NU 323: Applied Drug Therapy Final

The use of adrenergic anorexiants such as phentermine are contraindicated in which of the following groups? Select one: a. Clients with cirrhosis b. Clients with cardiovascular disease c. Clients with hypothyroidism d. Clients with a BMI > 35

Adrenergic anorexiants (or appetitie suppressants) are CNS and cardiovascular stimulants and are contraindicated in cardiovascular disease, hyperthyroidism, glaucoma, and agitated states. The correct answer is: Clients with cardiovascular disease

A benzodiazepine-like hypnotic that is approved for long term treatment is ... Select one: a. Zolpidem (Ambien) b. Temazepam (Restoril) c. Gabapentin (Neurontin) d. Eszopiclone (Lunesta)

Correct Answer: D. Eszopiclone (Lunesta)

Which of the following symptoms can be relieved with the use of acetaminophen (Tylenol)? Please select all that apply. Select one or more: a. Fever b. Inflammation c. Mild to moderate pain d. Atherosclerosis e. Halitosis

Correct Answers: A. Fever Correct & C. Mild to moderate pain

A patient with thallassemia requires frequent blood transfusions resulting in chronic iron overload. Which of the following medications is an appropriate treatment for this patient? Select one: a. Calcium gluconate b. Deferoxamine (Desferal) c. Deferasirox (Exjade) d. Sodium polystyrene sulfonate (Kayexalate)

Deferasirox (Exjade) is an oral iron chelating agent that is used to treat chronic iron overload in patients who require frequent blood transfusions for severe chronicanemia. Calcium gluconate, deferoxamine (Desferal), and sodium polystyrene sulfonate (Kayexalate) are not used to treat chronic iron overload. The correct answer is: Deferasirox (Exjade)

The older adult patient diagnosed with Parkinson's disease (PD) has been prescribed carbidopa/levodopa (Sinemet). Which data indicates the medication is effective? Select one: a. The patient has cogwheel motion when swinging the arms. b. The patient does not display emotions when discussing the illness. c. The patient is able to walk upright without stumbling. d. The patient eats 30%-40% of meals within 1 hour.

One of the symptoms of PD is a forward shuffling gait, so being able to walk upright without stumbling would indicate that the medication is effective. The correct answer is: The patient is able to walk upright without stumbling.

A patient is prescribed an antitussive agent with codeine. Which of the following statements by the patient indicates that your teaching has been effective? Select one: a. "I will take this medication whenever I am coughing." b. "This medication causes drowsiness and I will not drive" c. "This medication will make me anxious and nervous" d. "I will call my physician if I develop diarrhea when I take it."

The correct answer is: "This medication causes drowsiness and I will not drive"

Which of the following drugs may be combined with local anesthetics such as lidocaine to prolong the anesthetic effect? Select one: a. Epinephrine b. Dilaudid c. Succinylcholine d. Acetaminophen

The correct answer is: Epinephrine

Which of the following is an example of an adverse effect of a drug? Select one: a. Lowered white blood cell count after drug therapy for cancer b. Lowered blood pressure after drug therapy for hypertension c. Increased urinary output after drug therapy for edema d. Increased cardiac output after drug therapy for chronic heart failure

The correct answer is: Lowered white blood cell count after drug therapy for cancer

Which of these is a reason why older adults are more likely to experience adverse drug reactions and interactions compared with younger adults? Select one: a. More predictable pharmacokinetics and pharmacodynamics b. Physiologic changes in body composition c. Use of fewer chronic medications d. Presence of fewer chronic disease states

The correct answer is: Physiologic changes in body composition

A patient claims to get better effects with a tablet of Brand X of a drug than with a tablet of Brand Y of the same drug. Both brands contain the same amount of the active ingredient. What does the nurse know to be most likely? Select one: a. Advertising by pharmaceutical companies can enhance patient expectations of one brand over another, leading to a placebo effect b. Because the drug preparations are chemically equivalent, the effects of the two brands must be identical c. Tablets can differ in composition and can have differing rates of disintegration and dissolution, which can alter the drug's effects in the body d. The bioavailability of a drug is determined by the amount of the drug in each dose

The correct answer is: Tablets can differ in composition and can have differing rates of disintegration and dissolution, which can alter the drug's effects in the body

A nurse working in a cancer center is preparing to administer medication to a 5-year-old child. The nurse will calculate the drug dosage by using which of the following? Select one: a. body surface area b. weight c. age in months d. age in years

The correct answer is: body surface area

Which of the following describes the mechanism of action of gabapentin (Neurontin)? Select one: a. Gabapentin inhibits calcium influx in T-type calcium channels b. Gabapentin promotes the release of gamma-aminobutyric acid (GABA) c. Gabapentin binds to sodium channels while they are in an inactive state d. Gabapentin binds to sodium channels in the peripheral nervous system

a. Gabapentin inhibits calcium influx in T-type calcium channels

A priority nursing assessment for a patient who is to receive an alpha- or beta-adrenergic antagonist would be to... Select one: a. assess heart rate b. check blood glucose level c. measure urine output d. monitor respiratory rate

a. assess heart rate

What role does Namenda play in pharmacotherapy for Alzheimer's dementia. Select one: a. Decreases the availability of glutamate b. Increases the availability of glutatmate c. Increases the availability of acetylcholine d. Decreases the availability of acetylcholine

b. Increases the availability of glutatmate

A patient receives a prescription for phenylephrine (Adipex). When providing education about this drug, which of the following statements indicates the nurses understanding about the action of this drug? Select one: a. It inhibits the reuptake of serotonin and norepinephrine b. It decreases the patient's ability to swallow c. It prevents the absorption of fat in fatty foods d. It neutralizes carbohydrates for less absorption

Adipex inhibits the reuptake of serotonin and norepinephrine in the brain, thereby increasing the amounts of these neurotransmitters. Adipex does not affect the swallowing reflex. Adipex does not prevent the absorption of fat in fatty foods. Adipex does not neutralize carbohydrates for less absorption. The correct answer is: It inhibits the reuptake of serotonin and norepinephrine

Which of the following classes of drugs is used in the treatment of Parkinson's Disease. Select one or more: a. Anticholinergics b. Dopamine agonists c. Acetylcholinesterase enzyme inhibitors d. COMT inhibitors e. Centrally acting muscle relaxants

Anticholinergics, dopamine agonists, dopaminergics, and COMT inhibitors are use in treatment for Parkinson's disease. Acetylcholinesterase enzyme inhibitors increase the amount of acetylcholine and centrally acting muscle relaxants are used for the treatment of muscle spasms. The correct answers are: Anticholinergics, Dopamine agonists, COMT inhibitors

A nurse will be prepared to administer naloxone (Narcan) to a patient who has had an overdose of morphine with the understanding that repeated doses of Narcan may be necessary, because Narcan... Select one: a. has less strength in each dose than do individual doses of morphine b. has a shorter half-life than morphine c. combined with morphine, increases the physiologic action of the morphine d. causes the respiratory rate to decrease.

Correct Anser: B. Has a shorter half-life than morphine.

A patient has been prescribed methocarbamol (Robaxin), a centrally acting muscle relaxant, for fibromyalgia. The nurse has spent an hour educating the patient on the use of methocarbamol for muscle pain. Which of the following statements by the patient indicates that she has an understanding of at least one of the significant side effects of methocarbamol? Select one: a. "My urine could be discolored while I take this drug." b. "I should have lots of energy while taking this drug." c. "I will probably have diarrhea while taking this drug." d. "This drug will help my tension headaches."

Correct Answer: A. "My urine could be discolored while I take this drug."

An adolescent is brought to the emergency department by a parent who reports that the patient took a whole bottle of extended-release acetaminophen tablets somewhere between 8 and 10 hours ago. The nurse will anticipate administering which of the following? Select one: a. Acetylcysteine [Mucomyst] b. Activated charcoal c. Hemodialysis d. Respiratory support

Correct Answer: A. Acetylcysteine [Mucomyst] The nurse should anticipate giving acetylcysteine, because it is the specific antidote for acetaminophen overdose. It is 100% effective when given within 8 to 10 hours after ingestion and may still have some benefit after this interval. Activated charcoal is effective only if given before the medication is absorbed, so it must be given much sooner. Hemodialysis is not indicated. Respiratory support is used for ASA overdose.

A patient has recently been prescribed a drug that treats his hypertension by blocking the sympathetic receptors in his sympathetic nervous system. This action is characteristic of which of the following? Select one: a. An adrenergic antagonist b. An adrenergic agonist c. A cardiotonic d. A neurotransmitter

Correct Answer: A. An adrenergic antagonist

A patient is suffering from a migraine headache and sumatriptan (Imitrex) is prescribed. What is the pharmacodynamic action of sumatriptan? Select one: a. Binding to serotonin receptors to produce vasoconstriction b. Binding to phospholipids to diminish anxiety c. Interrupting the calcium intake in the neuron d. Reducing inflammation in the temporal arteries

Correct Answer: A. Binding to serotonin receptors to produce vasoconstriction

A patient has a history of tonic-clonic seizures that have been successfully treated with phenytoin (Dilantin) for several years. Which of the following explains how phenytoin achieves a therapeutic effect? Select one: a. Decreasing the influx of sodium into neurons b. Increasing the levels of available glutamate c. Simultaneously potentiating the effects of GABA and inhibiting reuptake d. By slowing the function of calcium channels within the neurological system

Correct Answer: A. Decreasing the influx of sodium into neurons.

A 12-year-old child who has been taking sertraline (Zoloft), an SSRI, for the past 2 weeks has returned to the clinic to be seen. It will be critical for the nurse to assess for which of the following? Select one: a. Onset of suicidal ideation b. Weight loss c. Feelings of grandiosity d. Decreased sleep

Correct Answer: A. Onset of suicidal ideation

A patient suffers from depression and experiences feelings of gloom and inability to perform normal activities of daily living. Neurotransmission of which of the following is likely to be decreased? Select one: a. Serotonin b. Acetylcholine c. Epinephrine d. Insulin

Correct Answer: A. Serotonin

The patient diagnosed with migraine headaches that occur every 2 to 3 days is placed on preventive therapy with the beta blocker propranolol (Inderal). Which data indicates the medication is effective? Select one: a. The patient has had only one headache in the past week. b. The patient's apical pulse is 78 beats per minute. c. The patient has developed orthostatic hypotension. d. The patient supplemented Inderal with Imitrex 4 times

Correct Answer: A. The patient has had only one headache in the past week.

A 50-year-old woman has been prescribed sumatriptan for the treatment of migraines. What instructions should then the nurse provide to the patient about the safe and effective use of this drug? Select one: a. "Take a dose of sumatriptan each morning when you suspect there's a chance of having a migraine." b. "Take this drug as soon as you feel the first signs of a migraine." c. "Lie down when you feel a migraine coming on and take some sumatriptan around 30 minutes later." d. "Take a dose of sumatriptan after you feel that you're unable to endure the pain of your migraine."

Correct Answer: B. "Take this drug as soon as you feel signs of a migraine." Administer sumatriptan as soon as the headache begins. Sumatriptan is more efficacious when given before the headache escalates. However, it is not normally taken on a prophylactic basis.

A patient in status epilepticus has been brought to the emergency department by emergency medical services. The nurse in the emergency department should anticipate which of the following treatment measures? Select one: a. Administration of oral or sublingual phenytoin (Dilantin) b. Administration of intravenous lorazepam (Ativan) c. Administration of zonisamide (Zonegran) d. Administration of intravenous gabapentin (Neurontin)

Correct Answer: B. Administration of intravenous lorazepam (Ativan)

Which of the following drugs used to treat anxiety would be appropriate for a patient who is a school teacher and is concerned about feeling sedated at work? Select one: a. Alprazolam (Xanax) b. Buspirone (BuSpar) c. Diazepam (Valium) d. Lorazepam (Ativan)

Correct Answer: B. Buspirone (BuSpar)

A patient has been experiencing muscle spasms in his neck from a four-wheeler accident. He is receiving 10 mg of cyclobenzaprine (Flexeril) PO tid. The nurse's teaching plan should include which of the following instructions? Select one: a. Take the medication with a small amount of water b. Do not drive or operate heavy machinery for the first week c. Increase the dosage if necessary d. Stop the drug if dizziness occurs

Correct Answer: B. Do not drive or operate heavy machinery for the first week. Since common adverse effects of cyclobenzaprine are drowsiness and dizziness, the patient should wait until he is aware of how cyclobenzaprine affects him before driving or operating machinery. The nurse would not tell the patient to increase the dosage if needed nor to stop the drug if dizziness occurs. Dizziness is an expected adverse effect of the drug, and the drug would not be stopped. The patient should take the medication with a full glass of water to enhance absorption.

A client diagnosed with bi-polar disorder will begin a regimen of lithium. He is instructed to return regularly to have his electrolyte levels checked. The client asks the nurse to explain the rationale for this. She correctly identifies that... Select one: a. Hypomagnesemia can worsen symptoms of mania b. Hyponatremia can increase the risk of lithium toxicity c. Hypocalcemia results in poor absorption of lithium d. Hypokalemia increases the number of depressive episodes

Correct Answer: B. Hyponatremia can increase the risk of lithium toxicity.

An adrenergic agonist is ordered for a patient in shock. The nurse will note that this drug has had its primary intended effect if which assessment finding is observed? Select one: a. Volume restoration b. Increased blood pressure c. Stable urine output d. Reduced anxiety

Correct Answer: B. Increased blood pressure. For a patient in shock, a primary benefit of an adrenergic agonist drug is to increase blood pressure. A drug in this category should not be used in place of volume restoration, nor does it provide volume restoration (IV fluids do this). Adrenergic agonists may enhance urine output if cardiac output and perfusion to the kidneys increase, but this is a secondary benefit.

A nurse has just administered an IM injection of meperidine (Demerol), an opioid agonist, to a patient. Which of the following is a priority nursing action for the nurse? Select one: a. Close the draperies b. Make sure the side rails are up c. Check the temperature of the room d. Make sure the patient is positioned comfortably

Correct Answer: B. Make sure the side rails are up.

By allowing stimulation or inhibition or the Mu, Kappa, and Delta opioid receptors, the goal of mixed opioid agents is to... Select one: a. Prevent addiction for clients with chronic pain b. Provide adequate pain relief while reducing adverse effects c. Equal the potency of IV morphine with an oral formulation d. Enhance the effectiveness of Narcan in the event of overdose

Correct Answer: B. Provide adequate pain relief while reducing adverse effects.

A nurse is caring for a patient who is in severe pain and is to receive an opioid analgesic. Which of the following would be the nurse's priority assessments before the therapy begins? Select one: a. Respiratory rate, seizure activity, and electrolytes b. Respiratory rate, evaluate for orientation, and adventitious sounds c. Liver function studies, pain intensity, and blood glucose level d. Respiratory rate, orthostatic hypotension, and blood glucose

Correct Answer: B. Respiratory rate, evaluate for orientation, and adventitious sounds. Before the opioid analgesic is started, the nurse must assess the patient's respiratory rate, evaluate for orieintation, and adventitious sounds. Seizure activity, electrolytes, liver function, blood glucose level, and mental status may need to be assessed during opioid analgesic therapy related to adverse effects, but they would not be the priority assessments.

