Final Exam Study Questions

ANS: 4 Want 2 g (2000 mg), Have 500 mg/tablet. 2000/500 = 4.

An adult who has adrenal gland hyperfunction is prescribed to receive 2 g of mitotane (Lysodren) orally immediately. The drug on hand is mitotane 500 mg/scored tablet. How many tablets should you prepare to give?

ANS: C A major adverse effect of ribavirin is that it is a teratogen, an agent that has a very high likelihood of increasing the risks for birth defects and fetal damage. It should not be given to pregnant or breastfeeding women, and it should not be handled or inhaled by anyone who is pregnant.

A 2-year-old patient with respiratory syncytial virus is prescribed aerosolized ribavirin (Virazole). Which visitor should you ensure is not in the patient's room during the aerosol treatments? a. 16-year-old brother b. 81-year-old grandmother c. 32-year-old pregnant mother d. 36-year-old father who has diabetes

ANS: B Want 25 mg, Have 50 mg/tablet. 25 mg/50 mg = tablet.

A 10-year-old child is prescribed cyclizine (Marezine) 25 mg orally for motion sickness. The drug is available as a 50 mg tablet. How many tablets should you instruct the parents to give the child? a. One fourth b. One half c. Two d. Four

ANS: 50 110 lb/2.2 = 50 kg. 4 mg 50 kg = 200 mg/day. 200 mg/4 doses/day = 50 mg/dose IV.

A 12-year-old child is prescribed a total daily IV dose of ranitidine (Zantac) 4 mg/kg/day. The child weighs 110 lb. The total dose is to be divided into four doses to be given every 6 hours. How many milligrams will you give for each dose?

ANS: D Maraviroc prevents cellular infection by blocking the CCR5 receptor on CD4+ T cells. Because this drug is not effective against all HIV subtypes, the patient must first be tested to ensure that his or her HIV infection is likely to respond to this therapy. When the HIV subtype does not use the CCR5 receptor, the drug is not prescribed for that patient.

A 40-year-old patient infected with human immunodeficiency virus (HIV) asks why the new drug maraviroc (Selzentry) is not being prescribed for her. What is your best response? a. "This drug is very expensive and your insurance may not cover it." b. "This drug can cause birth defects and should not be prescribed for anyone who is pregnant or might become pregnant." c. "This drug is very toxic to the heart and lungs. It is prescribed only for patients who are young and have no other health problems." d. "This drug is not effective against all HIV subtypes and the HIV causing your infection does not have the target for this drug."

ANS: 0.7 1 kg = 2.2 lb The child's weight in kilogram is 14.54 (32 lb/2.2 = 14.54 kg). The correct dose is 72.7 mcg (5 mcg 14.54 kg). The drug has a concentration of 100 mcg/mL. Divide the dose you want (72.7 mcg) by the dose you have (100 mcg/mL), which equals 0.727 mL. Round down to 0.7 mL.

A 6-year-old child is being started on levothyroxine (Synthroid) intravenously and is prescribed 5 mcg/kg. The child weighs 32lb. The drug vial contains 100 mcg/mL. How many milliliters should you draw up for a correct dose?

ANS: B Although all of these values are abnormal, only the potassium level is dangerously out of the normal range (it is low, indicating hypokalemia; normal is 3.5 to 5 mEq/L). Abnormal potassium levels change the effectiveness of digoxin. In the case of hypokalemia, the sensitivity of the cardiac muscle membrane is increased to the effects of digoxin. This means that the risk for toxicity is greatly increased. The prescriber will probably order a digoxin level and lower the dosage of the drug. The patient is also at risk for cardiac rhythm changes.

A 70-year-old patient who has been taking digoxin (Lanoxin) for 4 years has all of the following laboratory blood tests. For which test value should you notify the prescriber immediately? a. Sodium (Na) 132 mEq/L b. Potassium (K) 2.1 mEq/L c. Blood urea nitrogen (BUN) 9 mg/dL d. International normalized ratio (INR) 1.5

ANS: C Want 120 mg in X mL/Have 10 mg in 1 mL. 120/10 = 12 mL = 120 mg.

A child is prescribed emtricitabine (Emtriva) 120 mg orally. The drug on hand is emtricitabine suspension 10 mg/mL. How many milliliters do you prepare for a correct dose? a. 2 b. 6 c. 12 d. 20

ANS: 8 Want 8 mg/X mL, Have 5 mg/5 mL = 1.6 5 mL = 8 mL.

A child is prescribed metoclopramide (Reglan) 8 mg by oral solution. The available drug solution is 5 mg/5 mL of solution. How many milliliters does the nurse administer?

ANS: 105.7 1 kg = 2.2 lb. Child's weight in kilogram is 18.18 (40/2.2 = 18.18). 7 mg 18.18 kg = 127.26 mg round to 127.3 mg. Determine how many milligrams are in 1 mL by dividing 50 mg by 60 mL, which equals 1 mg in 0.83 mg/ mL. Multiply 127.3 mg by 0.83 mL, which equals 105.65 mL, round up to 105.7 mL.

A child who is HIV positive and weighs 40 lb is prescribed to receive atazanavir (Reyataz) at a dose of 7 mg/kg. The drug on hand is a premixed oral suspension of 50 mg/60 mL. How many milliliters will you prepare as the correct dose?

ANS: 2 1 kg = 2.2 lb. Child's weight in kilogram is 48/2.2, which is 21.8 kg. 0.1 mg 21.8 kg = 2.18 mg, rounded up to 2.2 mg. Want 2.2 mg/X tablets, Have 1 mg/scored tablet. 2.2/1 = 2.2 tablets. You cannot cut a scored tablet into less than 0.5 tablet. Therefore, the dose must be rounded down to 2 tablets.

A child who weighs 48 lb has been ordered warfarin (Coumadin) 0.1 mg/kg. The available drug is 1 mg/scored tablet. How many tablets will you give this child?

ANS: C There are many different dosage strengths for this drug, including both 20 and 40 mg tablets. The patient is right to question a dose that seems different from what is taken at home. You know that the drug available on the hospital unit is available as lovastatin 20 mg tablets and should reassure the patient by explaining the differences in tablet content. If further evidence is needed to completely reassure the patient, you can provide the drug container.

A hospitalized patient who is prescribed lovastatin (Mevacor) 80 mg orally looks at the four tablets you provides and says, "At home, I only take two pills for 80 mg. I think this is too many pills." What is your best action? a. Hold the dose and contact the prescriber or pharmacist to confirm that the order is correct. b. Remind the patient that the prescriber knows what is best for his or her particular health problem. c. Explain that each tablet contains 20 mg of the drug instead of 40 mg, and that four 20 mg tablets are the same dosage as two 40 mg tablets. d. Explain to the patient that while at home a lower dosage of the drug may have been prescribed than what is required while being hospitalized.

ANS: C Antiretroviral drugs for HAART are recommended to be taken by pregnant women who are known to be HIV positive because the virus can cross the placenta and infect the fetus. These drugs, when taken as prescribed, can reduce the chances of fetal infection from about 30% to about 8%. Dosages are based on the woman's viral load, not on weight or pregnancy status.

A human immunodeficiency virus (HIV)-positive patient taking highly active antiretroviral therapy informs you that she is now pregnant. What advice regarding drug therapy do you give this patient? a. "Stop taking these drugs for your entire pregnancy." b. "Stop taking these drugs for the first trimester and start again for the second and third trimesters." c. "Continue to take these drugs throughout your pregnancy exactly as they have been prescribed." d. "It will be necessary to double your dosages of these drugs to ensure your unborn baby is adequately protected."

ANS: A Breast enlargement in men (gynecomastia) is a common side effect of isoniazid. This physical change can be very distressing and embarrassing to men, and they should be reassured that the problem is temporary. Even though it is distressing, breast enlargement is not a reason to stop drug therapy.

A male patient who has been prescribed isoniazid (INH, Nydrazid) reports that his breasts have enlarged since starting therapy. What is your best response? a. "This is common with isoniazid and will disappear after you stop drug therapy." b. "Is the enlargement the same on both sides or is one breast larger than the other?" c. "If you are not having difficulty getting an erection, do not worry about this change." d. "I will report this problem to your prescriber and see if it is possible for you to stop taking this drug."

ANS: D This WBC count is lower than normal. Terbinafine and flucytosine (Ancobon) can further reduce this patient's WBC count and greatly increase his or her risk for infection.

A patient about to start systemic antifungal therapy has a white blood cell (WBC) count of 3200 cells/mm3. Which antifungal drug must be avoided for this patient? a. Fluconazole (Diflucan) b. Ketoconazole (Nizoral) c. Micafungin (Mycamine) d. Terbinafine (Lamisil)

ANS: B Anticoagulant drugs are sometimes called "blood thinners" but they do not thin the blood, prevent clots from migrating, or dissolve existing clots. These drugs prevent new clots from forming and prevent existing clots from becoming larger.

A patient asks why an anticoagulant has been prescribed. What is your best response? a. "It will dissolve any clots in your blood vessels." b. "It will prevent any new clots from forming." c. "It will prevent a clot from migrating." d. "It will thin your blood."

ANS: D Because these drugs increase blood cell production, the blood becomes more viscous (thicker). This effect raises blood pressure, increases clot formation, and slows blood movement through small vessels. This patient is hypertensive, so the next dose of darbepoetin can increase the pressure to dangerous levels and greatly increase the risk for stroke and heart attack. The drug should not be administered until the patient's blood pressure is in the normal range.

A patient coming to the clinic for a weekly infusion of darbepoetin alpha (Aranesp) has all of the following changes. For which change should you hold the dose of the drug? a. Weight loss of 5 lb b. Hemoglobin increase from 8 to 10 g/dL c. Blood potassium increase from 3.8 to 4.8 mEq/L d. Blood pressure increase from 126/80 to 148/92 mm Hg

ANS: C Assess a patient's ability to swallow before giving drugs for Alzheimer's disease because he or she may be at risk for aspiration.

A patient diagnosed with probable Alzheimer's disease is having his swallowing ability tested. His wife asks you why this is necessary. What is your best response? a. "This is a routine assessment that is completed for every patient." b. "The prescriber ordered this test to be done to prevent side effects of a new drug for your husband's disease." c. "This test tells us where your husband's swallowing is now, because it may get worse as his disease progresses." d. "We are concerned about whether we will need to place a feeding tube to give his medications."

ANS: 8.5 1 kg = 2.2 lb, Divide the patient's weight in pounds (186) by 2.2 to get 84.5 kg. Multiply 84.5 kg by 1 mg to get 84.5 mg. Divide 84.5 mg by 10 mg to get 8.45 mL, round up to 8.5 mL.

A patient for whom other drugs have failed to control his chemotherapy induced nausea/vomiting is prescribed to receive metoclopramide (Reglan) 1 mg/kg intravenously right before he receives chemotherapy. He weighs 186 lb. The available drug is metoclopramide 10 mg/mL. How many milliliters should you prepare for the correct dose?

ANS: C A dry mouth is an expected response to atropine, which inhibits oral secretions. You should also offer the patient the opportunity to brush his or her teeth and rinse the mouth; however, the first action is to relieve the patient's concerns about this side effect.

A patient given atropine (atropine sulfate) intravenously as a one-time dose for bradycardia now reports a very dry mouth. What is your best response? a. Notify the prescriber immediately. b. Document the report as the only action. c. Reassure the patient that this is a normal drug response. d. Offer the patient the opportunity to brush his or her teeth and rinse the mouth.

ANS: A Warfarin therapy increases the INR, which normally ranges between 0.7 and 1.8. Therapeutic warfarin levels should maintain the INR between 2.0 and 3.0. When the effects of warfarin are no longer present, the INR returns to normal levels. Warfarin therapy does not affect white blood cell count, serum ferritin levels, or the reticulocyte count.

A patient has been discontinued from warfarin (Coumadin) therapy for 3 weeks. Which laboratory test indicates that all effects of the warfarin have been eliminated? a. International normalized ratio (INR) of 0.9 b. Red blood cell count of 5 million/mm3 c. Hemoglobin of 16 g/dL d. Hematocrit of 42%

ANS: A All of these values are abnormal; however, only the RBC count is seriously out of the normal range. One of the most serious adverse effects of rifampin (a major part of first-line drug therapy for TB) is suppression of RBC production, leading to anemia. This patient's RBC level is only about half of normal.

A patient has been prescribed all four first-line drugs for tuberculosis (TB). Which laboratory blood value is most important to report to the prescriber first? a. Red blood cells (RBCs) 2.2 million/mm3 b. International normalized ratio 1.6 c. White blood cells 6000/mm3 d. Sodium 134 mEq/L

ANS: C The total cholesterol, triglyceride, and HDL levels are all within the normal range. The LDL level is high and should be reported to the prescriber because a high level increases the patient's risk for atherosclerosis.

A patient has been prescribed an antihyperlipidemic drug. Which laboratory value should you report to the prescriber? a. Total cholesterol 198 mg/dL b. Triglycerides 135 mg/dL c. Low-density lipoprotein (LDL) 195 mg/dL d. High-density lipoprotein (HDL) 60 mg/dL

ANS: B, C, E Rasagiline is an MAO-B inhibitor. Patients must be taught to avoid foods with tyramine, an amino acid that can cause a hypertensive crisis when patients are taking these drugs. Examples of such foods are aged cheeses, sour cream, and soy sauce (see Box 23-2 in the text).

A patient has been prescribed rasagiline (Azilect). Which foods should you teach the patient to avoid? (select all that apply) a. Green leafy vegetables b. Aged cheeses c. Sour cream d. Fresh apples and pears e. Soy sauce f. Chicken and beef

ANS: C Protease inhibitors suppress viral replication and release. They do not kill the virus, and currently no therapy for HIV infection kills the virus. The patient needs to understand that even on antiretroviral therapy, the disease can be spread through exchange of body fluids and precautions still must be taken.

A patient has human immunodeficiency virus (HIV) disease and is taking a "cocktail" consisting of protease inhibitors, nucleoside analogue reverse-transcriptase inhibitors, and nonnucleoside analogue reverse-transcriptase inhibitors. Which statement made by the patient indicates that more teaching about the drug therapy is needed? a. "Using three drugs at the same time enhances suppression of viral replication." b. "There is no problem using these drugs during the last trimester of my pregnancy." c. "Because this drug combination kills HIV, I do not need to worry about transmitting the virus." d. "If the virus becomes resistant to this cocktail, another combination of drugs may be required to reduce my viral load."

ANS: A When an ischemic stroke occurs there is an existing clot in an artery in the brain. To resolve this problem early after symptoms develop, a thrombolytic drug (clot buster) is prescribed. These drugs must be administered within 3 hours of the onset of symptoms for stroke. Thrombin inhibitors and clotting factor synthesis inhibitors prevent new clots from forming and existing clots from getting larger. Antiplatelet drugs prevent platelets from clumping together (aggregating).

A patient in the emergency department developed stroke symptoms 1 hour ago. Which type of drug should you expect to prepare to resolve this problem? a. Thrombolytic b. Thrombin inhibitor c. Antiplatelet drug d. Clotting factor synthesis inhibitor

ANS: A A major advantage of using low-molecular-weight heparins such as enoxaparin is that patients are not required to have laboratory work done to guide their therapy. The drug is given two times daily subcutaneously. Its purpose is to prevent venous thromboembolic events and pulmonary embolism.

A patient is being discharged on enoxaparin (Lovenox). Which statement should you include in the discharge teaching plan? a. "An advantage of this drug is that labs do not need to be drawn to guide therapy." b. "Follow-up lab work must be drawn every 2 to 6 months." c. "Enoxaparin is given intramuscularly twice a day." d. "The purpose of this drug is to dissolve clots."

ANS: 0.75 Want 15000 units/X mL, Have 20,000 units/1 mL; 15,000/20,000 = 0.75 1 mL = 0.75 mL.

A patient is prescribed 15,000 units/mL of heparin subcutaneously. The drug on hand is heparin 20,000 units/mL. How many milliliters should you administer? _____ mL

ANS: 4 Want 300 mg/X tablets, Have 75 mg/tablet. 300/75 = 4 tablets.

A patient is prescribed 300 mg of oral clopidogrel (Plavix) as a first dose. The drug on hand is clopidogrel 75 mg. How many tablets should you give?

ANS: C Want 420 mg/Have 60 mg in 1 mL. 420/60 = 7 mL.

A patient is prescribed 420 mg of rifampin to be added to 500 mL of dextrose 5% in water (D5W). The vial contains rifampin 60 mg/mL. How many milliliters should you add to the D5W for the correct? a. 0.16 mL b. 5mL c. 7mL d. 8mL

ANS: 0.5 Because the milliliter concentration of the drug is known, divide 45 mg by 90 mg, which is 0.5 mL.

A patient is prescribed 45 mg of enfuvirtide by subcutaneous injection. The available drug is a premixed solution of enfuvirtide with a concentration of 90 mg/mL.

ANS: A 500 mL/6 = 83.3 mL/h. 83.3 mL/60 minutes = 1.38 mL/min. Round up to 1.4 mL/min.

A patient is prescribed 50 mg of amphotericin B (Fungizone) by intravenous infusion in 500 mL of dextrose 5% in water (D5W) over 6 hours. How many milliliters (mL) per minute should you set the pump to infuse? a. 1.4 mL b. 2.2 mL c. 4.2 mL d. 6.2 mL

ANS: D An order for Zocor (simvastatin) may be confused with Cozaar (losartan). Zocor is a lipid-lowering statin, whereas Cozaar is a blood pressure-lowering angiotensin II receptor antagonist.

A patient is prescribed Cozaar (losartan) 25 mg orally for hyperlipidemia. What is your best action? a. Administer the drug as ordered. b. Check that the dosage is correct. c. Always give the drug early in the morning. d. Hold the drug and contact the prescriber.

ANS: D Rapid administration of IV amphotericin B is associated with more severe rigors, hyperkalemia, and a more rapid onset of renal insufficiency. It is recommended that the drug be administered over a 6-hour time period regardless of the dose.

A patient is prescribed amphotericin B (Fungizone) 400 mg intravenously. How fast should you infuse this drug? a. Immediately by intravenous (IV) push b. Over a period of 60 minutes c. Over a period of 2 hours d. Over a minimum of 6 hours

ANS: B Want 1600 mg/X tablets, Have 400 mg/1 tablet; 1600/400 = 4 tablets.

A patient is prescribed an oral loading dose of amiodarone (Cordarone) 1600 mg. Amiodarone is available in 400 mg tablets. How many tablets should you give? a. 2 b. 4 c. 6 d. 8

ANS: A Bile acid sequestrants inhibit absorption of fat-soluble vitamins (A, D, E, and K), so patients may need to take a daily vitamin supplement. Bile acid sequestrants may change the action of the anticoagulant warfarin (Coumadin) in two ways. They can decrease the absorption of vitamin K which would intensify (increase) the effects of warfarin and increase the risk of bleeding. If administering a bile acid sequestrant to a patient who is also taking warfarin, be prepared to administer vitamin K, which is the antidote for warfarin. Bile acid sequestrants can also directly bind warfarin in the intestinal tract and cause its rapid elimination.

A patient is prescribed cholestyramine (Questran) is also taking warfarin (Coumadin). For which specific action should you be prepared? a. To administer IV vitamin K b. To ask the patient about diarrhea c. To keep accurate intake and output records d. To teach the patient about the need for a fat-free diet

ANS: B Need 1875 mg/X tablets, Have 625 mg/1 tablets. 1875/625 = 3 tablets.

A patient is prescribed colesevelam (WelChol) 1875 mg twice a day. Available tablets are 625 mg each. How many tablets should you administer to the patient for each dose? a. 2 b. 3 c. 4 d. 5

ANS: D Digoxin can cause a decrease in heart rate. You must check the apical heart rate for a full minute before giving this drug. If the heart rate is less than 60 beats/min, hold the drug and notify the prescriber.

A patient is prescribed digoxin. The patient's apical heart rate is 58 beats/min. What is your best action? a. Give the drug as ordered. b. Document the finding because this is an expected effect of the drug. c. Recheck the heart rate and blood pressure after 30 minutes. d. Hold the drug and notify the prescriber.

ANS: D Donepezil is an acetylcholinesterase inhibitor. This drug may cause GI bleeding. Monitor the patient carefully for any signs of bleeding. Monitor emesis and stools for blood.

A patient is prescribed donepezil (Aricept) for Alzheimer's disease. What assessment is most important after giving this drug? a. Blood pressure b. Bowel sounds c. Peripheral pulses d. Signs of bleeding

ANS: B Have 200 mg/1 tablet, Want 800 mg/X tablets; 800/200 = 4 tablets.

A patient is prescribed entacapone (Comtan) 800 mg/day. The drug is available in 200 mg tablets. How many tablets should you give? a. 2 b. 4 c. 6 d. 8

ANS: B Acyclovir reduces the effectiveness of phenytoin, a drug that is used to prevent seizures. The prescriber may need to adjust the phenytoin dosage while the patient is on antiviral therapy.

A patient is prescribed intravenous (IV) acyclovir (Zovirax). Which question is most important to ask before giving the first dose of this drug? a. "Do you have a hearing problem or any trouble with your ears?" b. "Do you take medications for seizures?" c. "Are you allergic to sulfa drugs?" d. "Have you ever had asthma?"

ANS: A Adenosine slows electrical impulse conduction through the AV node. It is always given rapidly by IV push (1 to 2 seconds). After the drug is given, there is usually a very brief period of asystole (when the heart stops beating) before the heart resumes a normal rhythm. Because of this, emergency equipment must be available at the patient's bedside before the drug is given.

A patient is prescribed intravenous (IV) adenosine (Adenocard) for treatment of supraventricular tachycardia. Which safety precaution is most important to perform before this drug is administered? a. Bring the crash cart and defibrillator to the patient's bedside. b. Make sure that all four bed side rails are in the upright position. c. Place the patient's bed in the lowest position. d. Continuously monitor blood pressure.

ANS: D Taking a thyroid hormone agonist drug with food or with a fiber supplement reduces the absorption of the drug. Teach patients to take it 2 to 3 hours before a meal or taking a fiber supplement or at least 3 hours after a meal or taking the supplement.

A patient is prescribed levothyroxine (Synthroid) and a fiber supplement. What key point would you be sure to teach the patient about these drugs? a. "Take the drugs together as there are no interactions between them." b. "Be sure to take the fiber supplement 2 hours before a meal and the levothyroxine 3 hours after a meal." c. "Take the fiber supplement in the morning with breakfast and the levothyroxine in the evening before you go to bed." d. "Do not take the drugs together because a fiber supplement will decrease the absorption of your levothyroxine."

ANS: D Want 25 mcg/X mL, Have 100 mcg/1 mL; 25/100 = 0.25 1 mL = 0.25 mL.

A patient is prescribed levothyroxine 25 mcg by IV push. The drug on hand is levothyroxine sodium 100 mcg/mL. How many milliliters should you administer? a. 2.5 b. 1 c. 0.5 d. 0.25

ANS: C Never substitute one type or brand of thyroid hormone replacement drug with another. Drug strengths vary (e.g., liothyronine is four times as potent as levothyroxine), and patient responses vary.

A patient is prescribed levothyroxine sodium (Synthroid) 25 mcg orally once a day. The pharmacy sends liothyronine sodium (Cytomel) 25 mcg. What is your best action? a. Give the drug as sent from the pharmacy. b. Contact the nurse manager for advice. c. Call the pharmacy to send the correct drug. d. Explain to the patient that both drugs are thyroid hormone agonists.

ANS: C Niaspan is an extended-release form of niacin that is taken once a day. Niacor is an immediate-release form of niacin. Immediate-release niacin should not be substituted for extended-release niacin. Additionally, extended-release niacin should be swallowed whole and never crushed or chewed because this causes immediate release of the entire drug dose and could lead to overdose.

A patient is prescribed niacin (Niaspan) 500 mg orally. The pharmacy sends niacin (Niacor) 500 mg. What is your best action? a. Hold the drug and contact the prescriber. b. Administer the Niacor in place of the Niaspan. c. Ask the pharmacy to send the patient's ordered Niaspan. d. Check the patient's chart to find out if he or she takes Niacor at home.

ANS: D Side effects rarely occur with PPIs. The most common side effects are diarrhea, constipation, belching and gas, abdominal pain, and headaches.

A patient is prescribed omeprazole (Prilosec) 40 mg orally for 6 weeks. For which common side effects will you monitor after giving this drug? a. Shortness of breath and increased respiratory rate b. Burning and itching with urination attempts c. Muscle aches and pains d. Diarrhea and gas

ANS: 4 Want 320 mg/X tablets, Have 80 mg/1 tablet; 320/80 = 4 tablets.

A patient is prescribed sotalol (Betapace) 320 mg orally once a day. Sotalol comes in 80 mg tablets. How many tablets would you give for each daily dose?

ANS: D Before giving an antiretroviral drug, always obtain a list of all other drugs the patient also takes, because antiretroviral drugs interact with many other drugs. Check with the pharmacist for possible interactions and the need to consult the prescriber about dosage or changing the patient's other drugs.

A patient is prescribed to begin highly active antiretroviral therapy (HAART). What is the most important question to ask this patient before beginning therapy? a. "Do you have any symptoms now of active infection?" b. "Is there any possibility that you are pregnant?" c. "Are you currently sexually active?" d. "What other drugs do you take?"

ANS: 6 Want 300 mg; Have 50 mg/mL. Because the milliliter concentration of this drug is already known, divide the dose you want (300 mg) by the dose you have (50 mg) to get 6. 6 mL is the correct dose.

A patient is prescribed to receive 300 mg of ribavirin by oral suspension. The drug on hand is ribavirin oral suspension with a concentration of 50 mg/mL. How many milliliters will you prepare as the correct dose?

ANS: 1.5 Want 60 mg, Have 40 mg/tablet. Divide 60 by 40, which equals 1.5.

A patient is prescribed to receive simvastatin (Zocor) 60 mg orally. The drug on hand is simvastatin 40 mg/scored tablet. How many tablets should you give for the correct dose?

ANS: C Among its many adverse effects, amphotericin B is very irritating and causes phlebitis at the site of infusion. This can occur quickly, sometimes after only one drug dose. When it is present, the IV site needs to be changed to prevent more complications and patient's discomfort.

A patient is receiving IV amphotericin B (Fungizone) for a systemic fungal infection. Which assessment parameter should you perform to determine whether the patient is having an adverse reaction to the therapy? a. Measure abdominal girth for presence of ascites b. Assess mouth and oral cavity for candidiasis c. Assess infusion site for phlebitis d. Assess calves for pain

ANS: A, B, D, G Echinocandins can increase the rate of clot formation, which increases the risk for deep vein thrombosis (DVT). DVT is most likely to occur in the veins of the lower legs and in the pelvis. Symptoms of DVT in an extremity include swelling, warmth, and pain or discomfort. All the systemic antifungal agents can cause renal insufficiency. Anyone prescribed these drugs must have renal function monitored. Any intravenous antifungal drug can irritate veins and cause phlebitis. Skin irritation and rashes can occur with systemic antifungal therapy. Rashes may be severe with many types of lesions (Stevens-Johnson syndrome). If the rashes become widespread with crusting, fever, and tissue necrosis, the condition can be life-threatening. Echinocandins do not affect intestinal motility or capillary refill. They also do not directly affect bone marrow production of white blood cells.

A patient is receiving IV caspofungin (Cancidas). Which assessments are most important to perform daily? (select all that apply) a. Assessing both calves for swelling, redness, and pain b. Examining the skin for rash and blisters c. Assessing capillary refill in fingers and toes d. Assessing the injection site for irritation or phlebitis e. Reviewing laboratory reports of white blood cell counts f. Listening for bowel sounds in all four abdominal quadrants g. Reviewing laboratory reports for blood urea nitrogen (BUN) and creatinine

ANS: B Oprelvekin is a thrombopoietic colony-stimulating factor that increases production of platelets. It is only used until the patient's platelet level reaches 50,000/mm3.

A patient is receiving oprelvekin (Neumega) subcutaneously daily. Which laboratory value indicates that the therapy is effective? a. Hemoglobin 12 g/dL b. Platelet level 55,000/mm3 c. Red blood cells 4.5 million/mm3 d. International normalized ratio (INR) 1.0

ANS: A Vitamin K is present in green, leafy vegetables and increases blood clotting by increasing the synthesis of specific clotting factors in the liver. Warfarin is a vitamin K antagonist. Ingestion of large amounts of vitamin K can counteract the therapeutic effects of warfarin.

A patient is taking warfarin (Coumadin) daily to prevent blood clots from forming in deep veins. Which statement made by the patient indicates that more teaching is needed about this therapy? a. "I have been eating more salads and other green, leafy vegetables to prevent constipation." b. "I have been using acetaminophen (Tylenol) instead of aspirin for pain." c. "Instead of a safety razor, I have been using an electric shaver." d. "On hot days, I make sure to drink at least two quarts of water."

ANS: 30 120 mL/h is 2 mL/min (120 mL/60 minutes in 1 hour). 2 mL/min 15 gtt/mL = 30 gtt/min.

A patient is to receive 200 mg of fluconazole (Diflucan) by intravenous (IV) piggyback over the next hour. The piggyback bag containing the fluconazole has a total of 120 mL and the drop factor of the administration set is 15 gtt/mL. How many drops per minute are needed to administer the 200 mg of fluconazole in 1 hour?

ANS: C When a patient is prescribed propafenone, you should always check whether the patient has a history of asthma. This drug blocks beta-adrenergic activity and can cause bronchospasm which worsens asthma.

A patient is to receive propafenone (Rythmol). What important question should you ask the patient before giving the first dose? a. "Do you have any hearing problems?" b. "Are you having difficulty reading?" c. "Have you ever had a problem with asthma?" d. "What other problems are being treated by your prescriber?"

ANS: C The clay-colored stools are associated with liver dysfunction. Because this drug can cause liver damage, it is important to stop this drug as soon as possible.

A patient on HAART that includes neviripine (Viramune) has all of the following side effects. Which one should you report to the prescriber immediately? a. Nausea b. 2 lb weight loss c. Clay-colored stools d. Dizziness on standing

ANS: D To answer the patient's question, you need to gather more information including heart rhythm, blood pressure, and ECG tracing. You may also want to notify the prescriber about the patient's sensation of skipped heartbeats.

A patient on a telemetry monitor reports feeling like the heart is skipping beats, and asks you what could be causing this. What is your best response? a. "Have you been exercising recently?" b. "Do you notice any other symptoms when your heart skips beats?" c. "You will have to tell your prescriber about this and ask him or her what is the cause." d. "Let me first listen to your heart, measure your blood pressure, and check your heart monitor."

ANS: D Systemic antifungal drugs have many common side effects, including loss of taste or changes in how food tastes. Unless this problem interferes with the patient's nutritional status, it is of no consequence. The patient should be reassured that the taste changes are an expected side effect and that normal taste sensation will return after the drug has been stopped after several days or a week.

A patient prescribed a systemic antifungal drug reports a change in how food tastes. What is your best action? a. Document the report as the only action. b. Hold the dose and notify the prescriber immediately. c. Caution the patient to wear sunglasses and a hat when outside. d. Reassure the patient that this is a common side effect of the drug.

ANS: D A male patient may experience pain or swelling in the scrotum while taking amiodarone. This should be reported to the prescriber immediately so that the drug dosage can be decreased.

A patient prescribed amiodarone (Cordarone) tells you that his scrotum is swollen and painful. What is your best action? a. Instruct the patient that this side effect is reversible and will go away over several months. b. Document this expected side effect as the only action. c. Support the patient's scrotum on a pillow. d. Hold the drug and notify the prescriber.

ANS: C Any person taking anticoagulants long term must avoid activities that can traumatize tissue and lead to bleeding, such as contact sports (e.g., football, hockey), and activities that put extra weight and stress on the leg joints and spine (e.g., jumping rope, jogging, high impact exercise). Jumping rope can cause bleeding into the joints, especially the knee, which can lead to permanent damage.

A patient prescribed an anticoagulant long term engages in all of the following activities. Which activity do you teach the patient to avoid? a. Golfing b. Bowling c. Jumping rope d. Walking 2 miles daily

ANS: B Atorvastatin can cause the adverse reaction of rhabdomyolysis, which is the breakdown of skeletal muscle. The symptoms of this problem are muscle aches and weakness. When a patient develops this problem, the drug should be stopped and a different antihyperlipidemic drug started.

A patient prescribed atorvastatin (Lipitor) reports all of the following problems or changes since starting this drug. Which problem or change do you report to the prescriber? a. Abdominal cramps and bloating b. Muscle aches and weakness c. Urinating more at night d. Loss of taste for sweets

ANS: D Atorvastatin is an HMG-CoA reductase inhibitor (statin) drug. Patients may develop rhabdomyolysis (muscle breakdown) as an adverse effect of these drugs. Signs and symptoms include general muscle soreness, muscle pain, and weakness. The drug should be held and the prescriber notified. The patient will need to be prescribed another antihyperlipidemic drug.

A patient prescribed atorvastatin (Lipitor) reports experiencing some muscle pain and weakness. What is your best action? a. Administer ordered acetaminophen (Tylenol) as needed. b. Document the finding as the only action. c. Reassure the patient that this is an expected side effect. d. Hold the drug and notify the prescriber.

ANS: A Donepezil (Aricept) is a cholinesterase inhibitor, therefore likely to increase succinylcholine-type muscle relaxation during anesthesia. If used during surgery, continued respiratory depression may occur due to prolonged neuromuscular blockade. Teach patients and families to discuss the risks associated with these drugs if the patient needs any type of surgery requiring general anesthesia. Those with dementia are at an increased risk for complications following surgery. They may awaken more slowly and are more likely to experience confusion and delirium. This might lead to longer stays in the postsurgical recovery room (PACU) and longer hospitalization.

A patient prescribed donepezil (Aricept) is to have surgery requiring general anesthesia. Her husband tells you that he read that taking this drug while having surgery can be dangerous. What is your best response? a. "Because of the action of donepezil, she may awaken more slowly and may need to remain in the postanesthesia care unit for a longer period of time." b. "Let me contact your surgeon because the danger of taking donepezil and having general anesthesia is that she may have a massive heart attack." c. "I don't think there is any danger because if there was your surgeon would certainly have discontinued use of this drug until after the surgery." d. "The most dangerous risk is that after the surgery your wife may lose her ability to swallow and aspirate food or medications, ending up with aspiration pneumonia."

ANS: C Swelling under the skin, usually around the eyes, nose, and lips are symptoms of angioedema, a rare adverse effect of ezetimibe. It is caused by blood vessel dilation and may be life threatening when it affects the airways.

A patient prescribed ezetimibe (Zetia) has developed swelling around the eyes, nose, and lips. What is your priority action at this time? a. Elevate the head of the bed. b. Notify the prescriber. c. Assess the patient's airway. d. Check the patient's blood pressure.

