Pharm Test #2 Study Questions

This medication is the MOST common drug used to treat oral candidiasis: A. Oseltamivir (Tamiflu) B. Griseofulvin (Fulvicin P/G) C. Nystatin (Mycostatin) D. Amantadine (Symmetrel)

C. Nystatin (Mycostatin)

A patient who has been diagnosed with osteoarthritis asks about the use of glucosamine. Which of the following statements should be included when answering? Select all that apply. A. "Glucosamine might increase bleeding." INCORRECT B. "Glucosamine can help lower blood pressure." C. "Clients who have shellfish allergies might experience reactions when taking glucosamine." INCORRECT D. "Glucosamine can increase blood glucose levels." E. "Glucosamine hydrochloride has been shown to decrease the discomfort of osteoarthritis."

"Glucosamine can help lower blood pressure" is incorrect. The nurse should inform the client that glucosamine can increase blood pressure and should not be used by clients who have hypertension. "Clients who have shellfish allergies might experience reactions when taking glucosamine" is correct. Glucosamine is produced from the shells of shrimp. The nurse should caution the client who has a shellfish allergy that they might experience an allergic reaction when taking glucosamine. Glucosamine can increase blood glucose levels" is correct. Glucosamine can increase blood glucose levels in clients who have diabetes mellitus when it is taken for a prolonged period of time. The nurse should instruct the client to monitor glucose levels closely if they have diabetes mellitus. "Glucosamine hydrochloride has been shown to decrease the discomfort of osteoarthritis" is incorrect. Glucosamine is manufactured in two forms, glucosamine hydrochloride and glucosamine sulfate. In a major study - the Glucosamine/chondroitin Arthritis Intervention Trial (GAIT), glucosamine hydrochloride was found to be no more effective than a placebo. Glucosamine sulfate, however, was effective in reducing pain scores and improving joint mobility. The nurse should instruct the client to read the medication label carefully in order to receive full benefit from the medication.

The nurse is assessing the patient who is about to receive anti fungal drug therapy. Which problem would be of most concern: A. Endocrine disease B. Hepatic disease C. Cardiac disease D. Pulmonary disease

B Hepatic disease

The nurse is aware that the typical antiemetics are very effective in controlling nausea and vomiting associated with alkylating agent chemotherapy administration. A. True B. False

B. False

A client ask the nurse what to expect when taking the new prescription for prednisone to treat her rheumatoid arthritis. How should the nurse respond? A. Increases bone density B. Reduces risk of infection C. Improves peripheral blood flow D.Decreases inflammation

A. Increases bone density Answer Rationale: Prednisone can cause reduced bone density and osteoporosis. B. Reduces risk of infection Answer Rationale: Prednisone causes immunosuppression, which can increase the risk for infection. The nurse should instruct the client to monitor for fever or sore throat. C. Improves peripheral blood flow Answer Rationale: Prednisone can cause reduced wound healing and does not increase peripheral blood flow. D. CORRECT Decreases inflammation Answer Rationale: Prednisone is used to treat rheumatoid arthritis because it produces anti-inflammatory and immunosuppressive effects, which reduces inflammation, decreases pain, and increases mobility.

A nursing student is performing teaching regarding Tamoxifen to a patient. Which of the following should be included. A. It is important to eat or drink fluids when taking this medication to avoid GI upset. B. Antacids may be given with the dose to avoid GI upset. C. This drug is safe to use in pregnancy. D. You may continue to take birth control which contains estrogen while taking this medication.

A. It is important to eat or drink fluids when taking this medication to avoid GI upset.

3. A client reports she takes a several herbal supplements. The client ask the nurse if they are safe to take with her levothyroxine she has been prescribed for hypothyroidism. The nurse responds the following are safe to take with Levothyroxine? (Select All That Apply) A. Soy B. Garlic C. Saw palmetto D. Cranberry

A. Soy Answer Rationale: The nurse should instruct the client to avoid soy because soy can reduce the effectiveness of the levothyroxine. B. Garlic CORRECT Answer Rationale: Garlic can increase the risk for bleeding in clients who take anticoagulants or antiplatelet medications. C. Saw palmetto CORRECT Answer Rationale: Saw palmetto can increase the risk for bleeding in clients who take anticoagulants or antiplatelet medications. D. Cranberry CORRECT Answer Rationale: Cranberry juice can increase the risk for uric acid kidney stones and can also increase the risk of bleeding in clients who take warfarin.

