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The nurse is performing medication reconciliation during a patient's admission assessment. Which question by the nurse reflects medication reconciliation? a. "Do you have any medication allergies?" b. "Do you have a list of all the medications, including over-the-counter, you are currently taking?" c. "Do you need to take anything to help you to sleep at night?" d. "What pharmacies do you use when you fill your prescriptions?"

"Do you have a list of all the medications, including over-the-counter, you are currently taking?"

A 77-year-old man who has been diagnosed with an upper respiratory tract infection tells the nurse that he is allergic to penicillin. Which is the most appropriate response by the nurse?

"What type of reaction did you have when you took penicillin?"

The nurse is compiling a drug history for a patient. Which question from the nurse will obtain the most information from the patient?

"When you have pain, what do you do to relieve it?"

source

(Taylor 1191-1192)Taylor, Carol. Fundamentals of Nursing. Wolters Kluwer Health, 10/2014. VitalBook file.

The nurse is administering medications. Examples of high-alert medications include: (Select all that apply.) a. Chemotherapeutic agents b. Antibiotics c. Opiates d. Antithrombotics e. Potassium chloride for injection

- Chemotherapeutic agents. - Opiates. -Antithrombotics. -Potassium chloride for injection.

In which step of the medication process can a medication error occur? (Select all that apply.) a. Prescribing. b. Verification. c. Transcribing. d. Procurement. e. Administration.

-Prescribing. -Transcribing -Procurement. -Administration. -Medication errors can occur at any point in the medication process: procuring, prescribing, transcribing, dispensing, and administration. Verification is a step in the medication reconciliation process.

The nurse is reviewing new medication orders that have been written for a newly admitted patient. The nurse will need to clarify which orders? (Select all that apply.)

-Sitagliptin (Januvia) 50 mg daily. -Docusate (Colace) as needed for constipation.

Which statement is an example of objective data? (Select all that apply.)

-The patient has clear urine. -The patient has had a fever for 5 days.

What things should the nurse check when reviewing a prescription with a patient? (Select all that apply.)

-The route of administration. -The signature of the prescriber.

What information should the nurse chart when documenting medication administration? (Select all that apply.)

-The time of administration. -The patient's age. -The route of administration. -The dosage of medication administered.

The nurse includes which information as part of a complete medication profile? (Select all that apply).

-Use of "street" drugs. -Use of alcohol. -Use of herbal products.

The nurse knows that the medication reconciliation process involves which steps? (Select all that apply.) a. Reporting. b. Verification. c. Clarification. d. Reconciliation. e. Administration.

-Verification. -Clarification. -Reconciliation. * The three steps of the medication reconciliation process are verification, clarification, and reconciliation.

The nurse is reviewing data collected from a medication history. Which of these data are considered objective data? (Select all that apply.)

-White blood cell count 22,000 mm3. -Blood pressure 150/94 mm Hg. -Patient's weight is 68 kg.

A client with a peptic ulcer reports epigastric pain that frequently awakens her during the night. The nurse should instruct the client to do which activities? Select all that apply. 1. Obtain adequate rest to reduce stimulation. 2. Eat small, frequent meals throughout the day. 3. Take all medications on time as ordered. 4. Sit up for one hour when awakened at night. 5. Stay away from crowded areas.

1, 2, 3, 4. The nurse should encourage the client to reduce stimulation that may enhance gastric secretion. The nurse can also advise the client to utilize health practices that will prevent recurrences of ulcer pain, such as avoiding fatigue and elimination of smoking. Eating small, frequent meals helps to prevent gastric distention if not actively bleeding and decreases distension and release of gastrin. Medications should be administered promptly to maintain optimum levels. After awakening during the night, the client should eat a small snack and return to bed, keeping the head of the bed elevated for an hour after eating. It is not necessary to stay away from crowded areas.

After drinking the prescribed dose of GOLYTELY and have numerous stools, the client reports feeling chest palpitations to the nurse. The nurse suspects an electrolyte imbalance and requests a physician order for Lab work. Which ones concern you? 1. sodium 126 mEq/ L 2. potassium 2.8 mEq/L 3. chloride 90 mEq/L 4. calcium 9.4 mEq/dL 5. phosphrous 3.5 mEq/dL 6. Blood Urea nitrogen (BUN) 16 mg/dL

1,2,3 rationale: sodium is the most abundant cation in the blood and functions in the body to maintain osmotic pressure and acid-base balance to transmit nerve impulses, very low values can result in seizures and neurologic symptoms, normal adult range between 135 adn 146 mEq/L - Potassium is essential for maintaining fluid balance, nerve impulse function, muscle function, and cardiac (heart muscle) function. Very low values can cause cardiac arrhythmias, normal range in an adult is 3.5 and 5.5 mEq - Chloride is influenced by the extracellular fluid balance and acid-base balance. Choloride passively follows water and sodium. Normal adult range is 95 to 112 mEq/L

The nurse is caring for a client who has just had an upper GI endoscopy. The client's vital signs must be taken every 30 minutes for 2 hours after the procedure. The nurse assigns an unlicensed nursing personnel (UAP) to take the vital signs. One hour later, the UAP reports the client, who was previously afebrile, has developed a temperature of 101.8 ° F (38.8 ° C). What should the nurse do in response to this reported assessment data? 1. Promptly assess the client for potential perforation. 2. Tell the assistant to change thermometers and retake the temperature. 3. Plan to give the client acetaminophen (Tylenol) to lower the temperature. 4. Ask the assistant to bathe the client with tepid water.

1. A sudden spike in temperature following an endoscopic procedure may indicate perforation of the GI tract. The nurse should promptly conduct a further assessment of the client, looking for further indicators of perforation, such as a sudden onset of acute upper abdominal pain; a rigid, boardlike abdomen; and developing signs of shock. Telling the assistant to change thermometers is not an appropriate action and only further delays the appropriate action of assessing the client. The nurse would not administer acetaminophen without further assessment of the client or without a physician's order; a suspected perforation would require that the client be placed on nothing-by-mouth status. Asking the assistant to bathe the client before any assessment by the nurse is inappropriate.

Place the steps of the nursing process in order, with (1) being the first step and (5) being the last step. ___ a. Implementation. ___ b. Planning. ___ c. Evaluation. ___ d. Assessment. ___ e. Diagnoses.

1. Assessment. 2. Diagnoses. 3 Planning. 4. Implementation. 5. Evaluation. *A Delicious P.I.E* An acronym for the Nursing Process

A client with peptic ulcer disease reports that he has been nauseated most of the day and is now feeling light-headed and dizzy. Based upon these findings, which nursing actions would be most appropriate for the nurse to take? Select all that apply. 1. Administering an antacid hourly until nausea subsides. 2. Monitoring the client's vital signs. 3. Notifying the physician of the client's symptoms. 4. Initiating oxygen therapy. 5. Reassessing the client in an hour.

2, 3. The symptoms of nausea and dizziness in a client with peptic ulcer disease may be indicative of hemorrhage and should not be ignored. The appropriate nursing actions at this time are for the nurse to monitor the client's vital signs and notify the physician of the client's symptoms. To administer an antacid hourly or to wait 1 hour to reassess the client would be inappropriate; prompt intervention is essential in a client who is potentially experiencing a gastrointestinal hemorrhage. The nurse would notify the physician of assessment findings and then initiate oxygen therapy if ordered by the physician.

The nurse is caring for a client who has had a gastroscopy. Which of the following signs and symptoms may indicate that the client is developing a complication related to the procedure? Select all that apply. 1. The client has a sore throat. 2. The client has a temperature of 100 ° F (37.8 ° C). 3. The client appears drowsy following the procedure. 4. The client has epigastric pain. 5. The client experiences hematemesis.

2, 4, 5. Following a gastroscopy, the nurse should monitor the client for complications, which include perforation and the potential for aspiration. An elevated temperature, complaints of epigastric pain, or the vomiting of blood (hematemesis) are all indications of a possible perforation and should be reported promptly. A sore throat is a common occurrence following a gastroscopy. Clients are usually sedated to decrease anxiety and the nurse would anticipate that the client will be drowsy following the procedure.

The nurse finds a client who has been diagnosed with a peptic ulcer surrounded by papers from his briefcase and arguing on the telephone with a coworker. The nurse's response to observing these actions should be based on knowledge that: 1. Involvement with his job will keep the client from becoming bored. 2. A relaxed environment will promote ulcer healing. 3. Not keeping up with his job will increase the client's stress level. 4. Setting limits on the client's behavior is an important nursing responsibility.

2. A relaxed environment is an essential component of ulcer healing. Nurses can help clients understand the importance of relaxation and explore with them ways to balance work and family demands to promote healing. Being involved with his work may prevent boredom; however, this client is upset and argumentative. Not keeping up with his job will probably increase the client's stress level, but the nurse's response is best if it is based on the fact that a relaxed environment is an essential component of ulcer healing. Nurses cannot set limits on a client's behavior; clients must make the decision to make lifestyle changes.

Which of the following would be an expected outcome for a client with peptic ulcer disease? The client will: 1. Demonstrate appropriate use of analgesics to control pain. 2. Explain the rationale for eliminating alcohol from the diet. 3. Verbalize the importance of monitoring hemoglobin and hematocrit every 3 months. 4. Eliminate contact sports from his or her lifestyle.

2. Alcohol is a gastric irritant that should be eliminated from the intake of the client with peptic ulcer disease. Analgesics are not used to control ulcer pain; many analgesics are gastric irritants. The client's hemoglobin and hematocrit typically do not need to be monitored every 3 months, unless gastrointestinal bleeding is suspected. The client can maintain an active lifestyle and does not need to eliminate contact sports as long as they are not stress-inducing.

A client with peptic ulcer disease tells the nurse that he has black stools, which he has not reported to his physician. Based on this information, which nursing diagnosis would be appropriate for this client? 1. Ineffective coping related to fear of diagnosis of chronic illness. 2. Deficient knowledge related to unfamiliarity with significant signs and symptoms. 3. Constipation related to decreased gastric motility. 4. Imbalanced nutrition: Less than body requirements related to gastric bleeding.

2. Black, tarry stools are an important warning sign of bleeding in peptic ulcer disease. Digested blood in the stool causes it to be black. The odor of the stool is very offensive. Clients with peptic ulcer disease should be instructed to report the incidence of black stools promptly to their primary health care provider. The data do not support the other diagnoses.

The nurse has been assigned to provide care for four clients at the beginning of the day shift. In what order should the nurse assess these clients? 1. The client awaiting hiatal hernia repair at 11 am. 2. A client with suspected gastric cancer who is on nothing-by-mouth (NPO) status for tests. 3. A client with peptic ulcer disease experiencing sudden onset of acute stomach pain. 4. A client who is requesting pain medication 2 days after surgery to repair a fractured jaw.

3, 4, 2, 1 The client with peptic ulcer disease who is experiencing a sudden onset of acute stomach pain should be assessed first by the nurse. The sudden onset of stomach pain could be indicative of a perforated ulcer, which would require immediate medical attention. It is also important for the nurse to thoroughly assess the nature of the client's pain. The client with the fractured jaw is experiencing pain and should be assessed next. The nurse should then assess the client who is NPO for tests to ensure NPO status and comfort. Last, the nurse can assess the client before surgery.

When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and symptoms should the nurse expect to assess? Select all that apply. 1. Epigastric pain at night. 2. Relief of epigastric pain after eating. 3. Vomiting. 4. Weight loss. 5. Melena.

3, 4, 5. Vomiting and weight loss are common with gastric ulcers. The client may also have blood in the stools (melena) from gastric bleeding. Clients with a gastric ulcer are most likely to complain of a burning epigastric pain that occurs about 1 hour after eating. Eating frequently aggravates the pain. Clients with duodenal ulcers are more likely to complain about pain that occurs during the night and is frequently relieved by eating.

The nurse is preparing to teach a client with a peptic ulcer about the diet that should be followed after discharge. The nurse should explain that the diet will most likely consist of which of the following? 1. Bland foods. 2. High-protein foods. 3. Any foods that are tolerated. 4. Large amounts of milk.

3. Diet therapy for ulcer disease is a controversial issue. There is no scientific evidence that diet therapy promotes healing. Most clients are instructed to follow a diet that they can tolerate. There is no need for the client to ingest only a bland or high-protein diet. Milk may be included in the diet, but it is not recommended in excessive amounts.

A client has been taking aluminum hydroxide (Amphojel) 30 mL six times per day at home to treat his peptic ulcer. He tells the nurse that he has been unable to have a bowel movement for 3 days. Based on this information, the nurse would determine that which of the following is the most likely cause of the client's constipation? 1. The client has not been including enough fiber in his diet. 2. The client needs to increase his daily exercise. 3. The client is experiencing an adverse effect of the aluminum hydroxide. 4. The client has developed a gastrointestinal obstruction.

3. It is most likely that the client is experiencing an adverse effect of the antacid. Antacids with aluminum salt products, such as aluminum hydroxide, form insoluble salts in the body. These precipitate and accumulate in the intestines, causing constipation. Increasing dietary fiber intake or daily exercise may be a beneficial lifestyle change for the client but is not likely to relieve the constipation caused by the aluminum hydroxide. Constipation, in isolation from other symptoms, is not a sign of a bowel obstruction.

A client is to take one daily dose of ranitidine (Zantac) at home to treat her peptic ulcer. The client understands proper drug administration of ranitidine when she says that she will take the drug at which of the following times? 1. Before meals. 2. With meals. 3. At bedtime. 4. When pain occurs.

3. Ranitidine blocks secretion of hydrochloric acid. Clients who take only one daily dose of ranitidine are usually advised to take it at bedtime to inhibit nocturnal secretion of acid. Clients who take the drug twice a day are advised to take it in the morning and at bedtime. It is not necessary to take the drug before meals. The client should take the drug regularly, not just when pain occurs.

A hospitalized client asks the nurse for sodium bicarbonate to relieve heartburn following a meal. The nurse reviews the client's medical record, knowing that the medication is contraindicated in which of the following conditions? 1. urinary calculi 2. chronic bronchitis 3. metabolic alkalosis 4. respiratory acidosis

3. Respiratory acidosis

An 80- year-old client has recently been started on cimetidine (Tagamet). The nurse monitors the client for which most frequent central nervous system (CNS) side effect of this medication? 1. Tremors 2. Dizziness 3. Confusion 4. Hallucination

3. confusion

A client is taking an antacid for treatment of a peptic ulcer. Which of the following statements best indicates that the client understands how to correctly take the antacid? 1. "I should take my antacid before I take my other medications." 2. "I need to decrease my intake of fluids so that I don't dilute the effects of my antacid." 3. "My antacid will be most effective if I take it whenever I experience stomach pains." 4. "It is best for me to take my antacid 1 to 3 hours after meals."

4. Antacids are most effective if taken 1 to 3 hours after meals and at bedtime. When an antacid is taken on an empty stomach, the duration of the drug's action is greatly decreased. Taking antacids 1 to 3 hours after a meal lengthens the duration of action, thus increasing the therapeutic action of the drug. Antacids should be administered about 2 hours after other medications to decrease the chance of drug interactions. It is not necessary to decrease fluid intake when taking antacids. If antacids are taken more frequently than recommended, the likelihood of developing adverse effects increases. Therefore, the client should not take antacids as often as desired to control pain.

A client with peptic ulcer disease is taking ranitidine (Zantac). What is the expected outcome of this drug? 1. Heal the ulcer. 2. Protect the ulcer surface from acids. 3. Reduce acid concentration. 4. Limit gastric acid secretion.

4. Histamine-2 (H2) receptor antagonists, such as ranitidine, reduce gastric acid secretion. Antisecretory, or proton-pump inhibitors, such as omeprazole (Prilosec), help ulcers heal quickly in 4 to 8 weeks. Cytoprotective drugs, such as sucralfate (Carafate), protect the ulcer surface against acid, bile, and pepsin. Antacids reduce acid concentration and help reduce symptoms.

A client with a peptic ulcer has been instructed to avoid intense physical activity and stress. Which strategy should the client incorporate into the home care plan? 1. Conduct physical activity in the morning so that he can rest in the afternoon. 2. Have the family agree to perform the necessary yard work at home. 3. Give up jogging and substitute a less demanding hobby. 4. Incorporate periods of physical and mental rest in his daily schedule.

4. It would be most effective for the client to develop a health maintenance plan that incorporates regular periods of physical and mental rest in the daily schedule. Strategies should be identified to deal with the types of physical and mental stressors that the client needs to cope with in the home and work environments. Scheduling physical activity to occur only in the morning would not be restful or practical. There is no need for the client to avoid yard work or jogging if these activities are not stressful.

A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric region along with a rigid, boardlike abdomen. These clinical manifestations most likely indicate which of the following? 1. An intestinal obstruction has developed. 2. Additional ulcers have developed. 3. The esophagus has become inflamed. 4. The ulcer has perforated.

4. The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This results in boardlike abdominal rigidity, usually with extreme pain. Perforation is a medical emergency requiring immediate surgical intervention because peritonitis develops quickly after perforation. An intestinal obstruction would not cause midepigastric pain. The development of additional ulcers or esophageal inflammation would not cause a rigid, boardlike abdomen.

