Pham Final

A patient will be receiving epoetin alfa (Epogen) 8000 units IV three times a week. The medication is available in a vial that contains 10,000 units/mL. How many milliliters will the nurse draw up for this dose? _______

0.8mL

The client diagnosed with cancer of the head of the pancreas has had a Whipple procedure (pancreatoduodenectomy). Which discharge instructions should the nurse teach the client? 1. Administer insulin subcutaneously. 2. Take acetaminophen for an elevated temperature. 3. Change the surgical dressing weekly. 4. Increase the calories and protein in the diet.

1

The client diagnosed with moderate benign prostatic hypertrophy (BPH) is being treated with the alpha-adrenergic agonist tamsulosin (Flomax). Which intervention should the nurse implement? 1. Check the client's blood pressure. 2. Send a urinalysis to the laboratory. 3. Determine if the client has nocturia. 4. Plan a scheduled voiding pattern.

1

The client diagnosed with the flu is prescribed the cough medication hydrocodone. Which information should the nurse teach the client regarding this medication? 1. Teach the client to monitor the bowel movements for constipation. 2. Driving or operating machinery is all right while taking this medication. 3. This medication usually causes insomnia, so plan for rest periods. 4. This medication is more effective when taken with a mucolytic.

1

The client is having an acute exacerbation of asthma. The health-care provider has prescribed epinephrine (adrenaline) subcutaneously. Which intervention should the nurse implement when administering this medication? 1. Administer the medication using a tuberculin syringe. 2. Dilute the medication to a 5-mL bolus prior to administering. 3. Perform a complete respiratory assessment. 4. Monitor the client's serum epinephrine level.

1

The client receiving chemotherapy for non-Hodgkin's lymphoma asks the nurse, "Why do I need to take steroids? I've heard they can cause problems." Which statement is the nurse's best response? 1. "Steroids suppress replication of lymphoid tissue and cause cell death." 2. "Steroids will decrease the inflammation caused by the tumor cells." 3. "The problems caused by the steroids are nothing compared to cancer." 4. "It is possible to have the HCP order different medications for the cancer."

1

The client taking chemotherapy has developed a white, patchy area on the tongue and buccal mucosa. Which medication is the best treatment for this condition? 1. Ketoconazole (Nizoral), an anti-infective, to swish and swallow. 2. Metronidazole (Flagyl), a GI anti-infective, by mouth. 3. Miconazole (Monistat), an anti-infective, topically. 4. Doxycycline (Vibramycin), an antibiotic, orally.

1

The client with reactive airway disease is taking the oral sympathomimetic bron- chodilator metaproterenol (Alupent) three times a day. Which intervention should the nurse implement? 1. Instruct the client to take the last dose a few hours before bedtime. 2. Teach the client to decrease the fluid intake when taking this medication. 3. Have the client demonstrate the correct way to use the inhaler. 4. Encourage the client to take the medication with an antacid.

1

The client with the flu has been taking acetylcysteine (Mucomyst), a mucolytic. Which adverse effect should the nurse assess for? 1. Bronchospasm. 2. Nausea. 3. Fever. 4. Drowsiness.

1

The client with the flu is prescribed the over-the-counter cough suppressant dextromethorphan. Which information should the nurse teach regarding this medication? 1. Take the medication every 4-8 hours as needed for cough. 2. The medication can cause addiction if taken too long. 3. Do not drive or operate machinery while taking the drug. 4. Do not take a beta blocker while taking this medication.

1

The nurse is administering 0800 medications on a medical floor. Which medication should the nurse administer first? 1. Prostigmin, a cholinesterase inhibitor, to a client diagnosed with myasthenia gravis. 2. Methylprednisolone, a glucocorticoid, to a client diagnosed with lupus erythematosus. 3. Morphine, a narcotic analgesic, to a client diagnosed with Guillain-Barré syndrome. 4. Etanercept, a biologic response modifier, to a client with rheumatoid arthritis.

1

The nurse is administering morning medications. Which combination of medications should the nurse question administering? 1. Terazosin (Hytrin), an alpha1-adrenergic agonist, and captopril (Capoten), an ACE inhibitor. 2. Finasteride (Proscar), a 5-alpha-reductase inhibitor, and digoxin (Lanoxin), a cardiac glycoside. 3. Tamsulosin (Flomax), an alpha1-adrenergic agonist, and metformin (Glucophage), a biguanide. 4. Serenoa repens (saw palmetto), an herbal preparation, and metoprolol (Toprol XL), a beta blocker.

1

The nurse is caring for clients on an oncology unit. Which medication should the nurse administer first? 1. The scheduled dose of leucovorin (folinic acid), a rescue factor. 2. The narcotic pain medication for a client with pain of 10 on the pain scale. 3. The antiemetic to a client complaining of nausea and an emesis of 200 mL. 4. The third dose of an aminoglycoside antibiotic to a client who has a fever.

1

The nurse on a medical unit is administering 0900 medications. Which medication should the nurse question administering? 1. Acetylcysteine (Mucomyst), a mucolytic, to a client who is coughing forcefully. 2. Cefazolin (Ancef), an antibiotic, IVPB to a client diagnosed with the flu. 3. Diphenhydramine (Benadryl), an antihistamine, to a client who is congested. 4. Dextromethorphan (Robitussin), an antitussive, to a client who has pneumonia.

1

The primary nurse is preparing to administer dobutamine (Dobutrex), a beta1-adrenergic agonist, to a client in cardiogenic shock. Which action by the primary nurse warrants intervention by the charge nurse? 1. The primary nurse is administering the dobutamine drip via gravity. 2. The primary nurse attaches a urometer to the client's Foley catheter. 3. The primary nurse applies a pulse oximeter to the client's finger. 4. The primary nurse checks the client for any medication allergies.

1

Which assessment data indicates the client with reactive airway disease has "good" control with the medication regimen? 1. The client's peak expiratory flow rate (PEFR) is greater than 80% of his or her personal best. 2. The client's lung sounds are clear bilaterally, both anterior and posterior. 3. The client has only had three acute exacerbations of asthma in the last month. 4. The client's monthly serum theophylline level is 18 g/mL. The client is taking the medication as directed by the health-care provider.

1

Which information should the nurse teach the client who is prescribed a glucocorti- coid inhaler? 1. Advise the client to gargle after each administration. 2. Instruct the client to use the inhaler on a PRN basis. 3. Encourage the client not to use a spacer when using the inhaler. 4. Teach the client to check his or her forced expiratory volume daily.

1

The female client tells the clinic nurse that she gets carsick every time the family goes on a vacation and the health-care provider prescribed the anticholinergic scopolamine (Transderm Scop). Which statement indicates the client understands the medication teaching? Select all that apply. 1. "I will put the Transderm Scop patch behind my ear." 2. "I will put the patch on for 12 hours and take it off at night." 3. "If my carsickness does not go away, I will wear two patches." 4. "I should leave the patch on for 3 days before changing it." 5. "I should take the medication with one glass of water."

1, 4

The client complaining of weakness, dizziness, and light-headedness is exhibiting the following telemetry strip. The nurse administered the antidysrhythmic medication atropine sulfate intravenously. Which data best indicates the medication was effective? 1. The client's apical pulse rate is 68. 2. The client's blood pressure is 110/70. 3. The client's oral mucosa is moist. 4. The client ambulates to the bathroom safely.

1. Atropine decreases vagal stimulation, increases the heart rate, and is the medication of choice to treat sympto matic bradycardia—weakness, dizziness, and light-headedness. An increased heart rate indicates the medication is effective.

Which client should the nurse question when administering the muscarinic antagonist atropine? 1. The 69-year-old client diagnosed with glaucoma. 2. The 60-year-old client diagnosed with symptomatic sinus bradycardia. 3. The 55-year-old client being prepped for an abdominal surgery. 4. The 28-year-old client with severe diarrhea.

1. Atropine is contraindicated in a client with glaucoma because atropine causes mydriasis and paralysis of the ciliary muscle, which would increase intraocular pressure and may cause blindness.

The client diagnosed with Alzheimer's disease (AD) is prescribed rivastigmine (Exelon), a cholinesterase inhibitor. Which medication should the nurse question administering to the client? 1. Amitriptyline (Elavil), a tricyclic antidepressant. 2. Warfarin (Coumadin), an anticoagulant. 3. Phenytoin (Dilantin), an anticonvulsant. 4. Prochlorperazine (Compazine), an antiemetic.

1. Tricyclic antidepressants, first-generation antihistamines, and antipsychotics can reduce the client's response to cholinesterase inhibitors. Antipsy chotics are useful for clients whose behavior is erratic and uncontrollable in the end stage of the disease. The cholinesterase inhibitor Exelon would not be useful in end-stage disease.

A patient will be receiving diphenhydramine (Benadryl) via a PEG tube, 25 mg, every 8 hours for an allergic rash. The medication is available as a 12.5 mg/5 mL syrup. Identify how many milliliters will the nurse administer with each dose. _______

10mL

A 2-year-old child will be receiving ferrous sulfate oral drops (Fer-Iron) 5 mg/kg/day in three divided doses. The child weighs 26 pounds. Identify how many milligrams will the nurse administer per dose. (record answer using one decimal place) _______

19.7mg

9. The client receiving doxorubicin (Adriamycin), an antineoplastic antibiotic, for cancer of the breast has developed alopecia. Which information is most helpful for the nurse to provide the client? 1. Have the client shave the entire head as a comfort measure. 2. Encourage the client to purchase a wig that matches her own hair. 3. Try to get the client to discuss her feelings about the alopecia. 4. Discuss measures to prevent sunburn of the scalp.

2

The client is in a code and is exhibiting ventricular fibrillation. Which medication would the nurse prepare to administer? 1. Dopamine, a vasopressor, intravenous drip. 2. Lidocaine, an antidysrhythmic, intravenous push. 3. Procainamide, an antidysrhythmic, intravenous push. 4. Dobutamine, an inotropic medication, intravenous drip.

2

The client receiving chemotherapy has developed stomatitis. Which referral should the nurse implement? 1. Refer to a social worker. 2. Refer to a dietician. 3. Refer to a hospice nurse. 4. Refer to a physical therapist.

2

The client who had a Whipple resection (pancreatoduodenectomy) for cancer of the pancreas has arterial blood gases of pH 7.29, PCO2 40, HCO3 18, and PaO2 100. Which medication should the nurse prepare to administer? 1. Intravenous normal saline at a keep-open rate. 2. Intravenous insulin by continuous infusion. 3. Sodium bicarbonate intravenously. 4. Sliding-scale Humulin N subcutaneous.

2

The client who has been using oxymetazoline (Afrin) nasal spray for several weeks complains to the nurse that the spray no longer seems to work to clear the nasal passages. Which information should the nurse teach? 1. Increase the amount of sprays used until the desired effect has been reached. 2. This type of medication can cause rebound congestion if used too long. 3. Alternate the Afrin with a saline nasal spray every 2 hours. 4. Place the Afrin nasal spray in a vaporizer at night for the best results.

2

The client who has had a gastric bypass surgery asks the nurse, "Why do I need to take vitamin B12 injections?" Which statement is the nurse's best response? 1. "You have pernicious anemia, and the injections will cure the problem." 2. "Your body cannot absorb the vitamin from the food you eat." 3. "Since the surgery you cannot eat enough food to get the amount you need." 4. "You will need to take the injections daily until your body begins to make B12."

2

The client with chronic reactive airway disease is taking the leukotriene receptor in- hibitor montelukast (Singulair). Which statement by the client warrants intervention by the nurse? 1. "I have been having a lot of headaches lately." 2. "I have started taking an aspirin every day." 3. "I keep this medication up on a very high shelf." 4. "I must protect this medication from extreme temperatures."

2

The elderly male client is prescribed tolterodine (Detrol-LA), an anticholinergic, for urge incontinence. Which statement warrants notifying the health-care provider? 1. "I have to suck on sugarless candy because my mouth is so dry." 2. "I am so glad I can go all day without having to go to the bathroom." 3. "I really have problems swallowing the pills whole with water." 4. "I hate I had to give up my grapefruit juice, but I know it is best."

2

The nurse administered edrophonium (Tensilon), a cholinesterase inhibitor, to a client diagnosed with rule-out myasthenia gravis (MG). Which response by the client indicates the client has myasthenia gravis? 1. The client loses the ability to breathe without mechanical support. 2. The client's strength improves briefly without signs of fasciculations. 3. The client cannot gaze at the ceiling for 2 minutes without fatigue. 4. The client's paroxysmal atrial tachycardia converts to normal sinus rhythm.

2

The nurse is caring for a client newly diagnosed with immunohemolytic anemia. Which medication should the nurse anticipate the HCP ordering? 1. Filgrastim (Neupogen), a hematopoietic growth factor. 2. Methylprednisolone (Solu-Medrol), a glucocorticoid. 3. A transfusion of red blood cells. 4. Leucovorin (folinic acid), a blood former.

2

The nurse observes the unlicensed assistive personnel (UAP) performing delegated tasks. Which action by the UAP requires immediate intervention? 1. The UAP measures the output of a client who had a transurethral resection of the prostate. 2. The UAP tells the client whose urine is green that something must be wrong for the urine to be such an odd color. 3. The UAP encourages the client to drink a glass of water after the nurse administered the oral antibiotic. 4. The UAP assists the client diagnosed with a urinary tract infection to the bedside commode every 2 hours.

2. A green-blue color indicates the client is taking bethanechol (Urecholine), a urinary stimulant used for clients with 16. 1. 17. 1. 18. 1. a neurogenic bladder. This is an expected color, and the UAP should not indicate that something is wrong with the client.

The home health-care nurse is caring for a client taking donepezil (Aricept), a cholinesterase inhibitor. Which finding indicates the medication is effective? 1. The client is unable to relate his or her name or birth date. 2. The client is discussing an upcoming event with the family. 3. The client is wearing underwear on the outside of the clothes. 4. The client is talking on a telephone that is signaling a dial tone.

2. Cholinesterase inhibitors are prescribed to increase cognitive ability for clients diagnosed with AD. Discussing an up coming event indicates the client is able to focus on a topic and remember that something will happen in the future.

Which statement is the scientific rationale for prescribing and administering donepezil (Aricept), a cholinesterase inhibitor? 1. Aricept works to bind the dopamine at neuron receptor sites to increase ability. 2. Aricept increases the availability of acetylcholine at cholinergic synapses. 3. Aricept decreases acetylcholine in the periphery to increase movement. 4. Aricept delays transmission of acetylcholine at the neuronal junction.

2. Cholinesterase inhibitors increase the availability of acetylcholine at cholinergic synapses, resulting in increased trans mission of acetylcholine by cholinergic neurons that have not been destroyed by the Alzheimer's disease.

The client diagnosed with late-stage Alzheimer's disease is agitated and having delusions. Which medication should the nurse anticipate the health-care provider prescribing? 1. The cholinesterase inhibitor donepezil (Aricept). 2. The antipsychotic medication haloperidol (Haldol). 3. The selective serotonin reuptake inhibitor fluoxetine (Prozac). 4. The tricyclic antidepressant amitriptyline (Elavil).

2. Delusions and agitation respond to antipsychotic medications. Haldol has been used and has proved to be effective in treating these symptoms, so the nurse 11. should anticipate this prescription.

The male client diagnosed with urinary retention is receiving bethanechol (Urecholine), a muscarinic agonist, medication. Which intervention should the nurse implement? 1. Limit the client's fluid intake to 1000 mL daily. 2. Have the client's urinal readily available. 3. Maintain hourly intake and output for the client. 4. Monitor the client's serum creatinine level.

2. This medication relaxes the urinary sphincters and increases voiding pres sure by contracting the detrusor mus cle of the bladder; therefore, the client will need to have a urinal available for frequent urination.

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

200mL/hr

A patient will be receiving oral theophylline (Theo-Dur), 600 mg/day, in three divided doses. Identify how many milligrams will the patient receive per dose. _______

200mg/dose

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

250mL/hr`

The 60-year-old female client has taken hormone replacement therapy for control of menopausal symptoms for the last 9 years. Which statement by the nurse indicates the client's risk for developing breast cancer? 1. "The risk of getting cancer decreases each year that the client takes hormones." 2. "The risk is the same as for women who do not take hormone replacement." 3. "The risk increases each year the client is taking hormone replacement therapy." 4. "The risk is only slightly greater while taking hormone replacement."