The patient ask for more information about the side effects of alkylating agent-type anticancer medication. The nurse states it is directly proportional to the dose. True or False? A. True B. False

A. True

20. The nurse is teaching a patient regarding administration of antiemetic medications. The nurse states combination therapy is preferred because: A. different vomiting pathways are blocked. B. increased sedation is achieved by higher doses of medication. C. the risk of constipation is decreased. D. lower doses of medication are cost-effective.

A. different vomiting pathways are blocked. Rational: Combining antiemetic drugs from various categories allows the blocking of the vomiting center and chemoreceptor trigger zone through different pathways, thus enhancing the antiemetic effect.

10. When teaching a client about sources of Vitamin C, which of the following should be included? (Select all that apply.) A) Green pepper B) Orange C) Mil D) Yogurt E) Cabbage

Answer Rationale: Green pepper is a correct response. Green peppers are a source of vitamin C and should be included as a source of vitamin C. Orange is a correct response. Oranges are a good source of vitamin C and should be included as a source of vitamin C. Milk is an incorrect response. Milk is a source of other vitamins including vitamin B12 and vitamin B6, but not a source of vitamin C. Yogurt is an incorrect response. Cabbage is a correct response. Cabbage should be included as a source of vitamin C.

18. A cancer patient takes Morphine for pain and is receiving chemotherapy. She reports the onset of nausea. The nurse knows she/he should prepare the following PRN dose of which medication? A. Morphine sulfate B. Zolpidem (Ambien) C. Ondansetron (Zofran) D. Dexamethasone (Decadron)

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

The nurse is administering Dexamethasone to a patient receiving chemotherapy. The patient ask why this drug the doctor has ordered this medication. The nurse responds: A. To avoid skin rashes while taking chemotherapy. B. Some patients have allergic reactions to their chemotherapy. C. To decrease nausea and vomiting while receiving chemotherapy. D.Prevention of respiratory problems

C. To decrease nausea and vomiting while receiving chemotherapy.

4. When teaching the patient regarding follow up test while prescribed Cytoxan, he ask why he will have to have his blood drawn? Which of the following is a correct response? A. Your insurance requires this. B. Your doctor has requested you have your blood drawn each week while taking this drug. C. Your White, Red blood cells and platelets may temporarily decrease after taking the medication. D. It is common to have a decrease in White blood cells while taking this drug.

C. Your White, Red blood cells and platelets may temporarily decrease after taking the medication.

While monitoring a patient who is receiving intravenous amphotericin B, the nurse expects to see which adverse effects: A. Hypertension B. Bradycardia C Fever and chills D. Diarrhea and stomach cramps

C. fever and chills

7. When teaching a client about chronic renal disease and therapy with epoetin alfa. What laboratory results indicate correct therapeutic effect of the medication? ANSWERS - Multiple Choice A) The hematocrit (Hct) B) The leukocyte count C) The platelet count D) The erythrocyte sedimentation rate (ESR)

CORRECT A) The hematocrit (Hct) Answer Rationale: Epoetin alfa is an antianemic medication that is indicated in the treatment of clients who have anemia due to reduced production of endogenous erythropoietin, which may occur in clients who have end-stage renal disease or myelosuppression from chemotherapy. The therapeutic effect of epoetin alfa is enhanced red blood cell production, which is reflected in an increased RBC, Hgb, and Hct. INCORRECT B) The leukocyte count Answer Rationale: Epoetin alfa does not affect the leukocyte, or WBC, count. INCORRECT C) The platelet count Answer Rationale: An increase in platelets is not the therapeutic or desired effect of epoetin alfa. INCORRECT D) The erythrocyte sedimentation rate (ESR) Answer Rationale: Epoetin alfa does not affect the ESR, which is a measurement of inflammation.