A nurse teaches a client experiencing heartburn to take 1 ½ oz of Maalox when symptoms appear. How many milliliters should the client take? ________________________ mL. .

45 mL

A nurse gives a medication that inhibits acetylcholinesterase. How would this drug affect autonomic activity? A. Parasympathetic activity would increase. B. Parasympathetic signals would be depressed. C. Sympathetic activity would increase. D. Respiratory centers would be depressed.

A

A nurse is preparing to give bethanechol (Urecholine). What is an expected outcome of this drug? A. Nondistended bladder B. Increased heart rate and blood pressure C. Improved pulse oximetry reading D. Relief of cardiac rhythm problems

A

A patient has been switched to the immunomodulator etanercept (Enbrel) for severe rheumatoid arthritis. What is the mechanism of action for etanercept? A) It neutralizes tumor necrosis factor (TNF), thereby delaying the inflammatory disease process B) It inhibits IL-1 from binding to interleukin receptor sites in cartilage and bone C) It blocks COX-2 receptors, which are needed for biosynthesis for prostaglandins D) It promotes uric acid reabsorption

A

A patient is admitted to the hospital with an acute gout attack. The nurse expects that which medication will ordered to treat acute gout? A) colchicine B) allopurinol C) probenecid D) sulfinpyrazone

A

A patient is experiencing symptoms of the fight-or-flight response. Which autonomic process orchestrates this response? A. Stimulation of the sympathetic system B. Stimulation of the predominant tone of the organs C. Stimulation of the baroreceptor reflex D. Stimulation of the parasympathetic system

A

A patient is taking aspirin for arthritis. Which adverse reaction should the nurse teach the patient to report to the HCP? A) Tinnitus B) Seizures C) Sinusitis D) Palpitations

A

A patient with a complicated medical history including hypertension, atrial fibrillation, and arthritis calls the health care provider's office to speak with a nurse about "all of these bruises I have all of a sudden." Which potential drug interaction should concern the nurse with these symptoms? A) Aspirin and warfarin B) Sulfasalazine and acetaminophen C) Tolmetin and propranolol D) Meloxicam and amlodipine

A

By which action does colchincine (Colcrys) relieve the symptoms of gout? A) It inhibits the migration of leukocytes to the inflamed area B) It blocks reabsorption of uric acid C) It blocks prostaglandin release D) It inhibits uric acid synthesis

A

Ibuprofen is a frequently prescribed anti-inflammatory, analgesic, and antipyretic. What is the positive aspect of this drug in relation to other NSAIDs? A) It tends to cause less GI irritation B) It may be taken between meals C) It has a long half-life of 20-30 hours D) It has no drug-drug interactions

A

In the failing heart, arterial pressure falls, stimulating the baroreceptor reflex to increase sympathetic nervous system activity. Which finding is an expected outcome of increased sympathetic activity? A. Tachycardia B. Bradypnea C. Hypotension D. Hypoglycemia

A

Teaching for a patient with angina who is being discharged with a prescription for nitroglycerin sublingual tablets should include which instruction? A. "Store the tablets in their original dark container." B. "The tablets are only good for 1 month after the container is opened." C. "Sublingual nitroglycerin tablets are also effective when swallowed whole." D. "Effects of sublingual nitroglycerin begin in 5 to 10 minutes."

A

The nurse has just administered the initial dose of enalapril (Vasotec) to a newly admitted patient. Which nursing intervention takes priority over the next several hours? A. Monitoring the blood pressure B. Measuring the heart rate C. Auscultating the lungs D. Drawing blood for potassium levels

A

The nurse in the cardiac care unit is caring for a patient receiving epinephrine. Which assessment criterion takes priority in the monitoring for adverse effects of this drug? A. Cardiac rhythm B. Blood urea nitrogen C. Central nervous system (CNS) tremor D. Lung sounds

A

The nurse is caring for a patient receiving atropine (Sal-Tropine). Which is a therapeutic indication for giving this drug? A. Use as a preanesthesia medication B. Treatment of tachycardias C. Prevention of urinary retention D. Reduction of intraocular pressure in glaucoma

A

The nurse is caring for a patient with a suspected overdose of pancuronium, which was used during surgery. Which drug does the nurse anticipate will be used as a reversal agent? A. Neostigmine (Prostigmin) B. Atropine (Sal-Tropine) C. Pralidoxime (DuoDote) D. Dobutamine (Dobutrex)

A

The nurse is caring for a pregnant patient who is experiencing a new episode of hypertension. Which agent does the nurse anticipate will be prescribed for this patient? A. Methyldopa (Aldomet) B. Propranolol (Inderal) C. Captopril (Capoten) D. Valsartan (Diovan)

A

The nurse is preparing to administer a daily dose of digoxin (Lanoxin). Which assessment receives priority at this time? A. Evaluating for a change in the heart rhythm B. Assessing for Homans' sign C. Checking the blood pressure D. Palpating the pedal pulses

A

The nurse is preparing to administer a dose of clonidine (Catapres). Which is the best description of the action of this drug? A. It selectively activates alpha2 receptors in the central nervous system (CNS). B. It causes peripheral activation of alpha1 and alpha2 receptors. C. It depletes sympathetic neurons of norepinephrine. D. It directly blocks alpha and beta receptors in the periphery.

A

The nurse knows that diuretics mostly affect which function of the kidneys? A. Cleansing and maintenance of extracellular fluid volume B. Maintenance of acid-base balance C. Excretion of metabolic waste D. Elimination of foreign substances

A

The nurse knows that which drug acts by suppressing axonal conduction? A. Lidocaine (Xylocaine) - local anesthetic B. Citalopram (Celexa) - antidepressant C. Morphine (Duramorph) - pain reliever D. Halothane (Fluothane) - general anesthetic

A

The nurse notices significant edema surrounding and proximal to the peripheral intravenous (IV) site where epinephrine is being infused. Which action would the nurse anticipate first? A. Prepare to administer phentolamine (Regitine) B. Ensure that naloxone (Narcan) is available C. Institute the protocol for congestive heart failure (CHF) D. Monitor the blood urea nitrogen (BUN), creatinine, and potassium levels

A

The nurse should monitor for which adverse effect after administering hydrochlorothiazide (HydroDIURIL) and digoxin (Lanoxin) to a patient? A. Digoxin toxicity B. Decreased diuretic effect C. Dehydration D. Heart failure

A

Which agent is in the category of drugs considered most effective for lowering LDL cholesterol? A. Atorvastatin (Lipitor) B. Cholestyramine (Questran) C. Gemfibrozil (Lopid) D. Ezetimibe (Zetia)

A

Which statement is the most appropriate to include in the teaching plan for a 30-year-old woman beginning a new prescription of clonidine (Catapres)? A. "If you stop taking this drug abruptly, your blood pressure might go up very high." B. "You will need to have your blood drawn regularly to check for anemia." C. "Take this medication first thing in the morning to reduce nighttime wakefulness." D. "This medication often is used to manage hypertension during pregnancy."

A

The nurse reads that the half-life of the medication being administered is 12 hours. What interpretation will guide the nurse's care of this patient? A. This medication will be 50% eliminated in 12 hours, so the dosing will be spread apart. B. The medication will be administered every 6 hours to maintain consistent blood levels. C. The medication will not work for the first 12 hours. D. The patient will require two doses of the medication before there is an effect.

A The half-life (t½) of a drug is the time it takes for one-half of the drug concentration to be eliminated. Metabolism and elimination affect the half-life of a drug. For example, with liver or kidney dysfunction, the half-life of the drug is prolonged, and less drug is metabolized and eliminated. When a drug is taken continually, drug accumulation may occur.

The nurse realizes that a drug administered by which route will require the most immediate evaluation of therapeutic effect? A. Intravenous B.Oral C. Subcutaneous D. Topical

A The percentage of bioavailability for the oral route is always less than 100%, but for the IV route it is 100%.

A patient is complaining of pain rated "10" on a scale of 1 to 10. The nurse has several choices of pain medication to administer. Which order is the best for the nurse to administer at this time? A. Morphine sulfate 1 mg IV (intravenous) B. MS Contin 2 tablets PO (by mouth) C. Transdermal patch D. Tylenol suppository

A When a drug is administered intravenously, it does not need to be absorbed because it is placed directly into general circulation. The other medications will not have an immediate effect.

A nurse is administering two highly protein-bound drugs to the patient. Which is the safest course of action for the nurse to take? A. Assess the patient frequently for the risk of drug-drug interactions. B. Administer the drugs with food. C. Administer the drugs with 8 ounces of water. D. Assess baseline liver function tests.

A When two highly protein-bound drugs are given concurrently, they compete for protein-binding sites, thus causing more free drug to be released into the circulation. In this situation, drug accumulation and possible drug toxicity can result. Also, a low serum protein level decreases the number of protein-binding sites and can cause an increase in the amount of free drug in the plasma. Drug toxicity may then result. Drug dose is prescribed according to the percentage in which the drug binds to protein.

Which systems are the primary regulators of arterial pressure? (Select all that apply.) A. Autonomic nervous system B. Renin-angiotensin-aldosterone system C. Renal system D. Pulmonary system E. P450 enzyme system

A, B, C

A patient is taking infliximab (Remicade) and asks the nurse what side effects/adverse reactions to expect from this drug? The nurse lists which side effects? (select all that apply) A) Fatique B) Headache C) Chest pain D) Renal damage E) Severe infections

A, B, C, & E

Which medication or medications should be used with caution in a hypertensive diabetic patient? (Select all that apply.) A. Furosemide (Lasix) B. Metoprolol (Lopressor) C. Diltiazem (Cardizem) D. Hydrochlorothiazide (HCTZ) E. Enalapril (Vasotec)

A, B, D

The nurse has administered several oral medications to the patient. Which factors will influence the absorption of these medications? (Select all that apply.) A. Presence of food in the stomach B. pH of the stomach C. Patient position upon intake of medication D. Form of drug preparation E. Pain F. Amount of saliva

A, B, D, E The presence of food in the stomach usually decreases absorption of drugs but may increase absorption for a few specific medications. The pH of the stomach affects absorption of drugs dependent on the pH of the drug. Alkaline drugs are absorbed more readily in an alkaline environment, and acidic drugs are absorbed more readily in an acidic environment. The form of the drug also affects absorption, with liquid drugs being absorbed the fastest and enteric-coated tablets the slowest. Pain can affect absorption by slowing gastric emptying time. Position will not influence absorption. Amount of saliva will not influence absorption.

A 68-year-old woman with a history of myocardial infarction is beginning a new prescription for lovastatin (Mevacor). Which statements by the nurse are appropriate to include in the teaching plan? (Select all that apply.) A. "Call if you get new prescriptions from other providers, because several medications can interact with lovastatin." B. "Return to the clinic every 6 to 12 months so we can run blood tests for possible side effects." C. "Take your medication once a day, first thing in the morning, with a full glass of water for best results." D. "Take one 325-mg aspirin 30 minutes before your dose to lessen the problem of flushing and itching that can occur with this drug." E. "Lower the total fat and saturated fat in your diet by increasing your intake of fresh fruits and vegetables and whole grains."

A, B, E

The nurse is teaching an older adult patient with hypertension who has a new prescription for verapamil (Calan). Which statement or statements by the patient indicate that the teaching was effective? (Select all that apply.) A. "I will increase my intake of fluid and foods high in fiber." B. "I will avoid exposing my skin to the sun." C. "I will call my physician if I notice swelling in my ankles." D. "I will avoid salt substitutes and potassium supplements." E. "I may notice easy bruising and bleeding with this drug."

A, C

The nurse is teaching a patient about taking aspirin. Which are important points for the nurse to include? (select all that apply) A) Advise patient to avoid alcohol while taking aspirin. B) Instruct the patient to take aspirin before meals on an empty stomach. C) Instruct the patient to inform the dentist of the aspirin dosage before having dental work D) Instruct the patient to inform surgeon of the aspirin dosage before having surgery. E) Suggest that aspirin may be given to children for flu symptoms.

A, C, & D

A patient has started on corticosteriods for an arthritic condition. What information should the nurse include in a health teaching plan? (Select all that apply) A) Corticosteroids are used to control arthritic flare-ups in severe cases B) Corticosteroids have a short half-life C) Corticosteroids are usually administered once a day D) Corticosteroids are tapered over the course of 5-10 days E) Corticosteroids may not be taken with prostaglandin inhibitors

A, C, D

Patients receiving nitroglycerin are at risk for which adverse effects? (Select all that apply.) A. Headache B. Wheezing C. Dizziness D. Tachycardia E. Bradycardia

A, C, D

A patient who is taking NSAIDs for arthritis complains of persistent heartburn. What further question(s) should the nurse ask the patient about heartburn? (Select all that apply) A) "Do you take your medications with food?" B) "Have you been drinking an increased amount of water?" C) "Have you noticed a change in the color of your bowel movements?" D) "What dosage of the NSAID are you taking?" E) "Where is your heartburn located?"

A, C, D, E

The nurse is administering isoproterenol, a beta1 and beta2 agonist. The nurse expects the patient to show which effects of this drug? (Select all that apply.) A. Increased heart rate B. Excessive drowsiness C. Increased force of heart contraction D. Decreased cardiac output E. Bronchial dilation F. Decreased glucose levels

A, C, E

The nurse assesses a client for the risk for gastric cancer. Which of these factors would likely increase the client's risk? Select all that apply. A. Having a history of untreated gastroesophageal reflux disease B. Being an adult between 20 and 40 years of age C. Eating a diet high in smoked and pickled foods D. Eating a diet with high-fiber foods E. Eating a diet high in salt and adding salt to food

A,C,E Gastric cancer seems to be correlated with eating pickled foods, nitrates from processed foods, and salt added to food. The ingestion of these foods over a long period can lead to atrophic gastritis, a precancerous condition. Clients with Barrett's esophagus from prolonged or severe GERD have an increased risk for cancer in the cardia (at the point where the stomach connects to the esophagus). The average age for developing gastric cancer is 70 years of age. Increasing the intake of high-fiber foods will decrease a person's risk for development of gastric cancer. Reference: p(

The nurse is teaching the client with peptic ulcer disease (PUD) about the prescribed drug regimen. Which statement made by the client indicates a need for further teaching before discharge? A. "Nizatidine (Axid) needs to be taken three times a day to be effective." B. "Taking ranitidine (Zantac) at bedtime should decrease acid production at night." C. "Sucralfate (Carafate) should be taken 1 hour before and 2 hours after meals." D. "Omeprazole (Prilosec) should be swallowed whole and not crushed."

A. "Nizatidine (Axid) needs to be taken three times a day to be effective." Nizatidine (Axid) is most effective if administered twice daily.

. The client has been diagnosed with terminal gastric cancer and is interested in obtaining support from hospice, but expresses concern that pain management will not be adequate. What is the nurse's best response? A. "Pain control is a major component of the care provided by hospice and its staff members." B. "What has your doctor told you about participating in hospice?" C. "I can speak to your physician about requesting adequate pain medication." D. "You don't want to become too dependent on pain medication and become an addict."

A. "Pain control is a major component of the care provided by hospice and its staff members." This response correctly describes the services provided by hospice and its staff members, and helps reassure the client about their expertise in pain management.

The patient is pregnant and asks the nurse about changing from her prescription antidepressant medication to St. John's wort because it is natural. What is the best response by the nurse? Select one: A. "St. John's wort is a drug, and this should be discussed with your doctor." B. "It should be okay because your baby has been exposed to an antidepressant." C. "No, herbal preparations are just not safe to take during pregnancy." D. "Yes, you can change, but let your doctor know at your next appointment."

A. "St. John's wort is a drug, and this should be discussed with your doctor."

A stroke patient who primarily uses a wheelchair for mobility has diarrhea with fecal incontinence. What should the nurse assess first? A. Fecal impaction B. Perineal hygiene C. Dietary fiber intake D. Antidiarrheal agent use

A. Fecal impaction Patients with limited mobility are at risk for fecal impactions due to constipation that may lead to liquid stool leaking around the hardened impacted feces, so assessing for fecal impaction is the priority. Perineal hygiene can be assessed at the same time. Assessing the dietary fiber and fluid intake and antidiarrheal agent use will be assessed and considered next.

A client with a history of duodenal ulcer is taking calcium carbonate chewable tablets. The nurse determines that the client is experiencing optimal effects of the medication if: A. Heart burn is relieved B. Muscle twitching stops C. Serum calcium levels rise D. Serum phosphrous levels decrease

A. Heart burn is relieved

. The nurse is caring for an older adult male client who reports stomach pain and heartburn. Which syndrome is most significant in determining whether the client's ulceration is gastric or duodenal in origin? A. Pain occurs 1 1/2 to 3 hours after a meal, usually at night. B. Pain is worsened by the ingestion of food. C. The client has a malnourished appearance. D. The client is a man older than 50 years.

A. Pain occurs 1 1/2 to 3 hours after a meal, usually at night. A key symptom characteristic of duodenal ulcers is that pain usually awakens the client between 1 AM and 2 AM, occurring 1 1/2 to 3 hours after a meal.

