/L. What will the nurse do? a. Contact the provider to request an increased dose of digoxin. b. Give the dose of digoxin and notify the provider of the potassium level. c. Request an order for a diuretic. d. Withhold the dose and notify the provider of the heart rate.

ANS: B The patient's serum potassium level is above normal limits, but only slightly. An elevated potassium level can reduce the effects of digoxin, so there is no risk of toxicity. There is no indication that an increased dose of digoxin is needed. There is no indication for a diuretic. The heart rate is acceptable; doses should be withheld if the heart rate is less than 60 beats per minute.

A patient admitted to the hospital has a history of peptic ulcer disease. The patient takes ranitidine [Zantac] and sucralfate [Carafate]. The patient tells the nurse that discomfort is usually controlled but that symptoms occasionally flare up. What will the nurse do? a.Ask the provider about ordering an endoscopic examination. b.Contact the provider to discuss serologic testing and an antibiotic. c.Contact the provider to discuss switching to a proton pump inhibitor. d.Counsel the patient to avoid beverages containing caffeine.

ANS: B The recommendation for all patients with gastric or duodenal ulcers and documented Helicobacter pylori infection is treatment with antibiotics. The nurse is correct to ask about serologic testing for this organism and to suggest adding an antibiotic to this patient's regimen. An endoscopic examination is not recommended. Changing to a proton pump inhibitor may not change the symptoms. There is no evidence that caffeine contributes to peptic ulcer disease (PUD).

When a patient is receiving a second-generation antipsychotic drug, such as risperidone (Risperdal), the nurse will monitor for which therapeutic effect? a. Fewer panic attacks b. Decreased paranoia and delusions c. Decreased feeling of hopelessness d. Improved tardive dyskinesia

ANS: B The therapeutic effects of the antipsychotic drugs include improvement in mood and affect, and alleviation or decrease in psychotic symptoms (decrease in hallucinations, paranoia, delusions, garbled speech). Tardive dyskinesia is a potential adverse effect of these drugs. The other options are incorrect.

A patient who experiences motion sickness is about to go on a cruise. The prescriber orders transdermal scopolamine [Transderm Scop]. The patient asks the nurse why an oral agent is not ordered. The nurse will explain that the transdermal preparation: a.can be applied as needed at the first sign of nausea. b.has less intense anticholinergic effects than the oral form. c.is less sedating than the oral preparation. d.provides direct effects, because it is placed close to the vestibular apparatus of the ear.

ANS: B The transdermal system of scopolamine is preferred, because it may have less intense anticholinergic effects than oral or subcutaneous dosing. Antinausea medications for motion sickness are more effective if given prophylactically than after symptoms begin. Sedation side effects are similar with all forms. Placement near the ear does not cause the medication to absorb directly into the vestibular apparatus.

The nurse is preparing to administer morning medications to a patient who has been newly diagnosed with tuberculosis. The patient asks, "Why do I have to take so many different drugs?" Which response by the nurse is correct? a. "Your prescriber hopes that at least one of these drugs will work to fight the tuberculosis." b. "Taking multiple drugs reduces the chance that the tuberculosis will become drug resistant." c. "Using more than one drug can help to reduce side effects." d. "Using multiple drugs enhances the effect of each drug."

ANS: B The use of multiple medications reduces the possibility that the organism will become drug resistant. The other options are incorrect.

6. A patient admitted to the hospital has been using phenylephrine nasal spray [Neo-Synephrine], 2 sprays every 4 hours, for a week. The patient complains that the medication is not working, because the nasal congestion has increased. What will the nurse do? a. Request an order for an oral decongestant to replace the intranasal phenylephrine. b. Request an order for an intranasal glucocorticoid to be used while the phenylephrine is withdrawn. c. Tell the patient to increase the dose of phenylephrine to 4 sprays every 4 hours. d. Tell the patient to stop using the phenylephrine and begin using an intranasal antihistamine.

ANS: B This patient is experiencing rebound congestion, which develops when topical sympathomimetics are used for longer than a few days. Abrupt withdrawal can stop the cycle of rebound congestion but is uncomfortable, so using an intranasal glucocorticoid, beginning one week before discontinuing the decongestant, while withdrawing the decongestant, is recommended. An oral decongestant is not recommended. Increasing the dose of the intranasal decongestant will only compound the problem of rebound congestion. Stopping the intranasal decongestant will only increase the congestion; using an intranasal antihistamine will not help with congestion.

Before beginning a patient's therapy with selective serotonin reuptake inhibitor (SSRI) antidepressants, the nurse will assess for concurrent use of which medications or medication class? a. Aspirin b. Anticoagulants c. Diuretics d. Nonsteroidal anti-inflammatory drugs

ANS: B Use of selective serotonin reuptake inhibitor (SSRI) antidepressants with warfarin results in an increased anticoagulant effect. SSRI antidepressants do not interact with the other drugs or drug classes listed. See Table 16-6 for important drug interactions with SSRIs.

3. A patient who has been anticoagulated with warfarin (Coumadin) has been admitted for gastrointestinal bleeding. The history and physical examination indicates that the patient may have taken too much warfarin. The nurse anticipates that the patient will receive which antidote? a. Vitamin E b. Vitamin K c. Protamine sulfate d. Potassium chloride

ANS: B Vitamin K is given to reverse the anticoagulation effects of warfarin toxicity. Protamine sulfate is the antidote for heparin overdose. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 416 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

The nurse is providing counseling to a woman who is HIV positive and has just discovered that she is pregnant. Which anti-HIV drug is given to HIV-infected pregnant women to prevent transmission of the virus to the infant? a. Acyclovir (Zovirax) b. Zidovudine (Retrovir) c. Ribavirin (Virazole) d. Foscarnet (Foscavir)

ANS: B Zidovudine, along with various other antiretroviral drugs, is given to HIV-infected pregnant women and even to newborn babies to prevent maternal transmission of the virus to the infant. The other drugs are non-HIV antiviral drugs.

A patient on chemotherapy is using ondansetron (Zofran) for treatment of nausea. The nurse will instruct the patient to watch for which adverse effect of this drug? a. Dizziness b. Diarrhea c. Dry mouth d. Blurred vision

ANS: B Diarrhea is an adverse effect of the serotonin blockers. The other adverse effects listed may occur with anticholinergic drugs

A patient is taking chemotherapy with a drug that has a high potential for causing nausea and vomiting. The nurse is preparing to administer an antiemetic drug. Which class of antiemetic drugs has proven most effective in preventing nausea and vomiting for patients receiving chemotherapy? a. Prokinetic drugs, such as metoclopramide (Reglan) b. Serotonin blockers, such a ondansetron (Zofran) c. Anticholinergic drugs, such as scopolamine d. Neuroleptic drugs, such as promethazine (Phenergan

ANS: B Serotonin blockers have proven to be very effective in preventing chemotherapy-induced and postoperative nausea and vomiting. The other options are incorrect.

The nurse asks a graduate nurse, "When a patient in the initial phase of HIV infection is assessed, which findings would you expect to see?" The graduate nurse would be correct to respond with which conditions? (Select all that apply.) a.Respiratory distress b.Fever c.Myalgia d.Lymphadenopathy e.Insomnia

ANS: B, C, D Fever, myalgia, and lymphadenopathy are early signs associated with HIV infection. Respiratory distress and insomnia are not consistent findings in the initial phase of HIV infection.

Which laxatives may be used safely in infants? (Select all that apply.) a.Castor oil b.Docusate sodium (Colace) c.Glycerin suppositories d.Lactulose e.Milk of magnesia

ANS: B, C, D Docusate, lactulose, and glycerin suppositories have been used to treat constipation safely in infants. Castor oil and milk of magnesia are not.

Which patients would be candidates for the use of dronabinol [Marinol] to treat nausea and vomiting? (Select all that apply.) a.A patient with a history of a psychiatric disorder b.A patient with acquired immunodeficiency syndrome (AIDS)-induced anorexia c.A patient with chemotherapy-induced nausea and vomiting d.A patient with nausea who has used marijuana in the past e.A patient with postoperative nausea and vomiting

ANS: B, C, D Two cannabinoids have been approved for medical use in the United States for AIDSinduced anorexia and CINV. Because these drugs do not produce the same "high" that smoking marijuana does, their use is not contraindicated in patients who have used marijuana in the past. They do cause potentially unpleasant effects, such as temporal disintegration, dissociation, depersonalization, and dysphoria, so they are contraindicated in patients with psychiatric disorders. They are not approved for postoperative nausea and vomiting.

A patient has a new prescription for phentermine (Ionamin) as part of the treatment for weight loss. Which information will the nurse include when teaching this patient about a stimulant such as phentermine? (Select all that apply.) a. Take this medication after meals. b. Take this medication in the morning. c. This drug is taken along with supervised exercise and suitable diet. d. Use mouth rinses, sugarless gum, or hard candies to minimize dry mouth. e. Avoid foods that contain caffeine, such as coffee, tea, and colas.

ANS: B, C, D, E This drug should be taken in the morning to avoid interference with sleep, and the patient should also be on a supervised exercise and dietary regime. Caffeine-containing products should be avoided because of possible additional stimulation. Dry mouth can be minimized by the use of mouth rinses, sugarless gum, or hard candy. The other option is incorrect.

The nurse is providing patient teaching about antacids. Which statements about antacids are accurate? (Select all that apply.) a. Antacids reduce the production of acid in the stomach. b. Antacids neutralize acid in the stomach. c. Rebound hyperacidity may occur with calcium-based antacids. d. Aluminum-based antacids cause diarrhea. e. Magnesium-based antacids cause diarrhea.

ANS: B, C, E Antacids neutralize acid in the stomach. Magnesium-based antacids cause diarrhea, and aluminum-based antacids cause constipation. Calcium-based antacids often cause rebound hyperacidity.

A patient will be receiving mitoxantrone (Novantrone), 12 mg/m2 every 3 weeks, as part of treatment for prostate cancer. Each dose is mixed into a 50-mL bag of D5W and needs to infuse over 15 minutes. The infusion pump delivers the dose at milliliters per hour. Identify the nurse will set the pump to infuse at what rate. _______

200 mL/hr

A patient with a viral infection is to receive ganciclovir (Cytovene) 5 mg/kg/day IVPB every morning. The patient weighs 110 pounds. Identify how many milligrams will this patient receive for this dose. _______

250 mg

1. A pregnant patient asks the nurse if she can take antihistamines for seasonal allergies during her pregnancy. What will the nurse tell the patient? a. Antihistamines should be avoided unless absolutely necessary. b. Second-generation antihistamines are safer than first-generation antihistamines. c. Antihistamines should not be taken during pregnancy but may be taken when breast-feeding. d. The margin of safety for antihistamines is clearly understood for pregnant patients.

A Antihistamines are pregnancy Category C, with debate currently occurring regarding degree of effects on the fetus. They should be avoided unless absolutely necessary. All antihistamines have adverse effects on the fetus. Antihistamines can be excreted in breast milk. The margin of safety of antihistamines in pregnancy is not clear, so these agents should be avoided unless a clear benefit of treatment outweighs any risks

3. A nurse is teaching a group of nursing students about antihistamines. Which statement by a student indicates an understanding of the mechanism of action of the antihistamines? a. "Antihistamines block H1 receptors to prevent actions of histamine at these sites." b. "Antihistamines block release of histamine from mast cells and basophils." c. "H1 antagonists can bind to H1 receptors, H2 receptors, and muscarinic receptors." d. "First-generation antihistamines are more selective than second-generation antihistamines."

A Antihistamines block H1 receptors to prevent the actions of histamine. They do not block the release of histamine. H1 antagonists do not bind to H2 receptors; they do bind to muscarinic receptors. Second-generation antihistamines are more selective than first-generation antihistamines.

10. A patient is taking a calcium channel blocker (CCB) for stable angina. The patient's spouse asks how calcium channel blockers relieve pain. The nurse will explain that CCBs: a. help relax peripheral arterioles to reduce afterload. b. improve coronary artery perfusion. c. increase the heart rate to improve myocardial contractility. d. increase the QT interval.

A CCBs promote relaxation of peripheral arterioles, resulting in a decrease in afterload, which reduces the cardiac oxygen demand. CCBs do not improve coronary artery perfusion. CCBs reduce the heart rate and suppress contractility; they do not affect the QT interval.

16. A patient who has renal impairment will begin taking ranolazine [Ranexa] as an adjunct to nitroglycerine to treat angina. What will the nurse include when teaching this patient? a. "You will need to monitor your blood pressure closely while taking this drug." b. "You should take this drug 1 hour before or 2 hours after a meal." c. "You may experience rapid heart rate while taking this medication." d. "You do not need to worry about drug interactions with this medication."

A Ranolazine can elevate blood pressure in patients with renal impairment, so patients taking this drug will need to monitor blood pressure. The drug can be taken without regard to food. It does not cause reflex tachycardia. It has many significant drug interactions. MULTIPLE RESPONSE

4. A patient who has chronic allergies takes loratadine [Claritin] and develops a severe reaction to bee stings. The patient asks the nurse why the antihistamine did not prevent the reaction. What will the nurse say? a. "Allergy symptoms that are severe are caused by mediators other than histamine." b. "H1 blockers do not prevent the release of histamine from mast cells and basophils." c. "Second-generation H1 blockers contain less active drug and do not work in severe reactions." d. "Severe allergic reactions occur through actions on muscarinic receptors."

A Severe allergic reactions with symptoms of anaphylaxis are caused by mediators other than histamine, so the benefits of antihistamines are limited. H1 blockers do not block the release of histamine, but this is not why they are not effective in anaphylaxis. Second-generation agents are as effective as first-generation agents in allergic reactions mediated by histamine; neither is effective for treating anaphylaxis.

18. The nurse has just received an order for tenecteplase [TNKase] for a patient experiencing an acute myocardial infarction. The nurse should administer this drug: a. by bolus injection. b. by infusion pump over 24 hours. c. slowly over 90 minutes. d. via monitored, prolonged infusion.

A Tenecteplase [TNKase] is given by bolus injection. Tissue plasminogen activator (tPA) must be infused over 90 minutes. Because tenecteplase [TNKase] is given by bolus injection, an infusion pump is not required. Although the patient should be monitored, tenecteplase [TNKase] does not require a prolonged infusion time.

12. A 5-year-old child with seasonal allergies has been taking 2.5 mL of cetirizine [Zyrtec] syrup once daily. The parents tell the nurse that the child does not like the syrup, and they do not think that the drug is effective. The nurse will suggest they discuss which drug with their child's healthcare provider? a. Cetirizine [Zyrtec] 5-mg chewable tablet once daily b. Loratadine [Claritin] 10-mg chewable tablet once daily c. Fexofenadine [Allegra] syrup 5 mL twice daily d. Desloratadine [Clarinex] 5-mg rapid-disintegrating tablet once daily

A The child is receiving a low dose of cetirizine and can receive up to 5 mg per day in either a single dose or two divided doses. Cetirizine is available in a chewable tablet, which this child may tolerate better, so the parents should be encouraged to explore this option with their provider. The loratadine 10-mg chewable tablet is approved for children 6 years and older. Fexofenadine would be safe for this child, but it is unlikely that the syrup would be any better than the cetirizine syrup. Desloratadine is not approved for children under the age of 12 years.

4. A patient with atrial fibrillation is receiving warfarin [Coumadin]. The nurse notes that the patient's INR is 2.7. Before giving the next dose of warfarin, the nurse will notify the provider and: a. administer the dose as ordered. b. request an order to decrease the dose. c. request an order to give vitamin K (phytonadione). d. request an order to increase the dose.

A This patient has an INR in the appropriate range, which is 2 to 3 for most patients and 2.5 to 3.5 for some, so no change in warfarin dosing is necessary. It is not correct to request an order to either decrease or increase the dose of warfarin. It is not necessary to give vitamin K, which is an antidote for warfarin toxicity.

7. A patient with angina who uses sublingual nitroglycerin tells the nurse that the episodes are increasing in frequency and usually occur when the patient walks the dog. The patient reports needing almost daily doses of the nitroglycerin and states that one tablet usually provides complete relief. What will the nurse do? a. Contact the provider to suggest ordering a transdermal patch for this patient. b. Question the patient about consumption of grapefruit juice. c. Suggest that the patient limit walking the dog to shorter distances less frequently. d. Suggest that the patient take two tablets of nitroglycerin each time, because the symptoms are increasing in frequency.

A Transdermal patches are good for sustained prophylaxis for anginal attacks and are especially useful when patients have a regular pattern of attacks. Grapefruit juice does not affect the metabolism of nitroglycerin. Patients with angina should be encouraged to increase, not decrease, exercise. Taking two tablets is not recommended when one is effective.

12. A nursing student is helping to care for a patient who takes verapamil for stable angina. The nurse asks the student to explain the purpose of verapamil in the treatment of this patient. Which statement by the student indicates a need for further teaching? a. "It relaxes coronary artery spasms." b. "It reduces peripheral resistance to reduce oxygen demands." c. "It reduces the heart rate, AV conduction, and contractility." d. "It relaxes the peripheral arterioles to reduce afterload."

A Verapamil does relax coronary artery spasms, but this is not useful in stable angina. Verapamil is used to relax coronary artery spasms in variant asthma. When used to treat stable angina, verapamil promotes relaxation of peripheral arterioles, which reduces peripheral resistance and decreases afterload. It also reduces the heart rate, AV conduction, and contractility.

17. A patient who is taking warfarin [Coumadin] has just vomited blood. The nurse notifies the provider, who orders lab work revealing a PT of 42 seconds and an INR of 3.5. The nurse will expect to administer: a. phytonadione (vitamin K1) 1 mg IV over 1 hour. b. phytonadione (vitamin K1) 2.5 mg PO. c. protamine sulfate 20 mg PO. d. protamine sulfate 20 mg slow IV push.

A Vitamin K1 is given for warfarin overdose and may be given IV in an emergency. To reduce the incidence of an anaphylactoid reaction, it should be infused slowly. In a nonemergency situation, it would be appropriate to give vitamin K1 orally. Protamine sulfate is used for heparin overdose.

9. A patient with stable exertional angina has been receiving a beta blocker. Before giving the drug, the nurse notes a resting heart rate of 55 beats per minute. Which is an appropriate nursing action? a. Administer the drug as ordered, because this is a desired effect. b. Withhold the dose and notify the provider of the heart rate. c. Request an order for a lower dose of the medication. d. Request an order to change to another antianginal medication.

A When beta blockers are used for anginal pain, the dosing goal is to reduce the resting heart rate to 50 to 60 beats per minute. Because this heart rate is a desired effect, there is no need to withhold the dose or notify the provider. The dosage does not need to be lowered, because a heart rate of 55 beats per minute is a desired effect. There is no indication of a need to change medications for this patient.

The nurse is preparing to administer a barbiturate. Which conditions or disorders would be a contraindication to the use of these drugs? (Select all that apply.) a. Gout b. Pregnancy c. Epilepsy d. Severe chronic obstructive pulmonary disease e. Severe liver disease f. Diabetes mellitus

ANS: B, D, E Contraindications to barbiturates include pregnancy, significant respiratory difficulties, and severe liver disease. The other disorders are not contraindications.

A patient newly diagnosed with diabetes expresses concern about losing her vision. Which interventions should be included in the plan of care to reduce this risk? (Select all that apply.) a. Initiation of reliable contraception to prevent pregnancy b. Ways to reduce hyperglycemic episodes c. Use of a prokinetic drug (eg, metoclopramide) d. Smoking cessation e. Emphasis on the importance of taking antihypertensive drugs consistently

ANS: B, D, E Tighter glycemic control and fewer hyperglycemic episodes have been correlated with fewer complications. Smoking cessation and strict compliance with any drugs prescribed for hypertension also help reduce the risk of complications. The use of contraception or a prokinetic drug is not related to a reduced risk of vision loss in patients with diabetes.

The nurse follows which procedures when giving intravenous (IV) cyclosporine? (Select all that apply.) a. Administering it as a single IV bolus injection to minimize adverse effects b. Using an infusion pump to administer this medication c. Monitoring the patient for potential delayed adverse effects, which may be severe d. Monitoring the patient closely for the first 30 minutes for severe adverse effects e. Checking blood levels periodically during cyclosporine therapy f. Performing frequent oral care during therapy

ANS: B, D, E, F Cyclosporine is infused intravenously with an infusion pump, not as an IV bolus. Monitor the patient closely for the first 30 minutes for adverse effects, especially for allergic reactions, and monitor blood levels periodically to ensure therapeutic, not toxic, levels of the medication. Perform oral hygiene frequently to prevent dry mouth and subsequent infections.

1. A patient with asthma and depression develops stable angina. In addition to organic nitrites, which other medications will be used to treat this condition? (Select all that apply.) a. ACE inhibitors b. Antiplatelet drugs c. Beta blockers d. Calcium channel blockers e. Cholesterol-lowering drugs

A, B, D, E ACE inhibitors have shown benefit in reducing the incidence of adverse outcomes in patients with coronary artery disease (CAD) and are recommended as part of therapy. Antiplatelet drugs are recommended to reduce the risk of thrombus formation. CCBs are used as adjuncts to nitroglycerin and are safe in patients with asthma and depression. Cholesterol-lowering drugs are recommended to help slow the progression of CAD. Beta blockers are not recommended in patients with asthma or depression.

1. A patient is brought to the emergency department after ingesting a handful of diphenhydramine [Benadryl] tablets. The patient has dilated pupils, a flushed face, and tremors. The patient is agitated and has a heart rate of 110 beats per minute. The nurse may anticipate administering which agents? (Select all that apply.) a. Activated charcoal b. Atropine c. Cathartics d. Lorazepam e. Second-generation H1 antagonists

A, C, The patient is showing signs of acute antihistamine toxicity. Activated charcoal and cathartics are given to absorb the drug and increase excretion. Atropine is not indicated. Lorazepam may be administered for seizures. Second-generation antihistamines are not indicated.

After receiving a nebulizer treatment with a beta agonist, the patient complains of feeling slightly nervous and wonders if her asthma is getting worse. What is the nurse's best response? A. "This is an expected adverse effect. Let me take your pulse." B. "The next scheduled nebulizer treatment will be skipped." C. "I will notify the physician about this adverse effect." D. "We will hold the treatment for 24 hours."

A. " This is an expected adverse effect. Let me take your pulse" Rationale: Nervousness, tremors, and cardiac stimulation are possible and expected adverse effects of beta agonists. The other options are incorrect responses.

A nurse counsels a patient with diabetes who is starting therapy with an alpha-glucosidase inhibitor. The patient should be educated about the potential for which adverse reactions? (Select all that apply.) a. Hypoglycemia b. Flatulence c. Elevated iron levels in the blood d. Fluid retention e. Diarrhea

ANS: B, E Acarbose and miglitol frequently cause flatulence, cramps, abdominal distention, borborygmus (rumbling bowel sounds), and diarrhea. Acarbose also can cause liver damage. Neither acarbose nor miglitol causes hypoglycemia, elevated iron levels, or fluid retention.

When applying transdermal nitroglycerin patches, which instruction by the nurse is correct? A. "Rotate application sites with each dose." B. "Use only the chest area for application sites." C. "Temporarily remove the patch if you go swimming." D. "Apply the patch to the same site each time."

A. "Rotate application sites with each dose." Rationale: Application sites for transdermal nitroglycerin patches need to be rotated. Apply the transdermal patch to any nonhairy area of the body; the old patch should first be removed. The patch may be worn while swimming, but if it does come off, it should be replaced after the old site is cleansed.

A 75-year-old woman with type 2 diabetes has recently been placed on glipizide (Glucotrol), 10 mg daily. She asks the nurse when the best time would be to take this medication. What is the nurse's best response? A. "Take this medication in the morning, 30 minutes before breakfast." B. "Take this medication in the evening with a snack." C. "This medication needs to be taken after the midday meal." D. "It does not matter what time of day you take this medication."

A. "Take this medication in the morning, 30 minutes before breakfast." Rationale: Glipizide is taken in the morning, 30 minutes before breakfast. When taken at this time, it has a longer duration of action, causing a constant amount of insulin to be released. This may be beneficial in controlling blood glucose levels throughout the day.

A patient's blood pressure elevates to 270/150 mm Hg, and a hypertensive emergency is obvious. He is transferred to the intensive care unit and started on a sodium nitroprusside (Nipride) drip to be titrated per his response. With this medication, the nurse knows that the maximum dose of this drug should be infused for how long? A. 10 minutes B. 30 minutes C. 1 hour D. 24 hours

A. 10 minutes Rationale: Sodium nitroprusside is a potent vasodilator and may lead to extreme decreases in the patient's blood pressure. For this reason, it is never infused at the maximum dose for more than 10 minutes. If this drug does not control a patient's blood pressure after 10 minutes, it will most likely be ordered to be discontinued. The other times listed are incorrect.

The nurse is administering insulin lispro (Humalog) and will keep in mind that this insulin will start to have an effect within which time frame? A. 15 minutes B. 1 to 2 hours C. 80 minutes D. 3 to 5 hours

A. 15 minutes Rationale: the onset of action for insulin lispro is 15 minutes. The peak plasma concentration is 1 to 2 hours; the elimination half-life is 80 minutes; and the duration is 3-5 hours.

When teaching a patient about antihypertensive drug therapy, which statements by the nurse are correct? (Select all that apply.) A. "You need to have your blood pressure checked once a week and keep track of the readings." B. "If you notice that the symptoms have gone away, you should be able to stop taking the drug." C. "An exercise program may be helpful in treating hypertension, but let's check with your doctor first." D. "If you experience severe side effects, stop the medicine and let us know at your next office visit." E. "Most over-the-counter decongestants are compatible with antihypertensive drugs." F. "Please continue taking the medication, even if you are feeling better."

A. A. "You need to have your blood pressure checked once a week and keep track of the readings." C. C. "An exercise program may be helpful in treating hypertension, but let's check with your doctor first." F. F. "Please continue taking the medication, even if you are feeling better." Rationale: Keeping a record of weekly blood pressure checks helps to monitor the effectiveness of the therapy. Remind the patient not to stop taking the medication just because he or she is feeling better. Abruptly stopping the medication may lead to rebound hypertension. Therapy is often lifelong, even though symptoms may improve. Many over-the-counter drugs, especially decongestants, have serious interactions with antihypertensive drugs. The patient needs to consult his or her prescriber before taking any other medication.

A patient arrives in the emergency department with severe chest pain. The patient reports that the pain has been occurring off and on for a week now. Which assessment finding would indicate the need for cautious use of nitrates and nitrites? A. Blood pressure of 88/62 mm Hg B. Apical pulse rate of 110 beats/min C. History of renal disease D. History of a myocardial infarction 2 years ago

A. BP of 88/62 mmHg Rationale: Hypotension is a possible contraindication to the use of nitrates because the medications may cause the blood pressure to decrease. The other options are incorrect.

The nurse is teaching a group of patients about management of diabetes. Which statement about basal dosing is correct? A. Basal dosing delivers a constant dose of insulin." B. "With basal dosing, you can eat what you want and then give yourself a dose of insulin." C. "Glargine insulin is given as a bolus with meals." D. "Basal-bolus dosing is the traditional method of managing blood glucose levels."

A. Basal dosing delivers a constant dose of insulin." Rationale: Basal-bolus therapy is the attempt to mimic a healthy pancreas by delivering basal insulin constantly as a basal, and then as needed as a bolus. Glargine insulin is used as a basal dose, not as a bolus with meals. Basal-bolus therapy is a newer therapy; historically, sliding-scale coverage was implemented.

A 74-year-old professional golfer has chest pain that occurs toward the end of his golfing games. He says the pain usually goes away after one or two sublingual nitroglycerin tablets and rest. What type of angina is he experiencing? A. Classic B. Variant C. Unstable D. Prinzmetal's

A. Classic Rationale: Classic, or chronic stable, angina is triggered by either exertion or stress and usually subsides within 15 minutes with either rest or drug therapy.

The nurse is discussing the use of adsorbents such as bismuth subsalicylate (Pepto-Bismol) with a patient who has diarrhea. The nurse will warn the patient about which possible adverse effects? A. Dark Stools and blue gums B. Urinary Hesitency C. Drowsiness and Dizziness D. Blurred vision and headache

A. Dark Stools and Blue Gums Rationale: Dark Stools and blue gums are two possible side effects of bismuth subsalicylate. The other adverse effects listed may occur with other antidiarrheals.

When monitoring a patient who is taking hydrochlorothiazide (HydroDIURIL), the nurse notes that which drug is most likely to cause a severe interaction with the diuretic? A. Digitalis B. Penicillin C. Potassium supplements D. Aspirin

A. Digitalis Rationale: There is an increased risk for digitalis toxicity in the presence of hypokalemia, which may develop with hydrochlorothiazide therapy. Potassium supplements are often prescribed with hydrochlorothiazide therapy to prevent hypokalemia. The other options do not have interactions with hydrochlorothiazide.

When administering mineral oil, the nurse recognizes that it can interfere with the absorption of which substance? A. Fat- Soluble Vitamins B. Water-Soluble Vitamins C. Minerals D. Electrolytes

A. Fat- Soluble Vitamins Rationale: Mineral Oil can decrease the absorption of fat-soluble vitamins (A,D,E, and K)

A patient is taking guaifenesin (Humibid) as part of treatment for a sinus infection. Which instruction will the nurse include during patient teaching? A. Force fluids to help loosen and liquefy secretions. B. Report clear-colored sputum to the prescriber. C. Avoid driving a car or operating heavy machinery because of the sedating effects. D. Report symptoms that last longer than 2 days.

A. Force fluids to help loosen and liquefy secretions. Rationale: Forcing fluids helps to loosen and liquefy secretions. The patient must be fully aware that any fever, chest tightness, change in sputum from clear to colored, difficult or noisy breathing, activity intolerance, or weakness needs to be reported. The patient must also report to the prescriber a fever of higher than 100.4° F (38° C) or symptoms that last longer than 3 to 4 days. Decongestants do not cause sedation, and therefore the patient does not need to avoid driving a car or operating heavy machinery.

Which action is most appropriate regarding the nurse's administration of a rapid-acting insulin to a hospitalized patient? A. Give it within 15 minutes of mealtime. B. Give it after the meal has been completed. C. Administer it once daily at the time of the midday meal. D. Administer it with a snack before bedtime.

A. Give it within 15 minutes of mealtime Rationale: Rapid-acting insulins, such as insulin lispro and insulin aspart, are able to mimic closely the body's natural rapid insulin output after eating a meal; for this reason, both insulins are usually administered within 15 minutes of the patient's mealtime. The other options are incorrect.

A patient with a tracheostomy has difficulty removing excessive, thick mucus from the respiratory tract. The nurse expects that which drug will be ordered to aid in the removal of mucus? A. Guaifenesin (Humibid) B. Benzonatate (Tessalon Perles) C. Diphenhydramine (Benadryl) D. Dextromethorphan (Robitussin DM)

A. Guaifenesin (Humibid) Rationale: Expectorants such as guaifenesin work to loosen and thin sputum and the bronchial secretions, thereby indirectly diminishing the tendency to cough. The other drugs listed do not have this effect.

A patient is receiving lactulose (Enulose) three times a day. The nurse knows that the patient is not constipated and is receiving this drug for which reason? A. High ammonia levels due to liver failure B. Prevention of constipation C. Chronic renal failure D. Chronic diarrhea

A. High ammonia levels due to liver failure Rationale: Lactulose (Enulose) produces a laxative effect but also works to reduce blood ammonia levels by converting ammonia to ammonium. Ammonium is a water-soluble cation that is trapped in the intestines and cannot be reabsorbed into the systemic circulation. This effect has proved helpful in reducing elevated serum ammonia levels in patients with severe liver disease. The other options are incorrect.

A patient is taking a sulfonylurea medication for new-onset type 2 diabetes mellitus. When reviewing potential adverse effects during patient teaching, the nurse will include information about which of these effects? (Select all that apply.) A. Hypoglycemia B. Nausea C. Diarrhea D. Weight gain E. Peripheral edema

A. Hypoglycemia B. Nausea D. Weight Gain Rationale: The most common adverse effect of the sulfonylureas is hypoglycemia, the degree to which depends on the dose, eating habits, and presence of hepatic or renal disease. Another predictable adverse effect is weight gain because of the stimulation of insulin secretion. Other adverse effects include skin rash, nausea, epigastric fullness, and heartburn.

A patient will be taking bismuth subsaliculate (Pepto- Bismol) to control diarrhea. When reviewing the patient's other ordered medication, the nurse recognizes that which medication or medication class will interact significantly with the pepto-bismol? A. Hypoglycemic Drugs B. Antibiotics C. Acetaminophen (Tylenol) D. Antidepressants

A. Hypoglycemic Drugs Rationale: Taking hypoglycemic drugs with an adsorbent such as pepto bismol may result in decreased absorption of hypoglycemic drugs. The other options are incorrect.

When counseling a male patient about the possible adverse effects of antihypertensive drugs, the nurse will discuss which potential problem? A. Impotence B. Bradycardia C. Increased libido D. Weight gain

A. Impotence Rationale: Sexual dysfunction is a common complication of antihypertensive medications and may be manifested in men as decreased libido or impotence. The other options are incorrect.

A patient is being discharged to home on a single daily dose of a diuretic. The nurse instructs the patient to take the dose at which time so it will be least disruptive to the patient's daily routine? A. In the morning B. At noon C. With supper D. At bedtime

A. In the Morning Rationale: It is better to take the diuretic medication early in the morning to prevent urination during the night. Taking the diuretic at the other times may cause nighttime urination and disrupt sleep.

Mannitol (Osmitrol) has been ordered for a patient with acute renal failure. The nurse will administer this drug using which procedure? A. Intravenously, through a filter B. By rapid intravenous bolus C. By mouth in a single morning dose D. Through a gravity intravenous drip with standard tubing

A. Intravenously, through a filter Rationale: Mannitol is administered via intravenous infusion through a filter because of possible crystallization. It is not available in oral form. The other options are incorrect.

A patient tells the nurse that she wants to start taking the herbal product goldenseal to improve her health. The nurse will assess for which potential cautions or contraindications to goldenseal? (Select all that apply.) A. Taking a proton-pump inhibitor B. Nasal congestion C. Hypothyroidism D. Hypertension E. Sinus infections F. Pregnancy

A. Taking a proton- pump inhibitor D. Hypertension F. Pregnancy Rationale: Goldenseal is contraindicated in patients with acute or chronic gastrointestinal disorders and during pregnancy (because it has uterine stimulant properties). It should be used with caution by those with cardiovascular disorders. Potential drug interactions may occur with gastric acid suppressors such as antacids, histamine H2 blockers (e.g., ranitidine), and proton pump inhibitors (e.g., omeprazole), theoretically because of their reduced effectiveness resulting from the acid-promoting effect of the herb, and with antihypertensive drugs (because of the vasoconstrictive activity of the herb). Goldenseal is potentially useful for sinus infections and chronic nasal allergies.

1. The nurse is providing education about the use of sublingual nitroglycerin tablets. She asks the patient, "What would you do if you experienced chest pain while mowing your yard? You have your bottle of sublingual nitroglycerin with you." Which actions by the patient are appropriate in this situation? (Select all that apply.) A.Stop the activity, and lie down or sit down. B. Call 911 immediately. C. Call 911 if the pain is not relieved after taking one sublingual tablet. D. Call 911 if the pain is not relieved after taking three sublingual tablets in 15 minutes. E. Place a tablet under the tongue. F. Place a tablet in the space between the gum and cheek. G. Take another sublingual tablet if chest pain is not relieved after 5 minutes, up to three total.

A.Stop the activity, and lie down or sit down. C. Call 911 if the pain is not relieved after taking one sublingual tablet. E. Place a tablet under the tongue. G. Take another sublingual tablet if chest pain is not relieved after 5 minutes, up to three total. Rationale: With sublingual forms, the medication is taken at the first sign of chest pain, not delayed until the pain is severe. The patient needs to sit down or lie down and take one sublingual tablet. According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes, after 1 dose, the patient (or family member) must call 911 immediately. The patient can take one more tablet while awaiting emergency care and may take a third tablet 5 minutes later, but no more than a total of three tablets. These guidelines reflect the fact that angina pain that does not respond to nitroglycerin may indicate a myocardial infarction. The sublingual dose is placed under the tongue, and the patient needs to avoid swallowing until the tablet has dissolved. Placing a tablet between the gum and cheek is the buccal route.

A patient is on a chemotherapy regimen in an outpatient clinic and is receiving a chemotherapy drug that is known to be highly emetogenic. The nurse will implement which interventions regarding the pharmacologic management of nausea and vomiting? (Select all that apply.) a.Giving antinausea drugs at the beginning of the chemotherapy infusion b.Administering antinausea drugs 30 to 60 minutes before chemotherapy is started c.For best therapeutic effects, medicating for nausea once the symptoms begin d.Observing carefully for the adverse effects of restlessness and anxiety e.Instructing the patient that the antinausea drugs may cause extreme drowsiness f.Instructing the patient to rise slowly from a sitting or lying position because of possible orthostatic hypotension

ANS: B, E, FAntiemetics should be given before any chemotherapy drug is administered, often 30 to 60 minutes before treatment, but not immediately before chemotherapy is administered. Do not wait until the nausea begins. Most antiemetics cause drowsiness, not restlessness and anxiety. Orthostatic hypotension is a possible adverse effect that may lead to injury.

An agitated patient is to receive an intravenous dose of diazepam (Valium). The order reads, "Give diazepam, 2 mg, IV push, now. Repeat in 15 minutes if needed." Identify how many milliliters will the nurse administer for this dose. The medication vial contains 5 mg/mL. _______

ANS: 0.4 mL

A patient will be on a tacrolimus (Prograf) infusion after receiving a liver transplant. The order reads, "Give 0.03 mg/kg/day as a continuous IV infusion." The patient weighs 159 pounds, and the medication injection solution is available in a 5-mg/mL strength. Identify how many milliliters will the nurse draw up for this infusion. (record answer using two decimal places) _______

ANS: 0.43 mL Convert pounds to kilograms: Calculate the mg/kg/day dosage in milligrams: Calculate the milliliters to administer:

The order reads, "Give atomoxetine (Strattera) 0.5 mg/kg/day once daily in the morning before school." The child weighs 88 pounds. Identify how many milligrams will be administered per dose. _______

ANS: 20 mg

A patient who is taking nelfinavir [Viracept] calls the nurse to report moderate to severe diarrhea. What will the nurse expect the provider to recommend? a.An over-the-counter antidiarrheal drug b.Immediate discontinuation of the nelfinavir c.Reducing the dose of nelfinavir by half d.Taking the nelfinavir with food to avoid side effects

ANS: A A dose-limiting effect of nelfinavir is moderate to severe diarrhea, which can be managed with OTC antidiarrheal medications. Unless the symptoms become severe, withdrawing the nelfinavir is not indicated. Reducing the dose by half or taking it with food is not indicated.

A nurse is discussing the care of a patient with cancer with a nursing student. The patient is about to begin chemotherapy with a bifunctional alkylating agent. Which statement by the student indicates an understanding of this chemotherapeutic agent? a."Alkylating agents are toxic to tissues that have rapidly dividing cells." b."Bifunctional alkylating agents cannot form cross-links in DNA." c."Resistance to alkylating agents is rare." d."This drug needs to be given as a prolonged infusion."

ANS: A Alkylating agents are toxic to rapidly dividing cells. Bifunctional agents form cross-links in cell DNA. Resistance to alkylating agents is common. These drugs may be given by bolus dosing.

A patient will begin chemotherapy with cisplatin. Which medications will the nurse expect to administer to offset this agent's side effects? a.Amifostine [Ethyol], diuretics, and antiemetics b.Antiemetics, vitamin B12, and glucocorticoids c.Dexamethasone, antiemetics, and vistonuridine d.Folic acid, gabapentin, and vitamin B12

ANS: A Amifostine and diuretics are given to help minimize kidney damage with cisplatin. Antiemetics are given to minimize nausea and vomiting, which can be severe with this drug. Vitamin B12 is used to reduce toxicity to the gastrointestinal (GI) tract caused by pralatrexate. Vistonuridine is used to treat fluorouracil overdose. Folic acid is not used to counter cisplatin side effects. Gabapentin is used to minimize neuropathy when oxaliplatin is used.

A nursing student asks the nurse how antibodies provide immune suppression. The nurse responds by telling the student that antibodies: a.block T-cell function. b.boost immune responses. c.reduce proliferation of B cells. d.suppress interferon production.

ANS: A Antibodies can be directed against components of the immune system to suppress the immune response and block T-cell function. They inhibit rather than boost immune responses. They do not reduce the proliferation of B cells or suppress interferon production

A nurse is teaching a group of nursing students about cancer treatment. Which statement by a student indicates an understanding of the characteristics of cancer cells? a."Cancer cells are characterized by unrestrained growth and division." b."Division of cancer cells is characteristically rapid." c."Malignant cells of solid tumors do not invade other tissues." d."Telomerase is an enzyme produced by cancer cells that promotes metastases."

ANS: A Because malignant cells are unresponsive to the feedback mechanisms that regulate cellular proliferation in healthy tissue, they are characterized by unrestrained growth and division. Division of tumor cells is not necessarily rapid. Malignant cells of all types can metastasize. Telomerase is an enzyme that permits repeated division of cancer cells.

A patient with colorectal cancer is admitted to the hospital oncology unit to receive cetuximab [Erbitux]. The nurse notes that the prescriber has not ordered any other medications. The nurse will contact the prescriber to request an order for which medication in order to minimize cetuximab's side effects? a.Diphenhydramine [Benadryl] b.Epinephrine c.Ondansetron [Zofran] d.Magnesium supplements

ANS: A Cetuximab can cause severe infusion reactions. Premedication with diphenhydramine can help reduce this risk. Epinephrine is used for medical management of an infusion reaction and not to minimize the risk. Ondansetron is not indicated because nausea and vomiting are not a concern. Magnesium supplements are given when hypomagnesemia is documented, not as a preventive.

A patient who has undergone surgical removal of a solid tumor has just begun chemotherapy. The patient experiences severe nausea and vomiting as well as alopecia. The nurse will expect the provider to: a.continue the chemotherapeutic agent at the same dose. b.decrease the dose of chemotherapy to minimize side effects. c.order lab tests to evaluate for the presence of residual cancer cells. d.stop the chemotherapy because the tumor has been removed.

ANS: A Cure of cancer requires 100% cell kill. Solid tumors, which often respond poorly to chemotherapeutic agents, can be "debulked" with surgery and then treated with cytotoxic drugs, because the remaining cells often re-enter the cell cycle and become sensitive to the drugs. Chemotherapeutic drugs must be given at the same dose throughout therapy because of the kinetics of drug-induced cell kill. Because chemotherapy has just begun, it is still necessary; moreover, cell counts of fewer than 1 billion cells are no longer detectable and treatment must continue until all cells are eradicated, so lab tests will not yield useful information. Stopping the chemotherapy right after surgery is not indicated.