3

The client admitted for an acute exacerbation of reactive airway disease is receiving intravenous aminophylline. The client's serum theophylline level is 28 g/mL. Which intervention should the nurse implement first? 1. Continue to monitor the aminophylline drip. 2. Assess the client for nausea and restlessness. 3. Discontinue the aminophylline drip. 4. Notify the health-care provider immediately.

3

The client diagnosed with Alzheimer's disease is taking vitamin E and Ginkgo biloba. Which information should the nurse teach the client? 1. Take the medications on an empty stomach. 2. Have regular blood tests to assess for toxic levels. 3. The medications only slow the progression of the disease. 4. Use a sunscreen of SPF 15 or greater when in the sun.

3

The client diagnosed with stage D congestive heart failure (CHF) has a brain natri uretic peptide (BNP) level greater than 1500. Which medication should the nurse anticipate the HCP prescribing? 1. Captopril (Capoten), an angiotensin-converting enzyme inhibitor, orally. 2. Digoxin (Lanoxin), a cardiac glycoside, IVP. 3. Dobutamine (Dobutrex), a synthetic catecholamine, IV. 4. Metoprolol (Lopressor), a beta blocker, orally.

3

The client in cardiogenic shock is receiving dopamine, a beta and alpha agonist. The peripheral intravenous site becomes infiltrated. Which intervention should the nurse implement? 1. Assess the client's blood pressure and apical pulse. 2. Elevate the arm and apply ice to the infiltrated area. 3. Inject phentolamine (Regitine) at the site of infiltration. 4. Discontinue the IV and take no other action.

3

The client is prescribed albuterol (Ventolin), a sympathomimetic bronchodilator, metered-dose inhaler. Which behavior indicates the teaching concerning the inhaler is effective? 1. The client holds his or her breath for 5 seconds and then exhales forcefully. 2. The client states the canister is full when it is lying on top of the water. 3. The client exhales and then squeezes the canister as the next inspiration occurs. 4. The client connects the oxygen tubing to the inhaler before administering the dose.

3

The client with an implanted port has completed the chemotherapy medications and is ready for discharge. Which intervention should the nurse take to prepare the client for discharge? 1. Teach the client how to manage the port at home. 2. Insert a sterile, noncoring needle into the port. 3. Flush the port with saline followed by heparin. 4. Scrub the port access with povidone-iodine (Betadine).

3

The daughter of a client diagnosed with Alzheimer's disease tells the home health nurse that she has been giving her mother Ginkgo biloba, an herbal medication. Which intervention should the nurse implement? 1. Tell her to stop giving her mother the herb because it will not help. 2. Teach her that herbs have many life-threatening adverse effects. 3. Explain that the effects may only last for 6-12 months. 4. Ask the HCP to prescribe tacrine (Cognex) instead of the herb.

3

The female client diagnosed with myasthenia gravis complains that the anti- cholinesterase medication makes her nauseated. Which information should the nurse teach the client? 1. Decrease the dose of the medication. 2. Hold the medication and notify the HCP. 3. Take the medication with milk and crackers. 4. Take an over-the-counter proton-pump inhibitor.

3

The nurse assesses excoriated skin surrounding the colostomy stoma of a client diag- nosed with cancer of the colon. Which intervention should the nurse implement first? 1. Request a consult from a wound ostomy continence nurse. 2. Apply a skin barrier protectant paste around the stoma. 3. Gently cleanse the area with mild soap and water. 4. Replace the pouch with one that is 1/3 inch larger than the stoma.

3

The nurse is preparing to administer the alpha-beta blocker labetalol (Normodyne) intravenous push (IVP) to a client diagnosed with hypertensive crisis. Which interven- tion should the nurse implement? 1. Monitor the client's labetalol serum drug level. 2. Keep the medication covered with tin foil. 3. Administer the medication slow IVP over 5 minutes. 4. Teach the client signs/symptoms of hypertension.

3

The client diagnosed with a solid tissue tumor is prescribed darbepoetin (Aranesp), a hematopoietic growth factor. Which data should the nurse monitor? 1. The white blood cell counts. 2. The client's lung capacity. 3. The client's blood pressure. 4. The platelet counts.

3 aranesp stimulates rbc production. when hematocrit rises, it can result in an increase in bp. the rn should monitor bp

The nurse is working at a senior citizen center. She is giving a lecture on health- promotion activities for the elderly. Which information should the nurse discuss with the group to help prevent constipation? 1. The antispasmodic dicyclomine (Bentyl), taken every morning with the breakfast meals, will help prevent constipation. 2. Eating five to six small meals a day including low-residue foods will help prevent the development of constipation. 3. Taking a daily stool softener along with daily exercise, increased fluids, and a high-fiber diet will help prevent constipation from developing. 4. Elderly clients must have at least one bowel movement a day to prevent the development of constipation.

3. Getting daily exercise, increasing fluid intake, eating a high-fiber diet, and using a stool softener that lubricates the stool lead to regular bowel movements, which, in turn, prevent constipation.

The family member of a client diagnosed with early-stage Alzheimer's disease (AD) who was prescribed the cholinesterase inhibitor donepezil (Aricept) without improve- ment asks the nurse, "Can anything be done to slow the disease since this medication does not work?" Which statement is the nurse's best response? 1. "I am sorry that the medication did not help. Would you like to talk about it?" 2. "You need to prepare for long-term care because confusion is inevitable now." 3. "Your loved one may respond to a different medication of the same type." 4. "No, nothing is going to slow the disease now. Have the client make a will."

3. If the client does not respond to one of the cholinesterase inhibitors, then another may be tried because the drugs are not identical. The client may be responsive to a different medication in the same classification.

The 28-year-old female client with chronic reactive airway disease is taking the leukotriene receptor inhibitor montelukast sodium (Singulair). Which statement by the client indicates the client teaching is effective? 1. "I will not drink coffee, tea, or any type of cola drinks." 2. "I will take this medication at the beginning of an asthma attack." 3. "It is all right to take this medication if I am trying to get pregnant." 4. "I should not decrease the dose or suddenly stop taking this medication."

4

The 39-year-old client diagnosed with breast cancer is prescribed the antiestrogen hormone tamoxifen (Nolvadex). Which information is most important for the nurse to teach the client? 1. The medication will cause menopause symptoms. 2. Nolvadex may cause vaginal discharge and nausea. 3. Tamoxifen will slow the growth of estrogen-positive tumors. 4. It is important to see the gynecologist regularly.

4

The client in cardiogenic shock is receiving norepinephrine (Levophed), a sympathomimetic. Which priority intervention should the nurse implement? 1. Do not abruptly discontinue the medication. 2. Administer medication on an infusion pump. 3. Check the client's creatinine level and BUN. 4. Monitor the client's blood pressure continuously.

4

The client is diagnosed with folic acid deficiency anemia and Crohn's disease. Which medication should the nurse anticipate being prescribed? 1. Oral folic acid. 2. Cyanocobalamin, vitamin B12 IM. 3. B complex vitamin therapy orally. 4. Intramuscular folic acid.

4

The nurse is administering iron dextran (Imferon), an iron preparation, to a client di- agnosed with iron-deficiency anemia. Which intervention should the nurse imple ment? 1. Make sure the client is well hydrated. 2. Give the medication subcutaneously in the deltoid. 3. Check for allergies to fish or other seafood. 4. Administer the medication by the Z-track method.

4

The nurse is discharging a client diagnosed with chronic obstructive pulmonary disease (COPD). Which discharge instructions should the nurse provide regarding the client's prescription for prednisone, a glucocorticoid? 1. Take all the prednisone as ordered until the prescription is empty. 2. Take the prednisone on an empty stomach with a full glass of water. 3. Stop taking the prednisone if a noticeable weight gain occurs. 4. The medication should never be abruptly discontinued.

4

Which intervention should the nurse in an oncology physician's office delegate to the unlicensed assistive personnel (UAP)? 1. Administer the premedications for the chemotherapy. 2. Provide discharge instructions to the client. 3. Document the antineoplastic agents the client received. 4. Apply A+D ointment to the head of a client who has alopecia.

4

Which medical treatment is recommended for the client who is diagnosed with mild intermittent asthma? 1. This classification of asthma requires a combination of long-term control medication plus a quick-relief medication. 2. Mild intermittent asthma needs a routine glucocorticoid inhaler and a sustained- relief theophylline. 3. This classification requires daily inhalation of an oral glucocorticoid and daily nebulizer treatments. 4. Mild intermittent asthma is treated on a PRN basis and no long-term control medication is needed.

4

The nurse is administering medications to the clients on a medical unit. Which medication should the nurse question administering? 1. Atropine, an antimuscarinic- to a client with myasthenia gravis. 2. Chloroquine, an antimalarial- to a client with a butterfly rash. 3. Prednisone, a corticosteroid- to a client with polymyalgia rheumatica. 4. Mestinon, a cholinesterase inhibitor- to a client in a cholinergic crisis.

4- mestinon is prescribed to increase avalaible amt of ACH for muscle movement. Cholinergic crisis= pt has too much med.

An adult patient is about to receive intravenous (IV) ondansetron (Zofran) during a chemotherapy treatment. A dose of 0.15 mg/kg IV 30 minutes before chemotherapy is ordered. The patient weighs 140 pounds. The medication is supplied in a vial marked 2 mg/mL for IV administration. Identify how many milliliters will the nurse administer for this dose. (record answer to one decimal place) _______

4.8mL

A 10-year-old child will be receiving docusate sodium (Colace), 120 mg/day PO, divided into 3 doses. Identify how many milligrams will the child receive per dose. _______

40mg/dose

A child will be receiving diphenhydramine (Benadryl), 5 mg/kg/day, in divided doses, every 6 hours. The child weighs 80 pounds. Identify how many milligrams of medication will the child receive with each dose. (record answer using one decimal place) _______

45.5

The nurse is accessing a newly implanted port intravenous line. Which interventions should the nurse implement? Rank in order of performance. 1. Set up the sterile field and don sterile gloves. 2. Cleanse the skin with antiseptic skin prep. 3. Palpate the rim of the port with two fingers. 4. Insert a noncoring needle between the fingers. 5. Explain the procedure to the client and wash hands.

5,1,2,3,4

A patient will be receiving pantoprazole (Protonix), 20 mg IV daily every morning. The medication, once reconstituted, has a strength of 40 mg/10 mL. Identify how many milliliters will the nurse draw up for this dose. _______

5mL

Levothyroxine is available in 88-mcg tablet form. Convert this dose to milligram strength. (do not round) _______

ANS: 0.088 mg One mg equals 1000 mcg. To convert 88 mcg to mg, divide 88 by 1000 to equal 0.088 mg, or move the decimal point to the left three spaces. Do not forget to include the leading zero.

The nurse is to administer epinephrine 0.3 mg subcutaneously. The ampule contains 1 mL of medication and is labeled "Epinephrine 1:1000." Identify how many milliliters of epinephrine will the nurse give. _______

ANS: 0.3 mL Note that 1:1000 indicates 1 gram per 1000 mL or 1000 mg per 1000 mL, which is a concentration of 1 mg/mL.

A patient is to receive glycopyrrolate (Robinul) 4 mcg/kg IM 30 minutes before a procedure. The patient weighs 110 pounds; the medication is available in a strength of 0.2 mg/mL. Identify how many milliliters of medication will the nurse draw up into the syringe. _______

ANS: 1 mL To calculate mcg/kg, multiply The patient will receive 200 mcg, or 0.2 mg. The medication is available in a strength of 0.2 mg/mL; therefore, the patient will receive 1 mL.

Digoxin is available in 0.125-mg tablet form. Convert this dose to microgram strength. (do not round) _______

ANS: 125 mcg One mg equals 1000 mcg. To convert 0.125 mg to mcg, multiply by 1000 to equal 125 mcg, or move the decimal point to the right three spaces.

A drug dose that delivers 250 mg has a half-life of 5 hours. Identify how much drug will remain in the body after one half-life. _______

ANS: 125 mg A drug's half-life is the time required for one half of an administered dose of a drug to be eliminated by the body, or the time it takes for the blood level of a drug to be reduced by 50%. Therefore, one half of 250 mg equals 125 mg.

A patient has an order for carvedilol (Coreg) 6.25 mg twice a day PO. The tablets are 3.125 mg. Identify how many tablets will the nurse administer per dose. _______

ANS: 2 tablets

A patient is to receive prednisone 7.5 mg PO daily. The tablets are available in a 2.5- mg strength. Identify how many tablets will the patient receive. _______

ANS: 3 tablets

A patient will be receiving mannitol (Osmitrol), 1.5 g/kg IV 1 hour before ocular surgery. The patient weighs 110 pounds. The medication is available as a 25% solution. Based on this patient's dose, calculate how many milliliters of mannitol this patient will receive, using the 25% solution. _______

ANS: 300 mL Convert the patient's weight to kilograms: Calculate the dose of mannitol: of mannitol. Using the 25% solution, which contains 25 g of mannitol in 100 mL of solution, calculate the milliliters needed: of the 25% mannitol solution.

A patient is receiving memantine (Namenda) 10 mg PO daily. The patient is unable to swallow pills, so an oral solution that contains 2 mg/mL is ordered. Identify how much will the patient receive per dose. _______

ANS: 5 mL

A patient has a metered-dose inhaler that contains 200 actuations ('puffs'), and it does not have a dose counter. He is to take two puffs two times a day. If he does not take any extra doses, identify how many days will this inhaler last at the prescribed dose. _______

ANS: 50 days Note the number of doses in the canister, and then calculate the number of days that the canister will last. For this question, assuming that two puffs are taken two times a day, and the inhaler has a capacity of 200 inhalations. Two puffs two times a day equal four inhalations per day. Four divided into 200 yields 50; that is, the inhaler will last approximately 50 days.

When teaching a patient about the proper application of timolol (Timoptic) eyedrops, the nurse will include which instruction? a. "Apply the drops into the conjunctival sac instead of directly onto the eye." b. "Apply the drops directly to the eyeball (cornea) for the best effect." c. "Blot your eye with a tissue immediately after applying the drops." d. "Tilt your head forward before applying the eyedrops."

ANS: A All ophthalmic drugs should be administered in the conjunctival sac. Gently use a tissue to remove excess eye medication—do not blot the eye after giving the medication. Tilt the head back before giving the eyedrops

When an adrenergic drug stimulates beta1-adrenergic receptors, the result is an increased force of contraction, which is known as what type of effect? a. Positive inotropic b. Anti-adrenergic c. Negative dromotropic d. Positive chronotropic

ANS: A An increased force of contraction is known as a positive inotropic effect.

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

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

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

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

During a teaching session about self-monitoring while taking a beta blocker at home, the nurse has taught the patient to take his apical pulse daily for 1 minute. If the pulse rate decreases to less than 60 beats/min, the nurse will instruct the patient to: a. notify his prescriber. b. reduce the dose of his beta blocker by half. c. continue the medication because this is an expected effect. d. skip the medication dose that day, and check his pulse again the next day.

ANS: A Cardiac depression can occur with beta blockers; instruct the patient to contact his prescriber if his pulse rate decreases to less than 60 per minute. The medication dose may need to be changed, but it is not appropriate for the nurse to change the dosage. The other options are incorrect.

The nurse is about to administer a stat dose of intravenous atropine sulfate to a patient who is experiencing a symptomatic cardiac dysrhythmia. During administration of this drug, the nurse will monitor the patient closely for which adverse effect? a. Tachycardia b. Bradycardia c. Ectopic beats d. Cardiac standstill

ANS: A Cardiovascular effects of cholinergic blockers include increased heart rate and dysrhythmias. One indication for use is the treatment of sinus bradycardia accompanied by hemodynamic compromise. The other options are incorrect.

The patient is asking the nurse about current U.S. laws and regulations of herbal products. According to the Dietary Supplement and Health Education Act of 1994, which statement is true? a. Medicinal herbs are viewed as dietary supplements. b. Herbal remedies are held to the same standards as drugs. c. Producers of herbal products must prove therapeutic efficacy. d. Herbal remedies are protected by patent laws.