ANS: B Metoclopramide (Reglan) can cause tardive dyskinesia, a chronic disorder of the nervous system. Signs and symptoms include uncontrolled rhythmic movement of the mouth, face, or extremities; lip smacking or puckering; puffing of cheeks; uncontrolled chewing; and rapid or wormlike movements of the tongue. This adverse effect usually occurs after a year or more of continued use of these drugs and is often irreversible. If diagnosed early, tardive dyskinesia may be reversed by stopping the drug.

A patient prescribed metoclopramide (Reglan) for 15 months develops these findings: uncontrolled rhythmic movement of the face, lip smacking, uncontrolled chewing, and rapid or wormlike movements of the tongue. What is your best action? a. Transfer the patient to a critical care bed immediately. b. Document the findings and contact the prescriber. c. Ask if the patient has any drug, pet or food allergies. d. Place the patient on bed rest and keep him or her NPO.

ANS: D Difficulty sleeping and concentrating, tiredness, and feeling hopeless are signs of depression. Metoclopramide can cause mild to severe depression. You should hold the drug and notify the prescriber. This drug should not be prescribed for patients with a history of depression.

A patient prescribed metoclopramide (Reglan) reports having difficulty sleeping, difficulty concentrating, tiredness, and feeling hopeless. What is your best action? a. Instruct the patient that these are expected side effects of the drug. b. Document these findings as the only action. c. Check the patient's chart history of depression. d. Hold the drug and notify the prescriber.

ANS: A Metoclopramide increases stomach and small intestine contractions (peristalsis) which helps move food through the GI system. Increased peristalsis causes increased and sometimes loud bowel sounds. The patient should be instructed that this is an expected action of the drug.

A patient prescribed metoclopramide (Reglan) tells you that his abdomen is making gurgling sounds. What is your best action? a. Tell the patient that this is an expected effect of the drug. b. Document this finding as the only action. c. Hold the drug and notify the prescriber. d. Listen for bowel sounds in all four quadrants of the abdomen.

ANS: D One adverse reaction to niacin is an increase in uric acid crystals and calcium that can precipitate in joints and cause gout. The great toe is one of the most common sites of gout. The condition is painful and reduces mobility. Usually, the patient can continue the niacin therapy along with another drug that reduces uric acid production. Teach the patient that drinking plenty of water can help reduce the precipitation of uric acid.

A patient prescribed niacin extended action (Niaspan) reports all of the following new onset problems. For which problem should you notify the prescriber? a. Moderate itchiness, especially at night b. Six to seven loose stools daily c. Increased nighttime urination d. Swollen, painful great toe

ANS: D Prochlorperazine (Compazine) may cause urine to change color to pink or reddish-brown. This is temporary and disappears within days after the drug is discontinued.

A patient prescribed prochlorperazine (Compazine) has reddish-brown urine. What is your best action? a. Collect a urine sample and send it for culture and sensitivity. b. Check the patient's vital signs with special emphasis on body temperature. c. Assess for signs of bleeding around the urethra. d. Teach the patient that this is an expected side effect of the drug.

ANS: B This drug can cause the adverse reaction of rhabdomyolysis, which is destruction of skeletal muscle. The symptoms of this problem are muscle aches and weakness. When a patient develops this problem, the drug should be stopped.

A patient prescribed raltegravir (Isentress) reports all of the following problems or changes since starting this drug. Which problem or change do you report to the prescriber? a. Abdominal cramps and bloating b. Muscle aches and weakness c. Urinating more at night d. Loss of taste for sweets

ANS: B Rasagiline is a monoamine oxidase B (MAO-B) inhibitor. These drugs inhibit the enzyme that breaks down dopamine in the brain. As a result, more dopamine is available, and the progression of Parkinson's disease is slowed.

A patient prescribed rasagiline (Azilect) for Parkinson's disease asks you how this drug will help his disease. What is your best response? a. "This drug works by increasing the amount of dopamine activity in the brain and reducing tremor and muscle rigidity to improve movement." b. "This drug works by allowing a larger amount of levodopa to reach the brain, which raises dopamine levels in the brain." c. "This drug works by blocking cholinergic nerve impulses that help control the muscles of the arms, legs, and body." d. "This drug works by helping provide a more stable, constant supply of levodopa, which makes its beneficial effects last longer."

ANS: B Common side effects of anticoagulant therapy include increased risk for bleeding. Bleeding from the gums, oozing from cuts or wounds, nosebleeds, and heavier than usual menstrual bleeding can occur.

A patient prescribed subcutaneous heparin tells you that her menstrual bleeding is heavier than usual. What is your best response? a. "I will hold the drug and notify your prescriber." b. "This is a fairly common and expected side effect of the drug." c. "Heavy bleeding is a concern because you might become anemic." d. "I will have to give you a shot of protamine sulfate to reverse the drug's action."

ANS: C A positive reaction to a TB skin test requires that the skin around the injection site be indurated, not just red. Induration is caused by infiltration of the skin around the test site with many white blood cells, making the area red and swollen, and the tissue much harder than the surrounding normal skin. Bruising is a result of bleeding into the injection site, not infiltration and induration from white blood cells.

A patient received a tuberculosis skin test injection of purified protein derivative (PPD) 72 hours ago. Which assessment finding of the test site should be interpreted as a positive reaction? a. The injected area has a blister-like swelling about 2 mm high and 2 mm in diameter. b. The injection site is puffy and soft with pus oozing from the needle hole. c. The skin is red and very hard for 12 mm around the injection site. d. There is a large bruise surrounding the injection site.

ANS: A Ondansetron is an antinausea drug that is given 30 minutes before meals and at bedtime to prevent the nausea that is associated with chemotherapy. Metoclopramide (Reglan) increases peristalsis to help move food through the GI tract. Antihistamines prevent the nausea/vomiting caused by opiate drugs such as morphine. If the drug were given after meals, its purpose would not be met.

A patient receiving chemotherapy and prescribed ondansetron (Zofran) asks why the drug is given before meals. What is your best response? a. "Ondansetron is given 30 minutes before your meals to prevent nausea." b. "The purpose of ondansetron is to move food rapidly through your GI tract." c. "Ondansetron works by preventing nausea caused by morphine given for your pain." d. "If ondansetron is given after your meals, food would interfere with its absorption."

ANS: B Laxative drugs are not meant for long-term use and should not be used for longer than 1 week unless following a prescriber's advice. The use of laxatives long-term can cause other health problems.

A patient reports taking an over-the-counter laxative for constipation daily for the past 3 weeks. What is your best action? a. Remind the patient about the importance of adequate fluid intake and exercise to prevent constipation. b. Instruct the patient that these drugs should not be used for more than a week without consulting the prescriber. c. Ask the patient about usual fluid intake, urinary and bowel habits, and have the patient describe the nature of his or her stools. d. Contact the prescriber about an order for a stronger laxative because the one the patient is taking is not working.

ANS: D Antidiarrheal drugs should not be taken for more than 2 days unless instructed by a prescriber. When a patient's diarrhea is not relieved after 2 days, he or she should contact the prescriber.

A patient reports taking attapulgite (Kaopectate) for diarrhea over the past 4 days. What is your best action? a. Send a stool specimen to the lab for analysis including culture, sensitivity, and parasites. b. Instruct the patient to notify nursing staff for episodes of diarrhea and save the stool for occult blood check. c. Check the patient's blood pressure, heart rate, respiratory rate, and oxygen saturation. d. Teach the patient that antidiarrheal drugs should not be taken for more than 2 days unless instructed to by their prescriber.

ANS: D Psyllium is a bulk-forming laxative and can be used once a day to help prevent constipation. Bulk-forming laxatives are the one exception to the rule that laxatives should not be used long-term. These drugs are not absorbed from the intestines into the body and are safe for long-term use.

A patient reports taking psyllium (Metamucil) every morning to prevent constipation. What is your best action? a. Teach that over-the-counter laxatives should not be taken for more than 1 week. b. Instruct the patient that long-term use of psyllium can cause health problems. c. Hold the drug and notify the prescriber immediately. d. Document this information as the only action.

ANS: A Entacapone may discolor a patient's urine brownish-orange. This is an expected side effect and is not harmful.

A patient taking entacapone (Comtan) for Parkinson's disease informs you that his urine is now brownish-orange in color. What is your best action? a. Explain that this is an expected side effect and is not harmful. b. Collect a urine sample and send it to the laboratory for urinalysis. c. Hold the drug and immediately notify the prescriber. d. Instruct the patient to increase his intake of fluids.

ANS: B All of these blood values are abnormal; however, only the lactate dehydrogenase level is very high (four times normal). This value indicates liver impairment. Nearly all antiretroviral drugs can cause liver impairment. This value must be reported immediately so that liver function can be explored and any needed changes in drug therapy made before irreversible liver damage occurs.

A patient taking highly active antiretroviral therapy (HAART) for a year has the following blood laboratory test values. Which value do you report to the prescriber immediately? a. White blood cell count 3500 cells/mm3 b. Lactate dehydrogenase 990 IU/L c. Sodium 132 mEq/L d. Hematocrit 32%

ANS: B The WBC count, lactate dehydrogenase, and hematocrit values are abnormal; however, only the lactate dehydrogenase level is very high (three to four times normal). This value indicates liver impairment, which can be caused by taking ketoconazole. This value must be reported immediately so that liver function can be explored and any needed changes in drug therapy made before irreversible liver damage occurs.

A patient taking ketoconazole (Nizoral) for the last 2 weeks has all of the following blood laboratory test values. Which value should you report to the prescriber immediately? a. White blood cell count (WBC) 10,500 cells/mm3 b. Lactate dehydrogenase 880 IU/L c. Potassium 3.6 mEq/L d. Hematocrit 32%

ANS: B Heparin exerts effects directly in the blood and does not enter breast milk.

A patient who delivered a baby 6 weeks ago is now prescribed low-molecular-weight heparin for a venous thrombosis in her leg. She asks whether she can continue to breastfeed her baby while taking this drug. What is your best response? a. "Yes, the baby's digestive system will inactivate the drug." b. "Yes, the drug does not pass into breast milk." c. "No, the drug will increase the baby's risk for bleeding." d. "No, the drug can delay your baby's growth and development."

ANS: B Depression is a side effect associated with taking beta blockers such as propranolol. The depression may be new onset, or a patient with a history of depression may find that it gets worse while taking these drugs. The patient should be instructed to report increased depression symptoms to the prescriber. The patient should not suddenly stop taking the drug. Although beta blockers often do affect sexual ability, this is not related to depression.

A patient who has a history of depression is prescribed propranolol (Inderal). Which precaution is most important for you to teach the patient? a. "You should expect a decrease in depression symptoms while you are taking propranolol." b. "While taking propranolol you may notice that your depression gets worse." c. "Stop taking propranolol whenever you experience depression symptoms." d. "Propranolol may cause difficulty with your ability to perform sexually."

ANS: A Warfarin is a long-acting drug. Although it is best taken daily, the effects of the drug are present for days. The patient should take today's drug dose at the usual time and not try to make up for the missed dose (which, if taken today, could greatly increase the risk for hemorrhage). There is no injectable form of warfarin. It is only an oral preparation. Patients should not take aspirin with warfarin because the risk for a cerebral hemorrhage is greatly increased.

A patient who has been on warfarin (Coumadin) therapy for a year calls to tell you he forgot to take the drug yesterday. What is your best advice? a. "Take today's dose as usual." b. "Take the forgotten dose right now and take today's dose at the usual time." c. "Come to the clinic to receive an injection of warfarin as soon as possible." d. "Take today's dose as usual and also take an 81 mg tablet of aspirin at the same time."

ANS: D Acebutolol is a beta blocker. Signs of drug overdose for these drugs include a very slow heart rate, severe dizziness or fainting, difficult breathing, bluish-colored fingernails or palms, and seizures. Although you should hold the drug and immediately notify the prescriber, the best first action for this patient who is showing signs of acute hypoxia is to apply oxygen, even when there might not be an order for it. This is an emergency situation.

A patient who has been prescribed acebutolol (Sectral) develops a heart rate of 48 beats/min, dizziness, difficulty breathing, and bluish fingernails. What is your best first action? a. Instruct the patient to take several slow deep breaths. b. Place the patient in high Fowler's position. c. Hold the drug and notify the prescriber. d. Apply oxygen by mask or nasal cannula.

ANS: C Amantadine has central nervous system side effects and can worsen glaucoma. Although the drug may still be given to a person who has glaucoma, more frequent checking of intraocular pressure or adjustment in glaucoma drugs may be needed.

A patient who has been prescribed amantadine (Symmetrel) has all of the following health problems. For which problem should you contact the prescriber before giving the first dose? a. Asthma b. Influenza c. Glaucoma d. Diabetes mellitus

ANS: D Carbidopa-levodopa can activate malignant melanoma. Patients should be instructed to report any changes in skin lesions immediately to their prescriber.

A patient who has been prescribed carbidopa-levodopa (Sinemet) informs you that a dark spot on his arm is getting larger. What is your best action? a. Measure the size of the spot and document the finding. b. Inform the patient that this is an expected side effect of the drug. c. Administer the drug as ordered by the prescriber. d. Hold the drug and contact the prescriber about this change.

ANS: C Always get an accurate weight on a patient to be placed on continuous IV heparin because the initial bolus is based on weight. The rate of the infusion is based on aPTT results. IV heparin is not the cause of weight gain. While all patients are weighed on admission to the hospital, this response does not answer the patient's question.

A patient who has been prescribed continuous intravenous (IV) heparin asks why being weighed is necessary. What is your best response? a. "All patients are weighed upon admission to the hospital." b. "IV heparin has been known to cause weight gain." c. "The initial IV bolus of heparin is prescribed based on your weight." d. "The rate of the heparin infusion is based on your weight."

ANS: D Peripheral neuropathy with loss of sensation in the extremities is a common and expected side effect of flucytosine therapy. Drug therapy is not stopped for this effect. The patient must implement precautions to prevent injury from not having full sensation for touch, temperature, and pressure.

A patient who has been prescribed flucytosine (Ancobon) reports reduced sensation in the fingers and toes. What is your best action? a. Document the report as the only action. b. Hold the dose and notify the prescriber. c. Remind the patient to continue the drug as usual and to take a multiple vitamin daily. d. Reassure the patient that this is an expected drug side effect and to use injury precautions.

ANS: C Renal failure can occur if rhabdomyolysis (muscle breakdown) happens as an adverse effect of statin drugs. The protein released from broken-down muscle can block urine flow through the kidneys leading to decreased urine output. Telling the patient that intake and output measurement is an important assessment of kidney function is essentially correct, but it does not fully address the patient's question.

A patient who has been prescribed lovastatin (Mevacor) asks why all urine must be saved for intake and output measurements. What is your best response? a. "All patients on this unit have orders for strict intake and output measurements." b. "Intake and output measurements are important indicators of how well your kidneys are functioning." c. "A side effect of this drug can be blockage of urine flow through the kidneys and decreased urine output." d. "Sometimes this drug can cause the kidneys to make extra urine resulting in increased urine output and dehydration."

ANS: C Black and tarry stools are never normal; they indicate bleeding and should be reported to the prescriber at once. Sending a stool sample to the laboratory to test for blood helps to confirm the presence of blood in the stool. You would also want to notify the prescriber of this finding.

A patient who has been prescribed rabeprazole (Acipex) develops black, tarry stools. What is your best first action? a. Check the patient's medication list for prescribed iron supplements. b. Teach the patient that this is an expected side effect of proton pump inhibitors. c. Send a stool sample to the laboratory to check for presence of occult blood. d. Keep track of the number of stools the patient has in a 24-hour period.

ANS: C Ranitidine contains a substance that darkens the tongue and the stools. This is a harmless side effect and does not indicate a health problem. It is not a reason to stop the drug.

A patient who has been prescribed ranitidine (Zantac) reports darkened stools. What is your best action? a. Hold the dose and notify the prescriber. b. Document the report as the only action. c. Reassure the patient that this is a common and harmless side effect. d. Ask the patient if he or she has been using aspirin or any other NSAID drug.

ANS: D Skin lesions, itching, achy joints, and fever are signs of Stevens-Johnson syndrome, an adverse effect of class IV antidysrhythmic drugs (calcium channel blockers). These symptoms should be reported immediately to the prescriber and the drug should be held because this syndrome has the potential to be fatal.

A patient who has been prescribed verapamil (Calan) develops skin lesions, itching, achy joints, and a temperature of 101o F. What is your best action? a. Administer an as-needed dose of diphenhydramine (Benadryl). b. Contact the prescriber and request an order for acetaminophen 650 mg. c. Draw a set of blood cultures to detect any infection. d. Hold the drug and notify the prescriber.

ANS: D The normal range for platelets is 200,000 to 400,000/mm3. Platelets are needed for blood clotting. This patient's platelet count is extremely low and he or she is at grave risk for severe bleeding. The low platelet count is an indication of an adverse reaction to heparin known as heparin-induced thrombocytopenia (HIT). The heparin needs to be discontinued and the patient needs to receive platelet therapy before life-threatening hemorrhage occurs.

A patient who has been receiving heparin subcutaneously for 3 weeks has all of the following laboratory blood test values. Which value should you report immediately to the prescriber? a. Activated partial thromboplastin time 1.5 b. International normalized ratio (INR) 1.7 c. Red blood cells 4.2 million/mm3 d. Platelets 20,000/mm3

ANS: B Procrit can increase the blood viscosity and cause clots to form. Drooping on one side of the face is a sign of a stroke. Immediate attention is needed to prevent permanent loss of neurological function from a stroke.

A patient who has been self-injecting epoetin alfa (Procrit) three times weekly for anemia now reports all of these problems. For which one do you tell him or her to call 911? a. Fever and chills b. Drooping on the right side of the face c. 3 lb weight gain over the past 2 weeks d. Intermittent pain and redness at the injection site

ANS: A Cimetidine can cause drug-induced hepatitis. Dark urine and white stool are symptoms of liver problems and should be investigated immediately before any damage becomes permanent. It is likely the drug will need to be discontinued.

A patient who has been taking cimetidine (Tagamet) for a year has all of the following symptoms. Which symptom should be reported immediately to the prescriber? a. Darkened urine and white stool b. Altered food taste and dry mouth c. Weekly constipation with bloating d. Reduced interest in sexual activity

ANS: A Efavirenz is a nonnucleotide analogue reverse-transcriptase inhibitor (NNRTI). A sore throat, fever, different types of rashes, blisters, or multiple bruises are all signs of serious adverse effects of drugs from this class. The drug should be stopped and the prescriber contacted.

A patient who has been taking efavirenz (Sustiva) reports a sore throat, fever, and blisters. What is your best action? a. Hold the dose and notify the prescriber. b. Document the report as the only action. c. Remind the patient that these are symptoms of opportunistic infection. d. Reassure the patient that these are common and expected side effects of the drug.

ANS: B Human immunodeficiency virus (HIV) can develop drug resistance relatively quickly, especially to protease inhibitors. This does not mean that the organism is resistant to all antiretroviral drugs and that the disease will then progress to AIDS. By changing the combination of drugs frequently, even an organism that has developed resistance to one antiretroviral drug can still have its replication suppressed and the disease can be controlled. Simply telling the patient that HIV easily becomes drug resistant may be a true statement, but it does not address the patient's concerns about the disease's progression.

A patient who has been taking indinavir (Crixivan) for a year has just been told that the organism is now resistant to this drug. The patient expresses worry to you that this means the disease will now progress to acquired immunodeficiency syndrome (AIDS) and death will soon follow. What is your best response? a. "Your health care provider can change this drug to the intravenous form, which prevents viral replication even in HIV that has developed drug resistance." b. "Although the HIV is now resistant to this drug, other antiretroviral drugs are likely to be effective in controlling your disease." c. "The HIV easily becomes drug resistant. That is why the drug combinations are switched so often." d. "That is a possibility because these drugs do not kill the virus. It is best to be prepared."

ANS: D Peripheral neuropathy with loss of sensation in the extremities is a common and expected side effect of therapy. Drug therapy is not stopped for this effect. The patient needs to implement precautions to prevent injury from not having full sensation for touch, temperature, and pressure.

A patient who has been taking lamivudine (Epivir) for 6 months reports reduced sensation in the fingers and toes. What is your best action? a. Document the report as the only action. b. Hold the dose and notify the prescriber. c. Remind the patient to continue the drug as usual and take a multiple vitamin daily. d. Reassure the patient that this is an expected drug side effect and to use injury precautions.

ANS: B Hypothyroidism decreases GI motility significantly. One of the parameters that can be used to determine if changes in the dose of a thyroid replacement drug should be adjusted is the frequency of bowel movements. A bowel movement everyday is a strong indication that the dose of thyroid replacement hormone is adequate.

A patient who has been taking levothyroxine (Synthroid) for 2 months has all of the following conditions. Which condition indicates that the drug therapy is effective? a. Increased thirst b. Daily bowel movement for 1 week c. White blood cell count of 6000/mm3 d. Weight unchanged for the last 3 weeks

ANS: B All of these blood values are abnormal; however, only the lactate dehydrogenase level is very high (four times normal). This value indicates liver impairment. Methimazole can cause liver impairment. This value must be reported immediately so that liver function can be explored and any needed changes in drug therapy made before irreversible liver damage occurs.

A patient who has been taking methimazole (Tapazole) for 3 weeks has all of the following laboratory blood test results. Which result do you report immediately to the prescriber? a. White blood cell count 3500 cells/mm3 b. Lactate dehydrogenase 990 IU/L c. Sodium 132 mEq/L d. Hematocrit 32%

ANS: A Niacin causes a mild systemic inflammatory response with vasodilation that can result in the sensation of itching. This is not an allergy but can be very distressing to the patient. Often, taking aspirin reduces the inflammatory response and eliminates the itchiness. If the patient has no other health problems that would be worsened by aspirin, this should be tried first.

A patient who has been taking niacin (Niacor) daily for 1 week reports intense itching. What is your best response? a. "This is a common side effect and many people can control it by taking aspirin." b. "Stop taking the drug and talk with your prescriber as soon as possible." c. "Unless your skin forms blisters or peels, continue to take the drug." d. "Do you have any other drug, food, pet, or pollen allergies?"

ANS: B Nizatidine is a histamine H2 blocker. This class of drugs can cause anemia. The patient's red blood cell count is more than 50% below normal.

A patient who has been taking nizatidine (Axid) for the last month has all of the following blood laboratory results. Which result must be reported to the prescriber as soon as possible? a. International normalized ratio (INR) of 0.9 b. Red blood cell count of 2 million/mm3 c. White blood cell count of 8000/mm3 d. Platelet count of 150,000/mm3

ANS: D GI symptoms including constipation, bloating, nausea, vomiting, and gas are common side effects of bile acid sequestrants such as cholestyramine. The drug should not be held. You should teach the patient to take the tablet form of this drug with at least 12 to 16 ounces of water to prevent stomach and intestinal problems such as bowel obstruction. Administering the drug with meals can help to decrease GI symptoms and aid their action, which is to bind with cholesterol in the intestines.

A patient who is prescribed cholestyramine (Questran) tablets reports experiencing bloating, nausea, and gas. What is your best action? a. Hold the drug and notify the prescriber. b. Document the finding as the only action. c. Administer the drug before meals to avoid nausea. d. Teach the patient to drink 12 to 16 ounces of water with the drug.

ANS: B Ethambutol at high doses can cause optic neuritis vision changes that include reduced color vision, blurred vision, and reduced visual fields. This problem can lead to blindness. When the problem is discovered early, the eye problems are usually reversed when the drug is stopped.

A patient who is prescribed ethambutol (EMB, Myambutol) reports trouble distinguishing colors. What is your best action? a. Document the report as the only action. b. Hold the dose and notify the prescriber immediately. c. Caution the patient to wear sunglasses and a hat when outside. d. Reassure the patient that this is a common side effect of the drug.

ANS: D Liothyronine increases the effectiveness of warfarin. Warfarin's effectiveness is measured by the INR. This value should be between 1.5 and 3.0 in a patient taking warfarin. With an INR level of 4.5 the patient is at extreme risk for excessive bleeding.

A patient who is prescribed liothyronine (Cytomel) also takes warfarin (Coumadin). Which laboratory blood test result indicates a possible drug interaction? a. Hematocrit 42% b. Hemoglobin 14.2 g/dL c. Blood urea nitrogen (BUN) 12 mg/dL d. International normalized ratio (INR) 4.5

ANS: D Flushing (redness) and hot flashes can be reduced by the use of aspirin or an NSAID 30 minutes before the niacin, or by giving the niacin during or after meals. While reassuring the patient that flushing and hot flashes are expected side effects is correct, it does not address the patient's discomfort.

A patient who is prescribed niacin (Niacor) reports experiencing flushing and hot flashes. What is your best action? a. Hold the drug and notify the prescriber. b. Give the niacin at least 1 hour before meals. c. Reassure the patient that this is an expected side effect. d. Administer the ordered NSAID 30 minutes before the niacin.

ANS: A Omeprazole is a proton pump inhibitor. These drugs work best when given before meals, preferably in the morning. Proton pump inhibitors can be given with antacids, with food, or without food.

A patient who is prescribed omeprazole (Prilosec) asks why the drug should be taken before breakfast. What is your best response? a. "The intended action of this drug is best achieved when given before meals, preferably in the morning." b. "It is best to take this drug in the morning so that antacids taken later in the day do not interfere with absorption." c. "This drug should always be taken on an empty stomach for maximal action and for better absorption." d. "Taking this drug early in the morning helps to minimize the occurrence of side effects or adverse effects."

ANS: D Quinidine is a class Ia antidysrhythmic drug that can slow the conduction of electrical impulses through the heart and lengthen the interval between the QRS complex and the T wave. This increases the patient's risk for development of an abnormal life-threatening ventricular rhythm called torsades de pointes, which can rapidly lead to ventricular fibrillation.

A patient who is prescribed oral quinidine (Quinaglute) for a tachydysrhythmia is on a cardiac monitor, which shows lengthening PR intervals. What is your best action? a. Perform a 12-lead electrocardiogram (ECG). b. Send a serum potassium level to the laboratory. c. Document this as an expected action of the drug. d. Notify the prescriber immediately.

ANS: C Prochlorperazine can trigger neuroleptic malignant syndrome, a rare and life-threatening side effect in which dangerously high body temperatures can occur. Without prompt and expert treatment, this condition can be fatal in as many as 20% of those who develop it. One of the first warning signs is increasing body temperature. At this point, steps must be taken quickly to prevent this adverse reaction from becoming worse.

A patient who is prescribed prochlorperazine (Compazine) for postoperative nausea/vomiting has all of the following changes. For which change should you immediately contact the prescriber? a. Systolic blood pressure decrease of 12 mm Hg b. Increased sleepiness but arouses with light shaking c. Oral temperature increase of 2° F d. Urine color change from yellow to reddish-brown

ANS: C Respiratory depression (decreased drive for breathing) is a life-threatening adverse effect that can occur with several antiemetic drugs, including promethazine. You must be sure to monitor the patient's respiratory rate after administering this drug and report a decrease in respiratory rate to the prescriber. The drug should be held because a respiratory rate of 8 breaths/min is very low. Raising the head of the bed, checking oxygen saturation, and applying oxygen are all good treatment strategies for the low respiratory rate, but the most important action is to notify the prescriber and hold the drug to prevent further respiratory depression.

A patient who is prescribed promethazine (Phenergan) currently has a respiratory rate of 8 breaths/min when it is time to give the next dose. What is your most important action? a. Apply oxygen at 2 L per nasal cannula. b. Check the patient's oxygen saturation. c. Hold the drug and notify the prescriber. d. Raise the head of the bed 90 degrees.

ANS: A Propafenone (Rythmol) is a class Ic oral antidysrhythmic drug that works by slowing the conduction of electrical impulses in the heart. The results of these drugs include decreased episodes of ventricular and supraventricular dysrhythmias.

A patient who is prescribed propafenone (Rythmol) asks how the drug works. What is your best response? a. "It slows the conduction of electrical impulses in your heart." b. "It increases your heart rate and the blood flow to your tissues." c. "It prevents your heart muscle from sensing electrical impulses." d. "It keeps the conduction of electrical impulses completely normal."

ANS: D Propylthiouracil increases the effectiveness of warfarin. Warfarin's effectiveness is measured by the INR. This value should be between 1.5 and 3.0 in a patient taking warfarin. With an INR level of 4.5 the patient is at extreme risk for excessive bleeding.

A patient who is prescribed propylthiouracil (Propacil) also takes warfarin (Coumadin). Which laboratory blood test result indicates a possible drug interaction? a. Hematocrit 42% b. Hemoglobin 14.2 g/dL c. Blood urea nitrogen (BUN) 12 mg/dL d. International normalized ratio (INR) 5.0

ANS: C Both pyrazinamide and ethambutol increase uric acid production and increase the risk for gout attacks. Drinking more water can help prevent the uric acid crystals from precipitating in joints or kidneys.

A patient who is prescribed pyrazinamide and ethambutol for active tuberculosis (TB) also has gout. What adjustments will this patient's condition require? a. Gout is not affected by TB drug therapy, and no adjustments are needed. b. The prescribed therapy will improve gout and reduce the need for drug therapy to treat gout. c. The prescribed therapy increases the risk for gout attacks, and the patient should increase his or her intake of water. d. The drugs for treatment of gout interact with the drugs for TB, and the patient must not take the gout drugs within 2 hours of taking the TB drugs.

ANS: A Simvastatin is a statin drug. These drugs may cause decreased liver function. Because of this, the prescriber orders liver function tests every 3 to 6 months. The tests are essential and important because early or mild liver problems may not cause symptoms.

A patient who is prescribed simvastatin (Zocor) asks why liver function tests must be drawn every 6 months. What is your best response? a. "The tests are important because early liver problems do not cause symptoms." b. "The tests help your prescriber decide what your dose of simvastatin should be." c. "The tests tell your prescriber how well your body is responding to the therapy." d. "The tests indicate how much cholesterol is being produced by your liver."

ANS: D All of these assessment findings can be side effects of sotalol, a beta blocker. However, if a patient develops chest pain it should be reported to the prescriber immediately because this symptom may indicate heart disease and require additional diagnostic testing. In addition, safe activity levels should be discussed with the patient.

A patient who is prescribed sotalol (Betapace) develops the following problems. For which finding should you immediately notify the prescriber? a. Heart rate of 60 beats/min b. Difficulty sleeping c. Cold hands and feet d. Chest discomfort

ANS: D Sucralfate is a cryoprotective drug. These drugs form a thick coating that covers an ulcer to protect the open sore from further damage and allow healing to occur. Histamine blockers decrease secretion of gastric acids. Proton pump inhibitors block secretion of gastric acids. Antibiotics are used to treat H. pylori infections.

A patient who is prescribed sucralfate asks how this drug will help treat his gastric ulcer. What is your best response? a. "Sucralfate decreases secretion of gastric acids to help your ulcer heal." b. "Sucralfate completely blocks the secretion of gastric acids so your ulcer can heal." c. "Sucralfate treats the infection with H. pylori that is the major cause of gastric ulcers." d. "Sucralfate forms a thick coating to cover the ulcer, protect it from further damage, and allow healing."

ANS: A One of the many serious adverse effects of ribavirin is suppression of bone marrow cell division, leading to fewer RBCs and anemia. This patient's RBC level is only about half of normal.

A patient who is taking interferon is also prescribed ribavirin (Virazole). Which laboratory blood test result for this patient do you report immediately to the prescriber? a. Red blood cells (RBCs) 2.2 million/mm3 b. White blood cells (WBCs) 6000/mm3 c. Sodium 134 mEq/L d. International normalized ratio (INR) 1.6

ANS: A Fatty foods tend to reduce intestinal absorption and make drug-induced diarrhea worse. Although fiber can prevent some types of diarrhea, it is of no benefit for diarrhea associated with antiviral drug therapy.

A patient who is taking zidovudine (Retrovir) reports diarrhea. Which dietary change should you suggest for this patient? a. "Avoid fatty and fried foods." b. "Increase your intake of fiber." c. "Take an antacid 30 minutes before each meal." d. "Restrict your intake of fluids to 1 L/day."

ANS: B Ketoconazole increases sun sensitivity and increases the risk for severe sunburn. Patients taking the drug should avoid direct sunlight, use sunscreen, and wear protective clothing whenever they are outdoors to prevent a severe sunburn. They should also avoid tanning beds and salons.

A patient who is very immunosuppressed is prescribed ketoconazole (Nizoral) for prevention of a fungal infection. Which statement made by this patient indicates the need for more teaching? a. "I will stop taking the drug if I should become pregnant." b. "I will stay in the sun as much as possible to avoid catching an infection." c. "I will avoid drinking alcoholic beverages during the time I am on this therapy." d. "If I miss a dose, I will take it as soon as I remember it and not wait until the next day."

ANS: A The only common side effect of IV magnesium sulfate is diarrhea. Additional actions would include assisting the patient to the bathroom and providing skin care to prevent breakdown.

A patient who received an intravenous (IV) dose of magnesium sulfate has developed diarrhea. What is your best response? a. Reassure the patient that diarrhea is a common side effect of magnesium sulfate. b. Order a bedside commode so that the patient does not have to walk to the bathroom. c. Hold the drug and notify the prescriber. d. Document the finding as the only action.

ANS: C Disopyramide should not be given close to the time procainamide was taken to avoid serious complications. The earliest it can be given after the immediate release formulation of procainamide is 6 hours.

A patient who received an oral dose of procainamide immediate release an hour ago at 9:00 a.m. is now prescribed to receive an oral dose of disopyramide. When is the earliest you should give the disopyramide? a. Immediately b. 12:00 noon c. 3:00 p.m. d. 9:00 p.m.

ANS: B After thrombolytic therapy to dissolve an existing clot, anticoagulation with heparin prevents the formation of new clots.

A patient who received the thrombolytic drug alteplase (Activase) asks why continuous heparin is now infusing intravenously. What is your best response? a. "There may be additional clots in your body and we want to be sure they are all dissolved." b. "Once the clot is dissolved, heparin is given continuously to prevent any new clots from forming." c. "The heparin finishes the job of dissolving the clot that the alteplase started." d. "Heparin is infused continuously in case we need to give additional dosages of alteplase."

ANS: 1.4 1 kg = 2.2 lb. The patient's weight in kilogram is 57.28 (126/2.2), round up to 57.3 kg. The correct dosage is 57.3 12.5 mg, which is 716.25 mg. Because the concentration for 1 mL is already known, divide the dose you want (716.25 mg) by the dose you have (500 mg), which is 1.43 mL. Round down to 1.4 mL.

A patient who weighs 126 lb is prescribed to receive an intramuscular dose of procainamide (Pronestyl) of 12.5 mg/kg immediately. The available parenteral form of procainamide is a solution with a concentration of 500 mg/mL. How many milliliters will you prepare for the correct dose?

ANS: 5 1 kg = 2.2 lb. Patient's weight in kilogram = 100 kg (220/2.2 = 100). 100 kg 2 kg/mg = 2000 mg (or 2 g). Want 2000 mg, Have 400 mg/tablet. 2000/400 = 5 tablets.

A patient who weighs 220 lb is prescribed 20 mg/kg of ethambutol (EMB). The ethambutol tablets available 400 mg/scored tablet. How many tablets will you give?