A patient who is experiencing withdrawal from heavy alcohol use has developed psychosis and will be treated with haloperidol. Which of the following assessment findings should prompt the care team to assess the patient for neuroleptic malignant syndrome? Select one: a. The patient demonstrates a significant increase in agitation after being given haloperidol. b. The patient develops muscle rigidity and a sudden, high fever. c. The patient complains of intense thirst and produces copious amounts of urine. d. The patient develops yellowed sclerae and intense pruritis (itchiness).

Correct Answer: B. The patient develops muscle rigidity and sudden, high fever. Neuroleptic malignant syndrome is characterized by fever, sweating, tachycardia, muscle rigidity, tremor, incontinence, stupor, leukocytosis, elevated creatinine phosphokinase levels, and renal failure. Agitation, pruritis, thirst, and increased urine output are not indicative of neuroleptic malignant syndrome.

A female client has been prescribed zolpidem (Ambien) mg at HS, PRN, for short-term relief of insomnia. The client calls the clinic with complaints that the medication is ineffective. Which of the following questions is most appropriate? Select one: a. Are you allergic to sunflowers? b. What does your typical evening meal consist of? c. Are you taking it with plenty of water? d. Have you tried drinking a glass of wine at the same time?

Correct Answer: B. What does your typical evening meal consist of?

An 80-year-old man has been prescribed oxycodone for severe, noncancer, chronic pain. He tells the nurse that he has difficulty swallowing and asks if he can crush the tablet before swallowing. The nurse will advise the patient that Select one: a. the tablet would have no effect if crushed and ingested. b. there is risk of an extremely high dose available all at once if the tablet is crushed. c. crushing the tablet increases the drug's efficacy. d. crushing the tablet is a safe option.

Correct Answer: B. there is risk of an extremely high dose available all at once if the tablet is crushed. The nurse should caution the patient against crushing the tablet before ingesting it. Crushing allows an extremely high dose of the drug to be available all at once, instead of being released slowly over time. Severe adverse effects are possible when it is used in this manner. The other options are false statements.

Mr. Lacuna is an 83-year-old resident of a long-term facility who has a diagnosis of moderate Alzheimer Disease. Mr. Lacuna's physician recently prescribed oral rivastigmine, but he was unable to tolerate the drug due to its gastrointestinal effects. As a result, he has been ordered the transdermal patch form of the medication. When administering this form of rivastigmine, the nurse should do which of the following? Select one: a. Teach Mr. Lacuna about the importance of rotating sites when he applies the patch. b. Teach Mr. Lacuna/s family to apply a second patch if they notice an acute exacerbation of his confusion. c. Apply the patch to Mr. Lacuna's back to reduce the chance that he will remove it. d. Apply the patch to a mucous membrane to facilitate complete absorption.

Correct Answer: C. Apply the patch to Mr. Lacuna's back to reduce the chance that he will remove it.

A client with hypertension is prescribed propanolol, a non-selective beta adrenergic blocker. The nurse correctly identifies that this drug will act by blocking which of the following? Select one: a. Alpha 2 and beta 2 receptors b. Alpha 1 and alpha 2 receptors c. Beta 1 and beta 2 receptors d. Alpha 1 and beta 1 receptors

Correct Answer: C. Beta 1 and beta 2 receptors

A trauma patient has been receiving frequent doses of morphine in the 6 days since his accident. This pattern of analgesic administration should prompt the nurse to carefully monitor the patient's... Select one: a. urine specific gravity b. skin integrity c. bowel patterns d. core body temperature

Correct Answer: C. Bowel Patterns

An anticholinergic drug is given to a 73-year-old man to treat his Parkinson disease. The man also has benign prostatic hyperplasia (BPH). Which of the following is the most important instruction the nurse can give to the patient with regard to his medication and medical diagnosis? Select one: a. Avoid a warm environment b. Avoid driving his car while taking the drug c. Call his doctor if he cannot urinate d. Take the drug with food to avoid gastrointestinal (GI) upset

Correct Answer: C. Call his doctor if he cannot urinate.

A patient is diagnosed with salicylate overdose. Which of the following medications will be administered for the treatment of this condition? Select one: a. Intravenous meperidine (Demerol) b. Intravenous furosemide (Lasix) c. Intravenous sodium bicarbonate d. Acetylcysteine via nebulizer

Correct Answer: C. Intravenous sodium bicarbonate

An 80-year-old patient has been taking lorazepam since his wife died a year ago. He has been staying with his son, but will now move to an assisted living facility. Before admission to the assisted living facility, the patient's physician has determined that the drug is no longer needed. The nurse at the facility will plan to Select one: a. stop the drug immediately. b. suggest that another anti-anxiety drug be prescribed to stop the craving for a benzodiazepine. c. withdraw the drug gradually over a 2 to 3 week period. d. observe for urticaria and rash.

Correct Answer: C. withdraw the drug gradually over a 2 to 3 week period. It is important for the nurse to understand that lorazepam should be gradually withdrawn, because the patient has been using the drug for a year. If stopped abruptly the patient could experience withdrawal symptoms. The craving for benzodiazepines will decrease over time without the use of another drug. Urticaria and rash are adverse effects of the drug, not withdrawal effects.

A nurse is aware that baclofen (Lioresal) is a centrally-acting spasmolytic that has been demonstrated to be safe and effective in the treatment of numerous disorders of muscle spasm and spasticity. The nurse should question the order if baclofen is prescribed for which of the following patients? Select one: a. A 22-year-old man whose muscle spasticity is attributable to a spinal cord injury that he suffered while snowboarding. b. A 49-year-old woman whose recent motor disturbances have culminated in a diagnosis of multiple sclerosis. c. A 14-year-old boy who has a diagnosis of cerebral palsy and who has experienced a recent increase in muscle spasticity. d. A 70-year-old man whose Parkinson disease has worsened in recent months, resulting in decreased mobility and self-care.

Correct Answer: D. A 70-year-old man whose Parkinson disease has worsened in recent months, resulting in decreased mobility and self-care. Baclofen is useful in the treatment of spasticity and myoclonus resulting from disorders such as MS, cerebral palsy, and traumatic injury to the spinal cord. However, it is not useful in treating spasms that follow a CVA or stroke, or those that occur in Parkinson disease or Huntington chorea.

Which of the following patients is at greatest risk for respiratory depression while receiving opioids for analgesia? Select one: a. An elderly chronic pain client with a hip fracture b. A client with a heroin addiction and back pain c. A young female client with advanced multiple myeloma d. A child with an arm fracture and cystic fibrosis

Correct Answer: D. A child with an arm fracture and cystic fibrosis.

Most antipsychotics promote a therapeutic effect through the blockade of which of the following neurotransmitters? Select one: a. Glutamate b. Norepinephrine c. MAO-B d. Dopamine

Correct Answer: D. Dopamine

A homeless man who is well known to care providers at the local hospital has been admitted to the emergency department after having a seizure outside a mall. The man is known to be a heavy alcohol user and is malnourished with a very low body mass index. How are this patient's characteristics likely to influence possible treatment with phenytoin? Select one: a. The patient will require oral phenytoin rather than intravenous administration. b. Phenytoin is contraindicated within 48 hours of alcohol use due to the possibility of paradoxical effects. c. The patient's heavy alcohol use will compete with phenytoin for binding sites and he will require a higher-than-normal dose. d. The patient's protein deficit will likely increase the levels of the free drug in his blood.

Correct Answer: D. The patient's protein deficit will likely increase the levels of the free drug in his blood.

Which of the following patients should be advised by the nurse to avoid over-the-counter cold and allergy preparations that contain phenylephrine? Select one: a. A 47-year-old female with hypertension b. A 52-year-old male with adult-onset diabetes c. A 17-year-old female with symptoms of an upper respiratory infection d. A 62-year-old male with gout

Correct Answer: a. A 47-year-old female with hypertension

Acetylsalicylic acid (aspirin) is administered to a patient for fever and headache. Which of the following statements demonstrates that the nurse has an understanding of the pharmacodynamic action of acetylsalicylic acid? Select one: a. "Acetylsalicylic acid works by inhibiting the release of norepinephrine to increase blood pressure" b. "Acetylsalicylic acid provides selective action by inhibiting prostaglandin synthesis in the CNS" c. "Acetylsalicylic acid works by suppressing the function of the hypothalamus to decrease inflammation" d. "Acetylsalicylic acid works by inhibiting prostaglandin synthesis in the central and peripheral nervous system".

Correct Answer: d. "Acetylsalicylic acid works by inhibiting prostaglandin synthesis in the central and peripheral nervous system".

A patient who takes aspirin for rheumatoid arthritis is admitted to the hospital complaining of headache and ringing in the ears. The plasma salicylate level is 300 mcg/mL, and the urine pH is 6.0. What will the nurse do? Select one: a. Increase the aspirin dose to treat the patient's headache. b. Notify the provider of possible renal toxicity. c. Prepare to provide respiratory support, because the patient shows signs of overdose. d. Withhold the aspirin until the patient's symptoms have subsided.

Correct Answer: d. Withhold the aspirin until the patient's symptoms have subsided. This patient shows signs of salicylism, which occurs when ASA levels climb just slightly above the therapeutic level. Salicylism is characterized by tinnitus, sweating, headache, and dizziness. Tinnitus is an indication that the maximum acceptable dose has been achieved. Toxicity occurs at a salicylate level of 400 mcg/mL or higher. ASA should be withheld until the symptoms subside and then should be resumed at a lower dose. Increasing the dose would only increase the risk of toxicity. Signs of renal impairment include oliguria and weight gain, which are not present in this patient. This patient has salicylism, not salicylate toxicity, so respiratory support measures are not indicated.

A client has been admitted to the medical-surgical unit for pain evaluation. The client has arthritis, and has been taking ibuprofen for many years to help alleviate the pain. Which of the following assessments should be performed on this client? Select one: a. BUN and serum creatinine for renal toxicity. b. An electrocardiogram for possible congestive heart failure. c. A CBC with differential to monitor for infection. d. Respiratory auscultation to rule out congestion.

Correct Answer:a. BUN and serum creatinine for renal toxicity. When used for a long duration, ibuprofen can cause renal insufficiency. Ensure that the client is well hydrated during therapy to help reduce this risk of toxicity. Ibuprofen and other NSAIDs should be used with caution in clients who have renal or hepatic dysfunction; the presence of these problems can alter the metabolism and excretion of these drugs.

Orlistat (Xenical, Alli) decrease the absorption of dietary fat from the intestine. Decreased fat absorption leads to decreased caloric intake resulting in weight loss. Which of the following is an additional response to the decrease in dietary fat absorption? Select one: a. Less need for vitamin supplementation b. Increased serum cholesterol levels c. Decreased serum cholesterol levels d. Anti-diarrheal effects

Decreased fat intake leads to decreased caloric intake resulting in weight loss and improved serum cholesterol levels. Orlistat causes poor absorption of fat soluble vitamins and a multivitamin is recommended. Fatty, loose stools and fecal incontinence are frequent side effects of orlistat especially in the first few weeks of therapy. The correct answer is: Decreased serum cholesterol levels

A patient has been newly diagnosed with multiple sclerosis (MS), and the nurse provides teaching about the medications for the disease. Which statement by the patient indicates a need for further teaching? Select one: a. "I may need to take additional drugs at times of acute relapse." b. "I will need to take medication indefinitely." c. "If medication is begun early, permanent remission can be achieved." d. "Some symptoms may need to be managed with symptom-specific drugs."

Drug therapy can reduce the frequency and severity of relapses, maintain quality of life, and prevent permanent damage to axons, but it does not produce permanent remission. Patients may need to take additional drugs during times of relapse and will need to take medications indefinitely. Some symptoms may be managed with symptom-specific drugs. The correct answer is: "If medication is begun early, permanent remission can be achieved."

The nurse demonstrates an understanding of the principles of total parenteral nutrition (TPN), with which of the following statements? Select one: a. TPN solutions are useful when a client eats moderately well, but needs an occasional supplement. b. TPN solutions that are greater than 10% dextrose (hypertonic) must be infused through a central line c. TPN is indicated for short-term use only (3-5 days) d. TPN solution contains enough electrolytes and carbohydrates to fulfill minimal metabolic needs only.

Hypertonic solutions (greater than 10% dextrose must be given via a central line so they can be diluted rapidly. TPN solutions are nutritionally adequate providing the patient with all nutrients required for normal body functioning, including tissue repair. The correct answer is: TPN solutions that are greater than 10% dextrose (hypertonic) must be infused through a central line

A nurse has been invited to speak to a support group for persons with movement disorders and their families. Which of the following statements by the nurse addresses the chronic nature of these diseases and the relevant drug therapies? Select one: a. "Drug therapy can consist of one or more drugs to eliminate the symptoms of these diseases." b. "Drugs do not cure these disorders; they instead enhance quality of life." c. "Persons of all cultures are treated similarly and respond in similar ways to treatment." d. "Drugs used to treat these disorders always pose a risk of severe liver and kidney dysfunction."

It is most important that patients and their families know that movement disorders are chronic, that there is no cure, and that drug therapy only serves to help decrease the severity of the symptoms. Symptoms are not normally eliminated completely. Culture must be considered because of catecholamine-O-methyltransferase (COMT), which affects the absorption of levodopa in the body. Some of the drugs used to treat movement disorders can pose a risk of causing renal or hepatic dysfunction, but not all. The correct answer is: "Drugs do not cure these disorders; they instead enhance quality of life."

A patient administers interferon beta-1a SQ [Rebif] 22 mcg/0.5 mL three times each week. The patient calls the nurse to report unrelieved itching and erythema at the injection site, despite the use of topical hydrocortisone for several weeks. What will the nurse tell this patient to do? Select one: a. Apply ice to the injection site before and after the injection. b. Ask the provider to reduce the dose of interferon beta to 8.8 mcg/0.2 mL. c. Discuss using a prescription-strength hydrocortisone product with the provider. d. Take oral diphenhydramine [Benadryl]

Oral diphenhydramine can help reduce itching and erythema. Ice is used to control pain and should be used before the injection; warm, moist compresses are used after the injection. Reducing the dose of interferon will not reduce the local reaction. Continuous use of topical steroids is not recommended because of the risk of skin damage. The correct answer is: Take oral diphenhydramine [Benadryl].

A nurse is teaching a group of patients about weight management options. Which statement by the patient indicates a need for further teaching? Select one: a. "Although some drugs often show benefits, these benefits do not outweigh the risks." b. " Antiobesity drugs should be used only as adjuncts to a comprehensive weight loss program of diet and exercise." c. "Most patients regain lost weight when antiobesity drugs are discontinued." d. "The side effects of most of these drugs are too uncomfortable to maintain compliance." IncorrectSeveral new drugs have shown promise in promoting weight loss, but they are not on the market because the benefits are not significant enough to offset possible risks. A few of these drugs have a high abuse potential, but most have a low abuse potential. Side effects of these drugs that affect comfort have been minor for the most part.