ANS: A Current U.S. laws view herbal products as dietary supplements and do not hold them to the same efficacy standards as drugs. The other options do not correctly reflect current U.S. laws regarding herbal supplements.

The nurse is discussing the use of adsorbents such as bismuth subsalicylate (Pepto-Bismol) with a patient who has diarrhea. The nurse will warn the patient about which possible adverse effects? a. Dark stools and blue gums b. Urinary hesitancy c. Drowsiness and dizziness d. Blurred vision and headache

ANS: A Dark stools and blue gums are two of the possible adverse effects of bismuth subsalicylate (see Table 51-2). The other adverse effects listed may occur with the use of other antidiarrheal drugs.

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

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

The patient is experiencing chest pain and needs to take a sublingual form of nitroglycerin. Where does the nurse instruct the patient to place the tablet? a. Under the tongue b. On top of the tongue c. At the back of the throat d. In the space between the cheek and the gum

ANS: A Drugs administered via the sublingual route are placed under the tongue. Drugs administered via the buccal route are placed in the space between the cheek and the gum; oral drugs are swallowed. The other options are incorrect.

The nurse is administering parenteral drugs. Which statement is true regarding parenteral drugs? a. Parenteral drugs bypass the first-pass effect. b. Absorption of parenteral drugs is affected by reduced blood flow to the stomach. c. Absorption of parenteral drugs is faster when the stomach is empty. d. Parenteral drugs exert their effects while circulating in the bloodstream.

ANS: A Drugs given by the parenteral route bypass the first-pass effect. Reduced blood flow to the stomach and the presence of food in the stomach apply to enteral drugs (taken orally), not to parenteral drugs. Parenteral drugs must be absorbed into cells and tissues from the circulation before they can exert their effects; they do not exert their effects while circulating in the bloodstream.

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

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

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

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

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

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

When a patient is taking an adrenergic drug, the nurse expects to observe which effect? a. Increased heart rate b. Bronchial constriction c. Constricted pupils d. Increased intestinal peristalsis

ANS: A Increased heart rate is one of the effects of adrenergic drugs. Sympathetic nervous system stimulation also results in bronchodilation, dilated pupils, and decreased gastrointestinal mobility, depending upon which receptors are stimulated.

A female patient will be starting therapy with oral isotretinoin (Amnesteem) as part of treatment for severe acne, and the nurse is providing teaching. Which teaching point will the nurse include in her teaching plan about isotretinoin? a. "You will have to use two contraceptive methods while on this drug." b. "You must avoid sexual activity while on this drug." c. "You will have to avoid pregnancy for 2 weeks after taking this drug." d. "If you are taking an oral contraceptive, you may take this drug."

ANS: A It is now required that at least two contraceptive methods be used by sexually active women during and for 1 month after completion of therapy with isotretinoin. The other statements are incorrect.

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

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

When administering mineral oil, the nurse recognizes that it can interfere with the absorption of which substance? a. Fat-soluble vitamins b. Water-soluble vitamins c. Minerals d. Electrolytes

ANS: A Mineral oil can decrease the absorption of fat-soluble vitamins (A, D, E, and K). The other options are incorrect.

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

ANS: A Nervousness, tremors, and cardiac stimulation are possible and expected adverse effects of beta agonists. The other options are incorrect

A patient is taking an alpha blocker as treatment for benign prostatic hyperplasia. The nurse will monitor for which potential drug effect? a. Orthostatic hypotension b. Increased blood pressure c. Decreased urine flow d. Discolored urine

ANS: A Orthostatic hypotension can occur with any dose of an alpha blocker, and patients must be warned to get up slowly from a supine position. The other responses are not drug effects of alpha blockers.

A patient is going home with a new prescription for the beta-blocker atenolol (Tenormin). The nurse will include which content when teaching the patient about this drug? a. Never stop taking this medication abruptly. b. The medication will be stopped once symptoms subside. c. If adverse effects occur, stop taking the drug for 24 hours, and then resume. d. Be watchful for first-dose hypotension.

ANS: A Patients need to be weaned off these medications slowly because rebound hypertension and chest pain are possible with abrupt withdrawal. The drugs should never be stopped abruptly nor doses skipped. First-dose hypotension occurs with alpha blockers

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

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

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

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

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

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

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

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

A patient will be taking bismuth subsalicylate (Pepto-Bismol) to control diarrhea. When reviewing the patient's other ordered medications, the nurse recognizes that which medication or medication class will interact significantly with the Pepto-Bismol? a. Hypoglycemic drugs b. Antibiotics c. Acetaminophen (Tylenol) d. Antidepressants

ANS: A Taking hypoglycemic drugs with an adsorbent such as bismuth subsalicylate may result in decreased absorption of the hypoglycemic drugs. The other options are incorrect.

A patient will be taking a 2-week course of combination therapy with omeprazole (Prilosec) and another drug for a peptic ulcer caused by Helicobacter pylori. The nurse expects a drug from which class to be ordered with the omeprazole? a. Antibiotic b. Nonsteroidal anti-inflammatory drug c. Antacid d. Antiemetic

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

When monitoring a patient who is taking a low-dose cholinergic drug, the nurse will watch for which cardiovascular effect? a. Bradycardia b. Tachycardia c. Vasoconstriction d. Palpitations

ANS: A The cardiovascular effects of low doses of cholinergic drugs are decreased heart rate (not tachycardia) and vasodilation. Palpitations are not effects of cholinergic drugs.

A patient with a new prescription for a diuretic has just reviewed with the nurse how to include more potassium in her diet. This reflects learning in which domain? a. Cognitive b. Affective c. Physical d. Psychomotor

ANS: A The cognitive domain refers to problem-solving abilities and may involve recall and knowledge of facts. The affective domain refers to values and beliefs. The term physical does not refer to one of the learning domains. The psychomotor domain involves behaviors such as learning how to perform a procedure.

A patient who has advanced cancer is receiving opioid medications around the clock to keep him comfortable as he nears the end of his life. Which term best describes this type of therapy? a. Palliative therapy b. Maintenance therapy c. Empiric therapy d. Supplemental therapy

ANS: A The goal of palliative therapy is to make the patient as comfortable as possible. It is typically used in the end stages of illnesses when all attempts at curative therapy have failed. Maintenance therapy is used for the treatment of chronic illnesses such as hypertension. Empiric therapy is based on clinical probabilities and involves drug administration when a certain pathologic condition has an uncertain but high likelihood of occurrence based on the patient's initial presenting symptoms. Supplemental (or replacement therapy) supplies the body with a substance needed to maintain normal function.

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

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

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

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

A patient has a new prescription for an antiglaucoma eyedrop. The next day, she calls the clinic and states, "The package insert says this medication might make my blue eyes turn brown! Is this true?" The nurse realizes that the patient has a prescription for which eye medication? a. Latanoprost (Xalatan), a prostaglandin agonist b. Dorzolamide (Trusopt), an ocular carbonic anhydrase inhibitor c. Betaxolol (Betoptic), a direct-acting beta blocker d. Pilocarpine (Pilocar), a direct-acting cholinergic

ANS: A There is one unique adverse effect associated with all prostaglandin agonists—in some people with hazel, green, or bluish-brown eye color, eye color will turn permanently brown, even if the medication is discontinued. This adverse effect appears to be cosmetic only, with no known ill effects on the eye. The other medications do not have this effect.

A 55-year-old obese patient was diagnosed with candidiasis in the skin folds under her breasts. When the nurse sees her at a follow-up visit 2 months later, she complains that it has returned. She said she applied the medicine for 1 week and stopped because the itching stopped and the cream was messy. Which statement is true regarding fungal infections of the skin? a. Fungal infections often require prolonged therapy. b. The patient has a new infection now. c. The patient needs to apply a dressing if the cream is too messy. d. This infection will probably never be cured.

ANS: A Topical fungal infections are difficult to treat and may require prolonged therapy of several weeks to as long as 1 year. Occlusive dressings should not be applied unless recommended by the medication's manufacturer.

The patient is receiving two different drugs. At current dosages and dosage forms, both drugs are absorbed into the circulation in identical amounts. Which term is used to identify this principle? a. Bioequivalent b. Synergistic c. Prodrugs d. Steady state

ANS: A Two drugs absorbed into the circulation in the same amount (in specific dosage forms) have the same bioavailability; thus, they are bioequivalent. A drug's steady state is the physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed from each dose. The term synergistic refers to two drugs, given together, with a resulting effect that is greater than the sum of the effects of each drug given alone. A prodrug is an inactive drug dosage form that is converted to an active metabolite by various biochemical reactions once it is inside the body.

The nurse is administering ophthalmic drops. Place the following administration steps in the correct order. (Select all that apply.) a. Close the eye gently. b. Apply gentle pressure to the inner canthus/lacrimal sac for 1 minute. c. Place drops into the conjunctival sac. d. Clean debris from the eye as needed. e. Have the patient tilt the head back and look up at the ceiling. f. Remove excess medication gently from around the eyes.

ANS: A, B, C, D, E, F Before applying eye medications, clean any debris from the eye, if needed, and have the patient tilt the head back and look up at the ceiling. Drops are placed into the conjunctival sac, and then the eye is closed gently. Pressure may be applied to the inner canthus/lacrimal sac for 1 minute to reduce systemic absorption, and any excess medication can then be removed from around the eyes.

The nurse is reviewing the medical record of a patient and notes an order for ophthalmic dexamethasone (Decadron) solution. The nurse knows that indications for ophthalmic dexamethasone include which conditions? (Select all that apply.) a. Uveitis b. Allergic conditions c. Removal of foreign bodies d. Ocular infections e. Glaucoma f. Conjunctival inflammation

ANS: A, B, C, F Dexamethasone (Decadron) is used to treat inflammation of the eye, eyelids, conjunctiva, and cornea, and it may also be used in the treatment of uveitis, iridocyclitis, allergic conditions, and burns and in the removal of foreign bodies. It is not indicated for infections or glaucoma.

A beta blocker is prescribed for a patient with angina. The nurse reviews the orders for other drugs that may interact with the beta blocker. Which drugs or drug classes are known to have an interaction with a beta blocker? (Select all that apply.) a. Diuretics b. Anticholinergics c. Penicillins d. Oral hypoglycemics e. Alcohol f. Anticoagulants

ANS: A, B, D, E When taken with beta blockers, diuretics and alcohol may cause additive hypotensive effects; oral hypoglycemic medications may cause the blood glucose to decrease; and anticholinergics may cause decreased beta-blocker effects. Penicillins and anticoagulants are not known to interact with beta blockers.

The nurse is reviewing the criteria for over-the-counter drugs. Which criteria for over-the-counter status in the United States are accurate? (Select all that apply.) a. The drug must be easy to use. b. The drug must have a low therapeutic index. c. The consumer must be able to monitor the drug's effectiveness. d. The drug must have a low potential for abuse. e. The drug must not have any interactions with other drugs.

ANS: A, C, D In the United States, criteria for over-the-counter status include the drug being easy to use, the drug having a low potential for abuse, and the consumer must be able to monitor the drug's effectiveness for the condition. The drug must have a high therapeutic index (not a low one), and the drug must have limited interactions with other drugs.

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

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

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

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

Which are appropriate considerations when the nurse is assessing the learning needs of a patient? (Select all that apply.) a. Cultural background b. Family history c. Level of education d. Readiness to learn e. Health beliefs

ANS: A, C, D, E Family history is not a part of what the nurse considers when assessing learning needs. The other options are appropriate to consider when the nurse is assessing learning needs.

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

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

The nurse is conducting a class for senior citizens about the use of over-the-counter (OTC) drugs. Which statements are true regarding the use of OTC drugs? (Select all that apply.) a. Use of OTC drugs may delay treatment of serious ailments. b. Drug interactions with OTC medications are rare. c. OTC drugs may relieve symptoms without addressing the cause of the problem. d. OTC drugs are indicated for long-term treatment of conditions. e. Patients may misunderstand product labels and use the drugs improperly.

ANS: A, C, E It is true that use of OTC drugs may delay treatment of serious ailments; OTC drugs may relieve symptoms without addressing the cause of the problem, and patients may misunderstand product labels and use the drugs improperly. These statements should be included when teaching patients about their use. In contrast, drug interactions with OTC medications are not rare and may indeed occur with prescription medications and other OTC drugs. Normally, OTC drugs are intended for short-term treatment of minor ailments.

Which adverse effects will the nurse expect in a teenage patient who is using topical tretinoin (Retin-A)? (Select all that apply.) a. Crusted skin b. Itching c. Altered skin pigmentation d. Rosacea e. Red and edematous blisters

ANS: A, C, E Some of the most common adverse effects of tretinoin are excessively red and edematous blisters, crusted skin, and temporary alterations in skin pigmentation. Itching and rosacea are not potential adverse effects.

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

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

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

ANS: A, D, E, G Stimulation of the sympathetic nervous system causes bronchodilation, increased heart rate, pupil dilation, and glycogenolysis as well as many other effects (see Table 18-1). The other responses are effects that occur as a result of the stimulation of the parasympathetic nervous system.

The nurse is reviewing the indications for atropine sulfate. Atropine is appropriate for which of these patients? (Select all that apply.) a. A patient who has suddenly developed symptomatic bradycardia with a heart rate of 32 beats/min b. A patient who has suddenly developed symptomatic tachycardia with a heart rate of 180 beats/min c. A patient with severe narrow-angle glaucoma d. A patient who is about to have surgery e. A patient newly diagnosed with myasthenia gravis f. A patient with anticholinesterase inhibitor poisoning

ANS: A, D, F Anticholinergic drugs are used for symptomatic bradycardia and certain other cardiac conditions. It is given preoperatively to control secretions during surgery and is used as an antidote for anticholinesterase inhibitor poisoning. The other options are contraindications to the use of atropine.

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

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

A child has been diagnosed with bacterial otitis externa and will be receiving eardrops. Which of these eardrops are appropriate for this infection? (Select all that apply.) a. Floxin Otic b. Cortic c. Debrox d. Acetasol HC e. Cipro HC Otic

ANS: A, E Both Floxin Otic and Cipro HC Otic are antibacterial eardrops. Cipro HC also contains a corticosteroid. Both Cortic and Acetasol HC are antifungal products; Debrox (carbamide peroxide) is an earwax emulsifier used to loosen earwax for easier removal.

A patient will be taking oral iron supplements at home. The nurse will include which statements in the teaching plan for this patient? (Select all that apply.) a. Take the iron tablets with meals. b. Take the iron tablets on an empty stomach 1 hour before meals. c. Take the iron tablets with an antacid to prevent heartburn. d. Drink 8 ounces of milk with each iron dose. e. Taking iron supplements with orange juice enhances iron absorption. f. Stools may become loose and light in color. g. Stools may become black and tarry. h. Tablets may be crushed to enhance iron absorption.

ANS: A, E, G Iron tablets need to be taken with meals to reduce gastrointestinal distress, but antacids and milk interfere with absorption. Orange juice enhances the absorption of iron. Stools may become black and tarry in patients who are on iron supplements. Tablets need to be taken whole, not crushed, and the patient needs to be encouraged to eat foods high in iron.

The nurse is reviewing medication errors. Which situation is an example of a medication error? a. A patient refuses her morning medications. b. A patient receives a double dose of a medication because the nurse did not cut the pill in half. c. A patient develops hives after having started an IV antibiotic 24 hours earlier. d. A patient complains of severe pain still present 60 minutes after a pain medication was given.

ANS: B A medication error is defined as a preventable adverse drug event that involves inappropriate medication use by a patient or health care provider. The other options are not preventable. The patient's refusing to take medications and complaining of pain after a medication is given are patient behaviors, and the development of hives is a possible allergic reaction.

A patient has been taking iron supplements for anemia for 2 months. During a follow-up assessment, the nurse will observe for which therapeutic response? a. Decreased weight b. Increased activity tolerance c. Decreased palpitations d. Increased appetite

ANS: B Absence of fatigue, increased activity tolerance and well-being, and improved nutrition status are therapeutic responses to iron supplementation. The other options are incorrect.