A nurse is teaching a group of nursing students about how cytotoxic anticancer drugs affect normal cells. Which statement by a student indicates an understanding of this teaching? a."Cytotoxic drugs lack tissue specificity." b."Cytotoxic drugs have a high degree of selective toxicity." c."Differences between cancer cells and normal cells are qualitative." d."Neoplastic cells and normal tissue cells are very different."

ANS: A Cytotoxic drugs kill target cells as well as normal cells, since they lack specificity for cancer cells alone. Cytotoxic drugs therefore have a low degree of selective toxicity. The differences between cancer cells and normal cells are quantitative and not qualitative. Neoplastic cells and normal cells are very similar.

A nurse is teaching a patient who will undergo chemotherapy with fluorouracil [Adrucil] to treat a solid tumor. Which statement by the patient indicates understanding of this chemotherapeutic agent's actions? a."Fluorouracil acts to deprive cancer cells of thymidylate needed to make DNA." b."Fluorouracil causes accumulation of adenosine, which inhibits DNA synthesis." c."Fluorouracil disrupts the biosynthesis of nucleic acids." d."Fluorouracil inhibits DNA polymerase in cancer cells."

ANS: A Fluorouracil acts by depriving cancer cells of thymidylate, which is necessary to make DNA. It does not cause the accumulation of adenosine, disrupt the biosynthesis of nucleic acids, or inhibit DNA polymerase.

A patient with HIV and mucocutaneous HSV is being treated with foscarnet after failing treatment with acyclovir. After 2 weeks, the patient's dose is increased to 90 mg/kg over 2 hours from 40 mg/kg over 1 hour. The patient reports numbness in the extremities and perioral tingling. What will the nurse do? a.Notify the provider and request an order for a serum calcium level. b.Notify the provider of potential foscarnet overdose. c.Request an order for a creatinine clearance level. d.Request an order of IV saline to be given before the next dose.

ANS: A Foscarnet frequently causes hypocalcemia and other electrolyte and mineral imbalances. Paresthesias, numbness in the extremities, and perioral tingling can indicate hypocalcemia, so a calcium level should be drawn. These are not signs of foscarnet overdose. Nephrotoxicity may occur, but these are not signs of renal complications, so a creatinine clearance is not indicated. If nephrotoxicity occurs, prehydration with IV saline is indicated to reduce the risk of renal injury.

A patient with cancer who is receiving chemotherapy develops a fever. The patient's chest radiograph is normal. The patient's neutrophil count is 750/mm3. The nurse expects the provider to: a.begin empiric therapy with intravenous antibiotics. b.obtain cultures and wait for results before prescribing antibiotics. c.order colony-stimulating factor to minimize neutrophilia. d.reassure the patient that serious infection is unlikely.

ANS: A In the absence of neutrophils, as occurs with bone marrow suppression in chemotherapy, fever is the principle sign of infection. Pus, abscesses, and infiltrates on a chest x-ray may all be absent. When a neutropenic patient develops an infection, immediate and vigorous intervention is required. Empiric IV antibiotic therapy should begin while waiting for laboratory results and cultures. It is not correct to wait for culture results before initiating antibiotic therapy. Colony-stimulating factor can minimize neutropenia but does not eliminate the need for IV antibiotics. It is not correct to reassure the patient that a serious infection is unlikely.

A nursing student asks a nurse why chemotherapeutic agents are given intermittently instead of continuously. The nurse will tell the student that intermittent dosing: a.allows normal cells to recover and repopulate. b.catches malignant cells in latent phases. c.increases cancer cell kill and speeds up treatment. d.suppresses drug resistance in tumor cells.

ANS: A Intermittent chemotherapy allows normal cells to repopulate between rounds of therapy. Cells in latent phases do not generally respond to chemotherapy. Intermittent therapy does not speed up treatment or increase tumor cell kill. Intermittent therapy does not suppress drug resistance in tumor cells.

A patient with a history of lung transplantation is admitted for treatment for a respiratory infection. The patient has been taking cyclosporine [Sandimmune], prednisone, and azathioprine [Imuran] for 8 months. The provider has ordered azithromycin [Zithromax] to treat the infection and acetaminophen [Tylenol] as needed for fever. The nurse will contact the provider to: a.ask whether a different antibiotic can be used. b.ask that the prednisone be discontinued until the infection clears. c.suggest increasing the dose of cyclosporine. d.suggest using ibuprofen instead of acetaminophen.

ANS: A Macrolide antibiotics, such as azithromycin, can inhibit cyclosporine metabolism, leading to increased levels of the drug. This patient needs either a reduced dose of cyclosporine or a different antibiotic. There is no indication for discontinuing the prednisone during treatment. The dose of cyclosporine would need to be reduced, because azithromycin leads to increased drug levels. There is no contraindication to using acetaminophen.

A patient who has a brain tumor will receive a nitrosourea agent. A nursing student asks why this type of drug is used for this type of cancer. The nurse will tell the student that nitrosoureas are useful because they: a.are lipophilic. b.are bifunctional alkylating agents. c.have a broad spectrum of antineoplastic characteristics. d.have delayed bone marrow suppression.

ANS: A Nitrosoureas are lipophilic and thus are able to cross the blood-brain barrier, making them more effective against solid tumors in the brain. They are alkylating agents with a broad spectrum of antineoplastic activity, but these are not the deciding factors in their use for brain tumors. Delayed bone marrow suppression is their major dose-limiting toxicity.

A patient with chronic myeloid leukemia (CML) begins treatment with imatinib [Gleevec]. Which statement by the patient indicates understanding of this medication? a."Resistance to this drug may develop over time." b."The intensity of side effects is dose dependent." c."This drug does not have significant drug interactions." d."This drug must be given intravenously."

ANS: A Over time, resistance to imatinib may develop because the genes that code for BCR-ABL can mutate. Side effects of imatinib are not dose-dependent. Imatinib has significant drug interactions with several drugs. Imatinib is given orally.

A patient asks a nurse about ways to minimize side effects of chemotherapy. Which response is correct? a."Avoid contact with people who are ill." b."Take antiemetics immediately after receiving chemotherapy." c."Treat fevers immediately with ibuprofen." d."Use a firm-bristled toothbrush to stimulate gums."

ANS: A Patients receiving chemotherapy should be taught to avoid contact with people who are ill in order to minimize their chances of contracting an illness, which could be devastating if they are neutropenic. Antiemetics are useful when given before chemotherapy. Fevers need to be investigated; taking antipyretics can mask fever, which is often the only indication of an infection. A firm-bristled toothbrush can further irritate gums; good oral hygiene is necessary, but with a soft-bristled brush.

A patient with advanced cancer of the prostate begins treatment with leuprolide [Lupron Depot] injections and will receive 7.5 mg IM once per month. After the first injection, the patient experiences an increase in cancer symptoms. What will the nurse tell the patient? a.Desensitization to the drug over time will result in a decrease in these symptoms. b.The dose of leuprolide may have to be increased to 22.5 mg per month. c.These symptoms indicate a need for surgical castration to treat the cancer. d.This is a sign that the patient's cancer is getting worse.

ANS: A Patients taking leuprolide may initially experience an increase in cancer symptoms until GnRH receptors in the pituitary become desensitized. Increasing the dose is not indicated, and these symptoms do not warrant surgical castration. They do not reflect a worsening of this patient's cancer symptoms.

A patient has lamivudine-resistant hepatitis B and has been taking entecavir [Baraclude] for 2 years. The patient asks the nurse why the provider has recommended taking the drug for another year. What will the nurse tell the patient? a."Entecavir can reverse fibrosis and cirrhosis of the liver when taken long term." b."It is necessary to continue taking entecavir to avoid withdrawal symptoms." c."The drug will be given until the infection is completely eradicated." d."You will need to continue taking entecavir to prevent lactic acidosis and hepatotoxicity."

ANS: A Recent evidence indicates that, with long-term use (3 years), entecavir can reverse fibrosis and cirrhosis. The drug is not continued to avoid withdrawal symptoms. Patients who stop taking entecavir may experience acute exacerbations of hepatitis B; the disease is not eradicated. Entecavir can cause lactic acidosis and hepatotoxicity; it does not prevent these adverse effects.

A patient has undergone liver transplantation. The provider orders cyclosporine [Sandimmune], prednisone, and sirolimus [Rapamune]. What will the nurse do? a.Question the order for sirolimus. b.Request an order for a serum glucose level. c.Request an order for a macrolide antibiotic. d.Suggest changing the cyclosporine to tacrolimus.

ANS: A Sirolimus is given to prevent rejection in renal transplantation; it has no proof of efficacy in patients with heart, lung, or liver transplants. A serum glucose level is not indicated; patients taking repaglinide for diabetes should be monitored closely while taking cyclosporine. Although antibiotic prophylaxis may be necessary, macrolide antibiotics increase the level of cyclosporine. Tacrolimus is more toxic than cyclosporine.

The nurse is caring for a patient who is HIV positive and has a previous history of drug and alcohol abuse. The patient is being treated with combination therapies, including didanosine [Videx]. Which laboratory findings would most concern the nurse? a.Increased serum amylase and triglycerides and decreased serum calcium b.Decreased serum amylase and serum triglycerides and increased serum calcium c.Decreased hemoglobin and hematocrit d.Increased serum amylase, decreased triglycerides, and increased platelets

ANS: A The nurse should be concerned about increased serum amylase triglycerides and a decreased serum calcium, which are symptoms of pancreatitis, the major adverse effect of didanosine. The other laboratory test results and assessment findings are not consistent with pancreatitis and are not a concern for the nurse.

The nurse is caring for a patient receiving intravenous acyclovir [Zovirax]. To prevent nephrotoxicity associated with intravenous acyclovir, the nurse will: a.hydrate the patient during the infusion and for 2 hours after the infusion. b.increase the patient's intake of foods rich in vitamin C. c.monitor urinary output every 30 minutes. d.provide a low-protein diet for 1 day before and 2 days after the acyclovir infusion.

ANS: A The nurse should ensure that the patient is hydrated during the acyclovir infusion and for 2 hours after the infusion to prevent nephrotoxicity. Increasing vitamin C would not help prevent nephrotoxicity. Monitoring urine output is important but would not help prevent nephrotoxicity. A low-protein diet is not indicated after an acyclovir infusion.

A patient comes to the clinic and receives valacyclovir [Valtrex] for a herpes-zoster virus. The nurse instructs the patient to take the medication: a.without regard to meals. b.without any dairy products. c.each morning. d.on an empty stomach.

ANS: A The patient may take the medication without regard to meals. The patient does not need to avoid dairy products, take the pill only in the morning, or take it on an empty stomach.

A 43-year-old patient with a strong family history of breast cancer considers taking tamoxifen [Nolvadex] for cancer prevention. Which assessment finding is a possible contraindication? a.History of deep vein thrombosis (DVT) b.History of osteoporosis c.Hyperlipidemia d.Prior hysterectomy

ANS: A The patient's age and DVT history place her at risk for thrombosis. Tamoxifen would not be indicated for this patient. A prior hysterectomy, osteoporosis, and hyperlipidemia are not contraindications to tamoxifen.

A male patient with hepatitis C will begin triple drug therapy with pegylated interferon alfa 2a [Pegasys], ribavirin [Ribasphere], and boceprevir [Victrelis]. The patient tells the nurse that his wife is pregnant. What will the nurse tell him? a.Boceprevir is contraindicated in males whose partners are pregnant. b.He should use a barrier contraceptive when having sex. c.He should use dual drug therapy with pegylated interferon alfa and ribavirin only. d.This combination drug therapy is safe for him to use.

ANS: A The triple combination is dangerous for pregnant women whose partners are using it, so it is contraindicated for any man whose partner is pregnant. Barrier contraceptives should be used by couples to prevent pregnancy when either partner is taking the triple combination therapy. Ribavirin is teratogenic and is not safe when a partner is pregnant. This combination is not safe for pregnant women whose partners are taking these drugs.

A nurse is preparing to administer medications to a patient recently started on delavirdine [Rescriptor]. Which concurrent prescription should the nurse question before administration? a.Alprazolam [Xanax] b.Diphenhydramine [Benadryl] c.Morphine d.Penicillin

ANS: A To prevent toxicity from excessive drug levels, patients should not take alprazolam while taking delavirdine. Diphenhydramine, morphine, and penicillin are not contraindicated for patients taking delavirdine.

A patient is receiving intravenous vincristine [Oncovin]. The patient complains of pain at the IV insertion site. The nurse examines the site and notes an area of erythema and edema. What will the nurse do? a.Change the IV site and notify the provider of the extravasation. b.Contact the provider to suggest using a different chemotherapeutic agent. c.Obtain an order for a topical anesthetic to minimize discomfort. d.Slow the rate of infusion to reduce the patient's discomfort.

ANS: A Vincristine is a vesicant; extravasation of these agents can cause severe local injury that sometimes requires surgical debridement and skin grafting. The site should be changed, and the provider should be notified. Requesting a different drug is not indicated. Topical anesthetics will not prevent local tissue injury. Slowing the rate of infusion will not prevent local tissue injury

9. A patient has heart failure and is taking an ACE inhibitor. The patient has developed fibrotic changes in the heart and vessels. The nurse expects the provider to order which medication to counter this development? a. Aldosterone antagonist b. Angiotensin II receptor blocker (ARB) c. Beta blocker d. Direct renin inhibitor (DRI)

ANS: A Aldosterone antagonists are added to therapy for patients with worsening symptoms of HF. Aldosterone promotes myocardial remodeling and myocardial fibrosis, so aldosterone antagonists can help with this symptom. ARBs are given for patients who do not tolerate ACE inhibitors. Beta blockers do not prevent fibrotic changes. DRIs are not widely used.

The nurse is teaching a patient how to self-administer triptan injections for migraine headaches. Which statement by the patient indicates that he needs further teaching? a. "I will take this medication regularly to prevent a migraine headache from occurring." b. "I will take this medication when I feel a migraine headache starting." c. "This medication does not reduce the number of migraines I will have." d. "I will keep a journal to record the headaches I have and how the injections are working."

ANS: A Although they may be taken during aura symptoms by patients who have auras with their headaches, these drugs are not indicated for preventive migraine therapy. The medication is intended to relieve the migraine and not to prevent it or to reduce the number of attacks. The triptans do not reduce the number of migraines a person will have. Journal recordings of headaches and the patient's responses to the medication are helpful.

A female patient is receiving palliative therapy with androgen hormones as part of treatment for inoperable breast cancer. The nurse will discuss with the patient which potential body image changes that may occur as adverse effects? a. Hirsutism and acne b. Weight gain c. Flushing and hot flashes d. Alopecia and body odor

ANS: A Androgens used for cancer treatment, such as fluoxymesterone and testolactone, can cause menstrual irregularities, virilization of female, gynecomastia, hirsutism, acne, anxiety, headache, and nausea. The patient needs to be told of these effects before therapy begins. The other options are incorrect.

14. A patient with heart failure who has been given digoxin [Lanoxin] daily for a week complains of nausea. Before giving the next dose, the nurse will: a. assess the heart rate (HR) and give the dose if the HR is greater than 60 beats per minute. b. contact the provider to report digoxin toxicity. c. request an order for a decreased dose of digoxin. d. review the serum electrolyte values and withhold the dose if the potassium level is greater than 3.5 mEq/L.

ANS: A Anorexia, nausea, and vomiting are the most common adverse effects of digoxin and should cause nurses to evaluate for more serious signs of toxicity. If the HR is greater than 60 beats per minute, the dose may be given. Nausea by itself is not a sign of toxicity. A decreased dose is not indicated. A serum potassium level less than 3.5 mEq/L is an indication for withholding the dose.

4. A patient newly diagnosed with heart failure is admitted to the hospital. The nurse notes a pulse of 90 beats per minute. The nurse will observe this patient closely for: a. decreased urine output. b. increased blood pressure. c. jugular vein distension. d. shortness of breath.

ANS: A As the heart rate increases, ventricular filling decreases, and cardiac output and renal perfusion decrease. Tachycardia does not elevate blood pressure. Jugular vein distension and shortness of breath occur with fluid volume overload.

The nurse is providing education to a patient who has been prescribed both an antacid and cimetidine [Tagamet]. Which instruction should the nurse give the patient about taking the medications? a."Take the antacid 1 hour after the ranitidine." b."The antacid and ranitidine should be taken at the same time for better effect." c."Take the antacid 15 minutes before the ranitidine." d."Take the antacid 30 minutes after the ranitidine."

ANS: A Because antacids raise the gastric pH, they can affect the dissolution and absorption of ranitidine; therefore, 1 hour should separate administration of antacids and ranitidine. Antacids and ranitidine should not be taken at the same time, because dissolution and absorption of ranitidine will be reduced. One hour should separate administration of antacids and ranitidine; intervals of 15 minutes and 30 minutes are not long enough

A patient who has received some traumatic news is panicking and asks for some medication to help settle down. The nurse anticipates giving which drug that is most appropriate for this situation? a. Diazepam (Valium) b. Zolpidem (Ambien) c. Phenobarbital d. Cyclobenzaprine (Flexeril)

ANS: A Benzodiazepines such as diazepam are used as anxiolytics, or sedatives. Zolpidem is used as a hypnotic for sleep. Phenobarbital is not used as an anxiolytic but is used for seizure control. Cyclobenzaprine is a muscle relaxant and is not used to reduce anxiety.

The nurse reads in the patient's medication history that the patient is taking buspirone (BuSpar). The nurse interprets that the patient may have which disorder? a. Anxiety disorder b. Depression c. Schizophrenia d. Bipolar disorder

ANS: A Buspirone is indicated for the treatment of anxiety disorders, not depression, schizophrenia, or bipolar disorder.

A nursing student is discussing with a nurse the plan of care for a patient about to undergo a third round of chemotherapy with cisplatin. Which statement by the nursing student about the treatment of CINV is correct? a."Aprepitant [Emend] will be necessary to treat CINV caused by cisplatin." b."Antiemetics are most effective if given just as the chemotherapy is finished." c."Lorazepam probably would not be helpful for this patient." d."This patient will need intravenous antiemetics for best effects."

ANS: A CINV caused by cisplatin is maximal 48 to 72 hours after dosing and can persist for 6 to 7 days, so an antiemetic such as aprepitant, which treats delayed emesis, is an important part of antiemetic therapy. Antiemetics should be started 30 minutes before initiation of chemotherapy. Lorazepam should be given to this patient, because the patient has had some experience with chemotherapy and is likely to have anticipatory emesis. There is no benefit to IV over oral dosing unless the patient has ongoing emesis.

A patient is receiving instructions regarding the use of caffeine. The nurse shares that caffeine should be used with caution if which of these conditions is present? a. A history of peptic ulcers b. Migraine headaches c. Asthma d. A history of kidney stones

ANS: A Caffeine should be used with caution by patients who have histories of peptic ulcers or cardiac dysrhythmias or who have recently had myocardial infarctions. The other conditions are not contraindications to the use of caffeine.

A patient is asking advice about which over-the-counter antacid is considered the most safe to use for heartburn. The nurse explains that calcium antacids are not used as frequently as other antacids because a. their use may result in kidney stones. b. they cause decreased gastric acid production. c. they cause severe diarrhea. d. their use may result in fluid retention and edema.

ANS: A Calcium antacids are not used as frequently as other antacids because their use may lead to the development of kidney stones; they also cause increased gastric acid production. The other options are incorrect.

A nurse is taking a history on a clinic patient who reports being constipated. Upon further questioning, the nurse learns that the patient's last stool was 4 days ago, that it was of normal, soft consistency, and that the patient defecated without straining. The patient's abdomen is not distended, and bowel sounds are present. The patient reports usually having a stool every 1 to 2 days. What will the nurse do? a.Ask about recent food and fluid intake. b.Discuss the use of polyethylene glycol [MiraLax]. c.Recommend a bulk laxative. d.Suggest using a bisacodyl [Dulcolax] suppository.

ANS: A Constipation cannot necessarily be defined by the frequency of bowel movements, because this varies from one individual to another. Constipation is defined in terms of a variety of symptoms, including hard stools, infrequent stools, excessive straining, prolonged effort, and unsuccessful or incomplete defecation. A common cause of constipation is diet, especially fluid and fiber intake; therefore, when changes in stool patterns occur, patients should be questioned about food and fluid intake. Because this patient has only more infrequent stools and is not truly constipated, laxatives are not indicated.

A patient newly diagnosed with PUD reports taking low-dose aspirin (ASA) for prevention of cardiovascular disease. The nurse learns that the patient drinks 2 to 3 cups of coffee each day and has a glass of wine with dinner 3 or 4 nights per week. The patient eats three meals a day. The nurse will counsel this patient to: a.change the meal pattern to five or six smaller meals per day. b.discontinue taking aspirin, because it can irritate the stomach. c.stop drinking wine or any other alcoholic beverage. d.switch to a decaffeinated coffee and reduce the number of servings

ANS: A Consumption of five or six smaller meals a day can reduce fluctuations in the intragastric pH, which may facilitate recovery. ASA should be avoided, along with other NSAIDs except for low-dose ASA used for the prevention of cardiovascular disease. No hard data implicate alcohol as a contributor to PUD. No data indicate that caffeine contributes to PUD.

The nurse notes in the patient's medication history that the patient is taking cyclobenzaprine (Flexeril). Based on this finding, the nurse interprets that the patient has which disorder? a. A musculoskeletal injury b. Insomnia c. Epilepsy d. Agitation

ANS: A Cyclobenzaprine (Flexeril) is the muscle relaxant most commonly used to reduce spasms following musculoskeletal injuries. It is not appropriate for insomnia, epilepsy, or agitation.

A patient is receiving doxorubicin (Adriamycin) as part of treatment for ovarian cancer. Which nursing diagnosis is related to this antineoplastic drug? a. Decreased cardiac output related to the adverse effect of cardiotoxicity b. Ineffective breathing pattern related to the adverse effect of pulmonary toxicity c. Risk for injury related to the effects of neurotoxicity (ataxia, numbness of hands and feet) d. Impaired urinary elimination pattern related to hyperuricemia

ANS: A Decreased cardiac output related to the adverse effect of cardiotoxicity is a nursing diagnosis related to doxorubicin because adverse effects of doxorubicin include liver and cardiovascular toxicities. The other options are incorrect.

A 22-year-old patient has been taking lithium for 1 year, and the most recent lithium level is 0.9 mEq/L. Which statement about the laboratory result is correct? a. The lithium level is therapeutic. b. The lithium level is too low. c. The lithium level is too high. d. Lithium is not usually monitored with blood levels.

ANS: A Desirable long-term maintenance lithium levels range between 0.6 and 1.2 mEq/L. The other responses are incorrect.

13. A patient who has a viral upper respiratory infection reports having a runny nose and a cough that prevents sleep and asks the nurse to recommend an over-the-counter medication. Which medication will the nurse recommend? a. Diphenhydramine [Benadryl] b. Fexofenadine/pseudoephedrine [Allegra-D] c. Guaifenesin [Mucinex] d. Phenylephrine drops

ANS: A Diphenhydramine is effective in suppressing cough and also has sedative effects when used in doses to suppress cough. Fexofenadine/pseudoephedrine is a combination antihistamine/decongestant and will not help with cough. Guaifenesin helps make coughs more productive but will not suppress cough or help with sleep. Phenylephrine drops have decongestant properties.

The nurse is monitoring a patient who has severe bone marrow suppression following antineoplastic drug therapy. Which is considered a principal early sign of infection? a. Fever b. Diaphoresis c. Tachycardia d. Elevated white blood cell count

ANS: A Fever and/or chills may be the first sign of an oncoming infection. Elevated white blood cell count will not occur because of the bone marrow suppression. The other options are incorrect.

18. A patient with severe, chronic COPD uses an inhaled LABA/glucocorticoid but continues to have frequent exacerbations of symptoms. The nurse will contact the provider to discuss: a. adding roflumilast [Daliresp] once daily. b. changing to oral theophylline twice daily. c. prescribing oral steroids once daily. d. Using an ipratropium/albuterol combination twice daily.

ANS: A For patients with chronic, severe COPD, the risk of exacerbations may be reduced with roflumilast. Theophylline is used only when other bronchodilators are not effective. Oral steroids are not indicated for this use. Ipratropium is used to treat bronchospasm in COPD.

1. A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30 breaths per minute, intercostal retractions, and frothy, pink sputum. The nurse caring for this patient will expect to administer which drug? a. Furosemide [Lasix] b. Hydrochlorothiazide [HydroDIURIL] c. Mannitol [Osmitrol] d. Spironolactone [Aldactone]

ANS: A Furosemide, a potent diuretic, is used when rapid or massive mobilization of fluids is needed. This patient shows severe signs of congestive heart failure with respiratory distress and pulmonary edema and needs immediate mobilization of fluid. Hydrochlorothiazide and spironolactone are not indicated for pulmonary edema, because their diuretic effects are less rapid. Mannitol is indicated for patients with increased intracranial pressure and must be discontinued immediately if signs of pulmonary congestion or heart failure occur.

5. A parent asks a nurse about growth suppression resulting from the use of an inhaled glucocorticoid in children. What will the nurse tell the parent? a. Growth may be slowed, but eventual adult height will not be reduced. b. The growth rate is not impaired, but overall height will be reduced. c. The growth rate slows while the drug is used and only resumes when the drug is stopped. d. Long-term use of the drug results in a decrease in adult height.

ANS: A Glucocorticoids can slow growth in children and adolescents, but they do not reduce the eventual adult height. The growth rate will return to normal within a year, even when the drug is continued. Long-term use does not affect the eventual adult height.

4. The nurse assesses a newly diagnosed patient for short-term complications of diabetes. What does this assessment include? a. Evaluation for hyperglycemia, hypoglycemia, and ketoacidosis b. Cranial nerve testing for peripheral neuropathy c. Pedal pulse palpation for arterial insufficiency d. Auscultation of the carotids for bruits associated with atherosclerosis

ANS: A High blood sugar, low blood sugar, and ketoacidosis are short-term complications of diabetes. Microvascular and macrovascular complications, such as peripheral neuropathy, are long-term complications of diabetes. Arterial insufficiency and atherosclerosis also are long-term complications of diabetes.

8. An older adult patient with congestive heart failure develops crackles in both lungs and pitting edema of all extremities. The physician orders hydrochlorothiazide [HydroDIURIL]. Before administering this medication, the nurse reviews the patient's chart. Which laboratory value causes the nurse the most concern? a. Elevated creatinine clearance b. Elevated serum potassium level c. Normal blood glucose level d. Low levels of low-density lipoprotein (LDL) cholesterol

ANS: A Hydrochlorothiazide should not be given to patients with severe renal impairment; therefore, an elevated creatinine clearance would cause the most concern. Thiazide diuretics are potassium-wasting drugs and thus may actually improve the patient's potassium level. Thiazides may elevate the serum glucose level in diabetic patients. Thiazides increase LDL cholesterol; however, this patient's levels are low, so this is not a risk.

7. An adolescent patient recently attended a health fair and had a serum glucose test. The patient telephones the nurse and says, "My level was 125 mg/dL. Does that mean I have diabetes?" What is the nurse's most accurate response? a. "Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes." b. "At this level, you probably have diabetes. You will need an oral glucose tolerance test this week." c. "This level is conclusive evidence that you have diabetes." d. "This level is conclusive evidence that you do not have diabetes."

ANS: A If a person has not fasted for 8 hours, a blood sugar level of 125 mg/dL would be considered normal, because it is less than 200 mg/dL for a random sampling. Also, a person must have positive outcomes on two separate days to be diagnosed with diabetes. This patient does not need to have an oral glucose tolerance test, because the 125 mg/dL reading is so far below 200 mg/dL, which would require further work-up. No conclusive evidence indicates that this patient has diabetes, because the random sample value is so low, and the patient has not had two separate tests on different days. However, this also is not conclusive evidence that the patient does not have diabetes.

The nurse is administering intravenous acyclovir (Zovirax) to a patient with a viral infection. Which administration technique is correct? a. Infuse intravenous acyclovir slowly, over at least 1 hour. b. Infuse intravenous acyclovir by rapid bolus. c. Refrigerate intravenous acyclovir. d. Restrict oral fluids during intravenous acyclovir therapy.

ANS: A Intravenous acyclovir is stable for 12 hours at room temperature and often precipitates when refrigerated. Intravenous infusions must be diluted as recommended (e.g., with 5% dextrose in water or normal saline) and infused with caution. Infusion over longer than 1 hour is suggested to avoid the renal tubular damage seen with more rapid infusions. Adequate hydration should be encouraged (unless contraindicated) during the infusion and for several hours afterward to prevent drug-related crystalluria.

17. A patient with stable COPD is prescribed a bronchodilator medication. Which type of bronchodilator is preferred for this patient? a. A long-acting inhaled beta2 agonist b. An oral beta2 agonist c. A short-acting beta2 agonist d. An intravenous methylxanthine

ANS: A LABAs are preferred over SABAs for COPD. Oral beta2 agonists are not first-line therapy. Although theophylline, a methylxanthine, was once standard therapy in COPD, it is no longer recommended. It is used only if beta2 agonists are not available.

Which condition would cause the nurse to withhold a PRN order for magnesium hydroxide? a.Chronic renal failure b.Cirrhosis c.Hemorrhoids d.Prostatitis

ANS: A Magnesium can accumulate to toxic levels in patients with renal dysfunction. The nurse should withhold the medication. Magnesium hydroxide is not contraindicated for patients with hemorrhoids, prostatitis, or cirrhosis.

6. A patient who was in a motor vehicle accident sustained a severe head injury and is brought into the emergency department. The provider orders intravenous mannitol [Osmitrol]. The nurse knows that this is given to: a. reduce intracranial pressure. b. reduce renal perfusion. c. reduce peripheral edema. d. restore extracellular fluid.

ANS: A Mannitol is an osmotic diuretic that is used to reduce intracranial pressure by relieving cerebral edema. The presence of mannitol in blood vessels in the brain creates an osmotic force that draws edematous fluid from the brain into the blood. Mannitol can also be used to increase renal perfusion. It can cause peripheral edema and is not used to restore extracellular fluid.

7. A 7-year-old child with asthma uses a daily inhaled glucocorticoid and an albuterol MDI as needed. The provider has added montelukast [Singulair] to the child's regimen. Which statement by the child's parent indicates understanding of this medication? a. "I may notice mood changes in my child." b. "I should give this medication twice daily." c. "I will give my child one 4-mg chewable tablet daily." d. "This drug can alleviate symptoms during an acute attack."

ANS: A Montelukast is given as an adjunct to inhaled glucocorticoids to help prevent inflammation. Some patients have reported mood changes when taking this drug, so parents should be warned of this effect. The medication is given once daily. The dose for a 7-year-old child is 5 mg daily. The drug does not treat symptoms of an acute attack.

The nurse is monitoring a patient who is receiving muromonab-CD3 (Orthoclone OKT3) after an organ transplant. Which effect is possible with muromonab-CD3 therapy? a. Chest pain b. Hypotension c. Confusion d. Dysuria

ANS: A Muromonab-CD3 may cause chest pain, fever, chills, tremor, gastrointestinal disturbances (nausea, vomiting, diarrhea), and other effects as noted in Table 48-2. The other options are incorrect.

A patient is recovering from a minor automobile accident that occurred 1 week ago. He is taking cyclobenzaprine (Flexeril) for muscular pain and goes to physical therapy three times a week. Which nursing diagnosis would be appropriate for him? a. Risk for injury related to decreased sensorium b. Risk for addiction related to psychologic dependency c. Decreased fluid volume related to potential adverse effects d. Disturbed sleep pattern related to the drug's interference with REM sleep

ANS: A Musculoskeletal relaxants have a depressant effect on the CNS; thus, the patient needs to be taught the importance of taking measures to minimize self-injury and falls related to decreased sensorium. "Risk for addiction" is not a NANDA nursing diagnosis. The other nursing diagnoses are not appropriate for this situation.

10. A patient with type 1 diabetes reports mixing NPH and regular insulin to allow for one injection. What should the nurse tell the patient? a. This is an acceptable practice. b. These two forms of insulin are not compatible and cannot be mixed. c. Mixing these two forms of insulin may increase the overall potency of the products. d. NPH insulin should only be mixed with insulin glargine.

ANS: A NPH insulin is the only insulin suitable for mixing with short-acting insulins, such as insulin aspart [NovoLog]. These insulins are compatible and are mixed frequently for management of diabetics. The overall potency of each insulin is not increased by mixing them. Insulin glargine cannot be mixed with any other insulin for administration.

A patient who is in her first trimester of pregnancy asks the nurse to recommend nonpharmaceutical therapies for morning sickness. What will the nurse suggest? a.Avoiding fatty and spicy foods b.Consuming extra clear fluids c.Eating three meals daily d.Taking foods later in the day

ANS: A Nausea and vomiting of pregnancy (NVP) can be treated with nondrug measures, including avoiding fatty and spicy foods. Consuming extra fluids does not help with nausea and vomiting (N/V) but may be needed to prevent dehydration. Patients should be advised to eat small portions of food throughout the day rather than three complete meals. "Morning sickness" may actually occur all day, so delaying intake is not recommended.

A patient is taking flurazepam (Dalmane) three to four nights a week for sleeplessness. She is concerned that she cannot get to sleep without taking the medication. What nonpharmacologic measures should the nurse suggest to promote sleep for this patient? a. Providing a quiet environment b. Exercising before bedtime to become tired c. Consuming heavy meals in the evening to promote sleepiness d. Drinking hot tea or coffee just before bedtime

ANS: A Nonpharmacologic approaches to induce sleep include providing a quiet environment, avoiding heavy exercise before bedtime, avoiding heavy meals late in the evening, and drinking warm decaffeinated drinks, such as warm milk, before bedtime.

The nurse is caring for an older adult patient after a right hip open reduction internal fixation (ORIF). The patient is taking an opioid every 6 hours as needed for pain. The nurse discusses obtaining an order from the prescriber for which medication? a.Docusate sodium [Colace] b.GoLYTELY c.Lactulose d.Polyethylene glycol [MiraLax]

ANS: A Oxycodone can be constipating. The patient needs something prophylactically, such as docusate sodium, that can be taken daily to prevent constipation. In addition, the patient's mobility is limited, which can further increase the risk of constipation. GoLYTELY is not indicated for constipation; it is used for cleansing the bowel before diagnostic procedures. Lactulose is not indicated; it typically is used for reducing ammonia levels in hepatic encephalopathy. Polyethylene glycol is indicated for occasional constipation; no information suggests that the patient is constipated.

One patient has cancer of the bone; another has cancer in the connective tissues of the thigh muscles; a third patient has cancer in the vascular tissues. Which of these is the correct term for these tumors? a. Sarcoma b. Leukemia c. Carcinoma d. Lymphoma

ANS: A Sarcomas are malignant tumors that arise from connective tissues. These tissues can be found in bone, cartilage, muscle, blood, lymphatic, and vascular tissues. The other options are incorrect.

A patient is about to undergo a kidney transplant. She will be given an immunosuppressant drug before, during, and after surgery to minimize organ rejection. During the preoperative teaching session, which information will the nurse include about the medication therapy? a. Several days before the surgery, the medication will be administered orally. b. The oral doses need to be taken 1 hour before meals to maximize absorption. c. Mix the oral liquid with juice in a disposable Styrofoam cup just before administration. d. Intramuscular injections of the medication will be needed for several days preceding surgery.

ANS: A Several days before transplant surgery, immunosuppressant drugs need to be taken by the oral route, if possible, to avoid intramuscular injections and the risk for infection caused by the injections. Avoid Styrofoam containers because the medication may adhere to the side of the container. These medications are taken with food to minimize gastrointestinal upset.

An elderly patient had gastric surgery due to a gastrointestinal bleed 3 days ago, and he has been stable since the surgery. This evening, his daughter tells the nurse, "He seems to be more confused this afternoon. He's never been like this. What could be the problem?" The nurse reviews the patient's medication record and suspects that which drug could be the cause of the patient's confusion? a. cimetidine (Tagamet) b. pantoprazole (Protonix) c. clarithromycin (Biaxin) d. sucralfate (Carafate)

ANS: A Sometimes H2 receptor antagonists such as cimetidine may cause adverse effects related to the central nervous system in the elderly, including confusion and disorientation. The nurse needs to be alert for mental status changes when giving these drugs, especially if the changes are new to the patient.

8. A patient with Stage C heart failure (HF) who has been taking an ACE inhibitor, a beta blocker, and a diuretic begins to have increased dyspnea, weight gain, and decreased urine output. The provider orders spironolactone [Aldactone]. The nurse will instruct the patient to: a. avoid potassium supplements. b. monitor for a decreased heart rate. c. take extra fluids. d. use a salt substitute instead of salt.

ANS: A Spironolactone is added to therapy for patients with worsening symptoms of HF. Because spironolactone is a potassium-sparing diuretic, patients should not take supplemental potassium. Patients taking digoxin need to monitor their heart rate. Extra fluids are not indicated. Salt substitutes contain potassium.

10. The potassium-sparing diuretic spironolactone [Aldactone] prolongs survival and improves heart failure symptoms by which mechanism? a. Blocking aldosterone receptors b. Increasing diuresis c. Reducing venous pressure d. Reducing afterload

ANS: A Spironolactone prolongs survival in patients with HF primarily by blocking receptors for aldosterone. Spironolactone cause only minimal diuresis. It does not reduce afterload, and it does not reduce venous pressure enough to prolong survival, because it causes only minimal diuresis.

A patient in the intensive care unit has a nasogastric tube and is also receiving a proton pump inhibitor (PPI). The nurse recognizes that the purpose of the PPI is which effect? a. Prevent stress ulcers b. Reduce bacteria levels in the stomach c. Reduce gastric gas formation (flatulence) d. Promote gastric motility

ANS: A Stress-related mucosal damage is an important issue for critically ill patients. Stress ulcer prophylaxis (or therapy to prevent severe gastrointestinal [GI] damage) is undertaken in almost every critically ill patient in an intensive care unit and for many patients on general medical surgical units. Procedures performed commonly in critically ill patients, such as passing nasogastric tubes, placing patients on ventilators, and others, predispose patients to bleeding of the GI tract. Guidelines suggest that all such patients receive either a histamine receptor-blocking drug or a proton pump inhibitor. The other options are incorrect.

14. A patient has just received a prescription for fluticasone/salmeterol [Advair Diskus]. What will the nurse include as part of the teaching for this patient about the use of this device? a. "You do not need good hand-lung coordination to use this device." b. "You will begin to inhale before activating the device." c. "You will need to use a spacer to help control the medication." d. "You will take 2 inhalations twice daily."

ANS: A The Advair Diskus is a dry powder inhaler and is activated by inhalation; therefore, hand-lung coordination is not required. There is no need for a spacer. Patients who use the Diskus take 1 inhalation twice daily.

1. The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients who were just admitted. Which patient should the nurse assess first? a. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin b. The patient with a pulse of 58 beats per minute who is about to receive digoxin [Lanoxin] c. The patient with a blood pressure of 136/92 mm Hg who complains of having a headache d. The patient with an allergy to penicillin who is receiving an infusion of vancomycin [Vancocin]

ANS: A The NPO patient with hypoglycemia who just received 70/30 Novolin insulin takes priority, because this patient needs to consume a good source of glucose immediately or perhaps the NPO status will be discontinued for this shift. The digoxin may be withheld for the patient with a pulse of 58 beats per minute, but this is not a priority action. The patient with a headache needs to be followed up, but because the blood pressure is 136/92 mm Hg, the headache is probably not caused by hypertension. The patient with an allergy to penicillin will not have a reaction to the vancomycin.

A patient will be taking a 2-week course of combination therapy with omeprazole (Prilosec) and another drug for a peptic ulcer caused by Helicobacter pylori. The nurse expects a drug from which class to be ordered with the omeprazole? a. An antibiotic b. A nonsteroidal antiinflammatory drug c. An antacid d. An antiemetic

ANS: A The antibiotic clarithromycin is active against H. pylori and is used in combination with omeprazole to eradicate the bacteria. First-line therapy against H. pylori includes a 10- to 14-day course of a proton pump inhibitor such as omeprazole plus the antibiotics clarithromycin and either amoxicillin or metronidazole, or a combination of a proton pump inhibitor, bismuth subsalicylate, and the antibiotics tetracycline and metronidazole. Many different combinations are used.

A nurse explains to a nursing student why opioid antidiarrheal medications are classified as drugs with little or no abuse potential. Which statement by the student indicates a need for further teaching? a."Formulations for the treatment of diarrhea have very short half-lives." b."Opioid antidiarrheal drugs contain other drugs with unpleasant side effects at higher doses." c."Some opioid antidiarrheal drugs do not cross the blood-brain barrier." d."Some opioid antidiarrheal medications are not water soluble and cannot be given parenterally."

ANS: A The half-life of the opioid antidiarrheal drugs is the same as that of the opioid analgesics. The formulations of opioid antidiarrheal medications that are classified with low abuse potential are often combined with atropine, which has unpleasant side effects at higher doses. Some opioid antidiarrheal drugs are formulated so that they do not cross the bloodbrain barrier. Others are not water soluble and therefore cannot be dissolved and injected.

During treatment of a patient who has brain cancer, the nurse hears the oncologist mention that the patient has reached the "nadir." The nurse knows that this term means which of these? a. The lowest level of neutrophils reached during therapy. b. The highest level of neutrophils reached during therapy. c. The point at which the adverse effects of chemotherapy will stop. d. The point at which the cytotoxic action against cancer cells is the highest.

ANS: A The lowest neutrophil count reached after a course of chemotherapy is known as the nadir. The other options are incorrect.

3. A patient who uses an inhaled glucocorticoid for chronic asthma calls the nurse to report hoarseness. What will the nurse do? a. Ask whether the patient is rinsing the mouth after each dose. b. Request an order for an antifungal medication. c. Suggest that the patient be tested for a bronchial infection. d. Tell the patient to discontinue use of the glucocorticoid.

ANS: A The most common side effects of inhaled glucocorticoids are oropharyngeal candidiasis and dysphonia. To minimize these, patients should be advised to gargle after each administration. Antifungal medications are used after a fungal infection has been diagnosed. Hoarseness is not a sign of a bronchial infection. There is no need to discontinue the glucocorticoid.

When metronidazole [Flagyl] is a component of the H. pylori treatment regimen, the patient must be instructed to do what? a.Avoid any alcoholic beverages b.Avoid foods containing tyramine c.Take the drug on an empty stomach d.Take the drug with food

ANS: A The patient should be instructed to avoid alcoholic beverages, because a disulfiram-like reaction can occur if metronidazole is taken with alcohol. Nothing indicates that the patient should avoid foods containing tyramine. Metronidazole may be taken with or without food.