ANS: D A slow heart rate (less than 50 beats/min) results in decreased in cardiac output, blood pressure, and perfusion to a patient's vital organs. This leads to symptoms such as dizziness, light-headedness, syncope, and decreased peripheral pulses. While you will want to notify the prescriber, the patient's blood pressure should be checked first.

A patient whose heart rate is 52 beats/min reports feeling dizzy and light-headed. What is your best first action? a. Start an IV line. b. Ask if the patient has experienced this before. c. Notify the prescriber immediately. d. Check the patient's blood pressure.

ANS: C Symptoms of drug overdose for memantine include upset stomach, vomiting, drooling, sweating, slow heart rate, difficulty breathing, muscle weakness, and seizures. The drug dose should be held and the prescriber notified immediately.

A patient with Alzheimer's disease has been prescribed memantine (Namenda). The patient has developed the symptoms of vomiting, drooling, heart rate of 56 beats/minute, and muscle weakness. What is your best action? a. Contact the prescriber and ask for an order for an as-needed antiemetic drug. b. Place the patient on a heart monitor and check the heart rate every 2 hours. c. Hold the drug dose and contact the prescriber immediately. d. Give the drug exactly as ordered.

ANS: B Both rivastigmine and galantamine (Reminyl) commonly cause the side effect of GI upset. Giving these drugs with food twice a day helps to minimize this side effect.

A patient with Alzheimer's disease is prescribed rivastigmine (Exelon). What action should you suggest to prevent a common side effect? a. Give the drug with a full glass of water. b. Administer the drug with meals twice a day. c. Assess the patient's level of consciousness. d. Keep an accurate record of all patient food intake.

ANS: C Patients should be taught to immediately notify their prescriber if symptoms of Parkinson's disease (e.g., shaking, stiffness, or slowness of movement) become worse in a relatively short time period.

A patient with Parkinson's disease informs you that the stiffness and slowness of movements associated with the illness have become worse. What should you teach the patient about this change? a. "These changes are normal and expected as your disease progresses." b. "You will need to use a walker at all times to avoid falls and accidents." c. "Whenever your symptoms worsen, contact your prescriber right away." d. "If your prescriber increases your drug dosage these functions will improve."

ANS: D Entacapone is a COMT inhibitor. These drugs can cause the adverse effect of rhabdomyolysis, a serious and potentially fatal effect involving destruction or degeneration of skeletal muscle. Signs and symptoms of rhabdomyolysis include muscle aches, muscle weakness, and dark cola-colored urine. You should hold the drug and notify the prescriber immediately.

A patient with Parkinson's disease who has been prescribed entacapone (Comtan) tells you he is experiencing muscle aches, weakness, and has dark cola-colored urine. What is your best action? a. Send a urine specimen to the laboratory for urinalysis. b. Help the patient back to bed and instruct him or her to rest. c. Tell the patient that these are expected side effects of the drug. d. Hold the drug and notify the prescriber immediately.

ANS: D The most common symptom of peptic ulcer is burning, gnawing pain caused by stomach acid coming into contact with an open wound (ulcer). The pain usually occurs somewhere between the navel and breastbone and may last from a few minutes to many hours. Even though foods and antacids may relieve the pain, the fact that this is new onset pain indicates that you should notify the prescriber immediately.

A patient with a history of GI ulcers reports feeling new onset burning, gnawing stomach pain. What is your best action? a. Assess the patient's abdomen for the presence of active bowel sounds. b. Administer the already ordered as-needed dose of liquid antacid. c. Offer the patient food to buffer excess stomach acid. d. Notify the prescriber immediately.

ANS: A Although both heparin and warfarin are anticoagulants, they have different mechanisms of action and onsets of action. Because warfarin has such a slow onset, it must be started while the patient is still receiving heparin.

A patient with a vein thromboembolism is ordered to be started on oral warfarin (Coumadin) while still receiving intravenous heparin. What is your best action? a. Administer the two drugs as prescribed. b. Remind the prescriber that two anticoagulants should not be administered concurrently. c. Hold the dose of warfarin until the patient's activated partial thromboplastin time is the same as the control value. d. Monitor the patient for clinical manifestations of internal or external bleeding at least every 2 hours.

ANS: B Rifampin normally turns urine an orange color. No intervention is needed; however, the color change can be very distressing to patients. The patient should be reassured that this color change is normal and be taught how to manage this change so that clothing does not become stained.

A patient with active tuberculosis who has been taking isoniazid (INH, Nydrazid) and rifampin (RIF, Rifadin) reports having urine that is an orange color. What your best action? a. Obtain a specimen for culture and test the urine for occult blood. b. Reassure the patient that this is a normal drug side effect. c. Hold the dose and contact the prescriber. d. Document the report as the only action.

ANS: D The prescriber can order a different form of the drug that is compatible with the patient's abilities. The pharmacy can send the drug but not without a valid order from the prescriber. The drug ordered is an extended release form and opening the capsule would give the patient too much drug quickly placing him or her at risk for side effects or adverse effects.

A patient with advanced Parkinson's disease is prescribed extended-release—50 mg carbidopa/200 mg levodopa capsule twice daily. The patient has difficulty swallowing. What is your best action? a. Open the capsule and mix the contents with apple sauce. b. Open the capsule and dissolve the contents in water. c. Contact the pharmacy to send a liquid form of the drug. d. Ask the prescriber to order a different form of the drug.

ANS: B Over-the-counter cold and cough drugs contain substances that can cause a rapid heart rate (tachycardia).

A patient with an upper respiratory infection reports feeling like the heart is pounding. After finding out that the patient does not having chest pain or difficulty breathing, what is the most important question you must ask the patient? a. "How long have you had upper respiratory infection symptoms?" b. "Are you using any over-the-counter cold or cough drugs?" c. "Is this the first time you have felt like this?" d. "What exercise have you done today?"

ANS: D Ask the patient about abdominal pain. Drugs for constipation should not be given to a patient experiencing undiagnosed abdominal pain or acute abdomen, because these drugs increase peristalsis and the risk of bowel perforation.

A patient with constipation is prescribed bisacodyl (Dulcolax). The patient also states he has severe abdominal pain. What is your best action? a. Administer the drug as prescribed to relieve the constipation. b. Ensure that the patient drinks a full glass of water with the drug. c. Listen for bowel sounds in all four quadrants before giving the drug. d. Hold the drug and contact the prescriber.

Which actions should you take before giving an antinausea drug? Select all A. Listen to active bowel sounds B. Look for abdominal distention C. Check patient's electrolyte values D. Check patient's deep tendon reflexes E. Ask about patient coagulation tests F. Ask the patient about usual diet intake

A, B, C, F

ANS: B Metoclopramide increases stomach and small intestine contractions (peristalsis), helping to move food through the GI system. Moving food quickly into the intestinal system decreases the likelihood of backup into the esophagus.

A patient with gastroesophageal reflux disease (GERD) asks why metoclopramide (Reglan) has been prescribed. What is your best response? a. "The purpose of this drug for GERD is to prevent nausea." b. "This drug has been prescribed to help move food along through your GI tract." c. "Metoclopramide will prevent vomiting and the risk for aspiration." d. "This drug causes growth of new cells to heal your esophagus."

ANS: C To prolong the effects of histamine H2 blockers like ranitidine, these drugs should be taken with meals. If a patient takes this drug once a day, giving it at bedtime prolongs the effects when there is no food in the stomach and reflux may be worse.

A patient with gastroesophageal reflux disease is prescribed ranitidine (Zantac). Which statement by the patient indicates the need for additional teaching? a. "I will notify my prescriber if I need to use ranitidine for more than 2 weeks." b. "I will look into a smoking cessation program when I go home." c. "I will take the ranitidine first thing in the morning so that its effect will last all day and night." d. "I will not drive until I know how the ranitidine affects me."

ANS: D People who do not show lipid profile improvement after following a low-fat diet for 3 months often have a genetic factor that leads to familial hyperlipidemia. This tends to run in families and requires antilipidemic drugs to lower blood lipid levels. Telling the patient that a drug is definitely required may be correct in this case, but it does not address the patient's question.

A patient with high blood lipids asks why the lipid profile did not improve after 3 months following a low-fat diet. What is your best response? a. "You may need to follow a no-fat diet to improve your lipid profile." b. "You must follow a low-fat diet for at least 6 months to see improvement." c. "You will definitely need to be prescribed a drug to see improvement." d. "You may have a genetic factor that is causing your high blood lipid levels."

ANS: B A complication of severe hyperthyroidism is thyroid crisis (also known as thyroid storm). Symptoms include fever, dangerously high blood pressure, and a rapid, irregular heartbeat. The symptoms can develop quickly, and if not treated, this problem can lead to seizures, heart failure, and death. An elevation in temperature may be an indication of impending thyroid crisis and requires immediate attention.

A patient with hyperthyroidism is in the hospital waiting for surgery to remove the thyroid gland. This patient has all of the following conditions. For which condition should you notify the prescriber immediately? a. High level of anxiety about having surgery on the neck b. Temperature increase of 2 F c. Pulse pressure decrease of 10 mm Hg d. Increased bowel sounds and flatulence

ANS: 3 Want 150 mg, Have 50 mg/tablet; 150/50 = 3; 3 1 tablet = 3 tablets.

A patient with hyperthyroidism is prescribed an immediate dose of propylthiouracil (Propacil) 150 mg orally. The available drug is propylthiouracil 50 mg/tablet. How many tablets should you administer? _____ tablets

ANS: B Hashimoto's thyroiditis results in a permanent loss of thyroid function. Without continuous thyroid replacement drugs, the patient's metabolism would eventually stop and death would occur.

A patient with hypothyroidism as a result of Hashimoto's thyroiditis asks how long thyroid replacement drugs will need to be taken. What is your best response? a. "You will need to take the thyroid replacement drug until the goiter is completely gone." b. "You will need thyroid replacement drugs for the rest of your life because thyroid function will not return." c. "The thyroiditis will be cured with antibiotics and then you will no longer need the thyroid replacement drugs." d. "When your thyroid function studies indicate a normal blood level of thyroid hormones you will be able to discontinue the drugs."

ANS: C Aluminum hydroxide is an aluminum-based antacid. The most common side effect of these drugs is constipation. Patients should be taught to consume a diet rich in fiber-containing foods to prevent this side effect.

A patient with indigestion is prescribed aluminum hydroxide (Amphojel). To prevent the most common side effect of this drug, what should you teach the patient? a. "Take this drug 30 minutes before each meal." b. "Do not drink fluids for at least 30 minutes after taking this drug." c. "Be sure to consume a diet with lots of vegetables and other foods with fiber." d. "Report any episodes of diarrhea immediately to your prescriber."

ANS: B A positive skin test for TB only means that the patient was infected with TB at one time. A TB scar also only indicates old, inactive disease. Cavitation and productive cough along with a positive skin test are indicators of active disease that can be spread to others, and this person must be treated. The person with a negative skin test and chest x-ray but with other symptoms probably has another type of respiratory infection.

A patient with which findings requires drug therapy for active tuberculosis (TB)? a. Negative TB skin test and chest x-ray but who has productive cough, fever, and shortness of breath b. Positive TB skin test, productive cough, and a cavitation on chest x-ray c. Positive TB skin test and a TB scar on chest x-ray d. Positive TB skin test as the only symptom

ANS: A The SA node initiates electrical impulses at a rate of 60 to 100 per minute. When the ECG shows P waves before every QRS complex with a rate between 60 and 100 per minute, the rhythm is a normal sinus rhythm which is initiated by the SA node.

A patient's heart rate is regular at 68 beats/min. The electrocardiogram (ECG) tracing shows P waves before every QRS complex. What is the likely pacemaker of the heart? a. SA node b. AV node c. Bundle of His d. Purkinje fibers

ANS: 2 Want 0.008 mg/X mL, Have 0.050 mg/1 mL; 0.008/0.050 = 0.16 1 mL = 0.16 mL, at 15 gtt/mL = 0.16 15 = 2.4 gtt, rounded down to 2 gtt.

A pediatric patient is prescribed 0.008 mg of digoxin (Lanoxin). The drug on hand is digoxin 0.05 mg/mL. One milliliter equals 15 gtt. How many drops (gtt) will you give?

ANS: A Want 450 mg in X scoops/Have 50 mg in 1 scoop. 450/50 = 9 scoops.

A pediatric patient is prescribed nelfinavir (Viracept) 450 mg orally. The available drug is 50 mg/scoop. How many level scoops do you measure into the patient's pudding to administer the correct dose? a. 9 scoops b. 6 scoops c. 3 scoops d. 2 scoops

ANS: B, E, F The risk for liver toxicity is higher when taking TB drug therapy during pregnancy, and close monitoring of liver function is needed. In addition, the pregnant woman needs higher doses of a B-complex vitamin supplement when taking INH. Avoiding alcohol during TB therapy is very important for all patients and is critical for pregnant women because of the increased risk for liver toxicity as well as fetal alcohol syndrome.

A pregnant patient is taking all four first-line drugs for tuberculosis (TB). Which additional health care actions are needed for this patient? (select all that apply) a. Ensuring that no weight is gained b. Checking liver function tests monthly c. Checking vision and intraocular pressure monthly d. Testing urine for the presence of the TB organism e. Supplementing with B-complex vitamins f. Avoiding alcoholic beverages

A normally healthy patient asks the nurse about how to prevent constipation. What teaching points can be offered to this patient about preventing constipation that are not associated with a medical condition? (select all that apply) A. Eat a high-fiber diet. B. Increase physical activity. C. Increase the use of laxatives. D. Decrease fluid intake. E. Decrease food intake.

A, B, The most common causes of constipation are low-fiber diet, lack of physical activity, not taking in enough fluid, and delaying going to the bathroom when the urge to have a bowel movement is felt. Stress, travel, and other changes in bowel habits can lead to constipation. Increasing the use of laxatives and a decrease in fluid intake are two of the most common causes of constipation. A decrease in food intake does not affect constipation.

What actions must you be sure to take before giving any drug for constipation? Select all A. Listen for active bowel sounds B. Check for abdominal distention C. Ask the patient about previous bacterial infections D. Prepare a full glass of fluid to give with oral drugs E. Ask about the patient's normal bowel habits

A, B, D, E

A nurse is about to give a patient a drug for constipation. What information is most crucial for the nurse to remember? A. Do not give to a patient with undiagnosed abdominal pain. B. Give the drug with 8 ounces of water or fruit juice. C. Administer the drug with antacids. D. Administer the drug with food.

A. Before administering a drug for constipation, the most important thing is to ask the patient about abdominal pain. Drugs for constipation should not be given to a patient experiencing undiagnosed abdominal pain or acute abdominal symptoms, because these drugs increase peristalsis and the risk of bowel perforation. Giving the drug with a full glass of liquid, or giving it with an antacid not knowing drug-drug interactions, or giving it with food are important but not the most crucial information to obtain.

A chemotherapy patient is complaining about having a lot of nausea/vomiting. What antiemetic would you expect to administer to this patient to manage the nausea/vomiting? A. Ondansetron (Zofran) B. Promethazine (Phenergan) C. Metoclopramide (Reglan) D. Cyclizine (Marezine)

A. Each drug affects different receptors, and some drugs affect several sites. Ondansetron is a 5HT3-receptor antagonist that works against nausea/vomiting caused by chemotherapy treatments. These drugs are commonly used to manage the nausea/vomiting resulting from cancer chemotherapy. These drugs are given 30 minutes before the chemotherapy begins. Promethazine (a phenothiazine), metoclopramide (a dopamine antagonist), and cyclizine (an antihistamine) are not usually used to treat the nausea associated with chemotherapy.

A hospital patient was given a bulk-forming drug for constipation 24 hours ago and now reports that it has not worked. What is your best response? A. "They take 12 hours to 3 days to be effective." B. "Let me get you another dose." C. "When did you last eat?" D. "This is normal; try getting up and moving around."

A. The best response is to tell the patient that they may work in as soon as 12 hours but can take as long as 3 days to be effective. Bulk-forming drugs for constipation add bulk to the stool, which increases stool mass that stimulates peristalsis. This helps stool move through the bowel. Getting the patient another dose is not appropriate and could lead to overdose. Asking the patient when he or she last ate is not pertinent to the issue of constipation. Telling the patient that that this is normal and not to worry about it is an unresponsive answer and may cause concern because it gives no information. Moderate exercise may help encourage peristalsis as well.

For which side effect must you notify the prescriber when a patient is taking metoclorpramide (Reglan)? A. Depression b. heartburn c. anxiety d. constipation

A. Depression

Which drug when prescribed for diarrhea slows the movement of stool through the bowel? A. Loperamide (Imodium) B. Bismuth Subsalicylate (Pepto) C. Calcium polycarbophil (Fibercon) D. Attapulgite (Kaopectate)

A. Loperamide (Imodium)

Which drug should not be prescribed to small children because of increased risk for the development of Reyes's syndrome? A. Bismuth subsalicylate (Pepto) B. Calcium polycarbophil (Fibercon) C. Attapulgite (Kaopectate) D. Loperamide (Imodium

A. Pepto

A child taking chemo drugs for cancer is prescribed metoclopramide for nausea and vomiting For which side effects do you monitor? A. muscle spasms of the jaw B. confusion C. hypotension D. depression

A. muscle spasms in the jaw

ANS: 2 Have 40 mg/1 tablet, Want 80 mg/X tablets; 40/80 = 2 tablets.

An adult patient is prescribed esomeprazole magnesium (Nexium) 80 mg orally once daily. The pharmacy has esomeprazole magnesium (Nexium) 40 mg tablets. How many tablets will you teach the patient to take for each dose?

ANS: C Lansoprazole is a proton pump inhibitor (PPI). Teach older adults who have been prescribed PPIs to take a daily multivitamin because PPIs decrease the absorption of vitamin B12 and calcium.

An older adult is prescribed lansoprazole (Prevacid) 15 mg orally each day. The patient asks you why a daily multivitamin has also been prescribed. What is your best response? a. "As you get older you need vitamin tablets to ensure that you get the minimum daily requirements." b. "Lansoprazole is a proton pump inhibitor (PPI) and these drugs interfere with absorption of all vitamins from the GI tract." c. "Taking a daily multivitamin is important because proton pump inhibitor drugs decrease the absorption of vitamin B12 and calcium." d. "Older adults have more difficulty processing vitamins and minerals from the daily foods consumed."

ANS: B, D, E Most of the antifungal drugs can affect cardiac rhythm. Patients should check their pulse daily for a full minute, and if new irregularities are present or the rate is slow, the prescriber should be notified. The risk for drug-induced liver toxicity is higher among older adults; often the first symptom of reduced liver function is yellowing of the sclera and skin. Older adults are also more likely to have some degree of renal insufficiency and can develop kidney problems more quickly while taking an antifungal drug; normal daily urine output should be very close to the volume of fluid taken in each day. There is no recommendation to avoid caffeine with any antifungal drug. GI infection is not a specific risk associated with antifungal therapy. Abdominal bloating and diarrhea are not especially associated with antifungal therapy and are not indications of the need to seek immediate medical attention.

An older adult patient is prescribed systemic antifungal therapy for 1 month. Which precautions are important to teach this patient? (select all that apply) a. "Avoid drinking coffee or any other beverages or food that contain caffeine." b. "Check your pulse daily and report any new irregularities to your prescriber." c. "Examine all bowel movements and any vomit for the presence of pus and report it to your prescriber." d. "Look at the whites of your eyes daily and if a yellow color appears, report it to your prescriber." e. "If your daily urine output drops below a liter less than your daily fluid intake, notify your prescriber immediately." f. "If you should develop abdominal bloating and diarrhea, go to the nearest emergency department as soon as possible."

ANS: D With older adults, signs of confusion may indicate lidocaine toxicity. Older adults are more sensitive to the effects and side effects of this drug. Notify the prescriber immediately; the drug must be stopped and the patient started on another antidysrhythmic drug to prevent life-threatening dysrhythmias such as ventricular tachycardia. Once the drug is discontinued and metabolized, these symptoms will resolve.

An older adult patient with frequent premature ventricular contractions (PVCs) is receiving intravenous (IV) lidocaine (Xylocaine) by continuous infusion. The patient becomes confused and sees insects on the walls. What is your best action? a. Reorient the patient to person, place, and time. b. Ask the patient's family about alcohol use or abuse. c. Check the patient's chart for a history of dementia. d. Slow the infusion and notify the prescriber immediately.

ANS: D Scopolamine is an anticholinergic drug that can cause urinary retention. Older men often have some degree of prostate enlargement that may be undiagnosed and result in some urinary retention. Scopolamine makes this problem worse and can cause kidney damage. Comparing urine output to fluid intake is important for this patient to determine whether severe urinary retention is occurring.

An older male patient with nausea is prescribed scopolamine (L-hyoscine). Which assessment determines whether he is experiencing a serious side effect? a. Checking capillary refill b. Measuring abdominal girth c. Evaluating handgrip strength d. Evaluating daily intake and output

ANS: A When a calcium channel blocker such as diltiazem is prescribed for an older patient, or a patient with hepatic (liver) or renal (kidney) impairment, lower than normal initial doses are prescribed. You should hold the drug and contact the prescriber about the dosage that has been prescribed for this patient.

An older patient with a history of liver impairment is prescribed diltiazem (Cardizem) SR 120 mg twice a day for supraventricular tachycardia. What is your best action before giving the first dose? a. Hold the drug and contact the prescriber. b. Administer the drug as ordered. c. Give 60 mg four times a day. d. Give an XR capsule of 240 mg once a day.

A nurse is monitoring a patient who has been taking metoclopramide (Reglan). What are the symptoms of the adverse effect neuroleptic malignant syndrome in patients who take this drug? (select all that apply) A. Puckering movements of the lips B. Elevated body temperature Correct C. Seizures Correct D. Muscle weakness E. Diaphoresis Correct

B, C, E Metoclopramide (Reglan) along with promethazine (Phenergan), and prochlorperazine (Compazine), can cause neuroleptic malignant syndrome. This is a rare and life-threatening side effect where dangerously high body temperatures can occur. Without prompt and expert treatment, this condition can be fatal in as many as 20% of those who develop it. Other signs and symptoms along with the initial fever include seizures and diaphoresis, respiratory distress, tachycardia, blood pressure changes, pallor, fatigue, severe muscle stiffness and not muscle weakness, and loss of bladder control. Puckering lip movements are symptoms of tardive dyskinesia, another adverse effect of metoclopramide.

Why must a patient taking bismuth subsalicylate (Pepto-Bismol) be taught to avoid taking aspirin? A. The drug contains aspirin and may turn the stool and tongue orange. B. The drug contains aspirin, and additional aspirin may cause tinnitus. C. Use of aspirin with bismuth subsalicylate can lead to diarrhea and dehydration. D. Use of aspirin with bismuth subsalicylate can lead to central nervous system depression.

B. Bismuth subsalicylate does contain aspirin, but it turns stool and the tongue black, not orange. Additional aspirin can result in tinnitus (ringing in the ears). Bismuth subsalicylate is an antidiarrheal drug used to decrease diarrhea. The use of alcohol or other CNS depressants, not bismuth subsalicylate, can lead to CNS depression.

2. A patient reports that his bowel movements are not normal. What is your best response? A. "Increase the amount of fiber in your diet." B. "Describe what you mean by 'not normal.'" C. "Do you need a laxative to be prescribed?" D. "What medications are you currently taking?"

B. Normal bowel function is different for every person. Bowel movements may occur anywhere between several times per day to several times a week. Consistency of bowel movements is more important than frequency. A person's stool should be soft enough to pass easily out of the bowel but should not be liquid. Further assessment is needed to determine if the patient needs a fiber, or a laxative, or if any of the patient's other medications are involved.

A patient who is taking bismuth subsalicylate (Pepto-Bismol) is concerned because his bowel movements are gray-black. What is your best response? A. "Take your next dose and see if it continues." B. "This is a normal side effect of bismuth subsalicylate." C. "Stop the medication and notify your prescriber immediately." D. "Brush your tongue when you brush your teeth."

B. Remind patients that this drug may turn stool and the tongue gray-black and is a normal side effect. Also, remind the patient that this drug contains an aspirin-like drug and should not be taken because it may cause ringing in the ears (tinnitus). Telling the patient to take the next dose and see if it continues would most likely result in the same side effect and is not useful. This is a normal side effect so the medication does not need to be stopped or the prescriber notified. It is not necessary or useful to instruct the patient to brush the tongue.

After giving a drug for constipation, how many mL of fluid do you instruct your patient to drink every day? A. 1200-1500 B. 1500-2000 C. 2000-2400 D. 2400-3000

B. 1500-2000 mL/day

What is the dosage of a drug for constipation for a child between 6 and 12 years old? A. one quarter of the adult dose B. one half of the adult dose C. three quarters of the adult dose D. the same as and adult

B. One half

Which antiemetic drugs can cause patients to experience decreased sweating, increasing the risk of body overheating? A. Cyclizine (Marezine) B. Proclorperazine (Compazine) C. Meclizine (Antivert) D. Ondansetron (Zofran)

B. prochlorperazine (Compazine)

ANS: D Ibutilide is administered by the IV route and the dosage is weight based (if a patient weighs more than 60 kg: 1 mg IV over 10 minutes; less than 60 kg: 0.01 mg/kg IV over 10 minutes; dose can be repeated once after 10 minutes if necessary).

By what route is the potassium channel blocker ibutilide (Corvert) usually given? a. Oral tablet b. Sublingual tablet c. Subcutaneously d. Intravenously

The nurse is caring for a patient with diarrhea. What problems is a patient with diarrhea at risk for? (select all that apply) A. Reye's syndrome B. Tardive dyskinesia C. Dehydration Correct D. Electrolyte imbalance Correct E. Toxic megacolon

C, D Goals of treatment for a patient with diarrhea include keeping the patient hydrated and watching for signs and symptoms of electrolyte imbalances that may be caused by diarrhea such as low potassium level (hypokalemia). Other goals of treatment include treating the underlying cause and relieving the diarrhea. Reye's syndrome is not a risk of diarrhea, but rather a serious adverse effect of bismuth subsalicylate (Pepto-Bismol), which is an antidiarrheal drug. Tardive dyskinesia is not a risk associated with diarrhea. Toxic megacolon is not a risk associated with diarrhea, but rather an adverse reaction of some antidiarrheal drugs.

A newly admitted patient has been diagnosed with a gastrointestinal (GI) disorder. What part of the GI system does the nurse tells the patient makes the difference between having diarrhea, a normal stool, and constipation? A. Alimentary canal B. Small bowel C. Large bowel D. Rectum

C. Depending on how long stool remains in the colon and how much water is absorbed, the consistency of stool may vary from soft and loose (watery diarrhea) to very hard lumps (constipation). The alimentary canal is another name for the GI system. Nutrients are absorbed in the small bowel. Stool is stored in and expelled from the rectum.

A patient with a history of depression has been prescribed an antiemetic. What drug should be avoided? A. Scopolamine (L-hyoscine) B. Promethazine (Phenergan) C. Metoclopramide (Reglan) D. Meclizine (Antivert)

C. Metoclopramide (Reglan) is a dopamine antagonist and can cause mild-to-severe depression. Ask patients about a history of depression. Scopolamine, promethazine, and meclizine are not known to cause depression.

A patient who is taking routine promethazine (Phenergan) reports that her tongue suddenly seems to "have a mind of its own." What is your best response? A. "Take your next dose and see if it continues." B. "This is a normal side effect of promethazine." C. "Stop the medication and notify your prescriber immediately." Correct D. "Suck on ice chips to numb your tongue."

C. Promethazine (Phenergan) and metoclopramide (Reglan) can cause tardive dyskinesia, a chronic disorder of the nervous system. Signs and symptoms include uncontrolled rhythmic movement of the mouth, face, or extremities; lip smacking or puckering; puffing of cheeks; uncontrolled chewing; and rapid or wormlike movements of the tongue. This adverse effect usually occurs after a year or more of continued use of these drugs and is often irreversible. If diagnosed early, tardive dyskinesia may be reversed by stopping the drug. Telling the patient to take the next dose puts the patient at risk for further injury. Problem with the tongue is not a normal side effect but an adverse effect of promethazine. Telling the patient to suck on ice chips also puts the patient at risk for further injury.

Which drug prescribed to relieve constipation is a lubricant? A. Magnesium hydroxide B. Milk of magnesia C. Glycerin suppository D. Bisacodyl

C. Glycerin suppository

Which electrolyte do you monitor carefully when a patient who has persistent diarrhea? A. Sodium B. Magnesium C. Potassium D. Chloride

C. Potassium

What do you teach a patient who is prescribed prochlorperazine (Compazine)? A. Take this drug with food to prevent GI upset B. A side effect of this drug is headaches, which can be relieved with Tylenol. C. This drug can cause your urine to change color to pink or reddish-brown D. The action of this drug is to cause food to move rapidly through GI tract

C. This drug can cause your urine to change color but will go away after a while

A patient complains about motion sickness. What antihistamine would you expect to be prescribed for this patient? A. Granisetron (Kytril) B. Prochlorperazine (Compazine) C. Trimethobenzamide (Tigan) D. Meclizine (Dramamine)

D Meclizine (Dramamine) like Antivert is an antihistamine used for nausea, vomiting, and dizziness from motion sickness and for vertigo associated with diseases affecting the inner ear vestibular apparatus. Granisetron is a 5HT3-receptor antagonist. Prochlorperazine is a phenothiazine and trimethobenzamide is a dopamine antagonist.

A pediatric nurse is caring for a child with diarrhea. Which antidiarrheal drug should be avoided in children? A. Loperamide (Immodium) B. Diphenoxylate with atropine (Lomotil) C. Bismuth subsalicylate (Kaopectate) D. Bismuth subsalicylate (Pepto-Bismol)

D. Children should not be given bismuth subsalicylate because it contains an aspirin-like drug and may cause Reye's syndrome. Children younger than 16 years should never be given bismuth subsalicylate (Pepto-Bismol). Reye's syndrome is a life-threatening condition that affects the liver and CNS and causes vomiting and confusion. Children are more sensitive to the drowsiness and dizziness caused by loperamide (Imodium). Bismuth subsalicylate (Kaopectate) and calcium polycarbophil (Fibercon) are not recommended for preschool children. Infants and children are at increased risk for dehydration with diarrhea. Diphenoxylate with atropine is approved for use in children.

The nurse is going to administer a patient a dose of promethazine (Phenergan) and is reviewing information about the drug. What is a serious adverse effect of this drug? A. Elevated white blood cell (WBC) counts B. Decreased platelet counts C. Pink or reddish-brown urine D. Tissue necrosis after undiluted intravenous (IV) administration

D. When given by IV push, undiluted promethazine has been associated with severe tissue necrosis. Decreased WBC counts, rather than increased, is an adverse effect of promethazine. Decreased platelet counts are not associated with promethazine. Pink or reddish-brown urine is associated with prochlorperazine (Compazine) and is not a serious adverse effect.

Which type of drug used for nausea and/or vomiting causes food to move quickly through the GI tract? A. Phenothiazines B. Anticholinergics C. 5HT-receptor antagonists D. Dopamine antagonists

D. Dopamine antagonists

When electrolyte abnormality must you monitor for when a patient is prescribed bisacodyl (Dulcolax)? A. Hypernatremia B. Hypercalcemia C. Hypophosphatemia D. Hypokalemia

D. Hypokalemia

ANS: D Monitor for signs of thyroid problems such as changes in heart rate, which are more likely to occur during the first few weeks of treatment with amiodarone (Cordarone).

For signs and symptom of which endocrine problem must you monitor when a patient is prescribed amiodarone (Cordarone)? a. Hypoaldosteronism b. Hyperaldosteronism c. Hypothyroidism d. Hyperthyroidism

ANS: C Adefovir dipivoxil, which is used to treat hepatitis B, is highly toxic to the liver and kidneys. Hepatitis B symptoms are only increased when the drug is stopped suddenly, not while it is being used. It does not increase the risk for birth defects and does not cause diabetes mellitus.

For what reason does adefovir dipivoxil have a black box warning? a. It induces type 2 diabetes mellitus. b. It increases the severity of hepatitis B symptoms. c. It is highly toxic to both the liver and the kidneys. d. It has a high likelihood of increasing the risk for birth defects and fetal damage.

ANS: D Although urokinase was used for other thrombotic events at one time, its only current approved use is for treatment of a massive, acute, pulmonary embolism.

For what specific health problem is urokinase (Abbokinase) approved? a. Acute myocardial infarction (heart attack) in which the symptoms began 24 hours ago b. Stroke caused by an embolus lodged in a small artery in the brain c. Stroke caused by a ruptured blood vessel in the brain d. Massive acute pulmonary embolism

ANS: D An adverse effect of ropinirole, a dopaminergic/dopamine antagonist drug, is episodes of falling asleep suddenly (narcolepsy). Neuroleptic malignant syndrome is an adverse effect of COMT inhibitors. Depression with suicidal tendencies is an adverse effect of carbidopa-levodopa (Sinemet). Central nervous system depression is an adverse effect of apomorphine (Apokyn) and can include respiratory depression, coma, and cardiac arrest.

For which adverse effect should you monitor in a patient with Parkinson's disease after administering ropinirole (Requip)? a. Neuroleptic malignant syndrome b. Depression with suicidal tendencies c. Central nervous system depression d. Narcolepsy or sleep attacks

ANS: A The most common side effects of drugs to treat Parkinson's disease are dizziness, nausea, and hypotension.

For which common side effects should you monitor after administering any anti-Parkinson's drug to a patient? a. Dizziness and hypotension b. Diarrhea and nausea c. Hypertension and headache d. Body rash and elevated temperature

ANS: A, C, E Tell patients taking drugs for PUD or GERD to notify their prescriber for difficulty swallowing; persistent abdominal pain; vomiting blood (bright red or coffee grounds-appearing emesis); or black, tarry stools.

For which occurrences should you teach a patient taking drugs for PUD or GERD to notify the prescriber? (select all that apply) a. Difficulty swallowing b. Persistent belching c. Vomiting bright red blood d. Brown formed stools e. Coffee ground appearing emesis f. Bright yellow urine g. Dry mouth h. Fissured tongue

ANS: D While whiplash and head injuries, hypertension, smoking, and high cholesterol all increase the risk for Alzheimer's disease, age is the greatest risk factor for development of Alzheimer's disease. A patient with Down syndrome has an increased risk by age 50 to 60 years.

For which patient do you watch most closely for symptoms of Alzheimer's disease? a. 35-year-old with Down syndrome b. 50-year-old with a whiplash injury c. 60-year-old with hypertension d. 75-year-old with a smoking history

ANS: C Nicotinic acid-based drugs dilate blood vessels and potentiate bleeding. Patients with any condition that includes active bleeding, such as a duodenal ulcer, should not be prescribed nicotinic acid.