A patient with a history of peptic ulcer disease has presented to the emergency department reporting severe abdominal pain and has a rigid, boardlike abdomen that prompts the health care team to suspect a perforated ulcer. What intervention should the nurse anticipate? A. Providing IV fluids and inserting a nasogastric (NG) tube B. Administering oral bicarbonate and testing the patient's gastric pH level C. Performing a fecal occult blood test and administering IV calcium gluconate D. Starting parenteral nutrition and placing the patient in a high-Fowler's position

A. Providing IV fluids and inserting a nasogastric (NG) tube A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Nothing is given by mouth, and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevant to the patient's suspected diagnosis, and parenteral nutrition is not a priority in the short term.

The client is scheduled to be discharged after a gastrectomy. The client's spouse expresses concern that the client will be unable to change the surgical dressing adequately. What is the nurse's highest priority intervention? A. Providing both oral and written instructions on changing the dressing and on symptoms of infection that must be reported to the physician B. Asking the physician for a referral for home health services to assist with dressing changes C. Asking the spouse whether other family members could be taught how to change the dressing D. Trying to determine specific concerns that the spouse has regarding dressing changes

A. Providing both oral and written instructions on changing the dressing and on symptoms of infection that must be reported to the physician Providing the spouse with both oral and written instructions on symptoms to report to the physician, as well as on how to perform the dressing change, will reinforce important points and boost the spouse's confidence.

The client is experiencing bleeding related to peptic ulcer disease (PUD). Which nursing intervention is the highest priority A. Starting a large-bore intravenous (IV) B. Administering intravenous (IV) pain medication C. Preparing equipment for intubation D. Monitoring the client's anxiety level

A. Starting a large-bore intravenous (IV) A large-bore IV should be placed as requested, so that blood products can be administered.

The physician prescribes docusate sodium (Colace) fo the client. The client asks the nurse to explain why the medication is needed. Which explanation given by the nurse correctly states the purpose of medication? A. To ease bowel evacuation and its related discomfort B. To irriatate the bowel and promote stool elimination C. To stimulate peristalsis to remove wastes after the digestion D. To reduce intestinal activity and decrease stool size

A. To ease bowel evacuation and its related discomfort Rationale: Docusate sodium (Colace) is a stool softner, retaining water in the stool, softens the mass and makes stool easier and less painful to pass.

A patient complains of nausea. When administering a dose of metoclopramide (Reglan), the nurse should teach the patient to report which potential adverse effect? A. Tremors B. Constipation C. Double vision D. Numbness in fingers and toes

A. Tremors Extrapyramidal side effects, including tremors and tardive dyskinesias, may occur as a result of metoclopramide (Reglan) administration. Constipation, double vision, and numbness in fingers and toes are not adverse effects of metoclopramide.

The nurse working during the day shift on the medical unit has just received report. Which client will the nurse plan to assess first? A. Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy B. Adult who had a subtotal gastrectomy and is experiencing dizziness and diaphoresis after each meal C. Middle-aged client with Zollinger-Ellison syndrome who needs to receive omeprazole (Prilosec) before breakfast D. Older adult with advanced gastric cancer who is scheduled to receive combination chemotherapy

A. Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy This client is experiencing symptoms of acute gastric dilation, which can disrupt the suture line. The surgeon should be notified immediately because the nasogastric tube may need irrigation or repositioning.

A physician has written an order for ranitidine (Zantac) once daily. The nurse schedules the medications for which of the following times? A. At bed time B. After lunch C. With supper D. Before breakfast

A. at bed time, ranitidine (Zantac) is an H2 blocker

The nurse knows that one of the more common complications resulting from drug-herbal interactions would involve Select one: A. blood coagulation. B. hair growth. C. vision loss. D. urine output.

A. blood coagulation.

A client has an order to take magnesium citrate to prevent constipation following a barium study of the upper gastrointestinal (GI) tract. The nurse plans to administer this medication: A. chilled B. with fruit juice only C. room temp D. with a full glass of water

A. chilled

Two days following a colectomy for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms are occurring as a result of A. impaired peristalsis. B. irritation of the bowel. C. nasogastric suctioning. D. inflammation of the incision site.

A. impaired peristalsis. Until peristalsis returns to normal following anesthesia, the patient may experience slowed gastrointestinal motility leading to gas pains and abdominal distention. Irritation of the bowel, nasogastric suctioning, and inflammation of the surgical site do not cause gas pains or abdominal distention.

A nurse is reviewing medications for a client who has a diagnosis of small bowel obstruction. The nurse should withhold Senna (Senoket) prescribed orally based on an understanding of which of the following? A. laxatives are contraindicated in clients who have small bowel obstruction B. Only bulk-forming laxatives such as psyllium (Metamucil) should be prescribed C. Medication should be administered via NG tube than oral route D. Opioid analgesics, rather than laxative should be prescribed to alleviate discomfort

A. laxatives are contraindicated in clients who have small bowel obstruction Rationale: Laxatives are contraindicated in clients who have fecal impactation, bowel obstruction, and acute abdominal surgery to prevent perforation. Laxatives will cause increased abdominal cramping and discomfort

Your client is dx with end stage liver failure and receiving lactulose/granulote. which lab test tells you it is effective? A. serum ammonia B. BUN C. sodium D. serum Creatinine

A. serum ammonia

A general term that encompasses all types of clinical problems related to medication use is a(n) _______ _____ ________.

Adverse drug event.

A(n) ______ ____ reaction is defined as unexpected, unintended, or excessive responses to medications given at therapeutic dosages (as opposed to overdose), which is one type of adverse drug event.

Adverse drug.

The pt develops Stevens-Johnson syndrome after administration of Dilantin. The nurse would recognize this is a(n)...

Adverse reaction.

Which organs are controlled primarily by the parasympathetic system? (Select all that apply.) A. Gastrointestinal tract B. Respiratory tract C. Cardiovascular system D. Skin E. Salivary glands

All except C

Which receptors below are considered adrenergic receptors? (Select all that apply.) A. Alpha1 B. Beta2 C. Dopamine D. Muscarinic1 E. Beta1 F. Alpha2

All except D

Which are beneficial effects that can be derived from simvastatin (Zocor) and other agents in this class? (Select all that apply.) A. Reduction of LDLs B. Elevation of HDLs C. Stabilization of the plaque in coronary arteries D. Reduction of risk of cardiovascular events E. Improvement of liver function

All except E

A(n) ________ reaction i an immunologic reaction resulting from an unusual sensitivity of a pt to a particular medication.

Allergic

The nurse keeps in mind that which measure is used to reduce the risk of medication errors?

Always double-check the many drugs with sound-alike and look-alike names because of the high risk of error.

The nurse is administering atenolol (Tenormin) to a client. Which concurrent drug does the nurse expect to most likely cause an interaction? a. ginseng herb b. An NSAID, such as aspirin c. methyldopa (Aldomet) d. heloperidol (Haldol)

An NSAID, such as aspirin

When admitting an older adult patient to an acute care setting, which nursing strategy is most appropriate to prevent medication errors?

Ask the patient or family to bring in all medications the patient was taking at home. -The USP recommends the use of "brown bagging" sessions of medications to identify drugs that patients are taking. Patients, family, or the primary care physician may not always accurately report all medications a patient is using. Actual examination of the medications and containers provides the most accurate assessment of current medications and allows for appropriate medication reconciliation.

The nurse is preparing to administer morning doses of medications to a pt and has just checked the pt's name on the id band. The pt has stated his name. Which is the nurse's next appropriate action?

Ask the pt to verify the pt's date of birth.

Which phase of the nursing process requires the nurse to establish a comprehensive baseline of data concerning a particular pt?

Assessment

The nurse is preparing a care plan for a patient who has been newly diagnosed with type 2 diabetes mellitus. Which of these reflect the correct order of the steps of the nursing process?

Assessment, Nursing Diagnoses, Planning, Implementation, Evaluation

A 35-year-old female patient has been prescribed ibuprofen 400 mg t.i.d. for arthritis. What statement by the patient would indicate a need for further education? A) "This medication should cause less GI upset than other NSAIDs." B) "Now I won't have to drink so much water." C) "I know this medicine might cause some diarrhea." D) "I will need to stop taking this medication if I get pregnant."

B

A nurse is preparing to give a drug that stimulates the parasympathetic nervous system. Which patient response is an expected outcome of this drug? A. Wheezing decreases due to bronchodilation. B. Heart rate decreases to 60 beats per minute. C. Diarrhea stool count decreases. D. Oxygenation improves because of bronchodilation.

B

A patient is admitted to the emergency department in hypertensive crisis, and examination reveals papilledema. The nurse would expect which IV medications to be administered to achieve rapid, controlled reduction of the patient's blood pressure? A. Furosemide (Lasix) B. Sodium nitroprusside (Nitropress) C. Metoprolol (Lopressor) D. Diltiazem (Cardizem)

B

Initial therapy for hypertension after a myocardial infarction (MI) includes drugs from which classes? A. Diuretic and beta blocker B. Beta blocker and ACE inhibitor C. ACE inhibitor and calcium channel blocker D. Diuretic and calcium channel blocker

B

Natriuretic peptides serve to protect the cardiovascular system under which condition? A. Hypovolemia B. Volume overload C. Myocardial infarction D. Hypotension

B

The heart undergoes cardiac remodeling during the early phase of heart failure. Which finding describes the geometric changes that occur during heart failure? A. Ventricular constriction B. Ventricular wall thickening C. Ventricular atrophy D. Ventricles become more cylindric

B

The nurse can best describe what is meant by activation of a receptor with which phrase? A. An effect that causes the physiologic process to speed up B. An effect that mimics the natural neurotransmitter for that receptor C. An effect that improves the function of the receptor D. An effect that causes the receptor to be more sensitive

B

The nurse is caring for a group of patients who are all receiving anticholinergic drugs. In which patient is an anticholinergic drug contraindicated? A. A 60-year-old woman with an overactive bladder (OAB) B. A 72-year-old man with glaucoma C. A 45-year-old woman with peptic ulcer disease (PUD) D. A 26-year-old man being prepared for surgery today

B

The nurse is caring for a patient receiving a nitroprusside (Nipride) intravenous infusion. The patient's wife asks why furosemide (Lasix) is being prescribed along with this drug. The nurse's response is based on which concept? A. Furosemide will help reduce reflex tachycardia. B. Many vasodilators cause retention of sodium and water. C. Thiocyanate may accumulate in patients receiving nitroprusside. D. Vasodilators can cause serious orthostatic hypotension.

B

The nurse is caring for a patient receiving propranolol (Inderal). Which finding is most indicative of an adverse effect of this drug? A. A heart rate of 100 beats per minute B. Wheezing C. A glucose level of 180 mg/dL D. Urinary urgency

B

The nurse is caring for a patient who has diabetes and hypertension. Which agent is most likely to be prescribed to treat this patient's hypertension? A. Hydrochlorothiazide (HCTZ) B. Enalapril (Vasotec) C. Propranolol (Inderal) D. Methyldopa (Aldomet)

B

The nurse is caring for a patient with bipolar disorder treated with lithium (Eskalith). The patient has a new prescription for captopril (Capoten) for hypertension. The combination of these two drugs makes which assessment particularly important? A. Potassium level B. Lithium level C. Creatinine level D. Blood pressure

B

The nurse is conducting discharge teaching for a patient with a new prescription for transdermal nitroglycerin. Which statement by the patient indicates a need for further teaching? A. "I will remove my patch at bedtime each evening." B. "I will limit my alcohol to one drink per day." C. "I will not use Viagra as long as I am on nitroglycerin." D. "I will move slowly when changing positions."

B

The nurse is preparing to give neostigmine (Prostigmin). What best describes the action of this drug? A. It inhibits acetylcholine at all cholinergic synapses. B. It prevents inactivation of acetylcholine. C. It prevents activation of muscarinic receptors. D. It stimulates activation of adrenergic receptors.

B

The nurse is teaching a patient who has just been prescribed a vasodilator. Which statement by the patient indicates that the teaching was effective? A. "I will take this medication in the morning to reduce nighttime urination." B. "I will rise slowly when changing from a sitting to a standing position." C. "My heart rate may slow down with this drug. I will call if my pulse is below 60." D. "I will increase my intake of fluids and foods that are high in fiber."

B

The renin-angiotensin-aldosterone system plays an important role in maintaining blood pressure. Which compound in this system is most powerful at raising the blood pressure? A. Angiotensin I B. Angiotensin II C. Angiotensin III D. Renin

B

Uricosuric agents such as probenecid (Benemid) are used in treatment of gout. What is the mechanism of action? A) Retention of urate crystals in the body B) Inhibitation of the reabsorption of uric acid C) Promotion of uric acid removal in the ureters D) Increased release of uric acid

B

What is the primary benefit of spironolactone (Aldactone) in patients with heart failure? A. Profound diuresis and fluid loss B. Blockage of aldosterone receptors C. Inhibition of beta activation by norepinephrine D. Stimulation of the renin-angiotensin-aldosterone system

B

When preparing discharge teaching for a patient who has been prescribed ibuprofen for arthritis, how does the nurse explain the mode of action? A) "Ibuprofen is a COX-2 inhibitor, so it blocks prostaglandin synthesis." B) "Ibuprofen inhibits prostaglandin synthesis." C) "Ibuprofen binds with opiate receptor sites." D) "Ibuprofen promotes vasodilation to increase blood flow."

B

Which label most aptly describes the drug atropine (Sal-Tropine)? A. Cholinergic B. Parasympatholytic C. Muscarinic agonist D. Parasympathomimetic

B

Which physiologic mechanism helps to ensure venous return despite low pressure in the venules? A. Positive pressure in the right atrium B. Negative pressure in the right atrium C. Vasodilation in the periphery D. Cardiac muscle relaxation

B

Which scenario would warrant an immediate call to the physician by the nurse? A. A patient who takes digoxin 0.125 mg orally daily presents with a serum digoxin level of 0.8 ng/mL. B. A patient who takes oral spironolactone (Aldactone) 25 mg daily and enalapril (Vasotec) 5 mg daily presents with a serum potassium level of 5.5 mEq/L. C. A patient who takes digoxin 0.25 mg orally daily presents with a serum potassium level of 4.0 mEq/L. D. A patient who takes oral lisinopril (Zestril) 5 mg daily and digoxin 0.125 mg daily presents with a serum digoxin level of 0.5 ng/mL.

B

Which statement made by the nurse is most important to include in the teaching plan for a patient being discharged from the hospital with a new prescription for prazosin (Minipress)? A. "You should increase your intake of fresh fruits and vegetables." B. "You should move slowly from a sitting to a standing position." C. "Be sure to wear a Medic Alert bracelet while taking this medication." D. "Take your first dose of this medication first thing in the morning."

B

Why does the nurse anticipate administering metoprolol (Lopressor) rather than propranolol (Inderal) for diabetic patients who need a beta-blocking agent? A. Metoprolol is less likely to cause diabetic nephropathy. B. Propranolol causes both beta1 and beta2 blockade. C. Metoprolol helps prevent retinopathy in individuals with diabetes. D. Propranolol is associated with a higher incidence of foot ulcers.

B

Which statement best indicates that the nurse understands the meaning of pharmacokinetics? A. "It involves the study of physiologic interactions of drugs." B. "It explains the distribution of the drug between various body compartments." C. "It explains interactions between various drugs." D. "It explains the adverse reactions to drugs."

B Pharmacokinetics involves the study of how the drug moves through the body, including absorption, distribution, metabolism, and excretion.

The nurse administers 650 mg of aspirin at 7 PM. The drug has a half-life of 3 hours. The nurse interprets this information to mean that 325 mg of the medication will have been eliminated from the patient's system by what time? A. 7 AM B. 10 PM C. 1 AM D. 10 AM

B The half-life (t½) of a drug is the time it takes for one-half of the drug concentration to be eliminated. If 650 mg of aspirin is administered at 7 PM, half of the amount (325 mg) will be eliminated in 3 hours, which would be 10 PM.

The nurse is caring for a patient with hypertension who is receiving verapamil (Calan). The patient has a healthy heart. What pharmacodynamic effects does the nurse expect from this drug? (Select all that apply.) A. Peripheral vasoconstriction B. Peripheral vasodilation C. Coronary vasodilation D. Increased heart rate E. Increased force of contraction

B, C

The nurse is preparing to give terbutaline (Brethine) to prevent preterm labor. Which concepts are important to keep in mind when working with this drug? (Select all that apply.) A. Terbutaline must be given by a parenteral route. B. The selectivity of terbutaline is dose dependent. C. The patient may experience tremor with terbutaline. D. Terbutaline is a sympathomimetic drug. E. Bronchoconstriction is a potential adverse effect of terbutaline.

B, C, D

Which are the main families of drugs used to prevent or relieve anginal pain? (Select all that apply.) A. Platelet inhibitors B. Beta blockers C. Nitrates D. Calcium channel blockers D. Statins

B, C, D

Which statement or statements accurately reflect Starling's law as applied to a healthy heart? (Select all that apply.) A. When venous return increases, stroke volume decreases. B. The right and left ventricles pump the same amount of blood. C. Cardiac output is equal to the volume of blood delivered by the veins. D. When venous return increases, cardiac output increases. E. As cardiac muscle fibers increase in length, their contractile force decreases.