17. The nursing student should be aware of which a potential interaction between ginkgo biloba with which of the following medications a client is taking? A. Warfarin B. Ranitidine 4) Loratadine 2) Levothyroxine

CORRECT A. Warfarin Answer Rationale: The nurse should identify a potential interaction between gingko biloba and warfarin. Ginkgo might suppress coagulation and should be used with caution with antiplatelet drugs such as aspirin or anticoagulants such as warfarin or heparin. INCORRECT B. Ranitidine Answer Rationale: There is no documented interaction between ginkgo biloba and ranitidine. INCORRECT 4) Loratadine Answer Rationale: There is no documented interaction between ginkgo biloba and loratadine. INCORRECT 2) Levothyroxine Answer Rationale: There is no documented interaction between ginkgo biloba and levothyroxine.

Which agent below is most likely to cause serious respiratory depression as a potential adverse reaction? A. Nalmefene (Revex) B. Pentazocine (Talwin) C. Hydrocodone (Lortab) D. Morphine (Duramorph)

D. Morphine (Duramorph) Morphine is a strong opioid agonist and as such has the highest likelihood of respiratory depression. Pentazocine, a partial agonist, and hydrocodone, a moderate to strong agonist, may cause respiratory depression but not as often and serious as morphine. Nalmefene is an opioid antagonist and would be used to reverse respiratory depression with opioids.

The nurse notices the patient's respiratory rate has declined to 8 breaths/min. Which medication would the nurse anticipate administering? A. Protamine sulfate B. Acetylcysteine (Mucomyst) C. Methylprednisolone (Solu-Medrol) D. Naloxone (Narcan)

D. Naloxone (Narcan) Naloxone is a narcotic antagonist that can reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.

6. The patient taking Cytoxan has concern about the use of this drug in treating his cancer. He ask if this drug is commonly used for treatment of his type of cancer. How should the nurse respond? A. thiopeta (Thioplex) ) is the most useful alkylating drug currently available. B. melphalan (Alkeran) is the most useful alkylating drug currently available. C. lomustine (CCNU,CeeNU) ) is the most useful alkylating drug currently available. D. cyclophosphamide (Cytoxan) is the most useful alkylating drug currently available.

D. cyclophosphamide (Cytoxan) is the most useful alkylating drug currently available

3. A nurse is assessing a client who is taking cyclophosphamide (Cytoxan). The nurse is aware of which potential complication to report to the doctor immediately when the patient reports the following: A. Nausea/Vomiting B. Thinning of hair. C. Fever of 101 degree x 2 days. D. Decrease in appetite.

Rationale: A, B, & D are side effects of Cytoxan that should be reported, however, they do not require emergency treatment. Fever of 100.4º F (38º C) or higher, chills (possible signs of infection)

A cancer patient is prescribed Liquid Lomotol for severe diarrhea. The following should be included in discharge teaching: (Select all that apply) A. Avoid alcohol while taking this drug. B. This medication may cause drowsiness. C. Take this medication after each loose stool throughout the day. D. It is important to maintain good oral hygiene.

A, B, D Advise patient avoid driving or other activities requiring alertness until response is known. Advise to rinse mouth frequently, use gum or sugarless candy to relieve dry mouth.

A patient ask if there are any side effects with his new pain medication, Hydrocodone. The correct response should be: (Select All That Apply) A. Dizziness B. Itching C. Increased Appetite D. Euphoria

A, B, D are correct

A client has been diagnosed with diabetes insipidus and has been prescribed vasopressin. What findings indicate the medication is effective? A. A decrease in urine output B. A decrease in blood sugar C. A decrease in specific gravity D. A decrease in blood pressure

A. (CORRECT) A decrease in urine output Answer Rationale: The major manifestations of diabetes insipidus are excessive urination and extreme thirst. Vasopressin is used to control frequent urination, increased thirst, and loss of water associated with diabetes insipidus. A decreased urine output is the desired response. B. A decrease in blood sugar Answer Rationale: Blood sugar level is not affected in diabetes insipidus. C. A decrease in specific gravity Answer Rationale: An increase in specific gravity (indicating a more concentrated urine) would be the desired response of vasopressin. D. A decrease in blood pressure Answer Rationale: Diabetes insipidus causes the loss of large amounts of urine, which can lead to hypotension. An increase (or at least no further decrease) in blood pressure would be the desired response to vasopressin.