For which patient is drug therapy with nicotinic acid contraindicated? a. 28-year-old who has familial hyperlipidemia b. 38-year-old who had hyperthyroidism and lactose intolerance c. 58-year-old who has an actively bleeding duodenal ulcer d. 78-year-old who takes an oral drug for type 2 diabetes

ANS: C An adverse effect of trimethobenzamide is increased risk for seizures and coma. This problem occurs more frequently among people who have a seizure disorder.

For which patient should question the order for trimethobenzamide (Tigan)? a. 70-year-old who has prostate cancer b. 50-year-old who has hypertension c. 40-year-old with a seizure disorder d. 30-year-old with asthma

ANS: B Statins should not be given to women who are pregnant, plan to become pregnant, or are breastfeeding. Statins decrease the amount of fat in the body. Fat is essential to brain development in the fetus and infant. When there is not enough fat in the body during pregnancy and infancy, the fetus can suffer poor brain development and mental retardation.

For which patient should statin drugs be avoided? a. Children over age 8 years b. Women who are pregnant c. Men who are over age 65 years d. Women who are over age 65 years

ANS: C Donepezil suppresses appetite and causes weight loss. In an individual who is underweight, the usual dosage can lead to toxicity. In addition, some Alzheimer's patients forget to eat and are already underweight. Weighing less than an ideal body weight increases the risk for many complications of old age and poor health.

For which patient should the drug donepezil (Aricept) for Alzheimer's disease be avoided? a. 54-year-old woman with early onset Alzheimer's disease b. 67-year-old man who also takes drugs for type 2 diabetes c. 72-year-old woman who is 20 lb underweight d. 72-year-old man who is unable to sit or stand

ANS: B Both thrombolytics and anticoagulants disrupt steps in clot formation. However, anticoagulants have no effect on clots that have already formed. Only thrombolytics can dissolve an existing clot. Neither drug causes a "thinning" of the blood. Blood viscosity (thickness or specific gravity) remains the same when a person receives either class of drug.

How are anticoagulant drugs and thrombolytic drugs different? a. There is no difference; they both have the same actions. b. Anticoagulants prevent clots from forming whereas thrombolytics can dissolve clots that have already formed. c. Thrombolytics must be administered intravenously while all anticoagulants are administered as oral agents. d. Anticoagulants prevent clots by actually thinning the blood whereas thrombolytics reduce platelet aggregation and do not affect blood thickness.

ANS: B A retrovirus is a special virus that always uses RNA as its genetic material, and carries with it the enzymes reverse transcriptase, integrase, and protease, which allow a much higher efficiency of cellular infection than common viruses. This means that disease may result even when low levels of retroviruses enter the body.

How are retroviruses different from common viruses? a. Retroviruses respond to antibacterial drugs but common viruses do not. b. Retroviruses have a greater efficiency of infection than common viruses. c. Common viral infections can be cured while retroviral infections can only be controlled. d. Common viruses can infect anyone whereas retroviruses can only cause infection in an immunosuppressed host.

ANS: B Viral infections are not "cured" but are self-limiting, meaning that in a person with a healthy immune system, the illness only lasts for a limited time. If the person's immune system is working properly, the body fights off the infection by itself. If the person's immune system is weak or if the body has other health problems, the person may die of the effects of the disease.

How are viral infections different from bacterial infections? a. Bacterial infections can be spread from one person to another, whereas viral infections cannot be spread directly. b. Bacterial infections can be cured by treatment with some anti-infective drugs, whereas viral infections are not cured by anti-infective therapy. c. Viruses only cause disease in a person who is immunocompromised, whereas bacteria can cause disease even among immunocompetent people. d. Viruses are the less mature form of a bacterium, so there is essentially no difference between viral infections and bacterial infections.

ANS: D Statins inhibit HMG CoA reductase, an enzyme that controls cholesterol production in the body. They lower blood lipid levels by slowing the production of cholesterol and increasing the ability of the liver to remove LDL cholesterol from the blood.

How do antihyperlipidemic drugs from the statin class lower "bad" cholesterol levels? a. They act as a filter in the blood to trap bad cholesterol and allow white blood cells to destroy it. b. They block the absorption of dietary fats through the walls of the intestinal tract. c. They bind to cholesterol in the intestinal tract and promote its excretion in stool. d. They inhibit HMG CoA reductase and decrease normal liver production of cholesterol.

ANS: C Platelets normally circulate in the blood freely without clumping (aggregating). To begin coagulation, platelets must become active and begin clumping. Antiplatelet drugs do not decrease the number of platelets the body makes or maintains in circulation, they prevent platelets from becoming active and aggregating.

How do antiplatelet drugs work? a. Increasing the elimination of formed platelets b. Decreasing the formation of new platelets c. Preventing platelets from aggregating d. Trapping platelets in the spleen

ANS: A Bile acid sequestrants help the body lose cholesterol. The drugs are taken by mouth and work directly on dietary fats in the intestine. They bind with cholesterol in the intestine, preventing the fats from being absorbed into the blood. This action then eliminates the cholesterol from the body through the stool.

How do bile acid sequestrants work to lower blood lipids? a. Increasing the intestinal excretion of dietary fat b. Preventing the liver from making excess lipids c. Decreasing the movement of blood lipids into blood vessel cells d. Moving extra lipids out of atheromas and into the intestinal tract

ANS: B Cholinesterase/acetylcholinesterase inhibitors reduce the activity of the enzyme acetylcholinesterase that breaks down acetylcholine in the synapses of neurons. This action keeps levels of acetylcholine higher. These drugs are used for early to moderate stages of Alzheimer's disease and their effects are temporary.

How do cholinesterase/acetylcholinesterase inhibitors work for treatment of Alzheimer's disease? a. Protecting the neurons from the changes that occur with Alzheimer's disease. b. Blocking the enzyme that breaks down the neurotransmitter at the neuron synapses. c. Blocking the amino acid glutamate at the N-methyl-D-aspartate receptors in the brain. d. Increasing the amount of white matter surrounding neurons to prevent the formation of "tangles."

ANS: C Ulcers do not heal in an acidic environment. Histamine increases acid production by stimulating the stomach's parietal cells to secrete hydrochloric acid. Histamine (H2) blockers reduce the amount of histamine that is present, which then results in less stimulation of the parietal cells.

How do histamine (H2) blockers help heal gastric ulcers? a. They promote cell division. b. They neutralize acids that are present in the stomach. c. They decrease the amount of acid secreted by stomach cells. d. They increase the rate that stomach contents move into the intestinal tract.

ANS: A Osmotic laxatives pull water from other body areas into the intestinal tract and prevent it from being reabsorbed through intestinal walls. The extra fluid enters stool, keeping it soft and easier to expel.

How do osmotic laxatives reduce constipation? a. They cause retention of fluid in the bowel, increasing the water content in stool. b. They add bulk to the stool, which increases stool mass that stimulates peristalsis. c. They soften stool, allowing the stool to mix with fatty substances, making it easier to eliminate. d. They cause chemical irritation of nerve receptors in the intestinal lining, which then triggers peristalsis.

ANS: C Protease inhibitors prevent viral replication and release of viral particles. Human immunodeficiency virus produces its proteins, including those needed to move viral particles out of the host cell, in one long (human immunodeficiency virus [HIV]) strand. For the proteins to be active, this large protein must be broken down into separate smaller proteins through the action of the viral enzyme HIV protease. Protease inhibitors, when taken into an HIV-infected cell, make the protease enzyme work on the drug rather than on the initial large protein. Thus active proteins are not produced and viral particles cannot leave the cell to infect other cells.

How do protease inhibitor (PI) drugs prevent viral replication? a. They are counterfeit bases that prevent reverse transcriptase from synthesizing the DNA needed for viral replication. b. They inactivate the enzyme that allows the viral genetic material to be integrated into the human host's cellular DNA. c. They prevent the production of proteins needed for viral particles to leave the cell and infect other cells. d. They prevent initial infection by blocking the receptor the virus uses to enter target cells.

ANS: C Proton pump inhibitors (PPIs) work by completely blocking the production of stomach acid. These drugs block the action of "pumps" located in acid-secreting cells, which totally blocks stomach acid secretion.

How do proton pump inhibitors work to treat peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD)? a. Forming a thick stomach coating b. Neutralizing acids in the stomach c. Blocking the production of stomach acid d. Decreasing the stimulation of H2 receptors

ANS: A Thyroid hormone replacement drugs change the effectiveness of insulin and other drugs for diabetes, and often these drugs need to be increased to prevent high blood glucose levels (hyperglycemia). Patients with diabetes and hypothyroidism should be taught to check blood glucose levels more frequently.

How do thyroid replacement drugs affect diabetes? a. Thyroid replacement drugs reduce the effectiveness of all antidiabetic drugs. b. When thyroid replacement drugs return metabolism to normal, diabetes is gone. c. Thyroid replacement drugs can allow a patient to switch from insulin to an oral antidiabetic drug. d. Thyroid replacement drugs require that a patient taking an oral antidiabetic drug be placed on insulin.

ANS: D Hypothyroidism is low thyroid functioning, which is demonstrated by very low production of thyroid hormones. Thyroid replacement drugs are thyroid hormone agonists. Taking these drugs provides an exogenous source of thyroid hormones.

How do thyroid replacement drugs work to treat hypothyroidism? a. Forcing the thyroid gland to secrete more thyroid hormones b. Inhibiting the enzymes that break down thyroid hormones c. Preventing damage to thyroid endocrine cells d. Providing thyroid hormones

ANS: C Memantine (Namenda) blocks the amino acid glutamate at N-methyl-D-aspartate receptors in the brain, preventing overstimulation (overstimulation of these receptors damages neurons and appears to be one cause of Alzheimer's disease). It can be effective in helping modify dementia (temporarily) in some patients with moderate-to-severe Alzheimer's disease.

How does memantine (Namenda) work for treatment of Alzheimer's disease? a. Protecting the neurons from the changes that occur with Alzheimer's disease b. Blocking the enzyme that breaks down the neurotransmitter at the neuron synapses c. Blocking the amino acid glutamate at the N-methyl-D-aspartate receptors in the brain d. Increasing the amount of white matter surrounding neurons to prevent the formation of "tangles"

ANS: C A patient who has nondrug-resistant tuberculosis must remain on the prescribed medications for at least 6 months. The organism is slow growing and is harder to control than other types of bacteria.

How long is the minimum course of drug therapy for an immunocompetent patient with active tuberculosis? a. 7 to 10 days b. 6 weeks c. 6 months d. 2 years

ANS: B Adenosine is rapidly metabolized and rendered ineffective. Its onset of action is immediate when given by IV bolus.

How should you prepare to administer adenosine (Adenocard) to a patient with persistent supraventricular tachycardia (SVT)? a. Sublingual spray b. Rapid IV bolus c. Continuous slow infusion d. Continuous transdermal patch

ANS: B Beta blockers are class II antidysrhythmic drugs. Class I drugs include sodium channel blockers. Class III drugs include potassium channel blockers. Class IV drugs include the calcium channel blockers. Although beta blockers can be considered class III drugs, their main class is class II.

In which class of antidysrhythmic drugs do beta blockers belong? a. Class I b. Class II c. Class III d. Class IV

ANS: C The normal level for T3 (triiodothyronine) ranges between 70 and 205 ng/dL.

Laboratory blood tests show that a patient has a T3 level of 190 ng/dL. How should you interpret this finding? a. Hypothyroidism b. Hyperthyroidism c. Normal thyroid function d. Thyroid function totally absent

ANS: D Signs of digoxin overdose (toxicity) include nausea, vomiting, loss of appetite, diarrhea, and vision problems. Other signs include heart rate or rhythm changes, palpitations, and fainting. When these signs and symptoms occur, hold the dose, notify the prescriber, and check the patient's serum digoxin level. This drug has a very narrow therapeutic range (0.8 to 2 ng/mL).

Nausea, vomiting, and an irregular heart rate develop in a patient who takes oral digoxin every morning. What is your best action? a. Give prescribed promethazine (Phenergan) as needed. b. Check the patient's cardiac monitor strip. c. Assess the apical pulse for a full minute. d. Check laboratory results for a digoxin level.

ANS: B Antihistamine drugs work best against nausea/vomiting caused by opiate drugs or motion.

Nausea/vomiting from which cause is helped best by antihistamines? a. Allergies b. Opiate drugs c. Cancer chemotherapy d. Exposure to bad odors

ANS: C The goal of continuous heparin therapy is to keep the aPTT within a therapeutic range of 1.5 to 2.5 times greater than the laboratory-established control value. Two times the control value is within this range. The prescriber should be notified, but the infusion rate, which is therapeutic, will not change at this time.

The aPTT of a patient who is prescribed continuous intravenous (IV) heparin is two times the control value. What is your best action? a. Increase the IV rate as ordered. b. Decrease the IV rate as ordered. c. Leave the rate unchanged. d. Stop the infusion and notify the prescriber.

ANS: A Thyroid agonists used for thyroid hormone replacement therapy enhance the action of drugs that reduce blood clotting (anticoagulants), especially warfarin. Acetaminophen is a pain reliever. Diphenhydramine is an antihistamine. And fiber supplements are dietary supplements, not drugs, and are unaffected by thyroid hormone replacement therapy although their use can inhibit intestinal uptake of thyroid agonists.

The action of which drug is known to be increased by thyroid hormone replacement drugs? a. Warfarin (Coumadin) b. Acetaminophen (Tylenol) c. Diphenhydramine (Benadryl) d. Fiber supplements (FiberCon)

ANS: C Increasing abdominal size while taking a drug for diarrhea is an indication of toxic megacolon, a serious complication of this therapy. Children taking diphenoxylate are more sensitive to the side effects and can develop a toxic megacolon quickly. Other signs and symptoms of this condition include fever, abdominal pain, rapid heart rate, and dehydration. A patient with toxic megacolon may go into shock. When this condition is not recognized and treated early, there is a risk for death.

The mother of a 6-year-old child receiving diphenoxylate (Lomotil) for the last 4 days for diarrhea reports by telephone that the diarrhea has stopped and that the child's pants cannot be zipped or buttoned today. What is your best advice? a. "Give the child only half the dose of the drug today." b. "Do not give the child fluids for the next 24 hours." c. "Stop the drug and go immediately to the prescriber's office." d. "This is expected because when diarrhea is cured the stool enlarges the abdomen."

ANS: B The most common cause of constipation in children of this age-group is insufficient fluid intake. A 9-month-old does not ask for fluids and is dependent on others to provide them. Increasing fluids is the action least likely to cause problems in this situation, as long as the intake does not exceed 2 L/day.

The mother of a 9-month-old child reports that the child has a bowel movement only every 2 or 3 days and that the stool is small and hard, "like marbles." What should you recommend as a beginning treatment for this problem? a. Use castor oil every 3 days. b. Increase the child's fluid intake. c. Ensure that the child gets adequate exercise. d. Mix a bulk-forming laxative in with the child's cereal.

ANS: A Contact the prescriber and question the order because administering a dose of atropine less than 0.5 mg may make the bradycardia worse (paradoxical bradycardia). The normal dose for an adult is 0.5 to 1 mg IV every 5 minutes up to 3 mg or 0.04 mg/kg.

The prescriber orders atropine 0.3 mg IV push for an adult patient with symptomatic bradycardia. What is your best action? a. Contact the prescriber and question the order. b. Give the drug exactly as prescribed. c. Administer a prepared amp of 1 mg atropine in 5 mL NS. d. Give half an amp of prepared atropine 1 mg in 5 mL NS.

ANS: C Promethazine, a phenothiazine-based drug, induces sedation and confusion in addition to having antiemetic effects. Some patients have reduced memory about events occurring within a few hours after receiving the drug. This is an expected, temporary side effect and does not denote any permanent reduced cognition. Both the patient and the spouse should be aware of this effect so that the patient is not at risk for injury. Driving, cooking, or operating dangerous equipment should not be performed until the drug's effects have worn off.

The spouse of a patient who is prescribed promethazine (Phenergan) as part of her antiemetic therapy with chemotherapy reports that after the last dose the patient did not remember the drive home. What is your best action? a. Thank the spouse for reporting the problem, and document the adverse drug reaction. b. Hold the dose of promethazine for this round of chemotherapy until the patient is seen by the prescriber. c. Reassure the patient and spouse that this is a normal response to the drug and stress that the patient should not drive. d. Perform a mini-mental status examination and assess the patient's pupillary reflexes before administering the promethazine.

ANS: C Amphojel is an aluminum-based antacid. Older adults with Alzheimer's disease should not take aluminum-based antacids because these drugs can worsen the patient's condition. AlternaGEL is not a good alternative because it is also aluminum-based.

The spouse of an older adult with Alzheimer's disease tells you that she has been giving him Amphojel (aluminum hydroxide) for heartburn. What is your best action? a. Ask the spouse how often the patient is taking the Amphojel. b. Suggest that the patient be given AlternaGEL instead. c. Teach the spouse that taking this drug can worsen the patient's condition. d. Remind the spouse that giving this drug often can interfere with bowel function.

ANS: C Dexamethasone is a drug that also has an immunosuppression action. Patients taking this drug are at increased risk for infections and should avoid being exposed to any infection. You should monitor patients receiving this drug for any signs of infection.

The wife of an inpatient who is prescribed dexamethasone (Decadron) tells you over the phone that she has developed a cold with a low-grade fever. What is your best advice at this time? a. "If you come in to visit you must wear an isolation gown." b. "Hospital rules do not allow visitors with colds or fevers for any patients." c. "It would be best to speak with your husband by phone and stay home today." d. "You must take care of yourself to be able to care for your husband after discharge."

ANS: B Proton pump inhibitors have been associated with increased hip fracture in older adults because of decreased calcium absorption. Teach patients to use side rails when going up or down stairs.

To prevent a common risk among older adults who are prescribed proton pump inhibitors, which safety precaution should you recommend? a. "Be sure to take a daily multivitamin." b. "Use handrails when going up or down stairs." c. "Take this drug with food or a full glass of fluid." d. "Notify your prescriber if you develop belching or gas."

ANS: B Niacin may increase blood glucose levels. You would check the patient's blood glucose level more often. Doses of drugs used to control blood glucose may need to be increased.

What action must you take for a diabetic patient who is prescribed niacin (Niacor)? a. Give insulin only in the presence of food. b. Check the blood glucose level more often. c. Decrease the morning insulin dosage. d. Encourage increased caloric intake.

ANS: A, C Low-molecular-weight heparin is given by deep subcutaneous injection with the patient lying down. The needle should be inserted into a skinfold held between the thumb and the forefinger. To avoid losing any of the drug, the nurse should not expel the air bubble before injection. The skinfold should be held until the injection is completed. Do not rub the injection site.

What actions are performed when giving a subcutaneous injection of low-molecular-weight heparin? (select all that apply) a. Position the patient lying down. b. Expel the air bubble before injection. c. Insert the needle into a skinfold held between the thumb and forefinger. d. Release the skinfold then inject the drug. e. Rub the injection site to avoid bruising.

ANS: C Decreased white blood cell count with increased risk for infection (neutropenia) is an adverse effect of both tocainide and phenytoin.

What advice would you give a patient prescribed tocainide (Tonocard) to avoid an adverse effect of this drug? a. "Be sure to avoid foods that are high in alkaline ash such as citrus fruits." b. "Wear protective clothing and a strong sunscreen when you go outdoors." c. "Avoid large crowds and people with flu or cold symptoms." d. "Report any pulmonary symptoms (e.g., cough) to your prescriber right away."

ANS: A, C, E, F The side effects of fibrates are usually mild. The most common side effects are stomach upset and diarrhea. Other common side effects include gastrointestinal discomfort such as indigestion or heartburn (dyspepsia) and nausea. Patients may also experience muscle weakness, headache, pruritus, and rash.

What are the common side effects of gemfibrozil (Lopid)? (select all that apply) a. Diarrhea b. Constipation c. Heartburn d. Polyps e. Rash f. Headache

ANS: A, C, E Intended responses for nicotinic acid agents include: total cholesterol level is decreased; total triglyceride level is decreased; LDL cholesterol level is decreased; and HDL cholesterol level is increased.

What are the expected and intended responses for nicotinic acid agents? (select all that apply) a. Total cholesterol is decreased. b. Total triglyceride level is increased. c. LDL cholesterol level is decreased. d. VLDL cholesterol is increased. e. HDL cholesterol level is increased.

ANS: A, B, D The goals of treatment for Parkinson's disease are to minimize disability, reduce possible side effects of drug therapy, and help the patient maintain a high quality of life. There is no cure for this illness, which is progressive. Drugs can help slow the progression and control the symptoms.

What are the goals of treatment for Parkinson's disease? (select all that apply) a. Help the patient to maintain a high quality of life. b. Reduce side effects of drug therapy. c. Regain as much function as possible. d. Minimize the patient's disability. e. Prolong the patient's life span. f. Maintain short-term memory

ANS: B, C, D The four major symptoms of Parkinson's disease are tremor at rest, rigidity, bradykinesia (slow movements and difficulty starting movements), and abnormal gait. Lack of facial expression is a symptom of this illness, but not a major symptom.

What are the major symptoms of Parkinson's disease? (select all that apply) a. Bradycardia b. Rigidity c. Abnormal gait d. Tremor at rest e. Lack of facial expression f. Facial swelling

ANS: A, C, D, F Signs and symptoms of diarrhea include a frequent need to have a bowel movement, abdominal pain and cramping, fever, chills, generally feeling ill, and weight loss. Bowels feeling full after a bowel movement and feeling bloated are symptoms of constipation.

What are the symptoms of diarrhea? (select all that apply) a. Weight loss b. Bowels still feeling full after a bowel movement c. Abdominal pain and cramping d. Fever and chills e. Feeling bloated f. Feeling ill

ANS: A, C, D Late symptoms of liver disease include yellowing (jaundice) of the skin, the whites of the eyes, and the roof of the mouth; pain over the liver on the right side just below the ribs; darkened urine; and pale gray-colored stools. The bile and bilirubin made by the liver usually leave the body in the stool, giving it a medium to dark brown color. When the liver is not working well, these products do not reach the stool, so it is a light gray or green color instead of brown. Bilirubin enters the urine and turns it dark, and gets into the skin and mucous membranes, making them yellow.

What are the symptoms of late liver disease? (select all that apply) a. Yellowing of the skin b. Light-colored diluted urine c. Pale gray-colored stools d. Pain on the right side just below the ribs e. Reddened mucous membranes in the mouth f. Increased risk for toenail fungal infections

ANS: B Atropine is a competitive muscarinic acetylcholine receptor antagonist used to treat abnormally slow heart rhythms known as bradydysrhythmias (bradycardia). The vagus nerve slows heart rate, and atropine blocks the actions of the vagus nerve on the heart. This drug is used for patients who have symptomatic bradycardia.

What cardiac dysrhythmia can be helped or corrected by the drug atropine? a. Tachycardia b. Bradycardia c. Premature atrial contractions d. Premature ventricular contractions

ANS: B The most common symptom of a peptic ulcer is burning, gnawing pain caused by stomach acid coming into contact with the open wound (ulcer). The pain usually occurs somewhere between the navel (umbilicus) and the breastbone (sternum) and may last from a few minutes to many hours.

What common symptom do you expect to find in a patient with peptic ulcer disease? a. Frequently vomiting bright red blood b. Burning gnawing pain between the navel and sternum c. Nausea with reflux before and after all meals d. Dark coffee-ground textured stools

ANS: C Although a goiter is a distinct swelling of the thyroid gland and the neck, it only indicates a thyroid problem. It is associated with some forms of hypothyroidism and some forms of hyperthyroidism.

What does a goiter indicate? a. Hypothyroidism b. Hyperthyroidism c. Thyroid problem d. Premature menopause

ANS: A Asystole is the absence of electrical or contraction activity within the heart. It appears on the electrocardiogram (ECG) monitor as a straight line or "flatline."

What does the term "asystole" mean What does the term "asystole" mean? a. Absence of electrical activity in the heart b. The ability of the heart to fire an impulse on its own c. Full heart contraction that occurs earlier than it should d. The normal rhythm of the heart as measured by an electrocardiogram

ANS: A A host is the person infected by a virus whose cells allow viral replication.

What does the term "host" mean? a. The person infected by a virus. b. The type of virus known as a retrovirus. c. The type of virus known as a common virus. d. The type of infection that occurs only in immunosuppressed people.

ANS: B Patients taking the "statin" type of cholesterol-lowering drugs may develop rhabdomyolysis (muscle breakdown). Signs and symptoms of rhabdomyolysis include general muscle soreness, muscle pain and weakness, vomiting, stomach pain, and brown urine. The urine turns brown because small reddish-brown pieces of broken-down muscle are removed from the body through the urine.

What does the term "rhabdomyolysis" mean? a. High blood lipid levels b. Skeletal muscle breakdown c. Coronary artery disease from atherosclerosis d. Skin yellowing (jaundice) from liver complications

ANS: B Give twice the normal dose when atropine is given by ET tube. Mix the dose with 5 to 10 mL normal saline. Use the acronym NAVEL to remember drugs that may be given by ET tube: narcan, atropine, Valium, epinephrine, and lidocaine.

What dose of atropine is prescribed to be administered via endotracheal tube? a. The same dose as normal b. Twice the normal dose c. Three times the normal dose d. Four times the normal dose

ANS: D Statins inhibit HMG CoA reductase, an enzyme that controls cholesterol production in the body. They lower blood lipid levels by slowing the production of cholesterol and increasing the ability of the liver to remove LDL cholesterol from the blood. Statins are the most effective group of these drugs for lowering LDL cholesterol.

What enzyme is inhibited by the "statin" type of lipid-lowering drugs? a. Integrase b. Alteplase c. Reverse transcriptase d. HMG CoA reductase

ANS: B All drugs that reduce the ability of the blood to form clots when needed greatly increase the risk for hemorrhage any time an injury occurs. A pulmonary embolism and a thrombosis are both clots. Reduced blood clotting reduces the incidence of clot formation. These drugs do nothing to stimulate the development of diabetes.

What health problem is a possible adverse effect of any drug that reduces blood clotting? a. Pulmonary embolism b. Hemorrhage c. Thrombosis d. Diabetes

ANS: C Although ESAs have the intended response of increasing the production of red blood cells, other cell types also have a somewhat increased production. This causes hyperviscous, thicker blood that increases the friction in blood vessels. As a result, blood pressure can increase, sometimes to dangerous levels.

What health problem is a possible side effect of erythropoiesis-stimulating agent (ESA) therapy? a. Increased risk for infection b. Low blood pressure c. Hypertension d. Anemia

ANS: D Intended responses of fibrates include: triglycerides are decreased and HDL cholesterol is mildly increased.

What is one of the main intended responses of fibrates? a. Increased triglycerides b. Increased blood clotting c. Increased LDL cholesterol d. Increased HDL cholesterol

ANS: C Side effects of antacids are very rare when they are taken as directed. The most common side effect of antacids containing calcium or aluminum salts is constipation. The most common side effect of antacids containing magnesium salts is diarrhea.

What is the common side effect of antacids containing calcium or aluminum? a. Allergies b. Bleeding c. Constipation d. Decreased urine output

ANS: A Clotting factor synthesis inhibitor drugs reduce the amount of certain clotting factors available to form a true blood clot. When this effect occurs, it takes much longer for blood to clot. These drugs do not affect the number of platelets a person has.

What is the intended response of clotting factor synthesis inhibitor drugs? a. Increased clotting times b. Decreased clotting times c. Increased platelet counts d. Decreased platelet counts

ANS: A Erythropoiesis is the production of red blood cells in the bone marrow. ESAs are drugs that increase this process resulting in greater or increased red blood cell counts. ESAs may also increase the platelet count but that is not their intended response.

What is the intended response to an erythropoiesis-stimulating agent (ESA)? a. Increased red blood cell counts b. Decreased red blood cell counts c. Increased platelet counts d. Decreased platelet counts

ANS: C Retroviruses carry a series of enzymes with them that allow them to incorporate into human DNA and use the host's DNA to help replication. This gives them a very high efficiency of infection. Common viruses, although some are very virulent, do not have those enzymes and their efficiency of infection is lower.

What is the major difference between retroviruses and common viruses? a. Retroviruses cannot be killed by antiviral therapy, but common viruses can. b. A retrovirus usually can cause disease over and over again in the same person. c. A retrovirus carries the enzyme reverse transcriptase, and common viruses do not. d. Retroviruses will respond to antibacterial drugs as well as to all the antiviral drugs.

ANS: B The tuberculosis (TB) bacteria are spread when bacteria-filled droplets travel through the air when a person with TB coughs, laughs, sneezes, sings, or whistles. These droplets can be inhaled by another person who then may develop the disease. Bacteria-filled droplets in the air are known as "aerosol transmission." It is possible to spread TB in other ways but aerosol transmission is by far the most common.

What is the major way in which tuberculosis is spread from one person to another? a. By blood transfusions b. By aerosol transmission c. Through direct skin contact d. From unprotected sexual intercourse

ANS: B The skin site where a rotigotine patch has been removed should be cleansed and not used again for a minimum of 14 days to prevent skin breakdown.

What is the minimum time period needed before reapplying a rotigotine patch to the same skin site? a. 7 days b. 14 days c. 21 days d. 28 days

ANS: B The most common purpose of the INR blood test is to determine how quickly a person's blood is able to begin clotting. It is used to determine the effectiveness of warfarin therapy and whether any adjustments in dosages are needed.

What is the most common purpose of the international normalized ratio (INR)? a. Measuring the total amount of blood a person has b. Reporting the results of warfarin anticoagulation c. Assessing the number of clotting factors present d. Determining the number of platelets

ANS: C Common side effects of adenosine include facial flushing, shortness of breath, and transient dysrhythmias such as atrial fibrillation and atrial flutter.

What is the most common side effect of adenosine (Adenocard)? a. Nightmares b. Constipation c. Facial flushing d. Leg and ankle swelling

ANS: A Side effects of bile acid sequestrants are rarely serious. The most common side effects are gastrointestinal symptoms, including constipation, bloating, nausea, vomiting, and gas.

What is the most common side effect of bile acid sequestrants? a. Intestinal gas b. Facial flushing c. Blurred vision d. Muscle weakness

ANS: A Nicotinic acid agents may cause many side effects. The most common are itching and nasal inflammation because the drug makes blood vessels dilate. Other common side effects include gastrointestinal symptoms such as nausea, indigestion, gas, vomiting, diarrhea, and abdominal pain. The patient may also experience flushing (redness) and hot flashes, chills, dizziness, fainting, headaches, rapid heart rate (tachycardia), shortness of breath (dyspnea), sweating (diaphoresis), and swelling caused by fluid retention.

What is the most common side effect of nicotinic acid agents? a. Itching b. Blurred vision c. Muscle weakness d. High blood pressure

ANS: A The most common symptom of GERD is dyspepsia (heartburn). Other common symptoms include sour or bitter taste; bitter stomach fluid going into the mouth, especially during sleep; hoarseness; water brash (regurgitation of watery acid from the stomach); a repeated need to clear the throat; difficulty swallowing food or liquid; wheezing or coughing at night; and worsening of symptoms after eating or when bending over or lying down.

What is the most common symptom of gastroesophageal reflux disease (GERD)? a. Heartburn b. Drowsiness c. Constipation d. Bloody sputum

ANS: D Beta blockers can increase or decrease blood glucose levels. They can also mask the signs of hypoglycemia such as rapid heart rate, making it difficult to recognize and treat. Whereas all of these actions are important, the most important action related to a diabetic patient receiving a beta blocker is to regularly check the patient's blood glucose.

What is the most important action when caring for a patient with type 2 diabetes mellitus who is prescribed a beta blocker? a. Assess the patient's feet daily. b. Monitor for infection. c. Administer oral diabetic drugs. d. Regularly check the patient's blood glucose.

ANS: A Metoclopramide can make depression worse and intensify thoughts of suicide. Patients with a history of depression should not be prescribed this drug.

What is the most important assessment question to ask a patient before administering intravenous metoclopramide (Reglan)? a. "Are you being treated for depression?" b. "Is your type 1 diabetes well controlled?" c. "Do you have a gastric or duodenal ulcer?" d. "Are you taking aspirin or any aspirin-containing products?"

ANS: A For effective antiviral therapy the patient must take the drug long enough to ensure suppression of viral reproduction. If the patient stops taking the drug as soon as he or she feels better, symptoms of infection may recur and resistant viruses may develop.

What is the most important precaution to teach a patient who is prescribed any antiviral drug? a. "Take the drug exactly as prescribed and for as long as prescribed." b. "Never take any antibacterial drugs while you are on antiviral therapy." c. "Drink at least 3 L of water daily for the entire time you are taking this drug." d. "Avoid unnecessary exposure to this drug by stopping it when you have no symptoms for 24 hours."

ANS: D Valacyclovir consists of a type of chemical that can easily turn into crystals. Crystals that form and clump in the kidneys can cause kidney failure or kidney stones. Drinking at least 3 L of fluids daily while taking this drug can prevent crystallization in the kidneys.

What is the most important precaution to teach a patient who is prescribed oral valacyclovir (Valtrex)? a. "Avoid coffee and other caffeinated beverages." b. "Wear long sleeves and a hat when going outdoors." c. "Take this drug 1 hour before or 4 hours after eating a full meal." d. "Drink at least 3 L of water daily for the entire time you are taking this drug."

ANS: A As for any drug delivered by transdermal patch, the old patch should be removed before applying the new one to prevent a drug overdose. The patches can irritate the skin and should not be replaced in the same position as the previous patch. Rotating sites prevents skin irritation and breakdown. Applying the patch closer to the brain does not increase brain absorption of the drug.

What is the most important precaution to teach a patient who is prescribed transdermal rivastigmine (Exelon)? a. Always remove old patches daily and apply the new patch to a different site. b. Report any difficulty starting the urinary stream to your prescriber immediately. c. Place the patch on the neck or forehead so that the drug reaches the brain more quickly. d. For best drug absorption, hold a warm washcloth over the patch for 5 minutes after applying it.

ANS: C The IV form of rifampin contains a sulfite preservative that can cause hypersensitivity reactions in patients allergic to sulfite preservatives such as sodium metabisulfite or potassium metabisulfite. This problem is not the same as an allergy to "sulfa" drugs.

What is the most important question to ask a patient before administering rifampin (RIF) intravenously? a. "Have you ever had gout?" b. "Are you allergic to sulfa drugs?" c. "Are you allergic to sulfite preservatives?" d. "Have you had any alcoholic beverages within the last month?"

ANS: C The formulation of darunavir contains sulfa. A patient who is allergic to sulfa drugs is likely to also be allergic to darunavir and have a serious reaction to the drug.

What is the most important question to ask before giving the first dose of darunavir to a patient newly prescribed this drug? a. "Do you have a hearing problem or any trouble with your ears?" b. "Do you take medications for seizures?" c. "Are you allergic to sulfa drugs?" d. "Have you ever had asthma?"

ANS: C Antibus and coagulus are not medical terms. An embolus is a clot that travels through the body and can lodge in a smaller blood vessel. A thrombus is a clot that usually forms within a blood vessel and stays there, often preventing blood from moving past that point.