The nurse is administering intravenous iron dextran for the first time to a patient with anemia. After giving a test dose, how long will the nurse wait before administering the remaining portion of the dose? a. 30 minutes b. 1 hour c. 6 hours d. 24 hours

ANS: B Although anaphylactic reactions usually occur within a few moments after the test dose, it is recommended that a period of at least 1 hour elapse before the remaining portion of the initial dose is given. The other options are incorrect

A patient asks the nurse about the difference between diphenoxylate with atropine (Lomotil) and the over-the-counter drug loperamide (Imodium). Which response by the nurse is correct? a. "Lomotil acts faster than Imodium." b. "Imodium does not cause physical dependence." c. "Lomotil is available in suppository form." d. "Imodium is a natural antidiarrheal drug."

ANS: B Although the drug exhibits many characteristics of the opiate class, physical dependence on loperamide has not been reported. All antidiarrheal drugs are orally administered. The other options are incorrect.

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

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

A patient has prescriptions for two inhalers. One inhaler is a bronchodilator, and the other is a corticosteroid. Which instruction regarding these inhalers will the nurse give to the patient? a. "Take the corticosteroid inhaler first." b. "Take the bronchodilator inhaler first." c. "Take these two drugs at least 2 hours apart." d. "It does not matter which inhaler you use first."

ANS: B An inhaled bronchodilator is used before the inhaled corticosteroid to provide bronchodilation before administration of the anti-inflammatory drug.

The nurse is reviewing the mechanism of action of antidiarrheal drugs. Which type of antidiarrheal medication works by decreasing the intestinal muscle tone and peristalsis of the intestines? a. Adsorbents such as Pepto-Bismol b. Anticholinergics such as belladonna alkaloids c. Probiotics such as Lactinex d. Lubricants such as mineral oil

ANS: B Anticholinergic drugs work to slow peristalsis by reducing the rhythmic contractions and the smooth muscle tone of the gastrointestinal tract. The other options are incorrect.

During a nursing assessment, which question by the nurse allows for greater clarification and additional discussion with the patient? a. "Are you allergic to penicillin?" b. "What medications do you take?" c. "Have you had a reaction to this drug?" d. "Are you taking this medication with meals?"

ANS: B Asking "What medications do you take?" is an open-ended question that will encourage greater clarification and additional discussion with the patient. The other options are examples of closed-ended questions, which prompt only a "yes" or "no" answer and provide limited information.

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

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

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

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

A patient wants to prevent problems with constipation and asks the nurse for advice about which type of laxative is safe to use for this purpose. Which class of laxative is considered safe to use on a long-term basis? a. Emollient laxatives b. Bulk-forming laxatives c. Hyperosmotic laxatives d. Stimulant laxatives

ANS: B Bulk-forming laxatives are the only laxatives recommended for long-term use. Stimulant laxatives are the most likely of all the laxative classes to cause dependence. The other options are incorrect.

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

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

A patient who has been diagnosed with Sjögren's syndrome will be given cevimeline for the treatment of xerostomia. The nurse will monitor for what therapeutic effect? a. Reduction of salivation b. Stimulation of salivation c. Reduction of gastrointestinal peristalsis d. Improvement of fine-motor control

ANS: B Cevimeline is a direct-acting cholinergic drug that is used to stimulate salivation in patients who have xerostomia (dry mouth), one of the manifestations of Sjögren's syndrome. The other options are incorrect.

In preparation for eye surgery, the nurse monitors for which desired drug effect in a patient who is receiving a cholinergic-blocking eyedrop medication? a. Miosis b. Mydriasis c. Increased intraocular fluid production d. Enhanced tear production

ANS: B Cholinergic-blocking eyedrops cause dilation of the pupil (mydriasis) and paralysis of the ocular lens (cycloplegia), both of which are important for eye surgery. The other options are incorrect.

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

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

A patient asks the nurse about the uses of echinacea. Which use will the nurse include in the response? a. Memory enhancement b. Boosting the immune system c. Improving mood d. Promoting relaxation

ANS: B Common uses of echinacea include stimulation of the immune system, antisepsis, treatment of viral infections and influenza-like respiratory tract infections, and promotion of the healing of wounds and chronic ulcerations. The other options are incorrect.

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

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

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

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

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

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

A patient has a new prescription for tamsulosin (Flomax) as treatment for benign prostatic hyperplasia. The nurse is checking his current medication list and will contact the prescriber regarding a potential interaction if the patient is also taking which drug? a. Levothyroxine (Synthroid) for hypothyroidism b. Sildenafil (Viagra), an erectile dysfunction medication c. Omeprazole (Prilosec), a proton pump inhibitor d. Low-dose aspirin for stroke prevention

ANS: B Drugs that interact with alpha blockers such as tamsulosin include erectile dysfunction drugs; additive hypotensive effects may occur. The other drugs do not interact with tamsulosin.

The nurse is preparing to give an earwax emulsifier to a patient and will assess the patient for which contraindication before administering the drops? a. Allergy to penicillin b. Drainage from the ear canal c. Partial deafness in the affected ear d. Excessive earwax in the outer ear canal

ANS: B Earwax emulsifiers are indicated for excessive earwax in the outer ear canal and are not to be used without prescription when ear drainage, tympanic membrane rupture, or significant pain or other irritation is present. Cerumen impaction may cause partial deafness in the affected ear.

A hospitalized patient is experiencing a severe anaphylactic reaction to a dose of intravenous penicillin. Which drug will the nurse expect to use to treat this condition? a. Ephedra b. Epinephrine c. Phenylephrine d. Pseudoephedrine

ANS: B Epinephrine is the drug of choice for the treatment of anaphylaxis. The other drugs listed are incorrect choices.

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

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

During therapy with a beta blocker, the patient notices that she has swollen feet, has gained 3 pounds within 2 days, feels short of breath even when walking around the house, and has been dizzy. The nurse suspects that which of these is occurring? a. The patient is experiencing an allergic reaction. b. The patient may be developing heart failure. c. More time is needed for the patient to see a therapeutic response to the drug. d. The patient is experiencing expected adverse effects of the drug.

ANS: B Even though some beta blockers may be used for the treatment of some types of heart failure, the patient needs to be assessed often for the development of heart failure, a potential adverse effect of the drugs. These symptoms do not indicate expected adverse effects, an allergic reaction, or a therapeutic response

A patient with an eye injury requires an ocular examination to detect the presence of a foreign body. The nurse anticipates that which drug will be used for this examination? a. Phenylephrine (Neo-Synephrine) b. Fluorescein sodium (AK-Fluor) c. Atropine sulfate (Isopto Atropine) d. Olopatadine (Patanol)

ANS: B Fluorescein sodium is an ophthalmic diagnostic dye used to identify corneal defects and to locate foreign objects in the eye. Phenylephrine is an ocular decongestant; atropine sulfate has mydriatic and cycloplegic effects, which are useful for examining the inner eye structures; olopatadine is an ophthalmic antihistamine.

An adrenergic agonist is ordered for a patient in shock. The nurse will note that this drug has had its primary intended effect if which expected outcome occurs? a. Volume restoration b. Increased cardiac output c. Decreased urine output d. Reduced anxiety

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

A patient has been advised to add a nasal spray (an adrenergic decongestant) to treat a cold. The nurse will include which instruction? a. "You won't see effects for at least 1 week." b. "Limit use of this spray to 3 to 5 days." c. "Continue the spray until nasal stuffiness has resolved." d. "Avoid use of this spray if a fever develops."

ANS: B Frequent, long-term, or excessive use of adrenergic nasal decongestants may lead to rebound congestion if used beyond the recommended time. The other instructions are incorrect.

An oral iron supplement is prescribed for a patient. The nurse would question this order if the patient's medical history includes which condition? a. Decreased hemoglobin b. Hemolytic anemia c. Weakness d. Concurrent therapy with erythropoietics

ANS: B Hemolytic anemia is a contraindication to the use of iron supplements. Decreased hemoglobin and weakness are related to iron-deficiency anemia. Iron supplements are given with erythropoietic drugs to aid in the production of red blood cells.

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

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

The nurse is teaching a patient's wife about administering eardrops to her husband. The nurse will use which technique when demonstrating the skill? a. Pull the pinna of the ear down and back. b. Pull the pinna of the ear up and back. c. Pull the pinna of the ear down and forward. d. Pull the pinna of the ear up and forward.

ANS: B Hold the pinna of the ear up and back when giving eardrops to adults or children older than 3 years of age. The other options are incorrect.

During a period of time when the computerized medication order system was down, the prescriber wrote admission orders, and the nurse is transcribing them. The nurse is having difficulty transcribing one order because of the prescriber's handwriting. Which is the best action for the nurse to take at this time? a. Ask a colleague what the order says. b. Contact the prescriber to clarify the order. c. Wait until the prescriber makes rounds again to clarify the order. d. Ask the patient what medications he takes at home.

ANS: B If a prescriber writes an order that is illegible, the nurse should contact the prescriber for clarification. Asking a colleague is not useful because the colleague did not write the order. Waiting for the prescriber to return is incorrect because it would delay implementation of the order. Asking the patient about medications is incorrect because this question will not clarify the current order written by the prescriber.

A cancer patient is receiving drug therapy with epoetin alfa (Epogen). The nurse knows that the medication must be stopped if which laboratory result is noted? a. White blood cell count of 550 cells/mm3 b. Hemoglobin level of 12 g/dL c. Potassium level of 4.2 mEq/L d. Glucose level of 78 mg/dL

ANS: B If epoetin is continued when hemoglobin levels are above 11 g/dL, patients may experience serious adverse events, including heart attack, stroke, and death. Guidelines now recommend that the drug be stopped when the hemoglobin level reaches 10 g/dL for cancer patients. For renal patients, the target hemoglobin level is 11 g/dL for patients on dialysis and 10 g/dL for chronic renal patients not on dialysis.

The nurse will be injecting a drug into the fatty tissue of the patient's abdomen. Which route does this describe? a. Intradermal b. Subcutaneous c. Intramuscular d. Transdermal

ANS: B Injections into the fatty subcutaneous tissue under the dermal layer of skin are referred to as subcutaneous injections. Injections under the more superficial skin layers immediately underneath the epidermal layer of skin and into the dermal layer are known as intradermal injections. Injections into the muscle beneath the subcutaneous fatty tissue are referred to as intramuscular injections. Transdermal drugs are applied to the skin via an adhesive patch.

The nurse is administering liquid oral iron supplements. Which intervention is appropriate when administering this medication? a. Have the patient take the liquid iron with milk. b. Instruct the patient to take the medication through a plastic straw. c. Have the patient sip the medication slowly. d. Have the patient drink the medication, undiluted, from the unit-dose cup.

ANS: B Liquid oral forms of iron need to be taken through a plastic straw to avoid discoloration of tooth enamel. Milk may decrease absorption.

The nurse is reviewing the mechanism of action of cholinergic drugs. The undesired effects of cholinergic drugs come from the stimulation of which receptors? a. Muscarinic b. Nicotinic c. Cholinergic d. Ganglionic

ANS: B Many of the undesirable adverse effects are due to nicotinic receptor stimulation. The desired effects come from muscarinic receptor stimulation. The other options are incorrect.

The nurse is preparing to administer methylnaltrexone (Relistor), a peripherally acting opioid antagonist. This drug is appropriate for which patient? a. A patient with diarrhea b. A terminally ill patient who has opioid-induced constipation c. A patient who is scheduled for a colonoscopy d. A patient who will be having colon surgery in the morning

ANS: B Methylnaltrexone is approved only for terminally ill (hospice) patients who have opioid-induced constipation. The other options are incorrect.

The nurse is reviewing laboratory results for a patient and notes that the patient has positive results for nasal colonization by methicillin-resistant Staphylococcus aureus (MRSA). The nurse anticipates an order for which medication? a. Acyclovir (Zovirax) b. Mupirocin (Bactroban) c. Clindamycin (Cleocin T) d. Clotrimazole (Lotrimin)

ANS: B Mupirocin (Bactroban) is used on the skin for treatment of staphylococcal and streptococcal impetigo. It is used topically and intranasally to treat nasal colonization by MRSA; however, it MRSA is becoming increasingly resistant to the drug. The other options are incorrect. Acyclovir (an antiviral drug) and clindamycin are not indicated for the treatment of MRSA; clotrimazole is an antifungal drug.

A patient is experiencing diastolic heart failure. The nurse expects which beta blocker to be ordered for this patient? a. Atenolol (Tenormin) b. Carvedilol (Coreg) c. Acebutolol (Sectral) d. Esmolol (Brevibloc)

ANS: B Not all beta blockers are used for the treatment of heart failure. Carvedilol and metoprolol are currently used in the treatment of heart failure. The other options are not indicated for the treatment of heart failure.

The nurse is administering antibiotic eyedrops to a patient for the first time. After the first drop is given, the patient states, "That eyedrop is making my eye sting! Is that normal?" Which is the best response by the nurse? a. "That's unusual. Let me rinse the medication from your eye." b. "Sometimes these eyedrops may cause burning and stinging, but it should go away soon." c. "These may be serious side effects, so I will notify your doctor before the next dose is due." d. "Let's wait and see if these effects happen the next time you receive these drops."

ANS: B Ocular antibiotics may cause local inflammation, burning, stinging, urticaria, and dermatitis. These effects are transient. The other options are incorrect.

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

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

The nurse is reviewing the medical record of a patient who is to receive wound care with topical silver sulfadiazine (Silvadene). Which finding, if noted, would be a potential contraindication? a. The patient has an open wound from a burn on her arm. b. The patient is allergic to sulfonamide drugs. c. The patient is allergic to shellfish. d. The patient's burn wound has been débrided.

ANS: B Patients with allergies to sulfonamide drugs must not receive silver sulfadiazine. The other options are incorrect.

The nurse notes in a patient's medication history that the patient is taking pilocarpine (Pilocar). Based on this finding, the nurse interprets that the patient has which disorder? a. Anticholinergic poisoning b. Glaucoma c. Bladder atony d. Myasthenia gravis

ANS: B Pilocarpine is a direct-acting drug that is used topically to reduce intraocular pressure in patients with glaucoma. The other disorders are not indications for pilocarpine

The nurse is preparing to administer a new order for eardrops. Which is a potential contraindication to the use of many otic preparations? a. Ear canal itching b. Perforated eardrum c. Staphylococcus aureus otitis externa infection d. Escherichia coli ear infection

ANS: B Potential contraindications to the use of otic preparations include perforated eardrum. The other options are potential indications for eardrops.

The preoperative nurse is ready to perform a skin prep with povidone-iodine (Betadine) on a patient who is about to have abdominal surgery. Which allergies, if present, would be a contraindication to the Betadine prep? a. Peanuts b. Shellfish c. Adhesives d. Latex

ANS: B Povidone-iodine, a widely used antiseptic, cannot be used in patients who are allergic to iodine or have shellfish allergies

A patient is about to undergo ocular surgery. The preoperative nurse anticipates that which drug will be used for local anesthesia? a. Oral glycerin b. Proparacaine (Alcaine) c. Timolol (Timoptic) d. Dipivefrin (Propine)

ANS: B Proparacaine (Alcaine) and tetracaine are used as a local anesthetic for ocular surgery or other procedures. The other drugs are used for glaucoma.

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

ANS: B Serotonin blockers used to prevent chemotherapy-induced and postoperative nausea and vomiting. The other options are incorrect.

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

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

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

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

A patient is taking a xanthine derivative as part of treatment for chronic obstructive pulmonary disease. The nurse will monitor for which adverse effects associated with the use of xanthine derivatives? a. Diarrhea b. Palpitations c. Bradycardia d. Drowsiness

ANS: B The common adverse effects of the xanthine derivatives include nausea, vomiting, and anorexia. In addition, gastroesophageal reflux has been observed to occur during sleep in patients taking these drugs. Cardiac adverse effects include sinus tachycardia, extrasystole, palpitations, and ventricular dysrhythmias. Transient increased urination and hyperglycemia are other possible adverse effects.

A patient is considering taking oral aloe supplements and asks the nurse about potential problems with this therapy. Which statement by the nurse is correct? a. "Aloe is not taken orally; it is only used topically to aid in wound healing." b. "Aloe is used by some to treat constipation; it may cause diarrhea." c. "This is a safe herbal supplement, with no known drug interactions." d. "This is a safe herbal supplement, with no known adverse effects."