A patient is diagnosed with peptic ulcer disease. The patient is otherwise healthy. The nurse learns that the patient does not smoke and that he drinks 1 or 2 glasses of wine with meals each week. The nurse anticipates that the provider will prescribe which drugs? a.Amoxicillin [Amoxil], clarithromycin, and omeprazole [Prilosec] b.Amoxicillin [Amoxil], metronidazole [Flagyl], and cimetidine [Tagamet] c.Clarithromycin, metronidazole [Flagyl], and omeprazole [Prilosec] d.Tetracycline, cimetidine [Tagamet], and lansoprazole [Prevacid]

ANS: A The regimen recommended for the treatment of PUD includes two antibiotics and an antisecretory agent. Amoxicillin, clarithromycin, and omeprazole would meet this recommendation. Patients taking metronidazole cannot consume alcohol, as this would precipitate a disulfiram-like reaction. The last option does not include two antibiotics

15. A patient who has been newly diagnosed with asthma is referred to an asthma clinic. The patient reports daily symptoms requiring short-acting beta2-agonist treatments for relief. The patient has used oral glucocorticoids three times in the past 3 months and reports awakening at night with symptoms about once a week. The patient's forced expiratory volume in 1 second (FEV1) is 75% of predicted values. The nurse will expect this patient to be started on which regimen? a. Daily low-dose inhaled glucocorticoid/LABA with a SABA as needed b. Daily low-dose inhaled glucocorticoid and a SABA as needed c. Daily medium-dose inhaled glucocorticoid/LABA combination d. No daily medications; just a SABA as needed

ANS: A This patient has moderate persistent asthma, which requires step 3 management for initial treatment. Step 3 includes daily inhalation of a low-dose glucocorticoid/LABA combination supplemented with a SABA as needed. A daily low-dose glucocorticoid with an as-needed SABA is used for step 2 management. A daily medium-dose glucocorticoid/LABA is used for step 4 management. Patients requiring step 1 management do not need daily medications.

5. A patient is recovering from a myocardial infarction but does not have symptoms of heart failure. The nurse will expect to teach this patient about: a. ACE inhibitors and beta blockers. b. biventricular pacemakers. c. dietary supplements and exercise. d. diuretics and digoxin.

ANS: A This patient is classified as having Stage B heart failure with no current symptoms but with structural heart disease strongly associated with the development of heart failure. Treatment at this stage includes an ACE inhibitor and a beta blocker to help prevent the progression of symptoms. Biventricular pacemakers are used for patients in Stage C heart failure and have more advanced structural disease and symptoms. Dietary supplements and exercise have not been proven to prevent structural heart disease. Diuretics and digoxin are used for patients with Stage C heart failure.

7. A patient with allergic rhinitis is taking a compound product of loratadine/pseudoephedrine [Claritin-D] every 12 hours. The patient complains of insomnia. The nurse notes that the patient is restless and anxious. The patient's heart rate is 90 beats per minute, and the blood pressure is 130/85 mm Hg. The nurse will contact the provider to: a. discuss using an intranasal glucocorticoid and loratadine [Claritin]. b. report acute toxicity caused by pseudoephedrine. c. suggest using an agent with a sympathomimetic drug only. d. suggest using a topical decongestant to minimize systemic symptoms.

ANS: A This patient is showing central nervous system (CNS) and cardiovascular side effects of the pseudoephedrine. A better option would be to use single-ingredient products for each symptom; an intranasal glucocorticoid and an oral antihistamine are considered first-line treatments. This patient is demonstrating adverse effects but not acute toxicity. Using a sympathomimetic agent would increase the adverse effects, because pseudoephedrine is a sympathomimetic drug. Topical decongestants are not first-line drugs for allergic rhinitis.

13. Which statement is correct about the contrast between acarbose and miglitol? a. Miglitol has not been associated with hepatic dysfunction. b. With miglitol, sucrose can be used to treat hypoglycemia. c. Miglitol is less effective in African Americans. d. Miglitol has no gastrointestinal side effects.

ANS: A Unlike acarbose, miglitol has not been associated with hepatic dysfunction. Sucrose should not be used to treat hypoglycemia with miglitol. Miglitol is more effective in African American patients. Miglitol has gastrointestinal side effects.

18. A patient has been taking digoxin [Lanoxin] 0.25 mg, and furosemide [Lasix] 40 mg, daily. Upon routine assessment by the nurse, the patient states, "I see yellow halos around the lights." The nurse should perform which action based on this assessment? a. Check the patient for other symptoms of digitalis toxicity. b. Withhold the next dose of furosemide. c. Continue to monitor the patient for heart failure. d. Document the findings and reassess in 1 hour.

ANS: A Yellow halos around lights indicate digoxin toxicity. The use of furosemide increases the risk of hypokalemia, which in turn potentiates digoxin toxicity. The patient should also be assessed for headache, nausea, and vomiting, and blood should be drawn for measurement of the serum digoxin level. The nurse should not withhold the dose of furosemide until further assessment is done, including measurement of a serum digoxin level. No evidence indicates that the patient is in worsening heart failure. Documentation of findings is secondary to further assessment and prevention of digoxin toxicity.

Which types of drugs are used to treat inflammatory bowel disease (IBD)? (Select all that apply.) a.Aminosalicylates b.Glucocorticoids c.Immunomodulators d.Opioid antidiarrheals e.Sulfonamide antibiotics

ANS: A, B, C Five types of drugs are used to treat IBD: aminosalicylates, glucocorticoids, immunosuppressants, immunomodulators, and antibiotics such as metronidazole and ciprofloxacin. Opioid antidiarrheal drugs and sulfonamide antibiotics are not used for this purpose.

What are the results of using glucocorticoid drugs to treat asthma? (Select all that apply.) a. Reduced bronchial hyperreactivity b. Reduced edema of the airway c. Reduced number of bronchial beta2 receptors d. Increased responsiveness to beta2-adrenergic agonists e. Increased synthesis of inflammatory mediators

ANS: A, B, D Glucocorticoids act by reducing bronchial hyperreactivity and airway edema and increasing airway responsiveness to beta2-adrenergic agonists. They do not reduce the number of beta2-adrenergic agonist receptors. They help reduce the synthesis of inflammatory mediators.

A patient is in the HIV clinic for a follow-up appointment. He has been on antiretroviral therapy for HIV for more than 3 years. The nurse will assess for which potential adverse effects of long-term antiretroviral therapy? (Select all that apply.) a. Lipodystrophy b. Liver damage c. Kaposi's sarcoma d. Osteoporosis e. Type 2 diabetes

ANS: A, B, D, E Anti-HIV drugs produce strain on the liver and may result in liver disease. A major adverse effect of protease inhibitors is lipid abnormalities, including lipodystrophy, or redistribution of fat stores under the skin. In addition, dyslipidemias such as hypertriglyceridemia can occur, and insulin resistance and type 2 diabetes symptoms can result. The increase in long-term antiretroviral drug therapy due to prolonged disease survival has led to the emergence of another long-term adverse effect associated with these medications—bone demineralization and possible osteoporosis. Kaposi's sarcoma is an opportunistic disease associated with HIV, not a result of long-term drug therapy.

The barbiturate phenobarbital is prescribed for a patient with epilepsy. While assessing the patient's current medications, the nurse recognizes that interactions may occur with which drugs? (Select all that apply.) a. Antihistamines b. Opioids c. Diuretics d. Anticoagulants e. Oral contraceptives f. Insulin

ANS: A, B, D, E The co-administration of barbiturates and alcohol, antihistamines, benzodiazepines, opioids, and tranquilizers may result in additive CNS depression. Co-administration of anticoagulants and barbiturates can result in decreased anticoagulation response and possible clot formation. Co-administration of barbiturates and oral contraceptives can result in accelerated metabolism of the contraceptive drug and possible unintended pregnancy. There are no interactions with diuretics and insulin.

What contributes to drug resistance to chemotherapeutic agents? (Select all that apply.) a.Cellular production of P-glycoprotein b.Creation of selection pressure by drugs c.Drug-induced cellular mutation d.Increased drug uptake by tumor cells e.Reduced target molecule sensitivity

ANS: A, B, E Drug resistance can occur by cellular production of a drug transport molecule, known as P-glycoprotein, that can transport the drug out of the cell; creation of selection pressure by favoring drug-resistant mutant cells; and reduction of target molecule sensitivity. Drug resistance does not occur by drug-induced mutation or increased drug uptake by tumor cells.

The nurse is providing education to a group of patients who are HIV positive. The nurse is discussing the various medications used to treat HIV infection. A patient asks about nevirapine [Viramune]. Which statements by the nurse most accurately reflect the facts about nevirapine? (Select all that apply.) a."Some herbal preparations can reduce the levels of this drug." b."This agent can damage the liver; therefore, liver function tests are needed periodically." c."Usually no adverse effects occur when this medication is used alone." d."The drug must be dosed five times per day at evenly spaced intervals." e."You should call your healthcare provider immediately if you develop a rash."

ANS: A, B, E Some herbal preparations can reduce the levels of nevirapine, which can damage the liver. The patient should call the healthcare provider immediately if a rash develops. Many adverse effects are associated with the use of nevirapine. In adults, nevirapine is dosed once daily initially, not five times a day.

1. A patient will be taking dabigatran (Pradaxa) as part of treatment for chronic atrial fibrillation. Which statements about dabigatran are true? (Select all that apply.) a. The dose of dabigatran is reduced in patients with decreased renal function. b. Bleeding is the most common adverse effect. c. Potassium chloride is given as an antidote in cases of overdose. d. Dabigatran levels are monitored by measuring prothrombin time/international normalized ratio (PT/INR) results. e. This drug is a prodrug and becomes activated in the liver.

ANS: A, B, E Dabigatran is excreted extensively in the kidneys, and the dose is dependent upon renal function. The normal dose is 150 mg twice daily, but it must be reduced to 75 mg twice daily if creatinine clearance is less than 30 mL/min. The most common and serious side effect is bleeding. Dabigatran is a prodrug that becomes activated in the liver. There is no antidote to dabigatran. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 417 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Besides having diuretic effects for patients with congestive heart failure, thiazides are also used to treat what? (Select all that apply.) a. Diabetes insipidus b. Hepatic failure c. Increased intracranial pressure d. Intraocular pressure e. Postmenopausal osteoporosis

ANS: A, B, E Thiazide diuretics have the paradoxical effect of reducing urine output in patients with diabetes insipidus. They can also be used to mobilize edema associated with liver disease. They promote tubular reabsorption of calcium, which may reduce the risk of osteoporosis in postmenopausal women. Mannitol is used to treat edema that causes increased intracranial pressure and intraocular pressure.

When a patient is receiving cisplatin (Platinol-AQ) chemotherapy, the nurse will monitor for which adverse effects? (Select all that apply.) a. Tinnitus b. Heart failure c. Hearing loss d. Elevated blood urea nitrogen and creatinine levels e. Numbness or tingling in the extremities f. Elevated glucose and ketone levels

ANS: A, C, D, E Cisplatin can cause nephrotoxicity, ototoxicity, and peripheral neuropathy. Nephrotoxicity is manifested by rising blood urea nitrogen and creatinine levels; ototoxicity is manifested by tinnitus, hearing loss, and dizziness; peripheral neuropathy is manifested by numbness or tingling of the extremities.

Methotrexate is ordered for a patient with a malignant tumor, and the nurse is providing education about self-care after the chemotherapy is given. Which statements by the nurse are appropriate for the patient receiving methotrexate? (Select all that apply.) a. Report unusual bleeding or bruising. b. Hair loss is not expected with this drug. c. Prepare for hair loss. d. Avoid areas with large crowds or gatherings. e. Avoid foods that are too hot or too cold or rough in texture. f. Restrict fluid intake to reduce nausea and vomiting.

ANS: A, C, D, E Counsel patients who are taking methotrexate to expect hair loss and to report any unusual bleeding or bruising. Because of the possibility of infection, avoid areas with large crowds or gatherings. Foods that are too hot or too cold or rough in texture may be irritating to the oral mucosa. Fluid intake is to be encouraged to prevent dehydration.

Which are guidelines for selecting chemotherapeutic agents to use in combination therapy? (Select all that apply.) a.Drugs used should have different mechanisms. b.Each drug should be delivered by different routes. c.Each drug should be effective. d.Each drug should have different dosing schedules. e.Toxicities should be minimally overlapping.

ANS: A, C, E When selecting drugs for combination therapy, each drug should be effective by itself and should have a different mechanism of action. The drugs should have minimally overlapping toxicities. The routes and the dosing schedules are not considerations.

When giving chemotherapy as cancer treatment, the nurse recognizes that toxicity to rapidly growing normal cells also occurs. Which rapidly growing normal cells are also harmed by chemotherapy? (Select all that apply.) a. Bone marrow cells b. Retinal cells c. Hair follicle cells d. Nerve myelin cells e. Gastrointestinal (GI) mucous membrane cells

ANS: A, C, E Chemotherapy toxicities generally stem from the fact that chemotherapy drugs affect rapidly dividing cells—both harmful cancer cells and healthy, normal cells. Three types of rapidly dividing human cells are the cells of hair follicles, GI tract cells, and bone marrow cells. The other options are incorrect.

A patient who has been taking a selective serotonin reuptake inhibitor (SSRI) is complaining of "feeling so badly" when he started taking an over-the-counter St. John's wort herbal product at home. The nurse suspects that he is experiencing serotonin syndrome. Which of these are symptoms of serotonin syndrome? (Select all that apply.) a. Agitation b. Drowsiness c. Tremors d. Bradycardia e. Sweating f. Constipation

ANS: A, C, E Common symptoms of serotonin syndrome include delirium, agitation, tachycardia, sweating, hyperreflexia, shivering, coarse tremors, and others. See Box 16-1 for a full list of symptoms.

Which medications are included in first-line therapy for heart failure? (Select all that apply.) a. Agents that inhibit the renin-angiotensin-aldosterone system (RAAS) b. Aldosterone antagonists c. Beta blockers d. Cardiac glycosides e. Diuretics

ANS: A, C, E For routine therapy, heart failure is treated with agents that inhibit the RAAS, beta blockers, and diuretics. Aldosterone antagonists and cardiac glycosides are not first-line drugs for HF.

A patient who is diagnosed with genital herpes is taking topical acyclovir. The nurse will provide which teaching for this patient? (Select all that apply.) a. "Be sure to wash your hands thoroughly before and after applying this medicine." b. "Apply this ointment until the lesion stops hurting." c. "Use a clean glove when applying this ointment." d. "If your partner develops these lesions, then he can also use the medication." e. "You will need to avoid touching the area around your eyes." f. "You will have to practice abstinence when these lesions are active."

ANS: A, C, E, F This medication needs to be applied as long as prescribed, and the medication needs to be applied with clean gloves. Prescriptions should not be shared; if the partner develops these lesions, the partner will have to be evaluated before medication is prescribed, if needed. Eye contact should be avoided. The presence of active genital herpes lesions requires sexual abstinence.

The nurse is reviewing the use of central nervous system stimulants. Which of these are indications for this class of drugs? (Select all that apply.) a. Narcolepsy b. Depression c. Panic attacks d. Neonatal apnea e. Attention deficit hyperactivity disorder (ADHD) f. Appetite suppression

ANS: A, D, E, F Central nervous system stimulants can be used for narcolepsy, neonatal apnea, ADHD, and appetite suppression in the treatment of obesity. They are not used for depression and panic attacks.

The nurse is assessing a patient who is receiving chemotherapy with an alkylating drug. Which assessment findings would be considered indications of an oncologic emergency? (Select all that apply.) a. Dry, "scratchy," or "swollen" throat b. Loss of hair c. Decreased red blood cell count d. White patches in the mouth or throat e. Temperature of 100.7° F (38.2° C) f. Decreased urine output

ANS: A, D, E, F Indications of an oncologic emergency include fever and/or chills with a temperature higher than 100.5° F (38.1° C); new sores or white patches in the mouth or throat; changes in bladder function or patterns; dry, burning, "scratchy," or "swollen" throat; and other signs and symptoms (see Box 46-4). The prescriber must be contacted immediately if any of the listed signs or symptoms occur. Loss of hair and decreased red blood cell count (a result of bone marrow suppression) are expected effects of chemotherapy.

Which non-pharmaceutical intervention can be used to reduce symptoms of gastroesophageal reflux disease? (Select all that apply.) a.Avoiding late-night meals b.Consuming a glass of wine with meals c.Drinking soft drinks d.Losing weight e.Stopping smoking

ANS: A, E Avoiding late-night meals and stopping smoking may help with symptoms of GERD.

A patient is receiving a tube feeding through a gastrostomy. The nurse expects that which typeof drug will be used to promote gastric emptying for this patient? a.Prokinetic drugs, such as metoclopramide (Reglan) b.Serotonin blockers, such as ondansetron (Zofran) c.Anticholinergic drugs, such as scopolamine (Scopace) d.Neuroleptic drugs, such as chlorpromazine (Thorazine)

ANS: AProkinetic drugs promote the movement of substances through the gastrointestinal tract and increase gastrointestinal motility

A patient who has severe nausea and vomiting following a case of food poisoning comes to the urgent care center. When reviewing his medication history, the nurse notes that he has an allergy to procaine. The nurse would question an order for which antiemetic drug if ordered for this patient? a.metoclopramide (Reglan) b.promethazine (Phenergan) c.phosphorated carbohydrate solution (Emetrol) d.palonosetron (Aloxi)

ANS: AThe use of metoclopramide (Reglan) is contraindicated in patients with a hypersensitivity to procaine or procainamide. There are no known interactions with the drugs listed in the other options

A nurse provides teaching to a patient who will begin taking oral cyclophosphamide to treat non-Hodgkin's lymphoma. Which statement by the patient indicates an understanding about how to minimize side effects while taking this drug? a."I don't need to worry about bone marrow suppression with this drug." b."I should drink plenty of fluids while taking this drug." c."I should take this drug on an empty stomach." d."If I shampoo less often, I can prevent hair loss."

ANS: B Acute hemorrhagic cystitis can occur; this can be minimized by maintaining adequate hydration and taking mesna [Mesnex], a protective agent. Bone marrow suppression is a dose-limiting side effect. This drug should be taken with food. Hair loss cannot be prevented by shampooing less often.

The nurse is preparing to administer a first dose of ado-trastuzumab emtansine [Kadcycla] to a patient who has metastatic breast cancer. Which nursing action is correct? a.Administer a test dose with an antihistamine. b.Ensure that the patient has HER2-positive disease. c.Infuse the initial dose over 30 to 45 minutes. d.Review renal function tests.

ANS: B Ado-trastuzumab emtansine is used for patients with HERS2-positive disease. Although severe hypersensitivity reactions may occur, it is not recommended that a test dose along with an antihistamine be given. The initial dose should be given over 90 minutes, with subsequent doses given over 30 minutes if tolerated. Liver damage is common, so liver function needs to be monitored.

A patient who is taking azathioprine [Imuran] to prevent rejection of a renal transplant develops gout and the provider orders allopurinol. The nurse will contact the provider to discuss: a.decreasing the allopurinol dose. b.decreasing the azathioprine dose. c.increasing the allopurinol dose. d.increasing the azathioprine dose.

ANS: B Allopurinol delays conversion of mercaptopurine to inactive products and increases the risk of azathioprine toxicity. Patients taking the two concurrently should have an approximate 70% reduction in the azathioprine dose. Altering the allopurinol dose is not indicated.

The nurse would be correct to state that the purpose of angiogenesis inhibitors is to: a.kill existing cancer cells directly. b.suppress the formation of new blood vessels in tumors. c.enhance the size of collateral vessels. d.enhance red cell development in the bone marrow.

ANS: B Angiogenesis inhibitors suppress the formation of new blood vessels, thereby depriving solid tumors of the expanding blood supply they need for continued growth. Angiogenesis inhibitors cannot kill tumor cells that already exist. Angiogenesis inhibitors do not enhance collateral vessel or red cell development.

A nursing student asks the nurse what differentiates antiestrogen drugs from aromatase inhibitors in the treatment of breast cancer. What is the correct response by the nurse? a.Antiestrogen drugs decrease the risk for thromboembolic events. b.Antiestrogen drugs increase the risk for endometrial cancer. c.Aromatase inhibitors block the production of estrogen by the ovaries. d.Aromatase inhibitors can be used for tumor cells that lack estrogen receptors

ANS: B Antiestrogen drugs cause proliferation of endometrial tissue by acting as receptor agonists at receptors in the uterus. Antiestrogen drugs increase the risk of thromboembolic events. Aromatase inhibitors block the production of estrogen from androgenic precursors, not by the ovaries. Aromatase inhibitors are used to treat ER-positive breast cancer

A patient is started on immunosuppressant drugs after kidney transplantation and will be taking azathioprine [Imuran] as part of the drug regimen. The patient asks the nurse why it is necessary to have a specimen for a complete blood count drawn at the beginning of therapy and then periodically thereafter. The nurse explains that azathioprine can alter blood cells and tells the patient to report: a.alopecia. b.easy bruising. c.fatigue. d.gastrointestinal (GI) upset.

ANS: B Azathioprine can cause bone marrow suppression, resulting in neutropenia and thrombocytopenia; therefore, a CBC must be evaluated at baseline and periodically thereafter. Patients who have low platelet counts bruise easily, so this symptom should be reported. Alopecia occurs with azathioprine but is not a life-threatening side effect. Fatigue is not a common adverse effect. GI side effects occur but are not life threatening

The nurse is caring for a patient in the oncology unit who was recently diagnosed with advanced renal carcinoma. The nurse prepares to administer aldesleukin [Proleukin] as part of the treatment regimen. What is the primary adverse effect of this drug? a.Hypertension b.Capillary leakage syndrome c.Hyperglycemia d.Hyperuricemia

ANS: B Capillary leakage syndrome, an adverse effect of aldesleukin, is a particular concern, because it is a potentially fatal reaction characterized by hypotension and reduced organ perfusion. Proleukin is not associated with hypertension, hyperglycemia, or hyperuricemia.

A nursing student asks about the differences between cell-cycle phase-specific chemotherapeutic agents and those that are cell-cycle phase nonspecific. What will the nurse explain? a.Cell-cycle phase-nonspecific drugs are less toxic. b.Cell-cycle phase-specific drugs do not harm "resting" cells. c.Cell-cycle phase-specific drugs should be given at specific intervals. d.Neither type is toxic to cells in the "resting" G0 phase.

ANS: B Cell-cycle phase-specific drugs do not harm "resting" cells, because these drugs are toxic only to cells that are active participants in the cell cycle. Cell-cycle phase-nonspecific drugs are not less toxic than cell-cycle phase-specific agents. Cell-cycle phase-specific drugs are usually given by prolonged infusion. Cell-cycle phase-nonspecific drugs are toxic to "resting" cells.

A patient with hepatitis B begins treatment with adefovir [Hepsera] and asks the nurse how long the drug therapy will last. The nurse will tell the patient that the medication will need to be taken for: a.a lifetime. b.an indefinite, prolonged period of time. c.48 weeks. d.until nephrotoxicity occurs

ANS: B Current guidelines recommend treatment only for patients at highest risk; it is unknown whether treatment should continue lifelong. Treatment is usually prolonged, without a specific period of time. Nephrotoxicity is common but is not the deciding factor when determining length of effective treatment.

A patient has a positive test for hepatitis C and is admitted to the hospital. The admission laboratory tests reveal a normal ALT, and a liver biopsy is negative for hepatic fibrosis and inflammation. The nurse will prepare this patient for: a.dual therapy with pegylated interferon alfa and ribavirin. b.no medication therapy at this time. c.pegylated interferon alfa only until ALT levels are elevated. d.triple drug therapy with pegylated interferon alfa, ribavirin, and boceprevir.

ANS: B Current recommendations are that treatment is used only for patients with HCV viremia, persistent elevation of ALT, and evidence of hepatic fibrosis and inflammation upon liver biopsy. Dual therapy has been the regimen of choice for patients with the above symptoms, but the addition of a protease inhibitor has been shown to improve outcomes. It is not correct to give pegylated interferon alfa until ALT levels are elevated. Triple drug therapy is used for patients with the above symptoms.

A patient who has leukemia is receiving chemotherapy and develops severe anemia. The provider has ordered hospitalization and blood transfusions. The patient asks the nurse about using erythropoietin (epoetin alfa) instead. What will the nurse tell this patient? a."Ask your provider about ordering erythropoietin instead of a transfusion." b."Erythropoietin (epoetin alfa) can make your leukemia worse." c."Erythropoietin is used to prolong life in patients with myeloid malignancies." d."You will probably receive erythropoietin along with the transfusion."

ANS: B Erythropoietin is used to stimulate erythrocyte production but can also stimulate proliferation of cancers in patients with leukemia and other myeloid malignancies. It is used when the goal is palliation, not to cure or to prolong life.

The nurse is caring for a 15-year-old patient who has undergone a liver transplant. Which provider order will the nurse question? a.Cyclosporine [Sandimmune] and ketoconazole [Nizoral] b.Everolimus [Zortress] 1 mg twice daily c.Prednisone 60 mg daily d.Tacrolimus [Prograf] 50 mcg/kg twice daily the day after surgery

ANS: B Everolimus is not approved in patients younger than 18 years of age. Ketoconazole can decrease the metabolism of cyclosporine and is often given concurrently to allow lower dosing and lower cost. Prednisone and tacrolimus are commonly used, and these doses are correct.

A patient with advanced prostate cancer will begin treatment with leuprolide [Lupron]. The provider has ordered flutamide to be given as adjunct therapy. The patient asks the nurse why both drugs are necessary. The nurse will tell the patient that: a.flutamide reduces the side effects, such as hot flushes, caused by leuprolide. b.flutamide suppresses initial tumor flare caused by leuprolide. c.leuprolide helps to reduce the toxicity of flutamide. d.the combination of both drugs increases cancer survival.

ANS: B Flutamide is given with GnRH agonists, such as leuprolide, to prevent tumor flare when GnRH therapy is begun. Flutamide increases hot flushes. Leuprolide does not decrease flutamide toxicity. There is no increase in cancer survival with this combination.

A patient with HIV contracts herpes simplex virus (HSV), and the prescriber orders acyclovir [Zovirax] 400 mg PO twice daily for 10 days. After 7 days of therapy, the patient reports having an increased number of lesions. The nurse will expect the provider to: a.extend this patient's drug therapy to twice daily for 12 months. b.give intravenous foscarnet every 8 hours for 2 to 3 weeks. c.increase the acyclovir dose to 800 mg PO 5 times daily. d.order intravenous valacyclovir [Valtrex] 1 gm PO twice daily for 10 days

ANS: B Foscarnet is active against all known herpesviruses and is used in immunocompromised patients with acyclovir-resistant HSV or VZV. This patient is demonstrating resistance to acyclovir, so extending acyclovir therapy or increasing the acyclovir dose will not be effective. Valacyclovir is not approved for use in immunocompromised patients because of the risk for thrombotic thrombocytopenic purpura/hemolytic uremic syndrome

A nurse is teaching a group of nursing students about influenza prevention. Which statement by a student indicates understanding of the teaching? a."I may develop a mild case of influenza if I receive the vaccine by injection." b."I should receive the vaccine every year in October or November." c."If I have a cold I should postpone getting the vaccine." d."The antiviral medications are as effective as the flu vaccine for preventing the flu."

ANS: B Influenza vaccine should be given every year in October or November. The vaccine will not cause influenza. Minor illnesses, such as a cold, are not a contraindication for receiving the vaccine. Antiviral medications are not as effective as the flu vaccine in preventing influenza.

A patient will begin taking tamoxifen [Nolvadex] to treat breast cancer. The nurse performs a medication history and learns that the patient is taking sertraline [Zoloft] for depression. The nurse will tell the patient to contact her provider to ask about: a.increasing her dose of sertraline. b.changing from sertraline to escitalopram [Lexapro]. c.switching from sertraline to fluoxetine [Prozac]. d.decreasing her dose of tamoxifen.

ANS: B Inhibitors of CYP2D6, such as sertraline, can negate the benefits of treatment with tamoxifen. Patients taking sertraline should request switching to another antidepressant, such as escitalopram. Increasing the dose of sertraline would only exacerbate the problem. Fluoxetine is similar to sertraline so changing to this drug would be incorrect. It is not correct to decrease the dose of tamoxifen.

A patient is receiving chemotherapy. Seven days after a dose, the patient's neutrophil count is 1000 cells/mm3. The nurse will tell this patient: a.that hospitalization is necessary to provide infection prophylaxis. b.that the provider will probably repeat the lab work in 3 to 5 days. c.to ask the provider about skipping the next dose of chemotherapy. d.to report any symptoms such as pus, abscesses, or cough.

ANS: B Normal neutrophil counts range from 2500 to 7000 cells/mm3. The lowest neutrophil count, or nadir, usually occurs 10 to 14 days after dosing, so this patient's neutrophil count should be repeated at that time. Hospitalization is controversial because of the risk of exposure to serious infections. The next dose should not be skipped unless the neutrophil count is below 500/mm3. Patients with neutropenia may not have symptoms of pus, abscess, or cough and should be instructed to report any fever.

A patient has a positive test for influenza type A and tells the nurse that symptoms began 5 days before being tested. The prescriber has ordered oseltamivir [Tamiflu]. The nurse will tell the patient that oseltamivir: a.may decrease symptom duration by 2 or 3 days. b.may not be effective because of the delay in starting treatment. c.may reduce the severity but not the duration of symptoms. d.will alleviate symptoms within 24 hours of the start of therapy.

ANS: B Oseltamivir is most effective when begun within 2 days after symptom onset. When started within 12 hours of symptom onset, it may decrease duration of symptoms by 2 to 3 days. The drug reduces both symptom severity and symptom duration when used in a timely fashion. It does not rapidly alleviate symptoms.

A hospitalized patient with cancer is receiving chemotherapy and reports oral pain. Inspection of this patient's oral mucosa reveals erythema and inflammation without denudation or ulceration. The nurse understands that: a.chemotherapy will have to be stopped until healing of the oral mucosa occurs. b.the patient can use a mouthwash with a topical anesthetic to control pain. c.the patient will need an antifungal agent to treat Candida albicans. d.the patient will need systemic opioids to control discomfort.

ANS: B Patients with mild stomatitis can use a mouthwash with a local anesthetic to control pain. Chemotherapy does not have to be stopped until the pain or ulceration is severe. Antifungal agents may be used to treat Candida albicans; this patient does not exhibit signs of that infection. Systemic opioids may be used when pain becomes severe.

A patient is receiving fluorouracil [Adrucil] as a continuous intravenous dose to treat a solid tumor. The patient reports soreness and blisters in the mouth, loose stools, and tingling of the hands and feet. What will the nurse do? a.Contact the provider to discuss bolus dosing instead of continuous dosing. b.Discontinue the medication and contact the provider to report these symptoms. c.Reassure the patient that these are expected, uncomfortable side effects. d.Request an order for dexamethasone to treat these side effects.

ANS: B Stomatitis, GI symptoms, and palmar-plantar erythrodysesthesias are dose-limiting side effects of fluorouracil, characterized by the symptoms described. When these occur, the provider should be notified. Continuous dosing is generally less toxic than bolus dosing. Reassurance without discontinuing the medication and contacting the provider is not correct. Dexamethasone is not given to counter these effects.

A 45-year-old patient with a family history of breast cancer is considering using tamoxifen [Nolvadex] for cancer prevention. The nurse performs a health history and learns that the woman had a child when she was 35 years old, that she has not had a hysterectomy, and that she experienced DVT when she was pregnant. What will the nurse tell the patient? a.Because of her family risk and late childbearing, this drug is a good choice for her. b.Her history of DVT outweighs any possible benefits she may have with this drug. c.Since she has not had a hysterectomy, the risk of endometrial cancer is too great. d.When she turns 50 years old, this drug will carry fewer risks for her.

ANS: B Tamoxifen is a good choice for women between the ages of 40 and 49 years as a cancer preventive, except for women at risk for DVT. Family risk and late childbearing age are indications for using tamoxifen, but only in women without increased risk of DVT. The risk of endometrial cancer increases with age and, without the risk of DVT, would not be a contraindication in a woman of the patient's age. The patient's risks of DVT do not change with age.

The nurse is preparing to discharge a patient with HIV who will continue to take enfuvirtide [Fuzeon] at home. The nurse is providing patient education about the medication. What information about the administration of enfuvirtide is most appropriate for the patient? a.The importance of injecting the drug into two alternating sites daily b.How to reconstitute and self-administer a subcutaneous injection c.The importance of taking the drug with high doses of vitamin E d.Likely drug interactions between enfuvirtide and other antiretroviral drugs

ANS: B The most appropriate information about the administration of enfuvirtide is how to reconstitute and self-administer a subcutaneous injection. The medication should never be injected into the same site or just between two sites. Vitamin E is not indicated for this medication. Enfuvirtide does not appear to cause significant drug interactions.

The nurse is caring for a patient who has been receiving vinorelbine [Navelbine] for about 5 days. Which assessment finding in this patient would cause the nurse to withhold the next dose and notify the prescriber? a.Alopecia b.Dyspnea and cough c.Neutrophil count of 1200/mm3 d.Peripheral neuropathy

ANS: B The nurse should withhold the dose if the patient has new-onset cough and dyspnea, because these may indicate the development of interstitial pulmonary changes and acute respiratory distress syndrome. Alopecia would not cause the nurse to withhold the dose. Neutropenia is expected and is not at a critical level. Although this count is low, it would not prevent administration of the medication. Peripheral neuropathy is expected with vinorelbine.

A patient taking stavudine [Zerit] telephones the clinic and reports numbness and tingling in the hands and feet. What should the nurse tell the patient? a.The numbness is an expected side effect of the medication and will diminish once the drug is withdrawn. b.The medication will probably be stopped, and the patient should come into the clinic for further evaluation. c.The dose may be too high, and the patient should cut the tablet in half. d.The patient should take the medication on a full stomach to reduce absorption of the drug.

ANS: B The patient has early signs and symptoms of neuropathy, which may resolve if the drug is stopped. The patient should be taught early in treatment to report these symptoms immediately. Numbness is not an expected side effect and these symptoms may diminish once the drug is withdrawn. The patient should never be advised to cut the dose in half unless instructed to do so by a prescriber. Taking the medication on a full stomach will not affect the amount of medication absorbed.

A patient is taking cyclosporine [Sandimmune] and prednisone to prevent organ rejection after right renal transplantation. The patient is febrile and complains of right-sided flank pain. The nurse reviews the patient's chart and finds that the patient's BUN and serum creatinine are elevated. The cyclosporine trough is 150 ng/mL. What will the nurse do? a.Be concerned that the left kidney is failing. b.Expect the provider to order intravenous methylprednisolone. c.Request an order for a urine culture. d.Suspect nephrotoxicity secondary to an elevated cyclosporine level.

ANS: B The patient is showing signs of acute organ rejection, which include pain at the graft site, fever, and elevated BUN and creatinine; therefore, intravenous methylprednisolone is indicated. Because the patient is having pain on the right side, along with fever and elevated renal function test results, there is no reason to suspect that the left kidney is failing or that an infection is present. The cyclosporine level is within normal limits.

The nurse is performing a physical assessment on a patient who is receiving treatment with abacavir, zidovudine, and lamivudine [Trizivir]. The patient complains of fatigue. Upon further assessment, the nurse finds a rash and notes that the patient has a temperature of 101.1°F. What is the nurse's best course of action? a.Tell the patient that this is an expected response to these medications and to continue the agents as prescribed. b.Have the patient hold the medications and arrange for an immediate evaluation by the prescriber. c.Have the patient continue the abacavir but discontinue the other two agents for 3 weeks. d.Instruct the patient to continue all three medications and administer an antihistamine for the symptoms.

ANS: B The patient should discontinue all the medications. Immediate assessment by the provider is required, because the patient is showing early symptoms of a fatal hypersensitivity reaction. This is not an expected response; it indicates a serious reaction, which the patient should report to the prescriber immediately. The patient should not continue the medications for any additional dosages.

A nurse is teaching a patient who is about to undergo allograft transplantation of the liver. Which statement by the patient indicates understanding of the post-transplant medications? a."Immunosuppressants help reduce the risk of postoperative infection." b."I will need to have periodic laboratory work to assess for toxicity." c."I will need to take immunosuppressants until all signs of organ rejection are gone." d."These drugs will prevent organ rejection."

ANS: B To prevent toxicity from high drug levels or organ rejection from low levels, blood levels of immunosuppressants should be checked periodically. Immunosuppressants do not prevent infection; they increase the risk of infection. Patients must take immunosuppressants for life. Immunosuppressants do not prevent organ rejection; they help minimize the risk.

A patient who has urinary bladder cancer will begin receiving the chemotherapeutic agent valrubicin [Valstar]. What will the nurse do when administering this drug? a.Administer the drug intravenously using a large bore needle and tubing. b.Ensure that the tubing used to administer the drug does not contain polyvinyl chloride. c.Monitor the patient closely for a variety of systemic drug adverse effects. d.Use a normal saline or sterile water diluent to dilute the medication.

ANS: B Valrubicin is given to treat urinary bladder cancer and, because the diluent used contains castor oil, it should not be given in tubing that contains PVC. It is given as an intravesical irrigation directly into the bladder and does not usually cause systemic side effects. The diluent contains castor oil.

10. A patient has had recent mechanical heart valve surgery and is receiving anticoagulant therapy. While monitoring the patient's laboratory work, the nurse interprets that the patient's international normalized ratio (INR) level of 3 indicates that: a. the patient is not receiving enough warfarin to have a therapeutic effect. b. the patient's warfarin dose is at therapeutic levels. c. the patient's intravenous heparin dose is dangerously high. d. the patient's intravenous heparin dose is at therapeutic levels.

ANS: B A normal INR (without warfarin) is 1.0. A therapeutic INR for patients who have had mechanical heart valve surgery ranges from 2.5 to 3.5, with a middle value of 3. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 419 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. A nurse is educating the staff nurses about ketoacidosis. To evaluate the group's understanding, the nurse asks, "Which sign or symptom would not be consistent with ketoacidosis?" The group gives which correct answer? a. Blood glucose level of 600 mg/dL b. Blood glucose level of 60 mg/dL c. Acidosis d. Ketones in the urine

ANS: B A patient with diabetic ketoacidosis (DKA) has a high glucose level (at least 500 mg/dL or higher); therefore, a glucose level of 60 mg/dL would not be consistent with DKA. A blood glucose level of 600 mg/dL, acidosis, and ketones in the urine are consistent with DKA.

2. A child with seasonal rhinitis has used budesonide [Rhinocort Aqua] for several years. The parents are concerned that the child's rate of growth has slowed. What will the nurse do? a. Reassure the parents that this is an expected side effect. b. Suggest that the parents discuss using fluticasone [Flonase] with the provider. c. Tell the parents to administer the drug only when symptoms are severe. d. Tell the parents that antihistamines work as well as intranasal glucocorticoids.

ANS: B A worrisome systemic effect of intranasal glucocorticoids is suppression of linear growth in children. Although rare, it can occur; however, it is less likely with fluticasone and mometasone, so these two preparations are better options for children. Reassuring parents that this is an expected side effect is incorrect. Intranasal glucocorticoids should be given daily and not as needed. Antihistamines are not as effective as glucocorticoids, because antihistamines work only against one mediator of allergic inflammation.

A 50-year-old man who has been taking phenobarbital for 1 week is found very lethargic and unable to walk after eating out for dinner. His wife states that he has no other prescriptions and that he did not take an overdose—the correct number of pills is in the bottle. The nurse suspects that which of these may have happened? a. He took a multivitamin. b. He drank a glass of wine. c. He took a dose of aspirin. d. He developed an allergy to the drug.

ANS: B Alcohol has an additive effect when combined with barbiturates and causes central nervous system (CNS) depression. Multivitamins and aspirin do not interact with barbiturates, and this situation does not illustrate an allergic reaction.

A nurse is providing teaching to a nursing student about to care for a woman with irritable bowel syndrome with diarrhea (IBS-D) who is receiving alosetron [Lotronex]. Which statement by the student indicates a need for further teaching? a."I should evaluate the patient's abdomen for distension and bowel sounds." b."Patients with diverticulitis and IBS-C may take this drug." c."This drug can cause ischemic colitis in some patients." d."This drug is given only to women with severe IBS-D."

ANS: B Alosetron is approved for use in women only with diarrhea-predominant IBS; it is contraindicated in patients with diverticulitis. Constipation can be a severe adverse effect, so patients should be assessed for signs of constipation, such as abdominal distension and diminished bowel sounds. Alosetron can cause ischemic colitis. Alosetron is approved for use in women with IBS-D regardless of the severity of the disease.

A patient must be treated immediately for acute organ transplant rejection. The nurse anticipates that muromonab-CD3 (Orthoclone OKT3) will be ordered. What is the priority assessment before beginning drug therapy with muromonab-CD3? a. Serum potassium level b. Fluid volume status c. Electrocardiogram d. Blood glucose level

ANS: B Assess fluid volume status because muromonab-CD3 is contraindicated in the presence of fluid overload. The other options are incorrect.

A 10-year-old patient will be started on methylphenidate hydrochloride (Ritalin) therapy. The nurse will perform which essential baseline assessment before this drug is started? a. Eye examination b. Height and weight c. Liver function studies d. Hearing test

ANS: B Assessment of baseline height and weight is important before beginning Ritalin therapy because it may cause a temporary slowing of growth in prepubertal children. The other studies are not as essential at this time.

The nurse is administering a combination of three different antineoplastic drugs to a patient who has metastatic breast cancer. Which statement best describes the rationale for combination therapy? a. There will be less nausea and vomiting. b. Increased cancer-cell killing will occur. c. The drugs will prevent metastasis. d. Combination therapy reduces the need for radiation therapy.

ANS: B Because drug-resistant cells commonly develop, exposure to multiple drugs with multiple mechanisms and sites of action will destroy more subpopulations of cells. The other options are incorrect.

A patient is taking bismuth subsalicylate [Pepto-Bismol] to prevent diarrhea. The nurse performing an assessment notes that the patient's tongue is black. What will the nurse do? a.Assess further for signs of gastrointestinal (GI) bleeding. b.Reassure the patient that this is an expected side effect of this drug. c.Request an order for liver function tests to evaluate for hepatotoxicity. d.Withhold the drug, because this is a sign of bismuth overdose.

ANS: B Bismuth subsalicylate can cause blackening of the tongue and stools, an expected side effect. This finding does not indicate GI bleeding, hepatotoxicity, or drug overdose.

When reviewing the health history of a patient who will be receiving antacids, the nurse recalls that antacids containing magnesium need to be used cautiously in patients with which condition? a. Peptic ulcer disease b. Renal failure c. Hypertension d. Heart failure

ANS: B Both calcium- and magnesium-based antacids are more likely to accumulate to toxic levels in patients with renal disease and are commonly avoided in this patient group. The other options are incorrect.

9. A patient is being discharged on anticoagulant therapy. The nurse will include in the patient-education conversation that it is important to avoid herbal products that contain which substance? a. Valerian b. Ginkgo c. Soy d. Saw palmetto

ANS: B Capsicum pepper, feverfew, garlic, ginger, ginkgo, St. John's wort, and ginseng are some herbals that have potential interactions with anticoagulants, especially with warfarin. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 417 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

A nurse receives an order to administer castor oil to a patient. Which action by the nurse is correct? a.Administer the medication at bedtime. b.Chill the medication and mix it with fruit juice. c.Provide teaching about home use of this medication. d.Teach the patient that the effects will occur slowly.