What is the name of a blood clot that forms and stays within a blood vessel or the heart? a. Antibus b. Embolus c. Thrombus d. Coagulus

ANS: C Antiviral drugs are only virustatic and reduce the number of viruses by preventing them from reproducing and growing. They are not virucidal and cannot kill the virus. By keeping the number of viruses low, antiviral drugs allow the body's natural defenses to destroy, eliminate, or inactivate them.

What is the purpose of antiviral drug therapy? a. To make the patient immune to infection by viruses. b. To reduce infection by killing the virus causing disease. c. To reduce illness duration by controlling viral reproduction. d. To prevent opportunistic infections in immunosuppressed patients.

ANS: A Truvada is a drug used for pre-exposure prophylaxis among HIV negative people who are having sex with HIV positive people. If a person develops HIV disease and becomes positive while taking this drug, the risk for the HIV to become highly drug resistant greatly increases. Patients should be taught to use safer sex practices even though they are taking this drug prophylactically.

What precaution is most important to teach a patient newly prescribed to take Truvada? a. "Continue to use safer sex practices." b. "Avoid caffeine and any fatty or fried foods." c. "Be sure to drink at least 3 L of fluids daily." d. "If you develop muscle or joint aches, notify your prescriber immediately."

ANS: A Adverse effects of memantine include shortness of breath, seizures, and hallucinations.

What problem is a possible adverse effect of memantine (Namenda) for Alzheimer's disease? a. Seizures b. Tachycardia c. Severe hypertension d. Peripheral neuropathy

ANS: B A potential life-threatening adverse effect of antimotility drugs such as loperamide is toxic megacolon which is characterized by a very inflated colon and abdominal distention. After giving an antimotility drug, you must be sure to check the patient's abdomen for distention and report this finding to the prescriber.

What problem is most important to assess for in a patient who is prescribed loperamide (Imodium)? a. Tachycardia b. Abdominal distention c. Peripheral edema d. Respiratory crackles

ANS: A Cholesterol is produced by the liver, and it is in the foods that you eat. However, your body needs only a small amount of cholesterol; too much cholesterol in the bloodstream can deposit in the walls of blood vessels forming plaque that contributes to the development of narrowed arteries such as atherosclerosis and coronary artery disease.

What problem is usually caused by high blood lipid levels? a. Atherosclerosis b. Blindness from glaucoma c. Chronic hypotension d. Deadly dysrhythmias

ANS: B Benztropine is an anticholinergic drug. These drugs cause decreased perspiration, leading to increased risk for overheating during hot weather. Patients should be taught to stay indoors, preferably in an air-conditioned environment, to avoid this side effect.

What safety precaution should you teach a patient with Parkinson's disease who is prescribed benztropine (Cogentin)? a. Always dress warmly and avoid extended exposure to cold weather. b. Stay indoors in an air-conditioned setting during hot weather. c. Change positions slowly to avoid dizziness or light-headedness. d. Avoid alcohol intake because drowsiness is associated with this drug.

ANS: A, C, D, E When a patient has peptic ulcer disease, smoking is not highly recommended because smoking slows ulcer healing; is related to ulcer recurrence; increases acid secretion; reduces prostaglandin, mucus, and bicarbonate production; and decreases mucosal blood flow.

What should you teach a patient about smoking and peptic ulcer disease? (select all that apply) a. Smoking increases acid secretion. b. Smoking is not a cause of ulcer formation. c. Smoking slows ulcer healing. d. Smoking is related to the reoccurrence of ulcers. e. Smoking decreases stomach mucus production. f. Smoking stimulates scar tissue formation in the stomach.

ANS: B Statin drugs have a high likelihood of increasing the risk for birth defects or fetal damage. They should not be taken by women who plan to become pregnant, are pregnant, or are breastfeeding. These drugs decrease the amount of fat in the body. Fat is essential to brain development in the fetus and infant. When there is not enough fat in the body during pregnancy and infancy, the results can be poor brain development and mental retardation.

What should you teach a woman of childbearing age who is prescribed a statin drug? a. "These drugs should not be taken during pregnancy, but are safe to use when breastfeeding." b. "Statins drugs can interfere with fetal brain development and should not be taken during pregnancy or breastfeeding." c. "Because these drugs control fats produced by the liver, they will help control weight gain during pregnancy." d. "You can take these drugs during pregnancy as long as you do not have a history of muscle or liver problems."

ANS: C Teach patients who have been prescribed antidysrhythmic drugs to check and record their heart rate and blood pressure daily.

What should you teach any patient prescribed an antidysrhythmic drug to do every day? a. Keep accurate intake and output records. b. Drink half of a glass of water with each drug. c. Check heart rate and blood pressure. d. Participate in an aerobic exercise program.

ANS: C Tell the patient and family to report to the prescriber immediately any worsening of depression or thoughts of suicide.

What specific precaution would you teach the family of a patient prescribed amantadine? a. "Be sure that the patient performs mouth care four to six times daily." b. "Remind the patient that monthly follow-up lab tests will be needed." c. "Contact the prescriber immediately for any worsening of depression or thoughts of suicide." d. "Ensure that the patient takes in at least 1000 mL more fluids that he or she puts out."

ANS: B Digoxin (Lanoxin) is a cardiac glycoside that may be used in small doses to increase contractility and slow conduction through the AV node, causing slowing of the heart rate. Always check the patient's pulse for a full minute before giving the dose. If the heart rate is less than 60 per minute hold the drug and notify the prescriber. Teach patients going home on this drug how to perform a pulse check and when to notify the prescriber.

What step must be taken before giving digoxin (Lanoxin)? a. Measure the size of both ankles. b. Take the apical pulse for a full minute. c. Make sure the patient has not eaten for at least an hour. d. Take the blood pressure in both the right arm and the left arm.

ANS: C A thrombin inhibitor is used to prevent a heart attack by reducing the blood's ability to clot. Hemophilia, hemorrhage, and gastric ulcers are all conditions that are or can lead to excessive bleeding, not clotting.

What type of clotting problem is most often treated with a thrombin inhibitor? a. Hemophilia b. Hemorrhage c. Heart attack d. Gastric ulcers

ANS: D Magnesium sulfate is used intravenously to prevent the ventricular dysrhythmia torsades de pointes from returning after a patient has been defibrillated (given an electric shock) to return into a normal rhythm. An IV magnesium sulfate bolus can sometimes eliminate torsades de pointes in a patient who is not symptomatic.

What type of dysrhythmia or cardiac problem is usually treated with magnesium sulfate? a. Asystole b. Heart block c. Chest pain d. Torsades de pointes

ANS: A Antifungal drugs that are applied topically do not penetrate tissues and only work against fungi that are on the surface.

What type of fungal infections can be treated with topical antifungal agents? a. Those that are confined to the skin or mucous membranes b. Those that are located under the toenails or fingernails c. Those that are infected by only one specific type of fungus d. The type that only infect humans and not animals

ANS: A Antiemetic drugs control nausea and prevent vomiting. Nausea/vomiting often occur together, and the same drugs are used for both problems.

What types of drugs prevent or control nausea/vomiting? a. Antiemetic drugs b. Antimotility drugs c. Antidiarrheal drugs d. Antipropulsion drugs

ANS: A Antiplatelet drugs can cause nausea, stomach upsets, and gastric irritation. They should be taken with or shortly after a meal. They should not be taken with an antacid because antacids inhibit their absorption.

When should antiplatelet drugs be administered? a. With or just after a meal b. At bedtime to prevent light-headedness c. At the same time as an oral antacid d. One hour before or 2 hours after a meal

ANS: B Instruct patients to take this drug 30 minutes before meals and at bedtime to help prevent reflux of stomach contents into the esophagus.

When should metoclopramide (Reglan) be taken? a. 1 hour before meals and at bedtime b. 30 minutes before meals and at bedtime c. 30 minutes after meals and at bedtime d. 1 hour after meals and at bedtime

ANS: B Bisacodyl may cause hypokalemia, which can lead to life-threatening dysrhythmias. Serum electrolytes may not have been ordered. Checking pulse regularity can help recognize new or worsening dysrhythmias.

Which action is most important after giving a patient bisacodyl (Dulcolax)? a. Comparing daily urine output with fluid intake. b. Assessing pulse rate and regularity every 4 hours. c. Ensuring that the patient complies with a low-sodium diet. d. Testing the patient's blood glucose level at least every shift.

ANS: D Thrombolytic drugs dissolve existing clots, so there is a high risk for bleeding with any invasive procedures such as intramuscular injections. Administration of IV drugs through an already existing line is acceptable, but you would not want to place a new line or discontinue an existing line. Use of electric razors and soft toothbrushes are safe with patients who have received a thrombolytic drug.

Which action should you avoid performing on a patient after he or she has received a thrombolytic drug? a. Administering IV drugs b. Using electric razors c. Providing a soft toothbrush d. Giving an intramuscular injection

ANS: A, B, D, F Bile acid sequestrants decrease the body's ability to absorb oral drugs. Give other drugs at least an hour before these drugs. They also inhibit fat-soluble vitamins (A, D, E, K), so patients may need to take a daily vitamin supplement. Giving the drugs with meals facilitates the drug's action and decreases common GI side effects including constipation. Powdered forms should be mixed with 4 to 6 ounces of juice or water. If the patient is taking warfarin, monitor for signs of bleeding such as easy bruising, clammy skin, pale skin, dizziness, increased heart rate, decreased blood pressure, shortness of breath, or confusion. Monitor INRs for changes that are higher or lower than the patient's prescribed therapeutic range.

Which actions are important when a patient is prescribed a bile acid sequestrant drug and is also prescribed warfarin (Coumadin)? (select all that apply) a. Administer a daily multivitamin. b. Give other medications at least an hour before this drug. c. Schedule the drug for 1 hour before meals. d. Ask the patient about symptoms of constipation. e. Mix powdered forms of the drug with 2 ounces of juice or water. f. Check for signs and symptoms of bleeding.

ANS: B Smoking interferes with the action of histamine H2 blockers so encourage patients to quit smoking.

Which activity interferes with the action of histamine H2 blockers? a. Going to bed late b. Smoking cigarettes c. Eating dairy products d. Taking oral contraceptives

ANS: A Successful drug therapy for TB requires that all first-line drugs be taken correctly without missing doses. Patients who have memory problems usually need some form of directly observed therapy (DOT) to ensure absolute adherence to this important therapy. Having one family member responsible for giving the drugs fulfills the requirements of DOT and reduces the risk that the patient will receive either too many drug doses or too few doses to be effective.

Which administration technique should you teach the family of a patient with memory problems for best adherence to first-line drug therapy for tuberculosis? a. Having one family member responsible for giving the drugs and watching the patient swallow them b. Setting up the patient's drugs using a daily pill dispenser that has separate slots for each individual drug c. Asking the patient every night whether he or she has remembered to take all the drug doses that day d. Administering all the drugs together at the same time every day and ensuring that the patient drinks plenty of water

ANS: D Antibiotics are essential to the treatment plan for PUD and are used to treat H. pylori infections of the GI tract. Clarithromycin is an example of a drug used to treat H. pylori infection.

Which antibiotic should be prescribed for H. pylori infection? a. Penicillin (Pen V) b. Ciprofloxacin (Cipro) c. Erythromycin (Erythrocin) d. Clarithromycin (Biaxin)

ANS: A, C, D Use the acronym NAVEL to remember which drugs may be given by endotracheal tube: narcan, atropine, Valium, epinephrine, and lidocaine.

Which antidysrhythmic drugs may be given by the endotracheal tube route? (select all that apply) a. Atropine (Atropine Sulfate) b. Digoxin (Lanoxin) c. Epinephrine (Adrenalin) d. Lidocaine (Xylocaine) e. Procainamide (Pronestyl)

ANS: A Amphotericin B causes massive vasodilation, especially if given too fast, which results in whole body flushing and a red appearance.

Which antifungal drug causes "red man syndrome?" a. Amphotericin B b. Ketoconazole c. Caspofungin d. Fluconazole

ANS: A Although some antifungal drugs have the potential to affect renal function if given at higher doses or for prolonged periods, only amphotericin causes renal impairment in everyone who receives it even if they only receive one dose.

Which antifungal drug causes some degree of renal impairment in everyone who receives it? a. Amphotericin (Amphocin) b. Terbinafine (Lamisil) c. Caspofungin (Cancidas) d. Fluconazole (Diflucan)

ANS: C Micafungin and amphotericin B are administered intravenously. Although flucytosine can be administered orally, it is not available as granules and is not prescribed for ringworm.

Which antifungal drug to treat ringworm is given to children as granules that are sprinkled over soft, nonacidic foods? a. Amphotericin B b. Flucytosine c. Terbinafine d. Micafungin

ANS: C Aspirin inhibits the enzyme that results in the formation of the proclotting substance, thromboxane A2. Acetaminophen does not prevent platelet aggregation. Dipyridamole inhibits another enzyme important in platelet aggregation, not the receptors.

Which antiplatelet drug prevents platelet aggregation by blocking a receptor on the surface of platelets? a. Aspirin b. Acetaminophen (Tylenol) c. Clopidogrel (Plavix) d. Dipyridamole

ANS: D Truvada, which is a combination of emtricitabine and tenofovir, has been found effective in preventing HIV infection among HIV-negative individuals who have sex with people who are HIV positive.

Which antiretroviral drug is now prescribed for preexposure prophylaxis to prevent human immunodeficiency virus (HIV) infection? a. Acyclovir b. Edurant c. Crixivan d. Truvada

ANS: C, D, E, F When administered with these drugs, ritonavir slows their metabolism and elimination. This action allows the drugs to remain in the blood at a higher level, which increases their effectiveness.

Which antiretroviral drugs have greater effectiveness when administered with ritonavir? (select all that apply) a. Edurant (rilpivirine) b. Emtriva (emtricitabine) c. Invirase (saquinavir) d. Lexiva (fosamprenavir) e. Prezista (darunavir) f. Reyataz (atazanavir) g. Tivicay (dolutegravir) h. Ziagen (abacavir)

ANS: B Rifampin is associated with discoloration of the urine, which turns a reddish orange or a reddish brown color. The cause of this discoloration is not known but may be related to the drug's action of increasing the renal excretion of bile acids.

Which antitubercular drug causes the urine to turn reddish orange? a. Isoniazid (INH) b. Rifampin (RIF) c. Pyrazinamide (PAS) d. Ethambutol (EMB)

ANS: D Ethambutol can cause serious eye problems that may lead to blindness in people of any age. Its use is avoided in children because they may not recognize vision changes caused by the drug soon enough to avoid permanent vision changes or blindness.

Which antitubercular drug is avoided in the treatment of children who have tuberculosis? a. Isoniazid (INH) b. Rifampin (RIF) c. Pyrazinamide (PAS) d. Ethambutol (EMB)

ANS: D The likelihood for acyclovir to increase the risk for birth defects or fetal harm is low. Zanamivir is orally inhaled and poorly absorbed, not a risk for birth defects. Rimantadine has a moderate likelihood of increasing the risk for birth defects. Ribavirin is a known teratogen and has a very high likelihood of increasing the risk for birth defects and fetal harm.

Which antiviral drug is highly likely to cause birth defects when taken by a pregnant woman? a. Acyclovir b. Zanamivir c. Rimantadine d. Ribavirin

ANS: B Amantadine crosses the blood-brain barrier and concentrates in the brain tissues. None of the other drugs concentrate in brain tissues.

Which antiviral drug is most likely to have more severe central nervous system side effects, including worsening of glaucoma? a. Acyclovir b. Amantadine c. Valacyclovir d. Zanamavir

ANS: B Acyclovir is given intravenously or as an orally swallowed drug. Oseltamivir and amantadine are swallowed orally.

Which antiviral drug is only given by oral inhalation? a. Cyclovir (Zovirax) b. Zanamivir (Relenza) c. Oseltamivir (Tamiflu) d. Amantadine (Symmetrel)

ANS: A, C, D, F Intended responses of antiemetic drugs include: vomiting reflex is inhibited, vomiting reflex pathways are interrupted or disrupted, patient is sedated, nausea is relieved, and vomiting is prevented.

Which are expected and intended responses to antiemetic drugs? (select all that apply) a. Vomiting reflex is inhibited. b. Vomiting reflex pathway is uninterrupted. c. Patient is sedated. d. Nausea is relieved. e. Retching occurs as expected. f. Vomiting is prevented.

ANS: A, C, E The intended responses for H2 blockers are: secretion of gastric acid is decreased, symptoms of GERD are decreased, and ulcers are healed and prevented.

Which are intended responses for histamine (H2) blockers? (select all that apply) a. Decreased gastric acid secretion b. Increased gastric acid secretion c. Esophageal reflux is decreased d. White blood cells are decreased e. Gastric ulcers are healed f. Occult bleeding is detected early

ANS: A, C, D, F Intended responses of thyroid hormone agonist drugs include: body temperature is normal; level of activity is normal; heart rate, blood pressure, and respiratory rate are normal for the patient's age and size; body weight is maintained when the patient takes in the amount of calories needed for his or her age, size, and activity level; the patient is mentally alert (he or she is able to remember people, places, and events from the recent and distant past); and bowel movement pattern is normal.

Which are intended responses of thyroid hormone agonist drugs? (select all that apply) a. Body temperature is normal. b. Activity level is decreased. c. Vital signs are normal. d. Body weight is maintained. e. Bowel movements occur at least twice a week. f. Patient is mentally alert.

ANS: A, C, E Nausea/vomiting create physiological complications which include bleeding, aspiration pneumonia, dehydration, and reopening of surgical wounds. These complications can be very costly and prolong hospital stays.

Which are potential complications of nausea/vomiting? (select all that apply) a. Bleeding b. Aortic aneurysm c. Aspiration pneumonia d. Bowel perforation e. Reopening of surgical wounds f. Respiratory acidosis

ANS: B, C, E, F Risk factors for development of GERD are listed in Box 23-3 in the text.

Which are risk factors for an individual to develop GERD? (select all that apply) a. Being underweight b. Being pregnant c. Taking NSAID drugs d. Eating foods high in alkaline content e. Drinking caffeinated beverages f. Eating spicy foods g. Drinking 2 L of water daily.

ANS: B, D, E Signs and symptoms of constipation include fewer than three bowel movements a week, a sudden decrease in the frequency of bowel movements, stools that are harder than normal, bowels that still feel full after a bowel movement, and feeling bloated.

Which are symptoms of constipation? (select all that apply) a. Having less than one bowel movement a day. b. Stools that is harder than normal. c. Sudden increase in frequency of bowel movements. d. Bowels that feel full after a bowel movement. e. Sensation of feeling bloated. f. Coffee-ground appearance of stools.

ANS: A The side effects and adverse effects of thyroid hormone replacement drugs increase metabolic rate and cardiac activity. Checking heart rate and rhythm before giving the drug provides a baseline to determine whether or not the drug is working correctly or is causing an overdose effect.

Which assessment is most important to perform before giving a patient who is prescribed levothyroxine (Synthroid) the first dose of the drug? a. Measuring heart rate and rhythm b. Determining level of consciousness c. Asking about an allergy to "sulfa" drugs d. Checking intake and output for the last 24 hours

ANS: B Research has shown that 80% to 90% of gastric ulcers are caused by infection with the Helicobacter pylori (H. pylori) bacteria. H. pylori infection is present in 20% to 30% of people in the United States. Some people experience no signs or symptoms, whereas others develop ulcers.

Which bacteria is often the cause of stomach ulcers? a. Escherichia coli b. Helicobacter pylori c. Staphylococcus aureus d. Streptococcus pneumoniae

ANS: B While fibrin creates threads that make the plasma sticky and able to clot, it is platelets that clump together to create the initial plug that helps to stop bleeding. Neutrophils and eosinophils are types of white blood cells that help the body fight off infection.

Which blood component forms the initial plug that helps stop bleeding? a. Fibrin b. Platelets c. Neutrophils d. Eosinophils

ANS: C Carbidopa-levodopa can suppress bone marrow activity and reduce the circulating levels of WBCs (neutropenia), greatly increasing the risk for infection. More patients with Parkinson's disease are older adults and may already have some age-related decrease in immune function. Neutropenia and infection are more likely when the patient's WBC count is low before treatment with the drug is started.

Which blood laboratory test result is most important to check before administering the first prescribed dose of carbidopa-levodopa (Sinemet) to a patient? a. International normalized ratio (INR) b. Blood urea nitrogen (BUN) level c. White blood cell (WBC) count d. Lactate dehydrogenase (LDH)

ANS: C All of the direct thrombin inhibitors can increase the blood potassium levels and cause hyperkalemia. This blood level should be monitored on a regular basis. The INR is not accurate in determining the effectiveness of direct thrombin inhibitors.

Which blood test should be performed on a regular basis for a patient who takes an oral direct thrombin inhibitor daily? a. International normalized ratio (INR) b. Complete blood cell count c. Potassium d. Sodium

ANS: D Warfarin decreases the synthesis of vitamin K in the intestinal tract, which then reduces the production of clotting factors II, VII, IX, and X, along with the anticoagulant proteins C and S. When the amounts of these critical clotting factors are reduced, anticoagulation results.

Which category of anticoagulant drugs includes warfarin (Coumadin)? a. Platelet inhibitors b. Heparin inhibitors c. Thrombin inhibitors d. Clotting factor synthesis inhibitors

ANS: D Heparin and antiplatelet drugs prevent clots from forming and also prevent existing clots from becoming larger. They do not dissolve existing clots. Coagulants would enhance blood clotting, not dissolve clots.

Which category of drugs actually dissolves existing clots? a. Heparins b. Coagulants c. Antiplatelets d. Thrombolytics

ANS: B, D, E Expected responses of first-line antituberculosis drugs include cough is reduced; sputum production is reduced; fatigue is reduced; weight is gained; and sputum culture is negative for TB organisms.

Which changes are intended responses of first-line antituberculosis drugs? (select all that apply) a. Sputum is mobilized (increased). b. Cough is decreased. c. Fatigue is eliminated. d. Weight is gained. e. Sputum culture for TB is negative. f. Future TB tests are negative.

ANS: D The activity of azole antifungal drugs can be reduced by grapefruit juice in large quantities. Patients should not take an azole with grapefruit juice and should limit their total grapefruit juice intake to no more than 24 ounces/day.

Which class of antifungal agents should never be given with grapefruit juice? a. Echinocandins b. Alyamines c. Polyenes d. Azoles

ANS: C In order for new viral particles to leave the infected cell to go on and infect new cells, they must use "chemical scissors" to cut up their genetic material in the right places. Protease inhibitors suppress the activity of this enzyme so that viral particles are unable to leave the infected cells even though the viruses have reproduced.

Which class of antiretroviral drugs works by preventing new viral particles from leaving the infected cell? a. Entry inhibitors b. Fusion inhibitors c. Protease inhibitors d. Reverse-transcriptase inhibitors

ANS: A Granisetron (Kytril) is a 5HT3-receptor antagonist that works well for nausea/vomiting caused by chemotherapy treatments.

Which common drug for nausea/vomiting is a 5HT3-receptor antagonist? a. Granisetron b. Promethazine c. Scopolamine d. Metoclopramide

ANS: A For many patients with Parkinson's disease, the initial symptom is a coarse, rhythmic tremor of the hand while the hand is at rest, also called pill-rolling tremor.

Which common initial symptom suggests that a patient may be developing Parkinson's disease? a. Pill-rolling tremor b. Muscle rigidity c. Stooped posture d. Stumble-run walk

ANS: A Aspirin is the most common antiplatelet drug and is available over-the-counter. It disrupts an enzyme system within platelets that prevents their activation. Tylenol has no antiplatelet activity and neither does vitamin C. Magnesium is a mineral that helps blood to clot in different areas of the blood clotting cascade.

Which common over-the-counter agent is an antiplatelet drug? a. Aspirin b. Tylenol c. Vitamin C d. Magnesium

ANS: B The most common side effects of adefovir dipivoxil are nausea and abdominal pain.

Which common side effects should you watch for when a patient is taking adefovir dipivoxil? a. Numbness and tingling in extremities b. Nausea, vomiting, and abdominal pain c. Dizziness and light-headedness d. Increased confusion

ANS: A Common side effects of atropine include tachycardia, drowsiness, blurred vision, dry mouth, and urinary hesitancy or retention.

Which condition is a common side effect of atropine? a. Urinary retention b. Loss of appetite c. Weight gain d. Difficulty sleeping

ANS: D When a thrombus develops in a coronary artery and blocks the blood supply to a part of the heart muscle, a heart attack (myocardial infarction) occurs. Cerebrovascular accident (stroke) occurs when a thrombus blocks an artery in the brain. Deep vein thrombosis occurs when a clot blocks a deep vein, such as a leg vein. Pulmonary embolus occurs when an embolus blocks blood flow in an artery in the lungs.

Which condition occurs as a result of a thrombus developing in a coronary artery? a. Cerebrovascular accident b. Deep vein thrombosis c. Pulmonary embolus d. Myocardial infarction

ANS: D Patients should be taught to maintain their current diet and not to adopt strict diets such as an all-vegetarian diet or the Atkins diet. Abrupt dietary changes can alter the INR test results. Foods rich in vitamin K may interfere with the action of warfarin (vitamin K is the antidote for warfarin). Alcohol can also interfere with the action of warfarin and patients should be instructed to discuss this with their prescriber before drinking.

Which dietary teaching do you include for a patient who is prescribed warfarin (Coumadin) on discharge? a. "Weight loss diets such as the Atkins diet are OK while taking this drug." b. "Be sure to eat lots of green leafy vegetables for extra vitamin K." c. "Dietary changes do not affect the action of this drug." d. "Drinking alcoholic beverages can change the action of warfarin."

ANS: B Fludrocortisone is a drug used for mineralocorticoid replacement and raises blood glucose levels as well as increasing blood sodium levels and decreasing blood potassium levels. Cortisol is a glucocorticoid. Aminoglutethimide and mitotane are adrenal gland suppressants.

Which drug belongs to the mineralocorticoid class? a. Aminoglutethimide (Cytadren) b. Fludrocortisone (Florinef) c. Cortisol (Prednisone) d. Mitotane (Lysodren)

ANS: B Atazanivir, maraviroc, and darunavir are all administered as oral tablets or capsules. Only enfuvirtide must be administered subcutaneously.

Which drug can only be given by subcutaneous injection? a. Atazanavir (Reytaz) b. Enfuvirtide (Fuzeon) c. Maraviroc (Selzentry) d. Darunavir (Prezista)

ANS: C Maraviroc prevents cellular infection by blocking the CCR5 receptor on CD4+ T cells. Because this drug is not effective against all HIV subtypes, the patient must first be tested to ensure that his or her HIV infection is likely to respond to this therapy. When the HIV subtype does not use the CCR5 receptor, the drug is not prescribed for that patient.

Which drug does not work on all strains of the human immunodeficiency virus (HIV) and therefore the patient must be tested before using the drug to make sure it will work? a. Atazanavir (Reytaz) b. Enfuvirtide (Fuzeon) c. Maraviroc (Selzentry) d. Raltegravis (Issentra)

ANS: B Although Parkinson's disease is very rare in women of childbearing age, bromocriptine (Parlodel) is usually not recommended during pregnancy or breastfeeding. It stops the production of breast milk.

Which drug for Parkinson's disease is not recommended for breastfeeding mothers because it stops the production of breast milk? a. Rasagiline (Azilect) b. Bromocriptine (Parlodel) c. Carbidopa (Sinemet) d. Tolcapone (Tasmar)

ANS: D Prochlorperazine (Compazine) can cause decrease in sweating, increasing the risk for overheating of the patient's body. Check body temperature every 4 to 8 hours while a patient is taking this drug.

Which drug for nausea/vomiting can cause decreased sweating and increased risk for overheating? a. Meclizine (Antivert) b. Ondansetron (Zofran) c. Trimethobenzamide (Tigan) d. Prochlorperazine (Compazine)

ANS: B Children may have muscle spasms of the jaw, neck, and back, along with jerky movements of the head and face while taking metoclopramide.

Which drug for nausea/vomiting can cause muscle spasms of the jaw, neck, and back when given to children? a. Meclizine (Antivert) b. Metoclopramide (Reglan) c. Trimethobenzamide (Tigan) d. Prochlorperazine (Compazine)

ANS: A Sucralfate (Carafate) forms a protective coating over an ulcer but does not coat normal stomach mucosa.

Which drug forms a protective coating over an ulcer but does not coat normal stomach mucosa? a. Sucralfate (Carafate) b. Lansoprazole (Prevacid) c. Metoclopramide (Reglan) d. Bismuth subsalicylate (Pepto-Bismol)

ANS: C Nicotinic acid agents can cause the adverse effect of gout. Gout (painful swelling and redness of the toes, feet, or ankles) can occur because of a buildup of excess uric acid and calcium.

Which lipid-lowering drug type can cause gout? a. Statins b. Fibrates c. Nicotinic acid agents d. Bile acid sequestrants

ANS: D Although atazanavir and maraviroc can cause liver side effects, they do not potentiate the risk for muscle weakness when taken along with a statin. Enfuvirtide does not induce liver problems nor does it increase muscle weakness.

Which drug increases the risk for muscle weakness in older patients who are also taking a "statin" type of lipid-lowering drug? a. Atazanavir (Reytaz) b. Enfuvirtide (Fuzeon) c. Maraviroc (Selzentry) d. Raltegravis (Issentra)

ANS: D The four first-line drugs to treat tuberculosis are isoniazid, ethambutal, rifampin, and pyrazinamide. Amphotericin is an antifungal drug.

Which drug is NOT one of the "first-line" antitubercular drugs? a. Isoniazid (INH) b. Rifampin (RIF) c. Pyrazinamide (PAS) d. Amphotericin (AMT)

ANS: C Teach all patients on TB drug therapy to avoid alcoholic beverages and acetaminophen for the entire therapy period. Both alcohol and acetaminophen are toxic to the liver and so are the antitubercular drugs. Taking all of these drugs and either acetaminophen or drinking alcohol greatly increases the risk for permanent liver damage.

Which drug must a patient be taught to avoid during TB drug therapy? a. Aspirin b. Ibuprofen c. Acetaminophen d. Iron supplements

ANS: A Levothyroxine and liothyronine are thyroid hormone agonists and increase metabolism. Metolazone is a diuretic, not a thyroid suppression agent.

Which drug suppresses thyroid activity? a. Methimazole (Tapazole) b. Metolazone (Mykrox) c. Levothyroxine (Synthroid) d. Liothyronine (Cytomel)

ANS: D Tolcapone is a COMT inhibitor. Rasagiline is an MAO-B inhibitor while carbidopa and bromocriptine are dopaminergic/dopamine antagonists.

Which drug used to treat Parkinson's disease is a COMT inhibitor? a. Rasagiline (Azilect) b. Bromocriptine (Parlodel) c. Carbidopa (Sinemet) d. Tolcapone (Tasmar)

ANS: D Trihexyphenidyl is an anticholinergic drug. Tolcapone is a COMT inhibitor. Selegiline is a MAO-B inhibitor. Only rotigotine is a pure dopamine agonist.

Which drug used to treat Parkinson's disease is a pure dopamine agonist? a. Trihexyphenidyl (Artane) b. Tolcapone (Tasmar) c. Selegiline (Zelapar) d. Rotigotine (Neupro)

ANS: C Lubricants coat the surface of stool and help it hold water so the body can more easily expel it. Lubricants include castor oil and glycerin suppositories.

Which drug used to treat constipation is a lubricant? a. Bisacodyl b. Lubiprostone c. Castor oil d. Docusate

ANS: B Osmotic laxatives cause retention of fluid in the bowel, increasing the water content in stool. Lubiprostone (Amitiza) is an osmotic laxative.

Which drug used to treat constipation is an osmotic laxative? a. Methylcellulose b. Lubiprostone c. Castor oil d. Docusate

ANS: D Antimotility drugs slow down peristalsis (movement) in the gastrointestinal (GI) track, and are used to treat diarrhea. Loperamide (Imodium) is an antimotility drug.

Which drug used to treat diarrhea is an antimotility drug? a. Bismuth subsalicylate (Pepto-Bismol) b. Calcium polycarbophil (FiberCon) c. Metoclopramide (Reglan) d. Loperamide (Imodium)

ANS: C Histamine H2 blockers decrease the secretion of gastric acid. Famotidine is an example of this class of drugs.

Which drug used to treat peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD) is a histamine H2 blocker? a. Metoclopramide (Reglan) b. Esomeprazole (Nexium) c. Famotidine (Pepcid) d. Cetirizine (Zyrtec)

ANS: B, C, E An accurate patient history is essential before giving a thrombolytic drug. Absolute contraindications include active internal bleeding, known allergy to streptokinase products, recent head trauma, known bleeding disorders, suspected aortic dissection, increased blood pressure of 200/120 mm Hg, pregnancy or recent delivery, cerebrovascular processes (e.g., recent stroke, recent spinal or cerebral surgery, cranial neoplasm, and prolonged cardiopulmonary resuscitation). Active peptic ulcer disease, endocarditis, and surgery within the past 10 days are relative contraindications for this therapy. The prescriber weighs the pros and cons of the treatment before making a decision to use the drug.

Which factors are absolute contraindications for thrombolytic therapy? (select all that apply) a. Active peptic ulcer disease b. Active internal bleeding c. Recent head trauma d. Endocarditis e. Suspected aortic aneurysm f. Surgery within the last 10 days

ANS: C Nevirapine is a nonnucleoside analogue reverse-transcriptase inhibitor (NNRTI). The effectiveness of drugs from this class is greatly reduced by the herbal supplement St. John's wort.

Which food, drink, or herbal supplement do you warn a patient who is prescribed nevirapine (Viramune) to avoid? a. Caffeinated beverages b. Grapefruit juice c. St. John's wort d. Dairy products

ANS: B The metabolism of gemfibrozil is affected by grapefruit and grapefruit juice to the extent that the drug's activity is reduced. If possible, patients should avoid grapefruit juice completely, or at least, patients should not take gemfibrozil with grapefruit juice.

Which food, drink, or herbal supplement should you warn a patient prescribed gemfibrozil (Lopid) to avoid? a. Caffeinated beverages b. Grapefruit juice c. St. John's wort d. Dairy products

ANS: B, D Baked potato, yogurt, and bananas are good sources for potassium. Box 17-4 lists additional food sources for magnesium.

Which foods should you teach patients are good sources of magnesium? (select all that apply) a. Baked potato b. Bran cereal c. Yogurt d. Whole-grain rice e. Bananas

ANS: A, B, E, F, G Alcohol, caffeine, and spicy foods irritate an existing ulcer and promote inflammation. Smoking slows cell division and can delay healing. In addition, smoking promotes acid secretion. NSAIDs inhibit prostaglandin synthesis, which reduces the amount of gel-like mucus in the stomach and increases the likelihood that ulcers will continue to form. Neither dairy products nor exercise promote ulcer formation or delay or reduce healing.