B, C, D

The nurse is planning teaching regarding antigout medication. What information should be included? (Select all that apply) A) Include large doses of vitamin C supplements B) Increase fluid intake C) Avoid alcoholic beverages D) Avoid foods high in purine E) Take medication with food F) Avoid direct sunlight

B, C, D, E

A client with a recent diagnosis of acute gastritis needs health teaching about nutrition therapy. Which foods and beverages should the nurse teach the client to avoid? Select all that apply. A. Potatoes B. Onions C. Apples D. Milk E. Orange juice F. Tomato juice

B,E,F (A balanced diet includes following the recommendations of the USDA and limiting the intake of foods and spices that can cause gastric distress. Acidic foods such as citrus fruits and juices and tomatoes should be avoided. Gas-forming foods such as onions should also be eliminated from the diet. Potatoes are relatively bland and often do not cause gastric upset. Apples are not acidic or irritating to the gastric mucosa and need not be avoided. Milk may actually have a beneficial coating effect on the gastric mucosa. Reference: p. 1225, Health Promotion and Maintenance

The older adult asks the nurse how dietary supplements will help support health. What is the best response by the nurse? Select one: A. "Chromium will help you achieve and maintain optimum weight." B. "Fish oil will help to enhance your brain function." C. "Dietary supplements will help support and maintain hydration." D. "Soy isoflavone will help prevent Alzheimer's disease."

B. "Fish oil will help to enhance your brain function."

The client with peptic ulcer disease (PUD) asks the nurse whether a maternal history of ovarian cancer will cause the client to develop gastric cancer. What is the nurse's best response? A. "Yes, it is known that a family history of ovarian cancer will cause someone to develop gastric cancer." B. "If you are concerned that you are at high risk to develop gastric cancer, I would recommend that you speak to your physician about the possibility of genetic testing." C. "Have you spoken to your physician about your concerns?" D. "I wouldn't be too concerned about that as long as your diet limits pickled, salted, and processed food."

B. "If you are concerned that you are at high risk to develop gastric cancer, I would recommend that you speak to your physician about the possibility of genetic testing." Genetic counseling will help the client determine whether he is at exceptionally high risk to develop gastric cancer.

A nurse is talking with a client who has peptic ulcer disease and is starting therapy with sucralfate (Carafate). The nurse should instruct the client to take this medication: A. with antacid B. 1 hr before meals C. with food or milk D. immediatly after meals

B. 1 hr before meals rationale: Sucralfate is a mucosal protectant, the client should take it on an empty stomach, 1 hr before meals, for maximum effectiveness

A 61-year-old patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the day shift staff should check the tube for patency at what times? A. 7:00 AM, 10:00 AM, and 1:00 PM B. 8:00 AM, 12:00 PM, and 4:00 PM C. 9:00 AM and 3:00 PM D. 9:00 AM, 12:00 PM, and 3:00 PM

B. 8:00 AM, 12:00 PM, and 4:00 PM A nasogastric tube should be checked for patency routinely at 4-hour intervals. Thus if the tube were inserted at 4:00 AM, it would be due to be checked at 8:00 AM, 12:00 PM, and 4:00 PM.

. The client with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's best response? A. "No, they probably won't be useful. You should use only prescription medications in your treatment plan." B. "These herbs could be helpful. However, you should talk with your physician before adding them to your treatment regimen." C. "Yes, these are known to be effective in managing this disease, but make sure you research the herbs thoroughly before taking them." D. "No, herbs are not useful for managing this disease. You can use any type of over-the-counter drugs though. They have been shown to be safe."

B. Although these herbs may be helpful in managing PUD, the client should consult his or her physician before making a change in the treatment regimen.

A nurse is caring for a client with cirrhosis who has a new prescription for cephulac (Lactulose). Following administration, the nurse will monitor the client for which adverse effect of this medication? A. Dry mouth B. Diarrhea C. Headache D. Peripheral edema

B. Diarrhea Rationale: The nurse will monitor for diarrhea, Lactulose is a synthetic disaccharide that the small intestine cannot utilize. It causes diarrhea by lowering the ph so that the bacterial flora are changed in the bowel

After administering a dose of promethazine (Phenergan) to a patient with nausea and vomiting, what common temporary adverse effect of the medication does the nurse explain may be experienced? A. Tinnitus B. Drowsiness C. Reduced hearing D. Sensation of falling

B. Drowsiness Although being given to this patient as an antiemetic, promethazine also has sedative and amnesic properties. For this reason, the patient is likely to experience drowsiness as an adverse effect of the medication. Tinnitus, reduced hearing, and loss of balance are not side effects of promethazine.

A client is relying on OTC laxatives for regular elimination. Which of the following pieces of information is most important for the nurse to provide to the client? A. daily bowel movements are not necessary for good intestinal health B. Excessive laxative use may cause decreased sodium levels C. Chronic use of laxatives can lead to dependency of elimination D. The client should increase intake of high-fiber diet

B. Excessive laxative use may cause decreased sodium levels Rationale: Excessive laxative use causes G.I. system to become dependent on external methods to achieve elimination - Laxative dependence weakens peristalsis and musculature of colon

The patient who is admitted with a diagnosis of diverticulitis and a history of irritable bowel disease and gastroesophageal reflux disease (GERD) has received a dose of Mylanta 30 mL PO. The nurse should evaluate its effectiveness by questioning the patient as to whether which symptom has been resolved? A. Diarrhea B. Heartburn C. Constipation D. Lower abdominal pain

B. Heartburn Mylanta is an antacid that contains both aluminum and magnesium. It is indicated for the relief of GI discomfort, such as heartburn associated with GERD. Mylanta can cause both diarrhea and constipation as a side effect. Mylanta does not affect lower abdominal pain.

A client has been taking omeprazole (Prilosec) for 4 weeks. The nurse determines that the client is receiving the optimal intended effect of the medication if the client reports absence of which of the following symptoms? A. Diarrhea B. Heartburn C. Flatulence D. Constipation

B. Heartburn ,omeprazole (Prilosec) is used for GERD

The nurse is planning care for a 68-year-old patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history increases the patient's risk for colorectal cancer? A. Osteoarthritis B. History of colorectal polyps C. History of lactose intolerance D. Use of herbs as dietary supplements

B. History of colorectal polyps A history of colorectal polyps places this patient at risk for colorectal cancer. This tissue can degenerate over time and become malignant. Osteoarthritis, lactose intolerance, and the use of herbs do not pose additional risk to the patient.

What information would have the highest priority to be included in preoperative teaching for a 68-year-old patient scheduled for a colectomy? A. How to care for the wound B. How to deep breathe and cough C. The location and care of drains after surgery D. Which medications will be used during surgery

B. How to deep breathe and cough Because anesthesia, an abdominal incision, and pain can impair the patient's respiratory status in the postoperative period, it is of high priority to teach the patient to cough and deep breathe. Otherwise, the patient could develop atelectasis and pneumonia, which would delay early recovery from surgery and hospital discharge. Care for the wound and location and care of the drains will be briefly discussed preoperatively, but done again with higher priority after surgery. Knowing which drugs will be used during surgery may not be meaningful to the patient and should be reviewed with the patient by the anesthesiologist.

. The admission assessment for a client with acute gastric bleeding indicates blood pressure 82/40, pulse 124, and respiratory rate 26. Which admission request will the nurse implement first A. Type and crossmatch for 4 units of packed red blood cells. B. Infuse lactated Ringer's solution at 200 mL/hr. C. Give pantoprazole (Protonix) 40 mg IV now and than daily. D. Insert nasogastric tube and connect to low intermittent suction.

B. Infuse lactated Ringer's solution at 200 mL/hr. The client's most immediate concern is the hypotension associated with volume loss. The most rapidly available volume expanders are crystalloids to treat hypovolemia.

The nurse should administer an as-needed dose of magnesium hydroxide (MOM) after noting what information while reviewing a patient's medical record? A. Abdominal pain and bloating B. No bowel movement for 3 days C. A decrease in appetite by 50% over 24 hours D. Muscle tremors and other signs of hypomagnesemia

B. No bowel movement for 3 days MOM is an osmotic laxative that produces a soft, semisolid stool usually within 15 minutes to 3 hours. This medication would benefit the patient who has not had a bowel movement for 3 days. MOM would not be given for abdominal pain and bloating, decreased appetite, or signs of hypomagnesemia.

The nurse is reviewing admitting requests for a client admitted to the intensive care unit with perforation of a duodenal ulcer. Which request will the nurse implement first? A. Apply antiembolism stockings. B. Place nasogastric (NG) tube, and connect to suction. C. Insert an indwelling catheter, and check output hourly. D. Give famotidine (Pepcid) 20 mg IV every 12 hours.

B. Place nasogastric (NG) tube, and connect to suction. To decrease spillage of duodenal contents into the peritoneum, NG suction should be rapidly initiated. This will minimize the risk for peritonitis.

How should the patient be taking (Prilosec) Omeprazole? A. take drugs 2 hours after a meal B. take 1 hour before meals and swallow tablets as whole C. take it with juice and crush tablets D. all of the above

B. Take 1 hour before meals and swallow tablet as whole rationale: Proton Pump inhibitors, decreases gastric juices and reduces pain, they are taken 1 hour before meals, not after and we don't take it crushed, take it whole

Which statement best describes the relationship of complementary and alternative therapies to pharmacology? Select one: A. They serve as competitors and should not be promoted. B. They can reduce patient medication needs. C. They have little-to-no value in disease prevention and treatment. D. They are more effective than medication use.

B. They can reduce patient medication needs.

The client has a long-term history of Crohn's disease and has recently developed acute gastritis. The client asks the nurse whether Crohn's disease was a direct cause of the gastritis. What is the nurse's best response? A. "Yes, Crohn's disease is known to be a direct cause of the development of chronic gastritis." B. "We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop." C. "What has your doctor told you about how your gastritis developed?" D. "Yes, a familial tendency to inherit Crohn's disease as well as gastritis has been reported. Have your other family members been tested for Crohn's disease?"

B. This is the only accurate statement. Crohn's disease may be an underlying disease process when chronic gastritis develops, but not when acute gastritis occurs.

A physician prescribes bisacodyl (Dulcolax) for a client in preparation for a diagnostic test and wants the client to achieve a rapid effect from the medication. The nurse then tells the client to take the medication: A. With a large meal B. On an empty stomach C. At bedtime with a snack D. With two glasses of juice

B. on an empty stomach, bisacodyl (Dulcolax) is a stool softner

The nurse is teaching a class on dietary supplements. The nurse determines that learning has occurred when the patients make which statement? Select one: A. "The manufacturer of the dietary supplement has the burden of proof for the safety of the supplement." B."Products can make claims based on body structure and function like 'promotes healthy urinary tract." C. "The Food and Drug Administration (FDA) is not involved with the approval of the dietary supplement and cannot remove it from the market." D. "Dietary supplements must go through rigorous testing prior to being marketed by the manufacturer."

B."Products can make claims based on body structure and function like 'promotes healthy urinary tract."

The nurse teaches the client receiving atropine to expect which side effect? a. Diarrhea b. Braydcardia c. Blurred vision d. Frequent urination

Blurred vision

A client is prescribed metoprolol (Lopressor) to reat hypertension. It is important for the nurse to monitor the client for which condition? a. Bradycardia b. Hypertension c. Ankle edema d. Decreased respirations

Bradycardia

A patient is prescribed lisinopril (Prinvil) as part of the treatment plan for heart failure. Which finding indicates that the patient is experiencing the therapeutic effect of the drug? A. +2 edema of the lower extremities B. Potassium level of 3.5 mEq/L C. Crackles in the lungs are no longer heard D. Jugular vein distention

C

A patient is taking ibuprofen. The nurse understands that COX-1 and COX-2 inhibitors are different in that ibuprofen is more likely than celecoxib to cause which adverse effect? A) Fever B) Constipation C) Peptic ulcer disease D) Metallic taste when eating

C

An adult male patient has taken medication for management of hypertension for 3 years. He says to the nurse, "I'm not going to take these drugs anymore, because they are interfering with my sex life." Which response by the nurse would be most helpful? A. "It is unfortunate that these drugs can cause erectile dysfunction, but managing your blood pressure is more important than your sexual performance." B. "I understand how discouraging it must be to live with this adverse effect, but you could have a stroke if you do not take your blood pressure medicines." C. "Let's discuss this effect with your prescriber. There are other drugs available to manage your blood pressure that may not have the same adverse effect." D. "I am glad you told me about your experience with this adverse effect. Sexual performance can be a difficult subject to discuss."

C

Before administering hydralazine (Apresoline), it is most important for the nurse to obtain which assessment? A. Peripheral pulses B. Homans' sign C. Blood pressure D. Capillary refill

C

Calcium channel blockers work by reducing calcium influx into the cells of the heart and blood vessels. Calcium channels are coupled to which type of autonomic nervous system receptors? A. Alpha1 B. Alpha2 C. Beta1 D. Beta2

C

The nurse is administering diphenhydramine (Benadryl), a neuropharmacologic agent that works by doing what? A. Preventing mast cells from releasing histamine B. Preventing axonal conduction C. Binding to histamine receptors, preventing receptor activation D. Acting as an agonist to H1 histamine receptors

C

The nurse is assessing a patient in a clinic who has been taking clonidine (Catapres) for hypertension. Which findings are most indicative of an adverse effect of this drug? A. Cough and wheezing B. Epigastric pain and diarrhea C. Drowsiness and dry mouth D. Positive Coombs' test result and anemia

C

The nurse is caring for a patient prescribed aliskiren (Tekturna). In which way does this medication act to lower blood pressure? A. It blocks the conversion of angiotensin I to angiotensin II. B. It prevents angiotensin II from binding to its receptors. C. It inhibits the conversion of angiotensinogen into angiotensin I. D. It selectively blocks aldosterone receptors in the kidneys.

C

The nurse is caring for a patient receiving nitrates for relief of angina. What pharmacodynamic action is responsible for the relief of anginal pain with nitrates? A. Vasoconstriction leads to improved cardiac output. B. Decreased force of contraction leads to decreased oxygen demand. C. Vasodilation leads to decreased preload, which decreases oxygen demand. D. Influx of calcium ions leads to relaxation of vascular smooth muscle.

C

The nurse is caring for a patient who takes spironolactone (Aldactone) and quinapril (Accupril) for treatment of heart failure. Which symptom, if found, would indicate a potential interaction between these two drugs? A. Elevated serum quinapril level B. Heart rate of 58 beats per minute C. Potassium level of 5.7 mEq/L D. Glucose level of 180 mg/dL

C

The nurse is caring for a patient with heart failure who needs a diuretic. Which agent is likely to be chosen, because it has been shown to greatly reduce mortality in patients with heart failure? A. Furosemide (Lasix) B. Hydrochlorothiazide (HydroDIURIL) C. Spironolactone (Aldactone) D. Mannitol (Osmitrol)

C

The nurse is caring for a patient with heart failure who takes digoxin (Lanoxin). Which finding would require immediate attention by the nurse? A. Potassium level of 3.7 mEq/L B. Digoxin level of 0.7 ng/mL C. Vomiting and diarrhea D. Heart rate of 68 beats per minute

C

The nurse is caring for a patient with myasthenia gravis who is beginning a new prescription of neostigmine (Prostigmin), 75 mg PO twice daily. What is the most important initial nursing action? A. Obtain a measurement of the plasma level of neostigmine B. Teach the patient to wear a Medic Alert bracelet C. Assess the patient's ability to swallow D. Check the patient's deep tendon reflexes (DTRs)

C

The nurse is caring for an adult male with renal artery stenosis who has been prescribed benazepril (Lotensin). Which symptom, if found, indicates an adverse effect of this drug? A. Potassium level of 3.2 mEq/L B. Blood glucose level of 180 mg/dL C. Serum creatinine level of 2.3 mg/dL D. Uric acid level of 10 mg/dL

C

The nurse is caring for several patients. For which patient is propranolol (Inderal) most likely to be contraindicated? A. A 30-year-old woman with cardiac dysrhythmias B. A 48-year-old man with hypertension C. A 60-year-old woman with diabetes D. A 72-year-old man with angina

C

The nurse is caring for several patients. For which patient would a prescription for nifedipine (Adalat) be least appropriate? A. A 60-year-old man with angina and hypertension B. A 48-year-old woman with primary hypertension C. A 78-year-old man with atrial fibrillation D. A 55-year-old woman with vasospastic angina

C

The nurse is evaluating the teaching done with a patient who has a new prescription for fosinopril (Monopril). Which statement by the patient indicates a need for further teaching? A. "I can take this medicine with breakfast each morning." B. "I will call if I notice a rash or wheals on my skin." C. "I will use a salt substitute to lower my sodium intake." D. "I will call if I develop a bothersome cough."