ANS: B Castor oil has an unpleasant taste that can be improved by chilling it and mixing it with fruit juice. The medication acts quickly and should not be given at bedtime. It is only used when prompt evacuation of intestinal contents is needed, as for radiological procedures, so the patient will not be instructed in home use of the medication and should be taught that the effects will be immediate.

The nurse is teaching a class about the various chemotherapy drugs. Which of these statements explains why alkylating drugs are also called "cell cycle-nonspecific drugs"? a. They are cytotoxic during a specific cell cycle. b. They are cytotoxic in any phase of the cell cycle. c. They are effective against several types of neoplasms. d. They are more highly differentiated than cell cycle-specific drugs.

ANS: B Cell cycle-nonspecific drugs kill cancer cells during any phase of the growth cycle, whereas cell cycle-specific drugs kill cancer cells during specific phases of the cell growth cycle. The other options are incorrect.

When giving cisplatin (Platinol-AQ), the nurse is aware that the major dose-limiting effect of this drug is which condition? a. Alopecia b. Kidney damage c. Cardiotoxicity d. Stomatitis

ANS: B Cisplatin may cause nephrotoxicity, and the patient's renal function must be monitored closely while on this drug. Ensuring hydration will help to prevent nephrotoxicity.

12. A 7-year-old child has a cough, runny nose, congestion, and fever, and the parents ask the nurse to recommend an over-the-counter product. Which response by the nurse is correct? a. "Any product will be effective when combined with vitamin C and zinc." b. "It is best to use single-agent medications to treat individual symptoms." c. "The fever indicates that your child may need an antibiotic; you should call your provider." d. "You should ask your provider to prescribe a combination product that will treat multiple symptoms."

ANS: B Combination medications may provide ingredients that are not needed or may provide ingredients that are either excessive or subtherapeutic. It is best to use single-agent drugs to treat individual symptoms. The efficacy of vitamin C and zinc for treating colds in children has not been established. Fever may accompany viral respiratory infections and not necessarily bacterial infections that need an antibiotic.

12. A patient asks a nurse why he cannot use digoxin [Lanoxin] for his heart failure, because both of his parents used it for HF. The nurse will explain that digoxin is not the first-line therapy for which reason? a. It causes tachycardia and increases the cardiac workload. b. It does not correct the underlying pathology of heart failure. c. It has a wide therapeutic range that makes dosing difficult. d. It may actually shorten the patient's life expectancy.

ANS: B Digoxin improves cardiac output, alters electrical effects, and helps to decrease sympathetic outflow from the central nervous system (CNS) through its neurohormonal effects; however, it does not alter the underlying pathology of heart failure or prevent cardiac remodeling. Digoxin causes bradycardia and increases the cardiac workload by increasing contractility. It has a narrow therapeutic range and many adverse effects. Digoxin does not improve life expectancy; in women it may actually shorten life expectancy.

11. A nurse and a nursing student are reviewing the care of a 30-kg patient who will receive intravenous aminophylline. Which statement by the student indicates an understanding of the administration of this medication? a. "After the loading dose has been given, the patient will receive 6 mg/kg/hr." b. "Dosing is titrated based on the serum theophylline levels." c. "If the patient's serum theophylline level is less than 15 mcg/mL, the rate should be reduced." d. "The patient will receive a loading dose of 180 mg over 5 minutes."

ANS: B Dosing for aminophylline is based on each patient's serum theophylline levels. The loading dose usually is 6 mg/kg; after that, the maintenance infusion is titrated according to the theophylline levels. A serum theophylline level of 15 mcg/mL is within the therapeutic range, so dosing would not need to change. The patient's total loading dose will be 180 mg, but infusions should never be given at a rate faster than 25 mg/min.

A patient who has been newly diagnosed with vertigo will be taking an antihistamine antiemetic drug. The nurse will include which information when teaching the patient about this drug a.The patient may skip doses if the patient is feeling well b.The patient will need to avoid driving because of possible drowsiness. c.The patient may experience occasional problems with taste. d.It is safe to take the medication with a glass of wine in the evening to help settle thestomach

ANS: B Drowsiness may occur because of central nervous system (CNS) depression, and patients should avoid driving or working with heavy machinery because of possible sedation. These drugs must not be taken with alcohol or other CNS depressants because of possible additive depressant effects. The medication should be taken as instructed and not skipped unless instructed to do so

A patient wants to take a ginseng dietary supplement. The nurse instructs the patient to look for which potential adverse effect? a. Drowsiness b. Palpitations and anxiety c. Dry mouth d. Constipation

ANS: B Elevated blood pressure, chest pain or palpitations, anxiety, insomnia, headache, nausea, vomiting, and diarrhea are potential adverse effects of ginseng. Drowsiness, difficulty with urination, and constipation are not potential adverse effects of ginseng.

A patient, diagnosed with lymphoma, has an allergy to one of the proposed chemotherapy drugs. The tumor has not responded to other types of treatment. The nurse expects the oncologist to follow which course of treatment? a. The physician will choose another drug to use. b. The chemotherapy will be given along with supportive measures to treat a possible allergic reaction. c. The patient will receive reduced doses of chemotherapy for a longer period of time. d. The chemotherapy cannot be given because of the patient's allergy.

ANS: B Even if a patient has a known allergic reaction to a given antineoplastic medication, the urgency of treating the patient's cancer may still necessitate administering the medication and then treating any allergic symptoms with supportive medications, such as antihistamines, corticosteroids, and acetaminophen.

10. A patient with a cough has been advised to use guaifenesin. The patient asks the nurse to explain the purpose of the drug. The nurse will explain that guaifenesin: a. dries secretions to help suppress coughing so patients can rest. b. helps stimulate the flow of secretions to increase cough productivity. c. helps to relieve chest pain associated with a cough. d. stimulates the body's natural immune responses.

ANS: B Expectorants stimulate the flow of respiratory tract secretions to improve cough productivity. Guaifenesin does not dry secretions, because it does not have anticholinergic effects. Guaifenesin does not alleviate pain associated with cough. Guaifenesin does not stimulate immune responses.

10. A patient who takes oral theophylline [Theochron] twice daily for chronic stable asthma develops an infection and will take ciprofloxacin. The nurse will contact the provider to discuss: a. changing to a different antibiotic. b. reducing the theophylline dose. c. giving theophylline once daily. d. switching from theophylline to a LABA.

ANS: B Fluoroquinolone antibiotics increase theophylline levels, so the dose of theophylline may need to be reduced to prevent theophylline toxicity. Changing antibiotics, giving the theophylline once daily, and changing to a LABA are not indicated.

A patient who has undergone a lung transplant has contracted cytomegalovirus (CMV) retinitis. The nurse expects which drug to be ordered for this patient? a. Acyclovir (Zovirax) b. Ganciclovir (Cytovene) c. Ribavirin (Virazole) d. Amantadine (Symmetrel)

ANS: B Ganciclovir is indicated for the treatment of cytomegalovirus retinitis. Acyclovir is used for herpes simplex types 1 and 2, herpes zoster, and chickenpox; amantadine is used for influenza type A; and zanamivir is used for influenza types A and B.

A patient with multiple sclerosis will be starting therapy with an immunosuppressant drug. The nurse expects that which drug will be used? a. Azathioprine (Imuran) b. Glatiramer acetate (Copaxone) c. Daclizumab (Zenapax) d. Sirolimus (Rapamune)

ANS: B Glatiramer acetate and fingolimod are the only immunosuppressants currently indicated for reduction of the frequency of relapses (exacerbations) in a type of multiple sclerosis known as relapsing-remitting multiple sclerosis.

A patient is receiving high doses of methotrexate and is experiencing severe bone marrow suppression. The nurse expects which intervention to be ordered with this drug to reduce this problem? a. A transfusion of whole blood b. Leucovorin rescue c. Therapy with filgrastim (Neupogen) d. Administration of allopurinol (Zyloprim)

ANS: B High-dose methotrexate is associated with bone marrow suppression, and it is always given in conjunction with the rescue drug leucovorin, which is an antidote for folic acid antagonists. Basically, leucovorin rescues the healthy cells from methotrexate. The other options are incorrect.

While monitoring a depressed patient who has just started SSRI antidepressant therapy, the nurse will observe for which problem during the early time frame of this therapy? a. Hypertensive crisis b. Self-injury or suicidal tendencies c. Extrapyramidal symptoms d. Loss of appetite

ANS: B In 2005, the U.S. Food and Drug Administration (FDA) issued special black-box warnings regarding the use of all classes of antidepressants in both adult and pediatric patient populations. Data from the FDA indicated a higher risk for suicide in patients receiving these medications. As a result, current recommendations for all patients receiving antidepressants include regular monitoring for signs of worsening depressive symptoms, especially when the medication is started or the dosage is changed. The other options are incorrect.

4. A patient asks the nurse what type of medications would be most effective for treating seasonal and perennial rhinitis. Which response by the nurse is correct? a. Pseudoephedrine [Sudafed] b. Fluticasone propionate [Fluticasone] c. Loratadine [Claritin] d. Intranasal cromolyn sodium [Atrovent]

ANS: B Intranasal glucocorticoids, such as fluticasone propionate, are the most effective drugs for prevention and treatment, because they prevent or suppress all the major symptoms of allergic rhinitis (congestion, rhinorrhea, sneezing, nasal itching, and erythema). Pseudoephedrine is an oral sympathomimetic used to reduce nasal congestion associated with allergic rhinitis. It has no effect on other symptoms. Loratadine, an oral antihistamine, reduces sneezing, rhinorrhea, and nasal itching only and is less effective than intranasal glucocorticoids. Intranasal cromolyn sodium is moderately effective in the treatment of allergic rhinitis, but the benefits are much less than those of intranasal glucocorticoids.

8. What is ipratropium bromide [Atrovent]? a. A cholinergic agent used for perennial rhinitis b. An anticholinergic used for allergic rhinitis and colds c. A medication that is used only in patients with asthma d. A drug that is inappropriate for use in patients with allergic rhinitis

ANS: B Ipratropium bromide is an anticholinergic that is indicated for allergic rhinitis, asthma, and the common cold. The drug reduces rhinorrhea. Ipratropium bromide is an anticholinergic. In addition to asthma, ipratropium bromide can be used for allergic rhinitis and the common cold. Ipratropium bromide can be used for allergic rhinitis.

When monitoring a patient who is on immunosuppressant therapy with azathioprine (Imuran), the nurse will monitor which laboratory results? a. Serum potassium levels b. White blood cell (leukocyte) count c. Red blood cell count d. Serum albumin levels

ANS: B Leukopenia is a potential adverse effect of azathioprine therapy, so white blood cells need to be monitored. The other options are incorrect.

6. A young adult woman will begin using an inhaled glucocorticoid to treat asthma. The nurse will teach this patient about the importance of which action? a. Lowering her calcium intake and increasing her vitamin D intake b. Participating in weight-bearing exercises on a regular basis c. Taking oral glucocorticoids during times of acute stress d. Using two reliable forms of birth control to prevent pregnancy

ANS: B Like oral glucocorticoids, inhaled glucocorticoids can promote bone loss in premenopausal women. Patients should be encouraged to participate in weight-bearing exercises to help minimize this side effect. Patients should increase both their calcium and vitamin D intakes. Patients taking oral glucocorticoids need increased steroids in times of stress. It is not necessary to use two reliable forms of birth control.

11. A child who has perennial allergic rhinitis has been using an intranasal glucocorticoid. The provider has ordered montelukast [Singulair] to replace the glucocorticoid, because the child has frequent nosebleeds. When teaching this child's parents about montelukast, the nurse will include which statement? a. "Montelukast is also effective for treating infectious rhinitis." b. "Montelukast may cause behavior changes in your child." c. "Montelukast will treat both congestion and rhinitis." d. "Montelukast works best when combined with a topical decongestant."

ANS: B Montelukast can cause rare but serious neuropsychiatric effects in patients, and parents should be warned of this possibility. It is not useful for treating infectious rhinitis. It does not affect congestion. It is not necessary to add a topical decongestant when using this drug for allergic rhinitis.

7. A patient is receiving heparin therapy as part of the treatment for a pulmonary embolism. The nurse monitors the results of which laboratory test to check the drug's effectiveness? a. Bleeding times b. Activated partial thromboplastin time (aPTT) c. Prothrombin time/international normalized ratio (PT/INR) d. Vitamin K levels

ANS: B Ongoing aPTT values are used to monitor heparin therapy. PT/INR is used to monitor warfarin therapy. The other two options are not used to monitor anticoagulant therapy. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 432 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient will undergo a colonoscopy, and the provider has ordered sodium phosphate as a bowel cleanser before the procedure. The nurse reviews the patient's chart and notes that the patient's creatinine clearance and blood urea nitrogen are both elevated. What will the nurse do? a.Reduce the amount of fluid given with the laxative to prevent fluid retention. b.Request an order to give polyethylene glycol and electrolytes (PEG-ELS) instead. c.Suggest that the patient reduce the dietary sodium intake. d.Suggest using a suppository laxative instead

ANS: B PEG-ELS solutions provide an isosmotic solution and do not cause dehydration or electrolyte imbalance. They are safe to use in patients with renal impairment or cardiovascular disease. This patient's laboratory values suggest renal impairment. Sodium phosphate products can cause kidney damage; giving them with less fluid only increases this possibility. Reducing the dietary intake of sodium is not recommended. Suppositories are not effective bowel cleansing agents.

The wife of a patient who has been diagnosed with depression calls the office and says, "It's been an entire week since he started that new medicine for his depression, and there's no change! What's wrong with him?" What is the nurse's best response? a. "The medication may not be effective for him. He may need to try another type." b. "It may take up to 6 weeks to notice any therapeutic effects. Let's wait a little longer to see how he does." c. "It sounds like the dose is not high enough. I'll check about increasing the dosage." d. "Some patients never recover from depression. He may not respond to this therapy."

ANS: B Patients and family members need to be told that antidepressant drugs commonly require several weeks before full therapeutic effects are noted. The other answers are incorrect.

17. An 88-year-old patient with heart failure has progressed to Stage D and is hospitalized for the third time in a month. The nurse will expect to discuss which topic with the patient's family? a. Antidysrhythmic medications b. End-of-life care c. Heart transplantation d. Implantable mechanical assist devices

ANS: B Patients in Stage D heart failure have advanced structural heart disease. For eligible patients, the best long-term solution is heart transplantation, but this patient probably is not eligible, given his advanced age. End-of-life care should be discussed. Antidysrhythmic medications are not indicated and may make symptoms worse. An implantable mechanical assist device is used in patients awaiting heart transplantation.

1. A nurse provides teaching to a patient with allergic rhinitis who will begin using an intranasal glucocorticoid. Which statement by the patient indicates understanding of the teaching? a. "If the glucocorticoid causes burning or itching, I should use it every other day." b. "I should use a decongestant if necessary before using the glucocorticoid." c. "I should use the glucocorticoid whenever I have symptoms." d. "I will probably develop systemic effects from the topical glucocorticoid."

ANS: B Patients using intranasal glucocorticoids should be taught to use a decongestant to unblock nasal passages if needed before using the medication. Intranasal glucocorticoids should be used regularly on a daily basis to achieve optimal effects and not every other day or as needed. Systemic effects from intranasal glucocorticoids can occur but are not likely.

The nurse is reviewing infection-prevention measures with a patient who is receiving antineoplastic drug therapy. Which statement by the patient indicates the need for further teaching? a. "I will avoid those who have recently had a vaccination." b. "I will eat only fresh fruits and vegetables." c. "I will report a sore throat, cough, or low-grade temperature." d. "It is important for both my family and me to practice good hand washing."

ANS: B Patients who are neutropenic and susceptible to infections need to adhere to a low-microbe diet by washing fresh fruits and vegetables and making sure foods are well cooked. The other options are correct.

A patient who has been taking cimetidine (Tagamet) for hyperacidity calls the clinic to say that the medication has not been effective. The nurse reviews his history and notes that which factor may be influencing the effectiveness of this drug? a. He takes the cimetidine with meals. b. He smokes two packs of cigarettes a day. c. He drinks a glass of water with each dose. d. He takes an antacid 3 hours after the cimetidine dose.

ANS: B Smoking may impair the absorption of H2 antagonists. The other factors are correct interventions for this medication.

9. A patient with chronic congestive heart failure has repeated hospitalizations in spite of ongoing treatment with hydrochlorothiazide [HydroDIURIL] and digoxin. The prescriber has ordered spironolactone [Aldactone] to be added to this patient's drug regimen, and the nurse provides education about this medication. Which statement by the patient indicates understanding of the teaching? a. "I can expect improvement within a few hours after taking this drug." b. "I need to stop taking potassium supplements." c. "I should use salt substitutes to prevent toxic side effects." d. "I should watch closely for dehydration."

ANS: B Spironolactone is a potassium-sparing diuretic used to counter the potassium-wasting effects of hydrochlorothiazides. Patients taking potassium supplements are at risk for hyperkalemia when taking this medication, so they should be advised to stop the supplements. Spironolactone takes up to 48 hours to have effects. Salt substitutes contain high levels of potassium and are contraindicated. Spironolactone is a weak diuretic, so the risk of dehydration is not increased.

The nurse is providing education to a patient with ulcerative colitis who is being treated with sulfasalazine [Azulfidine]. What statement by the patient best demonstrates understanding of the action of sulfasalazine? a."It treats the infection that triggers the condition." b."It reduces the inflammation." c."It enhances the immune response." d."It increases the reabsorption of fluid."

ANS: B Sulfasalazine reduces the inflammation seen with ulcerative colitis; this statement indicates understanding. Although similar to sulfonamides, sulfasalazine is not used to treat infections; further teaching is needed. Sulfasalazine does not enhance the immune response or increase the reabsorption of fluid; further teaching is needed.

Chlorpromazine (Thorazine) is prescribed for a patient, and the nurse provides instructions to the patient about the medication. The nurse includes which information? a. The patient needs to avoid caffeine while on this drug. b. The patient needs to wear sunscreen while outside because of photosensitivity. c. Long-term therapy may result in nervousness and excitability. d. The medication may be taken with an antacid to reduce gastrointestinal upset.

ANS: B Sun exposure and tanning booths need to be avoided with conventional antipsychotics because of the adverse effect of photosensitivity. Instruct the patient to apply sunscreen liberally and to wear sun-protective clothing and hats.

When administering cyclosporine, the nurse notes that allopurinol is also ordered for the patient. What is a potential result of this drug interaction? a. Reduced adverse effects of the cyclosporine b. Increased levels of cyclosporine and toxicity c. Reduced uric acid levels d. Reduced nephrotoxic effects of cyclosporine

ANS: B The allopurinol may cause increased levels of cyclosporine, and toxicity may result. The other options are incorrect.

A patient reports taking an oral bisacodyl laxative [Dulcolax] for several years. The provider has suggested discontinuing the laxative, but the patient is unsure how to do this. The nurse will tell the patient to: a.stop taking the oral laxative and use a suppository until normal motility resumes. b.stop taking the laxative immediately and expect no stool for several days. c.switch to a bulk-forming laxative, such as methylcellulose [Metamucil]. d.withdraw from the laxative slowly to avoid a rebound constipation effect

ANS: B The first step in breaking the laxative habit is abrupt cessation of laxative use. Bowel movements will be absent for several days after laxative withdrawal. Using a suppository, a bulk-forming laxative, or tapering the laxative only prolongs the habit and prevents normal function from returning.

The nurse is providing patient teaching for a patient who is starting antitubercular drug therapy. Which of these statements should be included? (Select all that apply.) a. "Take the medications until the symptoms disappear." b. "Take the medications at the same time every day." c. "You will be considered contagious during most of the illness and must take precautions to avoid spreading the disease." d. "Stop taking the medications if you have severe adverse effects." e. "Avoid alcoholic beverages while on this therapy." f. "If you notice reddish-brown or reddish-orange urine, stop taking the drug and contact your doctor right away." g. "If you experience a burning or tingling in your fingers or toes, report it to your prescriber immediately." h. "Oral contraceptives may not work while you are taking these drugs, so you will have to use another form of birth control."

ANS: B, E, G, H Medications for tuberculosis must be taken on a consistent schedule to maintain blood levels. Medication therapy for tuberculosis may last up to 24 months, long after symptoms disappear, and patients are infectious during the early part of the treatment. Compliance with antitubercular drug therapy is key, so if symptoms become severe, the prescriber should be contacted for an adjustment of the drug therapy. The medication must not be stopped. Because of potential liver toxicity, patients on this drug therapy must not drink alcohol. Discoloration of the urine is an expected adverse effect, and patients need to be warned about it beforehand. Burning or tingling in the fingers or toes may indicate that peripheral neuropathy is developing, and the prescriber needs to be notified immediately. A second form of birth control must be used because antitubercular drug therapy makes oral contraceptives ineffective.

A patient who has AIDS has lost weight and is easily fatigued because of his malnourished state. The nurse anticipates an order for which antinausea drug to stimulate his appetite? a.metoclopramide (Reglan), a prokinetic drug b.dronabinol (Marinol), a tetrahydrocannabinoid c.ondansetron (Zofran), a serotonin blocker d.aprepitant (Emend), a substance P/NK1 receptor antagonist

ANS: BDronabinol is used for the treatment of nausea and vomiting associated with cancer chemotherapy, generally as a second-line drug after treatment with other antiemetics has failed. It is also used to stimulate appetite and weight gain in patients with AIDS and in patients undergoing chemotherapy. The drugs in the other options are used to reduce or prevent nausea and vomiting but are not used to stimulate appetite

A mother calls the pediatrician's office to report that her 18-month-old child has eaten half of a bottle of baby aspirin. She says, "I have a bottle of syrup of ipecac. Should I give it to him? He seems fine right now. What do I do?" What is the nurse's best response? a."Go ahead and give him the ipecac, and then call 911." b."Don't give him the ipecac. Call the Poison Control number immediately for instructions." c."Please come to the office right away so that we can check him." d."Go ahead and take him to the emergency room right now."

ANS: BThe American Academy of Pediatrics no longer recommends the use of syrup of ipecac for home treatment for poisoning. Instructions state that if the poison has been ingested, firstcall the national poison control hotline at 800-222-1222. In allcases of poisoning,if the victim is conscious and alert, call the local poison control center. If the victim has collapsed or stopped breathing, call 911 for emergency transport to a hospital

The nurse is caring for a patient who is human immunodeficiency virus (HIV) positive and is taking high doses of zidovudine [Retrovir]. The nurse is providing patient education about the adverse effects of the medication. Which statement by the patient demonstrates a need for further teaching? a."I may experience fatigue from anemia." b."I may be more susceptible to infection from neutropenia." c."I may have a deficiency of vitamin B6." d."I may have a deficiency of folic acid."

ANS: C A deficiency of vitamin B12, not vitamin B6, would be expected; this statement indicates that further teaching is required. With high-dose zidovudine, the patient can expect anemia, neutropenia, and folic acid deficiency.

The nurse is caring for a patient who is taking a protease inhibitor (PI). Upon review of the laboratory test results, the nurse notes that the patient has newly elevated plasma triglycerides and cholesterol. The nurse expects that the prescriber will manage these levels with: a.lovastatin [Mevacor]. b.simvastatin [Zocor]. c.modified diet and exercise. d.Pancrease.

ANS: C All PIs can elevate plasma levels of cholesterol and triglycerides. Potential interventions for hyperlipidemia include modified diet, exercise, and lipid-lowering agents. Lovastatin and simvastatin should be avoided, because they can accumulate to dangerous levels. Pancrease is not indicated to lower triglycerides and cholesterol.

The nurse is preparing to administer basiliximab [Simulect] to a patient to prevent acute rejection. By which route will the nurse administer the drug? a.Oral b.Intramuscular c.Intravenous d.Transdermal

ANS: C Basiliximab is used to prevent acute rejection and is administered intravenously

The nurse is administering medications to a patient who is receiving cyclosporine [Sandimmune]. Which medication, when administered concurrently with cyclosporine, would warrant a reduction in the dosage of cyclosporine? a.Phenytoin [Dilantin] b.Prednisone c.Ketoconazole [Nizoral] d.Trimethoprim/sulfamethoxazole [Bactrim]

ANS: C Concurrent use of ketoconazole would warrant a reduction in the dosage of cyclosporine. Ketoconazole often is given concurrently with cyclosporine so that the patient's dosage of cyclosporine, which is costly, can be reduced. Phenytoin would cause a decrease in cyclosporine levels. Prednisone often is given concurrently with cyclosporine to suppress the immune response. Trimethoprim/sulfamethoxazole reduces levels of cyclosporine in the body

These patients are receiving chemotherapy. Which patient should the nurse see first? a.The patient with lightly bleeding gums b.The patient with nausea and vomiting c.The patient with a fever of 100.3°F d.The patient with diarrhea and stomatitis

ANS: C Fever is the principal early sign of infection, which can have extremely serious implications for an immunosuppressed patient. Because of a lack of neutrophils as a result of chemotherapy, signs of infection may be masked. Lightly bleeding gums, nausea, and vomiting are to be expected in patients receiving chemotherapy. Diarrhea and stomatitis also are common in patients receiving chemotherapy.

A nurse provides teaching for a patient with cytomegalovirus (CMV) retinitis who will receive the ganciclovir ocular implant [Vitrasert]. Which statement by the patient indicates a need for further teaching? a."My vision may be blurred for 2 to 4 weeks after receiving the implant." b."Surgical placement of the implant is an outpatient procedure." c."The implant will remain in place permanently." d."The implant will slow progression of CMV retinitis."

ANS: C Ganciclovir ocular implants must be replaced every 5 to 8 months and do not remain in place permanently. It is correct that vision may be blurred for 2 to 4 weeks after placement of the implant, that placement is an outpatient procedure, and that the implant will slow progression of CMV retinitis.

The nurse on an oncology unit prepares to administer the fourth cycle of docetaxel [Taxotere] to a patient with breast cancer. Which clinical finding would cause the nurse to withhold the dose and call the prescriber? a.Alanine transaminase (ALT) 1.2 times the upper limit b.Alkaline phosphatase 2 times the upper limit c.Neutrophil count below 1500/mm3 d.Creatinine clearance of 130 mL/min/1.73 m2

ANS: C If the neutrophil count drops below 1500/mm3, the nurse should withhold the dose and notify the prescriber. An ALT 1.5 times the upper limit and an alkaline phosphatase 2.5 times the upper limit are concerning. The creatinine clearance is not a concern.

A nurse provides teaching to a patient who has undergone kidney transplantation and will begin taking cyclosporine [Sandimmune], a glucocorticoid, and sirolimus [Rapamune]. Which statement by the patient indicates understanding of the teaching? a."I should take sirolimus at the same time as the cyclosporine." b."I will need to have my blood sugar checked regularly." c."I will need to take an antibiotic to prevent lung infections." d."Taking this combination of drugs lowers my risk of kidney damage."

ANS: C Immunosuppressant drugs increase the risk of infections, especially the BK virus, which can cause renal damage, and other organisms that cause lung infections. Patients taking these drugs must take antibiotics for the first 12 months to help prevent infection. Sirolimus and cyclosporine should be taken 4 hours apart. Patients with diabetes may have trouble with glucose tolerance and require monitoring. Taking cyclosporine and sirolimus increases the risk of renal damage.

A patient who is pregnant has a history of recurrent genital herpesvirus (HSV). The patient asks the nurse what will be done to suppress an outbreak when she is near term. The nurse will tell the patient that: a.antiviral medications are not safe during pregnancy. b.intravenous antiviral agents will be used if an outbreak occurs. c.oral acyclovir [Zovirax] may be used during pregnancy. d.topical acyclovir [Zovirax] must be used to control outbreaks.

ANS: C Oral acyclovir is devoid of serious adverse effects and may be used safely during pregnancy. It is incorrect to tell this patient that antiviral medications are not safe during pregnancy. Oral acyclovir is used to suppress recurrent genital herpes near term; intravenous antiviral medications are not indicated. It is not necessary to rely on topical medications because oral acyclovir is safe.

A nurse is preparing to administer a second infusion of trastuzumab [Herceptin] to a patient who has breast cancer. The patient tells the nurse that she experienced chills, fever, pain, and nausea after her first infusion. What will the nurse do? a.Contact the provider to request a CBC to assess for neutropenia. b.Ensure that oxygen and respiratory support measures are readily available. c.Reassure the patient that these symptoms will diminish with each infusion. d.Request an order for an electrocardiogram.

ANS: C Patients taking trastuzumab may experience a flu-like syndrome with their first infusion that will diminish with subsequent infusions. Neutropenia is not a concern with this drug. Hypersensitivity reactions may occur, but the patient's symptoms are not characteristic of this. Cardiotoxicity may occur, but the symptoms are not characteristic of this.

A nursing student asks a nurse why pegylated interferon alfa is used instead of regular interferon for a patient with hepatitis C. The nurse will tell the student that pegylated interferon: a.decreases the need for additional medications. b.has fewer adverse effects than interferon. c.is administered less frequently than interferon. d.may be given orally to increase ease of use.

ANS: C Pegylated interferon alfa preparations are preferred because of their convenience and superior efficacy. These preparations may be given once weekly instead of three or more times per week like the regular interferon. Using pegylated interferons does not decrease the need for additional medications. Pegylated interferons have similar adverse effects. Pegylated interferons are not given orally.

A nursing student asks a nurse how cancer cells become resistant to methotrexate [Rheumatrex]. The nurse is correct to respond by saying that cancer cells acquire resistance to methotrexate by: a.reduced production of transporter that pumps methotrexate out of cells. b.reduced synthesis of dihydrofolate reductase. c.reduced uptake of methotrexate into cells. d.increased ability to convert the drug to a polyglutamated form.

ANS: C Resistance to methotrexate occurs through five mechanisms, including reduced uptake of methotrexate into cells. Resistance also occurs through increased production of the transporter pump, increased synthesis of dihydrofolate reductase, and a decreased ability to convert the drug.

The nurse is caring for a patient after recent renal transplantation. The patient is taking sirolimus [Rapamune] to prevent transplant rejection. What other medications would the nurse expect the patient to be taking? a.Rifampin and ketoconazole b. Carbamazepine and phenobarbital c.Cyclosporine and glucocorticoids d.Amphotericin B and erythromycin

ANS: C Sirolimus should be used in conjunction with cyclosporine and glucocorticoids to reduce the risk of transplant rejection. Rifampin can reduce and ketoconazole can increase therapeutic levels of sirolimus and cyclosporine; therefore, they are not indicated for transplant patients. Carbamazepine and phenobarbital are not indicated, because they can reduce the therapeutic levels of sirolimus and cyclosporine. Amphotericin B and erythromycin are not indicated, because they can increase the therapeutic levels of sirolimus and cyclosporine.

A nurse explains to a patient with cancer why it is difficult to achieve 100% cell kill to cure cancer with chemotherapy. Which statement by the patient indicates a need for further teaching? a."It is necessary to continue giving the same dose of chemotherapeutic agents throughout therapy, even if toxicity occurs." b."Symptoms of cancer often disappear before all malignant cells are eradicated." c."The immune system attacks chemotherapeutic agents and renders them impotent." d."The immune system often fails to recognize cancer cells as foreign."

ANS: C The immune system does not attack chemotherapeutic agents, so this statement would indicate a need for further teaching. The same dose of chemotherapeutic agents must be given throughout therapy, which becomes difficult when patients have severe toxic reactions. Because cancer symptoms often disappear before all cells are killed, some therapies are stopped prematurely. The immune system does not recognize cancer cells as foreign and thus does not assist in cell kill.

The nurse wants to evaluate a nursing student's understanding of chemotherapy. The nurse asks, "Which factor would be a major obstacle to successful chemotherapy?" What is the student's best response? a."The patient's reluctance about the doses administered." b."The patient's degree of nausea." c."The toxicity of anticancer drugs to normal tissues." d."The difficulty attaining and maintaining venous access.

ANS: C The major obstacle to successful chemotherapy is the toxicity of anticancer drugs to normal tissues. The patient's reluctance regarding the dose is a vague response. The patient's degree of nausea should not be an issue, because many good antiemetics may be given prophylactically. The question does not address whether the chemotherapy is administered PO or IV; therefore, the response regarding venous access would be an assumption.

An immunocompromised child is exposed to chickenpox and the provider orders valacyclovir [Valtrex] to be given orally three times daily. The nurse will contact the provider to change this order for which reason? a.Valacyclovir is not used as varicella prophylaxis. b.The dosage is too high for this indication. c.The drug may cause serious adverse effects in immunocompromised patients. d.Valacyclovir is not approved for use in children.

ANS: C Valacyclovir is approved for use for varicella in immunocompetent children. In immunocompromised patients, it has produced a syndrome known as thrombotic thrombocytopenic purpura/hemolytic uremia syndrome (TTP/HUS). The dosage is fine for immunocompetent children.

A nurse is discussing vesicant chemotherapeutic agents with a nursing student. Which statement by the student indicates a need for further teaching about this type of drug? a."Extravasation of this type of drug may result in the need for skin grafts." b."If an IV line used for a vesicant drug infiltrates, it must be discontinued immediately." c."These drugs may be administered orally as well as intravenously." d."This type of drug may not be infused at a site of previous irradiation."

ANS: C Vesicants are given intravenously. Extravasation may cause severe local tissue injury, requiring skin grafts. Vesicants that infiltrate must be stopped immediately. Sites of previous irradiation should not be used.

6. A patient with type 1 diabetes recently became pregnant. The nurse plans a blood glucose testing schedule for her. What is the recommended monitoring schedule? a. Before each meal and before bed b. In the morning for a fasting level and at 4:00 PM for the peak level c. Six or seven times a day d. Three times a day, along with urine glucose testing

ANS: C A pregnant patient with type 1 diabetes must have frequent blood sugar monitoring (eg, six or seven times a day) to manage both the patient and the fetus so that no teratogenic effects occur. Monitoring the blood sugar level before meals and at bedtime is not significant enough to provide the necessary glycemic control. Morning and 4:00 PM monitoring is not enough to provide glycemic control. Urine glucose testing is not sensitive enough to aid glycemic control, and monitoring three times a day is not enough.

The nurse is reviewing the food choices of a patient who is taking a monoamine oxidase inhibitor ( MAOI). Which food choice would indicate the need for additional teaching? a. Orange juice b. Fried eggs over-easy c. Salami and Swiss cheese sandwich d. Biscuits and honey

ANS: C Aged cheeses, such a Swiss or cheddar cheese, and Salami contain tyramine. Patients who are taking MAOIs need to avoid tyramine-containing foods because of a severe hypertensive reaction that may occur. Orange juice, eggs, biscuits, and honey do not contain tyramine.

8. The nurse notes in the patient's medication orders that the patient will be starting anticoagulant therapy. What is the primary goal of anticoagulant therapy? a. Stabilizing an existing thrombus b. Dissolving an existing thrombus c. Preventing thrombus formation d. Dilating the vessel around a clot

ANS: C Anticoagulants prevent thrombus formation but do not dissolve or stabilize an existing thrombus, nor do they dilate vessels around a clot. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 414 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient has been taking temazepam (Restoril) for intermittent insomnia. She calls the nurse to say that when she takes it, she sleeps well, but the next day she feels "so tired." Which explanation by the nurse is correct? a. "Long-term use of this drug results in a sedative effect." b. "If you take the drug every night, this hangover effect will be reduced." c. "These drugs affect the sleep cycle, resulting in daytime sleepiness." d. "These drugs increase the activity of the central nervous system, making you tired the next day."

ANS: C Benzodiazepines suppress REM sleep to a degree (although not as much as barbiturates) and, thus, result in daytime sleepiness (a hangover effect). The other statements are incorrect.

A patient's provider has recommended a bulk-forming laxative for occasional constipation. Which statement by the patient indicates understanding of the teaching about this agent? a."I can take this medication long term." b."I should not take this drug if I have diverticulitis." c."I should take each dose with a full glass of water." d."This drug can cause severe diarrhea."

ANS: C Bulk-forming laxatives provide insoluble substances that swell in water to both soften and increase the size of the fecal mass. Patients should be taught to take the dose with a full glass of water. Laxatives in general are not recommended for long-term use. Bulkforming laxatives are safe for patients with diverticulitis. They are often used to treat diarrhea, because they help form the fecal mass

A patient is receiving a third session of chemotherapy with daunorubicin (Cerubidine). The nurse will assess the patient for which signs of a potential severe toxic effect of this drug? a. Tinnitus and hearing loss b. Numbness and tingling in the fingers c. A weight gain of 2 pounds or more in 24 hours d. Decreased blood urea nitrogen and creatinine levels

ANS: C Cardiac toxicity may occur, so frequent checking of heart and breath sounds is necessary and daily weights need to be recorded (with reporting of an increase of 2 pounds or more in 24 hours or 5 pounds or more in 1 week).

A 30-year-old male patient will begin a three-drug regimen to treat peptic ulcer disease. The regimen will consist of bismuth subsalicylate, tetracycline, and cimetidine [Tagamet]. The nurse will include which information when teaching this patient about this drug regimen? a.Black discoloration of the tongue and stools should be reported immediately. b.Central nervous system depression and confusion are likely to occur. c.Decreased libido, impotence, and gynecomastia are reversible side effects. d.Staining of the teeth may occur and is an indication for discontinuation of these drugs.

ANS: C Cimetidine has antiandrogenic effects and can cause decreased libido, impotence, and gynecomastia. These effects are reversible. Black stools and discoloration of the tongue are side effects associated with bismuth but are not harmful. Central nervous system (CNS) depression and confusion are not likely. Staining of the teeth associated with tetracycline use occurs only in developing teeth; it is a problem in children younger than 8 years and in pregnant woman because of this risk to the fetus.

The nurse is reviewing medications used for depression. Which of these statements is a reason that selective serotonin reuptake inhibitors (SSRIs) are more widely prescribed today than tricyclic antidepressants? a. SSRIs have fewer sexual side effects. b. Unlike tricyclic antidepressants, SSRIs do not have drug-food interactions. c. Tricyclic antidepressants cause serious cardiac dysrhythmias if an overdose occurs. d. SSRIs cause a therapeutic response faster than tricyclic antidepressants.

ANS: C Death from overdose of tricyclic antidepressants usually results from either seizures or dysrhythmias. SSRIs are associated with significantly fewer and less severe systemic adverse effects, especially anticholinergic and cardiovascular adverse effects. The other options are incorrect.

9. A parent asks a nurse to recommend an intranasal decongestant for a 6-year-old child. Which response by the nurse is correct? a. "Decongestants are too sedating for children and should not be used." b. "Decongestants should not be given to children under 7 years old." c. "Decongestant drops are recommended instead of decongestant sprays." d. "Decongestant sprays should be used no longer than 5 to 10 days."

ANS: C Decongestant drops are recommended for children, because the number of drops can be controlled precisely. When sprays are used, the amount given is not well controlled. Decongestants cause CNS excitation. Decongestants may be given to children over the age of 4 years. Intranasal decongestants should not be used for longer than 5 days.

A patient who has started drug therapy for tuberculosis wants to know how long he will be on the medications. Which response by the nurse is correct? a. "Drug therapy will last until the symptoms have stopped." b. "Drug therapy will continue until the tuberculosis develops resistance." c. "You should expect to take these drugs for as long as 24 months." d. "You will be on this drug therapy for the rest of your life."

ANS: C Drug therapy commonly lasts for 24 months if consistent drug therapy has been maintained. The other options are incorrect.

5. A patient has been instructed to take one enteric-coated low-dose aspirin a day as part of therapy to prevent strokes. The nurse will provide which instruction when providing patient teaching about this medication? a. Aspirin needs to be taken on an empty stomach to ensure maximal absorption. b. Low-dose aspirin therapy rarely causes problems with bleeding. c. Take the medication with 6 to 8 ounces of water and with food. d. Coated tablets may be crushed if necessary for easier swallowing.

ANS: C Enteric-coated aspirin is best taken with 6 to 8 ounces of water and with food to help decrease gastrointestinal upset. Enteric-coated tablets should not be crushed. Risk for bleeding increases with aspirin therapy, even at low doses. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 431 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

When monitoring patients on antitubercular drug therapy, the nurse knows that which drug may cause a decrease in visual acuity? a. Rifampin (Rifadin) b. Isoniazid (INH) c. Ethambutol (Myambutol) d. Streptomycin

ANS: C Ethambutol may cause a decrease in visual acuity or even blindness resulting from retrobulbar neuritis. The other options are incorrect.

A 75-year-old woman comes into the clinic with complaints of muscle twitching, nausea, and headache. She tells the nurse that she has been taking sodium bicarbonate 5 or 6 times a day for the past 3 weeks. The nurse will assess for which potential problem that may occur with overuse of sodium bicarbonate? a. Constipation b. Metabolic acidosis c. Metabolic alkalosis d. Excessive gastric mucus

ANS: C Excessive use of sodium bicarbonate may lead to systemic alkalosis. The other options are incorrect.

A patient has been taking haloperidol (Haldol) for 3 months for a psychotic disorder, and the nurse is concerned about the development of extrapyramidal symptoms. The nurse will monitor the patient closely for which effects? a. Increased paranoia b. Drowsiness and dizziness c. Tremors and muscle twitching d. Dry mouth and constipation

ANS: C Extrapyramidal symptoms are manifested by tremors and muscle twitching, and the incidence of such symptoms is high during haloperidol therapy. The other options are incorrect.

14. An elderly patient who has type 2 diabetes has a history of severe hypoglycemia. The patient's spouse asks the nurse what the optimum A1c level is for the patient. Which is correct? a. Between 6.5 and 7.0 b. Below 7.0 c. Below 8.0 d. Between 7.0 and 8.5

ANS: C For patients with a history of severe hypoglycemia and those with a limited life expectancy or advanced micro- and macrovascular complications, the target A1c level should be below 8.0. For most other patients with diabetes, the target is 7.0 and below.

15. A patient who has type 2 diabetes will begin taking glipizide [Glucotrol]. Which statement by the patient is concerning to the nurse? a. "I will begin by taking this once daily with breakfast." b. "It is safe to drink grapefruit juice while taking this drug." c. "I may continue to have a glass of wine with dinner." d. "I will need to check my blood sugar once daily or more."

ANS: C Glipizide is a sulfonylurea antidiabetic agent and can cause a disulfiram-like reaction when combined with alcohol. Patients should be taught to avoid alcohol while taking this medication. The initial dosing is once daily with breakfast. There is no drug interaction with grapefruit juice. Patients will need to monitor their blood glucose.

A patient is receiving intravenous promethazine [Phenergan] 25 mg for postoperative nausea and vomiting. What is an important nursing action when giving this drug? a.Giving the dose as an IV push over 3 to 5 minutes b.Infusing the dose with microbore tubing and an infusion pump c.Observing the IV insertion site frequently for patency d.Telling the patient to report dry mouth and sedation

ANS: C If IV administration must be done with this drug, it should be given through a large-bore, freely flowing line. The site should be monitored closely for local burning or pain or any sign of extravasation, which can cause abscess formation, tissue necrosis, and gangrene requiring amputation. Giving the medication as a rapid IV push or through microbore tubing does not adequately slow the infusion or dilute the drug. Dry mouth and sedation are expected side effects of this drug and are not dangerous.