Which foods, activities, and drugs should you teach the patient with peptic ulcer disease to avoid? (select all that apply) a. Alcohol b. Caffeine c. Dairy products d. Exercising e. Smoking f. Spicy food g. Nonsteroidal anti-inflammatory drugs (NSAIDs)

ANS: B NRTIs increase the risk for lactic acidosis in pregnant women. This problem is not a common occurrence for other patients. Lactic acidosis is the buildup of lactic acid in muscle and other tissues when not enough oxygen is present to allow metabolism to occur normally. Signs and symptoms of lactic acidosis are muscle aches, tiredness and difficulty remaining awake, abdominal pain, hypotension, and a slow, irregular heartbeat.

Which health problem must you be specifically alert for in pregnant women who are prescribed any nucleoside analogue reverse-transcriptase inhibitor (NRTI)? a. Headache b. Lactic acidosis c. Diabetes mellitus d. Nausea/vomiting

ANS: A, B, D Chronic hyperlipidemia contributes to development of narrowed arteries. It can cause health problems including atherosclerosis, coronary artery disease (angina, heart attack), hypertension, pancreatitis, peripheral vascular disease, stroke, and xanthomas (skin atheromas or abnormal fat deposits).

Which health problems should you teach a patient can be caused by chronic hyperlipidemia? (select all that apply) a. Hypertension b. Pancreatitis c. Peptic ulcer disease d. Xanthoma e. Diabetes mellitus

ANS: C The most common dietary sources of iodine are saltwater fish and table salt to which iodide is added.

Which is the best dietary source of iodine? a. Salt substitutes b. Salted nuts c. Saltwater fish d. Salted chips

ANS: C Alzheimer's disease is a form of dementia. Parkinson's disease is a neurodegenerative disease. Both illnesses involve interrupted nerve impulse transmissions.

Which is the common underlying pathophysiology of both Alzheimer's disease and Parkinson's disease? a. Both are neurodegenerative diseases. b. Both are forms of dementia. c. Both involve interrupted transmission of nerve impulses. d. Both are primarily caused and directly related to environmental factors.

ANS: D Colestipol can change the action of the anticoagulant warfarin in two ways. It can decrease the absorption of vitamin K, which would intensify the effects of warfarin and increase the risk for bleeding (as evidenced by a high INR). Bile acid sequestrants can also directly bind warfarin in the intestinal tract and cause its rapid elimination. This action would inactivate warfarin activity and increase the risk for clot formation (as evidenced by an INR level that is lower than the therapeutic range). Although all of the above laboratory blood values can help diagnose a bleeding problem, the most sensitive test is the INR.

Which laboratory blood value is most important for you to monitor when a patient is prescribed both colestipol (Colestid) and warfarin (Coumadin)? a. Hematocrit b. Hemoglobin c. Red blood cell (RBC) count d. International normalized ratio (INR)

ANS: A The normal range for aspartate aminotransferase is 10 to 34 IU/L. This laboratory value is high and indicates that the patient has liver problems. One of the side effects of these drugs is liver damage. All of the other liver functions tests are within normal limits. See Table 1-3.

Which laboratory finding should be reported to the prescriber before giving any antihyperlipidemic drug? a. Aspartate aminotransferase 41 IU/L b. Alanine aminotransferase 24 IU/L c. Alkaline phosphatase 130 IU/L d. Gamma-glutamyltransferase 50 IU/L

ANS: C The drug can affect how the kidney reabsorbs or excretes potassium. A serum potassium level of 2.2 is very low and could lead to serious problems. The low potassium level is likely to cause greater problems in an older adult.

Which laboratory value in a 76-year-old woman on systemic fluconazole (Diflucan) therapy should you report immediately to the prescriber? a. Hematocrit of 38% b. Bilirubin of 0.4 mg/dL c. Potassium of 2.2 mEq/L d. Blood urea nitrogen (BUN) of 12.2 mg/dL

ANS: B A common side effect of bisacodyl is hypokalemia (low blood potassium). You must monitor this value when a patient is prescribed this drug and report decreased values to the prescriber.

Which laboratory value must be monitored after a patient takes bisacodyl (Dulcolax) for constipation? a. Sodium b. Potassium c. Creatinine d. Blood urea nitrogen

ANS: B Fibrates increase cholesterol loss in bile, which may lead to the development of cholesterol-based gallstones.

Which lipid-lowering drug type can cause gallstones? a. Statins b. Fibrates c. Nicotinic acid agents d. Bile acid sequestrants

ANS: D Thyroid hormones (TH) are made from the amino acid tyrosine and the mineral iodine. For the thyroid gland to make correct amounts of TH, the diet must contain enough protein and iodine.

Which mineral is critical for the thyroid to use in making thyroid hormones? a. Lithium b. Sodium c. Chloride d. Iodine

ANS: C Fludrocortisone causes an increase in fluid and sodium reabsorption and potassium excretion. Congestive heart failure is a possible outcome of this therapy. Crackles in the bases of the lungs can occur along with heart failure when too much water and sodium are reabsorbed.

Which new assessment finding in a patient taking fludrocortisone (Florinef) indicates the dose may be too high? a. Serum potassium change from 5.2 to 4.4 mEq/L b. Heart rate decrease from 88 to 76 beats/min c. Crackles in the bases of the lungs d. Decreased taste sensation

ANS: C The normal pacemaker of the heart is the SA node, which initiates 60 to 100 electrical impulses to the heart per minute.

Which part of the heart normally controls the heart rate? a. Atrioventricular (AV) node b. His-Purkinje system c. Sinoatrial (SA) node d. Left ventricle

ANS: D With hypothyroidism all body functions are slow. Constipation is always present and may be severe. Having a daily bowel movement indicates a positive response to therapy for hypothyroidism.

Which patient condition indicates that drug therapy for hypothyroidism is effective? a. The patient is thirsty. b. The patient's weight has been the same for 3 weeks. c. The patient's total white blood cell count is 6000 cells/mm3. d. The patient has had a daily bowel movement for the past 8 days.

ANS: B Recent major surgery results in damage to blood vessels. When blood vessels lose their integrity, bleeding results. It takes some time for blood vessels to heal after surgery, during which time the patient remains at risk for bleeding. When the patient is also given a drug that reduces blood clotting before all blood vessels have completely healed, the risk for bleeding is greatly increased.

Which patient factor increases the risk for bleeding during anticoagulant therapy? a. Pregnancy b. Recent major surgery c. History of severe arthritis d. Uncontrolled low blood pressure

ANS: A, C, D, F The human immunodeficiency virus (HIV) retrovirus selectively infects the helper/inducer T cells, known as CD4+ cells, which coordinate the patient's immune response. When these cells are destroyed, the person has little protection from opportunistic infection. Successful antiretroviral therapy reduces the number of viral particles in the blood and increases the CD4+ cell numbers in the blood. These actions reduce the risk for opportunistic infection and reduce the likelihood of HIV disease spread by the patient. Antiretroviral therapy does not affect the number of CD8+ cells and does not change the patient's antibody status.

Which patient outcomes are major goals of antiretroviral therapy? (select all that apply) a. Prevention of opportunistic infections b. Conversion to an HIV-negative antibody status c. Reduction of the number of viral particles in the patient's blood d. Increase in CD4+ cells e. Decrease in CD8+ cells f. Prevention of disease spread

ANS: A Depression is a side effect that has been associated with taking beta blockers. A patient with a history of depression may notice that it becomes worse while taking these drugs. Beta blockers may also cause depression for the first time.

Which patient problem can be made worse by beta blocker drugs? a. Depression b. Glaucoma c. Indigestion d. Heat intolerance

ANS: C The four major symptoms of Parkinson's disease are tremor at rest, rigidity, bradykinesia (slow movements and difficulty starting to move), and abnormal gait.

Which problem is a major symptom of Parkinson's disease? a. Memory loss b. Urinary retention c. Abnormal gait d. Nausea/vomiting

ANS: A Remind patients with heart failure not to take sodium-containing antacids (e.g., Alka-Seltzer, Bromo-Seltzer) because they increase sodium and water retention. This problem causes an increase in the workload of the heart and can worsen heart failure.

Which patient should always avoid taking sodium-containing antacids such as, Alka-Seltzer and Bromo-Seltzer? a. 55-year-old female with heart failure b. 65-year-old male with overactive bladder c. 8-year-old child with Crohn's disease d. 25-year-old with leukemia

ANS: C Heart rate is related to a person's state of health and whether he or she is exercising or resting. For example, a young athlete may have a normal resting heart rate of 50 beats/min with an exercising heart rate of 100, whereas an older adult may have a resting heart rate of 80 or 90 beats/min and an exercising heart rate of 120 to 140. Newborns and children generally have faster resting heart rates.

Which person is likely to have the lowest resting heart rate? a. Newborn infant b. Exercising child c. Young adult athlete d. Older adult female

ANS: B Zanamivir is an inhalation drug. When a patient also takes a bronchodilator for asthma, chronic obstructive pulmonary disease, or any other airway problem, the manufacturer recommends using the bronchodilator at least 5 minutes before zanamivir to ensure a wider airway and improved inhalation of the antiviral drug.

Which precaution about zanamivir (Relenza) therapy do you teach a patient who also uses a bronchodilator for asthma control? a. "Drink at least 3 L of water daily while using this drug." b. "Use the bronchodilator 15 minutes before taking the zanamivir." c. "Avoid taking the zanamivir within 2 hours of using the bronchodilator." d. "Take your pulse daily while on this drug because when taken with a bronchodilator heart rhythm problems are common."

ANS: B Cimetidine reduces the level of certain liver enzymes that are responsible for drug metabolism and elimination. As a result, the blood levels of many drugs are increased and can lead to toxic effects. This is especially true for antiseizure medications, calcium channel blockers and other antidysrhythmics, warfarin, and benzodiazepine.

Which precaution is important to teach a patient who plans to use over-the-counter cimetidine to help control gastroesophageal reflux disease? a. "Watch your stools for changes that indicate bleeding such as bright red blood or a tarry appearance." b. "Be sure to tell your health care provider that you are taking this drug." c. "Avoid taking antacids while taking cimetidine." d. "Always take cimetidine with a full meal."

ANS: D The older adult's resistance to infection is already lower than a younger adult's because of age-related changes that occur in the immune system. The decreased bone marrow activity caused by methimazole makes this problem worse, greatly increasing the older adult's risk for infection.

Which precaution is important to teach an older patient who is prescribed methimazole (Tapazole)? a. "If you miss a dose, go to the nearest emergency department and get an injection of methimazole." b. "Be sure to wear sunscreen and a hat whenever you go outside into the sunshine." c. "Drink at least 3 L of fluid daily while taking this drug." d. "Avoid contact with crowds or anyone who is ill."

ANS: A Fludrocortisone is a mineralocorticoid that increases sodium and water reabsorption. It can lead to congestive heart failure. Monitoring daily weights is a great way to assess whether congestive heart failure may be developing.

Which precaution is most important to teach a patient taking fludrocortisone (Florinef)? a. "Weigh yourself daily and keep a record." b. "Avoid aspirin and aspirin-containing drugs." c. "Increase your intake of carbohydrates while taking this drug." d. "Do not take prednisone or prednisolone while taking this drug."

ANS: D Although all instructions are appropriate when a patient begins treatment with thyroid replacement drugs, the most important instruction is D. The starting drug dosage is very low, with no attempt to bring the blood thyroid hormone level back to normal quickly. These drugs can change metabolism quickly and lead to adverse effects such as heart attack or seizure. Dosages start low and are raised very slowly (about every 3 weeks). The patient should never increase the dose unless instructed to do so by the prescriber.

Which precaution is most important to teach a patient who is newly prescribed a thyroid hormone replacement drug? a. "Avoid taking fiber supplements while on this drug." b. "Be sure to take this drug at the same time everyday." c. "Weigh yourself daily and keep a record of these weights." d. "Do not increase the dose without your prescriber's knowledge."

ANS: C Antacids interfere with the absorption of other drugs. This can render other drugs completely ineffective. Patients should be taught to never take other drugs with antacids and to separate taking antacids from taking other drugs by 2 hours.

Which precaution is most important to teach a patient who is prescribed an antacid? a. "Avoid using extra pepper on your food while taking this drug." b. "If you become constipated, stop taking the antacid completely." c. "Take this drug at least 2 hours before or after taking any other drug." d. "Notify your prescriber if heartburn continues after you have taken the drug for 3 days."

ANS: B Enfuvirtide is given twice daily by subcutaneous injection. The patient self-injects this drug at home and must use sterile technique. Injection site infections are common.

Which precaution is most important to teach a patient who is prescribed enfuvirtide (Fuzeon)? a. "After the drug is mixed, store it away from light." b. "Use sterile technique to draw up and inject the drug." c. "Do not take this drug if there is any possibility that you are pregnant." d. "Mix the drug with tap water, then rinse the drug's original container and add that fluid to the drug mixture."

ANS: D Isoniazid raises blood pressure. When this drug is taken in combination with other drugs or agents that also raise blood pressure, the patient can develop dangerous hypertension. Caffeine is a common food ingredient that greatly increases the risk for hypertension when taken in combination with isoniazid.

Which precaution is most important to teach a patient who is prescribed isoniazid (INH, Nydrazid)? a. "Use another form of birth control in addition to oral contraceptives to prevent an unplanned pregnancy." b. "Do not drive or operate dangerous equipment until you know how this drug affects you." c. "Wear glasses rather than contact lenses throughout this drug therapy." d. "Avoid coffee and any foods or beverages that contain caffeine."

ANS: A Rabeprazole increases sun sensitivity and patients can develop severe sunburn if precautions are not taken. This effect also can occur in people who have very dark skin and have never before experienced sunburn. Increased sun sensitivity is present during drug therapy and for many weeks after therapy is completed.

Which precaution is most important to teach a patient who is prescribed rabeprazole (Aciphex)? a. "Wear a hat and sunscreen outdoors to prevent sunburn." b. "Take this drug 1 hour before or 2 hours after a meal." c. "Drink at least 3 L of fluid daily to prevent constipation." d. "Avoid eating raw fruits and vegetables while taking this drug."

ANS: C Atazanavir can impair electrical conduction in the heart and lead to heart block, especially in older adults or people who have an abnormally slow heart rate.

Which precaution is most important to teach an older patient who is prescribed atazanavir (Reyataz)? a. "Be sure to take this drug at least 1 hour before or 4 hours after taking an antacid." b. "Weigh yourself daily and notify your prescriber if you gain more than 2 lb in 1 week." c. "Check your pulse for a full minute daily and notify your prescriber if it becomes irregular or slow." d. "Check your calves daily for swelling or redness. If these symptoms appear, go to the emergency department immediately."

ANS: D Older adults are more likely to experience drowsiness and acute confusion when taking these drugs. They should avoid driving or operating dangerous equipment until they know how the drug affects them. Although the drug should be taken with a meal or before bedtime, the safety issue with the confusion and drowsiness has the highest priority. Avoiding caffeine and elevating the head of the bed are helpful for GERD but are not related to drug therapy.

Which precaution is most important to teach an older patient who is starting histamine H2 blockers for gastroesophageal reflux disease (GERD)? a. "Do not drink caffeine while taking this drug." b. "Elevate the head of your bed by 6 to 10 inches." c. "Take this drug with meals and before going to bed." d. "Avoid driving until you know how this drug affects you."

ANS: C Orthostatic hypotension is more likely to develop in older adults taking maraviroc, increasing the risk for falls. Patients need to change positions slowly and use handrails when going up or down steps.

Which precaution is most important to teach older adults who are prescribed maraviroc (Selzentry)? a. "If an injection site infection occurs, do not reuse that site until the skin has healed completely." b. "Take the drug with food or milk to reduce the likelihood of GI side effects." c. "Change positions slowly when moving from a sitting to a standing position." d. "Store the drug at room temperature."

ANS: A Sinemet can cause a profound reduction in the white blood cell count (neutropenia), which then greatly increases the risk for infection.

Which precaution should you teach patients prescribed carbidopa-levodopa (Sinemet)? a. Avoid crowds and people who are ill. b. Take this drug with an antacid to prevent ulcers. c. Restrict your fluid intake to less than 1.5 L daily. d. Keep the bottle containing the drug in the refrigerator.

ANS: B, D, E Sexual intercourse should be avoided for several reasons: the drug can make holes in a condom or diaphragm and increase the risk for an unplanned pregnancy; in addition, the infection can be spread to a sexual partner. The applicator should be washed regularly with soap and water after each use. Although hands should be washed before and after applying the drug, the vagina is not a sterile body cavity, so it is not necessary to wear gloves during the application. There are no bathing restrictions while using the drug. Vaginal application of the drug does not affect pregnancy (however, a vaginal infection can have adverse effects on the pregnancy). To ensure eradication of the infection and prevent the development of resistant organisms, the drug should be used for as long as prescribed even after symptoms are no longer present.

Which precautions are important to teach a woman using a vaginal cream form of an antifungal drug? (select all that apply) a. Wear gloves to insert the cream. b. Wash the applicator with soap and water. c. Do not tub bathe until treatment is completed. d. Avoid sexual intercourse during the treatment period. e. Remind the patient that the cream can make holes in a condom or diaphragm. f. Stop the drug immediately if you think you are pregnant. g. Stop the drug when symptoms have disappeared to avoid unnecessary exposure to it.

ANS: D A major sign that indicates an ulcer is getting worse is blood in stools. Other signs are listed in Box 23-2 in the text.

Which problem indicates a gastric ulcer is getting worse? a. Gaining weight b. Abdominal gas c. Frequent diarrhea d. Blood in the stools

ANS: D The most common side effects of cholinesterase/acetylcholinesterase inhibitors are nausea, vomiting, diarrhea, stomach cramps, headaches, dizziness, fatigue, weakness, insomnia, and loss of appetite (anorexia).

Which problem is a common side effect of donepezil (Aricept) for treatment of Alzheimer's disease? a. Weight gain b. Hypertension c. Constipation d. Nausea/vomiting

ANS: B The most common side effects of drugs to treat Parkinson's disease are dizziness, nausea, and hypotension.

Which problem is a common side effect of most drugs used to treat Parkinson's disease? a. Asthma b. Hypotension c. Constipation d. Weight gain

ANS: B Hyperthyroidism increases overall metabolism and speeds up the entire cardiovascular system. The increased action of the cardiac system includes an increased heart rate, hypertension (which can become severe), and an irregular heart rate. People with hyperthyroidism lose weight rather than gain weight and often have difficulty sleeping any time of the day. It does not cause peripheral neuropathy.

Which problem is a side effect of excessive thyroid hormone replacement drugs? a. Weight gain b. Hypertension c. Peripheral neuropathy d. Increased daytime sleepiness

ANS: D Allergic and anaphylactic symptoms include swelling of the face or throat, hives, itching, redness, low blood pressure, feeling a lump in the throat, an irregular heartbeat, a sense that something bad is happening, and light-headedness.

Which problem is a sign or symptom of an allergic or anaphylactic response to an antiviral drug? a. Nausea b. Vivid dreams c. Intolerance to fatty foods d. Swelling of the face or throat

ANS: A The most common side effects of drugs for constipation are diarrhea, abdominal cramps, abdominal distention, and nausea. For a list of common side effect for individual constipation drugs, see Table 22-3 in the text.

Which problems are the most common side effects of drugs used to treat constipation? a. Abdominal cramps and diarrhea b. Hypertension and swollen feet c. Skin rash and blurred vision d. Insomnia and infection

ANS: B The stomach secretes a thick gel-like mucus that coats and protects it from contact with stomach acids. Acid production is usually balanced by mucous secretion. When acid production exceeds mucous production, the risk for tissue damage and ulcer formation increases.

Which protective mechanism by the stomach protects it from stomach acids and the formation of gastric ulcers? a. Buffers such as bicarbonate neutralize stomach acids. b. The stomach secretes a thick gel-like mucus to coat itself. c. Acid secretion is decreased when food is not present in the stomach. d. Stomach secretions such as lipase digest foods and protect the stomach.

ANS: D The most common side effects for any drug used to manage adrenal gland function are nausea/vomiting. They also cause many other gastrointestinal upsets. They are not associated with blurred vision, dry mouth, headache, mouth sores, or increased sweating. Urine output is usually increased, not decreased.

Which side effects are most common when taking any drug to manage adrenal gland hyperfunction? a. Decreased urine output and increased sweating b. Blurred vision and dry mouth c. Headache and mouth sores d. Nausea/vomiting

ANS: A Hantavirus causes hantavirus pulmonary syndrome. Epstein-Barr virus causes chronic fatigue syndrome and some types of lymphomas, not mononucleosis. West Nile virus causes an infection with encephalitis and/or meningitis problems, not mononucleosis.

Which specific virus causes mononucleosis? a. Cytomegalovirus b. Hantavirus c. Epstein-Barr virus d. West Nile virus

ANS: D Alzheimer's disease is a progressive and incurable condition that destroys brain cells, with gradual loss of intellectual abilities such as memory and extreme changes in personality and behavior. It is the most feared and common form of dementia. Alzheimer's disease is the most common form of dementia.

Which statement about Alzheimer's disease is true? a. The causes of Alzheimer's disease are known but not treatable. b. Physical deterioration occurs before intellectual deterioration. c. The onset of the disorder is sudden and dramatic. d. It is the most common form of dementia.

ANS: D Hormones from the adrenal cortex, especially the glucocorticoids, are essential for life. They regulate the stress response; carbohydrate, protein, and fat metabolism; immune function; sodium and water balance; and excitability of heart muscle cells. If these hormones are not present in sufficient amounts or are not provided as drugs, death will occur.

Which statement about adrenal cortex hormones is true? a. When underproduced, these hormones can lead to high blood pressure and stroke. b. When overproduced, these hormones can cause cancer. c. These hormones differ between men and women. d. These hormones are essential for life.

ANS: C Drugs are not able to "kill" a virus in the human body. Antiviral drugs are only "virustatic" in that they can only suppress viral replication. Only a person's immune system can kill, inactivate, or eliminate viruses.

Which statement about antiviral drugs is true? a. They are all most effective at killing viruses. b. They are all effective against any type of infection. c. They all work by slowing the replication of viruses. d. They are all only effective in people with strong immune systems.

ANS: D Cholesterol is a fatty, waxy material that the body needs to function and is present in cell membranes everywhere in the body. There are two sources of cholesterol: food and the liver. The body needs small amounts of cholesterol for important functions including production of hormones, vitamin D, and bile acids that help digest fat. Inadequate amounts of cholesterol would lead to a deficit of bile acids.

Which statement about cholesterol is true? a. The only source of cholesterol is from the foods a person eats. b. Cholesterol always has harmful effects on a person's body. c. Too much cholesterol leads to a deficit of bile acids that digest fat. d. It is a fatty, waxy material present in cell membranes of the body.

ANS: A People infected with HIV develop antibodies to the virus and become HIV positive. Not everyone who is HIV positive will progress with the disease and develop AIDS, the most severe form of the disease.

Which statement about human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) is true? a. Everyone with AIDS has HIV infection but not everyone with HIV infection has AIDS. b. Everyone with HIV infection eventually dies of it because the disease cannot be cured. c. With successful antiretroviral therapy, HIV-infected patients become HIV-antibody negative. d. When HIV disease becomes AIDS, the infection is in the blood and treatment must be given intravenously.

ANS: D Normal bowel function varies from individual to individual, from several times a day to several times a week. Consistency is more important than frequency. Stool should be soft enough to pass easily from the bowel, but not liquid. Bowel movements are a complex process involving several muscles and nerves located on the pelvic floor.

Which statement about normal bowel function is true? a. Bowel movements should occur once a day every day. b. Bowel movement frequency is more important than their consistency. c. Bowel movements are very simple processes. d. Bowel movements should be soft and easily pass out of the bowel.

ANS: C The vomiting process involves three phases: nausea, vomiting, and retching. Nausea usually occurs before vomiting, and retching occurs after vomiting. Vomiting is a reflex, not a voluntary action.

Which statement about the vomiting reflex is accurate? a. The vomiting process consists of four phases. b. Retching precedes vomiting in the process. c. Nausea usually occurs prior to vomiting. d. Vomiting may be a reflex or a voluntary action.

ANS: C TB is the most common bacterial infection worldwide. However, it requires an overwhelming exposure in a susceptible host to develop the disease. Therefore many more people are exposed to and take in the bacteria than who actually go on to develop the disease.

Which statement about tuberculosis (TB) is true? a. The lungs are the only organ ever affected by TB. b. A positive TB test means the person has active tuberculosis. c. Far more people are infected with TB than actually develop the disease. d. Any redness in the area where the TB test was performed is considered positive.

ANS: C Antidiarrheal drugs should relieve diarrheal symptoms within 2 days. Remind patients to notify their prescriber if the diarrhea is not relieved in 2 days while taking antidiarrheal drugs. Antidiarrheal drugs should not be taken for more than 2 days unless instructed to do so by the prescriber.

Which statement by a patient prescribed an antidiarrheal drug indicates the need for additional teaching? a. "I will never take a double dose of my medication even if I miss a dose." b. "I will get up slowly when I get out of bed or rise from a chair." c. "I will contact my prescriber if the diarrhea is not relieved within 4 days." d. "I will avoid alcohol while taking my antidiarrheal medication."

ANS: A All lipid-lowering drugs reduce high blood lipid levels, but they do not cure the problem. Treatment is long term, and these drugs need to be taken even after blood fat levels are normal.

Which statement by a patient who has been prescribed an antilipidemic drug indicates the need for additional teaching? a. "Once my lipid profile levels are normal, I will no longer need to take the drug." b. "Taking this drug will decrease my risk for having a heart attack." c. "My goal is to increase my HDL cholesterol and decrease my LDL cholesterol." d. "I will continue walking and watching the fat in my diet while I'm taking this drug."

ANS: A Taking St. John's wort at the same time as quinidine can cause decreased serum levels of the drug and decrease the intended effects of the drug. Teach patients to avoid this combination.

Which statement by a patient who has been prescribed quinidine (Quinaglute) indicates the need for additional teaching? a. "I use over-the-counter St. John's wort to help with my memory." b. "I am careful not to eat too much food that is high in alkaline ash." c. "I check my heart rate and blood pressure at least once a day." d. "I take a multivitamin and calcium supplement daily."

ANS: C While taking heparin, patients should avoid contact sports and other activities that may cause injury. Falls, blows to the body or head, headaches that won't go away, or other injuries should be reported to the prescriber right away.

Which statement by a patient who is prescribed heparin indicates the need for additional teaching? a. "I'll be sure to have my follow-up aPTT drawn when the prescriber tells me to." b. "I will not take over-the-counter drugs that contain aspirin." c. "I will get plenty of exercise playing soccer." d. "I'll tell my prescriber if I have headaches."

ANS: D Dopaminergic drugs increase the amount of dopamine activity in the brain. COMT (catechol-o-methyltransferase) inhibitors allow a larger amount of levodopa to reach the brain, which increases the brain's dopamine levels. MAO-B inhibitors inhibit the enzyme monoamine oxidase B that breaks down dopamine in the brain. Anticholinergic drugs are effective against tremors and rigidity by blocking cholinergic nerve impulses that help control the muscles of the arms, legs, and body.

Which statement is true about how drugs for Parkinson's disease work? a. Dopaminergic drugs decrease the amount of dopamine activity in the brain. b. COMT inhibitors allow a larger amount of levodopa to reach the brain, which lowers the brain's dopamine levels. c. MAO-B inhibitors facilitate the enzyme monoamine oxidase B that breaks down dopamine in the brain. d. Anticholinergic drugs block cholinergic nerve impulses to minimize tremors and rigidity.

ANS: D Usually TB is no longer contagious and clinical improvement is seen after drugs have been taken for 2 to 3 consecutive weeks. However, the organism growth has only been suppressed and the immune system and drugs have not had sufficient time to eradicate it. Stopping treatment after only a month will allow the disease to again become active and the organisms can become resistant to these drugs. The patient must continue taking the drugs for 6 months or longer, exactly as prescribed.

Which statement made by a patient indicates the need for more teaching about first-line drug therapy for tuberculosis (TB)? a. "To prevent nausea/vomiting, I have been taking my drugs at night with a small snack." b. "I have stopped taking all herbal supplements and stopped drinking beer until I finish this drug therapy." c. "Now that my symptoms have disappeared after a month of drug therapy, I can no longer infect my family." d. "Now that my symptoms have disappeared after a month of drug therapy, I can stop taking all of these drugs."

ANS: C Statin drugs can help control LDL cholesterol levels but do not cure hyperlipidemia. For some people, lifestyle changes and reduced intake of cholesterol and saturated fats can lower cholesterol levels; however, no one is considered cured of hyperlipidemia based on a single test of blood cholesterol level. The fact that this patient's LDL cholesterol is in the normal range is likely a response to the drug. Continuing to have a normal LDL level is most likely to require continued therapy with simvastatin.

Which statement made by a patient who has been prescribed simvastatin (Zocor) indicates the need for more teaching? a. "I have been taking this drug every night at bedtime as directed by my pharmacist." b. "I have stopped using butter when I cook and have been using olive oil instead." c. "My LDL cholesterol level today is 101 mg/dL so the drug has cured my cholesterol problem." d. "I hope that by reducing my fatty food intake, I might not have to take medications to manage my cholesterol problem."

ANS: D When blood thyroid hormone levels are insufficient to maintain a normal metabolic rate, symptoms of hypothyroidism return. Patients usually feel tired or weak and often report an increase in time spent sleeping, sometimes up to 14 to 16 h/day.

Which statement made by a patient who is taking a thyroid replacement drug indicates that a higher dose may be needed? a. "My goiter seems to be smaller." b. "I seem to feel the heat more than other people." c. "Food just doesn't taste good without a lot of salt." d. "I am always tired, even when I get 10 or 12 hours of sleep."

ANS: A No drug has been developed that will protect neurons from the changes that occur with Alzheimer's disease. Drug treatments can temporarily slow the progression of symptoms in some patients. The drugs do not cure the disease and a patient should not expect to regain lost function. The only way to definitively diagnose this illness is by seeing the plaques and tangles in the brain on autopsy after death.

Which statement made by a patient with Alzheimer's disease indicates the need for additional teaching? a. "When I have been taking donepezil for 6 weeks I should regain my memories." b. "The only way to be sure that I have Alzheimer's disease is by autopsy after I die." c. "Even with medication, eventually I will need total care to prevent complications." d. "The rivastigmine I am taking may slow down the progression of my symptoms."

ANS: A Because patients with Alzheimer's disease have difficulty with memory and cognition, the individual providing care in the home should be included when doing any teaching about the disease, including drugs and dosages.

Which strategy best supports safe medication administration for patients with Alzheimer's disease? a. Include the patient's care provider when teaching about the patient's drugs. b. Provide written guidelines about each drug to the patient. c. Create a chart listing the drugs, dosages, and times they should be taken. d. Suggest that the patient set up the drugs each week in labeled boxes.

ANS: C Alzheimer's disease symptoms begin very slowly. In the early stage, the first symptom is mild forgetfulness, which is sometimes confused with age-related memory changes.

Which symptom is often the earliest to occur in a patient with Alzheimer's disease? a. Difficulty solving simple math problems b. Problems performing simple tasks c. Mild forgetfulness d. Inability to read

ANS: C Exophthalmos is a bulging or protrusion of the eyes, causing blurred vision. This problem is unique to hyperthyroidism because the disorder causes tissue behind the eye to swell, pushing the eyeball forward.

Which symptom of hyperthyroidism occurs only with the Graves' disease form of the problem? a. Goiter b. Hypertension c. Exophthalmos d. Thinning scalp hair

ANS: C The most common symptom of a peptic ulcer is burning, gnawing pain caused by stomach acid coming into contact with the open wound (ulcer). It often occurs when the stomach is empty and can be relieved by eating foods that buffer stomach acids or by taking a drug that reduces stomach acid such as an antacid.

Which symptoms are associated with gastric ulcers? a. Constant bloating and diarrhea b. Shortness of breath in any position c. Burning pain that is relieved by eating d. Lower abdominal pain that is relieved by moving the bowels

ANS: C Warn patients taking terbinafine or flucytosine for more than 1 week that they are at an increased risk for infection and should avoid crowds and people who are ill.

Which teaching point should you stress when a patient is prescribed terbinafine (Lamisil)? a. Avoid citrus fruits while taking this drug. b. Do not drive until you know how the drug affects you. c. Stay away from crowds or people who are ill. d. Get lots of extra rest while you are taking this drug.

ANS: A, B, D Patients taking antihyperlipidemic drugs should be taught to continue lifestyle changes such as low-fat diets, exercise, and weight loss while taking the drugs. Some, but not all, are best taken with food. Follow-up laboratory specimens must be drawn every 3 to 6 months and the patient should fast for at least 8 hours before the blood is taken because test results can be changed by some substances in food or fluids.

Which teaching points should you include for a patient prescribed any antihyperlipidemic drug? (select all that apply) a. Continue to follow a low-fat diet. b. Be sure to exercise regularly. c. Always take these drugs with food. d. Fast for at least 8 hours before your lipid levels are drawn. e. You will need follow-up laboratory tests once a year.

ANS: A, C, D Adequate fluid intake (1500 to 2000 mL), bulk foods in the diet, and regular daily exercise are important strategies to prevent constipation. Patients should be taught to use the bathroom right away when the urge to have a bowel movement occurs. At least 9 ounces of fluid should be given with oral laxatives so that they can be safe and effective. Laxatives should not be taken for more than a week without consulting with a prescriber.

Which teaching points would you include for a patient who is taking laxatives for constipation? (select all that apply) a. Drink between 1500 and 2000 mL of fluids every day. b. Avoid bulk foods such as whole-grain bread and vegetables. c. Use the bathroom right away when you feel the urge to have a bowel movement. d. Try to get some regular exercise each day to prevent constipation. e. Take your laxative with at least 4 ounces of water so it can be effective. f. Laxatives are usually prescribed for one 2 to 3 weeks.

ANS: A, C Using the smallest needle possible results in less tissue trauma and less risk for bleeding. Applying pressure over the injection site for at least 5 minutes after administration compresses surrounding blood vessels and reduces the risk for bleeding. Injecting the drug slowly can increase the risk for bleeding by traumatizing tissues longer. Placing the needle in the same puncture site as a previous injection can increase the risk for bleeding by enlarging the hole and not allowing the previously damaged tissue to heal. Cleansing the skin can reduce infection risk but does nothing to reduce bleeding risk. Applying warm compresses is more likely to increase bleeding risk by dilating blood vessels in the area. Cold compresses or ice applied to the area would reduce bleeding risk.

Which techniques should you perform to prevent excessive bleeding when administering an intramuscular injection to a patient who is on anticoagulation therapy? (select all that apply) a. Using the smallest possible injection needle b. Injecting the drug slowly, over at least a 60-second period c. Applying pressure to the site for at least 5 minutes after the injection d. Ensuring that the needle is placed within a previous injection puncture site e. Cleansing the skin at the injection site for at least 30 seconds before the injection f. Applying warm compresses to the site for at least 15 minutes after the injection

ANS: C The term metabolism means the energy use of each cell and the work performed by the body. The thyroid gland has great influence over all of metabolism. Menarche is the time when a young girl begins menstruating. A goiter is a distinct swelling of the thyroid gland in the neck. Thyrotoxicosis is another name for hyperthyroidism.