The correct answer is: "Although some drugs often show benefits, these benefits do not outweigh the risks."

A nurse is giving aspirin to a patient during acute management of STEMI. The patient asks why a chewable tablet is given. Which response by the nurse is correct? Select one: a. "Aspirin is absorbed more quickly when it is chewed." b. "Chewing aspirin prevents it from being metabolized by the liver." c. "Chewing aspirin prevents stomach irritation." d. "More of the drug is absorbed when aspirin is chewed."

The correct answer is: "Aspirin is absorbed more quickly when it is chewed."

A nurse is discussing how beta blockers work to decrease blood pressure with a nursing student. Which statement by the student indicates a need for further teaching? Select one: a. "Beta blockers block the actions of angiotensin II." b. "Beta blockers decrease heart rate and contractility." c. "Beta blockers decrease peripheral vascular resistance." d. "Beta blockers decrease the release of renin."

The correct answer is: "Beta blockers block the actions of angiotensin II."

A patient with variant angina wants to know why a beta blocker cannot be used to treat the angina. Which response by the nurse is correct? Select one: a. "A beta1-selective beta blocker could be used for variant angina." b. "Beta blockers do not help relax coronary artery spasm." c. "Beta blockers do not help to improve the cardiac oxygen supply." d. "Beta blockers promote constriction of arterial smooth muscle."

The correct answer is: "Beta blockers do not help relax coronary artery spasm."

A nurse is caring for a patient who has just been diagnosed with Parkinson disease. The patient does not understand how the medication ordered, carbidopa-levodopa, is going to help her condition. Which of the following is the correct response by the nurse? Select one: a. "Carbidopa-levodopa will delay the loss of muscle strength and limb function for several months." b. "This drug will change the immune processes in your body to help decrease the tissue damage." c. "Carbidopa-levodopa increases the activity of dopamine in your body, which will decrease your symptoms." d. "Your drug therapy will reduce excessive reflex activity causing your muscle spasms and will allow for muscle relaxation."

The correct answer is: "Carbidopa-levodopa increases the activity of dopamine in your body, which will decrease your symptoms." The pathophysiology of Parkinson disease is the lack of dopamine and the excess of acetylcholine, which cause the symptoms of muscle rigidity, tremors at rest, akinesia or bradykinesia, and postural instability. Carbidopa-levodopa (Sinemet) increases the activity of dopamine and decreases the excessive amount of acetylcholine, which causes improved nerve impulse control and decreases the symptoms exhibited. Drug therapy that slows down the disease's progression by delaying the loss of muscle strength and limb function for several months is characteristic of the drug riluzole (Rilutek). This drug is given to patients with amyotrophic lateral sclerosis. Inflammation and scarring of the myelin in the brain and spinal cord are characteristics of multiple sclerosis (MS). Glatiramer (Copaxone) is given to change the immune processes in the body to help decrease the tissue damage. Baclofen (Lioresal) is a drug given to patients with Moersch-Woltmann syndrome, which is characterized by muscular rigidity accompanied by paroxysmal painful spasms. This drug reduces the excessive reflex activity and will allow for muscle relaxation.

A nurse teaches a nursing student about the differences between desmopressin (DDAVP) and vasopressin [Pitressin]. Which statement by the student indicates a need for further teaching? Select one: a. "Desmopressin has a shorter duration of action than vasopressin." b. "Desmopressin is easier to administer than vasopressin." IncorrectDesmopressin has a long duration of action, which is the reason it is preferred for the treatment of diabetes insipidus. It can be administered intranasally, so it is easier to administer than vasopressin. Vasopressin has hemodynamic effects that can be beneficial during cardiac resuscitation but that also can cause serious adverse cardiovascular effects. c. "Vasopressin can be used in cardiac resuscitation." d. "Vasopressin can cause serious adverse cardiovascular effects."

The correct answer is: "Desmopressin has a shorter duration of action than vasopressin."

A nursing student asks a nurse why patients with chronic renal failure (CRF) have low erythrocyte counts. Which response by the nurse is correct? Select one: a. "Damage to the renal tubules increases serum blood loss." b. "Dialysis accelerates the breakdown of red blood cells." c. "Erythropoietin is no longer produced by cells in the kidneys." d. "Patients with CRF are deficient in iron, folic acid, and vitamin B12."

The correct answer is: "Erythropoietin is no longer produced by cells in the kidneys."

A nurse explains to a nursing student why opioid antidiarrheal medications are classified as drugs with little or no abuse potential. Which statement by the student indicates a need for further teaching? Select one: a. "Formulations for the treatment of diarrhea have very short half-lives." CorrectThe half-life of the opioid antidiarrheal drugs is the same as that of the opioid analgesics. The formulations of opioid antidiarrheal medications that are classified with low abuse potential are often combined with atropine, which has unpleasant side effects at higher doses. Some opioid antidiarrheal drugs are formulated so that they do not cross the blood-brain barrier. Others are not water soluble and therefore cannot be dissolved and injected. b. "Opioid antidiarrheal drugs contain other drugs with unpleasant side effects at higher doses." c. "Some opioid antidiarrheal drugs do not cross the blood-brain barrier." d. "Some opioid antidiarrheal medications are not water soluble and cannot be given parenterally."

The correct answer is: "Formulations for the treatment of diarrhea have very short half-lives."

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

The correct answer is: "I broke out in hives and got terribly itchy when I started a new prescription last year."

A patient who has type 2 diabetes will begin taking glipizide [Glucotrol]. Which statement by the patient is concerning to the nurse? Select one: a. "I will begin by taking this once daily with breakfast." b. "It is safe to drink grapefruit juice while taking this drug." c. "I may continue to have a glass of wine with dinner." d. "I will need to check my blood sugar once daily or more." IncorrectGlipizide is a sulfonylurea antidiabetic agent and can cause a disulfiram-like reaction when combined with alcohol. Patients should be taught to avoid alcohol while taking this medication. The initial dosing is once daily with breakfast. There is no drug interaction with grapefruit juice. Patients will need to monitor their blood glucose.

The correct answer is: "I may continue to have a glass of wine with dinner."

A patient with endometriosis is being treated with the gonadotropin-releasing hormone (GnRH) agonist leuprolide [Lupron Depot]. A nurse is teaching the patient about the drug. Which statement by the patient indicates understanding of the teaching? Select one: a. "I can continue to take the medication if I get pregnant." b. "I can expect the medication to cure my symptoms." c. "I may have menopausal-like symptoms when taking this medication." CorrectBecause the GnRH agonists deprive the ovary of the stimulation to produce estrogen, women may experience symptoms associated with menopause, including hot flashes, vaginal dryness, decreased libido, mood changes, and headache. GnRH agonists are teratogenic and should not be used during pregnancy. The medication does not produce a cure; symptoms return in up to 50% of women after discontinuation of the drug. GnRH agonists should be discontinued after 6 months of treatment because of the risk of osteoporosis. d. "I will need to take the medication for several years."

The correct answer is: "I may have menopausal-like symptoms when taking this medication."

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

The correct answer is: "I need to stop taking potassium supplements."

A nurse is providing education to a patient who is beginning therapy with AndroGel testosterone gel. What statement made by the patient demonstrates a need for further teaching? Select one: a. "I should not shower or swim for at least 5 to 6 hours after application." b. "I should avoid direct skin-to-skin contact with my spouse where the medication was applied." c. "I should have my blood drawn for laboratory tests in 14 days." d. "I should apply the medication to my genitals for best results." CorrectThe medication should be applied to the arms, shoulders, and abdomen, not to the genitalia; this statement indicates a need for further teaching. The patient should be instructed not to shower, bathe, or swim for 5 to 6 hours after applying the medication. The patient should be instructed to keep areas where the medication was applied covered to prevent direct skin-to-skin contact with others. The patient should be advised to return to the clinic within 2 weeks for blood tests.

The correct answer is: "I should apply the medication to my genitals for best results."

A nurse is teaching a patient who will begin taking methimazole [Tapazole] for Graves' disease about the medication. Which statement by the patient indicates understanding of the teaching? Select one: a. "Because of the risk for liver toxicity, I will need frequent liver function tests." IncorrectAgranulocytosis is rare but can occur with methimazole, so patients should report signs of infection, such as a sore throat or fever. Liver toxicity is not a side effect, so liver function tests are not indicated. Because agranulocytosis often develops rapidly, periodic blood counts do not guarantee early detection. Methimazole is contraindicated in the first trimester of pregnancy. b. "I should report a sore throat or fever to my provider if either occurs." c. "I will need a complete blood count every few months." d. "It is safe to get pregnant while taking this medication."

The correct answer is: "I should report a sore throat or fever to my provider if either occurs."

A nurse provides teaching to a patient who has had a hysterectomy and is about to begin hormone therapy to manage menopausal symptoms. Which statement by the patient indicates understanding of the teaching? Select one: a. "Because I am not at risk for uterine cancer, I can take hormones indefinitely." b. "I can take estrogen to reduce my risk of cardiovascular disease." c. "I should take the lowest effective dose for the shortest time needed." CorrectFor patients who have undergone hysterectomy, progestin is unnecessary; estrogen-only preparations still carry increased risk of breast cancer and should be taken in the lowest effective dose for the shortest time possible. Even though uterine cancer is no longer a possibility, breast cancer is still a risk. Studies have shown no protection against coronary heart disease but increased risk of stroke and breast cancer with estrogens. d. "I will need a progestin/estrogen combination since I have had a hysterectomy."

The correct answer is: "I should take the lowest effective dose for the shortest time needed."

A nurse is caring for a patient who will begin taking hydralazine to treat hypertension. Which statement by the patient indicates understanding of the nurse's teaching about this drug? Select one: a. "I will need to ask for assistance when getting up out of a chair." b. "I will also take a beta blocker medication with this drug to prevent rapid heart rate." c. "I may develop joint pain, but this side effect will decrease over time." d. "This drug may cause excessive hair growth on my face, arms, and back."

The correct answer is: "I will also take a beta blocker medication with this drug to prevent rapid heart rate."

A patient who has experienced preterm births with her previous two pregnancies will begin receiving hydroxyprogesterone caproate [Makena] to prevent preterm delivery with her current pregnancy. Which statement by the patient indicates a need for further teaching about this drug? Select one: a. "I should report any calf pain immediately." IncorrectHydroxyprogesterone caproate is given IM and must be given by a healthcare provider and not by the patient. Although serious side effects are rare, thrombosis and thromboembolism may occur, so the patient should report signs of thrombosis immediately. Fluid retention and glucose intolerance may occur. The medication is given weekly from 16 to 21 weeks' gestation up to 37 weeks or delivery of the baby. b. "I will eventually learn to administer the injections of this drug myself." c. "This drug may cause fluid retention and glucose intolerance." d. "This medication must be given once a week until 37 weeks' gestation."

The correct answer is: "I will eventually learn to administer the injections of this drug myself."

A nurse is providing teaching for a nondiabetic adult who develops growth hormone deficiency and who will begin treatment with somatropin [Humatrope]. Which statement by the patient indicates understanding of the teaching? Select one: a. "Intramuscular dosing is more effective than subcutaneous dosing." b. "I will have increased muscle mass and strength as well as increased height." c. "I will need to monitor my blood pressure frequently while taking this drug." d. "I will need to take insulin while using this, because it causes hyperglycemia." IncorrectGrowth hormone in adults causes an increase in systolic blood pressure, so patients should be taught to monitor blood pressure while taking the drug. Subcutaneous dosing is as effective as IM dosing and is preferred, because it is less painful. Although muscle mass will increase, strength and height will not. Growth hormone is diabetogenic but causes significant problems in patients with preexisting diabetes.

The correct answer is: "I will need to monitor my blood pressure frequently while taking this drug."

A nurse is providing teaching for a patient with stable angina who will begin taking nitroglycerin. Which statement by the patient indicates understanding of the teaching? Select one: a. "I should not participate in aerobic exercise while taking this drug." b. "I should take aspirin daily to reduce my need for nitroglycerin." c. "If I take nitroglycerin before exertion, I can reduce the chance of an anginal attack." d. "I take nitroglycerin to increase the amount of oxygen to my heart."

The correct answer is: "If I take nitroglycerin before exertion, I can reduce the chance of an anginal attack."

A nurse is teaching a patient about the use of sildenafil [Viagra] for erectile dysfunction. Which statement by the patient indicates understanding of the teaching? Select one: a. "If my erection lasts longer than 4 hours, I should contact my provider." CorrectPriapism can occur and can cause tissue damage to the penis, so an erection lasting longer than 4 hours should be reported. Patients who use nitroglycerin should not use sildenafil within 24 hours of taking this drug. Patients should be advised to take sildenafil 30 minutes to 4 hours before anticipated sexual activity. Sildenafil does not cause an erection without sexual stimuli. b. "I should not use nitroglycerin within 12 hours of using sildenafil." c. "I should take this drug about 15 minutes before sexual activity." d. "This drug may cause me to have an erection when I don't want one."

The correct answer is: "If my erection lasts longer than 4 hours, I should contact my provider."

Parents ask the nurse why an over-the-counter cough suppressant with sedative side effects is not recommended for infants. Which response by the nurse is correct? Select one: a. "Babies have a more rapid gastric emptying time and don't absorb drugs well." b. "Cough medicine tastes bad, and infants usually won't take it." c. "Infants are more susceptible to central nervous system effects than are adults." d. "Infants metabolize drugs too rapidly, so drugs aren't as effective."

The correct answer is: "Infants are more susceptible to central nervous system effects than are adults."

A nurse is discussing the concept of efficacy with a patient who recently began a drug that his physician had suggested. Which of the following is the appropriate response by the nurse? Select one: a. "It refers to the amount of the drug that must be given to produce a particular response" b. "It refers to how well a drug produces its desired effect" c. "It refers to a drug's strength of attraction for a receptor site" d. "It refers to a drug's ability to stimulate its receptor"

The correct answer is: "It refers to how well a drug produces its desired effect"

A healthy male patient who does not have erectile dysfunction asks about medications to improve sexual stamina. What will the nurse tell this patient? Select one: a. "Medications for ED can improve the duration of erection in healthy men." IncorrectMedications for ED will have little or no effect on erection quality or duration in otherwise healthy men who do not have ED. These medications will not cause priapism in otherwise healthy men. b. "Medications for ED can improve the quality of erection in healthy men." c. "Medications for ED have no effect on erections in healthy men." d. "Medications for ED will cause priapism in healthy men."

The correct answer is: "Medications for ED have no effect on erections in healthy men."