C

The nurse is reviewing drugs on the emergency cart with regard to their therapeutic action. Which medications can help initiate heart contraction during a cardiac arrest? A. Topical phenylephrine B. Subcutaneous terbutaline C. Intravenous epinephrine D. Inhaled albuterol

C

The nurse is teaching a group of patients about dietary approaches to reduce cholesterol levels. Which statement is most important to include in the teaching? A. "Lower your cholesterol to 300 mg/day." B. "Eliminate red meat and pork from your diet." C. "Read food labels and reduce your intake of saturated fats." D. "Reduce salt consumption to keep your sodium intake to 2400 mg/day."

C

The nurse is teaching a patient who has a new prescription for spironolactone (Aldactone). Which statement by the patient indicates that the teaching was effective? A. "I will use salt substitutes to lower my sodium intake." B. "I will increase my intake of foods that are high in potassium." C. "I will call my doctor if I begin having menstrual irregularities." D. "I will take this medication at bedtime each evening."

C

The nurse knows that the advantage of patients having multiple types of receptors to regulate bodily functions is what? A. Improved maximal efficacy B. Reduction of side effects and toxicity C. Higher degree of selectivity D. Lower therapeutic index

C

The nurse plans to closely monitor for which clinical manifestation after administering Furosemide (Lasix)? A. Decreased pulse B. Decreased temperature C. Decreased blood pressure D. Decreased respiratory rate

C

The nurse understands that cholesterol is carried through the blood by means of lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis? A. Very-low-density lipoprotein (VLDL) B. Apolipoprotein B-100 C. Low-density lipoprotein (LDL) D. High-density lipoprotein (HDL)

C

The patient with a history of asthma has been prescribed ibuprofen for arthritis. What can ibuprofen cause that should concern the nurse? A) Tachycardia B) Increased secretions C) Bronchospasm D) Fluid retention

C

What advantage does piroxiam (Feldene) have over other NSAIDs? A) No GI irritation B) Few drug-drug interactions C) Long half-life D) Rapid onset

C

When discontinuing steroid therapy, the dosage should be tapered over a period of how many days? A) No taper is necessary B) 1-4 days C) 5-10 days D) More than 10 days

C

When teaching a patient who is receiving allopurinol, what should the nurse encourage the patient to do? A) Eat more meat. B) Increase vitamin C intake C) Have annual eye examinations D) Take medication 2 hours before meals.

C

Which medication combination is useful in the treatment of variant angina? A. Metoprolol (Lopressor) and ranozaline (Ranexa) B. Isosorbide dinitrate (Isordil) and metoprolol (Lopressor) C. Diltiazem (Cardizem) and isosorbide mononitrate (Imdur) D. Propranolol (Inderal) and diltiazem (Cardizem)

C

The nurse is administering an injection to a patient and wants the medication to take effect as quickly as possible. Which injection site will the nurse select? A. Subcutaneous tissue B. Ventrogluteal C. Deltoid D. Dorsogluteal

C Drugs given intramuscularly are absorbed faster in muscles that have more blood vessels (e.g., deltoids) than in those that have fewer blood vessels (e.g., gluteals). Subcutaneous tissue has fewer blood vessels, so absorption is slower in such tissue.

The nurse recognizes that the administration of a drug influences cell physiology. What is the term for this concept? A. Pharmacokinetics B. Pharmacotherapeutics C. Pharmacodynamics D. Pharmacology

C Pharmacodynamics refers to what the drug does to the body, that is, how it influences cellular physiology. Pharmacokinetics is the study of what the body does to the drug. Pharmacotherapeutics refers to the study of the therapeutic use of drugs. Pharmacology is the study of drugs.

The nurse is administering medications to a patient with chronic renal failure. What is the nurse's priority action? A. Administer all medications via IV route. B. Assess drug levels daily. C. Assess the patient for toxicity to the medications. D. Hold medications for low urinary output.

C The kidneys are responsible for the majority of drug excretion. With excretion impaired, the medication can remain in the system longer, and there is more chance for toxicity to develop.

The Seventh Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7 report), released in 2003, is the guiding document for treatment of hypertension in the United States. Which principles are included in these guidelines? (Select all that apply.) A. People with blood pressure above 120 to 139 systolic and 80 to 89 diastolic should receive medication treatment. B. In people older than 50 years, an elevated diastolic blood pressure is more dangerous than an elevated systolic pressure. C. For most patients, thiazide diuretics should be used as the initial medication therapy. D. Blood pressure should be measured twice at a clinic visit, with the patient seated in a chair with feet on the floor. E. The diagnosis of hypertension typically is made after several elevated readings at more than one clinic visit.

C, D, E

The nurse is preparing to give epinephrine by the IV push route. Which actions are essential before giving this drug? (Select all that apply.) A. Check the blood urea nitrogen (BUN) and creatinine levels B. Obtain insulin from the medication cart C. Assess the patency of the IV line D. Review the allergy history E. Assess the vital signs

C, D, E

Which clinical manifestations of inflammatory bowel disease are common to both patients with ulcerative colitis (UC) and Crohn's disease (select all that apply)? A. Restricted to rectum B. Strictures are common. C. Bloody, diarrhea stools D. Cramping abdominal pain E. Lesions penetrate intestine.

C, D. Clinical manifestations of UC and Crohn's disease include bloody diarrhea, cramping abdominal pain, and nutritional disorders. Intestinal lesions associated with UC are usually restricted to the rectum before moving into the colon. Lesions that penetrate the intestine or cause strictures are characteristic of Crohn's disease.

A nurse is caring for a caring for a client who is receiving esomeprazole (Nexium) to manage GERD. Which of the following best indicates the desired therapeutic effect? A. " I don't pass gas a often" B. "my abdomen is no longer firm" C. "I don't have pain in my stomach" D. " I have regular BM's"

C. "I don't have pain in my stomach" rationale: esomeprazole (Nexium) is proton pump inhibitor (PPI) and works in the parietal cells of the stomach by inhibiting the proton pump enzyme that generates gastric acid secretion. - Treatment is for gastric ulcers, duodenal ulcers and GERD. - an expected finding if medication is effective will be a decrease in the client's symptoms of an ulcer or GERD. Heartburns are a common sign of GERD, so absence of pain means the medication is working

After the nurse teaches a patient with gastroesophageal reflux disease (GERD) about recommended dietary modifications, which statement by the patient indicates that the teaching has been effective? A. "I can have a glass of low-fat milk at bedtime." B. "I will have to eliminate all spicy foods from my diet." C. "I will have to use herbal teas instead of caffeinated drinks." D. "I should keep something in my stomach all the time to neutralize the excess acids."

C. "I will have to use herbal teas instead of caffeinated drinks." Rationale: Patients with gastroesophageal reflux disease should avoid foods (such as tea and coffee) that decrease lower esophageal pressure. Patients should also avoid milk, especially at bedtime, as it increases gastric acid secretion. Patients may eat spicy foods, unless these foods cause reflux. Small, frequent meals help prevent overdistention of the stomach, but patients should avoid late evening meals and nocturnal snacking.

The patient tells the nurse that he has been taking herbal preparations to boost his immune system functioning. He does not know the names of the preparations. What is the best assessment question for the nurse to ask? Select one: A. "Would you please tell your doctor about the herbs during the next visit?" B. "Would you please ask your wife to discuss this with me during her next visit?" C. "Would you please ask your wife to call the hospital pharmacist with the names?" D. "Would you please have your wife bring the bottles to the hospital?"

C. "Would you please ask your wife to call the hospital pharmacist with the names?"

The nurse finds a client vomiting coffee ground-type material. On assessment, the client has blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thready pulse. Which intervention will be the nurse's first priority? A. Administering an H2 antagonist B. Initiating enteral nutrition C. Administering intravenous (IV) fluids D. Administering antianxiety medication

C. Administering intravenous (IV) fluids Administration of IV fluids is necessary to treat the hypovolemia caused by acute GI bleeding.

The patient with chronic gastritis is being put on a combination of medications to eradicate H. pylori. Which drugs does the nurse know will probably be used for this patient? A. Antibiotic(s), antacid, and corticosteroid B. Antibiotic(s), aspirin, and antiulcer/protectant C. Antibiotic(s), proton pump inhibitor, and bismuth D. Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs)

C. Antibiotic(s), proton pump inhibitor, and bismuth To eradicate H. pylori, a combination of antibiotics, a proton pump inhibitor, and possibly bismuth (for quadruple therapy) will be used. Corticosteroids, aspirin, and NSAIDs are drugs that can cause gastritis and do not affect H. pylori.

Your elderly pt is being administered Lomotil, what kind of drug? A. Antiflatulent B. Laxative C. Antidiarrheal D. Emetic

C. Antidiarrheal, its a narcotic

The nurse determines that a patient has experienced the beneficial effects of therapy with famotidine (Pepcid) when which symptom is relieved? A. Nausea B. Belching C. Epigastric pain D. Difficulty swallowing

C. Epigastric pain Famotidine is an H2-receptor antagonist that inhibits parietal cell output of HCl acid and minimizes damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain. Famotidine is not indicated for nausea, belching, and dysphagia.

A female patient has a sliding hiatal hernia. What nursing interventions will prevent the symptoms of heartburn and dyspepsia that she is experiencing? A. Keep the patient NPO. B. Put the bed in the Trendelenberg position. C. Have the patient eat 4 to 6 smaller meals each day. D. Give various antacids to determine which one works for the patient.

C. Have the patient eat 4 to 6 smaller meals each day. Eating smaller meals during the day will decrease the gastric pressure and the symptoms of hiatal hernia. Keeping the patient NPO or in a Trendelenberg position are not safe or realistic for a long period of time for any patient. Varying antacids will only be done with the care provider's prescription, so this is not a nursing intervention.

Which statement is accurate regarding the Dietary Supplement Health and Education Act (DSHEA) of 1994? Select one: A. It mandates that herbal product labels contain accurate information. B. It requires that herbal products undergo the same rigorous testing as drugs do under the FDA. C. It mandates that herbal product labels state that the products are not intended to diagnose, treat, cure, or prevent disease. D. It ensures that herbal products provide proof of their intended effects.

C. It mandates that herbal product labels state that the products are not intended to diagnose, treat, cure, or prevent disease.

A client has begun medication therapy with pancrelipase (Pancrease). The nurse determines that the medication is having the optimal intended benefit if which effect is observed? A. Weight loss B. Relief of heartburn C. Reduction of steatorrhea D. Absence of abdominal pain

C. Reduction of steatorrhea

Following administration of a dose of metoclopramide (Reglan) to the patient, the nurse determines that the medication has been effective when what is noted? A. Decreased blood pressure B. Absence of muscle tremors C. Relief of nausea and vomiting D. No further episodes of diarrhea

C. Relief of nausea and vomiting Metoclopramide is classified as a prokinetic and antiemetic medication. If it is effective, the patient's nausea and vomiting should resolve. Metoclopramide does not affect blood pressure, muscle tremors, or diarrhea.

Following bowel resection, a patient has a nasogastric (NG) tube to suction, but complains of nausea and abdominal distention. The nurse irrigates the tube as necessary as ordered, but the irrigating fluid does not return. What should be the priority action by the nurse? A. Notify the physician. B. Auscultate for bowel sounds. C. Reposition the tube and check for placement. D. Remove the tube and replace it with a new one.

C. Reposition the tube and check for placement. The tube may be resting against the stomach wall. The first action by the nurse (since this is intestinal surgery and not gastric surgery) is to reposition the tube and check it again for placement. The physician does not need to be notified unless the tube function cannot be restored by the nurse. The patient does not have bowel sounds, which is why the NG tube is in place. The NG tube would not be removed and replaced unless it was no longer in the stomach or the obstruction of the tube could not be relieved.

Which of the following is a reason for the increase in popularity of herbal remedies? Select one: A. Their popularity is decreasing, not increasing. B. They are more effective for treating bacterial infections. C. They are being marketed very aggressively. D. Most insurance policies cover them.

C. They are being marketed very aggressively.

A nurse teaches a client taking metoclopramide (Reglan) to discontinue the medication immediately and call the physician if which side effect occurs with long- term use? A. Excessive excitability B. Anxiety or irritability C. Uncontrolled rhythmic movements of the face or limbs D. Dry mouth not helped by the use of sugar-free hard candy

C. Uncontrolled rhythmic movements of the face or limbs

A client has a PRN order for loperamide (Imodium). The nurse should plan to administer this medication if the client has: A. constipation B. abdominal pain C. episode of diarrhea D. Hematest-positive nasogastric tube drainage

C. episode of diarrhea, loperamide (Imodium) is an antidiarrheal

A physician orders a colonoscopy b/c of the client's persistent diarrhea. The nurse instructs the client to drink 250 mL of an electrolyte solution called GOLYTELY every 15 minutes over a 2 hour period. Which observation by the nurse provides the best evidence that the solution has achieved its primary purpose? A. the client's serum electrolyte levels are normal B. the client's intake approximates the output C. the client's stools become clear liquid D. the client's bladder fills with urine

C. the client's stools become clear liquid Rationale: GOLYTELY is given as a colonic lavage. Within 30 minutes of ingesting the 1st volume of the solution, the client should experience the 1st of many bowel movements. The bowel must be clear of feces for the colonoscopy to be effective! The solution is preferable to other forms of bowel clensing its less likely to deplete electrolytes or cause water intoxification

Atenolol (Tenormin) is prescribed fro a client. The nurse realizes that this drug is a beta-adrenergic blocker and that this drug classification is contraindicated for clients with which condiiton? a. Hypothyroidism b. Angia pectoris c. Cardiogenic shock d. Liver dysfunction

Cardiogenic shock

Which medication is appropriately administered at the correct time? a. Amoxicillin ordered at 0800 and given at 0700. b. Cardizem ordered at 0900 and given at 0930. c. Furosemide ordered at 0730 and given at 0825. d. Synthroid ordered at 1000 and given at 0915.

Cardizem ordered at 0900 and at 0930.

The nurse is giving medications to a newly admitted patient who is to receive nothing by mouth (NPO status) and finds an order written as follows: "Digoxin, 250 mcg stat." Which action is appropriate?

Clarify the order with the prescribing physician before giving the drug.

The nurse is assessing a client with tonsillitis. The client asks the nurse why the tissues in the neck seem swollen. Which nursing response is best? "Your lymph nodes and tissues sometimes swell in attempts to fight infection." "The swelling is a direct effect of histamine being released throughout the body." "T cells are activated in the neck area, which causes the neck to swell." "The neck area contains proteins that collect and cause the swelling."

Correct answer "Your lymph nodes and tissues sometimes swell in attempts to fight infection."

Which​ anti-inflammatory drug inhibits only one type of​ cyclooxygenase? Nuprin Celebrex Motrin Ecotrin

Correct answer Celebrex

The pediatric nurse is assessing a child in the clinic who has tested positive for an influenza virus. Assessment vital signs reveal a temperature of 102.4°F (39.4°C). Which medication does the nurse anticipate will be ordered for the client? Select all that apply. Ibuprofen (Motrin) Acetylcyclic acid (aspirin) Diphenhydramine (Benadryl) Brompheniramine/phenylephrine (Dimetapp) Acetaminophen (Tylenol)

Correct answer Ibuprofen (Motrin) Acetaminophen (Tylenol)

What is the most common physical issue related to Nonsteroidal Antiinflammatory Drug​ (NSAID) therapy that the nurse should assess for before and during​ administration? Gastrointestinal​ (GI) bleeding Migraine Autoimmune disorder Dysrhythmia

Correct answer gastrointestinal bleeding

What instructions should you give to a client who is taking​ enteric-coated ​aspirin? Select all that apply. Do not crush or chew the medication. Take with 240 mL of water or milk. Report pregnancy. Avoid alcoholic beverages. Stop medication 2 days before dental work.

Correct answers Do not crush or chew the medication report pregnancy avoid alcoholic beverages

The nurse is teaching a client with an ankle sprain about the drug ibuprofen (Advil). What should be included in the teaching? Select all that apply. Use sunscreen and protective clothing when outdoors. Do not take aspirin and ibuprofen together. Report any unusual bruising to the health care provider. Expect to have visual changes. Avoid the use of alcohol while taking ibuprofen.

Correct answers Use sunscreen and protective clothing when outdoors. Do not take aspirin and ibuprofen together. Report any unusual bruising to the health care provider. Expect to have visual changes.