Which term means the energy use of each cell and the work performed by the body? a. Goiter b. Menarche c. Metabolism d. Thyrotoxicosis

ANS: D HIV selectively infects and causes the destruction of CD4+ cells (T-helper cells). An increase in ratio of this population of cells compared with CD8+ cells in a patient with HIV disease indicates the drug regimen is effective in suppressing viral replication.

Which test results indicate that a patient's antiretroviral therapy is effective? a. White blood cell count 5000 cells/mm3 b. Blood urea nitrogen level 15 mg/dL c. Blood positive for human immunodeficiency virus (HIV) antibodies d. CD4+ to CD8+ ratio increased

ANS: A Argatroban, lepirudin, and bivalirudin are administered only intravenously. Heparin can be administered as an intravenous bolus, as a continuous intravenous infusion, or as a subcutaneous injection.

Which thrombin inhibitor can be given by subcutaneous injection? a. Heparin b. Argatroban c. Lepirudin d. Bivalirudin

ANS: B ESAs stimulate the bone marrow to produce more red blood cells. The person with chronic kidney disease has chronic anemia because the damaged kidney no longer produces natural erythropoietin. The use of ESAs in patients with chronic kidney disease improves red blood cell counts and reduces anemia to such an extent that blood transfusions often are no longer needed.

Why are erythropoiesis-stimulating agents (ESAs) prescribed for patients with chronic kidney disease? a. To protect the kidney from further hypoxic damage during anemia episodes. b. To improve blood cell counts and reduce the need for blood transfusions. c. To prevent vein thromboembolism during periods of dehydration. d. To reduce the risk of uric acid precipitation and renal failure.

ANS: A Because the TB organism is slow growing, many common antibacterial drugs are not effective in controlling or killing it. Combination drug therapy with agents effective against the TB organism is needed to treat TB and prevent its transmission.

Why are most standard antibacterial drugs ineffective against tuberculosis? a. The TB organism is slow growing. b. The TB organism is not really a type of bacteria. c. The TB organism does not have a true cell wall. d. The TB organism is usually located in the brain stem where antibacterial drugs cannot reach.

ANS: B The change in acidity of stomach contents reduces the absorption of calcium through the intestinal tract. As calcium is lost from bones, it is not replaced and the bones become more fragile. More bone density is lost from the hip, making hip fractures more likely, even without a fall or other trauma.

Why are older patients who are prescribed proton pump inhibitors more at risk for drug-induced hip fracture? a. Induced drowsiness increases the risk for falling. b. Inhibited calcium absorption makes bones more fragile. c. Excessive potassium loss reduces muscle strength and balance. d. Anemia and fatigue prevent participation in exercise and reduce muscle weakness.

ANS: B Fungi have many differences from bacteria that make antibacterial drugs less effective or not at all effective in controlling their growth. Fungi have a tough, thick cell wall and a hardy plasma membrane. Antibacterial drugs are not able to penetrate the thick cell wall or disrupt the plasma membrane.

Why are standard antibacterial drugs ineffective against fungal infections? a. Funguses are slow growing. b. Funguses have a thick cell wall. c. Fungal infections usually occur in the brain stem where antibacterial drugs cannot reach. d. Fungal infections have so few symptoms that most people are unaware of the problem until the infection is widespread.

ANS: D Viruses are foreign invaders. When a person is infected with them to the extent that they become sick, the immune system learns to make antibodies against them. Then, on another exposure to the same virus, the antibodies take defensive steps to remove or eliminate the viruses before the person becomes sick again.

Why do most people become ill with a specific viral infection only once? a. Once a virus is killed by the body, it is gone from the earth forever. b. During a viral infection, the body changes the virus to be less virulent. c. Antiviral drugs change the viral DNA so it cannot infect the same person again. d. During a specific viral infection, the person's immune system improves protection against that virus.

ANS: B Bile acid sequestrants are taken by mouth and work directly on dietary fats in the intestinal tract. They bind with cholesterol in the intestine, preventing fats from being absorbed into the blood. This action then eliminates the cholesterol from the body through the stool and is also likely to change the general activity of the intestinal tract, leading to intestinal side effects.

Why do the most common side effects of any bile acid sequestrant include bloating, abdominal discomfort, and constipation? a. Many patients are lactose intolerant and these drugs contain lactose. b. Bile acid sequestrants exert their effects directly in the intestinal tract. c. The action of bile acid sequestrants on the liver releases bile into the intestinal tract. d. The drugs inhibit the absorption of dietary fiber, increasing its concentration and effects in the intestinal tract.

ANS: A Thyroid-suppressing drugs enter the thyroid gland and combine with the enzyme responsible for connecting iodine (iodide) with tyrosine to make active thyroid hormones, preventing further thyroid hormone synthesis. These drugs do not affect the hormones already formed and stored in the thyroid gland, so it may take as long as 3 or 4 weeks for the person to use up all the thyroid hormones made before the drug was started. Until that time, the person continues to have symptoms of hyperthyroidism.

Why does a patient who is taking drugs for thyroid suppression continue to have symptoms of hyperthyroidism for 3 weeks (or longer) after drug therapy is started? a. Thyroid hormones are stored and thyroid suppressing drugs only stop the synthesis of new hormones. b. At first, the patient's metabolism is so high that the thyroid cells continue to synthesize thyroid hormones. c. The activity of the intestinal tract is increased and the drug is eliminated before complete suppression can occur. d. The side effects of thyroid suppression drugs are so uncomfortable that most patients do not take the full dose of the drug that is needed to prevent further hormone secretion.

ANS: B The stomach is the site where protein digestion begins. Acid is secreted in the stomach to enhance this process. Because the acids can damage the stomach lining, the stomach secretes a thick gel-like mucus to protect it. Neither the esophagus nor the duodenum has this protection. Stomach contents that reflux up into the esophagus are highly acidic and cause inflammatory damage with ulcer formation to the lining.

Why does the backward flow of stomach contents into the esophagus cause tissue damage? a. No digestive processes occur in the esophagus. b. The esophagus does not have the thick gel-like mucus to protect it from acid. c. The esophagus secretes only bicarbonate, which is not strong enough to neutralize stomach acids. d. The esophagus cannot expand with extra volume and the excessive stretching damages the muscle layer.

ANS: B Adenosine is an IV drug used to treat supraventricular tachycardia. It should be given as a rapid IV bolus injection (1 to 2 seconds). When given slowly, adenosine is eliminated from the body before it can get to the heart and act to slow down the rhythm.

Why is adenosine (Adenocard) given to a patient rapidly by intravenous (IV) push? a. If given slowly, the heart rate will dramatically increase. b. When given slowly, the drug is eliminated before it can act on the heart. c. Slow administration can lead to tissue irritation and IV infiltration. d. The drug is given rapidly so that within a minute, second or third doses may be given if needed.

ANS: A Bromocriptine suppresses the secretion and release of prolactin from the pituitary gland. Without secretion of this important hormone, lactation with milk production does not occur.

Why is bromocriptine (Parlodel) not recommended for women who are breastfeeding? a. It stops the production of milk. b. It enters the milk and slows infant growth. c. It enters the milk and causes symptoms of Parkinson's disease in the infant. d. It is a pregnancy category C drug and has been found to cause birth defects in animals.

ANS: C Ethambutol is only bacteriostatic. When taken alone, it cannot eradicate the tuberculosis bacteria and cure the disease.

Why is ethambutol always used in combination with other antitubercular drugs? a. Its presence enhances or potentiates the other first-line antitubercular drugs. b. Its side effects are more serious when taken alone. c. It is only bacteriostatic and not bactericidal. d. It is not a first-line antitubercular drug.

ANS: D Warfarin has a high likelihood of increasing the risk for birth defects or fetal harm. It is a teratogen with a chemical composition the same as rat poison. It can cause birth defects and can reduce clotting in the fetus to such an extent that severe and fatal hemorrhage in the fetus is possible (especially brain hemorrhage).

Why is warfarin (Coumadin) avoided during pregnancy? a. Warfarin can induce premature closure of the foramen ovale in the fetus. b. The fetal and newborn liver cannot metabolize warfarin and anemia results. c. The fetus and newborn are more likely to have allergic reactions to warfarin. d. Warfarin crosses the placenta and causes birth defects or hemorrhage in the fetus.

ANS: D Most dysrhythmias have a negative effect on how well the heart works as a pump by decreasing cardiac output (the amount of blood the heart pumps in a minute). Dysrhythmias decrease cardiac output, which leads to symptoms such as dizziness, light-headedness, fainting (syncope), and decreased peripheral pulses.

Why must most cardiac dysrhythmias be treated? a. They increase preload. b. They decrease preload. c. They increase cardiac output. d. They decrease cardiac output.

ANS: B Patients with GERD should avoid chocolate, peppermint, alcohol, nicotine, and caffeinated drinks because they lower the pressure of the LES and promote reflux.

Why should a patient with GERD avoid substances such as chocolate, peppermint, alcohol, nicotine, and caffeinated drinks? a. These substances increase the pressure in the lower esophageal sphincter and lead to reflux. b. These substances decrease the pressure in the lower esophageal sphincter leading to reflux. c. These substances increase the pressure in the duodenal sphincter causing reflux and emesis. d. These substances decrease the pressure in the duodenal sphincter causing reflux and emesis.

ANS: A Children should not be given bismuth subsalicylate because it contains an aspirin-like drug and may cause Reye's syndrome. This is a life-threatening condition that affects the liver and CNS and causes vomiting and confusion. It occurs soon after the onset of a viral illness in which a child was treated with aspirin.

Why should bismuth subsalicylate (Pepto-Bismol) be avoided in children? a. It contains an aspirin-like drug that may cause Reye's syndrome. b. Safe use of this drug in children has not been researched. c. This drug can inhibit the action of growth hormone, stunting a child's growth. d. It can increase the risk for dehydration and diarrhea in children.

ANS: A Children should not be given bismuth subsalicylate (Pepto-Bismol) because it contains aspirin and can cause Reye's syndrome, a life-threatening condition that affects the liver and central nervous system.

Why should parents be taught never to give bismuth subsalicylate (Pepto-Bismol) to a child? a. It contains aspirin that can cause Reye's syndrome. b. It changes stool color making the identification of GI bleeding more difficult. c. It has such powerful antidiarrheal effects that toxic megacolon can occur. d. It produces a paradoxical reaction in children that results in worsening of the symptoms.

ANS: B The thyroid gland secretes hormones that are necessary for life. Not taking the drug can lead to problems with the pregnancy and with the fetus. The pregnant woman often needs a higher dose of the drug.

Why should pregnant patients who have hypothyroidism continue to take thyroid replacement drugs throughout pregnancy? a. These drugs have a low likelihood of increasing the risks for birth defects. b. Without continuing thyroid replacement drugs, the pregnancy may not continue. c. Pregnancy is a high metabolism condition and less drug is needed but should still be taken. d. The fetus produces thyroid hormones that help supplement the pregnant woman's hormone level, but minimal replacement is needed during pregnancy.

ANS: B Cholestyramine (Questran) and colestipol (Colestid) should be avoided in children because they can cause intestinal obstructions.

Why should the use of cholestyramine (Questran) and colestipol (Colestid) be avoided in children? a. These drugs can cause muscle breakdown in children. b. These drugs can cause intestinal obstruction in children. c. These drugs can cause mental deficits in children. d. These drugs can cause bleeding and easy bruising in children.

ANS: C Ask patients about their alcohol consumption. Statin drugs can damage the liver. Statins should not be given to patients who consume more than two alcoholic drinks per day because drinking alcohol puts even more stress on the liver.

Why should you ask a patient prescribed a "statin" drug for hyperlipidemia about his or her daily alcohol consumption? a. Alcohol increases the action of most statin drugs and can lead to side effects. b. Statin drugs increase the action of alcoholic beverages causing a person to feel drunk only after two drinks. c. Taking a statin and consuming more than two alcoholic drinks per day is stressful on the liver. d. Alcohol interferes with the action of statin drugs so the prescriber must order a much higher dose.

ANS: B Mifepristone works to control adrenal gland hyperfunction by blocking corticosteroid receptors, which results in inhibiting the action of cortisol. It is approved for use only in people who have type 2 diabetes along with adrenal gland hyperfunction. Because it can cause pregnancy loss, it should not be given to a pregnant woman except to induce an abortion.

With which patient is an order for mifepristone (Korlym) most appropriate? a. 62-year-old patient who has adrenal gland hypofunction and breast cancer b. 52-year-old patient who has adrenal gland hyperfunction and type 2 diabetes c. 42-year-old patient who has adrenal gland hypofunction and type 1 diabetes d. 32-year-old who has adrenal gland hyperfunction and is 4 months pregnant

ANS: C Methimazole is toxic to the liver and should not be used in a person who has any type of liver disorder or impairment. Hepatitis B, especially during an active phase, significantly reduces liver function and makes the liver at great risk for other damage.

With which patient should you question the order for methimazole (Tapazole)? a. 10-year-old girl who has new onset hyperthyroidism b. 30-year-old woman who also takes oral contraceptives c. 50-year-old man who has active hepatitis B d. 60-year-old man who has an enlarged prostate gland

ANS: A Cyclizine is an antiemetic drug. Most of these drugs cause drowsiness as a side effect. You must instruct the patient to call for help when getting out of bed and make sure that the call light is within easy reach. This is especially important because this is the patient's first dose of the drug and its effects for this patient are unknown.

You are administering a patient's first dose of cyclizine (Marezine). What safety action should you take to ensure safety for this patient? a. Instruct the patient to call for help when getting out of bed. b. Raise all four side rails to the upright position. c. Give the patient a full glass of water with the medication. d. Tell the patient to avoid eating for at least 2 hours.

ANS: B While drinking bottled water is good, ice cubes may be made with tap water, which in certain countries may contain bacteria that can cause diarrhea. Washing hands before and after handling raw meat or poultry is important, but it is not necessary to wear gloves. The patient should continue drinking adequate fluids while having diarrhea to prevent dehydration. Washing hands after using the bathroom or changing diapers can prevent the spread of diarrhea.

You are instructing a patient about how to help prevent the spread of diarrhea. Which important point should you stress? a. "When travelling internationally it is best to drink bottled water with ice cubes." b. "Be sure to wash your hands after using the bathroom or changing diapers." c. "Always wear clean gloves when handling raw meat or poultry." d. "Cut down on your fluid intake to decrease the number of diarrhea episodes."

ANS: D To prevent constipation, a patient should be taught to consume a diet that is high in fiber, drink plenty of fluids, and be physically active. Misuse of laxatives can cause constipation because the body becomes dependent on these drugs, needing higher and higher doses until the bowel no longer works.

You are instructing a patient on how to prevent constipation. Which point should you stress? a. "Be sure to eat a diet that is low in fiber." b. "Use a laxative on a daily basis to prevent constipation." c. "Physical inactivity will not affect your bowel function." d. "You should drink plenty of fluids every day to prevent constipation."

ANS: D Patients prescribed sucralfate should take the drug exactly as directed by their prescriber. You must teach the patient that this drug is usually prescribed for 4 to 8 weeks and the patient should continue to take it even if feeling better. This is needed because complete healing of the ulcer under good conditions may take 4 to 8 weeks.

You are instructing a patient who has been prescribed sucralfate (Carafate) for peptic ulcer disease. Which statement by the patient indicates the need for additional teaching? a. "This drug coats my ulcer and protects it so that healing can occur." b. "I should eat foods with lots of fiber while I'm taking this drug." c. "If I feel dizzy, I will be sure to get up from bed slowly." d. "Once I am feeling better I can stop taking the drug."

ANS: D All of the antiemetic drugs cause some degree of central nervous system depression, although some drugs have a more profound depressive action than others. Alcohol increases CNS depression, increasing the risks for injury, cognitive changes, and respiratory depression. In addition, alcohol may intensify the experience of nausea. Although it is also important to remind patients to avoid sun exposure because of increased sun sensitivity, and to rinse the mouth to reduce dry mouth sensation, alcohol avoidance is the most important precaution because it can lead to more serious complications.

You are instructing a patient who is experiencing chronic nausea/vomiting, about antiemetic therapy. What is the most important precaution you must teach the patient? a. "Rinse your mouth frequently to reduce the unpleasant sensation of dry mouth." b. "Report any constipation lasting 2 days or longer to your prescriber." c. "Wear sunscreen and protective clothing when going outdoors." d. "Avoid drinking alcoholic beverages while taking this drug."

ANS: C The use of histamine H2 blockers has not been studied in pregnant women and safe use has not been established. These drugs pass into breast milk so should be avoided while breastfeeding. During pregnancy, lifestyle changes (e.g., eating more slowly, eating smaller meals) should be tried first to control reflux. Pregnant women must consult with their prescriber before taking any drug for reflux.

You are instructing a pregnant patient about how to manage reflux. Which point about histamine H2 blockers should you include in the teaching plan? a. They are safe for use during pregnancy. b. They may be used while breastfeeding. c. They should only be taken with a prescriber's approval. d. They can be prescribed instead of lifestyle changes to control reflux.

ANS: A Famotidine is a histamine H2 blocker. The most common side effect of these drugs is confusion. You must teach the patient's family to monitor for changes in level of consciousness and confusion and to notify the prescriber if this occurs.

You are teaching an older adult patient who has been prescribed famotidine (Pepcid) and his or her family about the drug. Which common side effect should you instruct the patient's family to watch for and report to the prescriber? a. Confusion b. Anxiety c. Depression d. Psychosis

A nurse gave a patient an antidiarrheal drug. After giving the drug, what sign of toxic megacolon is it important for the nurse to monitor the patient for? A. Temperature elevation B. Abdominal distention C. Increased diarrhea D. Vomiting

b. Toxic megacolon can occur after an antidiarrheal drug is given. It is characterized by abdominal distension from a very inflated colon. Other signs and symptoms of this condition include fever, abdominal pain, rapid heart rate, and dehydration. A patient with toxic megacolon may go into shock. If not treated early, death can result. Temperature elevation, increased diarrhea, and vomiting are not signs of toxic megacolon.

ANS: B When prescribed to treat heart failure, only the sustained-release form of metoprolol is used. Metoprolol (Toprol XL) is the sustained-release form of the drug, whereas metoprolol (Lopressor) is not.

A patient with heart failure is prescribed metoprolol (Toprol XL) 25 mg daily. The pharmacy sends metoprolol (Lopressor) 25 mg. What is your best action? a. Give the dose as provided because the drugs are the same. b. Ask the pharmacy to send the drug as ordered. c. Contact the prescriber for clarification. d. Check the patient's heart rate before giving the dose.

ANS: C People who took the weight loss drug fenfluramine/phentermine (known as "fen-phen") had a greatly increased incidence of the relatively rare health problem of pulmonary artery hypertension.

The use of which drug or drugs is/are associated with later development of pulmonary artery hypertension (PAH)? a. Amiodarone and ambrisentan b. Macitentan and cyclophosphamide c. Fenfluramine/phentermine d. Disease-modifying antirheumatic drugs

ANS: D Digoxin is a cardiac glycoside drug that works on the muscle fiber of the heart to crease the force of each contraction. It also slows down the heart rate. These actions help to improve cardiac output.

A patient asks you how prescribed digoxin (Lanoxin) will help improve heart failure. What is your best response? a. "It dilates your arteries and decreases your blood pressure." b. "It directly perfuses your kidneys which decreases your fluid volume and blood pressure." c. "It increases your heart rate which will result in improved cardiac output." d. "It increases the force of heart contractions and slows down the heart rate to improve cardiac output."

ANS: D A peak expiratory flow rate of 40% below the patient's personal best indicates that the patient is still having difficulty moving air into the respiratory passages because of airway narrowing. The asthma is not responding sufficiently to the drug. Although the respiratory rate is slightly high, many conditions can cause this and it alone is not an indication of ineffective drug response.

A patient has been medicated during an asthma attack. Which assessment finding indicates that the therapy is ineffective? a. Trachea is at the midline. b. Oxygen saturation is 96%. c. Respiratory rate is 22 breaths/min. d. Peak expiratory flow is 40% below expected value.

ANS: D The HandiHaler is a dry-powder inhaler that needs to be loaded by the patient and requires considerable manipulation. This action can be difficult or even impossible for patients with arthritis of the hands. This drug delivery choice is not appropriate for this patient and you should ask the prescriber to consider an inhaler type that does not require loading of the drug.

A 75-year-old patient with chronic obstructive pulmonary disease (COPD) is prescribed tiotropium (Spiriva), an inhaled drug that must be loaded into a HandiHaler with each dose. The patient has all of the following health problems. For which problem do you suggest to the prescriber that this drug may not be appropriate? a. Reduced hearing b. Visual impairment c. Chronic high blood pressure d. Arthritis of hands and knees

ANS: B The actions of diuretic drugs help heart failure in several ways. They can relax blood vessels and lower blood pressure so that less effort is needed for the heart contraction to move blood into the general circulation. Removing extra fluid from the circulation also can reduce blood pressure. In addition, some diuretics work on the heart muscle itself.

A patient asks you how a prescribed diuretic can help heart failure. What is your best response? a. "Urinating more prevents heart failure from damaging your kidneys." b. "Diuretics reduce blood pressure so your heart won't have to work as hard." c. "Taking a diuretic reduces salt levels so you don't have to limit your intake of salty foods." d. "The diuretic counteracts the side effects of the other drugs prescribed for your heart failure."

ANS: A Excessive use of steroid inhalers reduces local immune function and increases the patient's risk for oral-pharyngeal infections, including candidiasis.

A home care patient with chronic obstructive pulmonary disease (COPD) has oral candidiasis. What additional information should you obtain from this patient? a. "How often are you using your steroid inhaler?" b. "Do you share a toothbrush with any members of your family?" c. "When was the last time your inhaler drug prescriptions were filled?" d. "Have you taken any over-the-counter drugs for a cold or flu lately?"

ANS: A, C, D, E Sublingual or buccal nitroglycerin should not be swallowed because the liver destroys most of the drug and makes it ineffective. The drug should be kept in place until it dissolved. Patients should not drink or eat until the tablet is dissolved. A tingling sensation as the tablet dissolves indicates that the drug is potent and any time a patient's chest pain persists after using one tablet, the prescriber should be notified.

A patient has been prescribed sublingual nitroglycerin. Which key points will you teach the patient about this drug? (select all that apply) a. Keep the tablet in place until it is dissolved. b. Swallow the tablet with a full glass of water. c. A tingling sensation means that the drug is potent. d. Do not eat anything until after the tablet is dissolved. e. Call your prescriber if chest pain persists after one tablet.

ANS: C Washing the DPI may cause the medication in the inhaler to clump together. This action reduces the precision of the delivery of the drug to the patient.

A patient is prescribed a dry-powder inhaler (DPI) for chronic obstructive pulmonary disease (COPD). Which statement made by the patient indicates that more instruction is needed? a. "I won't exhale into the inhaler." b. "The inhaler will be kept in the drawer of my bedroom dresser." c. "I will wash the inhaler mouthpiece daily with soap and water." d. "I'll inhale twice as hard through this inhaler as I do with my aerosol inhaler."

ANS: C When a patient is prescribed both an inhaled bronchodilator and anti-inflammatory, give the bronchodilator first, and then wait at least 5 minutes before giving the inhaled anti-inflammatory. Giving the bronchodilator first allows the greatest widening of the airways so that the anti-inflammatory can be inhaled more deeply into the respiratory tract and be more effective.

A patient is prescribed an inhaled bronchodilator and an inhaled corticosteroid. What precaution for using these drugs should you stress to the patient? a. "Use the corticosteroid right before meals to reduce mucus secretion." b. "Use the bronchodilator inhaler only in the morning to prevent sleep difficulties." c. "Use the bronchodilator first, wait at least 5 minutes, then use the corticosteroid." d. "Use the corticosteroid first, wait at least 5 minutes, then use the bronchodilator."

ANS: 0.6 Want 0.03 mg, Have 0.05 mg/1 mL. Cancel mg; 0.05X = 0.03; X = 0.6. 0.6 1 mL = 0.6 mL.

A patient is prescribed digoxin (Lanoxin) 0.03 mg as a liquid dose. The drug on hand is digoxin 0.05 mg/mL. How many milliliters do you give?

ANS: A The two drugs, Inocor and Primacor, are not the same, although both are positive inotropes. Their dosages and infusion rates are very different. The pharmacy has sent up the wrong drug or has labeled the infusion bag incorrectly. Either way, you must stop the existing infusion and clarify all of this with the prescriber first and then the pharmacy.

A patient is prescribed inamrinone (Inocor) by continuous intravenous infusion. When you make rounds and assess the patient, the intravenous bag infusing is labeled (Primacor). What should you do? a. Stop the infusion and notify the prescriber. b. Assess the infusion site for a blood return. c. Document the infusion and site conditions as the only action. d. Slow the infusion rate because Primacor is more potent than Inocor.

ANS: A Isosorbide dilates blood vessels to allow better blood flow to the heart muscle. However, blood vessels are dilated in many body areas. When blood vessels in the brain or head are dilated, headaches can occur.

A patient is prescribed isosorbide (Isordil). Which condition will you teach the patient is an expected side effect of this drug? a. Frequent headaches b. Cold hands and feet c. Change in urine color d. Distaste for sweet foods or drinks

ANS: C At 45 mcg/puff, two puffs are needed per dose for 90 mcg. A drug taken every 4 hours should be taken a total of six times in 24 hours. 6 2 = 12 puffs.

A patient is prescribed to receive 90 mcg of levalbuterol (Xopenex) every 4 hours by oral inhalation. The available drug is levalbuterol 45 mcg/puff. How many total puffs will you tell this patient to take daily? a. 4 puffs b. 8 puffs c. 12 puffs d. 16 puffs

ANS: A High blood levels of magnesium interfere with muscle contraction, causing muscle weakness. Breathing is dependent on good contraction of respiratory muscles. Shallow and slow respirations are a serious manifestation of excess blood magnesium levels.

A patient is receiving magnesium by intravenous infusion. Which finding indicates that the patient's blood magnesium level may be too high? a. Respirations are 10 per minute and shallow. b. Heart rate is 66 beats/min and regular. c. The patient reports difficulty staying asleep. d. Episodes of diarrhea.

ANS: C Cromolyn sodium is a prophylactic (preventive) drug that stabilizes mast cell membranes, inhibiting inflammatory responses in the tissues it contacts. It is not useful during acute attacks.

A patient is starting on the drug cromolyn sodium. Which statement made by the patient indicates a need for clarification about the purpose, administration schedule, or side effects of this drug? a. "If I get a skin rash, I will call my doctor right away." b. "I will keep using the drug even if I don't notice a difference in my asthma after the first week." c. "I will keep the inhaler with me at all times so that I can use it quickly when an asthma attack occurs." d. "I have been trying to inhale deeply when I trigger the inhaler so that more of the drug reaches my lungs."

ANS: A, C, E Nesiritide is given by the IV route, so you should always ensure that the IV line is patent. Heart and respiratory rate should always be assessed before giving this drug. The heart rate should be between 60 and 100 beats/min and the respiratory rate should be between 12 and 20 breaths/min.

A patient is to receive nesiritide (Natrecor). Which patient assessments must be checked before giving this drug? (select all that apply) a. Heart rate b. Swallowing reflex c. IV line for patency d. Oral intake e. Respiratory rate factors

ANS: 17,040 1 kg = 2.2 lb Patient's weight in kilograms is 56.8 kg. Dose is 1.25 ng multiplied by 56.8 kg, 71 ng. There are 240 minutes in 4 hours. 71 ng multiplied by 240 minutes = 17,040 ng.

A patient who weighs 125 lb is prescribed to receive treprostinil (Remodulin) 1.25 ng/kg/min for the next 4 hours. What is the total dose this patient should receive in 4 hours?

ANS: C Unlike for asthma, short-acting beta2-adrenergic agonists are often prescribed on a schedule and as an additional rescue drug for the patient with COPD. Extra doses may be needed to open the airways whenever the patient feels especially breathless.

A patient newly diagnosed with chronic obstructive pulmonary disease (COPD) is prescribed inhaled pirbuterol (Maxair) every 6 hours. You should instruct the patient to take additional drug doses during which specific times or conditions? a. At bedtime b. When feeling especially nervous c. When feeling especially breathless d. If the peak expiratory flow rate is 80% or greater than his or her personal best

ANS: A Salmeterol is a long-acting beta2 agonist. This type of drug needs time to build up an effect and is useful in preventing asthma attacks. The effects of this drug are longer lasting, but are not of value during an acute asthma attack.

A patient reaches for the salmeterol (Serevent) inhaler with the onset of an asthma attack. What is your best instruction to the patient? a. Use the albuterol (Proventil) inhaler instead. b. Wait at least one full minute between puffs. c. Attach the spacer to the inhaler before using it. d. Take a deep breath, hold it for 15 seconds, and then exhale before using the inhaler.

ANS: A Patients with PAH are using anticoagulants. In addition, prostacyclin agents can increase the risk for serious bleeding. The parameter for this therapy is to keep the INR under 3.

A patient receiving a prostacyclin agent and an endothelin-receptor antagonist for treatment of pulmonary artery hypertension (PAH) has an international normalized ratio (INR) of 1.9. What is your best action? a. Document the INR level as the only action. b. Hold the next dose of the drugs and notify the prescriber. c. Ask the patient whether he or she has lost more than 3 lb this week. d. Inspect the infusion site for any other indications of inflammation or infection.

ANS: D Dobutamine is a positive inotropic drug. Side effects include improved urine output and increased blood pressure. Facial flushing is common but not serious. Chest pain indicates the heart is working too hard, which may be related to the dosage level. You should slow the drip rate and immediately notify the prescriber.

A patient receiving dobutamine (Dobutrex) at 180 mcg/min is having all of the following physiologic responses. Which response indicates that the drip rate may be too high? a. Systolic blood pressure increase from 106 to 122 mm Hg b. Hourly urine output of 100 mL c. Facial flushing d. Chest pain

ANS: B Serum potassium level affects the activity of digoxin. A value of 2.8 is low (hypokalemia). Any abnormal potassium value (high or low) requires the prescriber to change the digoxin dosage. In addition, action is needed to bring this critical electrolyte value back to its normal range. Although the other laboratory values are slightly abnormal, none are critically abnormal or likely to have an effect on digoxin activity.

A patient taking digoxin (Lanoxin) has all of the following laboratory blood values. Which value do you report to the prescriber before administering the next dose of digoxin? a. Sodium 133 mEq/L b. Potassium 2.8 mEq/L c. Blood urea nitrogen 9 mg/dL d. White blood cell count 11,000 cells/mm3

ANS: B Many conditions can cause a cough, but a dry, nonproductive cough is the most common side effect of lisinopril and all other ACE inhibitors. Coughs associated with pulmonary infections or worsening of heart failure are usually productive. After assessing the patient's issues with the cough, if the patient is uncomfortable or if the cough interferes with sleeping and other activities, report these problems to the prescriber.

A patient taking lisinopril (Zestril) for heart failure reports a nagging, nonproductive cough. What is your best first action? a. Ask the patient whether he or she has received the annual influenza vaccination. b. Ask the patient how much the cough is interfering with sleep or other activities. c. Document the report as the only action. d. Notify the prescriber immediately.

ANS: B The white blood cell count, lactate dehydrogenase, and hematocrit values are abnormal; however, only the lactate dehydrogenase level is very high (four to five times normal). This value indicates liver impairment. Leukotriene inhibitors can cause liver impairment. This value must be reported immediately so that liver function can be explored and any needed changes in drug therapy made before irreversible liver damage occurs.

A patient taking montelukast (Singulair) for the last 2 months has the following blood laboratory test values. Which value do you report to the prescriber immediately? a. White blood cell count of 10,500 cells/mm3 b. Lactate dehydrogenase 950 IU/L c. Potassium 3.6 mEq/L d. Hematocrit 32%

ANS: D When a patient is prescribed an anti-inflammatory drug, there is an increased risk of opportunistic infections. A thick white coating on the tongue and mucous membrane suggests that the patient has developed a candidiasis (yeast) infection that will need to be treated with an antifungal drug. The nurse should document the finding and notify the prescriber so that appropriate treatment actions can be taken.

A patient who has been prescribed an inhaled corticosteroid develops a thick white coating on the tongue and patches on the inside cheeks. What is your best action? a. Instruct the patient to stop using the inhaler until the coating is gone. b. Obtain a culture of the coating and take the patient's temperature. c. Hold the dose and notify the prescriber immediately. d. Document the finding and notify the prescriber.

ANS: C Terbutaline is a beta2 agonist that dilates airways and constricts blood vessels. Expected side effects of this drug include dry mouth, feeling of nervousness, difficulty sleeping, bad taste in the mouth, rapid heart rate, and increased blood pressure. When a patient is extra sensitive to the drug or has other cardiac problems, constriction of the blood vessels may include the coronary arteries and lead to angina (chest pain) or a heart attack. Notify the prescriber immediately if a patient develops chest pain.

A patient who is prescribed oral terbutaline (Brethine) reports all of the following signs and symptoms. Which should you report to the prescriber? a. Difficulty sleeping b. Taste changes c. Chest pain d. Dry mouth

ANS: 0.8 1 kg = 2.2 lb. The patient's weight in kilogram is 117.72 kg (259/2.2). The correct dose is 2 mcg 117.72 kg, 235.4 mcg. 1 mL of the drug = 0.3 mg (divide 1.5 mg by 5 to get the concentration per mL) or 300 mcg/mL (1 mg = 1000 mcg). Divide 235.4 mcg by 300 mcg for the correct volume to prepare, which is 0.78 mL, round up to 0.8 mL.

A patient who weighs 259 lb is prescribed to receive nesiritide (Natrecor) 2 mcg/kg as an intravenous bolus. The drug available is 1.5 mg/5 mL. How many milliliters of the drug will you prepare to make the correct dose?

ANS: A Because damage can occur with any asthma attack, the main focus of therapy should be on attack prevention rather than just on symptom management.

A patient with asthma asks why he must take regularly scheduled systemic drugs when he can stop several asthma attacks each day within a few minutes of their onset by using a short-acting beta agonist inhaler. What is your best response? a. "Frequent asthma attacks, even if they are halted relatively quickly, damage the bronchial tissues over time." b. "If asthma attacks are uncontrolled they lead to the eventual development of lung cancer and emphysema." c. "Using only short-acting beta agonists will lead to drug resistance and then the drug won't work when you need it." d. "Inhaled beta agonist drugs only treat the constriction aspects of asthma and do not help the inflammatory aspects of the disease."

ANS: C Even though both drugs are beta2 agonists, they are both normally prescribed for the patient with asthma. Short-acting (rapid-acting) beta2 agonists (albuterol) are used to reduce the severity or stop an asthma attack. Long-acting beta2 agonists (salmeterol) can prevent attacks when taken daily; however, their onset of action is so slow that these drugs are not helpful to stop an attack that has already started.