ANS: B The dried juice of the leaves of the aloe plant contains anthranoids, which give aloe a laxative effect when taken orally. The topical application of the plant juice has been known for years to help the healing of wounds. Common adverse effects include diarrhea, nephritis, abdominal pain, and dermatitis when used topically. Potential drug interactions include digoxin, antidysrhythmics, diuretics, and corticosteroids.

A patient is in an urgent care center with an acute asthma attack. The nurse expects that which medication will be used for initial treatment? a. An anticholinergic such as ipratropium (Atrovent) b. A short-acting beta2 agonist such as albuterol (Proventil) c. A long-acting beta2 agonist such as salmeterol (Serevent) d. A corticosteroid such as fluticasone (Flovent)

ANS: B The short-acting beta2 agonists are commonly used during the acute phase of an asthmatic attack to reduce airway constriction quickly and to restore airflow to normal levels. The other drugs listed are not appropriate for acute asthma attacks. Anticholinergic drugs and long-acting beta2 agonists are used to prevent attacks; corticosteroids are used to reduce airway inflammation

During an assessment, the patient tells the nurse that he eats large amounts of garlic for its cardiovascular benefits. Which drug or drug class, if taken, would have a potential interaction with the garlic? a. Acetaminophen (Tylenol) b. Insulin c. Antilipemic drugs d. Sedatives

ANS: B The use of garlic may interfere with hypoglycemic drugs. The other options are incorrect because acetaminophen, antilipemic drugs, and sedatives do not have interactions with garlic.

A patient wants to take the herb gingko to help his memory. The nurse reviews his current medication list and would be concerned about potential interactions if he is taking a medication from which class of drugs? a. Digitalis b. Anticoagulants c. Sedatives d. Immunosuppressants

ANS: B The use of gingko increases the risk of bleeding with anticoagulants (warfarin, heparin) and antiplatelets (aspirin, clopidogrel). The other concerns do not occur with gingko supplements.

A female patient has been taking isotretinoin (Amnesteem) for 3 months. During a follow-up appointment, which statement by the patient would be of highest concern to the nurse? a. "I am using two forms of contraception while on this drug." b. "I have been feeling rather down and lonely lately." c. "I wish I didn't have to be on this medication." d. "It's scary to know that this drug can cause birth defects."

ANS: B There have been case reports of suicide and suicide attempts in patients receiving isotretinoin. Instruct patients to report immediately to their prescribers any signs of depression. Follow-up treatment may be needed, and simply stopping the drug may be insufficient.

A teenage boy is taking tretinoin (Retin-A) for acne. Which statement will the nurse include in the teaching plan? a. "Avoid foods that are heavy in salt and oils." b. "This drug may cause increased redness of your skin." c. "Try using an abrasive cleanser to remove old skin layers." d. "Being out in the sunlight will help your skin heal."

ANS: B Tretinoin may cause increased redness and drying, and the patient needs to avoid weather extremes, ultraviolet light, and abrasive cleansers. Certain foods do not need to be avoided.

The nurse is reviewing medications for the treatment of asthma. Which drugs are used for acute asthma attacks? (Select all that apply.) a. Salmeterol (Serevent) inhaler b. Albuterol (Proventil) nebulizer solution c. Epinephrine d. Montelukast (Singulair) e. Fluticasone (Flovent) Rotadisk inhaler

ANS: B, C Albuterol (a short-acting beta2 agonist) and epinephrine (a beta1 and beta2 agonist) are used for acute bronchospasms. Salmeterol is a long-acting beta2 agonist that is indicated for maintenance treatment, not acute episodes. Fluticasone is an inhaled corticosteroid; montelukast is a leukotriene receptor antagonist (LTRA). These types of medications are used for asthma prophylaxis.

The nurse can prevent medication errors by following which principles? (Select all that apply.) a. Assess for allergies after giving medications. b. Use two patient identifiers before giving medications. c. Do not give a medication that another nurse has drawn up in a syringe. d. Minimize the use of verbal and telephone orders. e. Use trade names instead of generic names to avoid confusion.

ANS: B, C, D Measures that prevent medication errors include using two patient identifiers, giving only medications that you have drawn up or prepared, and minimizing the use of verbal and telephone orders. Assessment for allergies should be done before medications are given. Generic names should be used to avoid the many sound-alike trade names of medications.

The nurse is reviewing the uses of oral laxatives. Which conditions are general contraindications to or cautions about the use of oral laxatives? (Select all that apply.) a. Irritable bowel syndrome b. Undiagnosed abdominal pain c. Nausea and vomiting d. Fecal impaction e. Ingestion of toxic substances f. Acute surgical abdomen

ANS: B, C, D, F Cautious use of laxatives is recommended in the presence of these: acute surgical abdomen; appendicitis symptoms, such as abdominal pain, nausea, and vomiting; intestinal obstruction; and undiagnosed abdominal pain. Oral laxatives must not be used with fecal impaction; mineral oil enemas are indicated for fecal impaction. The other options are indications for laxative use.

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

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

A cholinergic drug is prescribed for a patient. The nurse checks the patient's medical history, knowing that this drug is contraindicated in which disorders? (Select all that apply.) a. Bladder atony b. Gastrointestinal obstruction c. Bradycardia d. Alzheimer's disease e. Hypotension f. Chronic obstructive pulmonary disease

ANS: B, C, E, F Contraindications to the use of cholinergic drugs include gastrointestinal or genitourinary obstruction, bradycardia, hypotension, and chronic obstructive pulmonary disease. The other options are possible indications for cholinergic drugs.

A patient has a prescription for topically applied 5% fluorouracil (Efudex) cream as part of treatment for basal cell carcinoma on her cheek. Which instructions will the nurse provide to the patient? (Select all that apply.) a. "You must use gloves to apply this medication." b. "You can use clean fingertips to apply the cream, but be sure to wash your hands afterward." c. "You will need to stay out of the sun during therapy with this medication." d. "Apply this medication to the affected site once a day in the evening." e. "Apply this medication to the affected site twice daily." f. "You may have swelling, scaling, burning, and tenderness in the affected area."

ANS: B, C, E, F Fluorouracil may be applied with gloves or clean fingertips, but if fingertips are used, the medication must be washed off thoroughly after application. The medication may cause photosensitivity, as well as local swelling, scaling, burning, and tenderness. The medication is applied twice daily.

The nurse is providing instructions to a patient who has a new prescription for a corticosteroid metered-dose inhaler. Which statement by the patient indicates that further instruction is needed? (Select all that apply.) a. "I will rinse my mouth with water after using the inhaler and then spit out the water." b. "I will gargle after using the inhaler and then swallow." c. "I will clean the plastic inhaler casing weekly by removing the canister and then washing the casing in warm soapy water. I will then let it dry before reassembling." d. "I will use this inhaler for asthma attacks." e. "I will continue to use this inhaler, even if I am feeling better." f. "I will use a peak flow meter to measure my response to therapy."

ANS: B, D The inhaled corticosteroid is a maintenance drug used to prevent asthma attacks; it is not indicated for acute asthma attacks. Rinsing the mouth with water is appropriate and necessary to prevent oral fungal infections; the water is not to be swallowed after rinsing. The patient needs to be given instructions about keeping the inhaler clean, including removing the canister from the plastic casing weekly and washing the casing in warm soapy water. Once the casing is dry, the canister and mouthpiece may be put back together and the cap applied. The glucocorticoid may predispose the patient to oral fungal overgrowth, thus the need for implicit instructions about cleaning inhaling devices. Use of a peak flow meter assists in monitoring the patient's response to therapy. The medication needs to be taken as ordered every day, regardless of whether the patient is feeling better.

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

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

The nurse is reviewing pharmacology terms for a group of newly graduated nurses. Which sentence defines a drug's half-life? a. The time it takes for the drug to cause half of its therapeutic response b. The time it takes for one half of the original amount of a drug to reach the target cells c. The time it takes for one half of the original amount of a drug to be removed from the body d. The time it takes for one half of the original amount of a drug to be absorbed into the circulation

ANS: C A drug's half-life is the time it takes for one half of the original amount of a drug to be removed from the body. It is a measure of the rate at which drugs are removed from the body. The other options are incorrect definitions of half-life.

The nurse is aware that adrenergic drugs produce effects similar to which of these nervous systems? a. Central nervous system b. Somatic nervous system c. Sympathetic nervous system d. Parasympathetic nervous system

ANS: C Adrenergic drugs mimic the effects of the sympathetic nervous system.

A laxative has been ordered for a patient. The nurse checks the patient's medical history and would be concerned if which condition is present? a. High ammonia levels due to liver failure b. Diverticulosis c. Abdominal pain of unknown origin d. Chronic constipation

ANS: C All categories of laxatives share the same general contraindications and precautions, including avoidance in cases of drug allergy and the need for cautious use in the presence of these: acute surgical abdomen; appendicitis symptoms such as abdominal pain, nausea, and vomiting; fecal impaction (mineral oil enemas excepted); intestinal obstruction; and undiagnosed

A patient has been treated with alosetron (Lotronex) for severe irritable bowel syndrome (IBS) for 2 weeks. She calls the clinic and tells the nurse that she has been experiencing constipation for 3 days. The nurse will take which action? a. Advise the patient to increase intake of fluids and fiber. b. Advise the patient to hold the drug for 2 days. c. Instruct the patient to stop taking the drug and to come to the clinic right away to be evaluated. d. Instruct the patient to continue the alosetron and to take milk of magnesia for the constipation.

ANS: C Alosetron must be discontinued immediately if constipation or signs of ischemic colitis occur. The other options are incorrect.

A nurse is giving instructions to a patient who will be receiving oral iron supplements. Which instructions will be included in the teaching plan? a. Take the iron tablets with milk or antacids. b. Crush the pills as needed to help with swallowing. c. Take the iron tablets with meals if gastrointestinal distress occurs. d. If black tarry stools occur, report it to the doctor immediately.

ANS: C Although taking iron tablets with food may decrease absorption, doing so helps to reduce gastrointestinal distress. Antacids and milk may cause decreased iron absorption; iron tablets must be taken whole and not crushed. Black, tarry stools are expected adverse effects of oral iron supplements.

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

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

When given an intravenous medication, the patient says to the nurse, "I usually take pills. Why does this medication have to be given in the arm?" What is the nurse's best answer? a. "The medication will cause fewer adverse effects when given intravenously." b. "The intravenous medication will have delayed absorption into the body's tissues." c. "The action of the medication will begin sooner when given intravenously." d. "There is a lower chance of allergic reactions when drugs are given intravenously."

ANS: C An intravenous (IV) injection provides the fastest route of absorption. The IV route does not affect the number of adverse effects, nor does it cause delayed tissue absorption (it results in faster absorption). The IV route does not affect the number of allergic reactions.

The nurse will monitor for which adverse effect when administering an anticholinergic drug? a. Excessive urination b. Diaphoresis c. Dry mouth d. Pupillary constriction

ANS: C Anticholinergic drugs commonly cause the adverse effects of dry mouth, blurred vision, constipation, and urinary retention. They also cause mydriasis (pupillary dilation).

A patient is on a low-dose dobutamine drip for heart failure. She had been feeling better but now has a sense of tightness in her chest, palpitations, and a bit of anxiety. Her heart rate is up to 110 per minute, and her blood pressure is 150/98 mm Hg (increased from previous readings of 86 per minute and 120/80 mm Hg). What is the nurse's immediate concern for this patient? a. She is experiencing normal adverse effects of dobutamine therapy. b. She may be experiencing an allergic reaction to the dobutamine. c. The medication may be causing a worsening of a pre-existing cardiac disorder. d. The dosage of the dobutamine needs to be increased to control the symptoms better.

ANS: C Because dobutamine is a vasoactive adrenergic, it works by increasing the cardiac output in heart failure patients by increasing myocardial contractility and stroke volume. However, adrenergic drugs may worsen a pre-existing cardiac disorder, such as causing a myocardial infarction in a patient with coronary artery disease. The other options are incorrect.

A father calls because his son has head lice. He reports that he used Kwell shampoo three times, but nothing happened." He wants to know what to do now. What will the nurse advise first? a. "It sounds like you need a prescription for a second product, malathion." b. "Try one of the lotion products instead." c. "Be sure to use a nit comb to remove nits from the hair shafts." d. "Try combing through the hair with mineral oil to loosen the lice from the hair shafts."

ANS: C Before trying another product, ensure that he is performing the regimen correctly. Because he only mentioned shampooing, ensure that after each shampoo he is using a nit comb to remove nits, or eggs, from the hair shafts.

The nurse will teach a patient who is receiving oral iron supplements to watch for which expected adverse effects? a. Palpitations b. Drowsiness and dizziness c. Black, tarry stools d. Orange-red discoloration of the urine

ANS: C Black, tarry stools and other gastrointestinal disturbances may occur with the administration of iron preparations. The other options are incorrect.

When administering a bulk-forming laxative, the nurse instructs the patient to drink the medication mixed in a full 8-ounce glass of water. Which statement best explains the rationale for this instruction? a. The water acts to stimulate bowel movements. b. The water will help to reduce the bulk of the intestinal contents. c. These laxatives may cause esophageal obstruction if taken with insufficient water. d. The water acts as a lubricant to produce bowel movements.

ANS: C Bulk-forming drugs increase water absorption, which results in greater total volume (bulk) of the intestinal contents. Bulk-forming laxatives tend to produce normal, formed stools. Their action is limited to the gastrointestinal tract, so there are few, if any, systemic effects. However, they need to be taken with liberal amounts of water to prevent esophageal obstruction and fecal impaction.

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

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

A patient is taking linaclotide (Linzess) to treat irritable bowel syndrome (IBS). The nurse will monitor this patient for which adverse effect? a. Chest pain b. Chronic constipation c. Abdominal pain d. Elevated blood glucose levels

ANS: C Common adverse effects of linaclotide (Linzess) are diarrhea, abdominal pain, and flatulence. Elevated blood glucose levels, chest pain, and chronic constipation are not adverse effects of linaclotide.

When giving dextromethorphan, the nurse understands that this drug suppresses the cough reflex by which mechanism of action? a. Causing depression of the central nervous system b. Anesthetizing the stretch receptors c. Having direct action on the cough center d. Decreasing the viscosity of the bronchial secretions

ANS: C Dextromethorphan suppresses the cough reflex through a direct action on the cough center. The other options are incorrect.

The nurse is reviewing a list of verbal medication orders. Which is the proper notation of the dose of the drug ordered? a. Digoxin .125 mg b. Digoxin .1250 mg c. Digoxin 0.125 mg d. Digoxin 0.1250 mg

ANS: C Digoxin 0.125 mg illustrates the correct notation with a leading zero before the decimal point. Omitting the leading zero may cause the order to be misread, resulting in a large drug overdose. Digoxin .125 mg and digoxin .1250 mg do not have the leading zero before the decimal point. Digoxin 0.1250 mg has a trailing zero, which also is incorrect.

A patient has been taking donepezil (Aricept) for 2 weeks as part of the treatment for early stages of Alzheimer's disease. Her daughter calls the prescriber's office and is upset because "Mother has not improved one bit!" Which response by the nurse is appropriate? a. "Increase the dosage to twice daily." b. "It takes time for the cure to take effect." c. "It may take up to 6 weeks to see an improvement." d. "Take the medication on an empty stomach for improved absorption."

ANS: C Donepezil therapy is not a cure for Alzheimer's disease, but it may help to improve symptoms in the early stages. It may take up to 6 weeks to see improvement. The family should be taught that the medication must be taken exactly as ordered and with meals, and the medication should not be abruptly stopped or the dosage increased without the physician's approval because of the possibility of serious complications.

During a routine checkup, a patient states that she is unable to take the prescribed antihistamine because of one of its most common adverse effects. The nurse suspects that which adverse effect has been bothering this patient? a. Constipation b. Abdominal cramps c. Drowsiness d. Decreased libido

ANS: C Drowsiness is usually the chief complaint of people who take antihistamines

A patient calls the clinic to speak to the nurse about taking an herbal product that contains ginkgo (Ginkgo biloba) to "help my memory." He states that he has read much information about the herbal product. Which statement by the patient indicates a need for further education? a. "I know the FDA has not approved this herbal product, but I'd like to try it to see if it helps my memory." b. "I need to watch for possible side effects, such as headaches, or stomach or intestinal upset." c. "I will take aspirin or ibuprofen (Motrin) if I have a headache." d. "Ginkgo may cause increased bleeding, so I'll have to be careful when doing yard work."