Prostaglandins provide several beneficial effects. Which beneficial effects are reduced when aspirin​ (Bayer) is​ used? Select all that apply. Clotting of blood Blood flow to the kidneys Protection from stomach acid Reduction of inflammation Maintenance of bronchial smooth muscle

Correct answers clotting of blood blood flow to the kidneys protection from stomach acid maintenance of bronchial smooth muscle

When administering a recommended dose of acetaminophen​ (Tylenol) to an adult​ client, what results can you​ expect? Select all that apply. Reduction of pain No progression of inflammation Reduction of inflammation Few adverse effects Reduction of fever

Correct answers reduction of pain fewer adverse effects reduction of fever

Which nonspecific body defenses are considered the first line against ​infection? Select all that apply. Skin Lymph node Phagocytes Mucous membranes Cilia

Correct answers skin mucus membranes cilia

Which signs are associated with aspirin​ (Bayer) toxicity? Select all that apply. Inflammation of joints Tinnitus Blood clots Decreased hearing Stomach discomfort

Correct answers tinnitus decreased hearing stomach discomfort

A father presents to the emergency department with his 4-year-old son. The father explains that his son had a fever, so he gave the child baby aspirin to decrease the fever and it has not worked. What should concern the nurse about the 4-year-old receiving aspirin? A) Aspirin has the potential to cause gastrointestinal (GI) bleeding in children B) Aspirin has the potential to cause ringing in the ears in children C) Aspirin has the potential to cause hyperglycemia in children D) Aspirin has the potential to cause Reye's syndrome in children

D

A nurse is preparing to give a medication that stimulates the beta2 receptors. What response will the nurse expect from this drug? A. Increased peristalsis B. Constriction of the pupil C. Hypoglycemia D. Bronchodilation

D

A nurse prepares to administer a new prescription for bethanechol (Urecholine). Which information in the patient's history should prompt the nurse to consult with the prescriber before giving the drug? A. Constipation B. Hypertension C. Psoriasis D. Asthma

D

A patient is prescribed verapamil (Calan) SR 120 mg daily. Which statement by the patient indicates understanding of the medication? A. "I will take the medication with grapefruit juice each morning." B. "I should expect occasional loose stools from this medication." C. "I'll need to reduce the amount of fiber in my diet." D. "I will swallow the pill whole."

D

Antimuscarinic poisoning can result from overdose of antihistamines, phenothiazines, and tricyclic antidepressants. Differential diagnosis is important, because antimuscarinic poisoning resembles which other condition? A. Epilepsy B. Diabetic coma C. Meningitis D. Psychosis

D

Complete the equation: Cardiac output = Volume of blood ejected at each heartbeat × ____. A. Stroke volume B. Preload C. Afterload D. Heart rate

D

The nurse caring for a patient taking furosemide (Lasix) is reviewing the patient's most recent laboratory results, which are: sodium, 136 mEq/L; potassium, 3.2 mEq/L; chloride, 100mEq/L; blood urea nitrogen, 15 mg/dL. What is the nurse's best action? A. Administer Lasix as ordered B. Place the patient on a cardiac monitor C. Begin a 24-hour urine collection D. Hold the Lasix and notify the physician

D

The nurse is caring for a patient receiving hydralazine (Apresoline). The primary care provider prescribes propranolol (Inderal). The nurse knows that a drug such as propranolol often is combined with hydralazine for what purpose? A. To reduce the risk of headache B. To improve hypotensive effects C. To prevent heart failure D. To protect against reflex tachycardia

D

The nurse is teaching a patient with a history of anaphylaxis how to use an EpiPen. Which statement made by the patient indicates that he understands the proper use of this drug? A. "I will keep my medication in the refrigerator when I'm not using it." B. "I should take this medication within 30 minutes of the onset of symptoms." C. "I must remove my pants before injecting the medication into the leg." D. "I will jab this medication firmly into my outer thigh if needed."

D

The nurse knows that which neurotransmitter is most commonly found at the synapses of the peripheral nervous system? A. Norepinephrine B. Epinephrine C. Dopamine D. Acetylcholine

D

The patient has been prescribed infliximab (Remicade) for severe rheumatoid arthritis. Her spouse calls the clinic and states his wife has a fever of 101.9 degrees F, chills, nausea, and vomiting, and is very dizzy. What will the nurse advise the patient's spouse to do? A) Nothing. These are common side affects of infliximab B) Have the patient take a cool bath C) Wait 24 hours and if symptoms continue, call back D) Bring the patient to the emergency department or clinic for further evaluation

D

What best describes the rationale for using neostigmine (Prostigmin) in the treatment of myasthenia gravis? A. It promotes neuromuscular blockade in the periphery. B. It promotes emptying of the bladder and sphincter relaxation. C. It reduces intraocular pressure and protects the optic nerve. D. It increases the force of skeletal muscle contraction.

D

What occurs during the vascular phase of inflammation? A) Leukocyte and protein infiltration into inflamed tissue B) Vasoconstriction with leukocyte infiltration into inflamed tissue C) Vasoconstriction and fluid influx into the interstitial space D) Vasodilation with increased capillary permeability

D

Which activity noted by the home care nurse indicates that the patient needs further teaching about topical nitroglycerin ointment? A. The patient rotates the application sites to minimize skin irritation. B. The patient uses the applicator paper to measure the prescribed dose. C. The patient removes ointment from a previous dose before applying the next dose. D. The patient applies the prescribed ribbon of ointment to the applicator paper and places it on the chest.

D

Which finding suggests that a patient is experiencing an adverse effect of metoprolol (Lopressor)? A. The patient complains of headaches. B. The patient's potassium level is 3.3 mEq/L. C. The patient's resting heart rate is 58 beats per minute on the cardiac monitor. D. The PR interval on the patient's cardiac rhythm strip is 0.32 seconds.

D

Which hemodynamic system serves as a reservoir for circulating blood? A. Heart B. Lungs C. Arteries D. Veins

D

Which is the only cardiovascular indication for minoxidil (Rogaine)? A. Heart failure B. Myocardial infarction C. Mild hypertension D. Severe hypertension

D

Which laboratory abnormality may be a consequence of therapy with a thiazide diuretic? A. Serum glucose level of 58 mg/dL B. Serum potassium level of 5.3 mEq/L C. Serum sodium level of 135 mEq/L D. Serum uric acid level of 10.4 mg/dL

D

Which statement by a patient indicates understanding of treatment with doxazosin? A. "I may experience an increase in hair growth as a side effect." B. "I'll notify the healthcare provider if I develop a persistent cough." C. "I'll make sure I include extra sources of potassium in my diet, such as bananas and baked potatoes." D. "When getting out of bed in the morning, I will sit on the side of the bed for several minutes before standing."

D

Which symptom is the most indicative of muscarinic poisoning? A. Constipation B. Heart rate of 140 beats per minute C. Blood pressure of 180/110 mm Hg D. Blurred vision

D

The patient is scheduled to receive an enteric-coated tablet immediately after a meal. The nurse will choose which food to include as part of the patient's meal? A.Hot dogs B. Avocados C. Salami D. Skim milk

D Advise not to eat high-fat food before ingesting an enteric-coated tablet, because high-fat foods decrease the absorption rate.

The pharmacist states that the patient's biotransformation of a drug was altered. The nurse interprets this to mean that A. absorption has affected the drug. B. dilution has affected the drug. C. excretion has affected the drug. D. metabolism has affected the drug.

D Metabolism connotes a breakdown of a product. Biotransformation is actually a more accurate term because some drugs are actually changed into an active form in the liver in contrast to being broken down for excretion. Biotransformation of a drug does not occur during absorption, nor with dilution, nor during excretion.

Patients at a senior citizen center have asked the nurse to do a presentation on herbal preparations. Which statement would be included in the best plan by the nurse? Select one: A. "Herbal preparations are safe as long as you carefully read the label." B. "As long as the herbal preparation has been tested in the clinical setting, it is safe." C. "Herbal preparations can be dangerous if you are allergic to them." D. "Herbal preparations actually are drugs; you must be careful with them."

D. "Herbal preparations actually are drugs; you must be careful with them."

The nurse has been teaching a patient about herbal preparations and determines that additional teaching is required when the patient makes which statement? Select one: A. "I should check with you before using an herbal product." B. "I need to be careful about where I store my herbal product." C. "Herbal preparations are available in solid and liquid forms." D. "Herbal products usually contain only one active ingredient.

D. "Herbal products usually contain only one active ingredient.

The nurse is teaching the client how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the client demonstrates correct understanding of the nurse's instruction? A. "It is okay to continue to drink coffee in the morning when I get to work." B. "I will need to take vitamin B12 shots for the rest of my life." C. "Ibuprofen (Advil, Motrin, others) can be taken for my headaches instead of aspirin." D. "Small meals should be eaten about six times a day."

D. "Small meals should be eaten about six times a day The client with chronic gastritis should eat six small meals daily to avoid symptoms.

The nurse is caring for a postoperative patient with a colostomy. The nurse is preparing to administer a dose of famotidine (Pepcid) when the patient asks why the medication was ordered since the patient does not have a history of heartburn or gastroesophageal reflux disease (GERD). What response by the nurse would be the most appropriate? A. "This will prevent air from accumulating in the stomach, causing gas pains." B. "This will prevent the heartburn that occurs as a side effect of general anesthesia." C. "The stress of surgery is likely to cause stomach bleeding if you do not receive it." D. "This will reduce the amount of HCl in the stomach until the nasogastric tube is removed and you can eat a regular diet again."

D. "This will reduce the amount of HCl in the stomach until the nasogastric tube is removed and you can eat a regular diet again." Famotidine is an H2-receptor antagonist that inhibits gastric HCl secretion and thus minimizes damage to gastric mucosa while the patient is not eating a regular diet after surgery. Famotidine does not prevent air from accumulating in the stomach or stop the stomach from bleeding. Heartburn is not a side effect of general anesthesia.

The nurse is monitoring the client with gastric cancer for signs and symptoms of upper GI bleeding. Which change in vital signs is most indicative of bleeding related to cancer? A. Respiratory rate from 24 to 20 breaths/min B. Apical pulse from 80 to 72 beats/min C. Temperature from 98.9° F to 97.9° F D. Blood pressure from 140/90 to 110/70 mm Hg

D. Blood pressure from 140/90 to 110/70 mm H A decrease in blood pressure is the most indicative sign of bleeding.

The nurse is caring for a 68-year-old patient admitted with abdominal pain, nausea, and vomiting. The patient has an abdominal mass, and a bowel obstruction is suspected. The nurse auscultating the abdomen listens for which type of bowel sounds that are consistent with the patient's clinical picture? A. Low-pitched and rumbling above the area of obstruction B. High-pitched and hypoactive below the area of obstruction C. Low-pitched and hyperactive below the area of obstruction D. High-pitched and hyperactive above the area of obstruction

D. High-pitched and hyperactive above the area of obstruction Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high-pitched, sometimes referred to as "tinkling" above the level of the obstruction. This occurs because peristaltic action increases to "push past" the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent.

The nurse is preparing to administer a dose of bisacodyl (Dulcolax). In explaining the medication to the patient, the nurse would explain that it acts in what way? A. Increases bulk in the stool B. Lubricates the intestinal tract to soften feces C. Increases fluid retention in the intestinal tract D. Increases peristalsis by stimulating nerves in the colon wall

D. Increases peristalsis by stimulating nerves in the colon wall Bisacodyl is a stimulant laxative that aids in producing a bowel movement by irritating the colon wall and stimulating enteric nerves. It is available in oral and suppository forms. Fiber and bulk forming drugs increase bulk in the stool; water and stool softeners soften feces, and saline and osmotic solutions cause fluid retention in the intestinal tract.

The nurse would question the use of which cathartic agent in a patient with renal insufficiency? A. Bisacodyl (Dulcolax) B. Lubiprostone (Amitiza) C. Cascara sagrada (Senekot) D. Magnesium hydroxide (Milk of Magnesia)

D. Magnesium hydroxide (Milk of Magnesia) Milk of Magnesia may cause hypermagnesemia in patients with renal insufficiency. The nurse should question this order with the health care provider. Bisacodyl, lubiprostone, and cascara sagrada are safe to use in patients with renal insufficiency as long as the patient is not currently dehydrated.

The nurse reviews a medication history for a client newly diagnosed with peptic ulcer disease (PUD) who has a history of using ibuprofen (Advil, Motrin, others) frequently for chronic knee pain. The nurse anticipates that the health care provider will request which medication for this client? A. Bismuth subsalicylate (Pepto-Bismol) B. Magnesium hydroxide (Maalox, Mylanta) C. Metronidazole (Flagyl) D. Misoprostol (Cytotec)

D. Misoprostol (Cytotec) Misoprostol (Cytotec) is a prostaglandin analogue that protects against NSAID-induced ulcers.

A client has a PRN order for ondansetron (Zofran). The nurse would administer this medication to the postoperative client for relief of: A. paralytic ileus B. incisional pain C. urinary retention D. Nausea and vomiting

D. Nausea and vomiting, ondansetron (Zofran) is an antiemetic

A client has just taken a dose of trimethobenzamide (Tigan). The nurse plans to monitor this client for relief of: A. Heartburn B. Constipation C. Abdominal Pain D. Nausea and vomiting

D. Nausea and vomiting, trimethobenzamide (Tigan) is an antiemetic

A patient reports having a dry mouth and asks for something to drink. The nurse recognizes that this symptom can most likely be attributed to a common adverse effect of which medication that the patient is taking? A. Digoxin (Lanoxin) B. Cefotetan (Cefotan) C. Famotidine (Pepcid) D. Promethazine (Phenergan)

D. Promethazine (Phenergan) A common adverse effect of promethazine, an antihistamine/antiemetic agent, is dry mouth; another is blurred vision. Common side effects of digoxin are yellow halos and bradycardia. Common side effects of cefotetan are nausea, vomiting, stomach pain, and diarrhea. Common side effects of famotidine are headache, abdominal pain, constipation, or diarrhea.

The Patient has GERD and they are prescribed( Prilosec) Omeprazole What kind of a drug is it? A. Antacid B. Histamine H2 Antagonist C. Anticholinergic D. Proton Pump Inhibitor

D. Proton Pump inhibitor

A client is taking docusate sodium (Colace). The nurse monitors which of the following to determine whether the client is having a therapeutic effect from this medication? A. Abdominal pain B. Reduction in steatorrhea C. Hematest-negative stools D. Regular bowel movements

D. Regular bowel movements

A 72-year-old patient was admitted with epigastric pain due to a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care? A. Chest pain relieved with eating or drinking water B. Back pain 3 or 4 hours after eating a meal C. Burning epigastric pain 90 minutes after breakfast D. Rigid abdomen and vomiting following indigestion

D. Rigid abdomen and vomiting following indigestion A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a perforation of the ulcer, especially if the manifestations of perforation appear suddenly. Midepigastric pain is relieved by eating, drinking water, or antacids with duodenal ulcers, not gastric ulcers. Back pain 3-4 hours after a meal is more likely to occur with a duodenal ulcer. Burning epigastric pain 1-2 hours after a meal is an expected manifestation of a gastric ulcer related to increased gastric secretions and does not cause an urgent change in the nursing plan of care.

What should the nurse instruct the patient to do to best enhance the effectiveness of a daily dose of docusate sodium (Colace)? A. Take a dose of mineral oil at the same time. B. Add extra salt to food on at least one meal tray. C. Ensure dietary intake of 10 g of fiber each day. D. Take each dose with a full glass of water or other liquid.

D. Take each dose with a full glass of water or other liquid. Docusate lowers the surface tension of stool, permitting water and fats to penetrate and soften the stool for easier passage. The patient should take the dose with a full glass of water and should increase overall fluid intake, if able, to enhance effectiveness of the medication. Dietary fiber intake should be a minimum of 20 g daily to prevent constipation. Mineral oil and extra salt are not recommended.

The client is exhibiting symptoms of gastritis. The nurse is assessing the client to determine whether the form of gastritis being experienced is acute or chronic. Which data are correlated with a diagnosis of chronic gastritis? A. Anorexia, nausea, and vomiting B. Frequent use of corticosteroids C. Hematemesis and anorexia D. Treatment with radiation therapy

D. Treatment with radiation therapy

When taking a history of a client diagnosed with a duodenal ulcer, which assessment finding does the nurse expect? A. Severe weight loss B. Pain while eating C. Hematemesis after eating D. Waking at night with pain

D. Waking at night with pain The pain associated with duodenal ulcers is often described as occurring 90 minutes to 3 hours after a meal and at night and often awakens the client between 1 and 2 AM. Reference:

A client has been taking omeprazole (Prilosec) for the past 4 weeks. The nurse determines that the medication is effective when the client reports? A. nausea B. diarrhea C.headache D. acid indigestion

D. acid indigestion Rationale: Omeprazole, a proton pump inhibitor, reduces gastric acid secretion and treats duodenal and gastric ulcers, prolonged dyspepsia, gastrointestinal reflux disease and erosive esophagitis

what do you tell patients to do with tablets (antacid)? A. take drugs 30 minutes before meals B. crush it and mix with orange juice C. take 1 hour after meal D. chew thoroughly and take with full glass of water

D. chew thoroughly and take with a full glass of water

A client with a gastric ulcer has an order for sucralfate (Carafate), 1 g orally four times a day. The nurse schedules the medications for which of the following times? A. With meals and at bedtime B. Every 6 hours around the clock C. One hour after meals and at bedtime D. One hour before meals and at bedtime

D. one hour before meals and at bedtime

A charge nurse and a newly licensed nurse are providing care for a client who reports nausea and has a presciption for metoclopramide (Reglan) as an antiemetic. Which of the following statements by the newly licensed nurse indicates a correct understanding of the actions of the medication. "Metoclopramide": A. depresses vagal nerve activity B. decreases gastric acid secretions C. slows peristalsis D. promotes gastric emptying

D. promotes gastric emptying Rationale: Metoclopramide is a gastrointestinal stimulant used to relieve nausea, vomiting, heartburn, stomach pain, bloating, and persistent feeling of fullness after meals. - Metoclopramide works by promoting gastric emptying

The nurse is attempting to administer the morning dose of the medication. The pt refuses the medication, stating, "It makes me sick to my stomach!" What is the RN's responsibility?