A patient with asthma is prescribed albuterol (Proventil) as needed and salmeterol (Serevent) every 12 hours. When the patient asks why two inhaler drugs are needed, what is your best response? a. "Albuterol opens your airways and salmeterol decreases the inflammation." b. "I will check with the prescriber to determine whether you can just use one drug." c. "Albuterol is a rescue drug to stop asthma attacks and salmeterol prevents attacks." d. "Salmeterol helps you breathe better and albuterol opens alveoli for gas exchange."

ANS: D When used as prescribed, inhaled drugs go more to the site where the intended responses are needed (the airways) and less drug is absorbed systemically. Thus inhaled drugs have fewer (but still have some) side effects. Oral drugs always have systemic side effects.

A patient with chronic obstructive pulmonary disease (COPD) who is prescribed a short-acting inhaled beta2 agonist reports hating the inhaler and asks why the drug can't be taken as a pill. What is the nurse's best response? a. "Inhaled drugs work more slowly." b. "Inhaled drugs have no side effects." c. "Oral drugs are usually more expensive." d. "Oral drugs have more systemic side effects."

ANS: B Spironolactone, when used in low doses, blocks the action of aldosterone, which causes the body to lose salt and water. Furosemide works in the loop of Henle to decrease reabsorption of salt and water. Spironolactone is usually prescribed with another diuretic to decrease the volume of fluid in the blood vessels, which reduces the workload of the heart. Additionally when used together, these drugs help the body maintain a more normal blood potassium level.

A patient with heart failure asks why two diuretic drugs, furosemide (Lasix) and spironolactone (Aldactone), have been prescribed. What is your best response? a. "Your prescriber wants you to lose fluids and that's why you are taking two diuretics." b. "Each of these diuretics works in a different way to decrease workload on your heart." c. "Using two diuretics will double the amount of fluid you lose to decrease the work your heart must do." d. "Let me contact your prescriber because patients usually do not take two diuretics at the same time."

ANS: B Decreasing blood pressure helps improve the heart's action as a pump and decreases the heart's workload. Diuretics are used to decrease blood volume. Enalopril is an angiotensin-converting enzyme (ACE) inhibitor that interferes with the transition of angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor that causes increased blood pressure and increased workload for the heart.

A patient with heart failure asks you why the antihypertensive drug enalapril (Vasotec) has been prescribed. What is your best response? a. "Hypertension is the most common cause of heart failure." b. "Lowering your blood pressure will allow your heart to pump more easily." c. "This drug will decrease the amount of blood your heart has to pump, leading to less work for your hart." d. "Enalapril will cause your heart to reestablish its normal electrical functions so that it works more effectively as a pump."

ANS: C The usual IV dose of furosemide ranges between 10 and 80 mg. A dose of 400 mg is very large. You must verify the correct drug dose before administering it.

A patient with heart failure is prescribed a one-time dose of furosemide (Lasix) 400 mg by intravenous (IV) push immediately. What is the best action? a. Contact the prescriber and request that the dose be changed from IV push to IV piggyback. b. Give the dose by IV push over a 10-minute period of time. c. Hold the dose and notify the prescriber immediately. d. Start an IV and administer the drug as prescribed.

ANS: C Nausea, blurry vision, and heart rate or rhythm changes are signs of digoxin overdose. The dose should be held and the prescriber notified. Most likely you will also be asked to obtain a blood sample to measure the digoxin level. Digoxin has a very narrow therapeutic range (0.8 to 2 ng/mL) and this level should be checked whenever a patient shows any signs of toxicity. Symptoms usually resolve when the drug is held and the body eliminates it.

A patient with heart failure is prescribed digoxin (Lanoxin). The patient reports nausea, blurry vision, and feeling like the heart is skipping beats. What is your best action? a. Administer the scheduled dose because it will correct these heart failure symptoms. b. Assess the patient's heart rate and then administer the scheduled dose. c. Hold the dose and notify the prescriber immediately. d. Place the patient on complete bed rest.

ANS: C Beta blockers and ACE inhibitors are often used together to treat heart failure. Beta blockers block the effects of epinephrine on the heart resulting in deceased heart rate and force of contraction, thus decreased blood pressure. You should notify the prescriber if the heart rate is less than 60 per minute.

A patient with heart failure is prescribed oral captopril (Capoten) and carvedilol (Coreg). The heart rate after giving these drugs is decreased from 84 per minute to 68 per minute. What is your best action? a. Hold the next dose. b. Immediately notify the prescriber. c. Document the finding as the only action. d. Schedule the captopril and carvedilol to be given at different times.

ANS: A Patients receiving dobutamine at home should be taught the signs and symptoms of IV lines that are no longer patent or have developed infection (e.g., burning, pain, redness, swelling, warmth at the site). Patients should be instructed to report these signs immediately to the prescriber or home health nurse.

A patient with heart failure is receiving dobutamine (Dobutrex) intravenously at home. Which sign or symptom should the patient and family be instructed to report to the prescriber immediately? a. Burning or pain at the intravenous (IV) site b. Heart rate between 60 and 70 beats/min c. Urine output of 1600 mL over 24 hours d. Brief episode of shortness of breath

ANS: D Patient weight gain and increased shortness of breath are signs of worsening heart failure. The prescriber should be notified because the plan of care may need to be modified. If the patient is taking a diuretic, it is likely that the dose may be increased.

A patient with heart failure reports a 5 lb weight gain during the past week and episodes of feeling more short of breath. What is your best response? a. "These changes are to be expected because you have heart failure." b. "You will probably need a decreased dose of your diuretic drug." c. "I will ask the dietitian to discuss a weight loss diet with you." d. "Your prescriber must be notified because your heart failure is getting worse."

ANS: D Common side effects of nitroglycerin ointment include hypotension and headaches. When this drug is administered, if a person's skin comes into contact with the drug as it is squeezed onto the special lined paper, these side effects may develop. Wearing gloves prevents skin contact with the drug and decreases the risk for side effects.

A patient with severe heart failure is discharged with a prescription for nitroglycerin ointment. What technique do you teach the patient's spouse to use to avoid experiencing side effects when applying this drug? a. Squeeze the ointment onto the special paper. b. Cleanse the skin before applying the drug. c. Rotate the drug application skin sites. d. Wear a pair of disposable gloves.

ANS: B Antihypertensive drugs decrease blood pressure and increase a patient's risk for dizziness, light-headedness, and hypotension. After giving the first dose of any antihypertensive drug, you should be sure that the call light is within easy reach and instruct the patient to call for assistance when getting out of bed. A wheelchair is not necessary and standards of practice state that all four side rails should not be raised because there is a risk for falls if the patient tries to get out of bed alone.

After giving the first dose of any antihypertensive drug for heart failure, what action must be taken for a hospitalized patient's safety? a. Recheck the drug order for accuracy. b. Ensure that the call light is within reach. c. Place a wheelchair in the patient's room. d. Raise all four side rails on the patient's bed.

ANS: A Children under the age of 4 years are rarely able to use an aerosol inhaler effectively. Administering the drug by nebulizer with a face mask is the best delivery method.

For which asthma patient is a beta2-adrenergic agonist best delivered by nebulizer? a. 3-year-old child who has a broken leg b. 16-year-old boy who has a broken nose c. 25-year-old woman who is 8 months pregnant d. 60-year-old man who has an enlarged prostate gland

ANS: C The usual dosage of digoxin is 0.125 to 0.25 mg/day. The order is for 10 to 20 times the normal dose. If this dose is given the results would be adverse effects of even death. The other drug dosages are within the correct ranges.

For which drug order would you contact the prescriber to verify it is correct? a. Furosemide (Lasix) 40 mg orally each day b. Fosinopril (Monopril) 20 mg orally each day c. Digoxin (Lanoxin) 2.5 mg orally each day d. Amiloride (Midamor) 5 mg orally each day

ANS: C Pulmonary fibrosis is characterized by increased cell division and formation of fibrous tissue. The goal of therapy is to slow cell division and the progression of the fibrosis. Only the corticosteroids and immunosuppressants work in this way. In fact, amiodarone and ambrisentan can lead to the development of pulmonary fibrosis.

Drugs from which classes are considered the mainstays of therapy for pulmonary fibrosis? a. Amiodarone and ambrisentan b. Nonsteroidal anti-inflammatories and opiates c. Corticosteroids and immunosuppressants d. Disease-modifying antirheumatic drugs and aspirin

ANS: B Asthma is a problem of airway obstruction caused by constriction of the bronchial smooth muscles that surround the airways and by inflammation in the airways. It occurs in episodes or attacks. Between attacks, the airways are open. Thus the problem is intermittent and reversible. COPD, however, has permanent airway changes and is not cured by therapy. Both disorders can cause such severe airway obstruction that death occurs.

How are asthma and chronic obstructive pulmonary disease (COPD) different? a. COPD is a genetic disease whereas asthma is largely caused by allergies. b. Breathing problems with asthma are reversible but those with COPD are permanent. c. Asthma is a disease of children and younger adults whereas COPD is found only in older adults. d. Breathing problems with COPD can lead to death, whereas those with asthma are not severe enough to be fatal.

ANS: C Sublingual means to place the drug under the tongue. Remind patients that sublingual nitroglycerin should be kept in place until dissolved.

How should sublingual nitroglycerin tablets for heart failure be taken? a. On a full stomach b. On an empty stomach c. Dissolved under the tongue d. Placed under a patch on the chest

ANS: B Corticosteroids decrease the production of the body chemicals that trigger inflammation. Inhaled corticosteroids can prevent or reduce the inflammation in the airways that leads to mucosal swelling in the airway lumen. This swelling narrows the lumen, reducing airflow.

How do corticosteroids improve breathing in patients with asthma or chronic obstructive pulmonary disease (COPD)? a. Relaxing bronchial smooth muscle, leading to wider airways b. Reducing mucosal swelling in the lumens, leading to wider airways c. Triggering the sympathetic nervous system, leading to deeper respirations d. Controlling anxiety, leading to an increased ability to focus on respiratory effort

ANS: C People who have COPD often have thick, sticky mucus that partially blocks airways and is difficult to cough up. With asthma, there is less mucus but some is still present. Mucolytic drugs reduce the thickness of mucus, allowing it to be more easily moved out of the airways.

How do mucolytics help asthma and chronic obstructive lung disease (COPD)? a. Reducing inflammation b. Inducing bronchodilation c. Reducing mucus thickness d. Enhancing respiratory rate

ANS: D Nesiritide (Natrecor) is human B-type natriuretic peptide, which is a hormone that is produced by the heart ventricles and a synthetic drug. The actions of this drug include increased water elimination and blood vessel dilation. Both are helpful when treating a patient with heart failure. This drug is given by the IV route and helps the body get rid of extra salt and water, thus lowering blood pressure.

How do natriuretic peptides work to help improve heart failure? a. Increasing preload b. Decreasing preload c. Decreasing water loss and raising blood pressure d. Increasing water loss and lowering blood pressure

ANS: C Hydralazine is a vasodilator. Vasodilators are a class of drugs that act directly on the peripheral arteries to cause them to dilate (widen). This leads to lowering of blood pressure and decreases the workload of the heart.

How does hydralazine (Apresoline) help improve heart failure? a. By directly stimulating the right heart muscle to increase the strength of heart muscle contraction b. By directly stimulating the left heart muscle to increase the strength of heart muscle contraction c. By directly relaxing blood vessel muscles and decreasing afterload d. By directly constricting blood vessel muscles and increasing afterload

ANS: C The three phases in the process of vomiting are nausea, retching, and vomiting. Retching (dry heaves) involves labored respiratory movements against a closed throat, with contractions of the abdominal muscles, chest wall muscles, and diaphragm without vomiting. Vomiting does not always follow retching, but retching usually causes enough pressure buildup to lead to vomiting.

How is retching different from vomiting? a. Nausea is not present in retching but is in vomiting. b. Nausea is not present in vomiting but is in retching. c. With retching, no vomiting occurs. d. With vomiting, no retching occurs.

ANS: 3 Want 30 mg, Have 10 mg/tablet. 30 mg/X tablets : 10 mg/1 tablet. Cancel mg; 30/10 = 3 tablets.

The patient is prescribed potassium (K-Dur) tablets 30 mg orally each morning. You have potassium (K-Dur) in 10 mg tablets. How many tablets will you give for each dose?

ANS: A Common side effects of hydralazine include tachycardia and salt retention.

What is a common side effect of hydralazine (Apresoline) therapy for heart failure? a. Tachycardia b. High blood pressure c. Constipation d. Difficulty sleeping

ANS: B Afterload is the pressure in the aorta that the left ventricle must overcome before blood can move from it into the aorta. Mean arterial pressure (MAP) is also the pressure that the left ventricle must overcome to move blood from the left ventricle into the aorta during contraction (afterload). Afterload increases because of increased peripheral resistance usually as a result of high blood pressure.

What does the term "afterload" mean? a. The amount of blood entering the left ventricle that must be pumped out of the heart b. The peripheral resistance of the arterial system, including mean arterial pressure c. The ability of the living muscle fibers of the heart to contract and pump blood d. The percentage of blood pumped out of the heart with each heartbeat

ANS: D Anti-inflammatory drugs reduce inflammation and dry all mucous membranes including those in the mouth and throat. They would reduce any cutaneous (skin) itching. They do not work on bronchial smooth muscles or the bone marrow (which produces red blood cells).

What is a common side effect of inhaled anti-inflammatory drugs for asthma? a. Anemia b. Bronchoconstriction c. Cutaneous itching d. Dry mouth

ANS: D The muscle of the left ventricle becomes overstretched. When any muscle is overstretched, its contraction is weaker. When the muscles of the left ventricle are overstretched or flabby and the contraction is weak, too much blood remains in the left ventricle, and more blood arriving from the left atrium is added to it. This overstretches the muscle more and continues to weaken contractions, leading to heart failure.

What is the main physiological problem in most types of heart failure? a. Overstretching of the right ventricle so that too much blood leaves the heart b. Overstretching of the right ventricle so that too little blood leaves the heart c. Overstretching of the left ventricle so that too much blood leaves the heart d. Overstretching of the left ventricle so that too little blood leaves the heart

ANS: A Iloprost is an inhaled drug used to treat pulmonary artery hypertension.

What is the main way iloprost (Ilomedin) is administered? a. Oral inhalation b. Subcutaneous injection c. Sublingual tablet d. Continuous intravenous infusion

ANS: A Cardiac glycosides are a class of drugs that improve heart failure by slowing down a heart rate that is too fast, allowing more time for the left ventricle to fill. They also work on the muscle fibers in the heart and increase the force of each heartbeat (contractility).

What is the mechanism of action for cardiac glycosides? a. Slowing the heart rate and increasing the force of the heart muscle contraction b. Increasing the heart rate and decreasing the force of the heart muscle contraction c. Directly relaxing blood vessel muscles and decreasing afterload d. Directly constricting blood vessel muscles and increasing afterload

ANS: A Most heart failure is caused by hypertension. Other causes of heart failure include myocardial infarction, coronary artery disease, cardiomyopathy, substance abuse (alcohol and illicit or prescribed drugs), heart valve disease, congenital defects, cardiac infections and inflammations, and conditions that increase cardiac output and energy demands such as sepsis.

What is the most common cause of heart failure? a. High blood pressure b. Low blood pressure c. Defective heart valves d. Defective coronary arteries

ANS: D Short-acting beta-adrenergic agonists work directly on the airways. They are delivered by oral inhalation so that their effects are exerted almost exclusively on the airway tissues.

What is the most common route used to deliver short-acting beta-adrenergic agonists? a. Oral b. Intravenous c. Transdermal d. Inhalation

ANS: B The most common side effects of digoxin (Lanoxin), a cardiac glycoside, are heart rhythm disturbances that are related to digoxin toxicity. Other common side effects to watch for include fatigue, bradycardia (slow heart rate less than 60 beats/min), anorexia (loss of appetite), nausea, and vomiting.

What is the most common side effect of cardiac glycoside drugs for heart failure therapy? a. Abdominal cramping and constipation b. Heart rhythm disturbances c. High blood pressure d. Skin rashes

ANS: A Although all the actions are important, the most important is to ensure that the pulse rate is between 60 and 100 beats/min and is regular before administering digoxin or any other cardiac glycoside. For an irregular heart rate or one that is outside of this range, the dose must be held and the prescriber notified immediately.

What is the most important action for you to teach a patient to perform before taking his or her daily dose of digoxin (Lanoxin)? a. Check the pulse for a full 60 seconds. b. Look for edema in your ankles. c. Notify the prescriber for any heart palpitations. d. Take the drug at exactly the same time every day.

ANS: B Anti-inflammatory drugs are not rescue drugs; they are controller or prevention drugs. They only work when taken daily on a scheduled basis. They are not helpful when there is a sudden narrowing of the airways.

What is the most important precaution to teach a patient about anti-inflammatory drugs used for respiratory problems? a. To keep the drug with them at all times to use for sudden narrowing of the airways. b. To take the drug daily, even when symptoms of airway obstruction are not present. c. To avoid crowds and people who are ill because of the greatly increased risk for infection. d. To brush their teeth at least four times daily to remove the drug from the mouth and improve taste.

ANS: C It is critical that there is no interruption in therapy while on continuous infusions of a prostacyclin agent. Even an interruption of minutes increases the risk for death.

What is the most important precaution to teach a patient who has a continuous infusion of treprostinil to manage pulmonary artery hypertension? a. "Avoid crowds and people who are ill." b. "Use at least two reliable forms of birth control." c. "Go to the nearest emergency room if the line clogs." d. "Report a headache lasting 24 hours to your prescriber immediately."

ANS: C Blood potassium levels have a very narrow range of normal. When intravenous potassium is administered at too high a dose or too rapidly, life-threatening cardiac rhythm problems develop and death is possible. Always check an intravenous potassium dose with another health care professional and never administer it either by intravenous push or as a bolus.

What is the most important reason intravenous potassium is considered a high alert drug? a. When intravenous potassium is administered at too low a dose its mechanism of action is greatly reduced. b. Intravenous potassium is a highly irritating solution and can cause significant pain or burning at the infusion site. c. Administering too much intravenous potassium or administering it too quickly may cause life-threatening problems. d. Excessive blood potassium levels can lead to nausea, vomiting, severe diarrhea, abdominal cramping, and other intestinal problems.

ANS: B Common side effects of potassium include nausea, vomiting, diarrhea, gas, and abdominal discomfort. Taking the drug with food or right after meals with a full glass of water or fruit juice will decrease or prevent these side effects. A patient should never take a double dose of a prescribed drug. Most salt substitutes are made by replacing sodium with potassium. Use of salt substitutes or eating excessive amounts of foods that are high in potassium while taking a potassium supplement increases the risk of hyperkalemia (high blood potassium).

What should you teach a patient who has been prescribed potassium (K-Dur) tablets? a. "If you miss a dose, double your next dose to keep your blood level of potassium normal." b. "Take your potassium with food or a full glass or water to avoid nausea/vomiting." c. "Be sure to use salt substitutes instead of salt so that your body will not retain water." d. "Eat lots of foods that are high in potassium such as bananas, spinach, broccoli, and sweet potatoes."

ANS: A Vasodilators act directly on the peripheral arteries, causing them to dilate, which leads to decreased blood pressure and workload on the heart. When patients cannot take ACE inhibitors or angiotensin II receptor blockers, vasodilators are often prescribed.

When are vasodilator drugs usually prescribed for heart failure? a. When angiotensin-converting enzyme (ACE) inhibitors cannot be taken b. When venous dilation is also needed c. When beta blockers are also being taken d. When heart failure is improving

ANS: B There is no propellant in the inhaler. Only a deep breath pulls the drug into the lungs.

Which action should be taught to the individual prescribed to use a dry-powder inhaler for asthma control? a. Shake the inhaler well before using. b. Breathe in deeply to pull the drug into your lungs. c. Keep the inhaler in the refrigerator between uses. d. Clean the mouthpiece daily by rinsing it in warm running water.

ANS: A, C, E The sympathetic nervous system releases the catecholamine hormones epinephrine and norepinephrine, which act on the heart in two ways. First they increase the heart rate, and second they increase the power of the heart muscle fibers to contract so that the heart pumps more forcefully. These actions increase cardiac output.

Which are sympathetic nervous system compensatory mechanisms of the body for heart failure? (select all that apply) a. Increased heart rate b. Decreased respiratory rate c. Increased contractility d. Decreased body temperature e. Increased cardiac output f. Decreased cardiac output

ANS: A The intended action of bronchodilators is to widen the airways to improve breathing. Listening to the lungs with a stethoscope determines drug effectiveness by comparing the patient's breath sounds before and after therapy.

Which assessment is most important to perform before administering a bronchodilator by inhalation? a. Listening with a stethoscope to the patient's breath sounds. b. Measuring blood pressure in the sitting and standing positions. c. Asking questions to assess the patient's cognition and mental status. d. Checking the oral mucous membranes for white or cream-colored patches.

ANS: D Ankle swelling is associated with heart failure, although other conditions also can cause it. If this is a new symptom or is occurring even when the patient is not spending a lot of time sitting or standing, the nurse should assess the patient for other symptoms of heart failure. Although the blood pressure is not high, the pulse pressure is wide which does not indicate failure. A pounding headache is most associated with elevated blood pressure. Foul-smelling urine is associated with urinary tract infection.

Which condition alerts you to assess a patient for worsening heart failure? a. Blood pressure of 106/40 mm Hg b. Pounding headache c. Foul urine odor d. Ankle swelling

ANS: D Dobutamine (Dobutrex) is a positive inotrope. This drug is a heart pump drug that makes the heart muscle contract more forcefully. It also relaxes blood vessels so blood can flow better.

Which drug for heart failure is a common positive inotrope? a. Amiloride (Midamor) b. Nesiritide (Natrecor) c. Captopril (Capoten) d. Dobutamine (Dobutrex)

ANS: C The presence of thick mucus in the respiratory tract is continuous in COPD and intermittent in asthma. It is often necessary to use systemic mucolytic agents or drugs that decrease mucous production in COPD, but is only rarely indicated for asthma.

Which drug is more commonly used as therapy for chronic obstructive pulmonary disease (COPD) than as therapy for asthma? a. Epoprostenol (Flolan) b. Warfarin (Coumadin) c. Guaifenesin (Organidin) d. Salmeterol (Serevent)

ANS: B, E, G PAH is managed using anticoagulants, guanylate cyclase stimulators, prostacyclin agents, and endothelin-receptor antagonists. Bosentan and macitentan are endothelin-receptor antagonists and riociguat is a guanylate cyclase stimulator.

Which drugs are useful in the management of pulmonary artery hypertension (PAH)? (select all that apply) a. Anoro Ellipta b. Bosentan (Tracleer) c. Cyclophosphamide (Cytoxan) d. Guaifenesin (Naldecon) e. Macitentan (Opsumit) f. Prednisone g. Riociguat (Adempas)

ANS: C As outlined in Box 21-1, it is important for the patient using an aerosol inhaler with a spacer to seal his or her lips tightly around the spacer's mouthpiece. Dose should be placed into the spacer and then inhaled one at a time. The drug works best when it is inhaled slowly and deeply. Breathing back into the spacer does no harm.

Which instruction is most important to teach a patient using an aerosol inhaler with a spacer? a. "Breathe in rapidly until the spacer makes a continuous whistling sound." b. "Seal your lips tightly around the spacer's mouthpiece." c. "Release both doses into the spacer before breathing in." d. "Avoid breathing back into the spacer."

ANS: B, C, E Lifestyle changes that are important in treating heart failure include weight loss, smoking cessation, and a low-salt and low-fat diet. A fluid restriction of 1000 mL can result in decreased perfusion of the kidneys. Patients with heart failure may not be able to tolerate an aerobic exercise program.

Which lifestyle changes should you suggest to a patient with heart failure? (select all that apply) a. Fluid restriction of 1000 mL/day b. Weight loss program c. Smoking cessation program d. Aerobic exercise program e. Low-salt, low-fat diet

ANS: C Albuterol and terbutaline are beta2 agonists. Aminophylline is a xanthine.

Which of these bronchodilators is a cholinergic antagonist? a. Albuterol b. Terbutaline c. Ipratropium d. Aminophylline

ANS: A The center of the airway, known as the lumen, is partially or completely plugged with excessive mucus (produced by cells in the mucous membranes). Cartilage and smooth muscle do not come into contact with mucus and are not affected by it.

Which part of the airway is affected by excessive mucus? a. Lumen b. Cartilage c. Smooth muscle d. Mucous membrane

ANS: B Asthma is a chronic disease characterized by intermittent changes in the lower and smaller airways, not the alveoli or the cartilage. The trachea, although it is an airway is too large to be affected by asthma.

Which part of the respiratory system is most affected by asthma? a. Alveoli b. Airway c. Trachea d. Cartilage

ANS: D The previous patch must be removed (and the area wiped clean of drug) before applying a new patch (to a different site) to prevent leftover drug from contributing to a drug overdose. Applying the patch directly over the heart does not increase the speed of drug action on the heart.

Which precaution should you stress when teaching a patient about a prescribed nitroglycerin transdermal patch? a. "If a patch comes loose, tape it tightly to the skin with several layers of tape." b. "Do not remove old patches, just let them fall off over time." c. "Take care to apply the patches directly over your heart." d. "Remove the old patch before applying the new patch."

ANS: A Although beta-adrenergic agonists relax bronchial smooth muscle, they cause constriction of vascular (blood vessel) smooth muscle. This action increases peripheral resistance and raises blood pressure.

Which problem is a common side effect of beta-adrenergic agonist types of bronchodilators? a. Hypertension b. Urinary retention c. Increased bleeding d. Shortness of breath

ANS: B The action of epoprostenol increases the cyclic adenosine monophosphate (cAMP) in blood vessel smooth muscle, which would cause hypotension not hypertension. It does increase the risk for prolonged bleeding. It is not associated with impotence. Congestive heart failure is a complication of disease and not of this drug.

Which problem is the main adverse effect of epoprostenol (Flolan)? a. Impotence b. Prolonged bleeding c. Severe hypertension d. Congestive heart failure

ANS: A, C, D Beta2-adrenergic agonists have actions similar to the sympathetic division of the autonomic nervous system. When these drugs are used heavily, they can have systemic effects, which include rapid heart rate, increased blood pressure, a feeling of nervousness, and difficulty sleeping. The inhaled drugs can dry the mouth and throat and also may leave a bad taste in the mouth. These drugs, even when absorbed systemically, do not cause diarrhea.

Which responses are possible side effects of inhaled beta2-adrenergic agonists? (select all that apply) a. Bad taste in the mouth b. Increased salivation c. Difficulty sleeping d. Rapid heart rate e. Hypotension f. Diarrhea

ANS: A Antihypertensive drugs lower blood pressure, placing the patient at increased risk for dizziness and hypotension. Changing positions slowly gives the body time to adjust, preventing dizziness and falls. The patient can get up at home without assistance if he or she changes positions slowly. Some, but not all, over-the-counter drugs may not be safe with these drugs. You should teach the patient to always consult with the prescriber before taking an over-the-counter drug.

Which safety precaution should be taught to a patient going home on any antihypertensive drug for heart failure? a. Always change positions slowly. b. Never get up without assistance. c. Take the drug in the evening before bedtime. d. Avoid all over-the-counter drugs while taking this drug.

ANS: A, C, D, F Ipratropium (Atrovent) is a cholinergic antagonist drug. Cholinergic antagonists can cause some specific side effects if they reach the bloodstream. These effects include urinary retention, blurred vision, eye pain, nausea, and headache.

Which side effects should you monitor for after a patient receives ipratropium (Atrovent)? (select all that apply) a. Headache b. Increased urine output c. Blurred vision d. Nausea e. Decreased heart rate f. Eye pain g. Muscle aches

ANS: B Drug therapy only improves heart function; drugs do not cure heart failure. Because the damage to the heart muscle is not reversible, the only real cure for heart failure is a heart transplant

Which statement about drug therapy for heart failure is true? a. The drugs work only directly on the heart muscle. b. Drug therapy improves heart function but does not cure heart failure. c. When heart function returns to normal, the drug therapy can be stopped. d. Drug therapy for heart failure does not work when the patient continues to smoke.

ANS: A The two causes of reversible and intermittent airway obstruction with asthma are bronchoconstriction and inflammation. Between asthma attacks the airways are open and normal breath sounds are heard. Mucous plugs can make the airway obstruction worse, but are not major causes of airway obstruction. Asthma affects only the airways, not the alveoli.

Which statement about the pathology of asthma is true? a. Breath sounds are normal between attacks. b. Mucous plugs are the major cause of airway obstruction. c. Eventually the alveoli are destroyed and gas exchange is limited. d. During an attack, arterial oxygen levels and carbon dioxide levels are decreased.

ANS: B Nitroglycerin ointment or patches lose their effectiveness when used continuously. The drug works much better when there is a "drug free" time during a 24-hour period. Usually the drug is removed at night when the patient has his or her longest sleeping period because the heart is less stressed during that time.

Which statement by a patient receiving nitroglycerin ointment indicates the need for additional teaching? a. "I will remove the previous dose before I put on the new dose." b. "I will reapply the dose every 4 hours around the clock." c. "I must avoid rubbing my skin when I put on a new dose." d. "I will put tape over the paper so that the dose stays in place."

ANS: C Heart failure can be improved with drug therapy but the underlying condition remains. When heart failure is a result of damage, it is not cured. Drug dosage needs may change to control heart failure, but usually the dosages only increase as time goes on.

Which statement made by a patient with heart failure indicates that more teaching is needed about the prescribed drug therapy? a. "I always try to take my heart failure drugs at the same time each day." b. "Now I am using a weekly pill dispenser to keep my drugs straight." c. "Now that my heart failure is cured I can cut back the drugs I take." d. "If I gain more than 3 lb in a week I will call my doctor."

ANS: D When the left ventricle fails, less blood is pumped out to the body and blood backs up into the pulmonary system causing signs of pulmonary congestion such as crackles and wheezes. Weight gain, peripheral swelling, and jugular vein distention are all signs of right ventricular failure.

Which symptom is commonly assessed when a patient has left ventricular heart failure? a. Weight gain b. Swelling in the legs c. Jugular vein distention d. Crackles in the lungs

ANS: D When the right ventricle contracts poorly, signs and symptoms of peripheral congestion occur (Box 17-2 in text) such as weight gain, swelling in the legs, jugular vein distention (Figure 17-4 in text), and increased blood pressure.

Which symptom occurs with only pure right-sided heart failure and does not occur with pure left-sided heart failure? a. Confusion b. Shortness of breath c. Decreased afterload d. Swelling in the ankles and legs

ANS: B Cardiac output is the movement of blood out of the heart and into general circulation. Preload is the amount of blood in the left ventricle before contraction. This volume stretches the muscle of the left ventricle to result in a better force of contraction. So, to a point, greater preload helps improve cardiac output. Afterload is the pressure in the aorta that must be overcome for blood to leave the left ventricle. When this pressure is lower, the heart does not have to work as hard to move blood out of the left ventricle into the aorta. So, greater preload and reduced afterload tend to improve cardiac output.

Which two factors are most likely to result in improved cardiac output? a. Greater preload; greater afterload b. Greater preload; reduced afterload c. Reduced preload; greater afterload d. Reduced preload; reduced afterload

ANS: C Bronchodilators relax bronchiolar smooth muscle and widen the airways. They do nothing to help flabby alveoli and do nothing to reduce inflammation. Inflammation is responsible for mucus production and mucosal swelling.

Which type of asthma problem is helped most by bronchodilator drugs? a. Thick mucus b. Mucosal swelling c. Bronchoconstriction d. Large, flabby alveoli

ANS: B Anti-inflammatory drugs reduce inflammation and do not help bronchoconstriction. They directly inhibit mucosal swelling and, thus indirectly, reduce mucosal production of mucus. They do not affect mucous that has already formed. Flabby alveoli are not caused by inflammation.

Which type of asthma problem is helped most directly by anti-inflammatory drugs? a. Thick mucus b. Mucosal swelling c. Bronchoconstriction d. Large, flabby alveoli

ANS: D The alveoli are not airways, they are air sacs. Emphysema is a disease of flabby airways, not of bronchoconstriction. With chronic bronchitis, the airways are narrowed with swollen mucous membranes not by constriction of the muscles in the airways.

Which type of problem narrows the airways by tightening bronchial smooth muscle? a. Alveoli b. Emphysema c. Chronic bronchitis d. Bronchoconstriction

ANS: A Hydralazine can be safely used for blood pressure control during pregnancy, but isosorbide and nitroglycerin may affect fetal circulation and should be used with caution during pregnancy. Minoxidil is a vasodilator that is not generally used in the treatment of heart failure.

Which vasodilator drug can be safely prescribed for a patient with heart failure during pregnancy? a. Hydralazine (Apresoline) b. Isosorbide (Isordil) c. Minoxidil (Lonitin) d. Nitroglycerin (Nitrostat)

ANS: B Long-acting beta2-adrenergic agonists (LABAs) work in the same way as SABAs but need time to build up an effect. Therefore LABAs are used to prevent an asthma attack because their effects last longer but have no value during an acute attack.

Why are long-acting beta-adrenergic agonists not useful during an actual acute asthma attack? a. They are likely to cause allergies. b. They need time to build up an effect. c. They take too long to be absorbed by the intestinal tract. d. They reduce inflammation rather than relax bronchial smooth muscle.

ANS: D The xanthines and methylxanthines are powerful systemic drugs that have a narrow therapeutic range. They have many dangerous and systemic side effects, especially for the cardiovascular and neurological systems.

Why are xanthines seldom used to treat asthma now? a. They increase bronchial secretions at the same time that they induce bronchial dilation. b. They have no role in preventing bronchoconstriction or inflammation. c. They are all administered intravenously. d. They have severe systemic side effects.

ANS: C Movement of blood through the other chambers of the heart is against low pressure, and the distance is short. Blood leaving the left ventricle must move with enough force to first overcome pressure in the aorta, which is the highest in the entire circulatory system, and then move long distances throughout the entire body. Contraction of the muscles in the walls of the left ventricle is what provides the pressure to move blood forward into general circulation.

Why must the muscles of the left ventricle be the strongest ones in the heart? a. The mitral (bicuspid) valve is larger than the aortic valve. b. The left ventricle receives blood under high pressure from the pulmonary system. c. The pressure in the aorta is higher than the pressures elsewhere in the circulatory system. d. Blood in the left ventricle is oxygenated, making it thicker and harder to move than deoxygenated blood.

ANS: D Some drugs for heart failure also slow the heart rate. If the heart rate is slow before taking the drug, the drug can slow the heart rate so much that the patient cannot adequately perfuse and oxygenate his or her vital organs. Usually, if the heart rate is less than 60 beats/min, the prescriber is notified. The next dose may be held until the pulse rate returns to normal.

You prepare to administer a drug for heart failure to a patient. Which assessment finding do you report to the prescriber before administering the drug? a. Systolic blood pressure increase from 128 to 136 b. Urine output of 2100 mL in 24 hours c. Weight gain of 1 lb in 3 days d. Heart rate of 54 beats/min