What is the nurse's priority action if extravasation of an antineoplastic drug occurs during intravenous (IV) administration? a. Reduce the infusion rate. b. Discontinue the IV, and apply warm compresses. c. Stop the infusion immediately, but leave the IV catheter in place. d. Change the infusion to normal saline, and inject the area with hydrocortisone.

ANS: C If extravasation is suspected, administration of the drug must be stopped immediately but the IV catheter left in place and the appropriate antidote instilled through the existing IV tube, after which the needle may be removed. The other options are incorrect.

A patient is receiving irinotecan (Camptosar), along with other antineoplastic drugs, as treatment for ovarian cancer. The nurse will monitor for which potentially life-threatening adverse effect that is associated with this drug? a. Severe stomatitis b. Bone marrow suppression c. Delayed-onset cholinergic diarrhea d. Immediate and severe nausea and vomiting

ANS: C In addition to producing hematologic adverse effects, irinotecan has been associated with severe diarrhea, known as cholinergic diarrhea, which may occur during infusions. Delayed diarrhea may occur 2 to 10 days after infusion of irinotecan. It is recommended that this condition be treated with atropine unless use of that drug is strongly contraindicated. This diarrhea can be severe and even life threatening.

A patient with a history of chronic alcohol abuse has been admitted to the unit with cirrhosis. Upon review of the patient's laboratory test results, the nurse notes that the patient's ammonia level is elevated at 218 mcg/dL. What medication should the nurse prepare to administer? a.0.9% NS b.Docusate sodium [Colace] c.Lactulose d.Polyethylene glycol [MiraLax]

ANS: C Lactulose is the only laxative known to lower ammonia levels in patients with portal hypertension and hepatic encephalopathy secondary to liver disease. No information suggests that the patient needs fluid or electrolyte replacement. Docusate sodium and polyethylene glycol are not effective at lowering ammonia levels.

A patient is admitted with lower abdominal pain and nausea. The nurse performing the initial assessment notes that the patient's abdomen is distended and firm, and hypoactive bowel sounds are present. The patient has not had a stool for 3 days. The nurse will contact the provider, who will: a.order a bulk-forming laxative. b.order extra fluids and fiber. c.perform diagnostic tests. d.prescribe a cathartic laxative.

ANS: C Laxatives are contraindicated for patients with abdominal pain, nausea, cramps, or other symptoms of abdominal disease or an acute surgical abdomen. Laxatives should not be used in patients with obstruction or impaction. This patient shows signs of abdominal obstruction, and laxatives could cause a bowel perforation secondary to increased peristalsis. A bulk-forming laxative is contraindicated. Patients with acute abdomens should be kept NPO pending diagnosis. A cathartic laxative is contraindicated.

A 6-year-old child has frequent constipation. The nurse provides teaching after the parent asks the nurse why the provider recommended using laxatives only when needed. Which statement by the parent indicates a need for further teaching? a."Children who take laxatives regularly can become dehydrated." b."Chronic laxative use can cause electrolyte imbalances." c."Frequent use of laxatives can cause diverticulitis." d."The normal reflex to defecate can be inhibited with overuse of laxatives."

ANS: C Laxatives do not cause diverticulitis, although some laxatives can aggravate this condition. Chronic use of laxatives can cause dehydration and electrolyte imbalances and can suppress the normal defecation reflex

At 0900, the nurse is about to give morning medications, and the patient has asked for a dose of antacid for severe heartburn. Which schedule for the antacid and medications is correct? a. Give both the antacid and medications at 0900. b. Give the antacid at 0900, and then the medications at 0930. c. Give the medications at 0900, and then the antacid at 1000. d. Give the medications at 0900, and then the antacid at 0915.

ANS: C Medications are not to be taken, unless prescribed, within 1 to 2 hours of taking an antacid because of their impact on the absorption of many medications in the stomach.

A patient who has been on methotrexate therapy is experiencing mild pain. The patient is asking for aspirin for the pain. The nurse recognizes that which of these is true in this situation? a. The aspirin will aggravate diarrhea. b. The aspirin will masks signs of infection. c. Aspirin can lead to methotrexate toxicity. d. The aspirin will cause no problems for the patient on methotrexate.

ANS: C Methotrexate interacts with weak organic acids, such as aspirin, and can lead to toxicity by displacing the methotrexate from protein-binding sites.

A patient with Crohn's disease will begin receiving an initial infusion of infliximab [Remicade]. The nurse explains how this drug works to treat this disease. Which statement by the patient indicates a need for further teaching? a."I may have an increased risk of infections, such as tuberculosis, when taking infliximab." b."I should report chills, fever, itching, and shortness of breath while receiving the infusion." c."This drug sometimes provides a complete cure of inflammatory bowel disease." d."I will take the second dose in 2 weeks, the third dose in 6 weeks, and then a dose every 8 weeks thereafter."

ANS: C None of the drugs used to treat obstructive bowel disease (OBD) are curative. Patients taking immunomodulators, such as infliximab, have an increased risk of infection, especially opportunistic infections such as TB. Infusion reactions may occur and include chills, fever, itching, and shortness of breath. The induction regimen is 5 mg/kg infused at 0, 2, and 6 weeks, followed by a maintenance regimen every 8 weeks.

During chemotherapy, a patient develops severe diarrhea caused by a vasoactive intestinal peptide-secreting tumor (VIPoma). The nurse expects to administer which drug for this problem? a. Dexrazoxane (Zinecard) b. Allopurinol (Zyloprim) c. Octreotide (Sandostatin) d. Bismuth subsalicylate (Pepto-Bismol)

ANS: C Octreotide (Sandostatin) is used for the management of a cancer-related condition called carcinoid crisis and treatment of the severe diarrhea caused by vasoactive intestinal peptide-secreting tumors (VIPomas). The other options are incorrect.

1. A patient is taking enalapril [Vasotec]. The nurse understands that patients taking this type of drug for heart failure need to be monitored carefully for: a. hypernatremia. b. hypertension. c. hyperkalemia. d. hypokalemia.

ANS: C One of the principal effects of angiotensin-converting enzyme (ACE) inhibitors is hyperkalemia, which is due to decreased aldosterone release arising from blockage of angiotensin II. There is no indication that careful monitoring of sodium for increased levels is indicated. Vasotec is indicated for heart failure, not hypertension. The drug therapy should be monitored to ascertain its effectiveness, but hyperkalemia is the main concern. Hyperkalemia, not hypokalemia, is a concern because of the decreased aldosterone release that occurs with blockage of angiotensin II.

When evaluating a patient who is taking orlistat (Xenical), which is an intended therapeutic effect? a. Increased wakefulness b. Increased appetite c. Decreased weight d. Decreased hyperactivity

ANS: C Orlistat (Xenical) is a nonstimulant drug that is used as part of a weight loss program. The other options are incorrect.

A patient who takes nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis asks a nurse what can be done to prevent ulcers. The nurse will recommend asking the provider about using which medication? a.Antibiotics b.Histamine-2 receptor antagonists c.Proton pump inhibitors d.Mucosal protectants

ANS: C Patients taking NSAIDs should use proton pump inhibitors for ulcer prophylaxis. The other agents are not used for prophylaxis

7. A patient is taking gentamicin [Garamycin] and furosemide [Lasix]. The nurse should counsel this patient to report which symptom? a. Frequent nocturia b. Headaches c. Ringing in the ears d. Urinary retention

ANS: C Patients taking furosemide should be advised that the risk of furosemide-induced hearing loss can be increased when other ototoxic drugs, such as gentamicin, are also taken. Patients should be told to report tinnitus, dizziness, or hearing loss. Nocturia may be an expected effect of furosemide. Headaches are not likely to occur with concomitant use of gentamicin and furosemide. Urinary retention is not an expected side effect.

4. A patient with asthma is admitted to an emergency department with a respiratory rate of 22 breaths per minute, a prolonged expiratory phase, tight wheezes, and an oxygen saturation of 90% on room air. The patient reports using fluticasone [Flovent HFA] 110 mcg twice daily and has used 2 puffs of albuterol [Proventil HFA], 90 mcg/puff, every 4 hours for 2 days. The nurse will expect to administer which drug? a. Four puffs of albuterol, oxygen, and intravenous theophylline b. Intramuscular glucocorticoids and salmeterol by metered-dose inhaler c. Intravenous glucocorticoids, nebulized albuterol and ipratropium, and oxygen d. Intravenous theophylline, oxygen, and fluticasone (Flovent HFA) 220 mcg

ANS: C Patients using inhaled glucocorticoids should be given IV or oral glucocorticoids for acute exacerbations. During asthma flares, nebulized albuterol with ipratropium may be better tolerated and more effective. Oxygen is indicated, because oxygen saturations are low despite the increased work of breathing. Increasing the dose of albuterol and giving theophylline are not indicated. Salmeterol is a long-term beta agonist and is not useful in an acute attack.

A patient with renal disease is scheduled for a colonoscopy. Before the procedure, the nurse will anticipate administering: a.glycerin suppository. b.magnesium hydroxide (MOM). c.polyethylene glycol and electrolytes. d.sodium phosphate.

ANS: C Polyethylene glycol (PEG) plus electrolytes (ELS) is one of two bowel cleansers used before colonoscopy to clear the bowel. PEG-ELS products are preferred, because unlike sodium phosphate, they are isotonic and do not increase the likelihood of dehydration and electrolyte imbalance. Glycerin suppositories and magnesium hydroxide are not used for bowel cleansing.

A patient is receiving cidofovir (Vistide) as part of treatment for a viral infection, and the nurse is preparing to administer probenecid, which is also ordered. Which is the rationale for administering probenecid along with the cidofovir treatment? a. Probenecid has a synergistic effect when given with cidofovir, thus making the antiviral medication more effective. b. The probenecid also prevents replication of the virus. c. Concurrent drug therapy with probenecid reduces the nephrotoxicity of the cidofovir. d. The probenecid reduces the adverse gastrointestinal effects of the cidofovir.

ANS: C Probenecid is recommended as concurrent drug therapy with cidofovir to help alleviate the nephrotoxic effects of probenecid. The other options are incorrect.

11. A patient has received an overdose of intravenous heparin, and is showing signs of excessive bleeding. Which substance is the antidote for heparin overdose? a. Vitamin E b. Vitamin K c. Protamine sulfate d. Potassium chloride

ANS: C Protamine sulfate is a specific heparin antidote and forms a complex with heparin, completely reversing its anticoagulant properties. Vitamin K is the antidote for warfarin (Coumadin) overdose. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 416 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

An older adult patient with severe gastroesophageal reflux disease (GERD) has had only minimal relief using a histamine2-receptor antagonist (H2RA). The patient is to begin taking omeprazole [Prilosec]. What will the nurse teach this patient? a.A complete cure is expected with this medication. b.Lifestyle changes can be as effective as medication therapy. c.Long-term therapy may be needed. d.The medication will be used until surgery can be performed.

ANS: C Proton pump inhibitors, such as omeprazole, are much better than H2RAs for treating GERD. For patients with severe GERD, long-term maintenance therapy is recommended. These drugs do not cure GERD; relapse is common when the drugs are discontinued. Lifestyle changes can help but should not be considered a substitute for drugs. Surgery is reserved for young, healthy patients who cannot or will not stick to a drug regimen.

A patient who has been taking isoniazid (INH) has a new prescription for pyridoxine. She is wondering why she needs this medication. The nurse explains that pyridoxine is often given concurrently with the isoniazid to prevent which condition? a. Hair loss b. Renal failure c. Peripheral neuropathy d. Heart failure

ANS: C Pyridoxine (vitamin B6) may be beneficial for isoniazid-induced peripheral neuropathy. The other options are incorrect.

15. A patient is taking a thiazide diuretic for hypertension and quinidine to treat a dysrhythmia. The prescriber orders digoxin 0.125 mg to improve this patient's cardiac output. The nurse should contact the provider to request: a. adding spironolactone [Aldactone]. b. reducing the dose of digoxin. c. discontinuing the quinidine. d. giving potassium supplements.

ANS: C Quinidine can cause plasma levels of digoxin to rise; concurrent use of quinidine and digoxin is contraindicated. There is no indication for adding spironolactone unless this patient's potassium level is elevated. The dose of digoxin ordered is a low dose. Potassium supplements are contraindicated with digoxin.

A patient is diagnosed with Zollinger-Ellison syndrome. Which medication does the nurse expect the provider to order for this patient? a.Cimetidine [Tagamet] b.Esomeprazole [Nexium] c.Ranitidine [Zantac] d.Sucralfate [Carafate]

ANS: C Ranitidine is used to treat Zollinger-Ellison syndrome. Although cimetidine can also be used, ranitidine is more potent and therefore is preferred. Esomeprazole and sucralfate are not indicated.

When hanging a new infusion bag of a chemotherapy drug, the nurse accidentally spills a small amount of the solution onto the floor. Which action by the nurse is appropriate? a. Let it dry, and then mop the floor. b. Wipe the area with a disposable paper towel. c. Use a spill kit to clean the area. d. Ask the housekeeping department to clean the floor.

ANS: C Special spill kits are employed to clean up even the smallest chemotherapy spills. These precautions are necessary to protect the health care provider from the cytotoxic effects of these drugs.

3. A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation of the lungs reveals crackles bilaterally, and the serum potassium level is 6 mEq/L. Which diuretic agent ordered by the prescriber should the nurse question? a. Bumetanide [Bumex] b. Furosemide [Lasix] c. Spironolactone [Aldactone] d. Hydrochlorothiazide [HydroDIURIL]

ANS: C Spironolactone is a non-potassium-wasting diuretic; therefore, if the patient has a serum potassium level of 6 mEq/L, indicating hyperkalemia, an order for this drug should be questioned. Bumetanide, furosemide, and hydrochlorothiazide are potassium-wasting diuretics and would be appropriate to administer in a patient with hyperkalemia.

A patient is being treated for chemotherapy-induced nausea and vomiting (CINV) with ondansetron [Zofran] and dexamethasone. The patient reports getting relief during and immediately after chemotherapy but has significant nausea and vomiting several days after each chemotherapy treatment. What will the nurse do? a.Contact the provider to discuss increasing the dose of ondansetron. b.Suggest giving prolonged doses of dexamethasone. c.Suggest adding aprepitant [Emend] to the medication regimen. d.Tell the patient to ask the provider about changing the ondansetron to aprepitant.

ANS: C The current regimen of choice for patients taking highly emetogenic drugs consists of three agents: aprepitant plus dexamethasone plus a 5-HT3 antagonist, such as ondansetron. Aprepitant has a prolonged duration of action and can prevent delayed CINV as well as acute CINV. Increasing the dose of ondansetron will not help treat the delayed CINV. Glucocorticoids should be given intermittently and for short periods to avoid side effects. Changing the ondansetron to aprepitant is not recommended.

2. A nurse is discussing heart failure with a group of nursing students. Which statement by a student reflects an understanding of how compensatory mechanisms can compound existing problems in patients with heart failure? a. "An increase in arteriolar tone to improve tissue perfusion can decrease resistance." b. "An increase in contractility to increase cardiac output can cause pulmonary edema." c. "When the heart rate increases to increase cardiac output, it can prevent adequate filling of the ventricles." d. "When venous tone increases to increase ventricular filling, an increase in arterial pressure occurs."

ANS: C The heart rate increases to improve cardiac output, but it may prevent adequate ventricular filling. An increase in arteriole tone improves tissue perfusion but also increases both the resistance to the pumping of the heart and the cardiac workload. Increased contractility helps improve cardiac output but is detrimental because it increases the oxygen demand of the heart. An increase in venous tone improves ventricular filling, but as the ventricles fail, blood can back up and cause pulmonary edema.

A 22-year-old nursing student has been taking NoDoz (caffeine) tablets for the past few weeks to "make it through" the end of the semester and exam week. She is in the university clinic today because she is "exhausted." What nursing diagnosis may be appropriate for her? a. Noncompliance b. Impaired physical mobility c. Disturbed sleep pattern d. Imbalanced nutrition: less than body requirements

ANS: C The main ingredient in NoDoz, caffeine, is a central nervous system stimulant that can be used to increase mental alertness. Restlessness, anxiety, and insomnia are common adverse effects. Thus, disturbed sleep pattern is the most appropriate nursing diagnosis of those listed.

A patient is brought to the emergency department for treatment of a suspected overdose. The patient was found with an empty prescription bottle of a barbiturate by his bedside. He is lethargic and barely breathing. The nurse would expect which immediate intervention? a. Starting an intravenous infusion of diluted bicarbonate solution b. Administering medications to increase blood pressure c. Implementing measures to maintain the airway and support respirations d. Administrating naloxone (Narcan) as an antagonist

ANS: C There are no antagonists/antidotes for barbiturates. Treatment supports respirations and maintains the airway. The other interventions are not appropriate.

A young adult calls the clinic to ask for a prescription for "that new flu drug." He says he has had the flu for almost 4 days and just heard about a drug that can reduce the symptoms. What is the nurse's best response to his request? a. "Now that you've had the flu, you will need a booster vaccination, not the antiviral drug." b. "We will need to do a blood test to verify that you actually have the flu." c. "Drug therapy should be started within 2 days of symptom onset, not 4 days." d. "We'll get you a prescription. As long as you start treatment within the next 24 hours, the drug should be effective."

ANS: C These drugs need to be started within 2 days of influenza symptom onset; they can be used for prophylaxis and treatment of influenza. The other options are incorrect.

16. A patient with heart failure who takes a thiazide diuretic and digoxin [Lanoxin] is admitted for shortness of breath. The patient's heart rate is 66 beats per minute, and the blood pressure is 130/88 mm Hg. The serum potassium level is 3.8 mEq/L, and the digoxin level is 0.8 ng/mL. The nurse admitting this patient understands that the patient: a. has digoxin toxicity. b. is showing signs of renal failure. c. is experiencing worsening of the disease. d. needs a potassium-sparing diuretic.

ANS: C This patient has a normal serum potassium level, and the digoxin level is normal. The patient is showing signs of pulmonary edema, which indicates progression of heart failure. The digoxin level is within normal limits, and the heart rate is above 60 beats per minute, so digoxin toxicity is not likely. There is no sign of renal failure. A potassium-sparing diuretic is not indicated.

2. A patient who is taking digoxin is admitted to the hospital for treatment of congestive heart failure. The prescriber has ordered furosemide [Lasix]. The nurse notes an irregular heart rate of 86 beats per minute, a respiratory rate of 22 breaths per minute, and a blood pressure of 130/82 mm Hg. The nurse auscultates crackles in both lungs. Which laboratory value causes the nurse the most concern? a. Blood glucose level of 120 mg/dL b. Oxygen saturation of 90% c. Potassium level of 3.5 mEq/L d. Sodium level of 140 mEq/L

ANS: C This patient has an irregular, rapid heartbeat that might be caused by a dysrhythmia. This patient's serum potassium level is low, which can trigger fatal dysrhythmias, especially in patients taking digoxin. Furosemide contributes to loss of potassium through its effects on the distal nephron. Potassium-sparing diuretics often are used in conjunction with furosemide to prevent this complication. This patient's serum glucose and sodium levels are normal and of no concern at this point, although they can be affected by furosemide. The oxygen saturation is somewhat low and needs to be monitored, although it may improve with diuresis.

3. A patient with chronic hypertension is admitted to the hospital. During the admission assessment, the nurse notes a heart rate of 96 beats per minute, a blood pressure of 150/90 mm Hg, bibasilar crackles, 2+ pitting edema of the ankles, and distension of the jugular veins. The nurse will contact the provider to request an order for which medication? a. ACE inhibitor b. Digoxin [Lanoxin] c. Furosemide [Lasix] d. Spironolactone [Aldactone]

ANS: C This patient shows signs of fluid volume overload and needs a diuretic. Furosemide is a loop diuretic, which can produce profound diuresis very quickly even when the glomerular filtration rate (GFR) is low. An ACE inhibitor will not reduce fluid volume overload. Digoxin has a positive inotropic effect on the heart, which may improve renal perfusion, but this is not its primary effect. Spironolactone is a potassium-sparing diuretic with weak diuresis effects; it is used in conjunction with other diuretics to improve electrolyte balance.

A nurse is admitting a patient to the hospital who reports having recurrent, crampy abdominal pain followed by diarrhea. The patient tells the nurse that the diarrhea usually relieves the pain and that these symptoms have occurred daily for the past 6 months. The patient undergoes a colonoscopy, for which the findings are normal. The nurse will plan to teach this patient to: a.use antispasmodic medications. b.avoid food containing lactose and gluten. c.keep a food, stress, and symptom diary. d.use antidiarrheal drugs to manage symptoms

ANS: C This patient shows signs of irritable bowel syndrome (IBS), which can be managed with drug and nondrug therapies. Patients should be taught to keep a log to identify foods and stressors that trigger symptoms. Antispasmodic medications frequently are used, but there is no clear evidence of their benefit. Patients with malabsorption disorders may need to avoid lactose or gluten but only if indicated. Antidiarrheal drugs do not have clear benefits, even though they are commonly used

A patient who is diagnosed with shingles is taking topical acyclovir, and the nurse is providing instructions about adverse effects. The nurse will discuss which adverse effects of topical acyclovir therapy? a. Insomnia and nervousness b. Temporary swelling and rash c. Burning when applied d. This medication has no adverse effects.

ANS: C Transient burning may occur with topical application of acyclovir. The other options are incorrect.

A patient has been admitted to the emergency department with a suspected overdose of a tricyclic antidepressant. The nurse will prepare for what immediate concern? a. Hypertension b. Renal failure c. Cardiac dysrhythmias d. Gastrointestinal bleeding

ANS: C Tricyclic antidepressant overdoses are notoriously lethal. The primary organ systems affected are the central nervous system and the cardiovascular system, and death usually results from either seizures or dysrhythmias.

The nurse is counseling a woman who will be starting rifampin (Rifadin) as part of antitubercular therapy. The patient is currently taking oral contraceptives. Which statement is true regarding rifampin therapy for this patient? a. Women have a high risk for thrombophlebitis while on this drug. b. A higher dose of rifampin will be necessary because of the contraceptive. c. Oral contraceptives are less effective while the patient is taking rifampin. d. The incidence of adverse effects is greater if the two drugs are taken together.

ANS: C Women taking oral contraceptives and rifampin need to be counseled about other forms of birth control because of the impaired effectiveness of the oral contraceptives during concurrent use of rifampin.

Which statements are true regarding the selective serotonin reuptake inhibitors (SSRIs)? (Select all that apply.) a. Avoid foods and beverages that contain tyramine. b. Monitor the patient for extrapyramidal symptoms. c. Therapeutic effects may not be seen for about 4 to 6 weeks after the medication is started. d. If the patient has been on an MAOI, a 2- to 5-week or longer time span is required before beginning an SSRI medication. e. These drugs have anticholinergic effects, including constipation, urinary retention, dry mouth, and blurred vision. f. Cogentin is often also prescribed to reduce the adverse effects that may occur.

ANS: C, D During SSRI medication, therapeutic effects may not be seen for 4 to 6 weeks. To prevent the potentially fatal pharmacodynamic interactions that can occur between the SSRIs and the MAOIs, a 2- to 5-week washout period is recommended between uses of these two classes of medications. The other options apply to other classes of psychotherapeutic drugs, not SSRIs.

Which are expected effects of cardiac glycosides? (Select all that apply.) a. Decreased cardiac output b. Decreased force of contraction c. Decreased heart rate d. Modulation of neurohormonal systems e. Positive inotropic effects

ANS: C, D, E Digoxin slows the heart rate, modulates the activity of neurohormonal systems, and increases the force of contraction. It does not decrease cardiac output or reduce the force of contraction.

Which are potentially worrisome adverse effects associated with proton pump inhibitor use in older patients? (Select all that apply.) a.Gastric cancer b.Headaches c.Medication interactions d.Osteoporosis e.Vitamin and mineral deficiencies

ANS: C, D, E Older patients who take PPIs have increased risks for medication interactions, osteoporosis, and vitamin and mineral deficiencies. Headache is a common side effect early in treatment but is not serious. The FDA has concluded that there is no increased risk of gastric cancer associated with PPIs.

A patient with motion sickness is planning a cross-country car trip and has a new prescription for a scopolamine transdermal patch The nurse provides teaching for the use of this patch medication. The patient shows a correct understanding of the teaching with which statement? a."I will change the patch every day." b."I will change the patch every other day." c."I will change the patch every 3 days." d."I will remove the patch only if it stops working."

ANS: CScopolamine patches are 72-hour doses and are changed every 3 days. The other options are incorrect.

A woman who is in the first trimester of pregnancy has been experiencing severe morning sickness. She asks, "I've heard that ginger tablets may be a natural way to ease the nausea andvomiting. Is it okay to try them?" What is the nurse's best response? a."They are a safe and natural remedy for nausea when you are pregnant." b. "Go ahead and try them, but stop taking them once the nausea is relieved." c. "Some health care providers do not recommend ginger during pregnancy. Let's check with your provider." d. "You will need to wait until after the first trimester to try them."

ANS: CThere is some anecdotal evidence that ginger may have abortifacient properties, and for this reason some clinicians do not recommend its use during pregnancy.

A patient with a liver transplant has been receiving cyclosporine [Sandimmune] for 6 months. The nurse reviews this patient's laboratory results and notes a sharp increase in the blood urea nitrogen (BUN) and serum creatinine. Vital signs are normal, and the patient reports no discomfort. What does the nurse suspect? a.Hepatotoxicity b.Infection c.Organ rejection d.Nephrotoxicity

ANS: D An elevation of BUN and serum creatinine is an indication of nephrotoxicity, which occurs in 75% of patients taking cyclosporine. Hepatotoxicity would cause elevations in liver enzymes, not the BUN and creatinine. Infection would be associated with fever. Organ rejection of a renal transplant would cause elevation in the BUN and creatinine but also would cause tenderness at the graft site and fever.

A premenopausal woman has ER-positive breast cancer, and her prescriber has ordered tamoxifen [Nolvadex]. She asks the nurse if anastrozole [Arimidex] would work better for her. What will the nurse tell her? a.Anastrozole is more likely to cause hot flushes than tamoxifen. b.Anastrozole is more likely to promote endometrial carcinoma. c.Cancer recurrence is higher with anastrozole. d.Until she is postmenopausal, anastrozole will not be effective.

ANS: D Anastrozole is used to treat ER-positive breast cancer in postmenopausal women. Because it does not block estrogen production in the ovaries, it is not effective in premenopausal women. It may cause hot flushes but is less likely to do so than tamoxifen. It is devoid of all estrogenic activity and does not promote endometrial cancer

A patient who is taking didanosine [Videx] reports nausea, vomiting, and abdominal pain. What will the nurse recommend to this patient? a."Take the drug with food to minimize these side effects." b."Stop taking the drug immediately and resume taking it once your symptoms subside." c."Take the medication in the evening to avoid experiencing these kinds of symptoms." d."You will need laboratory tests to determine if these are serious effects of the drug."

ANS: D As with all NRTIs, pancreatitis may occur and may manifest as nausea, vomiting, and abdominal pain. The patient will need evaluation of serum amylase, triglycerides, and calcium. Taking the drug with food or at a different time of day are not indicated. It is not correct to discontinue the drug and to resume it when symptoms subside, since pancreatitis may be fatal.

A patient with cancer has a tumor composed mostly of G0 cells. When teaching this patient about the disease, the nurse will make which statement? a."Cells in this patient's type of tumor will proliferate rapidly." b."Chemotherapeutic agents that are not toxic to other tissues may be used." c."This type of tumor is especially sensitive to chemotherapy." d."This tumor will be managed primarily with surgery."

ANS: D Cells in the G0 phase are mitotically dormant; tumors composed mostly of G0 cells have low growth fractions. Because cytotoxic agents are more active against tumors with high growth fraction, this patient's type of tumor will be managed primarily by surgery and not chemotherapy. Cells in this type of tumor do not proliferate rapidly.

A patient will receive intrathecal liposomal cytarabine [DepoCyt] to treat acute myelogenous leukemia. The provider has ordered the concurrent administration of dexamethasone. The nurse understands that this is given to: a.prevent bone marrow suppression. b.prevent hair loss and stomatitis. c.reduce the incidence of pulmonary edema. d.reduce the severity of chemical arachnoiditis

ANS: D Chemical arachnoiditis can occur with the liposomal formulation of cytarabine; dexamethasone is given to reduce the incidence and severity of this side effect. It is not used to prevent bone marrow suppression. It is not given to minimize hair loss or stomatitis. It does not reduce the incidence of pulmonary edema

The nurse is preparing to administer medication to a patient receiving cyclophosphamide [Cytoxan]. To protect against the side effect of hemorrhagic cystitis, the nurse would expect to administer which drug? a.Decadron b.Diphenhydramine [Benadryl] c.Leucovorin d.Mesna [Mesnex]

ANS: D Cyclophosphamide can cause acute hemorrhagic cystitis; to prevent this, the nurse should expect to administer mesna, which is a protective agent. Decadron, diphenhydramine, and leucovorin are indicated for the prevention of side effects associated with different anticancer agents.

A patient has just been diagnosed with cancer and will begin chemotherapy. The patient asks the nurse about the possibility of nausea and vomiting. The nurse will tell the patient that: a.nausea and vomiting can be avoided by having a snack before chemotherapy. b.nausea and vomiting are common side effects and will abate over time. c.nausea and vomiting are common and will be treated with antiemetics when they occur. d.the provider will order drugs to help prevent nausea and vomiting before each dose.

ANS: D Nausea and vomiting are common but can be reduced by premedication with antiemetics. Having a snack before dosing is not effective. This side effect will not abate over time. Antiemetics are most effective when given before dosing, not as needed.

A patient will begin receiving vincristine [Oncovin] to treat Hodgkin's lymphoma. Which side effect(s) will the nurse tell the patient to report immediately? a.Diarrhea, nausea, and vomiting b.Hair loss c.Headaches d.Tingling of the extremities

ANS: D Peripheral neuropathy is the major dose-limiting toxicity of vincristine. Patients should be counseled to report tingling of the extremities. Diarrhea, nausea, vomiting, and hair loss may occur but are expected. Headaches are not likely.

After starting an antiviral protease inhibitor, a patient with HIV telephones the nurse, complaining, "I'm so hungry and thirsty all the time! I'm urinating 10 or 12 times a day." The nurse recognizes these findings to be consistent with: a.pancreatic infiltration by HIV. b.allergic reaction. c.nonadherence to the antiviral regimen. d.hyperglycemia.

ANS: D Protease inhibitors have been associated with hyperglycemia, new-onset diabetes, abrupt exacerbation of existing diabetes, and diabetic ketoacidosis. These symptoms are not consistent with pancreatic infiltration or an allergic reaction. No evidence indicates that the patient is noncompliant.

A female patient who has hepatitis C is being treated with pegylated interferon alfa and ribavirin [Ribasphere]. It will be important for the nurse to teach this patient that: a.if she gets pregnant, she should use the inhaled form of ribavirin [Virazole]. b.if she is taking oral contraceptives, she should also take a protease inhibitor. c.she should use a hormonal contraceptive to avoid pregnancy. d.she will need a monthly pregnancy test during her treatment.

ANS: D Ribavirin causes severe fetal injury and is contraindicated during pregnancy. Women taking ribavirin must rule out pregnancy before starting the drug, monthly during treatment, and monthly for 6 months after stopping treatment. Inhaled ribavirin is also embryo lethal and teratogenic. Adding a protease inhibitor will reduce the efficacy of oral contraceptives. Women using ribavirin should use two reliable forms of birth control.

A patient starting therapy with efavirenz [Sustiva] asks about the timing of the medication with regard to meals. What patient education about the administration of this medication should the nurse provide? a.The drug must be taken within 30 minutes after a meal. b.The drug is best taken with a high-fat meal. c.The drug can be taken anytime without regard to meals. d.The drug should be taken once daily on an empty stomach.

ANS: D The nurse should advise the patient that the medication should be taken once daily on an empty stomach. Thirty minutes after a meal is too soon to take the medication. The medication is taken on an empty stomach, because high-fat meals increase plasma levels by 39% with capsules and by 79% with tablets. The medication must not be taken with high-fat meals.

The nurse is caring for a patient who is HIV positive and is taking zidovudine [Retrovir]. Before administering the medication, the nurse should monitor which laboratory values? a.Ketones in the urine and blood b.Serum immunoglobulin levels c.Serum lactate dehydrogenase d.Complete blood count (CBC)

ANS: D The nurse should monitor the patient's CBC to determine whether the patient has anemia and neutropenia. Ketones are not an adverse effect of zidovudine. Nothing indicates a need to monitor the immunoglobulin levels or serum lactate dehydrogenase.

4. When administering heparin subcutaneously, the nurse will follow which procedure? a. Aspirating the syringe before injecting the medication b. Massaging the site after injection c. Applying heat to the injection site d. Using a - to -inch 25- to 28-gauge needle

ANS: D A - to -inch 25- to 28-gauge needle is the correct needle to use for a subcutaneous heparin injection. The other options would encourage hematoma formation at the injection site. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 429 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient has been taking antitubercular therapy for 3 months. The nurse will assess for what findings that indicate a therapeutic response to the drug therapy? a. The chronic cough is gone. b. There are two consecutive negative purified protein derivative (PPD) results over 2 months. c. There is increased tolerance to the medication therapy, and there are fewer reports of adverse effects. d. There is a decrease in symptoms of tuberculosis along with improved chest x-rays and sputum cultures.

ANS: D A therapeutic response to antitubercular therapy is manifested by a decrease in the symptoms of tuberculosis, such as cough and fever, and by weight gain. The results of laboratory studies (culture and sensitivity tests) and the chest radiographic findings will be used to confirm the clinical findings of resolution of the infection.

3. A patient who has seasonal allergies in the spring and fall asks the nurse about oral antihistamines. Which response by the nurse is correct? a. "Anticholinergic effects are more common with second-generation antihistamines." b. "First-generation antihistamines, such as diphenhydramine [Benadryl], are more effective." c. "Make sure you take antihistamines only when you have symptoms to minimize side effects." d. "You should take oral antihistamines daily during each allergy season to get maximum effects."

ANS: D Antihistamines are most effective when they are taken prophylactically, and they should be administered on a regular basis throughout the allergy season, even when symptoms are not present. They are less helpful when taken after symptoms appear. Second-generation antihistamines have fewer anticholinergic effects than first-generation antihistamines. First-generation antihistamines are not more effective than second-generation antihistamines. Oral antihistamines are not as effective when given on a PRN basis.

A patient has been taking phenobarbital for 2 weeks as part of his therapy for epilepsy. He tells the nurse that he feels tense and that "the least little thing" bothers him now. Which is the correct explanation for this problem? a. These are adverse effects that usually subside after a few weeks. b. The drug must be stopped immediately because of possible adverse effects. c. This drug causes the rapid eye movement (REM) sleep period to increase, resulting in nightmares and restlessness. d. This drug causes deprivation of REM sleep and may cause the inability to deal with normal stress.

ANS: D Barbiturates such as phenobarbital deprive people of REM sleep, which can result in agitation and the inability to deal with normal stress. A rebound phenomenon occurs when the drug is stopped (not during therapy), and the proportion of REM sleep increases, sometimes resulting in nightmares. The other options are incorrect.

A patient is taking a combination of antiviral drugs as treatment for early stages of a viral infection. While discussing the drug therapy, the patient asks the nurse if the drugs will kill the virus. When answering, the nurse keeps in mind which fact about antiviral drugs? a. They are given for palliative reasons only. b. They will be effective as long as the patient is not exposed to the virus again. c. They can be given in large enough doses to eradicate the virus without harming the body's healthy cells. d. They may also kill healthy cells while killing viruses.

ANS: D Because viruses reproduce in human cells, selective killing is difficult; consequently, many healthy human cells, in addition to virally infected cells, may be killed in the process, and this results in the serious toxicities that are involved with these drugs. The other options are incorrect.

12. A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why is the nurse concerned? a. The beta blocker can cause insulin resistance. b. Using the two agents together increases the risk of ketoacidosis. c. Propranolol increases insulin requirements because of receptor blocking. d. The beta blocker can mask the symptoms of hypoglycemia.

ANS: D Beta blockers can delay awareness of and response to hypoglycemia by masking signs associated with stimulation of the sympathetic nervous system (eg, tachycardia, palpitations) that hypoglycemia normally causes. Furthermore, beta blockade impairs glycogenolysis, which is one means by which the body can counteract a fall in blood glucose; beta blockers, therefore, can worsen insulin-induced hypoglycemia. Propranolol does not cause insulin resistance. The incidence of DKA is not increased by concurrent use of propranolol and insulin. Insulin requirements are not increased because of receptor blocking by propranolol.

2. A patient is receiving thrombolytic therapy, and the nurse monitors the patient for adverse effects. What is the most common undesirable effect of thrombolytic therapy? a. Dysrhythmias b. Nausea and vomiting c. Anaphylactic reactions d. Internal and superficial bleeding

ANS: D Bleeding, both internal and superficial, as well as intracranial, is the most common undesirable effect of thrombolytic therapy. The other options list possible adverse effects of thrombolytic drugs, but they are not the most common effects. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 424 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient who is HIV- positive has been receiving medication therapy that includes zidovudine (Retrovir). However, the prescriber has decided to stop the zidovudine because of its dose-limiting adverse effect. Which of these conditions is the dose-limiting adverse effect of zidovudine therapy? a. Retinitis b. Renal toxicity c. Hepatotoxicity d. Bone marrow suppression

ANS: D Bone marrow suppression is often the reason that a patient with HIV infection has to be switched to another anti-HIV drug such as didanosine. The two drugs can be taken together, cutting back on the dosages of both and thus decreasing the likelihood of toxicity. The other options are incorrect.

A 6-year-old boy has been started on an extended-release form of methylphenidate hydrochloride (Ritalin) for the treatment of attention deficit hyperactivity disorder (ADHD). During a follow-up visit, his mother tells the nurse that she has been giving the medication at bedtime so that it will be "in his system" when he goes to school the next morning. What is the nurse's appropriate evaluation of the mother's actions? a. She is giving him the medication dosage appropriately. b. The medication should not be taken until he is at school. c. The medication should be taken with meals for optimal absorption. d. The medication should be given 4 to 6 hours before bedtime to diminish insomnia.

ANS: D Central nervous system stimulants should be taken 4 to 6 hours before bedtime to decrease insomnia. Generally speaking, once-a-day dosing is used with extended-release or long-acting preparations. These formulations eliminate the need to take this medication at school.

The nurse is developing a plan of care for a patient who is experiencing gastrointestinal adverse effects, including anorexia and nausea, after the first course of antineoplastic therapy. What is an appropriate outcome for this patient when dealing with this problem? a. The patient will eat three balanced meals a day within 2 days. b. The patient will return to normal eating pattern within 4 weeks. c. The patient will maintain normal weight by consuming healthy snacks as tolerated. d. The patient will maintain a diet of small, frequent feedings with nutrition supplements within 2 weeks.

ANS: D Consuming small, frequent meals with nutritional supplements, and maintaining a bland diet help to improve nutrition during antineoplastic therapy.

A patient has experienced insomnia for months, and the physician has prescribed a medication to help with this problem. The nurse expects which drug to be used for long-term treatment of insomnia? a. Secobarbital (Seconal), a barbiturate b. Diazepam (Valium), a benzodiazepine c. Midazolam (Versed), a benzodiazepine d. Eszopiclone (Lunesta), a nonbenzodiazepine sleep aid

ANS: D Eszopiclone (Lunesta) is one of the newest prescription hypnotics to be approved for long-term use in treatment of insomnia. Barbiturates and benzodiazepines are not appropriate for long-term treatment of insomnia; midazolam is used for procedural (moderate) sedation.

A patient has been taking the monoamine oxidase inhibitor (MAOI) phenelzine (Nardil) for 6 months. The patient wants to go to a party and asks the nurse, "Will just one beer be a problem?" Which advice from the nurse is correct? a. "You can drink beer as long as you have a designated driver." b. "Now that you've had the last dose of that medication, there will be no further dietary restrictions." c. "If you begin to experience a throbbing headache, rapid pulse, or nausea, you'll need to stop drinking." d. "You need to avoid all foods that contain tyramine, including beer, while taking this medication."

ANS: D Foods containing tyramine, such as beer and aged cheeses, should be avoided while a patient is taking an MAOI. Drinking beer while taking an MAOI may precipitate a dangerous hypertensive crisis. The other options are incorrect.

5. A parent asks a nurse about giving diphenhydramine [Benadryl] to a child to relieve cold symptoms. Which response by the nurse is correct? a. "Benadryl must be given in higher doses to provide relief for cold symptoms." b. "Intranasal glucocorticoids are more effective for treating cold symptoms." c. "Nasal antihistamines are more effective for treating cold symptoms." d. "Because histamine doesn't cause cold symptoms, Benadryl would not be effective."

ANS: D Histamine does not contribute to symptoms of infectious rhinitis; therefore, antihistamines are of no use in treating cold symptoms. Giving antihistamines in higher doses does not provide relief for infectious rhinitis. Intranasal glucocorticoids are not useful for infectious rhinitis. Nasal antihistamines are not effective for treating infectious rhinitis.

5. Which statement is accurate about the long-term complications of diabetes? a. Long-term complications are almost always the result of hypoglycemia and ketoacidosis. b. The complication rates for patients with optimally controlled type 2 diabetes are the same as for those whose disease is not optimally controlled. c. Optimal control of type 1 diabetes produces excessive episodes of life-threatening hypoglycemia. d. Optimal control of both types of diabetes reduces the risk of eye, kidney, and nerve damage.

ANS: D In both types of diabetes, optimal control of the disease slows the development of microvascular complications. Short-term complications are more apt to result from hypoglycemia and ketoacidosis. Patients with type 2 diabetes have fewer complications if their blood sugar level is optimally controlled. Hypoglycemia does not occur more frequently in patients with optimally controlled type 1 diabetes.

2. A patient with stable COPD receives prescriptions for an inhaled glucocorticoid and an inhaled beta2-adrenergic agonist. Which statement by the patient indicates understanding of this medication regimen? a. "I should use the glucocorticoid as needed when symptoms flare." b. "I will need to use the beta2-adrenergic agonist drug daily." c. "The beta2-adrenergic agonist suppresses the synthesis of inflammatory mediators." d. "The glucocorticoid is used as prophylaxis to prevent exacerbations."

ANS: D Inhaled glucocorticoids are used daily to prevent acute attacks. They are not used PRN. The beta2-adrenergic agonist drugs should not be used daily; they are used to treat symptoms as needed. They do not suppress mediators of inflammation.

13. A patient with persistent, frequent asthma exacerbations asks a nurse about a long-acting beta2-agonist medication. What will the nurse tell this patient? a. LABAs are safer than short-acting beta2 agonists. b. LABAs can be used on an as-needed basis to treat symptoms. c. LABAs reduce the risk of asthma-related deaths. d. LABAs should be combined with an inhaled glucocorticoid.