ANS: C Drug interactions may occur between the taking of aspirin and nonsteroidal anti-inflammatory drugs and the taking of ginkgo. The other options are incorrect

A gardener needs a decongestant because of seasonal allergy problems and asks the nurse whether he should take an oral form or a nasal spray. Which of these is a benefit of orally administered decongestants? a. Immediate onset b. A more potent effect c. Lack of rebound congestion d. Shorter duration

ANS: C Drugs administered by the oral route produce prolonged decongestant effects, but the onset of action is more delayed and the effect less potent than those of decongestants applied topically. However, the clinical problem of rebound congestion associated with topically administered drugs is almost nonexistent with oral dosage forms.

The nurse will be giving ophthalmic drugs to a patient with glaucoma. Which drug is given intravenously to reduce intraocular pressure when other medications are not successful? a. Tobramycin (Tobrex) b. Bacitracin (AK-Tracin) c. Mannitol (Osmitrol) d. Ketorolac (Acular)

ANS: C Drugs used to reduce intraocular pressure include osmotic diuretics such as mannitol, which is given intravenously. Tobramycin and bacitracin are antibiotics; ketorolac has anti-inflammatory actions.

A patient is receiving a dose of edrophonium (Tensilon). The nurse recognizes that this drug is given to determine the diagnosis of which disease? a. Parkinson's disease b. Multiple sclerosis c. Myasthenia gravis d. Alzheimer's disease

ANS: C Edrophonium, another indirect-acting cholinergic drug, is commonly used to diagnose myasthenia gravis. Edrophonium is not used in diagnosing Parkinson's disease, multiple sclerosis, or Alzheimer's disease.

A patient with end-stage renal failure has been admitted to the hospital for severe anemia. She is refusing blood transfusions. The nurse anticipates drug therapy with which drug to stimulate the production of red blood cells? a. Folic acid b. Cyanocobalamin (vitamin B12) c. Epoetin alfa (Epogen) d. Filgrastim (Neupogen)

ANS: C Epoetin alfa is a colony-stimulating factor that is responsible for erythropoiesis, or formation of red blood cells. The other options are incorrect.

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

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

When taking a telephone order for a medication, which action by the nurse is most appropriate? a. Verify the order with the charge nurse. b. Call back the prescriber to review the order. c. Repeat the order to the prescriber before hanging up the telephone. d. Ask the pharmacist to double-check the order.

ANS: C For telephone or verbal orders, repeat the order back to the prescriber before hanging up the telephone. The other options are incorrect.

During therapy with the hematopoietic drug epoetin alfa (Epogen), the nurse instructs the patient about adverse effects that may occur, such as: a. anxiety. b. drowsiness. c. hypertension. d. constipation.

ANS: C Hypertension is an adverse effect of hematopoietic drugs, along with headache, fever, pruritus, rash, nausea, vomiting, arthralgia, cough, and injection site reaction. The other options are incorrect

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

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

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

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

A patient who has had abdominal surgery has been discharged on a cholinergic drug to assist in increasing gastrointestinal peristalsis. The nurse will teach this patient to look for which therapeutic effect? a. Decreased pulse rate b. Abdominal cramping c. Passage of flatus d. Decreased urge to void

ANS: C In patients suffering a decrease in GI peristalsis postoperatively, taking a cholinergic drug should result in an increase in bowel sounds, the passage of flatus, and the occurrence of bowel movements that indicate increased GI peristalsis.

The nurse is reviewing the use of ophthalmic preparations. Indications for the direct- and indirect-acting miotics include which condition? a. Cataracts b. Removal of foreign bodies c. Open-angle glaucoma d. Ocular infections

ANS: C Indications for the direct- and indirect-acting miotics include open-angle glaucoma, angle-closure glaucoma, ocular surgery, and convergent strabismus.

A factory worker has been admitted to the emergency department after an industrial accident involving organophosphate insecticides. The nurse will prepare to administer which drug? a. Pilocarpine (Salagen) b. Bethanechol (Urecholine) c. Physostigmine (Antilirium) d. Tacrine (Cognex)

ANS: C Indirect-acting drugs such as physostigmine inhibit acetylcholinesterase, thus reversing the neuromuscular blockade produced by anticholinergic poisoning as well as poisoning by irreversible cholinesterase inhibitors such as the organophosphates and carbamates, common classes of insecticides. The other drugs listed are not appropriate antidotes.

A patient is to receive iron dextran injections. Which technique is appropriate when the nurse is administering this medication? a. Intravenous administration mixed with 5% dextrose b. Intramuscular injection in the upper arm c. Intramuscular injection using the Z-track method d. Subcutaneous injection into the abdomen

ANS: C Intramuscular iron is given using the Z-track method deep into a large muscle mass. If given intravenously, it is given with normal saline, not 5% dextrose.

The nurse is giving oral mineral oil as an ordered laxative dose. The nurse will take measures to prevent which potential problem that may occur with mineral oil? a. Fecal impaction b. Electrolyte imbalances c. Lipid pneumonia d. Esophageal blockage

ANS: C Lipid pneumonia may occur if the oral mineral oil is accidentally aspirated into the respiratory tract. The other options are incorrect.

While recovering from surgery, a 74-year-old woman started taking a stimulant laxative, senna (Senokot), to relieve constipation caused by the pain medications. Two weeks later, at her follow-up appointment, she tells the nurse that she likes how "regular" her bowel movements are now that she is taking the laxative. Which teaching principle is appropriate for this patient? a. She needs to be sure to take this medication with plenty of fluids. b. It is important to have a daily bowel movement to promote bowel health. c. Long-term use of laxatives often results in decreased bowel tone and may lead to dependency. d. She needs to switch to glycerin suppositories to continue having daily bowel movements.

ANS: C Long-term use of laxatives may lead to dependency. Patients need to be taught that daily bowel movements are not necessary for bowel health.

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

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

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

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

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

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

The nurse is assessing a child with otitis media. Which statement about otitis media is correct? a. It is treated with over-the-counter medications. b. In children, it commonly follows a lower respiratory tract infection. c. Common symptoms include pain, fever, malaise, and a sensation of fullness in the ears. d. Hearing deficits are associated only with inner ear infections, not with otitis media.

ANS: C Otitis media is rarely treated with over-the-counter medications and commonly follows an upper respiratory tract infection in children. Hearing deficits may occur if prompt therapy is not started. Common symptoms include pain, fever, malaise, and a sensation of fullness in the ear.

A patient is severely constipated and needs immediate relief. The nurse knows that which class of laxative will provide the most rapid results? a. Bulk-forming laxative, such as psyllium (Metamucil) b. Stool softener, such as docusate salts (Colace) c. Magnesium hydroxide (MOM) d. Magnesium oxide tablets

ANS: C Saline laxatives such as magnesium hydroxide (MOM) produce a watery stool, usually within 3 to 6 hours of ingestion. Bulk-forming laxatives such as psyllium do not produce a bowel movement rapidly. Stool softeners such as docusate salts do not cause patients to defecate; they simply soften the stool to ease its passage. Magnesium oxide tablets are used as magnesium supplements, not as laxatives.

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

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

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

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

The nurse recognizes that adrenergic drugs cause relaxation of the bronchi and bronchodilation by stimulating which type of receptors? a. Dopaminergic b. Beta1 adrenergic c. Beta2 adrenergic d. Alpha1 adrenergic

ANS: C Stimulation of beta2-adrenergic receptors results in bronchodilation. The other choices are incorrect.

A cholinergic drug is prescribed for a patient with a new diagnosis of myasthenia gravis, and the nurse provides instructions to the patient about the medication. What is important to include in the teaching? a. Take the medication with meals to avoid gastrointestinal distress. b. Give daytime doses close together for maximal therapeutic effect. c. Take the medication 30 minutes before eating to improve swallowing and chewing. d. Take the medication only if difficulty swallowing occurs during a meal.

ANS: C Taking the medication 30 minutes before meals allows time for the onset of action and therapeutic effects during the meal. The doses should be spaced evenly apart to optimize the effects of the medication. The other options are incorrect.

During an admission assessment, the nurse discovers that the patient does not speak English. Which is considered the ideal resource for translation? a. A family member of the patient b. A close family friend of the patient c. A translator who does not know the patient d. Prewritten note cards with both English and the patient's language

ANS: C The nurse should communicate with the patient in the patient's native language if at all possible. If the nurse is not able to speak the patient's native language, a translator should be made available so as to prevent communication problems, minimize errors, and help boost the patient's level of trust and understanding of the nurse. In practice, this translator may be another nurse or health care professional, a nonprofessional member of the health care team, or a layperson, family member, adult friend, or religious leader or associate. However, it is best to avoid family members as translators, if possible, because of issues with bias, misinterpretation, and potential confidentiality issues.

A patient will be taking bismuth subsalicylate (Pepto-Bismol) to control diarrhea. When reviewing the patient's other ordered medications, the nurse recognizes that which medication will interact significantly with the Pepto-Bismol? a. Acetaminophen (Tylenol), an analgesic b. Levothyroxine (Synthroid), a thyroid replacement drug c. Warfarin (Coumadin), an anticoagulant d. Fluoxetine (Prozac), an antidepressant

ANS: C The oral anticoagulant warfarin is more likely to cause increased bleeding times or bruising when co-administered with adsorbents. This is thought to be because the adsorbents bind to vitamin K, which is needed to make certain clotting factors. Vitamin K is synthesized by the normal bacterial flora in the bowel. The other options are incorrect

When evaluating a patient's use of a metered-dose inhaler (MDI), the nurse notes that the patient is unable to coordinate the activation of the inhaler with her breathing. What intervention is most appropriate at this time? a. Notify the doctor that the patient is unable to use the MDI. b. Obtain an order for a peak flow meter. c. Obtain an order for a spacer device. d. Ask the prescriber if the medication can be given orally.

ANS: C The use of a spacer may be indicated with metered-dose inhalers, especially if success with inhalation is limited. The other options are not appropriate interventions.

A patient calls the clinic to ask about taking cranberry dietary supplement capsules because a friend recommended them. The nurse will discuss which possible concern when a patient is taking cranberry supplements? a. It may increase the risk for bleeding if the patient is taking anticoagulants. b. It may increase the risk of toxicity of some psychotherapeutic drugs. c. It may reduce elimination of drugs that are excreted by the kidneys. d. Cranberry may increase the intensity and duration of effects of caffeine.

ANS: C The use of cranberry decreases the elimination of many drugs that are renally excreted. The other concerns do not occur with cranberry supplements.

The nurse is developing a care plan for a patient who will be self-administering insulin injections. Which statement reflects a measurable outcome? a. The patient will know about self-administration of insulin injections. b. The patient will understand the principles of self-administration of insulin injections. c. The patient will demonstrate the proper technique of self-administering insulin injections. d. The patient will comprehend the proper technique of self-administering insulin injections.

ANS: C The word demonstrate is a measurable verb, and measurable terms should be used when developing goals and outcome criteria statements. The other options are incorrect because the terms know, understand, and comprehend are not measurable terms.

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

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

The prescriber has changed the patient's medication regimen to include the leukotriene receptor antagonist (LTRA) montelukast (Singulair) to treat asthma. The nurse will emphasize which point about this medication? a. The proper technique for inhalation must be followed. b. The patient needs to keep it close by at all times to treat acute asthma attacks. c. It needs to be taken every day on a continuous schedule, even if symptoms improve. d. When the asthma symptoms improve, the dosage schedule can be tapered and eventually discontinued.

ANS: C These drugs are indicated for chronic, not acute, asthma and are to be taken every day on a continuous schedule, even if symptoms improve. These drugs are taken orally

The teaching for a patient who is taking tamsulosin (Flomax) to reduce urinary obstruction due to benign prostatic hyperplasia will include which of these? a. Fluids need to be restricted while on this medication. b. Take the medication with breakfast to promote the maximum effects of the drug. c. Get up slowly from a sitting or lying position. d. Blood pressure must be monitored because the medication may cause hypertension.

ANS: C This medication is used to relieve impaired urinary flow in men with benign prostatic hyperplasia, but it also can cause orthostatic hypotension when changing positions from sitting or lying positions. Because of these effects, the blood pressure may become dramatically lowered, and lightheadedness may occur, increasing the risk of falling.

The nurse is reviewing a patient's medication history and notes that the patient is taking the cholinergic blocker tolterodine (Detrol). Which is an indication for this medication? a. Irritable bowel disease b. Induction of mydriasis c. Urge incontinence d. Reduction of secretions preoperatively

ANS: C Tolterodine (Detrol) is used for urinary frequency, urgency, and urge incontinence caused by bladder (detrusor) overactivity. The conditions in the other options are not indications.

The nurse is administering a stat dose of epinephrine. Epinephrine is appropriate for which situation? a. Severe hypertension b. Angina c. Cardiac arrest d. Tachycardia

ANS: C Treatment of cardiac arrest is an indication for the use of epinephrine. The other options are not indications for epinephrine.

The patient wants to take the herb valerian to help him rest at night. The nurse would be concerned about potential interactions if he is taking a medication from which class of drugs? a. Digitalis b. Anticoagulants c. Sedatives d. Immunosuppressants

ANS: C Valerian may cause increased central nervous system depression if used with sedatives. Digitalis, anticoagulants, and immunosuppressants do not have interactions with valerian.

When reviewing a patient's medical record, the nurse notes an order for carbamide peroxide eardrops. Based on this information, the nurse interprets that these eardrops are being used for which purpose? a. To reduce inflammation b. To reduce production of cerumen c. To loosen the cerumen for easier removal d. To inhibit growth of microorganisms in the external canal

ANS: C Wax emulsifiers such as carbamide peroxide work to loosen the cerumen for easier removal. The other options are incorrect.

The nurse is teaching a patient about proper administration of eardrops. Which statements are correct? (Select all that apply.) a. Remove cerumen with a cotton-tipped swab before instilling the drops. b. Instill the drops while still cool from refrigeration. c. Warm the eardrops to room temperature before instillation. d. The adult patient should pull the pinna of the ear up and back. e. Insert a dry cotton ball firmly into the ear canal after instillation. f. Massage the earlobe after instillation.

ANS: C, D, E Remove cerumen before instillation by irrigation, not with cotton-tipped swabs. The drops must be at room temperature; cold drops may cause dizziness or other discomfort. Hold the pinna of the ear up and back when giving eardrops to adults or children older than 3 years of age. Massage the tragus area after instillation to encourage flow through the ear canal. A small cotton ball may be inserted gently into the ear canal to keep the drug in place, but do not force or jam it into the ear canal. Gentle massage to the tragus area of the ear (not the earlobe) may also help to increase coverage of the medication after it is given.

When teaching a patient who will be receiving antihistamines, the nurse will include which instructions? (Select all that apply.) a. "Antihistamines are generally safe to take with over-the-counter medications." b. "Take the medication on an empty stomach to maximize absorption of the drug." c. "Take the medication with food to minimize gastrointestinal distress." d. "Drink extra fluids if possible." e. "Antihistamines may cause restlessness and disturbed sleep." f. "Avoid activities that require alertness until you know how adverse effects are tolerated."

ANS: C, D, F Antihistamines should be taken with food, even though this slightly reduces the absorption of the drug, so as to minimize the gastrointestinal upset that can occur. Over-the-counter medications must not be taken with an antihistamine unless approved by the physician because of the serious drug interactions that may occur. Drinking extra fluids will help to ease the removal of secretions, and activities that require alertness, such as driving, must not be engaged in until the patient knows how he or she responds to the sedating effects of antihistamines.