A nurse is providing teaching to a nursing student about to care for a woman with irritable bowel syndrome with diarrhea (IBS-D) who is receiving alosetron [Lotronex]. Which statement by the student indicates a need for further teaching? Select one: a. "I should evaluate the patient's abdomen for distension and bowel sounds." b. "Patients with diverticulitis and IBS-C may take this drug." CorrectAlosetron is approved for use in women only with diarrhea-predominant IBS; it is contraindicated in patients with diverticulitis. Constipation can be a severe adverse effect, so patients should be assessed for signs of constipation, such as abdominal distension and diminished bowel sounds. Alosetron can cause ischemic colitis. Alosetron is approved for use in women with IBS-D regardless of the severity of the disease. c. "This drug can cause ischemic colitis in some patients." d. "This drug is given only to women with severe IBS-D."

The correct answer is: "Patients with diverticulitis and IBS-C may take this drug."

A nurse is working with a group of patients. One patient states, "My goal is to reduce my weight from 280 pounds to 230 pounds in 6 months." What response by the nurse would be most appropriate for this patient? Select one: a. "Most weight loss occurs in the first 6 months, so you should try to reduce your weight to 200 pounds." b. "Safe and maintainable weight loss should be about 10% of body weight in 6 months." CorrectSafe weight loss should be about 10% of body weight in 6 months (ie, 28 pounds for this patient). A loss of 50 pounds in 6 months is unsafe for this patient. Advising the patient to aim for a weight loss of 80 pounds in the first 6 months is less realistic than a reduction of 50 pounds and may harm the patient. Weight loss of more than 20 pounds in 6 months is not dangerous, because it falls within the guideline of 10% of body fat (ie, 28 pounds for this patient). c. "That is a realistic goal for your weight-reduction program." d. "Weight loss of more than 20 pounds in 6 months could be dangerous."

The correct answer is: "Safe and maintainable weight loss should be about 10% of body weight in 6 months."

A patient with polycystic ovary syndrome (PCOS) asks the nurse what she can do to improve her chances of getting pregnant. Which statement by the patient indicates a need for further teaching? Select one: a. "Clomiphene will help induce ovulation but will not treat the other symptoms of polycystic ovarian disease." IncorrectSpironolactone is antiandrogenic; it can reduce hirsutism and acne, but it also can harm the fetus and should not be used in patients trying to conceive. Clomiphene helps induce ovulation but does not treat symptoms of PCOS. Patients who lose weight might experience a reversal of symptoms without medications, although weight loss may be difficult to achieve. Metformin reduces serum insulin levels by increasing insulin sensitivity and indirectly lowers androgen levels. b. "If I lose weight, my infertility and irregular periods could resolve without medications." c. "Metformin improves insulin sensitivity and reduces male hormone levels." d. "Spironolactone, which reduces androgens and facial hair, is helpful if I'm trying to conceive."

The correct answer is: "Spironolactone, which reduces androgens and facial hair, is helpful if I'm trying to conceive."

A patient will begin taking atorvastatin [Lipitor] to treat elevated LDL levels. The patient asks the nurse what to do to minimize the risk of myositis associated with taking this drug. What will the nurse counsel this patient? Select one: a. "Consume an increased amount of citrus fruits while taking this drug." b. "Take vitamin D and coenzyme Q supplements." c. "Ask your provider about adding a fibrate medication to your regimen." d. "Have your creatine kinase levels checked every 4 weeks."

The correct answer is: "Take vitamin D and coenzyme Q supplements."

A nurse is teaching a patient who has chronic renal failure who will begin receiving epoetin alfa [Epogen] about this drug therapy. Which statement by the patient indicates understanding of the teaching? Select one: a. "If I have to start dialysis, I will have to stop taking this drug." b. "Taking this drug will not eliminate my need for blood transfusions." c. "Taking this medication will prevent the need for dialysis in the future." d. "When I take this, my serum ferritin levels will increase."

The correct answer is: "Taking this drug will not eliminate my need for blood transfusions."

A nurse is concerned about an 84-year-old patient who is taking several medications. She confers with her supervisor suggesting that the drug combination should never be used because of the potential for nephrotoxicity. Which response by the charge nurse indicates an understanding of core patient variables. Select one: a. "That combination always poses a threat to patients' renal function. Call the physician and suggest he change it" b. "That combination could pose a threat to this patient's renal function. Baseline data of renal status should be completed prior to administration" c. "That combination is the cheapest way to address the diagnosis; don't worry, in this age group adverse effects are expected" d. "That combination could pose a threat to her renal function, but as long as we keep pushing fluids she'll be fine"

The correct answer is: "That combination could pose a threat to this patient's renal function. Baseline data of renal status should be completed prior to administration"

A client receiving a chemotherapeutic drug for treatment of leukemia asks the nurse why she is receiving a drug that can cause cancer to treat her cancer. The nurse explains... Select one: a. "The carcinogenic effects often do not show up for a few decades, and we want to cure this leukemia now." b. "The incidence of carcinogenic effects is really quite small, and you shouldn't be concerned about it." c. "The risk for causing another cancer is there, but sometimes the benefit of the treatment outweighs the risks." d. "Since you are receiving such potent drugs, they have to warn of you of every possible side effect."

The correct answer is: "The risk for causing another cancer is there, but sometimes the benefit of the treatment outweighs the risks."

A patient with Crohn's disease will begin receiving an initial infusion of infliximab [Remicade]. The nurse explains how this drug works to treat this disease. Which statement by the patient indicates a need for further teaching? Select one: a. "I may have an increased risk of infections, such as tuberculosis, when taking infliximab." b. "I should report chills, fever, itching, and shortness of breath while receiving the infusion." c. "This drug sometimes provides a complete cure of inflammatory bowel disease." CorrectNone of the drugs used to treat obstructive bowel disease (OBD) are curative. Patients taking immunomodulators, such as infliximab, have an increased risk of infection, especially opportunistic infections such as TB. Infusion reactions may occur and include chills, fever, itching, and shortness of breath. The induction regimen is 5 mg/kg infused at 0, 2, and 6 weeks, followed by a maintenance regimen every 8 weeks. d. "I will take the second dose in 2 weeks, the third dose in 6 weeks, and then a dose every 8 weeks thereafter."

The correct answer is: "This drug sometimes provides a complete cure of inflammatory bowel disease."

A nurse is discussing the difference between stable and variant angina with a group of nursing students. Which statement by a student indicates the need for further teaching? Select one: a. "Beta blockers are effective in stable angina but not in variant angina." b. "In both types of angina, prophylactic treatment is possible." c. "Variant angina is primarily treated with vasodilators to increase oxygen supply." d. "Variant angina is the result of increased oxygen demand by the heart."

The correct answer is: "Variant angina is primarily treated with vasodilators to increase oxygen supply."

A patient with osteopenia asks a nurse about the benefits of hormone therapy in preventing osteoporosis. Which statement by the nurse is correct? Select one: a. "Estrogen can help reverse bone loss." b. "Hormone therapy increases bone resorption." c. "Hormone therapy does not decrease fracture risk." IncorrectBenefits of HT for patients with osteopenia are not permanent; bone loss resumes when HT is discontinued. HT does not reverse bone loss that has already occurred. HT reduces bone resorption. HT can decrease fracture risk by a small amount. d. "When hormone therapy is discontinued, bone mass is quickly lost."

The correct answer is: "When hormone therapy is discontinued, bone mass is quickly lost."

A patient with a history of elevated triglycerides and LDL cholesterol begins taking nicotinic acid [Niacin]. The patient reports uncomfortable flushing of the face, neck, and ears when taking the drug. What will the nurse advise the patient? Select one: a. "Ask your provider about taking an immediate-release form of the medication." b. "Ask your provider about assessing your serum uric acid levels which may be elevated." c. "You should stop taking the Niacin immediately since this is a serious adverse effect." d. "You should take 325 mg of aspirin a half hour before each dose of Niacin to prevent this effect."

The correct answer is: "You should take 325 mg of aspirin a half hour before each dose of Niacin to prevent this effect."

A nurse provides dietary counseling for a patient newly diagnosed with type 1 diabetes. Which instruction should be included? Select one: a. "You may eat any foods you want and cover the glucose increase with sliding scale, regular insulin." b. "Most of the calories you eat should be in the form of protein to promote fat breakdown and preserve muscle mass." c. "Your total caloric intake should not exceed 1800 calories in a 24-hour period." d. "You should use a carbohydrate counting approach to maintain glycemic control." CorrectPatients with diabetes should be given intensive insulin therapy education using either a carbohydrate counting or experience-based estimation approach in achieving glycemic control. A patient with diabetes cannot eat any foods desired and then cover the glucose increase with a sliding scale of regular insulin. Evidence suggests that there is not an ideal percentage of calories that should be ingested from carbohydrate, fat, or protein. Every patient with diabetes must be assessed individually to determine the number of total calories the person should have daily. The total caloric intake should be spread evenly throughout the day, with meals spaced 4 to 5 hours apart.

The correct answer is: "You should use a carbohydrate counting approach to maintain glycemic control."

In which of the following patients would a nurse expect alterations in drug metabolism? Select one: a. A 35 year-old woman with cervical cancer b. A 41 year-old man with kidney stones c. A 50 year-old man with cirrhosis of the liver d. A 62 year-old woman in acute renal failure

The correct answer is: A 50 year-old man with cirrhosis of the liver

A nurse is explaining to the parents of a 6-year-old child suffering from angina why nitroglycerin patches for chest pain would not be appropriate. Which of the following will the nurse include in an explanation? Select one: a. A child has an erratic blood flow from an immature peripheral circulation, which increases drug absorption, causing an increase in adverse effects b. A child's gastric pH is decreased causing less of the drug to be adsorbed from the subcutaneous skin, thereby producing more adverse effects c. A child has a greater body surface area creating greater permeability, resulting in an increase in absorption of topical agents, which may result in more adverse effects d. A child has a smaller body surface area, resulting in an increase in topical absorption, which can cause more adverse effects

The correct answer is: A child has a greater body surface area creating greater permeability, resulting in an increase in absorption of topical agents, which may result in more adverse effects

The nurse is caring for a patient receiving an aminoglycoside (antibiotic) that can be nephrotoxic. Which of the following will alert the nurse that the patient may be experiencing nephrotoxicity? Select one: a. Visual disturbances b. Yellowing of the skin c. A decrease in urine output d. Ringing noise in the ears

The correct answer is: A decrease in urine output

A client develops angioedema and difficulty swallowing after receiving an intravenous medication. The nurse recognizes this is characteristic of... Select one: a. A minor adverse effect b. A life-threatening adverse effect c. A reaction secondary to urticaria d. An unpredictable side effect

The correct answer is: A life-threatening adverse effect

A nurse is caring for a 59-year-old patient with Parkinson disease. Which of the following would indicate to the nurse that the patient is experiencing a serious adverse reaction related to the drug carbidopa-levodopa? Select one: a. Altered complete blood count b. Abnormal and involuntary movement c. Nausea and vomiting d. Orthostatic hypotension

The correct answer is: Abnormal and involuntary movement Abnormal and involuntary movements indicate serious adverse reaction to carbidopa-levodopa. & needs to be reported to physician immediately. Nausea and vomiting & orthostatic hypotension are adverse reactions, but not serious ones. An altered complete blood count is not associated with this drug but with another drug used to treat Parkinson disease, riluzole.

A nurse is caring for a patient who has had part of her small intestine removed due to cancer. She has also now developed hypertension and has been prescribed a new medication to decrease her blood pressure. While planning the patient's care, the nurse should consider a possible alteration in which of the following aspects of pharmacokinetics? Select one: a. Absorption b. Distribution c. Metabolism d. Elimination

The correct answer is: Absorption

The nurse understands that the four phases of pharmacokinetics that a drug goes through include: Select one: a. Active transport, ionization, diffusion, and excretion b. Diffusion, bioavailability, metabolism, and excretion c. Absorption, distribution, metabolism, and excretion d. Absorption, distribution, ionization, and metabolism

The correct answer is: Absorption, distribution, metabolism, and excretion

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

The correct answer is: Administer the drug as ordered, because this is a desired effect.

A hospitalized client has been started on an ACE inhibitor for high blood pressure. Upon assessment of vital signs, the client's BP is 89/58. The nurse correctly identifies this as which of the following? Select one: a. An allergic response to the drug. b. An idiosyncratic drug reaction. c. A therapeutic drug effect. d. An adverse drug effect.

The correct answer is: An adverse drug effect.

A patient arrives in the emergency department complaining of muscle weakness and drowsiness. The nurse notes a heart rate of 80 beats per minute, a respiratory rate of 18 breaths per minute, and a blood pressure of 90/50 mm Hg. The electrocardiogram reveals an abnormal rhythm. The nurse will question the patient about which over-the-counter medication? Select one: a. Antacids b. Aspirin c. Laxatives d. Potassium supplements

The correct answer is: Antacids

A 29-year-old pregnant patient is extremely upset about having to take medication for a pre-existing medical condition. She is consumed with fear that her baby will be born with a physical deformity or a congenital anomaly but knows that she has to take the medication. She talks constantly about this and is unable to sleep most nights. Which of the following is the most appropriate nursing diagnosis for this patient is? Select one: a. Injury, risk to the fetus r/t adverse effects of maternal drug therapy b. Injury, risk to the patient r/t failure to receive needed drug therapy c. Anxiety related to the perceived danger of drug therapy to fetus or infant d. Noncompliance with drug therapy

The correct answer is: Anxiety related to the perceived danger of drug therapy to fetus or infant

A 50-year-old patient with a body mass index (BMI) of 26 and a waist circumference (WC) of 37 who smokes asks a nurse about drugs for weight loss. She tells the nurse, "I keep trying to eat less, but it doesn't work." What will the nurse do? Select one: a. Ask her to begin keeping a log of her food intake and activities. CorrectDrug therapy can be used for people at increased health risk, such as this woman, but only as an adjunct to diet and exercise and only after a 6-month diet and exercise regimen has failed. The first step should be to ask the patient to keep a log of intake and activity so that she is aware of how many calories she consumes and how many she burns. Counseling her to quit smoking is appropriate in terms of overall health but does not address her current concern. Exercise without diet is not effective, although exercise is a useful adjunct to diet modification. The patient is not a candidate for drug therapy until she has tried a diet and exercise program for 6 months. b. Counsel her to quit smoking to reduce her health risk. c. Suggest she begin walking every day to increase the number of calories burned. d. Tell her she is a candidate for drug therapy and suggest she contact her provider.

The correct answer is: Ask her to begin keeping a log of her food intake and activities.

A nurse working at a clinic notices that a client is having problems reading his prescription bottles. Sometimes the client takes medications incorrectly because of the small print. What is a suggestion that the nurse can make to alleviate this problem? Select one: a. Stop taking the medications as they are more likely to cause problems than to help if not taken correctly b. Ask the pharmacist to provide labels with large print that explain how to take the medication c. Let the pharmacist get easy-open caps d. Put the medication in a zip-top bag with the instructions written in large print

The correct answer is: Ask the pharmacist to provide labels with large print that explain how to take the medication

A nurse is caring for a 68-year-old woman who has just returned to her room after a gastroscopy. Prior to beginning the procedure, lidocaine was given to numb her throat. Which of the following is the priority nursing intervention? Select one: a. Check blood pressure and heart rate every 30 minutes for the next 12 hours. b. Ask the patient if she needs to urinate. c. Assess swallowing ability prior to offering fluids d. Allow the patient to ambulate only with assistance.