ANS: D LABAs can increase the risk of asthma-related deaths when used improperly; this risk is minimized when LABAs are combined with an inhaled glucocorticoid. LABAs are not safer than SABAs, and they are not used PRN. LABAs increase the risk of asthma-related deaths.

12. The nurse is reviewing new medication orders for a patient who has an epidural catheter for pain relief. One of the orders is for enoxaparin (Lovenox), a low-molecular-weight heparin (LMWH). What is the nurse's priority action? a. Give the LMWH as ordered. b. Double-check the LMWH order with another nurse, and then administer as ordered. c. Stop the epidural pain medication, and then administer the LMWH. d. Contact the prescriber because the LMWH cannot be given if the patient has an epidural catheter.

ANS: D LMWHs are contraindicated in patients with an indwelling epidural catheter; they can be given 2 hours after the epidural is removed. This is very important to remember, because giving an LMWH with an epidural has been associated with epidural hematoma. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 416 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

During an admission assessment, the patient tells the nurse that he has been self-treating his heartburn for 1 year with over-the-counter Prilosec OTC (omeprazole, a proton pump inhibitor). The nurse is aware that this self-treatment may have which result? a. No serious consequences b. Prevention of more serious problems, such as an ulcer c. Chronic constipation d. Masked symptoms of serious underlying diseases

ANS: D Long-term self-medication with antacids may mask symptoms of serious underlying diseases, such as bleeding ulcer or malignancy. Patients with ongoing symptoms need to undergo regular medical evaluations, because additional medications or other interventions may be needed.

A patient who has traveler's diarrhea asks the nurse about using loperamide to stop the symptoms. What will the nurse tell the patient about this drug? a."Loperamide is used for moderate to severe symptoms only." b."This drug is useful as prophylaxis to prevent symptoms." c."This drug is only effective to treat certain infectious agents." d."Use of this drug may prolong symptoms by slowing peristalsis."

ANS: D Loperamide is a nonspecific antidiarrheal that slows peristalsis; by this action, it may delay transit of the causative organism and may prolong the infection. It is used to treat mild symptoms and is used once symptoms start. It is not an antibiotic agent and is nonspecific.

A patient with gastroesophageal reflux disease (GERD) is to begin taking oral metoclopramide [Reglan]. The patient asks the nurse about the medication. Which response by the nurse is correct? a."After 3 months, if the drug is not effective, you may need to increase the dose." b."Metoclopramide may cause hiccups, especially after meals." c."Serious side effects may occur but will stop when the drug is discontinued." d."You should take the drug 30 minutes before each meal and at bedtime."

ANS: D Metoclopramide should be given 30 minutes before meals and at bedtime. Metoclopramide should not be used long term, and increasing the dose after 3 months of therapy is not recommended. Metoclopramide is used to treat hiccups; it does not cause hiccups. Tardive dyskinesia is a serious and irreversible side effect

Cyclosporine is prescribed for a patient who had an organ transplant. The nurse will monitor the patient for which common adverse effect? a. Nausea and vomiting b. Fever and tremors c. Agitation d. Hypertension

ANS: D Moderate hypertension may occur in as much as 50% of patients taking cyclosporine. The other options are potential adverse effects of other immunosuppressant drugs.

The nurse is teaching a patient who will be taking a proton pump inhibitor as long-term therapy about potential adverse effects. Which statement is correct? a. Proton pump inhibitors can cause diarrhea. b. These drugs can cause nausea and anorexia. c. Proton pump inhibitors cause drowsiness. d. Long-term use of these drugs may contribute to osteoporosis.

ANS: D New concerns have arisen over the potential for long-term users of proton pump inhibitors (PPIs) to develop osteoporosis. This is thought to be due to the inhibition of stomach acid, and it is speculated that PPIs speed up bone mineral loss. The other options are incorrect.

14. Which medication used for asthma has off-label uses to treat allergic rhinitis? a. Diphenhydramine [Benadryl] b. Fexofenadine/pseudoephedrine [Allegra-D] c. Guaifenesin [Mucinex] d. Omalizumab [Xolair]

ANS: D Omalizumab is a monoclonal antibody directed against IgE that plays a role in the release of inflammatory mediators from mast cells and basophils. It is currently only approved for allergy-mediated asthma but is being used off-label to treat other allergic symptoms. Diphenhydramine, fexofenadine/pseudoephedrine, and guaifenesin are not used to treat asthma.

A patient is taking omeprazole (Prilosec) for the treatment of gastroesophageal reflux disease (GERD). The nurse will include which statement in the teaching plan about this medication? a. "Take this medication once a day after breakfast." b. "You will be on this medication for only 2 weeks for treatment of the reflux disease." c. "The medication may be dissolved in a liquid for better absorption." d. "The entire capsule must be taken whole, not crushed, chewed, or opened."

ANS: D Omeprazole needs to be taken before meals, and an entire capsule must be taken whole, not crushed, chewed, opened, or dissolved in liquid when treating GERD. This medication is used on a long-term basis to maintain healing.

8. A nurse is teaching a group of nursing students about the different formulations of beta2-adrenergic agonist medications. Which statement by a student indicates understanding of the teaching? a. "Beta2-adrenergic agonists provide quick relief via any formulation." b. "Long-acting beta2 agonists may be used alone to prevent attacks." c. "Short-acting beta2 agonists are usually given by nebulizer." d. "Oral beta2 agonists are not useful for short-term treatment."

ANS: D Oral beta2 agonists are used only for long-term control. All formulations vary; long-acting beta2 agonists (LABAs) and oral preparations are used for long-term control, whereas short-acting beta2 agonists (SABAs) are useful for acute episodes. LABAs are used in conjunction with inhaled glucocorticoids to prevent attacks. SABAs may be given by MDI or nebulizer and usually are given by MDI.

A patient who has gastroesophageal reflux disease (GERD) receives a prescription for a proton pump inhibitor (PPI) medication. What will the nurse include when teaching the patient about this drug? a."The FDA has determined that there is a gastric cancer risk with this drug." b."This drug will be given on a short-term basis only." c."You may experience hypermagnesemia when taking this drug." d."You should report any fever and cough to your provider."

ANS: D PPIs can increase the risk of community-acquired and hospital-acquired pneumonia in the first few days of use and patients should be taught to report symptoms to their provider. The FDA has concluded that there is no increased risk of gastric cancer associated with PPIs. PPIs are often used long-term to treat GERD, since the risk of relapse is greater than 80%. There is a risk of hypomagnesemia, not hypermagnesemia with long-term use.

A nurse is caring for a patient with cancer who has been undergoing chemotherapy. The patient has oral mucositis as a result of the chemotherapy, and the provider has ordered palifermin [Kepivance]. Which is an appropriate nursing action when giving this drug? a.Administering the drug as a slow IV infusion b.Flushing the IV line with heparin before infusing the drug c.Giving the drug within 6 hours of the chemotherapy d.Warning the patient about the potential for distortion of taste

ANS: D Palifermin is generally well tolerated but commonly causes reactions involving the skin and mouth, including taste distortion. The drug should be given as an IV bolus. Palifermin binds with heparin, so the IV line should not be flushed with heparin before giving palifermin. If the interval between administration of palifermin and the chemotherapeutic drugs is too short, palifermin actually may increase the severity and duration of oral mucositis; therefore, palifermin should be given 24 hours before the chemotherapeutic drugs

16. Which medication should be used for asthma patients as part of step 1 management? a. Combination inhaled glucocorticoids/long-acting beta2 agonists b. Inhaled low-dose glucocorticoids c. Long-acting beta2 agonists d. Short-acting beta2 agonists

ANS: D Patients needing step 1 management have intermittent, mild symptoms and can be managed with a SABA as needed. Combination inhaled glucocorticoids/LABAs are used for step 3 management. Inhaled low-dose glucocorticoids are used for step 2 management. LABAs, along with inhaled glucocorticoids, are used for step 3 management.

The nurse is discussing adverse effects of antitubercular drugs with a patient who has active tuberculosis. Which potential adverse effect of antitubercular drug therapy should the patient report to the prescriber? a. Gastrointestinal upset b. Headache and nervousness c. Reddish-orange urine and stool d. Numbness and tingling of extremities

ANS: D Patients on antitubercular therapy should report experiencing numbness and tingling of extremities, which may indicate peripheral neuropathy. Some drugs may color the urine, stool, and other body secretions reddish-orange, but this is not an effect that needs to be reported. Patients need to be informed of this expected effect. The other options are incorrect.

A patient tells the nurse that he likes to drink kava herbal tea to help him relax. Which statement by the patient indicates that additional teaching about this herbal product is needed? a. "I will not drink wine with the kava tea." b. "If I notice my skin turning yellow, I will stop taking the tea." c. "I will not take sleeping pills if I have this tea in the evening." d. "I will be able to drive my car after drinking this tea."

ANS: D Patients should not drive after drinking this tea because it may cause sedation. Kava tea may cause skin discoloration (with long-term use). In addition, it must not be taken with alcohol, barbiturates, and psychoactive drugs.

7. A patient with heart failure who has been taking an ACE inhibitor, a thiazide diuretic, and a beta blocker for several months comes to the clinic for evaluation. As part of the ongoing assessment of this patient, the nurse will expect the provider to evaluate: a. complete blood count. b. ejection fraction. c. maximal exercise capacity. d. serum electrolyte levels.

ANS: D Patients taking thiazide diuretics can develop hypokalemia, which can increase the risk for dysrhythmias; therefore, the serum electrolyte levels should be monitored closely. A complete blood count is not recommended. This patient is taking the drugs recommended for patients with Stage C heart failure; although the patient's quality of life and ability to participate in activities should be monitored, routine measurement of the ejection fraction and maximal exercise capacity is not recommended.

8. A nurse provides dietary counseling for a patient newly diagnosed with type 1 diabetes. Which instruction should be included? a. "You may eat any foods you want and cover the glucose increase with sliding scale, regular insulin." b. "Most of the calories you eat should be in the form of protein to promote fat breakdown and preserve muscle mass." c. "Your total caloric intake should not exceed 1800 calories in a 24-hour period." d. "You should use a carbohydrate counting approach to maintain glycemic control."

ANS: D Patients with diabetes should be given intensive insulin therapy education using either a carbohydrate counting or experience-based estimation approach in achieving glycemic control. A patient with diabetes cannot eat any foods desired and then cover the glucose increase with a sliding scale of regular insulin. Evidence suggests that there is not an ideal percentage of calories that should be ingested from carbohydrate, fat, or protein. Every patient with diabetes must be assessed individually to determine the number of total calories the person should have daily. The total caloric intake should be spread evenly throughout the day, with meals spaced 4 to 5 hours apart.

A patient with the diagnosis of schizophrenia is hospitalized and is taking a phenothiazine drug. Which statement by this patient indicates that he is experiencing a common adverse effect of phenothiazines? a. "I can't sleep at night." b. "I feel hungry all the time." c. "Look at how red my hands are." d. "My mouth has been so dry lately."

ANS: D Phenothiazines produce anticholinergic-like adverse effects of dry mouth, urinary hesitancy, and constipation.

The parent of a child with cerebral palsy reports that the child has pebblelike stools most of the time and seems uncomfortable if several days have passed between stools. The nurse will suggest that the parent discuss which medication with the child's provider? a.Bisacodyl [Dulcolax] suppositories b.Magnesium citrate c.Methylcellulose [Citrucel] d.Polyethylene glycol [MiraLax]

ANS: D Polyethylene glycol is an osmotic laxative widely used for chronic constipation, which this child has, because it provides relief from abdominal discomfort, improves stool consistency, and increases frequency. Bisacodyl is not recommended for long-term use. Magnesium citrate causes increased water loss, and methylcellulose can also cause impaction

A patient has been taking psyllium [Metamucil] two to three times daily for several days. The patient complains of stomach pain but has not had a stool. What will the nurse do? a.Ask the patient to drink a full glass of water. b.Give another dose of the psyllium. c.Request an order for a bisacodyl [Dulcolax] suppository. d.Palpate the patient's abdomen and auscultate for bowel sounds.

ANS: D Psyllium is a bulk-forming laxative and can cause a fecal impaction or obstruction. Abdominal pain can be a sign of impaction or obstruction, so the nurse should assess the patient for this complication. Giving fluids by mouth, administering more laxative, or giving a suppository are all contraindicated if an obstruction has developed and should not be done until this condition is ruled out

2. A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding scale and are ordered before a meal and at bedtime. The patient's blood sugar level is 317 mg/dL. Which formulation of insulin should the nurse prepare to administer? a. No insulin should be administered. b. NPH c. 70/30 mix d. Lispro [Humalog]

ANS: D Regular insulin is indicated for sliding scale coverage. Insulin is definitely indicated for this high blood sugar level. NPH is used for scheduled insulin doses and is a longer-acting insulin. A 70/30 mix is also used for scheduled insulin coverage.

A patient who started taking orlistat (Xenical) 1 month ago calls the clinic to report some "embarrassing" adverse effects. She tells the nurse that she has had episodes of "not being able to control my bowel movements." Which statement is true about this situation? a. These are expected adverse effects that will eventually diminish. b. The patient will need to stop this drug immediately if these adverse effects are occurring. c. The patient will need to increase her fat intake to prevent these adverse effects. d. The patient will need to restrict fat intake to less than 30% to help reduce these adverse effects.

ANS: D Restricting dietary intake of fat to less than 30% of total calories can help reduce some of the GI adverse effects, which include oily spotting, flatulence, and fecal incontinence. The other options are incorrect.

The nurse will assess the patient for which potential contraindication to antitubercular therapy? a. Glaucoma b. Anemia c. Heart failure d. Hepatic impairment

ANS: D Results of liver function studies (e.g., bilirubin level, liver enzyme levels) need to be assessed because isoniazid and rifampin may cause hepatic impairment; severe liver dysfunction is a contraindication to these drugs. In addition, the patient's history of alcohol use needs to be assessed.

A patient newly diagnosed with tuberculosis (TB) has been taking antitubercular drugs for 1 week calls the clinic and is very upset. He says, "My urine is dark orange! What's wrong with me?" Which response by the nurse is correct? a. "You will need to stop the medication, and it will go away." b. "It's possible that the TB is worse. Please come in to the clinic to be checked." c. "This is not what we usually see with these drugs. Please come in to the clinic to be checked." d. "This is an expected side effect of the medicine. Let's review what to expect."

ANS: D Rifampin, one of the first-line drugs for TB, causes a red-orange-brown discoloration of urine, tears, sweat, and sputum. Patients need to be warned about this side effect. The other options are incorrect.

5. A patient with hypertension is taking furosemide [Lasix] for congestive heart failure. The prescriber orders digoxin to help increase cardiac output. What other medication will the nurse expect to be ordered for this patient? a. Bumetanide [Bumex] b. Chlorothiazide [Diuril] c. Hydrochlorothiazide [HydroDIURIL] d. Spironolactone [Aldactone]

ANS: D Spironolactone is used in conjunction with furosemide because of its potassium-sparing effects. Furosemide can contribute to hypokalemia, which can increase the risk of fatal dysrhythmias, especially with digoxin administration. The other diuretics listed are all potassium-wasting diuretics.

4. A nurse preparing to administer morning medications notes that a patient with a history of hypertension has been prescribed spironolactone [Aldactone]. The nurse assesses the patient and notes dyspnea, bilateral crackles, and pitting edema in both feet. Which intervention is appropriate? a. Administer the medications as ordered. b. Ask the patient about the use of salt substitutes. c. Contact the provider to request an order for serum electrolytes. d. Request an order for furosemide [Lasix].

ANS: D Spironolactone takes up to 48 hours for its effects to develop, so it should not be used when the patient needs immediate diuresis. This patient has shortness of breath, crackles, and edema and needs a short-acting diuretic, such as furosemide. Asking the patient about the use of salt substitutes is not indicated. The patient does not need assessment of serum electrolytes.

A nursing student is caring for a patient who is taking sucralfate [Carafate] and ciprofloxacin [Cipro] to treat peptic ulcer disease. The student asks the nurse about the pharmacokinetics of sucralfate. Which statement by the student indicates a need for further teaching? a."Sucralfate adheres to the ulcer and blocks the back-diffusion of hydrogen ions." b."Sucralfate and ciprofloxacin should be administered 1 hour apart." c."Sucralfate does not cause systemic side effects." d."Sucralfate has a moderate acid-neutralizing capacity."

ANS: D Sucralfate does not have any acid-neutralizing capacity, so this statement is incorrect. The other statements about sucralfate are correct

A patient has been taking senna [Senokot] for several days, and the nurse notes that the urine is yellowish-brown. What does the nurse know about this symptom? a.It indicates that renal failure has occurred. b.It is caused by dehydration, which is a laxative side effect. c.It is a sign of toxicity, indicating immediate withdrawal of the drug. d.It is an expected, harmless effect of senna.

ANS: D Systemic absorption of senna, followed by renal excretion, may impart a harmless yellowish-brown or pink color to the urine. This symptom is not an indication of renal failure, dehydration, or toxicity.

9. What is the most reliable measure for assessing diabetes control over the preceding 3-month period? a. Self-monitoring blood glucose (SMBG) graph report b. Patient's report c. Fasting blood glucose level d. Glycosylated hemoglobin level

ANS: D The glycosylated hemoglobin level tells much about what the plasma glucose concentration has been, on average, over the previous 2 to 3 months. The SMBG graph report is done by the patient and indicates each blood sugar level the patient has on a daily basis. It is not as reliable as the glycosylated hemoglobin level, because the equipment used might not be accurate and the testing may not reflect actual measurements 100% of the time. The patient's report of blood sugar levels is not considered as accurate as the glycosylated hemoglobin level for the same reason that the SMBG is not. One fasting blood glucose level indicates the patient's blood sugar level for that one time when it was obtained.

A patient has been taking the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft) for about 6 months. At a recent visit, she tells the nurse that she has been interested in herbal therapies and wants to start taking St. John's wort. Which response by the nurse is appropriate? a. "That should be no problem." b. "Good idea! Hopefully you'll be able to stop taking the Zoloft." c. "Be sure to stop taking the herb if you notice a change in side effects." d. "Taking St. John's wort with Zoloft may cause severe interactions and is not recommended."

ANS: D The herbal product St. John's wort must not be used with SSRIs. Potential interactions include confusion, agitation, muscle spasms, twitching, and tremors. The other responses by the nurse are inappropriate.

The nurse is preparing to administer an injection of monoclonal antibodies. Which additional drug will the nurse administer to minimize adverse reactions to the monoclonal antibodies? a. A nonsteroidal anti-inflammatory drug b. A benzodiazepine c. An opioid pain reliever d. A corticosteroid

ANS: D The monoclonal antibodies basiliximab and daclizimab have a tendency to cause the allergy-like reaction known as cytokine release syndrome, which can be severe and even involve anaphylaxis. In an effort to avoid or alleviate this problem, it is recommended that an injection of a corticosteroid, such as methylprednisolone, be administered before the injection of monoclonal antibodies.

12. A child is receiving a combination albuterol/ipratropium [DuoNeb] inhalation treatment. The patient complains of a dry mouth and sore throat. What will the nurse do? a. Contact the provider to report systemic anticholinergic side effects. b. Discontinue the aerosol treatment immediately. c. Notify the provider of a possible allergic reaction. d. Reassure the patient that these are expected side effects.

ANS: D The most common adverse effects of this combination drug are dry mouth and irritation of the pharynx. The patient should be reassured that these are common and minor effects. Systemic anticholinergic side effects are rare. It is not necessary to discontinue the medication. Patients with peanut allergy may have severe anaphylactic reactions, but the patient's symptoms are not those associated with anaphylaxis.

Just before the second course of chemotherapy, the laboratory calls to report that the patient's neutrophil count is 450 cells/mm3. The nurse expects that the oncologist will follow which course of treatment? a. Chemotherapy will continue as scheduled. b. Chemotherapy will resume with a lowered dosage. c. Chemotherapy will resume after a transfusion of neutrophils. d. Chemotherapy will be withheld until the neutrophil count returns toward normal levels.

ANS: D The normal range for neutrophils is above 1500 cells/mm3. If neutrophils are decreased to levels of less than 500 cells/mm3 (neutropenia), there is risk for severe infection. Chemotherapy will be held until the count returns toward normal levels.

A patient has an order for cyclosporine (Sandimmune). The nurse finds that cyclosporine-modified (Neoral) is available in the automated medication cabinet. Which action by the nurse is correct? a. Hold the dose until the prescriber makes rounds. b. Give the cyclosporine-modified drug. c. Double-check the order, and then give the cyclosporine-modified drug. d. Notify the pharmacy to obtain the Sandimmune form of the drug.

ANS: D The nurse must double-check the formulation before giving cyclosporine. Cyclosporine-modified products (such as Neoral or Gengraf) are interchangeable with each other but are not interchangeable with Sandimmune. In this case, the nurse must obtain the Sandimmune form of the drug from the pharmacy. The other options are incorrect.

The nurse is reviewing new postoperative orders and notes that the order reads, "Give hydroxyzine (Vistaril) 50 mg IV prn nausea or vomiting." The patient is complaining of slight nausea. Which action by the nurse is correct at this time? a.Hold the dose until the patient complains of severe nausea. b.Give the dose orally instead of intravenously c.Give the patient the IV dose of hydroxyzine as ordered. d.Call the prescriber to question the route that is ordered

ANS: D The nurse needs to question the route. Hydroxyzine (Vistaril) is an antihistamine-class antiemetic that is only to be given either by oral or intramuscular routes. It may be easy to make the mistake of giving hydroxyzine intravenously because many other antiemetics are given by that route. It is important to note that intravenous, intraarterial, or subcutaneous administration of hydroxyzine may result in significant tissue damage, thrombosis, and gangrene. The nurse cannot change the route of an ordered medication without a prescriber's order. Antiemetic drugs are best given before the patient's nausea become severe.

11. A nurse prepares to administer a scheduled dose of digoxin. The nurse finds a new laboratory report showing a plasma digoxin level of 0.7 ng/mL. What action should the nurse take? a. Withhold the drug for an hour and reassess the level. b. Withhold the drug and notify the prescriber immediately. c. Administer Digibind to counteract the toxicity. d. Check the patient's apical pulse, and if it is within a safe range, administer the digoxin.

ANS: D The optimum plasma digoxin range is 0.5 to 0.8 ng/mL. The patient's pulse should be checked before administration, as always, and the digoxin should be administered. The digoxin does not have to be withheld, nor does the prescriber need to be notified. If the digoxin level is demonstrating a trend of increasing, the issue should be discussed in rounds. Digibind is not indicated, because the digoxin level is therapeutic.

A patient is receiving her third course of 5-fluorouracil therapy and knows that stomatitis is a potential adverse effect of antineoplastic therapy. What will the nurse teach her about managing this problem? a. "You can take aspirin to prevent stomatitis." b. "Be sure to watch for and report black, tarry stools immediately." c. "You need to increase your intake of foods containing fiber and citric acid." d. "Be sure to examine your mouth daily for bleeding, painful areas, and ulcerations."

ANS: D The symptoms of stomatitis consist of pain or burning in the mouth, difficulty swallowing, taste changes, viscous saliva, dryness, cracking, and fissures, with or without bleeding mucosa. Teach patients to avoid consuming foods containing citric acid and foods that are hot or spicy or high in fiber. Assessing stools is important but is not related to stomatitis, and aspirin must not be used during this therapy.

1. A patient has been prescribed warfarin (Coumadin) in addition to a heparin infusion. The patient asks the nurse why he has to be on two medications. The nurse's response is based on which rationale? a. The oral and injection forms work synergistically. b. The combination of heparin and an oral anticoagulant results in fewer adverse effects than heparin used alone. c. Oral anticoagulants are used to reach an adequate level of anticoagulation when heparin alone is unable to do so. d. Heparin is used to start anticoagulation so as to allow time for the blood levels of warfarin to reach adequate levels.

ANS: D This overlap therapy is required in patients who have been receiving heparin for anticoagulation and are to be switched to warfarin so that prevention of clotting is continuous. This overlapping is done purposefully to allow time for the blood levels of warfarin to rise, so that when the heparin is eventually discontinued, therapeutic anticoagulation levels of warfarin will have been achieved. Recommendations are to continue overlap therapy of the heparin and warfarin for at least 5 days; the heparin is stopped after day 5 when the international normalized ratio (INR) is above 2. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 417 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

19. A patient with COPD is prescribed tiotropium [Spiriva]. After the initial dose, the patient reports only mild relief within 30 minutes. What will the nurse tell the patient? a. "You may have another dose in 4 hours." b. "You may need to take two inhalations instead of one." c. "You should have peak effects in about 6 hours." d. "You should see improved effects within the next week."

ANS: D Tiotropium shows therapeutic effects in about 30 minutes, with improved bronchodilation occurring with subsequent doses, up to 8 days. The medication is given once daily, with inhalation of one capsule. Peak effects occur in 3 hours.

9. A patient with asthma comes to a clinic for treatment of an asthma exacerbation. The patient's medication history lists an inhaled glucocorticoid, montelukast [Singulair], and a SABA as needed via MDI. The nurse assesses the patient and notes a respiratory rate of 18 breaths per minute, a heart rate of 96 beats per minute, and an oxygen saturation of 95%. The nurse auscultates mild expiratory wheezes and equal breath sounds bilaterally. What will the nurse do? a. Contact the provider to request a systemic glucocorticoid. b. Contact the provider to suggest using a long-acting beta2 agonist. c. Evaluate the need for teaching about MDI use. d. Question the patient about how much albuterol has been used.

ANS: D To determine the next course of action, it is important to assess the drugs given before these symptoms were observed. Patients who continue to wheeze after using a SABA need systemic glucocorticoids and nebulized albuterol. If a SABA has not been used, that will be the first intervention. LABAs are not used for exacerbations. If a patient reports using a SABA without good results, evaluating the MDI technique may be warranted.

A patient is preparing to travel to perform missionary work in a region with poor drinking water. The provider gives the patient a prescription for ciprofloxacin [Cipro] to take on the trip. What will the nurse instruct this patient to do? a.Combine the antibiotic with an antidiarrheal medication, such as loperamide. b.Start taking the ciprofloxacin 1 week before traveling. c.Take 1 tablet of ciprofloxacin with each meal for best results. d.Use the drug if symptoms are severe or do not improve in a few days.

ANS: D Traveler's diarrhea is generally caused by Escherichia coli; treatment is usually unnecessary, because the disease runs its course in a few days. If symptoms are severe or prolonged, an antibiotic, such as ciprofloxacin, may be helpful. Patients should be instructed to take it only if needed. Antidiarrheal medications may just slow the export of the organism and prolong the course of the disease, but they may be used when symptoms are mild for relief from discomfort. Prophylactic treatment with antibiotics is not recommended. Ciprofloxacin is given twice daily, not with meals.

A patient stops taking a proton pump inhibitor (PPI) after 6 weeks of therapy for treatment of peptic ulcer disease. The patient reports symptoms of dyspepsia to the nurse. The nurse will tell this patient to: a.come to the clinic to be tested for Clostridium difficile. b.resume taking the PPI, because long-term therapy is necessary. c.resume taking the PPI until symptoms resolve completely. d.try an antacid to see whether it relieves these symptoms.

ANS: D When patients stop taking a PPI, a rebound hypersecretion of gastric acid can cause dyspepsia. This can be managed with an antacid. Although C. difficile infection is associated with dose-related increases in PPIs, the symptoms include diarrhea, not dyspepsia, so testing is not indicated for this patient. Resuming the PPI is not indicated, because these symptoms can be managed with antacids.

1. A patient with asthma will be using a metered-dose inhaler (MDI) for delivery of an inhaled medication. The provider has ordered 2 puffs to be given twice daily. It is important for the nurse to teach this patient that: a. the patient should inhale suddenly to receive the maximum dose. b. the patient should activate the device and then inhale. c. the patient should store the MDI in the refrigerator between doses. d. the patient should wait 1 minute between puffs.

ANS: D When two puffs are needed, an interval of at least 1 minute should separate the first puff from the second. Sudden inhalation can cause bronchospasm. The patient should begin inhaling and then activate the device. There is no need to store the drug in the refrigerator.

13. A patient is admitted to the hospital with unstable angina and will undergo a percutaneous coronary intervention. Which drug regimen will the nurse expect to administer to prevent thrombosis in this patient? a. Aspirin, clopidogrel, omeprazole b. Aspirin, heparin, abciximab [ReoPro] c. Enoxaparin [Lovenox], prasugrel [Effient], warfarin [Coumadin] d. Heparin, alteplase, abciximab [ReoPro]

B Abciximab, combined with ASA and heparin, is approved for IV therapy for patients undergoing PCI.

13. A patient with angina who is taking ranolazine [Ranexa] has developed a respiratory infection and a dysrhythmia. The provider has ordered azithromycin [Zithromax] for the infection and amlodipine for the dysrhythmia. A nursing student caring for this patient tells the nurse that the patient's heart rate is 70 beats per minute, and the blood pressure is 128/80 mm Hg. The nurse asks the student to discuss the plan for this patient's care. Which action is correct? a. Observe the patient closely for signs of respiratory toxicity. b. Question the order for azithromycin [Zithromax]. c. Report the patient's increase in blood pressure to the provider. d. Request an order for a different calcium channel blocker.

B Agents that inhibit CYP3A4 can increase levels of ranolazine and also the risk of torsades de pointes. Macrolide antibiotics, such as azithromycin, are CYP3A4 inhibitors. Respiratory toxicity is not an expected effect with this patient. The patient's blood pressure is not elevated enough to notify the provider. Amlodipine is the only CCB that should be used with ranolazine.

14. A nurse provides teaching to a patient with angina who also has type 2 diabetes mellitus, asthma, and hypertension. Which statement by the patient indicates a need for further teaching? a. "An ACE inhibitor, in addition to nitroglycerin, will lower my risk of cardiovascular death." b. "Beta blockers can help me control hypertension." c. "I should begin regular aerobic exercise." d. "Long-acting, slow-release calcium channel blockers can help with anginal pain."

B Beta blockers can be used for angina in most patients but are contraindicated in patients with asthma, because they cause bronchoconstriction. ACE inhibitors help reduce the risk of death in patients with hypertension. Regular aerobic exercise is recommended to control weight and improve cardiovascular function. Long-acting, slow-release CCBs are recommended for patients who have coexisting type 2 diabetes.

7. A patient who has taken warfarin [Coumadin] for a year begins taking carbamazepine. The nurse will anticipate an order to: a. decrease the dose of carbamazepine. b. increase the dose of warfarin. c. perform more frequent aPTT monitoring. d. provide extra dietary vitamin K.

B Carbamazepine is a powerful inducer of hepatic drug-metabolizing enzymes and can accelerate warfarin degradation. The warfarin dose should be increased if the patient begins taking carbamazepine. Decreasing the dose of carbamazepine is not indicated. It is not necessary to perform more frequent aPTT monitoring or to add extra vitamin K.

11. A patient has seasonal allergies and needs an antihistamine to control symptoms. The patient likes to have wine with dinner occasionally and wants to know which antihistamine will be the safest to take. The nurse will tell the patient to discuss which medication with the provider? a. Cetirizine [Zyrtec] b. Fexofenadine [Allegra] c. Levocetirizine [Xyzal] d. Loratadine [Claritin]

B Fexofenadine is the least sedating of the second-generation antihistamines and so is the least likely to have synergistic effects with alcohol. Cetirizine, levocetirizine, and loratadine all have sedative side effects to some extent and thus would be less safe.

6. A patient will begin taking fexofenadine [Allegra] for hay fever. The nurse teaching this patient will tell the patient that: a. fexofenadine should be taken with food to prevent gastrointestinal (GI) symptoms. b. the medication may be taken once or twice daily. c. tolerance to sedation will occur in a few weeks. d. with renal impairment, this drug should be taken every other day.

B Fexofenadine may be given 60 mg twice daily or 180 mg once daily. Fexofenadine does not need to be given with food. Sedation is not a common side effect of fexofenadine. There is no caution to reduce the dosage or increase the dosing interval in patients with renal impairment who take fexofenadine.

5. A patient tells a nurse that antihistamines help relieve cold symptoms and wants to know why they are not recommended or prescribed for this purpose. The nurse tells the patient that antihistamines provide only mild relief from some cold symptoms by: a. anticholinergic properties that decrease rhinorrhea. b. blocking H1 receptors in nasal passages. c. reducing secretions at H2 receptor sites. d. having sedative effects, which help patients rest and sleep.

B Histamine does not mediate cold symptoms, so antihistamines do not provide relief through H1 blockade. Their anticholinergic effects at muscarinic receptor sites can moderately reduce rhinorrhea, so some patients may experience some relief of this symptom. H1-receptor sites do not play a role in cold symptoms. H2-receptor sites do not play a role in cold symptoms. Sedative side effects do not alleviate cold symptoms.

9. A patient will begin taking dabigatran etexilate [Pradaxa] to prevent stroke. The nurse will include which statement when teaching this patient? a. Dabigatran should be taken on an empty stomach to improve absorption. b. It is important not to crush, chew, or open capsules of dabigatran. c. The risk of bleeding with dabigatran is less than that with warfarin [Coumadin]. d. To remember to take dabigatran twice daily, a pill organizer can be useful.

B Patients should be taught to swallow capsules of dabigatran intact; absorption may be increased as much as 75%, increasing the risk of bleeding, if the capsules are crushed, chewed, or opened. Dabigatran may be taken with or without food. The risk of bleeding is not less than that of warfarin. Dabigatran is unstable when exposed to moisture, so using a pill organizer is not recommended.

10. A postoperative patient will begin anticoagulant therapy with rivaroxaban [Xarelto] after knee replacement surgery. The nurse performs a history and learns that the patient is taking erythromycin. The patient's creatinine clearance is 50 mL/min. The nurse will: a. administer the first dose of rivaroxaban as ordered. b. notify the provider to discuss changing the patient's antibiotic. c. request an order for a different anticoagulant medication. d. request an order to increase the dose of rivaroxaban.

B Patients with impaired renal function who are taking macrolide antibiotics will experience increased levels of rivaroxaban, increasing the risk of bleeding. It is correct to discuss using a different antibiotic if possible. The nurse should not administer the dose without discussing the situation with the provider. The patient's renal impairment is minor; if it were more severe, using a different anticoagulant might be appropriate. It is not correct to increase the dose of rivaroxaban.

2. A family is preparing for travel and the parents report that their 5-year-old child has frequent motion sickness. The nurse will tell the parents to ask the provider about which antihistamine to help prevent symptoms? a. Desloratadine [Clarinex] b. Dimenhydrinate [Dramamine] c. Hydroxyzine [Vistaril] d. Promethazine [Phenergan]

B Some antihistamines, including dimenhydrinate and promethazine, are labeled for use in motion sickness. Promethazine, however, is contraindicated in children under age 2 years and should be used with caution in children older than 2 years because of the risks for severe respiratory depression. Desloratadine and hydroxyzine are not used for motion sickness.

3. A patient with new-onset exertional angina has taken three nitroglycerin sublingual tablets at 5-minute intervals, but the pain has intensified. The nurse notes that the patient has a heart rate of 76 beats per minute and a blood pressure of 120/82 mm Hg. The electrocardiogram is normal. The patient's lips and nail beds are pink, and there is no respiratory distress. The nurse will anticipate providing: a. an angiotensin-converting enzyme (ACE) inhibitor. b. intravenous nitroglycerin and a beta blocker. c. ranolazine (Ranexa) and quinidine. d. supplemental oxygen and intravenous morphine.

B This patient has unstable angina, and the next step, when pain is unrelieved by sublingual nitroglycerin, is to give intravenous nitroglycerin and a beta blocker. ACE inhibitors should be given to patients with persistent hypertension if they have left ventricular dysfunction or congestive heart failure (CHF). Ranolazine is a first-line angina drug, but it should not be given with quinidine because of the risk of increasing the QT interval. Supplemental oxygen is indicated if cyanosis or respiratory distress is present. IV morphine may be given if the pain is unrelieved by nitroglycerin.

15. A nurse caring for a patient receiving heparin therapy notes that the patient has a heart rate of 98 beats per minute and a blood pressure of 110/72 mm Hg. The patient's fingertips are purplish in color. A stat CBC shows a platelet count of less than 100,000 mm3. The nurse will: a. administer oxygen and notify the provider. b. discontinue the heparin and notify the provider. c. request an order for protamine sulfate. d. request an order for vitamin K (phytonadione).

B This patient is showing signs of heparin-induced thrombocytopenia, so the heparin should be discontinued immediately and the provider should be notified. The purplish color of the fingertips is caused by thrombosis, not hypoxia, so oxygen is not indicated. This patient may need continued anticoagulation therapy, so a request for protamine sulfate is not correct. Heparin is not a vitamin K inhibitor.

11. A patient with variant angina wants to know why a beta blocker cannot be used to treat the angina. Which response by the nurse is correct? a. "A beta1-selective beta blocker could be used for variant angina." b. "Beta blockers do not help relax coronary artery spasm." c. "Beta blockers do not help to improve the cardiac oxygen supply." d. "Beta blockers promote constriction of arterial smooth muscle."

B Variant angina occurs when coronary arteries go into spasm, thus reducing the circulation and oxygen supply to the heart. CCBs help to reduce coronary artery spasm; beta blockers do not. Beta1-selective beta blockers are used for stable angina for patients who also have asthma, because they do not activate beta2 receptors in the lungs to cause bronchoconstriction. Beta blockers help improve the oxygen supply in stable angina, but they do not relieve coronary artery spasm, so they are not useful in variant angina. Beta blockers do not constrict arterial smooth muscle.

16. A patient is admitted to the emergency department with chest pain. An electrocardiogram shows changes consistent with an evolving myocardial infarction. The patient's cardiac enzymes are pending. The nurse caring for this patient will expect to: a. administer aspirin when cardiac enzymes are completed. b. give alteplase [Activase] within 2 hours. c. give tenecteplase [TNKase] immediately. d. obtain an order for an INR.

B When alteplase is given within 2 hours after symptom onset, the death rate for MI has been shown to be 5.4%, compared with 9.4% if given 4 to 6 hours after symptom onset. ASA may be given at the first sign of MI; it is not necessary to wait for cardiac enzyme results. Tenecteplase may be given more than 2 hours after onset of symptoms. Obtaining an order for an INR is not indicated.

The nurse is providing instructions to a patient who has a new prescription for a corticosteroid metered-dose inhaler. Which statement by the patient indicates that further instruction is needed? (Select all that apply.) A. "I will rinse my mouth with water after using the inhaler and then spit out the water." B. "I will gargle after using the inhaler and then swallow." C. "I will clean the plastic inhaler casing weekly by removing the canister and then washing the casing in warm soapy water. I will then let it dry before reassembling." D. "I will use this inhaler for asthma attacks." E. "I will continue to use this inhaler, even if I am feeling better." F. "I will use a peak flow meter to measure my response to therapy."

B. " I will gargle after using the inhaler and then swallow." D. " I will use this inhaler for asthma attacks" Rationale: The inhaled corticosteroid is a maintenance drug used to prevent asthma attacks; it is not indicated for acute asthma attacks. Rinsing the mouth with water is appropriate and necessary to prevent oral fungal infections; the water is not to be swallowed after rinsing. The patient needs to be given instructions about keeping the inhaler clean, including removing the canister from the plastic casing weekly and washing the casing in warm soapy water. Once the casing is dry, the canister and mouthpiece may be put back together and the cap applied. The glucocorticoid may predispose the patient to oral fungal overgrowth, thus the need for implicit instructions about cleaning inhaling devices. Use of a peak flow meter assists in monitoring the patient's response to therapy. The medication needs to be taken as ordered every day, regardless of whether the patient is feeling better.

A patient has been advised to add a nasal spray (an adrenergic decongestant) to treat a cold. The nurse will include which instruction? A. "You won't see effects for at least 1 week." B. "Limit use of this spray to 3 to 5 days." C. "Continue the spray until nasal stuffiness has resolved." D. "Avoid use of this spray if a fever develops."

B. " Limit use of this spray to 3 to 5 days" Rationale: Frequent, long-term, or excessive use of adrenergic nasal decongestants may lead to rebound congestion if used beyond the recommended time. The other instructions are incorrect.

A patient has prescriptions for two inhalers. One inhaler is a bronchodilator, and the other is a corticosteroid. Which instruction regarding these inhalers will the nurse give to the patient? A. "Take the corticosteroid inhaler first." B. "Take the bronchodilator inhaler first." C. "Take these two drugs at least 2 hours apart." D. "It does not matter which inhaler you use first."

B. " Take the bronchodilator inhaler first" Rationale: An inhaled bronchodilator is used before the inhaled corticosteroid to provide bronchodilation before administration of the anti-inflammatory drug.

Which client statement demonstrates understanding of teaching by the nurse regarding the use of histamine2-receptor antagonists? A. "Because I am taking this medication, it is OK for me to eat spicy foods." B. "Smoking decreases the effects of this medication, so I should look into cessation programs." C. "I should take this medication 1 hour after each meal to maximally decrease gastric acidity." D. "I should increase bulk and fluids in my diet to prevent constipation."

B. "Smoking decreases the effects of this medication, so I should look into cessation programs." Clients taking histamine2-receptor-blocking drugs should avoid spicy foods, extremes in temperatures, alcohol, and smoking. Diarrhea, not constipation, is a GI adverse effect. Whereas cimetidine should be taken with meals, famotidine can be taken without regard to meals.

A patient is in an urgent care center with an acute asthma attack. The nurse expects that which medication will be used for initial treatment? A. An anticholinergic such as ipratropium (Atrovent) B. A short-acting beta2 agonist such as albuterol (Proventil) C. A long-acting beta2 agonist such as salmeterol (Serevent) D. A corticosteroid such as fluticasone (Flovent)

B. A short-acting beta2 agonist such as albuterol (Proventil) Rationale: The short-acting beta2 agonists are commonly used during the acute phase of an asthmatic attack to reduce airway constriction quickly and to restore airflow to normal levels. The other drugs listed are not appropriate for acute asthma attacks. Anticholinergic drugs and long-acting beta2 agonists are used to prevent attacks; corticosteroids are used to reduce airway inflammation.

The nurse is reviewing medications for the treatment of asthma. Which drugs are used for acute asthma attacks? (Select all that apply.) A. Salmeterol (Serevent) inhaler B. Albuterol (Proventil) nebulizer solution C. Epinephrine D. Montelukast (Singulair) E. Fluticasone (Flovent) Rotadisk inhaler

B. Albuterol (Proventil) nebulizer solution C. Epinephrine Rationale: Albuterol (a short-acting beta2 agonist) and epinephrine (a beta1 and beta2 agonist) are used for acute bronchospasms. Salmeterol is a long-acting beta2 agonist that is indicated for maintenance treatment, not acute episodes. Fluticasone is an inhaled corticosteroid; montelukast is a leukotriene receptor antagonist (LTRA). These types of medications are used for asthma prophylaxis.

A patient who has been taking antihypertensive drugs for a few months complains of having a persistent dry cough. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs? A. Beta blockers B. Angiotensin-converting enzyme (ACE) inhibitors C. Angiotensin II receptor blockers (ARBs) D. Calcium channel blockers

B. Angiotensin-converting enzyme (ACE) inhibitors Rationale:ACE inhibitors cause a characteristic dry, nonproductive cough that reverses when therapy is stopped. The other drug classes do not cause this cough.