Which drugs would be affected by the first-pass effect? (Select all that apply.) a. Morphine given by IV push injection b. Sublingual nitroglycerin tablets c. Diphenhydramine (Benadryl) elixir d. Levothyroxine (Synthroid) tablets e. Transdermal nicotine patches f. Esomeprazole (Nexium) capsules g. Penicillin given by IV piggyback infusion

ANS: C, D, F Orally administered drugs (elixirs, tablets, capsules) undergo the first-pass effect because they are metabolized in the liver after being absorbed into the portal circulation from the small intestine. IV medications (IV push and IV piggyback) enter the bloodstream directly and do not go directly to the liver. Sublingual tablets and transdermal patches also enter the bloodstream without going directly to the liver, thus avoiding the first-pass effect.

Which nursing diagnosis is appropriate for the patient who has just received a prescription for a new medication? a. Noncompliance related to new drug therapy b. Impaired memory related to new drug therapy c. Lack of knowledge regarding newly prescribed drug therapy d. Deficient knowledge related to newly prescribed drug therapy

ANS: D A patient who has a limited understanding of newly prescribed drug therapy may have the nursing diagnosis of deficient knowledge. Noncompliance is incorrect because that term implies that the patient does not follow a recommended regimen, which is not the case with a newly prescribed drug. Impaired memory is not appropriate in this situation. "Lack of knowledge" is not a nursing diagnosis.

When monitoring the patient receiving an intravenous infusion to reduce blood pressure, the nurse notes that the patient's blood pressure is extremely low, and the patient is lethargic and difficult to awaken. This would be classified as which type of adverse drug reaction? a. Adverse effect b. Allergic reaction c. Idiosyncratic reaction d. Pharmacologic reaction

ANS: D A pharmacologic reaction is an extension of a drug's normal effects in the body. In this case, the antihypertensive drug lowered the patient's blood pressure levels too much. The other options do not describe a pharmacologic reaction. An adverse effect is a predictable, well-known adverse drug reaction that results in minor or no changes in patient management. An allergic reaction (also known as a hypersensitivity reaction) involves the patient's immune system. An idiosyncratic reaction is unexpected and is defined as a genetically determined abnormal response to normal dosages of a drug.

The nurse is teaching a 16-year-old patient who has a new diagnosis of type 1 diabetes about blood glucose monitoring and the importance of regulating glucose intake. When developing a teaching plan for this teenager, which of Erikson's stages of development should the nurse consider? a. Trust versus mistrust b. Intimacy versus isolation c. Industry versus inferiority d. Identity versus role confusion

ANS: D According to Erikson, the adolescent (12 to 18 years of age) is in the identity versus role confusion stage of development. Trust versus mistrust reflects the infancy stage; intimacy versus isolation reflects the young adulthood stage; and industry versus inferiority reflects the school-age stage of development.

The nurse is reviewing the medication orders for a patient who will be taking an H2 antagonist. Which drug may have an interaction if taken along with the H2 antagonist? a. Ibuprofen (Motrin) b. Ranitidine (Zantac) c. Tetracycline (Doryx) d. Ketoconazole (Nizoral)

ANS: D All H2 receptor antagonists may inhibit the absorption of certain drugs, such as the antifungal ketoconazole, that require an acidic gastrointestinal environment for gastric absorption. The other options are incorrect.

The nurse will instruct patients about a possible systemic effect that may occur if excessive amounts of topically applied adrenergic nasal decongestants are used. Which systemic effect may occur? a. Heartburn b. Bradycardia c. Drowsiness d. Palpitations

ANS: D Although a topically applied adrenergic nasal decongestant can be absorbed into the bloodstream, the amount absorbed is usually too small to cause systemic effects at normal dosages. Excessive dosages of these medications, however, are more likely to cause systemic effects elsewhere in the body. These may include cardiovascular effects, such as hypertension and palpitations, and central nervous system effects such as headache, nervousness, and dizziness. The other options are incorrect.

The nurse working in a preoperative admitting unit administers an anticholinergic medication to a patient before surgery. What is the purpose of this drug in the preoperative setting? a. Control the heart rate b. Relax the patient c. Reduce urinary frequency d. Reduce oral and gastrointestinal secretions

ANS: D Anticholinergic drugs are given preoperatively to control oral and gastrointestinal secretions during surgery. The other options are incorrect.

The nurse is reviewing the use of anticholinergic drugs. Anticholinergic drugs block the effects of which nervous system? a. Central nervous system b. Somatic nervous system c. Sympathetic nervous system d. Parasympathetic nervous system

ANS: D Anticholinergic drugs block or inhibit the actions of acetylcholine in the parasympathetic nervous system. The other options are incorrect.

A woman suffered a second-degree burn of the skin on her arm and hand while cooking breakfast. After examination in the urgent care center, silver sulfadiazine cream (Silvadene) is ordered for the burned area. The nurse will apply the medication using which procedure? a. Gently patting a moderate amount over the burned area b. Massaging the cream completely into the wound c. Applying a thick layer over the burned area, and then leaving the area open d. Applying a thin layer with a sterile, gloved hand to clean and débrided areas

ANS: D Apply a thin layer of medication with a sterile, gloved hand to clean and débrided wounds. The other options are incorrect.

A child has been diagnosed with impetigo, a skin infection. The nurse anticipates that which drug will be used to treat this condition? a. Spinosad (Natroba) b. Nystatin (Mycostatin) c. Acyclovir (Zovirax) d. Bacitracin

ANS: D Bacitracin is applied topically for the treatment of local skin infections caused by susceptible aerobic and anaerobic gram-positive organisms, which can lead to impetigo. Spinosad (Natroba) is used for pediculosis; nystatin is an antifungal drug; and acyclovir is an antiviral drug.

A patient is admitted to the hospital for possible septicemia. He has a large pressure ulcer on his heel that is open and includes necrotic tissue. However, his prothrombin time/international normalized ratio (PT/INR) values are too high to permit surgical débridement at this time. The nurse expects that which wound-care product will be used to treat the wound? a. Cadexomer iodine (Iodosorb) b. Biafine topical emulsion c. Povidone-iodine (Betadine) d. Collagenase (Santyl)

ANS: D Because this patient has an elevated PT/INR, he cannot receive surgical débridement because of concerns about excessive bleeding. Collagenase is useful for patients taking anticoagulants and for those in whom surgery is contraindicated; it selectively removes necrotic tissue but does not harm normal tissue. Cadexomer iodine is not appropriate for a wound with necrotic tissue. Betadine is used as a skin cleanser; biafine is indicated for radiation dermatitis.

A 58-year-old man has had a myocardial infarction (MI), has begun rehabilitation, and is ready for discharge. He is given a prescription for metoprolol (Lopressor) and becomes upset after reading the patient education pamphlet. "I don't have high blood pressure—why did my doctor give me this medicine?" Which explanation by the nurse is correct? a. "This medication will prevent blood clots that may lead to another heart attack." b. "Beta blockers will improve blood flow to the kidneys." c. "This drug is prescribed to prevent the high blood pressure that often occurs after a heart attack." d. "Studies have shown that this medication has greatly increased survival rates in patients who have had a heart attack."

ANS: D Beta blockers are frequently given to patients after they have suffered an MI because of their cardioprotective properties. The other responses are incorrect.

A 60-year-old patient is on several new medications and expresses worry that she will forget to take her pills. Which action by the nurse would be most helpful in this situation? a. Teaching effective coping strategies b. Asking the patient's prescriber to reduce the number of drugs prescribed c. Assuring the patient that she will not forget once she is accustomed to the routine d. Assisting the patient with obtaining and learning to use a calendar or pill container

ANS: D Calendars, pill containers, or diaries may be helpful to patients who may forget to take prescribed drugs as scheduled. The nurse must ensure that the patient knows how to use these reminder tools. Teaching coping strategies is a helpful suggestion but will not help with remembering to take medications. Asking the prescriber to reduce the number of drugs that are prescribed is not an appropriate action by the nurse. Assuring the patient that she will not forget is false reassurance by the nurse and inappropriate when education is needed.

A patient has been taking the corticosteroid dexamethasone (Decadron) but has developed bacterial conjunctivitis and has a prescription for gentamicin (Garamycin) ointment. The nurse notes that which interaction is possible if the two drugs are used together? a. The infection may become systemic. b. The gentamicin effects may become more potent. c. The corticosteroid may cause overgrowth of nonsusceptible organisms. d. Immunosuppression may make it more difficult to eliminate the eye infection.

ANS: D Concurrent use of corticosteroids, such as dexamethasone and ophthalmic antimicrobials, may cause immunosuppression that may make it more difficult to eliminate the eye infection.

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

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

A patient has a prescription for oxybutynin (Ditropan), an anticholinergic drug. When reviewing the patient's medical history, which condition, if present, would be considered a contraindication to therapy with this drug? a. Diarrhea b. Hypertension c. Neurogenic bladder d. Uncontrolled angle-closure glaucoma

ANS: D Contraindications include drug allergy, urinary or gastric retention, and uncontrolled angle-closure glaucoma. Neurogenic bladder is an indication for oxybutynin. The other options are incorrect.

The nurse is administering eardrops that contain a combination of an antibiotic and a corticosteroid. What is the rationale for combining these two drugs in eardrops? a. The combination works to help soften and eliminate cerumen. b. The corticosteroid reduces pain associated with ear infections. c. The drops help to eliminate fungal infections. d. The corticosteroid reduces the inflammation and itching associated with ear infections.

ANS: D Corticosteroids, such as hydrocortisone, are commonly used in combination with otic antibiotics to reduce the inflammation and itching associated with ear infections. Antibiotics do not eliminate fungal infections. The other options are incorrect.

A patient has been receiving epoetin alfa (Epogen) for severe iron-deficiency anemia. Today, the provider changed the order to darbepoetin (Aranesp). The patient questions the nurse, "What is the difference in these drugs?" Which response by the nurse is correct? a. "There is no difference in these two drugs." b. "Aranesp works faster than Epogen to raise your red blood cell count." c. "Aranesp is given by mouth, so you will not need to have injections." d. "Aranesp is a longer-acting form, so you will receive fewer injections."

ANS: D Darbepoetin (Aranesp) is longer-acting than epoetin alfa (Epogen); therefore, fewer injections are required. The other options are incorrect.

The nurse is setting up a teaching session with an 85-year-old patient who will be going home on anticoagulant therapy. Which educational strategy would reflect consideration of the age-related changes that may exist with this patient? a. Show a video about anticoagulation therapy. b. Present all the information in one session just before discharge. c. Give the patient pamphlets about the medications to read at home. d. Develop large-print handouts that reflect the verbal information presented.

ANS: D Developing large-print handouts addresses altered perception in two ways. First, by using visual aids to reinforce verbal instructions, one addresses the possibility of decreased ability to hear high-frequency sounds. By developing the handouts in large print, one addresses the possibility of decreased visual acuity. Showing a video does not allow discussion of the information; furthermore, the text and print may be small and difficult to read and understand. Presenting all the information in one session before discharge also does not allow for discussion, and the patient may not be able to hear or see the information sufficiently. Because of the possibility of decreased short-term memory and slowed cognitive function, giving pamphlets to read may not be appropriate.

The nurse is providing teaching regarding drug therapy to the husband of a woman with Alzheimer's disease. She was diagnosed 3 months ago, has mild memory loss, and will be receiving donepezil (Aricept). What is the drug's expected action? a. Prevents memory loss in later stages b. Reverses the course of Alzheimer's disease c. Provides sedation to prevent agitation and restlessness d. May help to improve the mood and decrease confusion

ANS: D Donepezil is used to treat mild-to-moderate dementia occurring in Alzheimer's disease and may improve the symptoms of the disease.

The nurse is preparing to administer dopamine. Which is the correct technique for administering dopamine? a. Orally b. Intravenous (IV) push injection c. Intermittent IV infusions (IV piggyback) d. Continuous IV infusion with an infusion pump

ANS: D Dopamine is available only as an IV injectable drug and is given by continuous infusion, using an infusion pump. The other options are incorrect.

When administering a new medication to a patient, the nurse reads that it is highly protein bound. Assuming that the patient's albumin levels are normal, the nurse would expect which result, as compared to a medication that is not highly protein bound? a. Renal excretion will be faster. b. The drug will be metabolized quickly. c. The duration of action of the medication will be shorter. d. The duration of action of the medication will be longer.

ANS: D Drugs that are bound to plasma proteins are characterized by longer duration of action. Protein binding does not make renal excretion faster, does not speed up drug metabolism, and does not cause the duration of action to be shorter.

When administering drugs, the nurse remembers that the duration of action of a drug is defined as which of these? a. The time it takes for a drug to elicit a therapeutic response b. The amount of time needed to remove a drug from circulation c. The time it takes for a drug to achieve its maximum therapeutic response d. The time period at which a drug's concentration is sufficient to cause a therapeutic response

ANS: D Duration of action is the time during which drug concentration is sufficient to elicit a therapeutic response. The other options do not define duration of action. A drug's onset of action is the time it takes for the drug to elicit a therapeutic response. A drug's peak effect is the time it takes for the drug to reach its maximum therapeutic response. Elimination is the length of time it takes to remove a drug from circulation.

A 72-year-old man has a new prescription for an anticholinergic drug. He is an active man and enjoys outdoor activities, such as golfing and doing his own yard work. What will the nurse emphasize to him during the teaching session about his drug therapy? a. Drowsiness may interfere with his outdoor activities. b. Increased salivation may occur during exercise and outside activities. c. Fluid volume deficits may occur as a result of an increased incidence of diarrhea. d. He will need to take measures to reduce the occurrence of heat stroke during his activities.

ANS: D Elderly patients who take an anticholinergic drug need to be reminded that they are at a greater risk for suffering heat stroke because of decreased sweating and loss of normal heat-regulating mechanisms.

The nurse is administering folic acid to a patient with a new diagnosis of anemia. Which statement about treatment with folic acid is true? a. Folic acid is used to treat any type of anemia. b. Folic acid is used to treat iron-deficiency anemia. c. Folic acid is used to treat pernicious anemia. d. The specific cause of the anemia needs to be determined before treatment.

ANS: D Folic acid should not be used to treat anemias until the underlying cause and type of anemia have been identified. Administering folic acid to a patient with pernicious anemia may correct the hematologic changes of anemia, but the symptoms of pernicious anemia (which is due to a vitamin B12 deficiency, not a folic acid deficiency) may be deceptively masked. The other options are incorrect.

The nurse is administrating eardrops that have been refrigerated. Which action by the nurse is correct before administering the drops? a. Leave the drops in the refrigerator until use. b. Heat the chilled solution for 10 seconds in the microwave. c. Soak the bottle for 60 seconds in a container of very hot water. d. Take the drops out of the refrigerator 1 hour before the dose is due.

ANS: D Give eardrops at room temperature. If the pharmacy indicates that the drug is to be refrigerated, it should be taken out of the refrigerator up to 1 hour before it is to be instilled so that it can warm up to room temperature. They are not to be placed in the microwave or soaked in hot water; eardrops that are overheated may lose potency. Administration of solutions that are too cold may cause a vestibular reaction that includes vomiting and dizziness. If the solution has been refrigerated, allow it to warm to room temperature.

A 49-year-old patient is in the clinic for a follow-up visit 6 months after starting a beta blocker for treatment of hypertension. During this visit, his blood pressure is 169/98 mm Hg, and he eventually confesses that he stopped taking this medicine 2 months ago because of an "embarrassing problem." What problem did the patient most likely experience with this medication that caused him to stop taking it? a. Urge incontinence b. Dizziness when standing up c. Excessive flatus d. Impotence

ANS: D Impotence is a potential adverse effect of beta blockers and may cause patients to stop taking the medication. The other options are not adverse effects of beta blockers.

The nurse is reviewing the medical record of a patient before giving a new order for iron sucrose (Venofer). Which statement regarding the administration of iron sucrose is correct? a. The medication is given with food to reduce gastric distress. b. Iron sucrose is contraindicated if the patient has renal disease. c. A test dose will be administered before the full dose is given. d. The nurse will monitor the patient for hypotension during the infusion.

ANS: D Iron sucrose (Venofer) is an injectable iron product indicated for the treatment of iron-deficiency anemia in patients with chronic renal disease. It is also used for patients without kidney disease. Its risk of precipitating anaphylaxis is much less than that of iron dextran, and a test dose is not required. Hypotension is the most common adverse effect and appears to be related to infusion rate. Low-weight elderly patients appear to be at greatest risk for hypotension.