The correct answer is: Assess swallowing ability prior to offering fluids

A patient who is in her first trimester of pregnancy asks the nurse to recommend nonpharmaceutical therapies for morning sickness. What will the nurse suggest? Select one: a. Avoiding fatty and spicy foods CorrectNausea and vomiting of pregnancy (NVP) can be treated with nondrug measures, including avoiding fatty and spicy foods. Consuming extra fluids does not help with nausea and vomiting (N/V) but may be needed to prevent dehydration. Patients should be advised to eat small portions of food throughout the day rather than three complete meals. "Morning sickness" may actually occur all day, so delaying intake is not recommended. b. Consuming extra clear fluids c. Eating three meals daily d. Taking foods later in the day

The correct answer is: Avoiding fatty and spicy foods

A patient with multiple sclerosis needs pharmacologic treatment for spasticity to begin strengthening exercises to improve walking ability. The nurse anticipates that which medication will be ordered for spasticity? Select one: a. Baclofen [Lioresal] b. Dantrolene [Dantrium] c. Diazepam [Valium] d. Metaxalone [Skelaxin]

The correct answer is: Baclofen [Lioresal] Baclofen is used to treat spasms associated with multiple sclerosis. It has no direct muscle relaxant effects, so it does not reduce muscle strength. Dantrolene works well to reduce spasms, but it also has significant effects on muscle strength. Diazepam is not the first-line drug of choice, but it could be used because it does not reduce muscle strength. Metaxalone is not indicated to treat spasms caused by multiple sclerosis.

A patient is experiencing an acute asthma attack. What is the first-line therapy for relief of an acute asthma attack? Select one: a. Leukotriene modifier b. Xanthine c. Beta2-adrenergic agonist d. Inhaled steroid

The correct answer is: Beta2-adrenergic agonist

Which of these is an age-related physiologic change that occurs in older adults? Select one: a. GI motility increases b. Brain mass increases c. The kidneys filter better and function more efficiently d. Blood flow to the liver decreases

The correct answer is: Blood flow to the liver decreases

A male patient reports decreased libido and the nurse notes galactorrhea during a physical assessment. The nurse will report these findings to the provider and will anticipate an order for which medication? Select one: a. Cabergoline CorrectThe patient is showing signs of prolactin hypersecretion. Cabergoline is a dopamine agonist and is used to inhibit prolactin release. Conivaptan is used to treat hypernatremia. Dopamine is not given. Prolactin would make the condition worse. b. Conivaptan c. Dopamine d. Prolactin

The correct answer is: Cabergoline

The nurse is teaching a class on how to prevent heart attacks to clients. It is a mixed-gender class. What important factor does the nurse need to include in the teaching plan related to gender? Select one: a. Certain medications such as aspirin are more effective in preventing heart attacks in men than in women b. All medications used to prevent heart attacks affect men and women the same c. Heart disease affects men and women equally d. The use of aspirin following a heart attack is to protect the stomach from stress ulcers.

The correct answer is: Certain medications such as aspirin are more effective in preventing heart attacks in men than in women

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

The correct answer is: Check the compatibility of the two drugs

A nurse receives an order to administer castor oil to a patient. Which action by the nurse is correct? Select one: a. Administer the medication at bedtime. b. Chill the medication and mix it with fruit juice. CorrectCastor oil has an unpleasant taste that can be improved by chilling it and mixing it with fruit juice. The medication acts quickly and should not be given at bedtime. It is only used when prompt evacuation of intestinal contents is needed, as for radiological procedures, so the patient will not be instructed in home use of the medication and should be taught that the effects will be immediate. c. Provide teaching about home use of this medication. d. Teach the patient that the effects will occur slowly.

The correct answer is: Chill the medication and mix it with fruit juice.

Which of the following activities would the nurse expect to complete during the evaluation phase of the nursing process in drug therapy? Select one: a. Compare the expected outcome with the actual patient outcome b. Reconsider core drug knowledge and core patient variables c. Ask questions to prepare an effective patient education program d. Establish a baseline for the patient's treatment and care

The correct answer is: Compare the expected outcome with the actual patient outcome

A nurse has just completed a medication history on a newly admitted patient. In order to complete medication reconciliation for this patient the nurse will do which of the following? Select one: a. Determine the best pharmacy for the patient to buy his medications b. Compare the medications ordered by the health care provider with the list of medications obtained from the patient and communicate discrepancies to the health care provider c. Provide instructions pertaining to each medication the patient is currently taking and then add the medications ordered during the hospitalization d. Explain to the patient the pharmacokinetics of each drug he will be taking in the hospital

The correct answer is: Compare the medications ordered by the health care provider with the list of medications obtained from the patient and communicate discrepancies to the health care provider

While performing an admission assessment on a patient, the nurse learns that the patient is taking furosemide [Lasix], digoxin, and spironolactone [Aldactone]. A diet history reveals the use of salt substitutes. The patient is confused and dyspneic and complains of hand and foot tingling. Which is an appropriate nursing action for this patient? Select one: a. Contact the provider to request orders for an electrocardiogram and serum electrolyte levels. b. Evaluate the patient's urine output and request an order for intravenous potassium. c. Hold the next dose of furosemide and request an order for intravenous magnesium sulfate. d. Request an order for intravenous insulin to help this patient regulate extracellular potassium.

The correct answer is: Contact the provider to request orders for an electrocardiogram and serum electrolyte levels.

An adolescent female patient with multiple sexual partners asks a nurse about birth control methods. The patient tells the nurse she tried oral contraceptives once but often forgot to take her pills. The nurse will recommend discussing which contraception with the provider? Select one: a. An intrauterine device with a spermicide b. DMPA (Depo-Provera) and condoms CorrectThis patient has demonstrated a previous history of nonadherence, so a long-acting contraceptive would be more effective for her. Because she has multiple sexual partners, she should use a condom for protection against STDs. An IUD is not indicated for her; patients with multiple sexual partners who use IUDs are at greater risk for STDs. Tubal ligation carries surgical risks and should not be used by young women, because it is irreversible. Progestin-only oral contraceptives must be taken every day. c. Tubal ligation and condoms d. Progestin-only oral contraceptives

The correct answer is: DMPA (Depo-Provera) and condoms

The nurse is caring for a patient who is taking a vasodilator that dilates capacitance vessels. The nurse will expect which effect in this patient? Select one: a. Decrease in cardiac work b. Increase in cardiac output c. Increase in tissue perfusion d. Increase in venous return

The correct answer is: Decrease in cardiac work

A nurse is caring for a patient who is receiving a drug that causes constriction of arterioles. The nurse expects to observe which effect from this drug? Select one: a. Decreased stroke volume b. Increased stroke volume c. Decreased myocardial contractility d. Increased myocardial contractility

The correct answer is: Decreased stroke volume

A nurse is teaching a group about the appropriate use of cough medications. Which preparation is appropriate for dry and harsh coughs? Select one: a. Guaifenesin (Mucinex) b. Guaifenesin (Robitussin GF) c. Acetylcysteine (Mucomyst) d. Dextromethorphan (Delsym)

The correct answer is: Dextromethorphan (Delsym)

A patient is hospitalized with head trauma after a motor vehicle accident. The nurse caring for the patient notes a marked increase in the output of pale, dilute urine. The nurse suspects which condition? Select one: a. Diabetes insipidus CorrectDeficiency of antidiuretic hormone (ADH) produces hypothalamic diabetes insipidus, in which large volumes of dilute urine are produced. Head trauma can cause the hypothalamus to stop producing ADH. Diabetes mellitus is an endocrine disorder of the pancreas that causes the production of large volumes of nondilute urine. SIADH is a condition in which too much ADH is produced, causing oliguria. Water intoxication occurs with SIADH. b. Diabetes mellitus c. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) d. Water intoxication

The correct answer is: Diabetes insipidus

Describe one area of assessment that is necessary to determine ethnic and cultural influences on pharmacotherapy

The correct answer is: Dietary habits

The nurse is caring for an older adult patient after a right hip open reduction internal fixation (ORIF). The patient is taking an opioid every 6 hours as needed for pain. The nurse discusses obtaining an order from the prescriber for which medication? Select one: a. Docusate sodium [Colace] CorrectOxycodone can be constipating. The patient needs something prophylactically, such as docusate sodium, that can be taken daily to prevent constipation. In addition, the patient's mobility is limited, which can further increase the risk of constipation. GoLYTELY is not indicated for constipation; it is used for cleansing the bowel before diagnostic procedures. Lactulose is not indicated; it typically is used for reducing ammonia levels in hepatic encephalopathy. Polyethylene glycol is indicated for occasional constipation; no information suggests that the patient is constipated. b. GoLYTELY c. Lactulose d. Polyethylene glycol [MiraLax]

The correct answer is: Docusate sodium [Colace]

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

The correct answer is: Elevated creatinine clearance

A surgical patient is receiving succinylcholine [Anectine] with an inhalation anesthetic. The patient is intubated, has an indwelling urinary catheter, and has ongoing monitoring of vital signs. Which symptom during the perioperative period is cause for concern? Select one: a. Elevated temperature b. Increased urine output c. Muscle paralysis d. No response to painful stimuli

The correct answer is: Elevated temperature

Ketamine (Ketalar) is contraindicated for adult patients with a history of psychiatric disorders because it may induce which of the following? Select one: a. Nausea and vomiting b. Anaphylaxis c. Emergence delirium d. Syncope

The correct answer is: Emergency delirium

A postoperative patient reports pain in the left lower extremity. The nurse notes swelling in the lower leg, which feels warm to the touch. The nurse will anticipate giving which medication? Select one: a. Aspirin b. Clopidogrel [Plavix] c. Enoxaparin [Lovenox] d. Warfarin [Coumadin]

The correct answer is: Enoxaparin [Lovenox]

A 65 year old client's laboratory work indicates hypoalbuminemia. Related to medication therapy, this may result in which of the following? Select one: a. Reduced therapeutic effect b. Decreased medication metabolism c. Prolonged half-life d. Excess free medication and possible toxicity

The correct answer is: Excess free medication and possible toxicity

A female patient who begins taking spironolactone [Aldactone] as an adjunct to furosemide [Lasix] complains that her voice is deepening. What will the nurse do? Select one: a. Contact the provider to obtain an order for a complete blood count (CBC) and liver function tests. b. Explain that this drug binds with receptors for steroid hormones, causing this effect. c. Report this side effect to the provider and request another medication for this patient. d. Teach the patient to report any associated cough, which may indicate a more severe side effect.

The correct answer is: Explain that this drug binds with receptors for steroid hormones, causing this effect.

A patient with epistaxis and a history of hemophilia A is admitted to the unit and is scheduled for replacement therapy. The nurse should prepare to administer which medication? Select one: a. Tranexamic acid [Cyklokapron] b. Aminocaproic acid [Amicar] c. Desmopressin [Stimate] d. Factor VIII

The correct answer is: Factor VIII

A nurse has been administering a drug to a patient intramuscularly (IM). The physician discontinued the IM dose and wrote an order for the drug to be given orally. The nurse notices that the oral dosage is considerably higher than the parenteral dose and understands that this due to which of the following? Select one: a. Passive diffusion b. Active transport c. Glomerular filtration d. First-pass effect

The correct answer is: First-pass effect

A nurse is reviewing a medication administration record before administering medications. Which order will the nurse implement? Select one: a. Furosemide [Lasix] 20 mg QD PO b. Furosemide [Lasix] 20 mg qd PO c. Furosemide [Lasix] 20 mg daily d. Furosemide [Lasix] 20 mg PO daily

The correct answer is: Furosemide [Lasix] 20 mg PO daily

The clinical nurse educator who oversees the emergency department in a children's hospital has launched an awareness program aimed at reducing drug errors. What measure addresses the most common cause of incorrect doses in the care of infants and children? Select one: a. Having nurses check their math calculations with a colleague before administering a drug b. Ensuring that a full assessment takes place no more than 30 minutes before giving a drug c. Recording drug administration in both the nurse's notes and the medication administration record (MAR) d. Avoiding intravenous administration of drugs whenever possible

The correct answer is: Having nurses check their math calculations with a colleague before administering a drug

Because of quickly changing glucose needs during delivery and the post-partum period, blood sugar levels are checked frequently. Which of the following types of insulin should be used during this period? Select one: a. Humulin NPH b. Humulin N c. Humulin L d. Humulin R

The correct answer is: Humulin R

A patient has three separate blood pressure (BP) readings of 120/100 mm Hg, 138/92 mm Hg, and 126/96 mm Hg. Which category describes this patient's BP? Select one: a. Hypertension b. Isolated systolic hypertension c. Normal d. Prehypertension

The correct answer is: Hypertension

The nurse is planning care for a patient with chronic lung disease. The patient is wheezing, with a HR of 130 and respiratory rate of 26 per minute; is using his accessory muscles of respiration; is coughing up yellow mucous; and has a pulse oximetry reading of 86%. The highest-priority nursing diagnosis is: Select one: a. Decreased Cardiac Output related to tachycardia and rapid breathing b. Potential for Nutritional Imbalance: less than required related to thick work of breathing c. Impaired Gas Exchange AEB low pulse oximeter reading d. Potential for Injury (respiratory arrest), secondary to severe respiratory impairment

The correct answer is: Impaired Gas Exchange AEB low pulse oximeter reading

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

The correct answer is: Improved exercise tolerance

A patient with COPD is experiencing difficulty with copious amounts of tenacious sputum. A mucolytic drug is prescribed. The outcome the nurse would track is... Select one: a. Decrease in wheezing b. Increased clearance of sputum c. Decrease in respiratory rate and increase in depth d. Resolution of atrial tachycardia

The correct answer is: Increased clearance of sputum

A patient who is having her sixth child has gone beyond term, and her labor is being induced with oxytocin [Pitocin]. The patient is having increased frequency, duration, and intensity of contractions. The nurse will interrupt the oxytocin infusion if what occurs? Select one: a. Contractions occur every 2 to 3 minutes. b. Individual contractions last 2 minutes. CorrectInduction of labor in patients of high parity (five or more pregnancies) carries a high risk of uterine rupture, and oxytocin should be used with great caution. Oxytocin infusions should be interrupted for contractions that last longer than 1 minute. Contractions that occur more often than every 2 to 3 minutes are a concern. Mild to moderate pain is normal with contractions. A resting intrauterine pressure greater than 15 to 20 mm Hg is a concern. c. Mild to moderate pain occurs with uterine contractions. d. Resting intrauterine pressure is greater than 10 to 15 mm Hg.

The correct answer is: Individual contractions last 2 minutes.