The nurse is reviewing the mechanism of action of antidiarrheal drugs. Which type of antidiarrheal medication works by decreasing the intestinal muscle tone and peristalsis of the intestines? A. Asorbents such as Pepto-Bismol B. Anticholinergics such as belladonna alkaloids C. Probiotics such as Lactinex D. Lubricants such as mineral oil

B. Anticholinergics such as belladonna alkaloids Rationale: Anticholinergic drugs work to slow peristalsis by reducing the rhythmic contractions and the smooth muscle tone of the GI tract.

A patient asks the nurse about the uses of echinacea. Which use will the nurse include in the response? A. Memory enhancement B. Boosting the immune system C. Improving mood D. Promoting relaxation

B. Boosting the immune system Rationale: Common uses of echinacea include stimulation of the immune system, antisepsis, treatment of viral infections and influenza-like respiratory tract infections, and promotion of the healing of wounds and chronic ulcerations. The other options are incorrect.

A patient wants to prevent problems with constipation and asks the nurse for advice about which type of laxative is safe to use for this purpose. Which class of laxative is considered safe to use on a long-term basis? A. Emollient Laxatives B. Bulk-Forming Laxatives C. Hyperosmotic Laxatives D. Stimulant Laxatives

B. Bulk-Forming Laxatives Rationale: Bulk-forming laxatives are the only laxatives recommended for long term use. Stimulant laxatives are the most likely of all laxative classes to cause dependence.

When monitoring a patient who has diabetes and is receiving a carbonic anhydrase inhibitor for edema, the nurse will monitor for which possible adverse effect? A. Metabolic alkalosis B. Elevated blood glucose C. Hyperkalemia D. Mental alertness

B. Elevated Blood Glucose Rationale: An undesirable effect of carbonic anhydrase inhibitors is that they elevate the blood glucose level and cause glycosuria in diabetic patients. They induce metabolic acidosis, making their usefulness limited. In addition, hypokalemia and drowsiness may occur.

After starting treatment for type 2 diabetes mellitus 6 months earlier, a patient is in the office for a follow-up examination. The nurse will monitor which laboratory test to evaluate the patient's adherence to the antidiabetic therapy over the past few months? A. Hemoglobin Levels B. Hemoglobin A1C level C. Fingerstick fasting blood glucose level D. Serum insulin levels

B. Hemoglobin A1C level Rationale: The hemoglobin A1C level reflects the patient's adherence to the therapy regimen for several months previously, thus evaluating how well the patient has been doing with diet and drug therapy. The other options are incorrect.

When administering morning medications for a newly admitted patient, the nurse notes that the patient has an allergy to sulfa drugs. There is an order for the sulfonylurea glipizide (Glucotrol). Which action by the nurse is correct? A. Give the drug as ordered 30 minutes before breakfast. B. Hold the drug, and check the order with the prescriber. C. Give a reduced dose of the drug with breakfast. D. Give the drug, and monitor for adverse effects.

B. Hold the drug, and check the order with the prescriber Rationale: There is a potential for cross-allergy in patients who are allergic to sulfonamide antibiotics. Although such an allergy is listed as a contraindication by the manufacturer, most clinicians do prescribe sulfonylureas for such patients. The order needs to be clarified.

A patient asks the nurse about the difference between diphenoxylate with atropine (Lomotil) and the over-the-counter drug loperamide (Imodium). Which response by the nurse is correct? A. Lomotil acts faster than Imodium B. Imodium does not cause physical dependence. C. Lomotil is available suppository form D. Imodium is a natural antidiarrheal drug

B. Imodium does not cause physical dependence. Rationale: Although the drug exhibits many characteristics of the opiate class, physical dependence on loperamide ( Imodium) has not been reported. All antidiarrheal drugs are orally administered.

The nurse is reviewing a patient's medication list and notes that sitagliptin (Januvia) is ordered. The nurse will question an additional order for which drug or drug class? A. Glitazone B. Insulin C. Metformin (Glucophage) D. Sulfonylurea

B. Insulin Rationale: Sitagliptin is indicated for management of type 2 diabetes either as monotherapy or in combination with metformin, a sulfonylurea, or a glitazone, but not with insulin.

The nurse is preparing to administer insulin intravenously. Which statement about the administration of intravenous insulin is true? A. Insulin is never given intravenously. B. Only regular insulin can be administered intravenously. C. Insulin aspart or insulin lispro can be administered intravenously, but there must be a 50% dose reduction. D. Any form of insulin can be administered intravenously at the same dose as that is ordered for subcutaneous administration.

B. Only regular insulin can be administered intravenously. Rationale: Regular insulin is the usual insulin product to be dosed via intravenous bolus, intravenous infusion, or even intramuscularly. These routes, especially the intravenous infusion route, are often used in cases of diabetic ketoacidosis, or coma associated with uncontrolled type 1 diabetes.

A patient in the neurologic intensive care unit is being treated for cerebral edema. Which class of diuretic is used to reduce intracranial pressure? A. Loop diuretics B. Osmotic diuretics C. Thiazide diuretics D. Vasodilators

B. Osmotic Diuretics Rationale: Mannitol, an osmotic diuretic, is commonly used to reduce intracranial pressure and cerebral edema resulting from head trauma.

A patient is taking a xanthine derivative as part of treatment for chronic obstructive pulmonary disease. The nurse will monitor for which adverse effects associated with the use of xanthine derivatives? A. Diarrhea B. Palpitations C. Bradycardia D. Drowsiness

B. Palpitations Rationale: The common adverse effects of the xanthine derivatives include nausea, vomiting, and anorexia. In addition, gastroesophageal reflux has been observed to occur during sleep in patients taking these drugs. Cardiac adverse effects include sinus tachycardia, extrasystole, palpitations, and ventricular dysrhythmias. Transient increased urination and hyperglycemia are other possible adverse effects.

A patient with a history of angina will be started on ranolazine (Ranexa). The nurse is reviewing the patient's history and will note potential contraindications to this drug therapy if which condition is present? (Select all that apply.) A. Type 2 diabetes mellitus B. Prolonged QT interval on the electrocardiogram C. Heart failure D. Closed-angle glaucoma E. Decreased liver function

B. Prolonged QT Interval on the Electrocardiogram E. Decreased Liver Function Rationale: Ranolazine is contraindicated in patients with pre-existing QT prolongation or hepatic impairment. The other options are not contraindications.

A patient with type 2 diabetes mellitus has been found to have trace proteinuria. The prescriber writes an order for an angiotensin-converting enzyme (ACE) inhibitor. What is the main reason for prescribing this class of drug for this patient? A. Cardioprotective effects B. Renal protective effects C. Reduces blood pressure D. Promotes fluid output

B. Renal Protective Effects Rationale: ACE inhibitors have been shown to have a protective effect on the kidneys because they reduce glomerular filtration pressure. This is one reason that they are among the cardiovascular drugs of choice for diabetic patients. The other drugs do not have this effect.

The nurse is creating a plan of care for a patient with a new diagnosis of hypertension. Which is a potential nursing diagnosis for the patient taking antihypertensive medications? A. Diarrhea B. Sexual dysfunction C. Urge urinary incontinence D. Impaired memory

B. Sexual Dysfunction Rationale: Sexual dysfunction is a potential nursing diagnosis related to possible adverse effects of antihypertensive drug therapy. The other nursing diagnoses are not appropriate.

A patient with a history of chronic obstructive pulmonary disease (COPD) and type 2 diabetes has been treated for pneumonia for the past week. The patient has been receiving intravenous corticosteroids as well as antibiotics as part of his therapy. At this time, the pneumonia has resolved, but when monitoring the blood glucose levels, the nurse notices that the level is still elevated. What is the best explanation for this elevation? A. The antibiotics may cause an increase in glucose levels. B. The corticosteroids may cause an increase in glucose levels. C. His type 2 diabetes has converted to type 1. D. The hypoxia caused by the COPD causes an increased need for insulin.

B. The corticosteroids may cause an increase in glucose levels. Rationale: Corticosteroids can antagonize the hypoglycemic effects of insulin, resulting in elevated blood glucose levels.

How will the nurse describe the action of proton pump inhibitors (PPIs)? A. They form a protective barrier that can be thought of as a liquid bandage. B. They irreversibly bind to the hydrogen-potassium-ATPase pump. C. They compete with histamine for binding sites on the parietal cells. D. They help to neutralize acid secretions to promote gastric mucosal defensive mechanisms.

B. They irreversibly bind to the hydrogen-potassium-ATPase pump. PPIs work to block the final step in the acid-secreting mechanisms of the proton pump. They do this by irreversibly binding to the ATPase pump, H+/K+ ATPase, the enzyme for this step.

A patient has been diagnosed with metabolic syndrome and is started on the biguanide metformin (Glucophage). The nurse knows that the purpose of the metformin, in this situation, is which of these? A. To increase the pancreatic secretion of insulin B. To decrease insulin resistance C. To increase blood glucose levels D. To decrease the pancreatic secretion of insulin

B. To decrease insulin resistance Rationale: Metformin decreases glucose production by the liver; decreases intestinal absorption of glucose; and improves insulin receptor sensitivity in the liver, skeletal muscle, and adipose tissue, resulting in decreased insulin resistance.

The nurse is reviewing the uses of oral laxatives. Which conditions are general contraindications to or cautions about the use of oral laxatives? (Select all that apply.) A. Irritable bowel syndrome B. Undiagnosed abdominal pain C. Nausea and vomiting D. Fecal impaction E. Ingestion of toxic substances F. Acute surgical abdomen

B. Undiagnosed abdominal pain C. Nausea and vomiting D. Fecal impaction F. Acute Surgical Abdomen Rationale: Cautious use of laxatives is recommended in the presence of these: acute surgical abdomen; appendicitis symptoms, such as abdominal pain, nausea, and vomiting; intestinal obstruction; and undiagnosed abdominal pain. Oral laxatives must not be used with fecal impaction; mineral oil enemas are indicated for fecal impaction. The other options are indications for laxative use.

The nurse knows to administer acarbose (Precose), an alpha-glucosidase inhibitor, at which time? A. 30 minutes before breakfast B. With the first bite of each main meal C. 30 minutes after breakfast D. Once daily at bedtime

B. With the first bite of each main meal Rationale: When an alpha-glucosidase inhibitor is taken with the first bite of a meal, excessive postprandial blood glucose elevation (a glucose spike) can be reduced or prevented.

The nurse is preparing to administer methylnaltrexone (Relistor), a peripherally acting opioid antagonist. This drug is appropriate for which patient? A patient with diarrhea B.A terminally ill patient who has opioid-induced constipation C. A patient who is scheduled for a colonoscopy D. A patient who will be having colon surgery in the morning

B.A terminally ill patient who has opioid-induced constipation Rationale: Methylnaltrexone is approved only for terminally ill (hospice) patients who have opioid-induced constipation. The other options are incorrect.

5. A hospitalized patient complains of acute chest pain. The nurse administers a 0.3-mg sublingual nitroglycerin tablet, but the patient continues to complain of pain. Vital signs remain stable. What is the nurse's next step? a. Apply a nitroglycerin transdermal patch. b. Continue dosing at 10-minute intervals. c. Give a second dose of nitroglycerin in 5 minutes. d. Request an order for intravenous nitroglycerin.

C An initial dose of sublingual nitroglycerin is taken, and if the chest pain persists, as in this case, the patient should take another dose in 5 minutes. Transdermal delivery systems are not useful for terminating an ongoing attack. Dosing at 10-minute intervals is incorrect. If the patient fails to respond or if the pain intensifies, intravenous nitroglycerin may be indicated.

14. A postoperative patient reports pain in the left lower extremity. The nurse notes swelling in the lower leg, which feels warm to the touch. The nurse will anticipate giving which medication? a. Aspirin b. Clopidogrel [Plavix] c. Enoxaparin [Lovenox] d. Warfarin [Coumadin]

C Enoxaparin is a low-molecular-weight heparin and is used in situations requiring rapid onset of anticoagulant effects, such as massive DVT. Aspirin, clopidogrel, and warfarin are useful for primary prevention but are not used when rapid anticoagulation is required.

10. A prescriber orders hydroxyzine [Vistaril] for a patient with acute urticaria. The nurse will include which information when teaching the patient about this drug? a. The drug will reduce redness and itching but not edema. b. This antihistamine is not likely to cause sedation. c. The patient should avoid drinking alcohol while taking the drug. d. The patient should report shortness of breath while taking the drug.

C Hydroxyzine is a first-generation antihistamine and has sedative effects, so patients should be cautioned not to consume alcohol while taking the drug. In capillary beds, antihistamines reduce edema, itching, and redness. This antihistamine causes sedation. It is not associated with respiratory depression at therapeutic doses.

8. A 5-year-old child is brought to the emergency department after ingesting diphenhydramine [Benadryl]. The child is uncoordinated and agitated. The nurse observes that the child's face is flushed, the temperature is 37.1oC, and the heart rate is 110 beats per minute. The nurse will expect to: a. administer atropine to reverse the adverse effects. b. apply ice packs to stop the flushing. c. give activated charcoal to absorb the drug. d. prepare to provide mechanical ventilation.

C In acute toxicity, patients present with agitation, a flushed face, tachycardia, and uncoordinated movements. There is no specific antidote, so drug removal is the focus of treatment, starting with activated charcoal to absorb the drug, followed by a cathartic to enhance excretion. Atropine would cause an increase in the heart rate. Application of ice packs is recommended for hyperthermia and not for flushing. The child's temperature is normal. Mechanical ventilation is not indicated with this presentation of symptoms, although cardiovascular collapse may eventually develop.

3. A patient has been receiving heparin while in the hospital to treat deep vein thromboses and will be discharged home with a prescription for enoxaparin [Lovenox]. The nurse provides teaching for the nursing student who asks about the advantages of enoxaparin over heparin. Which statement by the student indicates a need for further teaching? a. "Enoxaparin does not require coagulation monitoring." b. "Enoxaparin has greater bioavailability than heparin." c. "Enoxaparin is more cost-effective than heparin." d. "Enoxaparin may be given using a fixed dosage."

C Low-molecular-weight (LMW) heparins have higher bioavailability and longer half-lives, so routine coagulation monitoring is not necessary and fixed dosing is possible. LMW heparins are more expensive, however, so this statement indicates a need for further teaching.

1. A nurse is providing teaching for a patient with stable angina who will begin taking nitroglycerin. Which statement by the patient indicates understanding of the teaching? a. "I should not participate in aerobic exercise while taking this drug." b. "I should take aspirin daily to reduce my need for nitroglycerin." c. "If I take nitroglycerin before exertion, I can reduce the chance of an anginal attack." d. "I take nitroglycerin to increase the amount of oxygen to my heart."

C Nitroglycerin can be taken before stressful events or exertion to reduce the chance of an attack of angina. Aerobic exercise is an important part of nondrug therapy to reduce the risk of heart attack. Aspirin therapy is an important adjunct to treatment to prevent coronary thrombus formation, but it does not reduce the need for nitroglycerin. Nitroglycerin reduces cardiac oxygen demand, but it does not increase the amount of oxygen available to the heart.

12. A patient who is taking clopidogrel [Plavix] calls the nurse to report black, tarry stools and coffee-ground emesis. The nurse will tell the patient to: a. ask the provider about using aspirin instead of clopidogrel. b. consume a diet high in vitamin K. c. continue taking the clopidogrel until talking to the provider. d. stop taking the clopidogrel immediately.

C Patients who experience bleeding should be warned not to stop taking the clopidogrel until the prescriber says they should, since abrupt withdrawal may precipitate a thrombotic event. Taking aspirin with an active GI bleed is contraindicated. Warfarin is a vitamin K inhibitor; consuming extra vitamin K will not reverse the effects of clopidogrel.

9. A provider has ordered intravenous promethazine [Phenergan] for an adult patient postoperatively to prevent nausea and vomiting (N/V). What will the nurse do? a. Administer the drug at a rate of 25 mg/min or more to achieve maximum effects. b. Contact the provider to suggest using dimenhydrinate [Dramamine] instead. c. Ensure that the IV is infusing freely through a large-bore needle. d. Monitor the patient closely for cardiac dysrhythmias.

C Promethazine can cause severe local tissue injury if it extravasates into tissues, so the medication should be administered in an IV that is flowing freely through a large-bore needle. The drug should be administered at a rate of 25 mg/min or less. Dimenhydrinate is indicated for motion sickness, not postoperative N/V. Cardiac dysrhythmias were a concern with two antihistamines no longer on the market, astemizole and terfenadine.

7. An 18-month-old child develops an urticarial reaction after a transfusion. The prescriber orders intravenous promethazine [Phenergan]. What will the nurse do? a. Give the medication as ordered. b. Monitor the child for bronchoconstriction. c. Question the order. d. Request an order to give the drug orally.

C Promethazine can cause severe respiratory depression, especially in very young patients; it is contraindicated in children younger than 2 years. The medication should not be given as ordered. It is not safe to give the drug and then monitor for bronchoconstriction. The drug is not safe in this age group when given orally.

15. A patient who takes nitroglycerine to treat stable angina reports having erectile dysfunction and states that he plans to ask his primary provider for a prescription for tadalafil [Cialis]. What will the nurse tell this patient? a. "You may take these two drugs together safely as long as you take them as directed." b. "You should not take tadalafil and nitroglycerine within 30 to 60 minutes of each other." c. "You should discuss another anti-angina medication with your provider." d. "You should avoid sexual activity since this increases oxygen demands on the heart."

C Use of nitroglycerine with any phosphodiesterase type 5 inhibitor, such as sildenafil or tadalafil is absolutely contraindicated. The patient should be advised to discuss another antianginal agent with the provider. Patients should be taught to increase all activity to maintain as normal a lifestyle as possible.

1. A nursing student who is preparing to care for a postoperative patient with deep vein thrombosis asks the nurse why the patient must take heparin rather than warfarin. Which response by the nurse is correct? a. "Heparin has a longer half-life." b. "Heparin has fewer adverse effects." c. "The onset of warfarin is delayed." d. "Warfarin prevents platelet aggregation."

C Warfarin is not useful for treating existing thromboses or for emergencies because the onset of action is delayed. Heparin has a shorter half-life and has more side effects. Warfarin does not prevent platelet aggregation.

2. Which parenteral antihistamines have sedative effects that are classified as low to none? (Select all that apply.) a. Cetirizine [Zyrtec] b. Clemastine [Tavist Allergy] c. Desloratadine [Clarinex] d. Fexofenadine [Allegra] e. Loratadine [Claritin]

C, D, E Desloratadine, fexofenadine, and loratadine all have sedative effects classified as low to none. Cetirizine and clemastine have moderate sedative effects.

The nurse is reviewing instructions for a patient with type 2 diabetes who also takes insulin injections as part of the therapy. The nurse asks the patient, "What should you do if your fasting blood glucose is 47 mg/dL?" Which response by the patient reflects a correct understanding of insulin therapy? A. "I will call my doctor right away." B. "I will give myself the regular insulin." C. "I will take an oral form of glucose." D. "I will rest until the symptoms pass."

C. " I will take an oral form of glucose" Rationale: Hypoglycemia can be reversed if the patient eats glucose tablets or gel, corn syrup, or honey, or drinks fruit juice or a nondiet soft drink or other quick sources of glucose, which must always be kept at hand. She should not wait for instructions from her physician, nor delay taking the glucose by resting. The regular insulin would only lower her blood glucose levels more.

When teaching a patient who will be receiving antihistamines, the nurse will include which instructions? (Select all that apply.) A. "Antihistamines are generally safe to take with over-the-counter medications." B. "Take the medication on an empty stomach to maximize absorption of the drug." C. "Take the medication with food to minimize gastrointestinal distress." D. "Drink extra fluids if possible." E. "Antihistamines may cause restlessness and disturbed sleep." F. "Avoid activities that require alertness until you know how adverse effects are tolerated."

C. "Take the medication with food to minimize gastrointestinal distress." D. "Drink extra fluids if possible." F. "Avoid activities that require alertness until you know how adverse effects are tolerated." Rationale: Antihistamines should be taken with food, even though this slightly reduces the absorption of the drug, so as to minimize the gastrointestinal upset that can occur. Over-the-counter medications must not be taken with an antihistamine unless approved by the physician because of the serious drug interactions that may occur. Drinking extra fluids will help to ease the removal of secretions, and activities that require alertness, such as driving, must not be engaged in until the patient knows how he or she responds to the sedating effects of antihistamines.

A patient is taking linaclotide (Linzess) to treat irritable bowel syndrome (IBS). The nurse will monitor this patient for which adverse effect? A. Chest Pain B. Chronic Constpiation C. Abdominal Pain D. Elevated Blood Glucose Levels

C. Abdominal Pain Rationale: Common adverse effects of linaclotide (Linzess) are diarrhea, abdominal pain, and flatulence. Elevated blood glucose levels, chest pain, and chronic constipation are not adverse effects of linaclotide.

A laxative has been ordered for a patient. The nurse checks the patient's medical history and would be concerned if which condition is present? A. High ammonia levels due to liver failure B. Diverticulitis C. Abdominal pain of unknown origin D. Chronic Constipation

C. Abdominal pain of unknown origin Rationale: All categories of laxatives share the same general contraindications and precautions, including avoidance in cases of drug allergy and the need for cautious use in the presence of these: acute surgical abdomen; appendicitis symptoms such as abdominal pain, nausea, and vomiting; fecal impaction (mineral oil enemas excepted); intestinal obstruction; and undiagnosed abdominal pain. The other options are possible indications for laxatives.

A patient in the emergency department was showing signs of hypoglycemia and had a fingerstick glucose level of 34 mg/dL. The patient has just become unconscious. What is the nurse's next action? A. Have the patient eat glucose tablets. B. Have the patient consume fruit juice, a non diet soft drink, or crackers. C. Administer intravenous glucose (50% dextrose). D. Call the lab to order a fasting blood glucose level.

C. Administer intravenous glucose (50% dextrose). Rationale: Intravenous glucose raises blood glucose levels when the patient is unconscious and unable to take oral forms of glucose.

While assessing a patient who is taking a beta blocker for angina, the nurse knows to monitor for which adverse effect? A. Nervousness B. Hypertension C. Bradycardia D. Dry cough

C. Bradycardia Rationale: Adverse effects of beta blockers include bradycardia, hypotension, dizziness, lethargy, impotence, and several other effects, but not dry cough or nervousness.

How does sucralfate (Carafate) achieve a therapeutic effect? A. By inhibiting the production of gastric acid secretion B. By enhancing gastric absorption C. By forming a protective barrier over the gastric mucosa D. By neutralizing gastric acid

C. By forming a protective barrier over the gastric mucosa Sucralfate has a local effect only on the gastric mucosa. It forms a protective barrier that can be thought of as a liquid bandage in the stomach. This liquid bandage adheres to the gastric lining, protecting against adverse effects related to gastric acid. It also stimulates healing of any ulcerated areas of the gastric mucosa.

The nurse is reviewing drug therapy for hypertension. According to the JNC-8 guidelines, antihypertensive drug therapy for a newly diagnosed hypertensive African-American patient would most likely include which drug or drug classes? A. Vasodilators alone B. ACE inhibitors alone C. Calcium channel blockers with thiazide diuretics D. Beta blockers with thiazide diuretics

C. Calcium Channel Blockers with thiazide diuretics Rationale: According to the JNC-8 guidelines, calcium channel blockers and diuretics are recommended as first-line therapy for management of hypertension in African-American patients. The other drugs are not recommended as first-line drugs for this group.

The nurse would teach a client prescribed simethicone (Mylicon) to avoid which substance? A. Over-the-counter antacids B. Histamine2-receptor antagonists C. Carbonated beverages D. Milk and dairy products

C. Carbonated beverages Simethicone is used to decrease gas and belching, both of which can be aggravated or caused by ingesting carbonated beverages. It may be given in combination with other medications used to decrease acidity.

When teaching about hypoglycemia, the nurse will make sure that the patient is aware of the early signs of hypoglycemia, including: A. Hypothermia and seizures B. Nausea and diarrhea C. Confusion and sweating D. fruity, acetone odor to the breath.

C. Confusion and Sweating Rationale: Early symptoms of hypoglycemia include the central nervous system manifestations of confusion, irritability, tremor, and sweating. Hypothermia and seizures are later symptoms of hypoglycemia.

A patient who has type 2 diabetes is scheduled for an oral endoscopy and has been NPO (nothing by mouth) since midnight. What is the best action by the nurse regarding the administration of her oral antidiabetic drugs? A. Administer half the original dose. B. Withhold all medications as ordered. C. Contact the prescriber for further orders. D. Give the medication with a sip of water.

C. Contact the prescriber for further orders. Rationale: When the diabetic patient is NPO, the prescriber needs to be contacted for further orders regarding the administration of the oral antidiabetic drugs. The other options are incorrect.

The nurse will instruct patients about a possible systemic effect that may occur if excessive amounts of topically applied adrenergic nasal decongestants are used. Which systemic effect may occur? A. Heartburn B. Bradycardia C. Drowsiness D. Palpitations

C. Drowsiness Rationale: Although a topically applied adrenergic nasal decongestant can be absorbed into the bloodstream, the amount absorbed is usually too small to cause systemic effects at normal dosages. Excessive dosages of these medications, however, are more likely to cause systemic effects elsewhere in the body. These may include cardiovascular effects, such as hypertension and palpitations, and central nervous system effects such as headache, nervousness, and dizziness. The other options are incorrect.

During a routine checkup, a patient states that she is unable to take the prescribed antihistamine because of one of its most common adverse effects. The nurse suspects that which adverse effect has been bothering this patient? A. Constipation B. Abdominal cramps C. Drowsiness D. Decreased libido

C. Drowsiness Rationale: Drowsiness is usually the chief complaint of people who take antihistamines.

When monitoring a patient's response to oral antidiabetic drugs, the nurse knows that which laboratory result would indicate a therapeutic response? A. Random blood glucose level 180 mg/dL B. Blood glucose level of 50 mg/dL after meals C. Fasting blood glucose level between 92 mg/dL D. Evening blood glucose level below 80 mg/dL

C. Fasting blood glucose level between 92 mg/dL Rationale: The American Diabetes Association recommends a fasting blood glucose level of between 80 and 130 mg/dL for diabetic patients. The other options are incorrect.

When giving dextromethorphan, the nurse understands that this drug suppresses the cough reflex by which mechanism of action? A. Causing depression of the central nervous system B. Anesthetizing the stretch receptors C. Having direct action on the cough center D. Decreasing the viscosity of the bronchial secretions

C. Having direct action on the cough center. Rationale: Dextromethorphan suppresses the cough reflex through a direct action on the cough center. The other options are incorrect.

A patient has been diagnosed with angina and will be given a prescription for sublingual nitroglycerin tablets. When teaching the patient how to use sublingual nitroglycerin, the nurse will include which instruction? A. Take up to 5 doses at 15-minute intervals for an angina attack. B. If the tablet does not dissolve quickly, chew the tablet for maximal effect. C. If the chest pain is not relieved after one tablet, call 911 immediately. D. Wait 1 minute between doses of sublingual tablets, up to 3 doses.

C. If the chest pain is not relieved after one tablet, call 911 immediately. Rationale: According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes, after 1 dose, the patient (or family member) must call 911 immediately. The patient may take one more tablet while awaiting emergency care and may take a third tablet 5 minutes later, but no more than a total of three tablets. The sublingual dose is placed under the tongue, and the patient needs to avoid swallowing until the tablet has dissolved.

When a patient is receiving diuretic therapy, which of these assessment measures would best reflect the patient's fluid volume status? A. Blood pressure and pulse B. Serum potassium and sodium levels C. Intake, output, and daily weight D. Measurements of abdominal girth and calf circumference

C. Intake, Output, and daily weight Rationale: Urinary intake and output and daily weights are the best reflections of a patient's fluid volume status.

The prescriber has changed the patient's medication regimen to include the leukotriene receptor antagonist (LTRA) montelukast (Singulair) to treat asthma. The nurse will emphasize which point about this medication? A. The proper technique for inhalation must be followed. B. The patient needs to keep it close by at all times to treat acute asthma attacks. C. It needs to be taken every day on a continuous schedule, even if symptoms improve. D. When the asthma symptoms improve, the dosage schedule can be tapered and eventually discontinued.

C. It needs to be taken every day on a continuous schedule, even if symptoms improve. Rationale: These drugs are indicated for chronic, not acute, asthma and are to be taken every day on a continuous schedule, even if symptoms improve. These drugs are taken orally.

A gardener needs a decongestant because of seasonal allergy problems and asks the nurse whether he should take an oral form or a nasal spray. Which of these is a benefit of orally administered decongestants? A. Immediate onset B. A more potent effect C. Lack of rebound congestion D. Shorter duration

C. Lack of rebound congestion Rationale: Drugs administered by the oral route produce prolonged decongestant effects, but the onset of action is more delayed and the effect less potent than those of decongestants applied topically. However, the clinical problem of rebound congestion associated with topically administered drugs is almost nonexistent with oral dosage forms.

The Nurse is giving oral mineral oil as an ordered laxative dose. The nurse will take measures to prevent which potential problem that may occur with mineral oil? A. Fecal impaction B. Electrolyte Imbalances C. Lipid Pneumonia D. Esophageal Blockage

C. Lipid Pneumonia Rationale: Lipid Pneumonia may occur if the oral mineral oil is accidentally aspirated into the respiratory tract.

While recovering from surgery, a 74-year-old woman started taking a stimulant laxative, senna (Senokot), to relieve constipation caused by the pain medications. Two weeks later, at her follow-up appointment, she tells the nurse that she likes how "regular" her bowel movements are now that she is taking the laxative. Which teaching principle is appropriate for this patient? A. She needs to be sure to take this medication with plenty of fluids B. It is important to have a daily bowel movement to promote bowel health. C. Long-term use of laxatives often results in decreased bowel tone and may lead to dependency. D. She needs to switch to glycerin suppositories to continue having daily bowel movements.

C. Long-term use of laxatives often results in decreased bowel tone and may lead to dependency. Rationale: Long-term use of laxatives may lead to dependency. Patients need to be taught that daily bowel movements are not necessary for bowel health.

A patient is severely constipated and needs immediate relief. The nurse knows that which class of laxative will provide the most rapid results? A. Bulk Forming laxative, such as psyllium (Metamucil) B. Stool softener, such as docusate salts (Colace) C. Magnesium Hydroxide (MOM) D. Magnesium Oxide Tablets

C. Magnesium Hydroxide (MOM) Rationale: Saline laxatives such as magnesium hydroxide (MOM) produce a watery stool, usually within 3 to 6 hours of ingestion. Bulk-forming laxatives such as psyllium do not produce a bowel movement rapidly. Stool softeners such as docusate salts do not cause patients to defecate; they simply soften the stool to ease its passage. Magnesium oxide tablets are used as magnesium supplements, not as laxative.

The nurse is reviewing the orders for a patient and notes a new order for an angiotensin-converting enzyme (ACE) inhibitor. The nurse checks the current medication orders, knowing that this drug class may have a serious interaction with what other drug class? A. Calcium channel blockers B. Diuretics C. Nonsteroidal anti-inflammatory drugs D. Nitrates

C. NSAIDs Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can reduce the antihypertensive effect of ACE inhibitors. In addition, the use of NSAIDs and ACE inhibitors may also predispose patients to the development of acute renal failure.

When evaluating a patient's use of a metered-dose inhaler (MDI), the nurse notes that the patient is unable to coordinate the activation of the inhaler with her breathing. What intervention is most appropriate at this time? A.Notify the doctor that the patient is unable to use the MDI. B. Obtain an order for a peak flow meter. C. Obtain an order for a spacer device. D. Ask the prescriber if the medication can be given orally.

C. Obtain an order for a peak flow meter Rationale: The use of a spacer may be indicated with metered-dose inhalers, especially if success with inhalation is limited. The other options are not appropriate interventions.

When the nurse is administering topical nitroglycerin ointment, which technique is correct? A. Apply the ointment on the skin on the forearm. B. Apply the ointment only in the case of a mild angina episode. C. Remove the old ointment before new ointment is applied. D. Massage the ointment gently into the skin, and then cover the area with plastic wrap.

C. Remove the old ointment before new ointment is applied. Rationale: The old ointment should be removed before a new dose is applied. The ointment should be applied to clean, dry, hairless skin of the upper arms or body, not below the elbows or below the knees. The ointment is not massaged or spread on the skin, and it is not indicated for the treatment of acute angina.

When administering a bulk forming laxative, the nurse instructs the patient to drink the medication mixed in a full 8 ounce glass of water. Which statement best explains the rationale for the instruction? A. The water acts to stimulate bowel movements B. The water will help to reduce the bulk of the intestinal contents C. These laxatives may cause esophageal obstruction if taken with insufficient water. D. The water acts as a lubricant to produce bowel movements.

C. These laxatives may cause esophageal obstruction if taken with insufficient water. Rationale: Bulk forming drugs increase water absorption which results in greater total volume (bulk) of the intestinal contents. Bulk forming laxatives tend to produce normal, formed stools. Their action is limited to the GI tract, so there are few, if any, systemic effects. However, they need to be taken with liberal amounts of water to prevent esophageal obstruction and fecal impaction.

When reviewing the mechanisms of action of diuretics, the nurse knows that which statement is true about loop diuretics? A. They work by inhibiting aldosterone. B. They are very potent, having a diuretic effect that lasts at least 6 hours. C. They have a rapid onset of action and cause rapid diuresis. D. They are not effective when the creatinine clearance decreases below 25 mL/min.

C. They have a rapid onset of action and cause rapid diuresis. Rationale: The loop diuretics have a rapid onset of action; therefore, they are useful when rapid onset is desired. Their effect lasts for about 2 hours, and a distinct advantage they have over thiazide diuretics is that their diuretic action continues even when creatinine clearance decreases below 25 mL/min.

A patient is started on a diuretic for antihypertensive therapy. The nurse expects that a drug in which class is likely to be used initially? A. Loop diuretics B. Osmotic diuretics C. Thiazide diuretics D. Potassium-sparing diuretics

C. Thiazide Diuretics Rationale: The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-8) guidelines reaffirmed the role of thiazide diuretics as one of the first-line treatment for hypertension. The other drug classes are not considered first-line treatments.

When teaching a patient who has a new prescription for transdermal nitroglycerin patches, the nurse tells the patient that these patches are most appropriately used for which situation? A. To prevent low blood pressure B. To relieve shortness of breath C. To prevent the occurrence of angina D. To keep the heart rate from rising too high during exercise

C. To prevent the occurrence of angina Rationale: Transdermal dosage formulations of nitroglycerin are used for the long-term prophylactic management (prevention) of angina pectoris. Transdermal nitroglycerin patches are not appropriate for the relief of shortness of breath, to prevent palpitations, or to control the heart rate during exercise.

A patient will be taking bismuth subsalicylate (Pepto-Bismol) to control diarrhea. When reviewing the patient's other ordered medications, the nurse recognizes that which medication will interact significantly with the Pepto-Bismol? A. Acetaminophen (Tylenol), an analgesic B. Levothyroxine (Synthroid), a thyroid replacing drug C. Warfarin (Coumadin), an anticoagulant D. Fluoxetine (Prozac), an antidepressant

C. Warfarin (Coumadin), an anticoagulant Rationale: The oral anticoagulant warfarin is more likely to cause increased bleeding times or bruising when co-administered with adsorbents. That is thought to be because adsorbents bind to Vitamin K, which is needed to make certain clotting factors. Vitamin K is synthesized by the normal flora in the bowel.

A patient has been treated with alosetron (Lotronex) for severe irritable bowel syndrome (IBS) for 2 weeks. She calls the clinic and tells the nurse that she has been experiencing constipation for 3 days. The nurse will take which action? A. Advise the patient to increase intake of fluids and fiber. B. Advise the patient to hold the drug for 2 days. C. Instruct the patient to stop taking the drug and to come to the clinic right away to be evaluated. D. Instruct the patient to continue the alosetron and to take milk of magnesia for the constipation.

C.Instruct the patient to stop taking the drug and to come to the clinic right away to be evaluated. Rationale: Alosetron must be discontinued immediately if constipation or signs of ischemic colitis occur. The other options are incorrect.

11. A 50-year-old female patient asks a nurse about taking aspirin to prevent heart disease. The patient does not have a history of myocardial infarction. Her cholesterol and blood pressure are normal, and she does not smoke. What will the nurse tell the patient? a. Aspirin is useful only for preventing a second myocardial infarction. b. She should ask her provider about using a P2Y12 ADP receptor antagonist. c. She should take one 81-mg tablet per day to prevent myocardial infarction. d. There is most likely no protective benefit for patients her age.

D ASA is used for primary prevention of myocardial infarction (MI) in men and in women older than 65 years. Aspirin for primary prevention may be used in women ages 55 to 79 years when the potential benefit of a reduction in MI outweighs the potential harm of increased GI hemorrhage. This patient has no previous history of MI, so the use of ASA is not indicated. ASA is useful for primary prevention, but only when indicated by cardiovascular risk, based on age, gender, cholesterol levels, blood pressure, and smoking status. A P2Y12 ADP receptor antagonist is used as secondary prevention. This patient should not begin taking ASA unless her risk factors change, or until she is 65 years old.

8. A nursing student asks a nurse how beta blockers increase the oxygen supply to the heart in the treatment of anginal pain. The nurse tells the student that beta blockers: a. dilate arterioles to improve myocardial circulation. b. improve cardiac contractility, which makes the heart more efficient. c. increase arterial pressure to improve cardiac afterload. d. increase the time the heart is in diastole.

D Beta blockers increase the time the heart is in diastole, which increases the time during which blood flows through the myocardial vessels, allowing more oxygen to reach the heart. Beta blockers do not dilate arterioles. They do not increase cardiac contractility; they decrease it, which reduces the cardiac oxygen demand. They do not increase arterial pressure, which would increase the cardiac oxygen demand.

2. A patient is receiving heparin postoperatively to prevent deep vein thrombosis. The nurse notes that the patient has a blood pressure of 90/50 mm Hg and a heart rate of 98 beats per minute. The patient's most recent aPTT is greater than 90 seconds. The patient reports lumbar pain. The nurse will request an order for: a. a repeat aPTT to be drawn immediately. b. analgesic medication. c. changing heparin to aspirin. d. protamine sulfate.

D Heparin overdose may cause hemorrhage, which can be characterized by low blood pressure, tachycardia, and lumbar pain. Protamine sulfate should be given, and the heparin should be discontinued. An aPTT may be drawn later to monitor the effectiveness of protamine sulfate. Analgesics are not indicated because the lumbar pain is likely caused by adrenal hemorrhage. Aspirin will only increase the risk of hemorrhage.

4. A patient asks a nurse how nitroglycerin works to relieve anginal pain. The nurse correctly states, "Nitroglycerin: a. dilates coronary arteries to increase blood flow to the heart." b. increases the oxygen supply to the cardiac muscle." c. increases ventricular filling to improve cardiac output." d. promotes vasodilation, which reduces preload and oxygen demand."

D Nitroglycerin dilates the veins, which reduces venous return to the heart, which in turn decreases ventricular filling. The resulting decrease in preload reduces the oxygen requirements of the heart. Nitroglycerin does not increase the blood flow or oxygen supply to the heart. An increase in ventricular filling would increase oxygen demand and result in increased anginal pain.

6. A patient who has begun using transdermal nitroglycerin for angina reports occasional periods of tachycardia. The nurse will expect the prescriber to order: a. digoxin [Lanoxin] to slow the heart rate. b. immediate discontinuation of the nitroglycerin. c. periods of rest when the heart rate increases. d. verapamil as an adjunct to nitroglycerin therapy.

D Nitroglycerin lowers blood pressure by reducing venous return and dilating the arterioles. The lowered blood pressure activates the baroreceptor reflex, causing reflex tachycardia, which can increase cardiac demand and negate the therapeutic effects of nitroglycerin. Treatment with a beta blocker or verapamil suppresses the heart to slow the rate. Digoxin is not recommended. Discontinuation of the nitroglycerin is not indicated. Resting does not slow the heart when the baroreceptor reflex is the cause of the tachycardia.

6. A patient who takes warfarin [Coumadin] is brought to the emergency department after accidentally taking too much warfarin. The patient's heart rate is 78 beats per minute and the blood pressure is 120/80 mm Hg. A dipstick urinalysis is normal. The patient does not have any obvious hematoma or petechiae and does not complain of pain. The nurse will anticipate an order for: a. vitamin K (phytonadione). b. protamine sulfate. c. a PTT. d. a PT and an INR.

D This patient does not exhibit any signs of bleeding from a warfarin overdose. The vital signs are stable, there are no hematomas or petechiae, and the patient does not have pain. A PT and INR should be drawn to evaluate the anticoagulant effects. Vitamin K may be given if laboratory values indicate overdose. Protamine sulfate is given for heparin overdose. PTT evaluation is used to monitor heparin therapy.

5. A patient who takes warfarin for atrial fibrillation undergoes hip replacement surgery. On the second postoperative day, the nurse assesses the patient and notes an oxygen saturation of 83%, pleuritic chest pain, shortness of breath, and hemoptysis. The nurse will contact the provider to report possible ____ and request an order for ____. a. congestive heart failure; furosemide [Lasix] b. hemorrhage; vitamin K (phytonadione) c. myocardial infarction; tissue plasminogen activator (tPA) d. pulmonary embolism; heparin

D This patient is exhibiting signs of pulmonary embolism. Heparin is used when rapid onset of anticoagulants is needed, as with pulmonary embolism. The patient would have respiratory cracks and a cough with congestive heart failure. Hemorrhage involves a decrease in blood pressure, bruising, and lumbar pain. The patient has pleuritic pain, which is not consistent with the chest pain of a myocardial infarction.

2. A nurse is discussing the difference between stable and variant angina with a group of nursing students. Which statement by a student indicates the need for further teaching? a. "Beta blockers are effective in stable angina but not in variant angina." b. "In both types of angina, prophylactic treatment is possible." c. "Variant angina is primarily treated with vasodilators to increase oxygen supply." d. "Variant angina is the result of increased oxygen demand by the heart."

D Variant angina is caused by coronary artery spasm, which reduces the oxygen supply to the heart. Beta blockers are not effective in variant angina but are useful with stable angina. Medications may be given to prevent anginal attacks in both types of angina. Vasodilators are used in variant angina to relieve coronary artery spasm and increase the oxygen supply to the heart.

8. A patient has been taking warfarin [Coumadin] for atrial fibrillation. The provider has ordered dabigatran etexilate [Pradaxa] to replace the warfarin. The nurse teaches the patient about the change in drug regimen. Which statement by the patient indicates understanding of the teaching? a. "I may need to adjust the dose of dabigatran after weaning off the warfarin." b. "I should continue to take the warfarin after beginning the dabigatran until my INR is greater than 3." c. "I should stop taking the warfarin 3 days before starting the dabigatran." d. "I will stop taking the warfarin and will start taking the dabigatran when my INR is less than 2."