A woman who is planning to become pregnant should ensure that she receives adequate levels of which supplement to reduce the risk for fetal neural tube defects? a. Vitamin B12 b. Vitamin D c. Iron d. Folic acid

ANS: D It is recommended that administration of folic acid be begun at least 1 month before pregnancy and continue through early pregnancy to reduce the risk for fetal neural tube defects.

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

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

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

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

The nurse is screening a patient who will be taking a nonspecific/nonselective beta blocker. Which condition, if present, may cause serious problems if the patient takes this medication? a. Angina b. Hypertension c. Glaucoma d. Asthma

ANS: D Nonspecific/nonselective beta-blocking drugs may precipitate bradycardia, hypotension, heart block, heart failure, bronchoconstriction, and/or increased airway resistance. Therefore, any pre-existing respiratory conditions such as asthma might be worsened by the concurrent use of any of these medications.

The patient is complaining of a headache and asks the nurse which over-the-counter medication form would work the fastest to help reduce the pain. Which medication form will the nurse suggest? a. A capsule b. A tablet c. An enteric-coated tablet d. A powder

ANS: D Of the types of oral medications listed, the powder form would be absorbed the fastest, thus having a faster onset. The tablet, the capsule, and, finally, the enteric-coated tablet would be absorbed next, in that order.

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

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

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

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

The nurse is teaching a patient with iron-deficiency anemia about foods to increase iron intake. Which food may enhance the absorption of oral iron forms? a. Milk b. Yogurt c. Antacids d. Orange juice

ANS: D Orange juice contains ascorbic acid, which enhances the absorption of oral iron forms; antacids, milk, and yogurt may interfere with absorption.

During initial rounds, the nurse notes that a dobutamine infusion has extravasated into the forearm of a patient. After stopping the infusion, the nurse follows standing orders and immediately injects phentolamine (Regitine) subcutaneously in a circular fashion around the extravasation site. What is the mechanism of action of the phentolamine in this situation? a. It neutralizes the extravasated dobutamine immediately. b. It causes arterial vasoconstriction and reduced pain and swelling at the site. c. It increases peripheral vascular resistance and reduces arterial pressure at the site. d. It increases blood flow to the ischemic site by vasodilation to prevent tissue damage.

ANS: D Phentolamine is an alpha blocker that reduces peripheral vascular resistance when given systemically, but local subcutaneous injection around the site of extravasated vasoconstrictive drugs, such as dobutamine, causes an alpha-adrenergic receptor blockade and vasodilation. This allows for increased blood flow to the ischemic tissue and may prevent permanent tissue damage.

A patient has received an accidental overdose of intravenous atropine. Which drug will the nurse prepare to administer? a. Atenolol (Tenormin) b. Bethanechol (Urecholine) c. Dicyclomine (Bentyl) d. Physostigmine (Antilirium)

ANS: D Physostigmine salicylate is the antidote to an atropine overdose in patients who show extreme delirium or agitation and could inflict injury to themselves. Its routine use as an antidote for cholinergic-blocker overdose is controversial, however. The other options are incorrect choices.

A patient is about to undergo a diagnostic bowel procedure. The nurse expects which drug to be used to induce total cleansing of the bowel? a. Docusate sodium (Colace) b. Lactulose (Enulose) c. Mineral oil d. Polyethylene glycol 3350 (GoLYTELY)

ANS: D Polyethylene glycol is a very potent laxative that induces total cleansing of the bowel and is most commonly used before diagnostic or surgical bowel procedures. The other options are incorrect.

A patient who has been on antibiotic therapy for 2 weeks has developed persistent diarrhea. The nurse expects which medication class to be ordered to treat this diarrhea? a. Lubricants b. Adsorbents c. Anticholinergics d. Probiotics .

ANS: D Probiotics work by replenishing bacteria that may have been destroyed by antibiotic therapy, thus restoring the balance of normal flora and suppressing the growth of diarrhea-causing bacteria

A patient has had an overdose of an intravenous cholinergic drug. The nurse expects to administer which drug as an antidote? a. Atenolol (Tenormin) b. Bethanechol (Urecholine) c. Dobutamine d. Atropine sulfate

ANS: D Prompt administration of atropine sulfate can reverse a toxic dose of cholinergic drugs. The other drugs listed are not antidotes to cholinergic toxicity.

A patient is receiving ocular cyclosporine (Restasis) and also has an order for an artificial tears product. The nurse includes which instructions in the teaching plan for these medications? a. "These two eye drugs cannot be given together. Let's check with your prescriber." b. "You may take these two drugs together at the same time." c. "First take the artificial tears, and then take the Restasis after 5 minutes." d. "Take the Restasis first, and then wait 15 minutes before taking the artificial tears."

ANS: D Restasis can be used together with artificial tears if the drugs are given 15 minutes apart. The other options are incorrect.

When the nurse teaches a skill such as self-injection of insulin to the patient, what is the best way to set up the teaching/learning session? a. Provide written pamphlets for instruction. b. Show a video, and allow the patient to practice as needed on his own. c. Verbally explain the procedure, and provide written handouts for reinforcement. d. After demonstrating the procedure, allow the patient to do several return demonstrations.

ANS: D Return demonstration allows the nurse to evaluate the patient's newly learned skills. The techniques in the other options are incorrect because those suggestions do not allow for evaluation of the patient's technique.

The nurse is providing instructions about the Advair inhaler (fluticasone propionate and salmeterol). Which statement about this inhaler is accurate? a. It is indicated for the treatment of acute bronchospasms. b. It needs to be used with a spacer for best results. c. Patients need to avoid drinking water for 1 hour after taking this drug. d. It is used for the prevention of bronchospasms.

ANS: D Salmeterol is a long-acting beta2 agonist bronchodilator, while fluticasone is a corticosteroid. In combination, they are used for the maintenance treatment of asthma and COPD. As a long-acting inhaler, Advair is not appropriate for treatment of acute bronchospasms. The other statements are incorrect.

A 14-year-old patient has been treated for asthma for almost 4 months. Two weeks ago, she was given salmeterol as part of her medication regimen. However, her mother has called the clinic to report that it does not seem to work when her daughter is having an asthma attack. Which response by the nurse is appropriate? a. "It takes time for a therapeutic response to develop." b. "She is too young for this particular medication; it will be changed." c. "She needs to take up to two puffs every 4 hours to ensure adequate blood levels." d. "This medication is indicated for prevention of bronchospasms, not for relief of acute symptoms."

ANS: D Salmeterol is indicated for the prevention of bronchospasms, not treatment of acute symptoms. The dosage is usually two puffs twice daily, 12 hours apart, for maintenance effects in patients older than 12 years of age. The other options are incorrect.

A patient is complaining of excessive and painful gas. The nurse checks the patient's medication orders and prepares to administer which drug for this problem? a. Famotidine (Pepcid) b. Aluminum hydroxide and magnesium hydroxide (Maalox or Mylanta) c. Calcium carbonate (Tums) d. Simethicone (Mylicon)

ANS: D Simethicone alters the elasticity of mucus-coated bubbles, causing them to break, and is an over-the-counter antiflatulent. The other options are incorrect.

A 25-year-old woman is visiting the prenatal clinic and shares with the nurse her desire to go "natural" with her pregnancy. She shows the nurse a list of herbal remedies that she wants to buy so that she can "avoid taking any drugs." Which statement by the nurse is correct? a. "Most herbal remedies are not harmful and are safe for use during pregnancy." b. "Please read each label carefully before use to check for cautionary warnings." c. "Keep in mind that products from different manufacturers are required to contain consistent amounts of the herbal products." d. "It's important to remember that herbal remedies do not have proven safety ratings for pregnant women."

ANS: D The fact that a drug is an herbal or a dietary supplement does not mean that it can be safely administered to children, infants, or pregnant or lactating women. Many herbal products have not been tested for safety during pregnancy. Simply reading the labels may not provide enough information for use during pregnancy. Last, manufacturers of herbal products are not required to guarantee the reliability of the contents

A patient has been taking tolterodine (Detrol), but today her prescriber changed her to a newer drug, darifenacin (Enablex). What advantage does darifenacin have over the tolterodine? a. The newer cholinergic-blocker drugs are more effective. b. It helps reduce urinary retention. c. It can be used in patients with narrow-angle glaucoma. d. The incidence of dry mouth is much lower with darifenacin.

ANS: D The incidence of dry mouth is much lower with use of the newer cholinergic-blocker drugs, such as darifenacin, because the actions of these drugs are more specific for the bladder as opposed to the salivary glands. These drugs are contraindicated if narrow-angle glaucoma or urinary retention is present. The newer cholinergic-blocker drugs are not necessarily more effective.

The nurse is administering medications to the patient who is in renal failure resulting from end-stage renal disease. The nurse is aware that patients with kidney failure would most likely have problems with which pharmacokinetic phase? a. Absorption b. Distribution c. Metabolism d. Excretion

ANS: D The kidneys are the organs that are most responsible for drug excretion. Renal function does not affect the absorption and distribution of a drug. Renal function may affect metabolism of drugs to a small extent.

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

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

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

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

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

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

A patient is taking intravenous aminophylline for a severe exacerbation of chronic obstructive pulmonary disease. The nurse will assess for which therapeutic response? a. Increased sputum production b. Increased heart rate c. Increased respiratory rate d. Increased ease of breathing

ANS: D The therapeutic effects of bronchodilating drugs such as xanthine derivatives include increased ease of breathing. The other responses are incorrect.

The patient has been taking an over-the-counter (OTC) acid-reducing drug because he has had "stomach problems" for several months. He tells the nurse that the medicine helps as long as he takes it, but once he stops it, the symptoms return. Which statement by the nurse is the best advice for this patient? a. "The over-the-counter drug has helped you, so you should continue to take it." b. "The over-the-counter dosage may not be strong enough. You should be taking prescription-strength for best effects." c. "For best results, you need to watch what you eat in addition to taking this drug." d. "Using this drug may relieve your symptoms, but it does not address the cause. You should be seen by your health care provider."

ANS: D The use of OTC drugs may postpone effective management of chronic disease states and may delay treatment of serious or life-threatening disorders because these drugs may relieve symptoms without necessarily addressing the cause of the disorder. The other options do not address the need to investigate the cause of the symptoms and are incorrect.

A patient has a new prescription for the transdermal form of scopolamine. The nurse knows that this form of scopolamine is used for which condition? a. Angina b. Chronic pain c. Hypertension d. Motion sickness

ANS: D Transdermal scopolamine (Transderm-Scop) is a patch that can be applied just behind the ear 4 to 5 hours before travel for the prevention of motion sickness. The other options are incorrect.

When given a scheduled morning medication, the patient states, "I haven't seen that pill before. Are you sure it's correct?" The nurse checks the medication administration record and verifies that it is listed. Which is the nurse's best response? a. "It's listed here on the medication sheet, so you should take it." b. "Go ahead and take it, and then I'll check with your doctor about it." c. "It wouldn't be listed here if it were not ordered for you!" d. "Let me check on the order first before you take it."

ANS: D When giving medications, the nurse should always listen to and honor any concerns or doubts expressed by the patient. If the patient doubts an order, the nurse should check the written order and/or check with the prescriber. The other options illustrate that the nurse is not listening to the patient's concerns.

When reviewing the mechanism of action of a specific drug, the nurse reads that the drug works by selective enzyme interaction. Which of these processes describes selective enzyme interaction? a. The drug alters cell membrane permeability. b. The drug's effectiveness within the cell walls of the target tissue is enhanced. c. The drug is attracted to a receptor on the cell wall, preventing an enzyme from binding to that receptor. d. The drug binds to an enzyme molecule and inhibits or enhances the enzyme's action with the normal target cell.

ANS: D With selective enzyme interaction, the drug attracts the enzymes to bind with the drug instead of allowing the enzymes to bind with their normal target cells. As a result, the target cells are protected from the action of the enzymes. This results in a drug effect. The actions described in the other options do not occur with selective enzyme interactions.

The 45 year old female pt with a family history of breast cancer asks the nurse, "is there anything I can do to improve my chances of not getting breast cancer like my sister and my mother?" Which statement is the rn's best response? a. there are medications and lifestyle changes to reduce the risk b. no. pt's that have a strong family history just have to hope they don't get it. c. you sound worried. Would you like to talk about how you feel. d. do any other relatives have breast or other female cancers?

a

Which statement by the pt receiving adjunct chemo for breast cancer warrants immediate intervention by the rn? a. the pt complains of numbness and tingling in her feet b. the pt complains that she feels unattractive without hair. c. the pt says she is unable to eat for 2 days after a treatment d. the pt tells the rn she has lost 2lbs since the last treatment.

a

The client has received chemotherapy 2 days a week every 3 weeks for the past 8 months. The client's current lab values are Hgb and Hct 10.3 and 31, WBC 5.2, neutrophils 50, and platelets 89. Which information should the nurse teach the class? a. use an electric razor when shaving. b. avoid individuals with colds or other infections c. be careful when using sharp objects such as scissors. d. plan for periods of rest to prevent fatigue. e. use a soft bristled toothbrush when brushing teeth.

a, c, e

The pt diagnosed with a brain tumor is prescribed decadron. Which instructions should the rn teach? a. take the medication with food b. the medication may increase appetite c. do not abruptly stop taking the medication d. decadron may cause a headache and nystagmus e. demonstrate how to perform subq injection

a,b,c

At 1000 the pt diagnosed with cancer and receiving chemo. is complaining of unrelieved nausea. Which intervention should the rn implement? a. administer another dose of compazine b. discuss the nausea medications with the PCP c. teach pt how to control nausea at home d. turn the pt on his/her side to prevent aspiration.

b

The nurse is preparing to administer 0900 medications on an oncology floor. Which medication should the nurse administer first? a. an analgesic to a female pt with a headache of 3 on the pain scale b. an antiemetic to a female pt who thinks she might become nauseated c. a mucosal barrier agent to a male pt who has peptic ulcer disease. d. a biologic response modifier to a male pt with low RBC cts.

b

Which pt should the rn question receiving the hematopoietic growth factor erythropoietin (epogen)? a. the pt diagnosed with end-stage renal disease b. the pt diagnosed with essential HTN c. the pt diagnosed with lung cancer and metastasis d. the pt diagnosed with anemia and leukopenia

b

The pt diagnosed with chronic kidney disease is prescribed erythropoietin (procrit). Which intervention should the rn implement? a. administer it IM in the deltoid b. Have the pt take tylenol prn pain c. monitor the pt's complete blood ct. d. teach the pt to pace activities. e. inform the pt not to drive for 90 days.

b, c, d, e

The male pt receiving plant alkaloid antineoplastic medications for cancer complains to the clinic rn that he has been "so clumsy lately that I can't even pick up a dime." Which statement is the rn's best response? a. this is normal and will resolve when your therapy is complete. b. there is no reason to worry about a minor side effect of the drugs. c. have you also noticed a difference in your bowel movements? d. are you also weak and dizzy when you try to stand up?

c

The pt diagnosed with cancer has received several treatments of combination chemo and has a WBC of 2.2 and neutrophil ct of 79. Which hematopoietic growth factor should the rn administer? a. darbepoetin (aranesp) b. oprelvekin (neumega) c. filgrastim (neupogen) d. erythropoietin (epogen)

c

The male pt diagnosed with prostate cancer is prescribed hormone suppression therapy. Which statement is the scientific rationale for administering this medication? a. statement suppression therapy will increase the pt's libido and the ability to maintain an erection. b. hormone suppression therapy shrinks the prostate tissue by destroying tumor cells during replication c. hormone suppression therapy will cause the pt to experience menopausal-like symptoms d. hormone suppression therapy changes the internal host environment to decrease cell growth.

d

The pt diagnosed with cancer has developed diarrhea after the 3rd round of chemo. Which intervention should the rn implement? a. have the pt take up to 12 Imodium 2mg tabs/day b. place the pt on a clear liq. diet c. medicate the pt with phenergan suppositories. d. discuss adding fiber to the pt's diet.

d

The pt on the medical unit is a Jehovah's Witness and has anemia, and the PCP orders erythropoietin (procrit). Which intervention should the rn implement? a. question the order on religious grounds b. have the pt sign an informed consent c. ask the lab to confirm the RBC d. administer the medication subq.

d