A 12-year-old male patient diagnosed with hypogonadism will begin testosterone injections. What will the nurse include when teaching the family about this therapy? Select one: a. Annual x-rays of the hands and wrists are necessary to monitor epiphyseal closure. b. Gynecomastia may occur and is a common side effect. c. Injections are given every 2 to 4 weeks for 3 to 4 years. CorrectFor the treatment of male hypogonadism, patients receive IM injections of testosterone every 2 to 4 weeks for 3 to 4 years. Evaluation for epiphyseal closure should be done with radiographs every 6 months, not annually. Gynecomastia is a rare side effect that usually occurs in patients taking testosterone in high doses. Testosterone only accelerates the growth of prostate cancer when it occurs; it does not cause it. d. Use of this drug may lead to prostate cancer later in life.

The correct answer is: Injections are given every 2 to 4 weeks for 3 to 4 years.

An unconscious patient has been brought to the hospital, and the physician has prescribed a life-saving drug to be administered parenterally. Which of the following methods would be the most appropriate for the nurse to use when administering the medication? Select one: a. Intravenous infusion. b. Subcutaneous administration. c. Intrathecal administration. d. Intramuscular administration.

The correct answer is: Intravenous infusion.

A patient with hypothyroidism begins taking PO levothyroxine [Synthroid]. The nurse assesses the patient at the beginning of the shift and notes a heart rate of 62 beats per minute and a temperature of 97.2°F. The patient is lethargic and difficult to arouse. The nurse will contact the provider to request an order for which drug? Select one: a. Beta blocker b. Increased dose of PO levothyroxine c. Intravenous levothyroxine CorrectIntravenous administration of levothyroxine is used for myxedema coma. This patient is showing signs of severe hypothyroidism, or myxedema. A beta blocker is useful in patients who show signs of hyperthyroidism to minimize cardiac effects. Because the half-life of oral levothyroxine is so long, increasing the PO dose will not provide immediate relief of this patient's symptoms. Methimazole is used to treat hyperthyroidism. d. Methimazole [Tapazole]

The correct answer is: Intravenous levothyroxine

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

The correct answer is: It does not correct the underlying pathology of heart failure.

A patient has been taking senna [Senokot] for several days, and the nurse notes that the urine is yellowish-brown. What does the nurse know about this symptom? Select one: a. It indicates that renal failure has occurred. b. It is caused by dehydration, which is a laxative side effect. IncorrectSystemic absorption of senna, followed by renal excretion, may impart a harmless yellowish-brown or pink color to the urine. This symptom is not an indication of renal failure, dehydration, or toxicity. c. It is a sign of toxicity, indicating immediate withdrawal of the drug. d. It is an expected, harmless effect of senna.

The correct answer is: It is an expected, harmless effect of senna.

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

The correct answer is: Knowledge, deficient r/t lack of understanding of treatment regimen

Your patient works from midnight to 8 AM and experiences insomnia during the day. This is an example of which of the following core patient variables? Select one: a. Health status b. Environment c. Life span and gender d. Lifestyle, diet, and habits

The correct answer is: Lifestyle, diet, and habits

A patient will be undergoing surgery, during which the anesthesiologist plans to administer vecuronium (Norcuron). The nurse will recognize that the administration of this drug creates a need for which of the following? Select one: a.Hemodynamic support b.Mechanical ventilation c.Electroencephalographic monitoring d.Active body core warming

The correct answer is: Mechanical ventilation

A nurse is caring for a patient and her newborn immediately after delivery. The patient's medication history includes prenatal vitamins throughout pregnancy, one or two glasses of wine before knowing she was pregnant, occasional use of an albuterol inhaler in her last trimester, and intravenous morphine during labor. What will the nurse expect to do? Select one: a. Administer opioids to the infant to prevent withdrawal syndrome b. Monitor the infant's respirations and prepare to administer naloxone if needed c. Note a high-pitched cry and irritability in the infant and observe for seizures d. Prepare the patient for motor delays in the infant caused by the alcohol use

The correct answer is: Monitor the infant's respirations and prepare to administer naloxone if needed

The nurse is teaching a patient about the beclomethasone (Beconase) nasal spray he will be using post-discharge. Which side effects will the nurse prepare the patient to manage? Select one: a. Salt sensitivity and elevation of blood pressure b. Dyspepsia and gastric irritation c. Nasal irritation and nosebleed d. Bone demineralization and increased risk of fracture

The correct answer is: Nasal irritation and nosebleed

The nurse is caring for a pregnant patient recently diagnosed with hypothyroidism. The patient tells the nurse she does not want to take medications while she is pregnant. What will the nurse explain to this patient? Select one: a. Hypothyroidism is a normal effect of pregnancy and usually is of no consequence. b. Neuropsychologic deficits in the fetus can occur if the condition is not treated. CorrectMaternal hypothyroidism can result in permanent neuropsychologic deficits in the child. Hypothyroidism is not a normal effect of pregnancy and is a serious condition that can affect both mother and fetus. The greatest danger to the fetus occurs in the first trimester, because the thyroid does not fully develop until the second trimester. Early identification is essential. Symptoms often are vague. Treatment should begin as soon as possible, or mental retardation and other developmental problems may occur. c. No danger to the fetus exists until the third trimester. d. Treatment is required only if the patient is experiencing symptoms.

The correct answer is: Neuropsychologic deficits in the fetus can occur if the condition is not treated.

A patient with hypertension with a blood pressure of 168/110 mm Hg begins taking hydrochlorothiazide and verapamil. The patient returns to the clinic after 2 weeks of drug therapy, and the nurse notes a blood pressure of 140/85 mm Hg and a heart rate of 98 beats per minute. What will the nurse do? Select one: a. Notify the provider and ask about adding a beta blocker medication. b. Reassure the patient that the medications are working. c. Remind the patient to move slowly from sitting to standing. d. Request an order for an electrocardiogram.

The correct answer is: Notify the provider and ask about adding a beta blocker medication.

A patient is receiving intravenous promethazine [Phenergan] 25 mg for postoperative nausea and vomiting. What is an important nursing action when giving this drug? Select one: a. Giving the dose as an IV push over 3 to 5 minutes IncorrectIf IV administration must be done with this drug, it should be given through a large-bore, freely flowing line. The site should be monitored closely for local burning or pain or any sign of extravasation, which can cause abscess formation, tissue necrosis, and gangrene requiring amputation. Giving the medication as a rapid IV push or through microbore tubing does not adequately slow the infusion or dilute the drug. Dry mouth and sedation are expected side effects of this drug and are not dangerous. b. Infusing the dose with microbore tubing and an infusion pump c. Observing the IV insertion site frequently for patency d. Telling the patient to report dry mouth and sedation

The correct answer is: Observing the IV insertion site frequently for patency

A patient who has erectile dysfunction asks a nurse whether sildenafil [Viagra] would be a good medication for him to take. Which aspect of this patient's history would be of most concern? Select one: a. Benign prostatic hypertrophy b. Mild hypertension c. Occasional use of nitroglycerin CorrectPatients taking nitroglycerin should not take sildenafil. Having BPH is not a contraindication. Mild hypertension requires caution but is not a contraindication. Patients with BPH taking finasteride may take sildenafil. d. Taking finasteride

The correct answer is: Occasional use of nitroglycerin

Insulin glargine is prescribed for a hospitalized patient who has diabetes. When will the nurse expect to administer this drug? Select one: a. Approximately 15 to 30 minutes before each meal IncorrectGlargine insulin is indicated for once daily subcutaneous administration to treat adults and children with type 1 diabetes and adults with type 2 diabetes. According to the package labeling, the once-daily injection should be given at bedtime. Glargine insulin should not be given more than once a day, although some patients require bid dosing to achieve a full 24 hours of basal coverage. b. In the morning and at 4:00 PM c. Once daily at bedtime d. After meals and at bedtime

The correct answer is: Once daily at bedtime

The nurse is caring for a patient who begins to complain of shortness of breath. The nurse assesses the patient and notes 3+ pitting edema bilaterally in the lower extremities. Which medication taken by the patient causes the most concern? Select one: a. Epoetin alfa b. Filgrastim (granulocyte colony-stimulating factor) c. Oprelvekin (interleukin-11) d. Sargramostim (granulocyte-macrophage colony-stimulating factor)

The correct answer is: Oprelvekin (interleukin-11)

A nurse administers the same medication in the same preparation in the same dose to several patients and notes that some patients have a better response to the drug than others. What is the most likely explanation for this phenomenon? Select one: a. Altered bioavailability of the drug b. Patient compliance with the therapeutic regimen c. Pharmacogenomic differences among individuals d. Placebo effects enhancing expectations of drug efficacy

The correct answer is: Pharmacogenomic differences among individuals

A patient who has endometriosis has been unable to conceive. She asks the nurse about medications to treat the condition. What will the nurse tell the patient? Select one: a. Combination oral contraceptives are effective for improving fertility. IncorrectSurgery reduces symptoms of endometriosis and improves fertility; drugs used to treat endometriosis only reduce discomfort. Combination oral contraceptives only treat symptoms; they do not improve fertility. Gonadotropin-releasing hormone agonists cannot be used long term because of side effects of osteoporosis and hot flashes. Nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line agents for endometriosis pain. b. Gonadotropin-releasing hormone agonists are used for long-term treatment. c. Nonsteroidal anti-inflammatory drugs are second-line agents for treating pain. d. Pharmacologic agents used to treat endometriosis do not enhance fertility.

The correct answer is: Pharmacologic agents used to treat endometriosis do not enhance fertility.

A nurse who is working with an older adult patient who takes eight medications a day wants to promote medication adherence. Which of the following nursing interventions would best promote medication adherence? Select one: a. Take prescribed medication as needed b. Refill prescription medication when the last dose is taken c. Place pills in a daily or weekly pillbox organized according to hours of the day or mealtimes d. Ask for child-proof caps for all medication bottles

The correct answer is: Place pills in a daily or weekly pillbox organized according to hours of the day or mealtimes

A nurse notes new drug orders for a patient who is already getting several medications. Which of the following is the most important consideration when preparing to administer the new drugs? Select one: a. How the patient will feel about new medications added to her drug therapy b. Possible drug-drug interactions that might occur c. Any special nursing considerations that the nurse must be aware of d. If generic preparations of the drugs can be used

The correct answer is: Possible drug-drug interactions that might occur

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

The correct answer is: Potassium level of 3.5 mEq/L

The Controlled Substances Act classified drugs into schedules based on which of the following concepts? Select one: a. Potential for abuse and addiction b. Potential for tolerance and dependence c. Potential for allergic or hypersensitivity reactions d. Potential for interactions with alcohol or nicotine

The correct answer is: Potential for abuse and addiction

Benzodiazepines may be used as IV anesthesia agents to do which of the following? Select one: a. Produce a wakeful state near the end of the surgical procedure b. Prevent post-operative nausea and vomiting c. Provide pain relief throughout the procedure d. Produce relaxation, sedation, or amnesia

The correct answer is: Produce relaxation, sedation, or amnesia

The nurse is preparing to care for a patient who will be taking an antihypertensive medication. Which action by the nurse is part of the assessment step of the nursing process? Select one: a. Asking the prescriber for an order to monitor serum drug levels b. Watching for adverse reactions c. Questioning the patient about over-the-counter medications d. Taking the patient's blood pressure throughout the course of treatment

The correct answer is: Questioning the patient about over-the-counter medications

A patient receives an injection of human chorionic gonadotropin after follicular maturation has been induced with another agent. The patient comes to the clinic 2 days later complaining of headache, irritability, and fatigue. What will the nurse do? Select one: a. Perform a urine pregnancy test. b. Reassure the patient that these are known adverse effects. c. Request an order for a serum estrogen level. IncorrectHeadache, irritability, and fatigue are known adverse effects of hCG. A urine pregnancy test is not indicated, because it is too soon for the patient to be pregnant. A serum estrogen level and an abdominal ultrasound are not indicated. d. Review the patient's abdominal ultrasound.

The correct answer is: Reassure the patient that these are known adverse effects.

A nurse is caring for a patient in the intensive care unit who is receiving intravenous lidocaine. The patient is drowsy and confused and reports numbness of the fingers and toes. Which standing order will the nurse initiate at this time? Select one: a. Administer diazepam. b. Reduce the rate of infusion. c. Discontinue the infusion. d. Prepare for mechanical ventilation.

The correct answer is: Reduce the rate of infusion.

A patient with hypertension is prescribed an angiotensin-converting enzyme (ACE) inhibitor. The nurse reviewing this patient's chart before administering the medication will be most concerned about which other disease process? Select one: a. Bronchial asthma b. Coronary artery disease c. Diabetes mellitus d. Renal artery stenosis

The correct answer is: Renal artery stenosis

A nurse is caring for a child whose respirations are shallow and marked by a prolonged expiratory phase. The nurse auscultates wheezes and poor air movement bilaterally. The child's respiratory rate is 26 breaths per minute, and the oxygen saturation is 89%. What does the nurse suspect? Select one: a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

The correct answer is: Respiratory acidosis

A 28-year-old patient is to receive a dose of lorazepam intravenously for sedation during a procedure. The nursing priority would be to assess for which of the following? Select one: a. Ataxia and confusion b. Respiratory disturbances and partial airway obstruction c. Seizures d. Leukopenia and diplopia

The correct answer is: Respiratory disturbances and partial airway obstruction

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

The correct answer is: Ringing in the ears

The nursing student is studying how priority drugs receive accelerated approval by the FDA as part of the FDA modernization. The student knows that priority drugs are used to treat: Select one: a. Diseases that affect only a small percentage of the population b. Serious and life-threatening conditions that lack effective treatments c. Diseases for which the community raises money for treatment

The correct answer is: Serious and life-threatening conditions that lack effective treatments

A patient with type 1 diabetes recently became pregnant. The nurse plans a blood glucose testing schedule for her. What is the recommended monitoring schedule? Select one: a. Before each meal and before bed IncorrectA pregnant patient with type 1 diabetes must have frequent blood sugar monitoring (eg, six or seven times a day) to manage both the patient and the fetus so that no teratogenic effects occur. Monitoring the blood sugar level before meals and at bedtime is not significant enough to provide the necessary glycemic control. Morning and 4:00 PM monitoring is not enough to provide glycemic control. Urine glucose testing is not sensitive enough to aid glycemic control, and monitoring three times a day is not enough. b. In the morning for a fasting level and at 4:00 PM for the peak level c. Six or seven times a day d. Three times a day, along with urine glucose testing

The correct answer is: Six or seven times a day

Which of the following is the expected outcome of antihistamine therapy in allergic rhinitis? Select one: a. The nasal airway opens wider b. Coughing becomes productive c. Sneezing and tearing decrease. d. The sinuses drain more effectively

The correct answer is: Sneezing and tearing decrease.