Document the pt's refusal in the record.

Which nursing action helps the nurse to prevent a medication error?

Encourage the patient to ask questions if the medication is different than expected. -The nurse should encourage patients to question any medication that they are not familiar with or are not expecting to take.

The nurse plans care for a male patient who is 80 years old. The nursing diagnosis is noncompliance with the medication regimen related to living alone, as evidenced by uncontrolled blood pressure. What should the nurse do next?

Enlist the help of a home care nurse for pharmacotherapy.

In which step of the nursing process does the nurse determine the outcome of medication administration?

Evaluation

The nurse monitors the fulfillment of goals, and may revise them, during which phase of the nursing process?

Evaluation

High-alert medications are involved in more errors than other drugs. True or False.

False

A(n) _____________ reaction is any abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to an individual pt.

Idiosyncratic

During the medication administration process, it is important that the nurse remembers which guideline?

If a patient expresses a concern about a drug, stop, listen, and investigate the concerns.

The nurse prepares and administers prescribed medication during which phase of the nursing process?

Implementation

A client is given epinephrine (Adrenalin), and adrenergic agonist (sympathomimetic). The nurse should monitor the client for which condiiton? a. Decreased pulse b. Pupil constriction c. Bronchial constriction d. Increased blood pressure

Increased blood pressure

The nurse realizes that beta 1 receptor stimulation is differentiated from beta 2 stimulation in that stimulation of beta 1 receptors leads tto which condition? a. Increased broncholdilation b. Decreased uterine contractility c. Increased myocardial contractility d. Decreased blood flow to skeletal muscles

Increased myocardial contractility

The nurse is administering a cholinergic agonist and should know that the expected cholinergic effects include which of the following? a. Increased heart rate b. Decreased peristalsis c. Decreased salivation d. Increased pupil constriction

Increased pupil constriction

When developing a plan of care, which nursing action ensures the goal statement is pt centered?

Involving the pt.

Dicyclomine (Bentyl) is an anticholinergic, which the nurse realizes is given to treat which condition? a. Mydriasis b. Constipation c. Urinary retention c. Irritable bowel syndrome

Irritable bowel syndrome

The nurse administers a medication to the wrong patient. Which is the appropriate nursing action following this error?

Notify the health care provider and document the error on an incident report. -All medication errors that involve a patient need to be called to the health care provider's attention and documented on an incident report.

If a student nurse realizes that he or she has made a drug error, the instructor should remind the student of which concept?

Once the student has committed a medication error, his or her responsibility is to the patient and to being honest and accountable.

The patient receiving chemotherapy rings the call bell and reports the onset of nausea. The nurse should prepare an as-needed dose of which medication? A. Morphine sulfate B. Zolpidem (Ambien) C. Ondansetron (Zofran) D. Dexamethasone (Decadron)

Ondansetron is a 5-HT3 receptor antagonist antiemetic that is especially effective in reducing cancer chemotherapy-induced nausea and vomiting. Morphine sulfate may cause nausea and vomiting. Zolpidem does not relieve nausea and vomiting. Dexamethasone is usually used in combination with ondansetron for acute and chemotherapy-induced emesis.

The nurse will monitor the client taking albuterol (Proventil) for which condiiton? a. Palpitations b. Hypoglycemia c. Bronchospasm d. Uterine contractions

Palpitaitons

When benztropine (Cogentin) is ordered for a client, the nurse acknowledges that this drug is an effective treatment for which condition? a. Parkinsonism b. Paralytic ileus c. Motion sickness d. urinary retention

Parkinsonism

A patient is transferred from an intensive care unit (ICU) to a general medical unit. Which nursing action is MOST appropriate to prevent a medication error?

Perform a medication reconciliation for the patient during care transition. -Medication reconciliation is a process of identifying the most accurate list of all medications a patient is taking at each point of care (e.g., transfer from ICU to the general medical unit) and is an important nursing action to prevent medication errors. Reports should be written for better documentation. Patients may not remember or be aware of specific medications they received. Asking the health care provider to rewrite medication prescriptions can only prevent errors if the health care provider also performs a medication reconciliation to verify that the correct medications are reordered.

During which phase of the nursing process does the nurse prioritize the nursing diagnoses?

Planning

A patient has a new prescription for a blood pressure medication that may cause him to feel dizzy during the first few days of therapy. Which is the best nursing diagnosis for this situation?

Risk for injury.

A patient's chart includes an order that reads as follows: "Atenolol 25 mg once daily at 0900." Which action by the nurse is correct?

The nurse contacts the prescriber to clarify the dosage route.

An 86-year-old patient is being discharged to home on digitalis therapy and has very little information regarding the medication. Which statement best reflects a realistic outcome of patient teaching activities?

The patient and patient's daughter will state the proper way to take the drug.

Why are specific medications identified as "high-alert" medications?

These drugs have increased potential for significant patient harm. -High-alert medications have been identified as such because of their potentially toxic nature and their need for special care when prescribing, dispensing, or administering them. Thus, the potential for patient harm is higher with high-alert medications.

Allergic reactions are often predictable. True or False

True

What organization announced new regulations requiring bar codes for all prescription and over-the-counter (OTC) medications? a. Drug Enforcement Agency (DEA). b.Federal Bureau of Investigation (FBI). c. U.S. Food and Drug Administration (FDA). d. Department of Health and Human Services (DHHS)

U.S. Food and Drug Administration (FDA)

5. The three types of responses to pain are physiologic, behavioral, and affective. Which are examples of behavioral responses to pain? Select all that apply. a. A patient cradles a wrist that was injured in a car accident. b. A child is moaning and crying due to a stomachache. c. A patient's pulse is increased following a myocardial infarction. d. A patient in pain strikes out at a nurse who attempts to bathe him. e. A patient who has chronic cancer pain is depressed and withdrawn. f. A child pulls away from a nurse trying to give him an injection.

a. A patient cradles a wrist that was injured in a car accident. b. A child is moaning and crying due to a stomachache. f. A child pulls away from a nurse trying to give him an injection.

2. One of the most common distinctions of pain is whether it is acute or chronic. Which examples describe chronic pain? Select all that apply. a. A patient is receiving chemotherapy for bladder cancer. b. An adolescent is admitted to the hospital for an appendectomy. c. A patient is experiencing a ruptured aneurysm. d. A patient who has fibromyalgia requests pain medication. e. A patient has back pain related to an accident that occurred last year. f. A patient is experiencing pain from second-degree burns.

a. A patient is receiving chemotherapy for bladder cancer. d. A patient who has fibromyalgia requests pain medication. e. A patient has back pain related to an accident that occurred last year.

11. Mr. Wright is recovering from abdominal surgery. When the nurse assists him to walk, she observes that he grimaces, moves stiffly, and becomes pale. She is aware that he has consistently refused his pain medication. What would be a priority nursing diagnosis for this patient? a. Acute Pain related to fear of taking prescribed postoperative medications b. Impaired Physical Mobility related to surgical procedure c. Anxiety related to outcome of surgery d. Risk for Infection related to surgical incision

a. Acute Pain related to fear of taking prescribed postoperative medications

19. A patient with cancer-related pain and a history of opioid abuse complains of breakthrough pain 2 hours before the next dose of sustained-release morphine sulfate (MS Contin) is due. Which action should the nurse take first? a. Administer the prescribed PRN immediate-acting morphine. b. Suggest the use of alternative therapies such as heat or cold. c. Utilize distraction by talking about things the patient enjoys. d. Consult with the doctor about increasing the MS Contin dose.

a. Administer the prescribed PRN immediate-acting morphine. The patient's pain requires rapid treatment and the nurse should administer the immediate-acting morphine. Increasing the MS Contin dose and use of alternative therapies also may be needed, but the initial action should be to use the prescribed analgesic medications.

10. The nurse is assessing the pain of a neonate who is admitted to the NICU with a heart defect. Which pain assessment scale would be the best tool to use with this patient? a. CRIES scale b. COMFORT scale c. FLACC scale d. FACES scale

a. CRIES scale

6. An elderly patient is confined to bedrest following cervical spine surgery to treat nerve pinching. The nurse is vigilant about turning the patient and assessing the patient regularly to prevent the formation of pressure ulcers. What type of agent is the stimulus for pressure ulcers? a. Mechanical b. Thermal c. Chemical d. Electrical

a. Mechanical

21. A patient who is using a fentanyl (Duragesic) patch and immediate-release morphine for chronic cancer pain develops new-onset confusion, dizziness, and a decrease in respiratory rate. Which action should the nurse take first? a. Remove the fentanyl patch. b. Notify the health care provider. c. Continue to monitor the patient's status. d.Give the prescribed PRN naloxone (Narcan).

a. Remove the fentanyl patch. The assessment data indicate possible overdose of opioid. The first action should be to remove the patch. Naloxone administration in a patient who has been chronically using opioids can precipitate withdrawal and would not be the first action. Notification of the health care provider and continued monitoring also are needed, but the patient's data indicate that more rapid action is needed.

14. A patient who uses extended-release morphine sulfate (MS Contin) for chronic abdominal pain caused by ovarian cancer asks the nurse to administer the prescribed hydrocodone (Vicodin) tablets, but the patient is asleep when the nurse returns with the medication. Which action is best for the nurse to take? a. Wake the patient and administer the hydrocodone. b. Wait until the patient wakes up and reassess the pain. c. Consult with the health care provider about changing the MS Contin dose. d. Suggest the use of nondrug therapies for pain relief instead of additional opioids.

a. Wake the patient and administer the hydrocodone. Since patients with chronic pain frequently use withdrawal and decreased activity as coping mechanisms for pain, the patient's sleep is not an indicator that she is pain free. The nurse should wake the patient and administer the hydrocodone.

18. A patient who has just started taking sustained-release morphine sulfate (MS Contin) for chronic pain complains of nausea and abdominal fullness. The best initial action by the nurse is to a. administer the ordered antiemetic medication. b. tell the patient that the nausea will subside in about a week. c. order the patient a clear liquid diet until the nausea decreases. d. consult with the health care provider about using a different opioid

a. administer the ordered antiemetic medication. Nausea is frequently experienced with the initiation of opioid therapy, and antiemetics usually are prescribed to treat this expected side effect. There is no indication that a different opioid is needed, although if the nausea persists, the health care provider may order a change of opioid. Although tolerance develops and the nausea will subside in about a week, it is not appropriate to allow the patient to continue to be nauseated. A clear liquid diet may decrease the nausea, but the best choice would be to administer the antiemetic medication and allow the patient to eat.

the nurse administers antidiarrheal drugs... a. after each loose bowel movement b. hourly until diarrhea ceases c. with food d. BID, in the AM and at bedtime

a. after each loose bowel movement

5. A patient with chronic abdominal pain has learned to control the pain with the use of imagery and hypnosis. A family member asks the nurse how these techniques work. The nurse's reply is based on the information that these strategies a. impact the cognitive and affective components of pain. b. increase the modulating effect of the efferent pathways. c. prevent transmission of nociceptive stimuli to the cortex. d. slow the release of transmitter chemicals in the dorsal horn.

a. impact the cognitive and affective components of pain. Cognitive therapies impact on the perception of pain by the brain rather than affecting efferent or afferent pathways or influencing the release of chemical transmitters in the dorsal horn.

The nurse realizes that cholinergic agonists mimic which parasympathetic neurotransmitter? a. dopamine b. acetylcholine c. cholinesterase d. monnoamine oxidase

acetylcholine

A histamine (H2) - receptor antagonist will be prescribed for a client. The nurse understands that which medications are H2- receptor antagonists, one of which could be prescribed. Select all that apply. 1. Nizatidine (Axid) 2. Ranitidine (Zantac) 3. Famotidine (Pepcid) 4. Cimetidine (Tagamet) 5. Esomeprazole (Nexium) 6. Lansoprazole (Prevacid)

answer: 1,2,3,4 - 5 and 6 are PPI's (proton pump inhibitors)

When the client has a cholinergic overdose, the nurse anticipated administration of which drug as the antidote? a. atropine b. bethanechol c. ambenonium d. metoclopramide

atropine

1. When doing a pain assessment for a patient who has been admitted with metastatic breast cancer, which question asked by the nurse will give the most information about the patient's pain? a. "How long have you had this pain?" b. "How would you describe your pain?" c. "How much medication do you take for the pain?" d."How many times a day do you medicate for pain?"

b. "How would you describe your pain?" Because pain is a multidimensional experience, asking a question that addresses the patient's experience with the pain is likely to elicit more information than the more specific information asked in the other three responses. All of these questions are appropriate, but the response beginning "How would you describe your pain?" is the best initial question.

15. When assessing a patient receiving a continuous opioid infusion, the nurse immediately notifies the physician when the patient has: a. A respiratory rate of 10/min with normal depth b. A sedation level of 4 c. Mild confusion d. Reported constipation

b. A sedation level of 4

9. Applying the gate control theory of pain, what would be an effective nursing intervention for a patient with lower back pain? a. Encouraging regular use of analgesics b. Applying a moist heating pad to the area at prescribed intervals c. Reviewing the pain experience with the patient d. Ambulating the patient after administering medication

b. Applying a moist heating pad to the area at prescribed intervals

20. Which nursing action should the nurse delegate to nursing assistive personnel (NAP) when caring for a patient who is using a fentanyl (Duragesic) patch and a heating pad for treatment of chronic back pain? a. Assess the skin under the heating pad. b. Check the respiratory rate every 2 hours. c. Monitor sedation using the sedation assessment scale. d. Ask the patient about whether pain control is effective.

b. Check the respiratory rate every 2 hours. Obtaining the respiratory rate is included in NAP education and scope of practice. Assessment for sedation, pain control, and skin integrity requires more education and scope of practice.

13. When assessing pain in a child, the nurse needs to be aware of what considerations? a. Immature neurologic development results in reduced sensation of pain. b. Inadequate or inconsistent relief of pain is widespread. c. Reliable assessment tools are currently unavailable. d. Narcotic analgesic use should be avoided.

b. Inadequate or inconsistent relief of pain is widespread.

1. The health care provider plans to titrate a patient-controlled analgesia (PCA) machine to provide pain relief for a patient with acute surgical pain who has never received opioids in the past. Which of the following nursing actions regarding opioid administration are appropriate at this time (select all that apply)? a. Assessing for signs that the patient is becoming addicted to the opioid b. Monitoring for therapeutic and adverse effects of opioid administration c. Emphasizing that the risk of some opioid side effects increases over time d. Educating the patient about how analgesics improve postoperative activity level e. Teaching about the need to decrease opioid doses by the second postoperative day

b. Monitoring for therapeutic and adverse effects of opioid administration d. Educating the patient about how analgesics improve postoperative activity level Monitoring for pain relief and teaching the patient about how opioid use will improve postoperative outcomes are appropriate actions when administering opioids for acute pain. Although postoperative patients usually need decreasing amount of opioids by the second postoperative day, each patient's response is individual. Tolerance may occur, but addiction to opioids will not develop in the acute postoperative period. The patient should use the opioids to achieve adequate pain control, and so the nurse should not emphasize the adverse effects.

1. A nurse instructor is teaching a class of student nurses about the nature of pain. Which statements accurately describe this phenomenon? Select all that apply. a. Pain is whatever the physician treating the pain says it is. b. Pain exists whenever the person experiencing it says it exists. c. Pain is an emotional and sensory reaction to tissue damage. d. Pain is a simple, universal, and easy-to-describe phenomenon. e.. Pain that occurs without a known cause is psychological in nature. f. Pain is classified by duration, location, source, transmission, and etiology.

b. Pain exists whenever the person experiencing it says it exists. c. Pain is an emotional and sensory reaction to tissue damage. d. Pain is a simple, universal, and easy-to-describe phenomenon. e.. Pain that occurs without a known cause is psychological in nature. f. Pain is classified by duration, location, source, transmission, and etiology.

16. The nurse assesses a postoperative patient who is receiving morphine through patient-controlled analgesia (PCA). Which information is most important to report to the health care provider? a. The patient complains of nausea after eating. b. The patient's respiratory rate is 10 breaths/minute. c. The patient has not had a bowel movement for 3 days. d. The patient has a distended bladder and has not voided.

b. The patient's respiratory rate is 10 breaths/minute. The patient's respiratory rate indicates a need to decrease the PCA dose or change the medication in order to avoid further respiratory depression. The other information also may require intervention, but is not as urgent to report as the respiratory rate.