D When switching from warfarin to dabigatran, patients should stop taking the warfarin and begin taking the dabigatran when the INR is less than 2. It is not correct to begin taking the dabigatran before stopping the warfarin. While warfarin is stopped before beginning the dabigatran, the decision to start taking the dabigatran is based on the patient's INR and not on the amount of time that has elapsed.

A patient has a new order for the adrenergic drug doxazosin (Cardura). When providing education about this drug, the nurse will include which instructions? A. "Weigh yourself daily, and report any weight loss to your prescriber." B. "Increase your potassium intake by eating more bananas and apricots." C. "The impaired taste associated with this medication usually goes away in 2 to 3 weeks." D. "Be sure to lie down after taking the first dose, because first-dose hypotension may make you dizzy."

D. " Be sure to lie down after taking the first dose, because first-dose hypotension may make you dizzy." RATIONALE: A patient who is starting doxazosin should take the first dose while lying down because there is a first-dose hypotensive effect with this medication. The other options are incorrect.

Furosemide (Lasix) is prescribed for a patient who is about to be discharged, and the nurse provides instructions to the patient about the medication. Which statement by the nurse is correct? A. "Take this medication in the evening." B. "Avoid foods high in potassium, such as bananas, oranges, fresh vegetables, and dates." C. "If you experience weight gain, such as 5 pounds or more per week, be sure to tell your physician during your next routine visit." D. "Be sure to change positions slowly and rise slowly after sitting or lying so as to prevent dizziness and possible fainting because of blood pressure changes."

D. "Be sure to change positions slowly and rise slowly after sitting or lying so as to prevent dizziness and possible fainting because of blood pressure changes." Rationale: Orthostatic hypotension is a possible problem with diuretic therapy. Foods high in potassium should be eaten more often, and the drug needs to be taken in the morning so that the diuretic effects do not interfere with sleep. A weight gain of 5 pounds or more per week must be reported immediately.

The nurse is teaching a review class to nurses about diabetes mellitus. Which statement by the nurse is correct? A. "Patients with type 2 diabetes will never need insulin." B. "Oral antidiabetic drugs are safe for use during pregnancy." C. "Pediatric patients cannot take insulin." D. "Insulin therapy is possible during pregnancy if managed carefully."

D. "Insulin therapy is possible during pregnancy if managed carefully." Rationale: Oral medications are generally not recommended for pregnant patients because of a lack of firm safety data. For this reason, insulin therapy is the only currently recommended drug therapy for pregnant women with diabetes. Insulin is given to pediatric patients, with extreme care. Patients with type 2 diabetes may require insulin in certain situations or as their disease progresses.

A patient has been taking a beta blocker for 4 weeks as part of his antianginal therapy. He also has type II diabetes and hyperthyroidism. When discussing possible adverse effects, the nurse will include which information? A. "Watch for unusual weight loss." B. "Monitor your pulse for increased heart rate." C. "Use the hot tub and sauna at the gym as long as time is limited to 15 minutes." D. "Monitor your blood glucose levels for possible hypoglycemia or hyperglycemia."

D. "Monitor your blood glucose levels for possible hypoglycemia or hyperglycemia." Rationale: Beta blockers can cause both hypoglycemia and hyperglycemia. They may also cause weight gain if heart failure is developing, and decreased pulse rate. The use of hot tubs and saunas is not recommended because of the possibility of hypotensive episodes.

A patient on diuretic therapy calls the clinic because he's had the flu, with "terrible vomiting and diarrhea," and he has not kept anything down for 2 days. He feels weak and extremely tired. Which statement by the nurse is correct? A. "It's important to try to stay on your prescribed medication. Try to take it with sips of water." B. "Stop taking the diuretic for a few days, and then restart it when you feel better." C. "You will need an increased dosage of the diuretic because of your illness. Let me speak to the physician." D. "Please come into the clinic for an evaluation to make sure there are no complications."

D. "Please come into the clinic for an evaluation to make sure there are no complications." Rationale: Vomiting and diarrhea cause fluid and electrolyte loss. The patient must not continue to take the diuretic until these problems have stopped. He needs to be checked for possible hypokalemia and dehydration. The other options are incorrect responses

When teaching a patient who is starting metformin (Glucophage), which instruction by the nurse is correct? A. "Take metformin if your blood glucose level is above 150 mg/dL." B. "Take this 60 minutes after breakfast." C. "Take the medication on an empty stomach 1 hour before meals." D. "Take the medication with food to reduce gastrointestinal (GI) effects."

D. "Take the medication with food to reduce gastrointestinal (GI) effects." Rationale: The GI adverse effects of metformin can be reduced by administering it with meals. The other options are incorrect.

During a follow-up visit, the health care provider examines the fundus of the patient's eye. Afterward, the patient asks the nurse, "Why is he looking at my eyes when I have high blood pressure? It does not make sense to me!" What is the best response by the nurse? A. "We need to monitor for drug toxicity." B. "We must watch for increased intraocular pressure." C. "The provider is assessing for visual changes that may occur with drug therapy." D. "The provider is making sure the treatment is effective over the long term."

D. "The provider is making sure the treatment is effective over the long term." Rationale: Blood pressure is determined by the product of cardiac output and systemic vascular resistance. The other options are incorrect.

A patient with primary hypertension is prescribed drug therapy for the first time. The patient asks how long drug therapy will be needed. Which answer by the nurse is the correct response? A. "This therapy will take about 3 months." B. "This therapy will take about a year." C. "This therapy will go on until your symptoms disappear." D. "Therapy for high blood pressure is usually lifelong."

D. "Therapy for high blood pressure is usually lifelong." Rationale: There is no cure for the disease, and treatment will be lifelong. The other answers are not appropriate.

A calcium channel blocker (CCB) is prescribed for a patient, and the nurse provides instructions to the patient about the medication. Which instruction is correct? A. Chew the tablet for faster release of the medication. B. To increase the effect of the drug, take it with grapefruit juice. C. If the adverse effects of chest pain, fainting, or dyspnea occur, discontinue the medication immediately. D. A high-fiber diet with plenty of fluids will help prevent the constipation that may occur.

D. A high-fiber diet with plenty of fluids will help prevent the constipation that may occur. Rationale: Constipation is a common effect of CCBs, and a high-fiber diet and plenty of fluids will help to prevent it. Grapefruit juice decreases the metabolism of CCBs. Extended-release tablets must never be chewed or crushed. These medications should never be discontinued abruptly because of the risk for rebound hypertension

A patient with severe liver disease is receiving the angiotensin-converting enzyme (ACE) inhibitor, captopril (Capoten). The nurse is aware that the advantage of this drug for this patient is which characteristic? A. Captopril rarely causes first-dose hypotensive effects. B. Captopril has little effect on electrolyte levels. C. Captopril is a prodrug and is metabolized by the liver before becoming active. D. Captopril is not a prodrug and does not need to be metabolized by the liver before becoming active.

D. Captopril is not a prodrug and does not need to be metabolized by the liver before becoming active. Rationale: A prodrug relies on a functioning liver to be converted to its active form. Captopril is not a prodrug, and therefore it would be safer for the patient with liver dysfunction.

A 79-year-old patient is taking a diuretic for treatment of hypertension. This patient is very independent and wants to continue to live at home. The nurse will know that which teaching point is important for this patient? A. He should take the diuretic with his evening meal. B. He should skip the diuretic dose if he plans to leave the house. C. If he feels dizzy while on this medication, he needs to stop taking it and take potassium supplements instead. D. He needs to take extra precautions when standing up because of possible orthostatic hypotension and resulting injury from falls.

D. He needs to take extra precautions when standing up because of possible orthostatic hypotension and resulting injury from falls. Rationale: Caution must be exercised in the administration of diuretics to the older adults because they are more sensitive to the therapeutic effects of these drugs and are more sensitive to the adverse effects of diuretics, such as dehydration, electrolyte loss, dizziness, and syncope. Taking the diuretic with the evening meal may disrupt sleep because of nocturia. Doses should never be skipped or stopped without checking with the prescriber.

An older adult patient will be taking a vasodilator for hypertension. Which adverse effect is of most concern for the older adult patient taking this class of drug? A. Dry mouth B. Restlessness C. Constipation D. Hypotension

D. Hypotension Rationale: The older adult patient is more sensitive to the blood pressure-lowering effects of vasodilators, and consequently experience more problems with hypotension, dizziness, and syncope. The other options are incorrect.

A patient is taking intravenous aminophylline for a severe exacerbation of chronic obstructive pulmonary disease. The nurse will assess for which therapeutic response? A. Increased sputum production B. Increased heart rate C. Increased respiratory rate D. Increased ease of breathing

D. Increased ease of breathing Raitonale: The therapeutic effects of bronchodilating drugs such as xanthine derivatives include increased ease of breathing. The other responses are incorrect.

The nurse is providing instructions about the Advair inhaler (fluticasone propionate and salmeterol). Which statement about this inhaler is accurate? A. It is indicated for the treatment of acute bronchospasms. B. It needs to be used with a spacer for best results. C. Patients need to avoid drinking water for 1 hour after taking this drug. D. It is used for the prevention of bronchospasms.

D. It is used for the prevention of bronchospasms. Rationale: Salmeterol is a long-acting beta2 agonist bronchodilator, while fluticasone is a corticosteroid. In combination, they are used for the maintenance treatment of asthma and COPD. As a long-acting inhaler, Advair is not appropriate for treatment of acute bronchospasms. The other statements are incorrect.

For a client with chronic renal failure, the nurse MOST likely will question a prescription for which type of antacid? A. Aluminum-containing antacids B. Calcium-containing antacids C. Sodium-containing antacids D. Magnesium-containing antacids

D. Magnesium-containing antacids Magnesium-containing antacids can cause hypermagnesemia in clients with chronic renal failure. Aluminum-containing antacids may be used as a phosphate binder in clients with chronic renal failure. Sodium- and aluminum-containing antacids are chemically more easily excreted in clients with renal compromise. Although calcium-containing antacids may accumulate in the bloodstream of clients with renal failure, they may also be appropriate because these patients may be hypocalcemic.

What condition will the nurse monitor for with a client using sodium bicarbonate to treat gastric hyperacidity? A. Hypercalcemia B. Hyperkalemia C. Metabolic acidosis D. Metabolic alkalosis

D. Metabolic alkalosis Solutions containing sodium bicarbonate (a base) can cause metabolic alkalosis. Serum potassium and serum calcium would decrease, not increase, with alkalosis.

A pregnant woman is experiencing hypertension. The nurse knows that which drug is commonly used for a pregnant patient who is experiencing hypertension? A. Mannitol (Osmitrol) B. Enalapril (Vasotec) C. Hydrochlorothiazide (HydroDIURIL) D. Methyldopa (Aldomet)

D. Methyldopa (Aldomet) Rationale: Methyldopa is used in the treatment of hypertension during pregnancy. The other options are incorrect.

When assessing a patient who is receiving a loop diuretic, the nurse looks for the manifestations of potassium deficiency, which would include what symptoms? (Select all that apply.) A. Dyspnea B. Constipation C. Tinnitus D. Muscle weakness E. Anorexia F. Lethargy

D. Muscle weakness E. Anorexia F. Lethargy Rationale: Symptoms of hypokalemia include anorexia, nausea, lethargy, muscle weakness, mental confusion, and hypotension. The other symptoms are not associated with hypokalemia.

The nurse is giving intravenous nitroglycerin to a patient who has just been admitted because of an acute myocardial infarction. Which statement is true regarding the administration of the intravenous form of this medication? A. The solution will be slightly colored green or blue. B. The intravenous form is given by bolus injection. C. It can be given in infusions with other medications. D. Non-polyvinylchloride (non-PVC) plastic intravenous bags and tubing must be used.

D. Non-polyvinylchloride (non-PVC) plastic intravenous bags and tubing must be used. Rationale: The non-PVC infusion kits are used to avoid absorption and/or uptake of the nitrate by the intravenous tubing and bag and/or decomposition of the nitrate. The medication is given by infusion via an infusion pump and not with other medications. It is not given by bolus injection. If the parenteral solution is discolored blue or green, it should be discarded.

A patient is about to undergo a diagnostic bowel procedure. The nurse expects which drug to be used to induce total cleansing of the bowel. A. Docusate Sodium ( Colace) B. Lactulose (Enulose) C. Mineral Oil D. Polyethylene glycol 3350 ( GoLYTELY)

D. Polyethylene glycol 3350 ( GoLYTELY) Rationale: Polyethylene glycol is a very potent laxative that induces total cleansing of the bowel and is most commonly used before diagnostic or surgical bowel procedures.

A patient who has been on antibiotic therapy for 2 weeks has developed persistent diarrhea. The nurse expects which medication class to be ordered to treat this diarrhea? A. Lubricants B. Adsorbents C. Anticholinergics D. Probiotics

D. Probiotics Rationale: Probiotics work by replenishing bacteria that may have been destroyed by antibiotic therapy, thus restoring the balance of normal flora and suppressing the growth of diarrhea-causing bacteria.

What action is often recommended to help reduce tolerance to transdermal nitroglycerin therapy? A. Omit a dose once a week. B. Leave the patch on for 2 days at a time. C. Cut the patch in half for 1 week until the tolerance subsides. D. Remove the patch at bedtime, and then apply a new one in the morning.

D. Remove the patch at bedtime, and then apply a new one in the morning. Rationale: To prevent tolerance, remove the transdermal patch at night for 8 hours, and apply a new patch in the morning. Transdermal patches must never be cut or left on for 2 days, and doses must not be omitted.

Which nursing diagnosis is appropriate for a patient receiving famotidine (Pepcid)? A. Ineffective peripheral tissue perfusion related to hypertension B. Risk for infection related to immunosuppression C. Impaired urinary elimination related to retention D. Risk for injury related to thrombocytopenia

D. Risk for injury related to thrombocytopenia A serious side effect of famotidine is thrombocytopenia, which is manifested by a decrease in platelet count and an increased risk of bleeding. The patient receiving famotidine may experience hypotension as an adverse effect, not hypertension. Famotidine does not cause immunosuppression or urinary retention.

The nurse is teaching patients about self-injection of insulin. Which statement is true regarding injection sites? A. Avoid the abdomen because absorption there is irregular. B. Choose a different site at random for each injection. C. Give the injection in the same area each time. D. Rotate sites within the same location for about 1 week before rotating to a new location

D. Rotate sites within the same location for about 1 week before rotating to a new location Rationale: Patients taking insulin injections need to be instructed to rotate sites, but to do so within the same location for about 1 week (so that all injections are rotated in one area—for example, the right arm—before rotating to a new location, such as the left arm). Also, each injection needs to be at least to 1 inch away from the previous site.

he nurse will monitor a patient for signs and symptoms of hyperkalemia if the patient is taking which of these diuretics? A. Hydrochlorothiazide (HydroDIURIL) B. Furosemide (Lasix) C. Acetazolamide (Diamox) D. Spironolactone (Aldactone)

D. Spironolactone (Aldactone) Rationale: Spironolactone (Aldactone) is a potassium-sparing diuretic, and patients taking this drug must be monitored for signs of hyperkalemia. The other drugs do not cause hyperkalemia but instead cause hypokalemia.

The nurse is teaching a group of patients about self-administration of insulin. What content is important to include? A. Patients need to use the injection site that is the most accessible. B. If two different insulins are ordered, they need to be given in separate injections. C. When mixing insulins, the cloudy (such as NPH) insulin is drawn up into the syringe first. D. When mixing insulins, the clear (such as regular) insulin is drawn up into the syringe first.

D. When mixing insulins, the clear (such as regular) insulin is drawn up into the syringe first. Rationale: If mixing insulins in one syringe, the clear (regular) insulin is always drawn up into the syringe first. Patients always need to rotate injection sites. Mixing of insulins may be ordered.

What is the mechanism of action for Famotidine (Pepcid)? A. It forms a protective coating against gastric acid, pepsin, and bile salts. B. It competes with histamine for binding sites on the parietal cells. C. It irreversibly binds to the hydrogen-potassium-adenosine triphosphatase (ATPase) pump. D. It causes a decrease in stomach pH, reducing stomach acidity.

It competes with histamine for binding sites on the parietal cells. Histamine receptor-blocking drugs decrease gastric acid by competing with histamine for binding sites on the parietal cells.

The nurse will teach clients that antacids are effective in the treatment of hyperacidity based on which mechanism of action? A. Neutralizes gastric acid B. Decreases gastric pH C. Decreases stomach motility D. Decreases duodenal pH

Neutralizes gastric acid Antacids work by neutralizing gastric acid, which would cause an increase in pH. They do not affect gastric motility.

A young adult begins taking clonidine [Kapvay] to treat ADHD symptoms after suffering anorexia with methylphenidate [Ritalin]. What will the nurse include when teaching this patient about taking clonidine? a. "Avoid consuming alcohol while taking this medication." b. "Insomnia may still occur while taking this drug." c. "You will need to pick up a written prescription every 30 days." d. "You may crush the tablets and put them in food."

a. "Avoid consuming alcohol while taking this medication."

A nurse provides teaching for a patient about to begin taking an FGA drug for schizophrenia. Which statement by the patient indicates a need for further teaching about side effects of these drugs? a. "Dry mouth and constipation are uncommon with this medication." b. "I may experience gynecomastia and galactorrhea." c. "I may feel lightheaded or dizzy and should sit or lie down if this occurs." d. "Sedation may occur initially, but will subside in 1 to 2 weeks."

a. "Dry mouth and constipation are uncommon with this medication."

A first-time parent of a 6-week-old infant tells the nurse that she feels anxious and sad, cries a lot, and has difficulty sleeping. What will the nurse do? a. Ask her to complete the Edinburgh Postnatal Depression Scale. b. Reassure her that the "baby blues" are normal after childbirth. c. Suggest that she get more sleep and try to increase her activity. d. Suggest that she talk to her provider about using an SSRI.

a. Ask her to complete the Edinburgh Postnatal Depression Scale.

A child has been taking SD methylphenidate [Ritalin], 10 mg at 0800 and 1200 and 5 mg at 1600, for 2 months. The parents tell the nurse that the child sometimes misses the noon dose while at school. The child's appetite is normal. The teacher has reported a slight improvement in hyperactivity and impulsivity. What will the nurse do? a. Ask the prescriber whether this child could be given methylphenidate [Concerta]. b. Contact the prescriber to suggest using a nonstimulant medication. c. Reinforce the need to take all doses as prescribed. d. Suggest drug holidays for the child on weekends.

a. Ask the prescriber whether this child could be given methylphenidate [Concerta].

A patient who has been taking an SSRI tells the nurse that the drug has caused reduced sexual performance, weight gain, and sedation. The nurse will suggest that the patient ask the provider about using which drug? a. Bupropion [Wellbutrin] b. Imipramine [Tofranil] c. Isocarboxazid [Marplan] d. Trazodone [Oleptro]

a. Bupropion [Wellbutrin]

A patient is about to begin therapy with ethambutol. The nurse knows that, before initiating treatment with this drug, it is important to obtain which test(s)? a. Color vision and visual acuity b. Complete blood cell (CBC) count c. Hearing testing and a tympanogram d. Hepatic function tests

a. Color vision and visual acuity

A nurse is preparing to administer an antibiotic to a patient with methicillin-resistant Staphylococcus aureus (MRSA). The nurse would expect the healthcare provider to order which antibiotic? a. Daptomycin [Cubicin] b. Levofloxacin [Levaquin] c. Norfloxacin [Noroxin] d. Ciprofloxacin [Cipro]

a. Daptomycin [Cubicin]

A patient who is being treated for HIV infection has a 5-mm area of induration after a routine TST. The patient's chest radiograph is normal, and there are no other physical findings. The nurse will expect this patient to begin treatment with which drugs? a. Isoniazid and rifabutin b. Isoniazid and rifampin c. Isoniazid and rifapentine d. Isoniazid and pyrazinamide

a. Isoniazid and rifabutin

A patient with HIV who takes protease inhibitors develops tuberculosis and will begin treatment. Which drug regimen will be used for this patient? a. Isoniazid, pyrazinamide, ethambutol + rifabutin b. Isoniazid, pyrazinamide, ethambutol c. Isoniazid, rifampin, pyrazinamide, ethambutol d. Isoniazid + rifabutin

a. Isoniazid, pyrazinamide, ethambutol + rifabutin

A 65-year-old patient who receives glucocorticoids for arthritis is admitted to the hospital for treatment of a urinary tract infection. The prescriber has ordered intravenous ciprofloxacin [Cipro]. Before administering the third dose of this drug, the nurse reviews the bacterial culture report and notes that the causative organism is Escherichia coli. The bacterial sensitivity report is pending. The patient complains of right ankle pain. What will the nurse do? a. Withhold the dose of ciprofloxacin and notify the provider of the patient's symptoms. b. Instruct the patient to exercise the right foot and ankle to minimize the pain. c. Question the patient about the consumption of milk and any other dairy products. d. Request an order to increase this patient's dose of glucocorticoids.

a. Withhold the dose of ciprofloxacin and notify the provider of the patient's symptoms.

A patient who is receiving intravenous ciprofloxacin for pneumonia develops diarrhea. A stool culture is positive for Clostridium difficile. The nurse will expect the provider to: a. add metronidazole [Flagyl]. b. increase the dose of ciprofloxacin. c. restrict dairy products. d. switch to gemifloxacin.

a. add metronidazole [Flagyl].

A patient with high-risk factors for tuberculosis will begin therapy for latent TB with isoniazid and rifampin. The nurse learns that this patient takes oral contraceptives. The nurse will counsel this patient to discuss ____ with her provider. a. another birth control method b. reducing the rifampin dose c. reducing the isoniazid dose d. increasing the oral contraceptive dose

a. another birth control method

A patient newly diagnosed with tuberculosis asks the nurse why oral medications must be given in the clinic. The nurse will tell the patient that medications are given in the clinic so that: a. clinic staff can observe adherence to drug regimens. b. nurses can monitor for drug toxicities. c. providers can adjust doses as needed. d. the staff can ensure that the U.S. Food and Drug Administration (FDA) regulations are met.

a. clinic staff can observe adherence to drug regimens.

An older adult patient who is to begin taking imipramine [Tofranil] asks the nurse when the drug should be taken. The nurse will instruct the patient to: a. divide the daily dose into two equal doses 12 hours apart. b. take the entire dose at bedtime to minimize sedative effects. c. take the medication once daily in the late afternoon. d. take the medication once daily in the morning.

a. divide the daily dose into two equal doses 12 hours apart.

A hospitalized patient is being treated for tuberculosis with a drug regimen that includes pyrazinamide. The patient complains of pain in the knee and shoulder joints. The nurse will contact the provider to request an order for: a. ibuprofen. b. renal function tests. c. discontinuation of the pyrazinamide. d. measurement of uric acid levels.

a. ibuprofen.

A neonate is born to a patient who reports taking venlafaxine [Effexor XR]. The nurse caring for the infant will observe the infant for: a. irritability, tremor, and respiratory distress. b. poor appetite and disturbed sleeping patterns. c. serotonin syndrome. d. sustained mydriasis.

a. irritability, tremor, and respiratory distress.

A nurse and a nursing student are discussing the plan of care for a patient with schizophrenia. The patient, who has been taking a high-potency FGA for 2 months, has become restless and constantly needs to be in motion. Which statement by the student indicates a need for further education? a. "Anticholinergic medications may help control these symptoms." b. "Because this may be an exacerbation of psychosis, the provider may increase the dose of the FGA." c. "The provider may try a low-potency FGA instead of the high-potency FGA." d. "This patient may need to take a benzodiazepine or a beta blocker."

b. "Because this may be an exacerbation of psychosis, the provider may increase the dose of the FGA."

A patient will receive oral ciprofloxacin [Cipro] to treat a urinary tract infection. The nurse provides teaching for this patient. Which statement by the patient indicates a need for further teaching? a. "I may have abdominal pain and nausea, but these are usually mild." b. "I should take this medication with food or milk to improve absorption." c. "I should stop taking the medication immediately if I experience heel pain." d. "I will need to use sunscreen every time I go outdoors."

b. "I should take this medication with food or milk to improve absorption."

A patient who has diabetes mellitus is diagnosed with schizophrenia and the provider orders thioridazine. The patient asks the nurse why the provider hasn't ordered olanzapine [Zyprexa], which the patient has seen advertised on television. Which response by the nurse is the most important reason that this patient is not receiving olanzapine? a. "Olanzapine is more expensive than thioridazine." b. "Olanzapine causes more metabolic side effects than thioridazine." c. "Thioridazine has fewer side effects than olanzapine." d. "Thioridazine has a faster onset of action than olanzapine.

b. "Olanzapine causes more metabolic side effects than thioridazine."

A nurse is teaching the parents of a child who has attention-deficit/hyperactivity disorder about methylphenidate [Concerta]. Which statement by the child's parents indicates understanding of the teaching? a. "The effects of this drug will wear off in 4 to 6 hours." b. "The tablet needs to be swallowed whole, not crushed or chewed." c. "This medication has fewer side effects than amphetamines." d. "We should call the provider if we see parts of the medicine in our child's stools."

b. "The tablet needs to be swallowed whole, not crushed or chewed."

A patient is about to begin treatment for latent tuberculosis. The patient is an alcoholic, has difficulty complying with drug regimens, and has mild liver damage. What will the nurse tell this patient? a. "You must stop drinking before adequate treatment can begin." b. "You must take isoniazid with close monitoring of hepatic function." c. "You must take rifampin daily for 4 months." d. "You will begin a regimen of isoniazid and rifampin."

b. "You must take isoniazid with close monitoring of hepatic function."

Which patient should begin treatment for tuberculosis? a. A patient with HIV and a tuberculin skin test result of a 4-mm region of induration b. A recent immigrant from a country with a high prevalence of TB with a 10-mm region of induration c. A patient with no known risk factors who has a job-related tuberculin skin test result of a 12-mm area of induration d. An intravenous drug abuser with a tuberculin skin test result of a 5-mm region of induration

b. A recent immigrant from a country with a high prevalence of TB with a 10-mm region of induration

A patient has been taking fluoxetine [Prozac] for 2 years and reports feeling cured of depression. The nurse learns that the patient is sleeping well, participates in usual activities, and feels upbeat and energetic most of the time. The patient's weight has returned to normal. The patient reports last having symptoms of depression at least 9 months ago. What will the nurse tell this patient? a. Indefinite drug therapy is necessary to maintain remission. b. Discuss gradual withdrawal of the medication with the provider. c. Stop the drug while remaining alert for the return of symptoms. d. Take a drug holiday to see whether symptoms recur.

b. Discuss gradual withdrawal of the medication with the provider.

A patient who is taking a first-generation antipsychotic (FGA) drug for schizophrenia comes to the clinic for evaluation. The nurse observes that the patient has a shuffling gait and mild tremors. The nurse will ask the patient's provider about which course of action? a. Administering a direct dopamine antagonist b. Giving an anticholinergic medication c. Increasing the dose of the antipsychotic drug d. Switching to a second-generation antipsychotic drug

b. Giving an anticholinergic medication

A patient is about to begin treatment for latent tuberculosis with a short course of daily rifampin. The patient asks why rifapentine [Priftin] cannot be used, because it can be given twice weekly. What will the nurse tell this patient about rifapentine? a. It is more toxic than rifampin. b. It is not approved for treatment of latent TB. c. It is not well absorbed and thus not as effective. d. It will stain contact lenses orange.

b. It is not approved for treatment of latent TB.

A patient in whom drug therapy has failed several times in the past is readmitted to a hospital to begin therapy for schizophrenia. What will the nurse do to help improve adherence? a. Encourage the patient to take responsibility for medication management. b. Teach the patient about drug side effects and how to manage them. c. Tell the patient that an abstinence syndrome will occur if the drug is stopped. d. Tell the patient that the drug may be taken as needed to control symptoms.

b. Teach the patient about drug side effects and how to manage them.

A patient comes to a clinic for tuberculosis medications 2 weeks after beginning treatment with a four-drug induction phase. The patient's sputum culture remains positive, and no drug resistance is noted. At this point, the nurse will expect the provider to: a. change the regimen to a two-drug continuation phase. b. continue the four-drug regimen and recheck the sputum in 2 weeks. c. obtain a chest radiograph and consider adding another drug to the regimen. d. question the patient about adherence to the drug regimen.

b. continue the four-drug regimen and recheck the sputum in 2 weeks.

A provider has indicated that a serotonin/norepinephrine reuptake inhibitor (SNRI) will be prescribed for a patient who is experiencing major depression. When conducting a pretreatment health history, the nurse learns that the patient has a recent history of alcohol abuse. Which SNRI would be contraindicated for this patient? a. Desvenlafaxine [Pristiq] b. Duloxetine [Cymbalta] c. Escitalopram [Lexapro] d. Venlafaxine [Effexor SR]

b. Duloxetine [Cymbalta]

A patient taking fluoxetine [Prozac] complains of decreased sexual interest. A prescriber orders a "drug holiday." What teaching by the nurse would best describe a drug holiday? a. "Cut the tablet in half anytime to reduce the dosage." b. "Discontinue the drug for 1 week." c. "Don't take the medication on Friday and Saturday." d. "Take the drug every other day."

c. "Don't take the medication on Friday and Saturday."

A patient with schizophrenia shows suicidal behaviors, and the provider orders clozapine [Clozaril]. The nurse teaches the family about the medication and its side effects. Which statement by a family member indicates a need for further teaching about this drug? a. "Blood counts are necessary for several weeks after discontinuation of the drug." b. "Fever, sore throat, and sores in the mouth should be reported immediately." c. "If the ANC is less than 3000, the drug will be discontinued permanently." d. "Use of this drug requires weekly evaluation of blood work."

c. "If the ANC is less than 3000, the drug will be discontinued permanently."

A nurse is teaching a group of nursing students about tricyclic antidepressants (TCAs). Which statement by a student indicates a need for further teaching? a. "TCAs block receptors for histamine, acetylcholine, and norepinephrine." b. "TCAs block the uptake of norepinephrine and 5-HT." c. "TCAs have many side effects, but none of them are serious." d. "TCAs have other uses than for depression."

c. "TCAs have many side effects, but none of them are serious."

A child is diagnosed with attention-deficit/hyperactivity disorder (ADHD). The prescriber orders a central nervous system stimulant. Which statement by the child's parent indicates a need for further teaching? a. "I should report insomnia and poor appetite to his provider." b. "I will make sure he takes his medication after breakfast every day." c. "This drug will make him less impulsive while he's at school." d. "This medication will help my child focus so he can learn new behaviors."

c. "This drug will make him less impulsive while he's at school."

A healthcare worker who is asymptomatic has a screening TST result of 10 mm of induration during a pre-employment physical. What will the nurse reading this test tell the patient? a. "This is a negative test, so you are cleared for employment." b. "You have latent TB and will need to take isoniazid for 6 to 9 months." c. "You need to have a chest radiograph and a sputum culture." d. "You will begin taking a four-drug regimen to treat tuberculosis."

c. "You need to have a chest radiograph and a sputum culture."

A patient with schizophrenia receives a dose of risperidone [Risperdal Consta] IM. The nurse teaching this patient about this medication will make which statement? a. "You will experience therapeutic levels of this drug in 1 to 2 weeks." b. "You will need injections of this drug every 6 weeks." c. "You will need to take an oral antipsychotic drug for 3 weeks." d. "You probably will not have extrapyramidal symptoms with this drug."

c. "You will need to take an oral antipsychotic drug for 3 weeks."

A patient has been taking an SSRI antidepressant for major depression and reports having headaches and jaw pain. What will the nurse tell the patient? a. This represents an irreversible extrapyramidal side effect. b. Discuss discontinuing the antidepressant with the provider. c. Discuss these symptoms with a dentist. d. Try stress-relieving methods and relaxation techniques.

c. Discuss these symptoms with a dentist.

A patient whose spouse has died recently reports feeling down most of each day for the past 2 months. On further questioning, the nurse learns that the patient has quit participating in church and social activities, has difficulty falling asleep, and has lost 5 pounds. The patient reports feeling tired and confused all the time but does not have suicidal thoughts. What does the nurse suspect? a. Grief and sadness b. Hypomania c. Major depression d. Situational depression

c. Major depression

A patient with schizophrenia has been taking an antipsychotic drug forcfrv several days. The nurse enters the patient's room to administer a dose of haloperidol [Haldol] and finds the patient having facial spasms. The patient's head is thrust back, and the patient is unable to speak. What will the nurse do? a. Administer the haloperidol as ordered. b. Discuss increasing the haloperidol dose with the provider. c. Request an order to give diphenhydramine. d. Request an order to give levodopa.

c. Request an order to give diphenhydramine.

A patient with schizophrenia has been taking an oral FGA for 1 week. The patient has been taking the drug daily in two divided doses. The individual complains of daytime drowsiness. The patient's family reports a decrease in the person's hostility and anxiety but states that the patient remains antisocial with disordered thinking. What will the nurse tell the patient and the family? a. An increased dose of the drug may be needed. b. Intramuscular dosing may be needed. c. Some symptoms take months to improve. d. The entire dose may be taken at bedtime.

c. Some symptoms take months to improve.

A woman who is nursing a newborn develops postpartum depression and her provider orders sertraline [Zoloft] to treat her symptoms. The patient is concerned about the safety of this medication for her infant. What will the nurse tell her about this medication? a. To stop nursing while taking the medication b. To expect symptoms of colic and poor weight gain in the baby c. That sertraline is safer than other antidepressants for nursing mothers d. To ask her provider about switching to fluoxetine [Prozac] instead

c. That sertraline is safer than other antidepressants for nursing mothers

A patient taking an MAOI is seen in the clinic with a blood pressure of 170/96 mm Hg. What will the nurse ask this patient? a. Whether any antihypertensive medications are used b. Whether the patient drinks grapefruit juice c. To list all foods eaten that day d. Whether SSRIs are taken in addition to the MAOI

c. To list all foods eaten that day

A child will begin taking methylphenidate [Ritalin] for attention-deficit/hyperactivity disorder. Important baseline information about this patient will include: a. results of an electrocardiogram (ECG). b. family history of psychosis. c. height and weight. d. renal function.

c. height and weight.

A young adult patient has been taking an antidepressant medication for several weeks and reports having increased thoughts of suicide. The nurse questions further and learns that the patient has attempted suicide more than once in the past. The patient identifies a concrete plan for committing suicide. The nurse will contact the provider to discuss: a. changing the medication to another drug class. b. discontinuing the medication immediately. c. hospitalizing the patient for closer monitoring. d. requiring more frequent clinic visits for this patient.

c. hospitalizing the patient for closer monitoring.

A patient has been taking isoniazid [Nydrazid] for 4 months for latent tuberculosis. The patient reports bilateral tingling and numbness of the hands and feet, as well as feeling clumsy. The nurse expects the provider to: a. discontinue the isoniazid. b. lower the isoniazid dose and add rifampin. c. order pyridoxine 100 mg per day. d. recheck the tuberculin skin test to see whether it worsens.

c. order pyridoxine 100 mg per day.

A patient who has fibromyalgia is diagnosed with major depression. The provider orders a TCA. The nurse will teach this patient to: a. avoid foods containing tyrosine. b. consume alcohol in moderation. c. sit or lie down when feeling lightheaded. d. take the medication in the morning.

c. sit or lie down when feeling lightheaded.

6. A patient will be receiving a thrombolytic drug as part of the treatment for acute myocardial infarction. The nurse explains to the patient that this drug is used for which purpose? a. To relieve chest pain b. To prevent further clot formation c. To dissolve the clot in the coronary artery d. To control bleeding in the coronary vessels

c. to dissolve the clot

A nurse caring for a patient who is undergoing a third round of chemotherapy is preparing to administer ondansetron [Zofran] 30 minutes before initiation of the chemotherapy. The patient tells the nurse that the ondansetron did not work as well the last time as it had the first time. What will the nurse do? a.Administer the ondansetron at the same time as the chemotherapy. b.Contact the provider to suggest using high-dose intravenous dolasetron [Anzemet]. c.Request an order to administer dexamethasone with the ondansetron. d.Suggest to the provider that loperamide [Lomotil] be given with the ondansetron.

c.Request an order to administer dexamethasone with the ondansetron. The drug is even more effective when combined with dexamethasone. Ondansetron is a serotonin receptor antagonist; drugs in this class are the most effective drugs available for suppressing nausea and vomiting associated with anticancer drugs. For best effect, Ondansetron should be given 30 minutes before beginning chemotherapy. Dolasetron is similar to ondansetron, but when given intravenously in high doses, it is associated with fatal dysrhythmias. Loperamide is used to treat diarrhea

A nurse working the night shift begins taking modafinil [Alertec]. The nurse is telling a coworker about the medication. Which statement is correct? a. "I can take it during pregnancy." b. "It doesn't have cardiovascular side effects." c. "It is safe and has no serious adverse effects." d. "It will not interfere with my normal sleep."

d. "It will not interfere with my normal sleep."

A patient who has drug-sensitive tuberculosis has completed 2 months of the standard four-drug therapy and asks the nurse how long he will have to take medication. Which response by the nurse is correct? a. "As long as you remain symptomatic, you will not have to take more medication." b. "The four-drug regimen will continue for 3 more months." c. "You will have to take maintenance drugs indefinitely." d. "You will need to take only two drugs for the next 4 months."

d. "You will need to take only two drugs for the next 4 months."

A patient is beginning treatment for active tuberculosis (TB) in a region with little drug-resistant TB. Which treatment regimen will be used initially? a. Isoniazid and pyrazinamide b. Isoniazid, pyrazinamide, and ethambutol c. Rifampin, pyrazinamide, and ethambutol d. Isoniazid, rifampin, pyrazinamide, and ethambutol

d. Isoniazid, rifampin, pyrazinamide, and ethambutol

A university student who is agitated and restless and has tremors is brought to the emergency department. The patient's heart rate is 110 beats per minute, the respiratory rate is 18 breaths per minute, and the blood pressure is 160/95 mm Hg. The patient reports using concentrated energy drinks to stay awake during finals week. What complication will the nurse monitor for in this patient? a. CNS depression b. Cardiac arrest c. Respiratory failure d. Seizures

d. Seizures

The nurse is caring for a patient who will begin receiving intravenous ciprofloxacin [Cipro] to treat pyelonephritis. The nurse learns that the patient has a history of myasthenia gravis. Which action by the nurse is correct? a. Administer the ciprofloxacin and monitor the patient for signs of muscle weakness. b. Ask the provider whether the ciprofloxacin can be given orally. c. Request an order for concurrent administration of metronidazole [Flagyl]. d. Suggest that the provider order a different antibiotic for this patient.

d. Suggest that the provider order a different antibiotic for this patient.

A patient is taking an FGA for schizophrenia. The nurse notes that the patient has trouble speaking and chewing and observes slow, wormlike movements of the patient's tongue. The nurse recognizes which adverse effect in this patient? a. Acute dystonia b. Akathisia c. Parkinsonism d. Tardive dyskinesia

d. Tardive dyskinesia

An adult patient will begin taking atomoxetine [Strattera] for attention-deficit/hyperactivity disorder. What will the nurse teach this patient? a. Appetite suppression does not occur, because this drug is not a stimulant. b. Stopping the drug abruptly will cause an abstinence syndrome. c. Suicidal thoughts may occur and should be reported to the provider. d. Therapeutic effects may not be felt for 1 to 3 weeks after beginning therapy.

d. Therapeutic effects may not be felt for 1 to 3 weeks after beginning therapy.

A nurse is preparing to administer oral ofloxacin to a patient. While taking the patient's medication history, the nurse learns that the patient takes warfarin and theophylline. The correct action by the nurse is to request an order to: a. reduce the dose of ofloxacin. b. increase the dose of ofloxacin. c. increase the dose of theophylline. d. monitor coagulation levels.

d. monitor coagulation levels.

A patient is about to begin treatment with isoniazid. The nurse learns that the patient also takes phenytoin [Dilantin] for seizures. The nurse will contact the provider to discuss: a. increasing the phenytoin dose. b. reducing the isoniazid dose. c. monitoring isoniazid levels. d. monitoring phenytoin levels.

d. monitoring phenytoin levels.

A patient who is taking drugs to treat HIV has tuberculosis and has been on a four-drug regimen for 3 months without improvement in symptoms. Which drug will the nurse anticipate that the provider will add to this patient's regimen? a. bedaquiline [Sirturo] b. capreomycin [Capastat Sulfate] c. ethionamide [Trecator] d. pyridoxine

d. pyridoxine

A nurse reads a tuberculin skin test on a patient and notes a 6- to 7-mm area of induration. The patient is a young adult who has recently immigrated from a country with a high prevalence of tuberculosis. The patient has no other risk factors. The nurse will expect the provider to: a. begin treating this patient with a two-drug regimen of isoniazid and rifampin. b. order a chest radiograph and a sputum culture to assess for active tuberculosis. c. order a nucleic acid amplification test of the patient's sputum. d. reassure the patient that this is not considered a positive test result.

d. reassure the patient that this is not considered a positive test result.

A provider orders intravenous moxifloxacin [Avelox] for a patient who has sinusitis. Before administering the drug, the nurse will review this patient's chart for: a. a history of asthma. b. concurrent use of digoxin. c. concurrent use of warfarin. d. recent serum electrolyte levels.

d. recent serum electrolyte levels.

A patient who has been taking a monoamine oxidase inhibitor (MAOI) for depression for several months tells the provider that the medication has not helped with symptoms. The provider plans to switch the patient to an SSRI. The nurse will teach this patient to: a. start taking the SSRI and stop the MAOI when symptoms improve. b. start taking the SSRI and then gradually withdraw the MAOI. c. stop taking the MAOI and wait 5 weeks before starting the SSRI. d. stop taking the MAOI 2 weeks before starting the SSRI.

d. stop taking the MAOI 2 weeks before starting the SSRI.

A patient who is taking calcium supplements receives a prescription for ciprofloxacin [Cipro] for a urinary tract infection. The nurse will teach this patient to: a. consume extra fluids while taking the ciprofloxacin to prevent hypercalciuria. b. stop taking the calcium supplements while taking the ciprofloxacin. c. take the two medications together to increase the absorption of both. d. take the calcium either 6 hours before or 2 hours after taking the ciprofloxacin.

d. take the calcium either 6 hours before or 2 hours after taking the ciprofloxacin.

A patient taking an FGA medication develops severe parkinsonism and is treated with amantadine [Symmetrel]. The amantadine is withdrawn 2 months later, and the parkinsonism returns. The nurse will expect the provider to: a. give anticholinergic medications. b. make a diagnosis of idiopathic parkinsonism. c. resume the amantadine indefinitely. d. try a second-generation antipsychotic (SGA).

d. try a second-generation antipsychotic (SGA).

A patient is diagnosed with major depression with severe symptoms and begins taking an antidepressant medication. Three weeks after beginning therapy, the patient tells the nurse that the drug is not working. The nurse will counsel this patient to ask the provider about: a. adding a second medication to complement this drug. b. changing the medication to one in a different drug class. c. increasing the dose of this medication. d. using nondrug therapies to augment the medication.

d. using nondrug therapies to augment the medication.