When checking on the potential interactions of two drugs being administered at the same time, the nurse recognizes the following principle... Select one: a. Some drug interactions can produce therapeutic effects b. Giving them with food will decrease the potential for interaction c. Drug interactions should always be avoided d. Drug - drug interactions are more serious than drug - food interactions

The correct answer is: Some drug interactions can produce therapeutic effects

A patient asks how she can consume optimal amounts of folate, because she is trying to get pregnant. The nurse will advise this patient to do what? Select one: a. Eat foods naturally high in folate. b. Stop worrying, because folate is present in many foods. c. Take synthetic folate on an empty stomach. d. Take synthetic folate in addition to foods high in folate. CorrectAll women of child-bearing age need 400 to 800 mg of synthetic folate in addition to dietary sources to help prevent neural tube defects in the fetus. The bioavailability of synthetic folate is increased in the presence of food. Dietary folate is not sufficient to prevent neural tube defects, even when these foods are consumed in increased amounts. Taking folate on an empty stomach reduces the amount absorbed. Feedback

The correct answer is: Take synthetic folate in addition to foods high in folate.

A patient has undergone a primary percutaneous coronary intervention with a stent placement. The provider has ordered a daily dose of 81 mg of aspirin and clopidogrel. The patient asks the nurse how long the medications must be taken. What will the nurse tell this patient about the medication regimen? Select one: a. This drug regimen will continue indefinitely. b. The clopidogrel will be discontinued in one year and the aspirin will be given indefinitely. c. The aspirin will be discontinued in one year and the clopidogrel will be given indefinitely. d. Both drugs will be discontinued in one year.

The correct answer is: The clopidogrel will be discontinued in one year and the aspirin will be given indefinitely.

A nurse is providing a patient with a list of drugs as a part of the patient's plan of care. Which of the following drug nomenclatures should the nurse use to list the drugs? Select one: a. The drugs' chemical names b. The drugs' generic names c. The drugs' trade names d. The drugs' biologic names

The correct answer is: The drugs' generic names

A patient is learning metered-dose inhaler technique. The patient says, "I don't understand why I have to use this thing. Can't I just take pills?" The nurse's response is based on the knowledge that... Select one: a. The inhalation route is easier to master than is oral therapy b. The inhalation route is less expensive than is oral therapy c. The inhalation route is safer and more effective than are pills d. The inhalation route is more likely to lead to termination of the disease process than are pills

The correct answer is: The inhalation route is safer and more effective than are pills

A postmenopausal woman will begin taking atorvastatin [Lipitor] to treat hypercholesterolemia. The woman reports a history of osteopenia with a family risk of osteoporosis. What will the nurse include when teaching this patient? Select one: a. The need to discuss taking a bisphosphonate medication with her provider b. That statins are known to reduce the risk of osteoporosis c. That she should avoid foods high in calcium d. To discuss vitamin D supplements with her provider since statins deplete calcium

The correct answer is: The need to discuss taking a bisphosphonate medication with her provider

A female patient taking an ACE inhibitor learns that she is pregnant. What will the nurse tell this patient? Select one: a. The fetus most likely will have serious congenital defects. b. The fetus must be monitored closely while the patient is taking this drug. c. The patient's prescriber probably will change her medication to an ARB. d. The patient should stop taking the medication and contact her provider immediately.

The correct answer is: The patient should stop taking the medication and contact her provider immediately.

A patient has been taking narcotic analgesics for chronic pain for several months. The nurse caring for this patient notes that the prescribed dose is higher than the recommended dose. The patient has normal vital signs, is awake and alert, and reports mild pain. What does the nurse recognize about this patient? Select one: a. This patient exhibits a negative placebo effect with a reduced response to the drug b. This patient has developed a reaction known as tachyphylaxis because of repeated exposure to the drug c. This patient has developed pharmacodynamic tolerance, which has increased the minimal effective concentration (MEC) needed for analgesic effect d. This patient produces higher than normal hepatic enzymes as a result of prolonged exposure to the drug

The correct answer is: This patient has developed pharmacodynamic tolerance, which has increased the minimal effective concentration (MEC) needed for analgesic effect

A patient with hemophilia A is undergoing a tooth extraction at the dentist's office. As an adjunct to factor VIII, what other drug should the nurse anticipate being ordered for this patient? Select one: a. Tranexamic acid [Cyklokapron] b. Acetaminophen [Tylenol] c. Desmopressin [Stimate] d. Vitamin K

The correct answer is: Tranexamic acid [Cyklokapron]

The nurse is caring for a patient who is taking a non-selective beta blocker preparation for hypertension. The patient starts to complain of shortness of breath. The nurse realizes that this kind of beta blocker... Select one: a. Triggers bronchoconstriction in the airways b. Promotes swelling inside airways c. Produces mucous plugs that can totally block off airways d. Irritates the mucosa in the airways

The correct answer is: Triggers bronchoconstriction in the airways

A patient is preparing to travel to perform missionary work in a region with poor drinking water. The provider gives the patient a prescription for ciprofloxacin [Cipro] to take on the trip. What will the nurse instruct this patient to do? Select one: a. Combine the antibiotic with an antidiarrheal medication, such as loperamide. b. Start taking the ciprofloxacin 1 week before traveling. c. Take 1 tablet of ciprofloxacin with each meal for best results. IncorrectTraveler's diarrhea is generally caused by Escherichia coli; treatment is usually unnecessary, because the disease runs its course in a few days. If symptoms are severe or prolonged, an antibiotic, such as ciprofloxacin, may be helpful. Patients should be instructed to take it only if needed. Antidiarrheal medications may just slow the export of the organism and prolong the course of the disease, but they may be used when symptoms are mild for relief from discomfort. Prophylactic treatment with antibiotics is not recommended. Ciprofloxacin is given twice daily, not with meals. d. Use the drug if symptoms are severe or do not improve in a few days.

The correct answer is: Use the drug if symptoms are severe or do not improve in a few days.

A child is diagnosed with rickets. The nurse knows that this child is most likely deficient in which vitamin? Select one: a. Niacin (nicotinic acid) b. Thiamin (vitamin B1) c. Vitamin C (ascorbic acid) d. Vitamin D CorrectVitamin D plays a critical role in the regulation of the metabolism of calcium and phosphorus. Classical effects of deficiency are rickets in children and osteomalacia in adults. Niacin, thiamin, and vitamin C do not play a role in the prevention of rickets.

The correct answer is: Vitamin D

A pregnant woman has a history of epilepsy and continues to take an AED during her pregnancy. Which of the following supplements should be taken during the last month of pregnancy? Select one: a. Vitamin K b. Vitamin A c. Iron d. Erythromycin

The correct answer is: Vitamin K

A nurse is caring for a patient with cancer who has been undergoing chemotherapy. The patient has oral mucositis as a result of the chemotherapy, and the provider has ordered palifermin [Kepivance]. Which is an appropriate nursing action when giving this drug? Select one: a. Administering the drug as a slow IV infusion b. Flushing the IV line with heparin before infusing the drug c. Giving the drug within 6 hours of the chemotherapy d. Warning the patient about the potential for distortion of taste CorrectPalifermin is generally well tolerated but commonly causes reactions involving the skin and mouth, including taste distortion. The drug should be given as an IV bolus. Palifermin binds with heparin, so the IV line should not be flushed with heparin before giving palifermin. If the interval between administration of palifermin and the chemotherapeutic drugs is too short, palifermin actually may increase the severity and duration of oral mucositis; therefore, palifermin should be given 24 hours before the chemotherapeutic drugs.

The correct answer is: Warning the patient about the potential for distortion of taste

An adolescent male patient is beginning androgen therapy for delayed puberty. His parents ask the nurse when this treatment may be stopped. The nurse will offer which response? Select one: a. After 3 to 4 years of therapy IncorrectTestosterone therapy is used to treat delayed maturity, but only for a limited course. Testicular enlargement is the first change associated with puberty and is a sign that puberty has begun. Males with hypogonadism need treatment for 3 to 4 years. Acne and facial hair are common side effects. Attaining complete sexual maturation is not necessary. b. If acne and facial hair develop c. When complete sexual maturation has occurred d. When testicular enlargement occurs

The correct answer is: When testicular enlargement occurs

A client will begin to take apomorphine (Apokyn) for on-off syndrome in Parkinson's Disease. The nurse provides information about the drug noting that nausea and vomiting are frequent adverse effects. The patient recalls that she has Zofran at home and will take one if needed. The nurse cautions her to avoid Zofran for which of the following reasons? Select one: a. Zofran is only indicated for nausea and vomiting in pregnancy b. Zofran and Apokyn in combination produce hypotension c. Apokyn is metabolized by the same enzymes as Zofran so distribution is erratic d. Zofran causes nausea and vomiting to worsen

The correct answer is: Zofran and Apokyn in combination produce hypotension

A patient who has recently immigrated to the United States from an impoverished country appears malnourished. The patient's folic acid levels are low, and the vitamin B12 levels are normal. The nurse expects this patient's treatment to include: Select one: a. a diet high in folic acid. b. intramuscular folic acid. c. oral folic acid and vitamin B12. d. oral folic acid supplements.

The correct answer is: a diet high in folic acid.

A patient with a recent onset of nephrosclerosis has been taking an ACE inhibitor and a thiazide diuretic. The patient's initial blood pressure was 148/100 mm Hg. After 1 month of drug therapy, the patient's blood pressure is 130/90 mm Hg. The nurse will contact the provider to discuss: Select one: a. adding a calcium channel blocker to this patient's drug regimen. b. lowering doses of the antihypertensive medications. c. ordering a high-potassium diet. d. adding spironolactone to the drug regimen.

The correct answer is: adding a calcium channel blocker to this patient's drug regimen.

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

The correct answer is: administer the dose as ordered.

Vistaril given in combination with Talwin diminishes the adverse effects of nausea caused by the Talwin. This drug interaction affecting the pharmacodynamics of the Talwin is... Select one: a. an additive effect b. a synergistic effect c. a potentiated effect d. an antagonistic effect

The correct answer is: an antagonistic effect

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

The correct answer is: an idiosyncratic response

A nurse is caring for a child who has hemophilia. While reviewing this child's immunization records, the nurse notes that the child needs the tetanus and reduced diphtheria toxoids and acellular pertussis (Tdap) vaccine and the hepatitis A vaccine. The nurse should notify the provider and obtain an order to give: Select one: a. both vaccines intramuscularly. b. both vaccines subcutaneously. c. the hepatitis A vaccine only subcutaneously. d. the Tdap vaccine only intramuscularly.

The correct answer is: both vaccines intramuscularly.

A patient calls a family planning clinic and tells the nurse that her vaginal ring, which has been in place for 2 weeks, came out sometime during the night while she was sleeping. The nurse will instruct her to: Select one: a. clean the ring with warm water, reinsert it, and use condoms for 7 days. b. discard the ring and insert a new ring after 1 week has passed. IncorrectIf a ring is expelled before 3 weeks have passed, it can be reinserted after being washed in warm water. If the ring has been out longer than 3 hours, backup contraception should be used for 7 days. Because this ring was expelled while the patient was sleeping, using backup contraception is prudent. Discarding the ring is not indicated if it can be cleaned. The ring should not be washed in hot water. c. discard the ring and insert a new one to begin a new cycle. d. wash the ring in hot, soapy water and reinsert it.

The correct answer is: clean the ring with warm water, reinsert it, and use condoms for 7 days.

A patient who will begin combination estrogen/progestin therapy (EPT) for menopause asks the nurse why she can't take an estrogen-only preparation. The patient has not had a hysterectomy, has a slightly increased risk of cardiovascular disease, and has mild osteopenia. The nurse will tell her that the progestin is necessary to: Select one: a. decrease her risk of endometrial cancer. b. increase bone resorption to prevent fractures. c. lower her risk of myocardial infarction (MI). IncorrectIn patients who still have a uterus, progestin is necessary to reduce the risk of endometrial carcinoma. Progestins do not have effects on bone density and do not decrease risk of MI or DVT. d. prevent deep vein thrombosis (DVT).

The correct answer is: decrease her risk of endometrial cancer.

A nurse is assessing a patient who has heart failure. The patient complains of shortness of breath, and the nurse auscultates crackles in both lungs. The nurse understands that these symptoms are the result of: Select one: a. decreased force of ventricular contraction. b. increased force of ventricular contraction. c. decreased ventricular filling. d. increased ventricular filling.

The correct answer is: decreased force of ventricular contraction.

A nurse is reviewing a patient's most recent blood count and notes that the patient has a hemoglobin of 9.6 gm/dL and a hematocrit of 33%. The nurse will notify the provider and will expect initial treatment to include: Select one: a. determining the cause of the anemia. b. giving intravenous iron dextran. c. giving oral carbonyl iron [Feosol]. d. teaching about dietary iron.

The correct answer is: determining the cause of the anemia.

A nurse caring for a patient receiving heparin therapy notes that the patient has a heart rate of 98 beats per minute and a blood pressure of 110/72 mm Hg. The patient's fingertips are purplish in color. A stat CBC shows a platelet count of less than 100,000 mm3. The nurse will: Select one: a. administer oxygen and notify the provider. b. discontinue the heparin and notify the provider. c. request an order for protamine sulfate. d. request an order for vitamin K (phytonadione).

The correct answer is: discontinue the heparin and notify the provider.

A nurse is developing a care plan for a patient who has multiple sclerosis. An expected outcome for the patient who is receiving glatiramer would be a decrease in which of the following? Select one: a. chest pain. b. fatigue. c. breathing difficulties. d. heart palpitations.

The correct answer is: fatigue. Glatiramer should reduce the frequency of multiple sclerosis-related attacks and therefore decrease fatigue. Fatigue, weakness, spasticity, balance problems, bladder and bowel problems, numbness, vision loss, tremor, and vertigo are the most common symptoms of multiple sclerosis. Chest pain, breathing difficulties, and heart palpitations are all identified side effects of glatiramer and are not common manifestations of MS.

A patient who experiences motion sickness is about to go on a cruise. The prescriber orders transdermal scopolamine [Transderm Scop]. The patient asks the nurse why an oral agent is not ordered. The nurse will explain that the transdermal preparation: Select one: a. can be applied as needed at the first sign of nausea. b. has less intense anticholinergic effects than the oral form. c. is less sedating than the oral preparation. d. provides direct effects, because it is placed close to the vestibular apparatus of the ear. IncorrectThe transdermal system of scopolamine is preferred, because it may have less intense anticholinergic effects than oral or subcutaneous dosing. Antinausea medications for motion sickness are more effective if given prophylactically than after symptoms begin. Sedation side effects are similar with all forms. Placement near the ear does not cause the medication to absorb directly into the vestibular apparatus.

The correct answer is: has less intense anticholinergic effects than the oral form.

A patient is admitted to the obstetric unit in preterm labor at 36 weeks' gestation. The prescriber orders a tocolytic agent. When teaching the patient about this medication, the nurse will tell her that tocolytics: Select one: a. are given until term to reduce fetal mortality. b. are used to help the fetal lungs mature. c. help delay delivery while glucocorticoids are given. CorrectTocolytic agents are used to postpone premature labor and, on average, for only 48 hours. During this time, glucocorticoids are given to help the fetal lungs mature. Tocolytic agents do not suppress labor long term. They do not directly help the fetal lungs to mature; they help by allowing time for glucocorticoids to be given. They do not treat infection. d. help treat the infections that cause preterm labor.