3. A patient complains of abdominal pain that is difficult to localize. The nurse documents this as which type of pain? a. Cutaneous b. Visceral c. Superficial d. Somatic

b. Visceral

8. A patient with second-degree burns has been receiving morphine through patient-controlled analgesia (PCA) for a week. The patient wakes up frequently during the night complaining of pain. The most appropriate action by the nurse is to a. administer a dose of morphine every 1 to 2 hours from the PCA machine while the patient is sleeping. b. consult with the health care provider about using a different treatment protocol to control the patient's pain. c. request that the health care provider order a bolus dose of morphine to be given when the patient awakens with pain. d. teach the patient to push the button every 10 minutes for an hour before going to sleep, even if the pain is minimal.

b. consult with the health care provider about using a different treatment protocol to control the patient's pain. PCAs are best for controlling acute pain; this patient's history indicates chronic pain and a need for a pain management plan that will provide adequate analgesia while the patient is sleeping. Administering a dose of morphine when the patient already has severe pain will not address the problem. Teaching the patient to administer unneeded medication before going to sleep can result in oversedation and respiratory depression. It is illegal for the nurse to administer the morphine for a patient through PCA.

15. These medications are prescribed by the health care provider for a patient who uses long-acting morphine (MS Contin) for chronic back pain, but still has ongoing pain. Which medication should the nurse question? a. morphine (Roxanol) b. pentazocine (Talwin) c. celecoxib (Celebrex) d. dexamethasone (Decadron)

b. pentazocine (Talwin) Opioid agonist-antagonists can precipitate withdrawal if used in a patient who is physically dependent on mu agonist drugs such as morphine. The other medications are appropriate for the patient.

12. When developing the plan of care for a patient with chronic pain, the nurse plans interventions based on the knowledge that chronic pain is most effectively relieved when analgesics are administered in what matter? a. On a PRN (as needed) basis b. Conservatively c. Around the clock (ATC) d. Intramuscularly

c. Around the clock (ATC)

7. A nurse uses a whirlpool to relax a patient following intense physical therapy to restore movement in her legs. What is a potent pain-blocking neuromodulator, released through relaxation techniques? a. Prostaglandins b. Substance P c. Endorphins d. Serotonin

c. Endorphins

9. When caring for a patient who is receiving epidural morphine, which information obtained by the nurse indicates that the patient may be experiencing a side effect of the medication? a. The patient has cramping abdominal pain. b. The patient becomes restless and agitated. c. The patient has not voided for over 10 hours. d. The patient complains of a "pounding" headache.

c. The patient has not voided for over 10 hours. Urinary retention is a common side effect of epidural opioids. Headache is not an anticipated side effect of morphine, although if there is a cerebrospinal fluid leak, the patient may develop a "spinal" headache. Sedation (rather than restlessness or agitation) would be a possible side effect. Hypotonic bowel sounds and constipation (rather than abdominal cramping) are concerns.

13. The nurse is caring for a diabetic patient who has chronic burning leg pain even when taking oxycodone (OxyContin) twice daily. Which of these prescribed medications is the best choice for the nurse to administer as an adjuvant to decrease the patient's pain? a. aspirin (Ecotrin) b. celecoxib (Celebrex) c. amitriptyline (Elavil) d. acetaminophen (Tylenol)

c. amitriptyline (Elavil) The patient's pain symptoms are consistent with neuropathic pain and the tricyclic antidepressants are effective for treating this type of pain. The other medications are more effective for nociceptive pain.

the pregnancy category for the antiflatulent drug simethicone is: a. category A b. category C c. category unknown d. category X

c. category unknown

12. Which of these prescribed therapies should the nurse use first when caring for a patient with cancer pain that the patient describes as at "level 8 (0 to 10 scale), deep, and aching." a. fentanyl (Duragesic) patch b. ketorolac (Toradol) tablets c. hydromorphone (Dilaudid) IV d. acetaminophen (Tylenol) suppository

c. hydromorphone (Dilaudid) IV The patient's pain level indicates that a rapidly-acting medication such as an IV opioid is needed. The other medications also may be appropriate to use, but will not work as rapidly or as effectively as the IV hydromorphone.

3. A postoperative patient asks the nurse how the prescribed ibuprofen (Motrin) will control the incisional pain. The nurse will teach the patient that ibuprofen interferes with the pain process by decreasing the a. modulating effect of descending nerves. b. sensitivity of the brain to painful stimuli. c. production of pain-sensitizing chemicals. d. spinal cord transmission of pain impulses.

c. production of pain-sensitizing chemicals. Nonsteroidal anti-inflammatory drugs (NSAIDs) provide analgesic effects by decreasing the production of pain-sensitizing chemicals such as prostaglandins at the site of injury. Transmission of impulses through the spinal cord, brain sensitivity to pain, and the descending nerve pathways are not affected by the NSAIDs.

The patient asks how stool softeners relieve constipation. Which of the following would be the best response by the nurse? Stool softeners relieve constipation by: a. stimulating the walls of the intestine b. promoting the retention of sodium in the fecal mass c. promoting the retention of water in the fecal mass d. lubricating the intestinal walls

c. promoting the retention of water in the fecal mass

Tommy Powell and his mother have come to your clinic. Tommy is a​ 6-year-old who presents with symptoms of chickenpox. What is the drug of choice for controlling​ Tommy's fever and​ pain? Aspirin​ (Bayer) Acetaminophen​ (Tylenol) Celecoxib​ (Celebrex Morphine sulfate​ (Duramorph)

correct answer

The nurse is reviewing the orders of a client admitted with a diagnosis of gastrointestinal (GI) bleeding. Which order would the nurse question? Serum hemoglobin and hematocrit levels now Ibuprofen (Advil) 200 mg, 2 tablets PO every 6 hours as needed for pain Intravenous infusion of 5% dextrose in half-normal saline at 125 mL/hr Acetaminophen (Tylenol) 650 mg PO as needed for fever (38.4 C) every 4 hours

correct answer Ibuprofen (Advil) 200 mg, 2 tablets PO every 6 hours as needed for pain

The nurse on a surgical unit is assessing the incision of a client who underwent an exploratory laparotomy. Which incision description indicates a normal inflammatory response? Pink skin, separation, and pain Redness, edema, and warmth to touch Odor, necrosis, and hot to touch Drainage, pallor, and pain

correct answer Redness, edema, and warmth to touch

The nurse is caring for a child with pneumonia and fever of 100​°F ​(38.1​°​C). The child​'s parent asks the​ nurse, "Why doesn​'t the doctor have something ordered for the temperature before it gets to 101​ degrees?" Which is the nurse​'s best​ response? ​"Your doctor does not want to give your child unnecessary​ medication." "A low-grade fever can aid in defense and repair of the​ body." ​"Don​'t worry. We will not let your child​'s temperature get too​ high." ​"A little fever is not going to hurt your​ child."

correct answer a low-grade fever can aid in defense and repair the body

The nurse is assessing a client with abdominal pain and a history of daily nonsteroidal antiinflammatory drug​ (NSAID) use for 6 months. Which assessment finding causes the nurse the most​ concern? Pain in the epigastric area of the abdomen Bright red blood in the stools Nausea related to the intake of food Dry mucous membranes in the oral cavity

correct answer bright red blood in the stools

Rosa​ Dillon, a​ 10-year-old client, is in the hospital following a car accident. She has sustained two broken​ ribs, along with cuts and bruises. As you clean and dress her​ wounds, Rosa worries because they are so swollen. As her​ nurse, what should you do to address​ Rosa's concerns? Explain to her how the lymphatic system works. Explain how inflammation helps her body heal. Assess for relief of symptoms. Consult with her admitting nurse.

correct answer explain how inflammation helps her body heal

Your​ client, Mrs. Valya​ Nelson, has been taking celecoxib​ (Celebrex) for three years for rheumatoid arthritis. She recently​ self-medicated with 800 mg of ibuprofen​ (Advil) twice a day for pain. Mrs. Nelson reports being chronically tired. Her eyes and skin are jaundiced. What adverse effect do you​ suspect? Liver dysfunction Low potassium High cholesterol Kidney disease

correct answer liver dysfunction

A client with arthritis has been prescribed acetylsalicylic acid​ (aspirin [Bayer]). Which information should the nurse teach the client about the ​drug? Select all that apply. Expect black stools as a side effect. Stop using aspirin 7 to 14 days prior to any scheduled surgery. Use ear plugs for ringing in the ears. Swallow the aspirin with a full glass of​ water, milk, or food. Avoid using alcohol while taking aspirin.

correct answer stop using aspirin 7 to 14 days prior to any scheduled surgery swallow the aspirin with a full glass of water, milk, or food avoid using alcohol while taking aspirin

The nurse on the orthopedic unit is caring for a client with bone infection secondary to an open fracture of the right leg. The client was found in a field following a tornado injury. Which best explains the cause of the​ infection? The break in the skin caused by the​ open-fracture injury The orthopedic surgeon​'s lack of sterility when treating the fracture The introduction of bacteria when the dressings were changed Inadequate nutrition to boost immunity

correct answer the break in the skin caused by the open fracture injury

A client admitted with gastric discomfort and peptic ulcer disease has a temperature of 102.8​°F ​(39.65​°​C). Which ordered medication does the nurse select to​ administer? Acetaminophen​ (Tylenol) Ketoprofen​ (Orudis) Ibuprofen​ (Advil) Acetylsalicylic acid​ (aspirin)

correct answer Acetaminophen (tylenol)

The nurse is reviewing the use of acetylsalicyclic acid (aspirin [Bayer]) in the client population. Which clients could benefit from the use of aspirin? Select all that apply. A client with gastrointestinal bleeding An adult client with a fever A client with mild back pain after a fall A client with primary dysmenorrhea A client with inflammatory arthritis

correct answers An adult client with a fever A client with mild back pain after a fall A client with primary dysmenorrhea A client with inflammatory arthritis

7. A patient with chronic back pain is seen in the pain clinic for follow-up. In order to evaluate whether the pain management is effective, which question is best for the nurse to ask? a. "Can you describe the quality of your pain?" b. "Has there been a change in the pain location?" c. "How would you rate your pain on a 0 to 10 scale?" d. "Does the pain keep you from doing things you enjoy?"

d. "Does the pain keep you from doing things you enjoy?" The goal for the treatment of chronic pain usually is to enhance function and quality of life. The other questions also are appropriate to ask, but information about patient function is more useful in evaluating effectiveness.

8. A patient is postoperative following an emergency cesarean section birth. The patient asks the nurse about the use of pain medications following surgery. What would be a correct response by the nurse? a. "It's not a good idea to ask for pain medication regularly as it can be addictive." b. "It is better to wait until the pain gets unbearable before asking for pain medication." c. "It's natural to have to put up with pain after surgery and it will lessen in intensity in a few days." d. "Your doctor has ordered pain medications for you, which you should not be afraid to request any time you have pain."

d. "Your doctor has ordered pain medications for you, which you should not be afraid to request any time you have pain."

4. A female patient who is having a myocardial infarction complains of pain that is situated in her jaw. The nurse documents this as what type of pain? a. Transient pain b. Superficial pain c. Phantom pain d. Referred pain

d. Referred pain

14. A pregnant woman is receiving an epidural analgesic prior to delivery. The nurse provides vigilant monitoring of this patient to prevent the occurrence of: a. Pruritus b. Urinary retention c. Vomiting d. Respiratory depression

d. Respiratory depression

4. A patient with chronic cancer pain is receiving imipramine (Tofranil) in addition to long-acting morphine for pain control. Which information is the best indicator that the imipramine is effective? a. The patient sleeps 8 hours every night. b. The patient has no symptoms of anxiety. c. The patient states, "I feel much less depressed since I've been taking the imipramine." d. The patient states, "The pain is manageable, and I can accomplish my desired activities.

d. The patient states, "The pain is manageable, and I can accomplish my desired activities. Imipramine is being used in this patient to manage chronic pain and improve functional ability. Although the medication also is prescribed for patients with depression, insomnia, and anxiety, the evaluation for this patient is based on improved pain control and activity level.

17. A patient who has chronic musculoskeletal pain tells the nurse, "I feel depressed because I ache too much to play golf." The patient says the pain is usually at a level 7 (0 to 10 scale). Which patient goal has the highest priority when the nurse is developing the treatment plan? a. The patient will exhibit fewer signs of depression. b. The patient will say that the aching has decreased. c. The patient will state that pain is at a level 2 of 10. d. The patient will be able to play 1 to 2 rounds of golf.

d. The patient will be able to play 1 to 2 rounds of golf. For chronic pain, patients are encouraged to set functional goals such as being able to perform daily activities and hobbies. The patient has identified playing golf as the desired activity, so a pain level of 2 of 10 or a decrease in aching would be less useful in evaluating successful treatment. The nurse also should assess for depression, but the patient has identified the depression as being due to the inability to play golf, so the goal of being able to play 1 or 2 rounds of golf is the most appropriate.

10. When the nurse visits a hospice patient, the patient has a respiratory rate of 8 breaths/minute and complains of severe pain. Which action is best for the nurse to take? a Inform the patient that increasing the morphine will cause the respiratory drive to fail. b. Administer a nonopioid analgesic, such as a nonsteroidal anti-inflammatory drug (NSAID), to improve patient pain control. c. Tell the patient that additional morphine can be administered when the respirations are 12. d. Titrate the prescribed morphine dose upward until the patient indicates adequate pain relief.

d. Titrate the prescribed morphine dose upward until the patient indicates adequate pain relief. The goal of opioid use in terminally ill patients is effective pain relief regardless of adverse effects such as respiratory depression. A nonopioid analgesic like ibuprofen would not provide adequate analgesia or be absorbed quickly. The rule of double effect provides ethical justification for administering an increased morphine dose to provide effective pain control even though the morphine may further decrease the patient's respiratory rate.

22. These medications are ordered for an 86-year-old patient with arthritis in both hips who is complaining of level 3 (0 to 10 scale) hip pain while ambulating. Which medication should the nurse use as initial therapy? a. aspirin (Bayer) 650 mg orally b. naproxen (Aleve) 200 mg orally c. oxycodone (Roxicodone) 5 mg orally d. acetaminophen (Tylenol) 650 mg orally

d. acetaminophen (Tylenol) 650 mg orally Acetaminophen is the best first-choice medication. The principle of "start low, go slow" is used to guide therapy when treating elderly adults because the ability to metabolize medications is decreased and the likelihood of medication interactions is increased. Nonopioid analgesics are used first for mild to moderate pain, although opioids may be used later. Aspirin and the NSAIDs are associated with a high incidence of gastrointestinal bleeding in elderly patients.

When recording the administration of diphenoxylate for multiple loose stools: a. document the daily number of drugs given b. record all stools once each shift c. indicate all stools on the MAR next to the drug d. document each dose on the MAR

d. document each dose on the MAR

6. A patient who is receiving sustained-release morphine sulfate (MS Contin) every 12 hours for chronic pain experiences level 9 (0 to 10 scale) breakthrough pain and anxiety. Which of these prescribed medications will be best for the nurse to administer? a. lorazepam (Ativan) 1 mg orally b. amitriptyline (Elavil) 10 mg orally c. ibuprofen (Motrin) 400 to 800 mg orally d. immediate-release morphine 30 mg orally

d. immediate-release morphine 30 mg orally The severe breakthrough pain indicates that the initial therapy should be a rapidly acting opioid, such as the immediate-release morphine. The Motrin and Elavil may be appropriate to use as adjuvant therapy, but they are not likely to block severe breakthrough pain. Use of anti-anxiety agents for pain control is inappropriate because this patient's anxiety is caused by the pain.

11. A patient with a history of chronic cancer pain is admitted to the hospital. When reviewing the patient's home medications, which of these will be of most concern to the admitting nurse? a. amitriptyline (Elavil) 50 mg at bedtime b. oxycodone (OxyContin) 80 mg twice daily c. ibuprofen (Advil) 800 mg 3 times daily d. meperidine (Demerol) 25 mg every 4 hours

d. meperidine (Demerol) 25 mg every 4 hours Meperidine is contraindicated for chronic pain because it forms a metabolite that is neurotoxic and can cause seizures when used for prolonged periods. The ibuprofen, amitriptyline, and oxycodone are all appropriate medications for long-term pain management.

2. A patient who uses a fentanyl (Duragesic) patch for chronic cancer pain complains to the nurse of the rapid onset of pain at a level 9 (0 to 10 scale) and requests "something for pain that will work quickly." The nurse will document this as a. somatic pain. b. referred pain. c. neuropathic pain. d.breakthrough pain.

d.breakthrough pain. Pain that occurs beyond the chronic pain already being treated by appropriate analgesics is termed breakthrough pain. Neuropathic pain is caused by damage to peripheral nerves or the central nervous system (CNS). Somatic pain is localized and arises from bone, joint, muscle, skin, or connective tissue. Referred pain is pain that is localized in uninjured tissue.

The nurse is reviewing medication orders. Which digoxin dose is written correctly? a. digoxin .25 mg b. digoxin .250 mg c. digoxin 0.250 mg d. digoxin 0.25 mg

digoxin 0.25 mg

For the client taking epinephrine, the nurse realizes there is a possible drug interaction with which drug? a. albuterol (Proventil) b. bethanechol (Urecholine) c. bethanechol (Detrol) d. tolterodine tartrate (Detrol)

metoprolol (Lopressor)

A client is receiving bethanechol (Urecholine). The nurse realizes that the action of this drug is to treat: a. Glaucoma b. Urinary retention c. Delayed gastric emptying d. Gastroesphageal reflux disease

urinarry retention