The correct answer is: help delay delivery while glucocorticoids are given.

A 76-year-old woman has a complex medical history that includes emphysema, osteoporosis, malnutrition, and hypothyroidism. Recently, the woman fell outside her home as a result of weakness and suffered a fracture to her femoral head. The woman's subsequent hip-replacement surgery has been scheduled and the care team recognizes that the use of isoflurane will be most significantly influenced by Select one: a. her history of emphysema. b. her compromised nutritional status. c. her impaired thyroid function. d. her advanced age.

The correct answer is: her history of emphysema

A nurse is going to administer medication to an infant using a medicine dropper. The best method is to open the child's mouth by gently squeezing the cheeks and placing the drops... Select one: a. at the back of the mouth b. in the buccal pouch c. under the tongue d. on top of the tongue

The correct answer is: in the buccal pouch

A nursing student asks a nurse how beta blockers increase the oxygen supply to the heart in the treatment of anginal pain. The nurse tells the student that beta blockers: Select one: a. dilate arterioles to improve myocardial circulation. b. improve cardiac contractility, which makes the heart more efficient. c. increase arterial pressure to improve cardiac afterload. d. increase the time the heart is in diastole.

The correct answer is: increase the time the heart is in diastole.

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

The correct answer is: is experiencing worsening of the disease.

A nurse is teaching a group of women about medications. The women want to know why so many drugs have unpredictable effects in women. The nurse will tell them that: Select one: a. drugs usually have more toxic effects in women b. most known drug effects are based on drug trials in men c. women have varying responses to drugs during menstrual cycles d. women metabolize drugs more slowly

The correct answer is: most known drug effects are based on drug trials in men

A patient begins taking nifedipine [Procardia], along with metoprolol, to treat hypertension. The nurse understands that metoprolol is used to: Select one: a. reduce flushing. b. minimize gingival hyperplasia. c. prevent constipation. d. prevent reflex tachycardia.

The correct answer is: prevent reflex tachycardia.

A patient is receiving heparin postoperatively to prevent deep vein thrombosis. The nurse notes that the patient has a blood pressure of 90/50 mm Hg and a heart rate of 98 beats per minute. The patient's most recent aPTT is greater than 90 seconds. The patient reports lumbar pain. The nurse will request an order for: Select one: a. a repeat aPTT to be drawn immediately. b. analgesic medication. c. changing heparin to aspirin. d. protamine sulfate.

The correct answer is: protamine sulfate.

A patient has been taking a progestin-only, or "minipill," OC for 3 months and reports spotting and irregular menstrual cycles. The nurse will: Select one: a. question the patient about any possible missed doses of the pill. b. reassure the patient that this is normal with this form of contraception. CorrectPatients taking the progestin-only OC may expect irregular bleeding, including spotting and irregular periods. This symptom does not indicate lack of compliance with the regimen. A pregnancy test is not indicated. It is not necessary to use a backup form of contraception. c. recommend that she take a pregnancy test to rule out pregnancy. d. suggest that she use a backup form of contraception until these symptoms resolve.

The correct answer is: reassure the patient that this is normal with this form of contraception.

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

The correct answer is: reduce intracranial pressure.

A patient is diagnosed with moderate vitamin B12 deficiency. The nurse reviews the laboratory work and notes that the plasma B12 is low; also, a Schilling test reveals B12 malabsorption. The provider orders oral cyanocobalamin 500 mcg per day. The nurse will contact the provider to: Select one: a. discuss IM dosing. b. request an order for folic acid. c. suggest an increased dose. d. suggest platelet transfusion therapy.

The correct answer is: suggest an increased dose.

A patient calls the nurse to report that she forgot to take a combination OC pill during the third week of her cycle. She tells the nurse that she missed another pill earlier that week. The nurse will tell her to: Select one: a. continue the pack, skip the inert pills, and use an additional form of contraception for 7 days. IncorrectIf one or two pills are missed during the second or third week of a 28-day cycle, the patient should be instructed to take one pill as soon as possible, continue the pack, skip the placebo pills, and go straight to a new pack. It is not necessary to use an alternative form of contraception. If three or more pills are missed, the risk of pregnancy increases. b. not to worry, because up to 7 days can be missed without an increased risk of pregnancy. c. take a pill immediately, continue the pack, and use an additional form of contraception for 1 month. d. take a pill now, continue the pack, skip the placebo pills, and start a new pack on week 4.

The correct answer is: take a pill now, continue the pack, skip the placebo pills, and start a new pack on week 4.

A woman has been taking a progestin-only oral contraceptive and will begin using a vaginal ring. The nurse will teach the patient to insert the ring: Select one: a. the day the last pill is taken and use backup contraception for 7 days. b. 1 week before taking the last pill. c. 1 to 5 days after taking the last pill and use backup contraception for 2 days. d. within 7 days after taking the last pill. IncorrectWhen patients who have been using a progestin-only OC begin using a vaginal ring, they should be instructed to insert the ring on the last day of the pill and use backup contraception for 7 days.

The correct answer is: the day the last pill is taken and use backup contraception for 7 days.

A nurse is providing care for a patient who suffered extensive burns to his extremities during a recent industrial accident. Topical lidocaine gel has been ordered to be applied to the surfaces of all his burns in order to achieve adequate pain control. When considering this order, the nurse should be aware that Select one: a. intravenous lidocaine may be preferable to topical application. b. lidocaine must be potentiated with another anesthetic in order to achieve pain control. c. pain relief is unlikely to be achieved due to the destruction of nerve endings in the burn site. d. there is a risk of systemic absorption of the lidocaine through the patient's traumatized skin.

The correct answer is: there is a risk of systemic absorption of the lidocaine through the patient's traumatized skin.

The nurse is providing patient education about the application of transdermal estrogen spray. Which statement made by the patient best demonstrates understanding of the application of this medication? "I should apply this medication to my: Select one: a. waistline and shoulders." IncorrectThe top of the thighs and the back of the calves are the preferred sites for application of the transdermal spray. The waistline and abdomen are used for the patches. The gel is applied to arms. Breasts are never used for application of transdermal estrogen. b. abdomen and arms." c. breasts and abdomen." d. thighs and calves."

The correct answer is: thighs and calves."

A 50-year-old postmenopausal patient who has had a hysterectomy has moderate to severe vasomotor symptoms and is discussing estrogen therapy (ET) with the nurse. The patient is concerned about adverse effects of ET. The nurse will tell her that: Select one: a. an estrogen-progesterone product will reduce side effects. b. an intravaginal preparation may be best for her. IncorrectTransdermal preparations of estrogen have fewer adverse effects, use lower doses of estrogen, and have less fluctuation of estrogen levels than do oral preparations. Progesterone is contraindicated in women who have undergone hysterectomy. Intravaginal preparations are most useful for treating local estrogen deficiency such as vaginal and vulvar atrophy. Side effects of ET are the same at the patient's age as for other women using ET. c. side effects of ET are uncommon among women her age. d. transdermal preparations have fewer side effects.

The correct answer is: transdermal preparations have fewer side effects.

Patients with a history of myocardial infarction should take which medications indefinitely? (Select all that apply.) Select one or more: a. ACE inhibitors b. Alteplase c. Aspirin d. Beta blockers e. Clopidogrel

The correct answers are: ACE inhibitors, Aspirin, Beta blockers

Which of the following belong to the therapeutic class of bronchodilators? (Choose all that apply). Select one or more: a. Leukotriene receptor antagonists (LTRA) b. Beta-adrenergic agonists c. Anticholinergics d. Xanthines e. Corticosteroids

The correct answers are: Beta-adrenergic agonists, Anticholinergics, Xanthines

A patient is being started on nicotinic acid [Niaspan] to reduce triglyceride levels. The nurse is providing patient education and should include teaching about which adverse effects? (Select all that apply.) Select one or more: a. Facial flushing b. Constipation c. Hypoglycemia d. Gastric upset e. Itching

The correct answers are: Facial flushing, Gastric upset, Itching

The nurse is conducting a nursing education class on hemophilia. The nurse correctly states that which characteristics are most likely to be seen in a patient with hemophilia? (Select all that apply.) Select one or more: a. Male gender b. Female gender c. Mother is a carrier. d. All races and ethnicities are susceptible. e. Both parents are carriers.

The correct answers are: Male gender, Mother is a carrier., All races and ethnicities are susceptible.

What are the properties of an ideal drug? (Select all that apply.) Select one or more: a. Irreversible action b. Predictability c. Ease of administration d. Chemical stability e. A recognizable trade name

The correct answers are: Predictability, Ease of administration, Chemical stability

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

The correct answers are: The patient's interview, The patient's medical history, The patient's medical record, The patient's physical examination

Fat soluble vitamins include which of the following? Select one or more: a. Vitamin A b. B-complex vitamins c. Vitamin C d. Vitamin D e. Vitamin E f. Vitamin K

The correct answers are: Vitamin A, Vitamin D, Vitamin E, Vitamin K

The nurse is evaluating the outcome of the intervention after a patient has been taught to self-administer oral iron tablets. Which patient statement indicates the need for further clarification? Select one: a. "The medicine helps my body build red blood cells." b. "I will have blood drawn after three or four weeks to see if this drug is improving my red blood cell count." c. "If I get constipated while I am taking this drug, I need to talk to my provider." d. "I should take this medication with meals, along with a big glass of milk."

The drug is indicated to improve red blood cell counts in anemia and alb tests will be utilized to evaluate its effectiveness. Constipation is a common adverse effect. Iron absorption is inhibited when taken in combination with dairy products and enhanced when taken with orange juice. The correct answer is: "I should take this medication with meals, along with a big glass of milk."

The nurse is presenting information to a class of students about adrenergic drugs. Which are effects of drugs that stimulate the sympathetic nervous system? Select all that apply. Select one or more: a. Dilation of bronchioles b. Constriction of bronchioles c. Decreased heart rate d. Increased heart rate e. Dilated pupils f. Constricted pupils

a. Dilation of bronchioles d. Increased heart rate e. Dilated pupils

The nurse is teaching a patient who is newly diagnosed with myasthenia gravis about managing the disease. Which is important when teaching this patient about adverse effects of cholinesterase inhibitors? Select one: a. "There are very few serious side effects associated with your medication." b. "It is important to notify your provider if you have excessive saliva." c. "If you experience urinary urgency, you may need to increase your dose." d. "Excessive sweating is a minor side effect and will improve over time."

b. "It is important to notify your provider if you have excessive saliva." Accumulation of ACh at muscarinic receptors can result in excessive salivation, bradycardia, sweating, increased gastric secretions, increased tone and motility of the GI tract, and urinary urgency. These responses may have to be suppressed with atropine. In toxic doses, accumulation of ACh may produce depolarizing neuromuscular blockade with paralysis of respiratory muscles. Patients should be taught to report any of these symptoms to their provider.

A nurse who works at an outpatient mental health clinic follows numerous clients who have schizophrenia, many of whom are being treated with olanzapine (Zyprexa). Which of the following clients likely has the highest susceptibility to the adverse effects of olanzapine? Select one: a. A client who is morbidly obese and who has a sedentary lifestyle b. A client who has type 1 diabetes and who practices poor glycemic control c. A client who has a body mass index of 16.5 (underweight) and who smokes one pack of cigarettes daily d. A client who was recently treated with intravenous antibiotics because of cellulitis in his lower leg

b. A client who has type 1 diabetes and who practices poor glycemic control Explanation: The development of polyuria and polydipsia is indicative of diabetes mellitus. Olanzapine has been associated with weight gain, hyperglycemia, and initiation or aggravation of diabetes mellitus. Urinary tract infection is not considered an adverse effect with olanzapine. Renal calculus is not an adverse effect of olanzapine. Hyperthyroidism is not an adverse effect of olanzapine.

A patient has developed muscarinic antagonist toxicity from ingestion of an unknown chemical. The nurse should prepare to administer which medication? Select one: a. Atropine [Sal-Tropine] IV b. Physostigmine [Antilirium] c. An acetylcholinesterase activator d. Pseudoephedrine [Ephedrine]

b. Physostigmine [Antilirium] Physostigmine is indicated for muscarinic antagonist toxicity. Atropine is a drying agent and would only complicate the drying action that arises from the muscarinic antagonist. An acetylcholinesterase activator would only contribute to dryness that arises from the muscarinic antagonist. Ephedrine is not indicated for muscarinic antagonist toxicity.

A patient with bipolar disorder has frequent manic episodes alternating with depressive episodes. The prescriber orders risperidone [Risperdal] in addition to the lithium [Lithobid] that the patient is already taking. The patient asks the nurse why another drug is needed. The nurse will tell the patient that the risperidone is used to: Select one: a. elevate mood during depressive episodes. b. help control symptoms during manic episodes. c. manage tremors associated with lithium use. d. prevent recurrence of depressive episodes.

b. help control symptoms during manic episodes. Risperidone is an antipsychotic often used in conjunction with lithium to help manage symptoms during manic episodes, regardless of whether psychotic symptoms occur. Risperidone does not elevate mood and is not used during depressive episodes. It is not used to counter side effects associated with lithium. It does not prevent recurrence of depressive episodes.

Meperidine (Demerol), a narcotic analgesic used for severe pain, is not used for long term therapy. Which of the following rationales explains this dosing guideline? Select one: a. Demerol is highly addictive in drug therapy lasting longer than two weeks Incorrect b. Demerol has a high level of food interactions that limit its use c. Demerol is metabolized into an active toxic metabolite that accumulates in the body d. Demerol has a short half life and therefore requires hourly administration

c. Demerol is metabolized into an active toxic metabolite that accumulates in the body

The nurse is reviewing a patient's medication history and notes that the patient is taking the cholinergic-blocker tolterodine (Detrol). Based on this finding, the nurse interprets that the patient Select one: a. Suffers from chronic irritable bowel disease b. Requires induction of mydriasis c. Has a diagnosis of urge incontinence caused by bladder (detrusor) overactivity d. Requires reduction of secretions preoperatively

c. Has a diagnosis of urge incontinence caused by bladder (detrusor) overactivity Tolterodine (Detrol) is used for urinary frequency, urgency, and urge incontinence caused by bladder (detrusor) overactivity. The conditions in the other options are not indications.

When screening a patient who will be taking a nonspecific/nonselective beta-blocker, the nurse knows that a patient with which condition may have serious problems while on this medication? Select one: a. Angina b. Hypertension c. Glaucoma d. Asthma

d. Asthma Nonspecific/nonselective beta-blocking drugs may precipitate bradycardia, hypotension, heart block, heart failure, bronchoconstriction, and/or increased airway resistance. Therefore, any preexisting condition such as asthma might be worsened by the concurrent use of any of these medications.