12. All of the following foods contain thiamine. Place each of the foods in order of the highest level of thiamine per serving to the lowest. A. 1 hard-boiled egg B, 1 cup dried pears C. 1 cup whole grain wheat flour D. 1 cup brussel sprouts

A. 1 hard-boiled egg Answer Rationale: Hard-boiled eggs contain 0.020 mg thiamine per egg; therefore, it is not the highest thiamine food choice. B, 1 cup dried pears Answer Rationale: Dried pears contain 0.010 mg thiamine per cup; therefore, it is not the highest thiamine food choice. C. 1 cup whole grain wheat flour CORRECT Answer Rationale: Whole or enriched grains contain 0.981 mg thiamine, which is the highest level of thiamine. D. 1 cup brussel sprouts Answer Rationale: Brussel sprouts contain 0.122 mg thiamine per cup; therefore, it is not the highest thiamine food choice.

When teaching a patient who is taking nystatin lozenges for oral candidiasis, which instruction by the nurse is correct? A. Allow the lozenge to dissolve slowly and completely in your mouth. B. You may chew the lozenges carefully before swallowing. C. Dissolve the lozenges until it is half the original size and then swallow. D. Swallow whole with a glass of water

A. Allow the lozenge to dissolve slowly and completely in your mouth.

A patient ask the nurse, "Why am I receiving codeine? My wife took that when she had a bad cough. I am not coughing." The nurse's response is based on the knowledge that codeine has which effects? (Select all that apply) A. Analgesic B. Antitussive C. Expectorant D. Immunosuppressant

A. Analgesic B. Antitussive Codeine provides both analgesic and antitussive therapeutic effects.

Which of the following findings is an indication of non-therapeutic response to liothyronine and a need for additional follow up with the client's MD? (Select All That Apply) A. Decrease in appetite B. Decrease in body temperature C. Increase in weight Answer Rationale: D. Increase in energy

A. Decrease in appetite Answer Rationale: Improved appetite is a therapeutic effect of liothyronine. A decrease in appetite is a manifestation of hypothyroidism. CORRECT B. Decrease in body temperature Answer Rationale: An increase in temperature is a manifestation of hypothyroidism. Body temperature should return to the expected reference range with effective therapy. CORRECT C. Increase in weight Answer Rationale: An increase in weight is a manifestation of hypothyroidism. One therapeutic effect of liothyronine is a reduction of this manifestation. CORRECT D. Increase in energy Answer Rationale: An increase in energy is a therapeutic response to liothyronine. Depression, lethargy, and fatigue are manifestations of hypothyroidism and effective treatment will improve these manifestations.

A client has taken a prescription of levothyroxine over the last 6 months. What is an indication of therapeutic to the medication? A. Decrease in level of thyroxine (T4) B. A gradual increase in weight C. Decrease in level of thyroid stimulating hormone (TSH). D. Increase in hr of sleep per night

A. Decrease in level of thyroxine (T4) Answer Rationale: If the dose of this medication has been adequate, the nurse should see an increase in the T4. B. A gradual increase in weight Answer Rationale: If the dose of this medication has been adequate, the nurse should see a decrease in weight, as hypothyroidism causes a decrease in metabolism with weight gain. CORRECT C. Decrease in level of thyroid stimulating hormone (TSH). Answer Rationale: In hypothyroidism, the nonfunctioning thyroid gland is unable to respond to the TSH, and no endogenous thyroid hormones are released. This results in an elevation of the TSH level as the anterior pituitary continues to release the TSH to stimulate the thyroid gland. Administration of exogenous thyroid hormones, such as levothyroxine, turns off this feedback loop, which results in a decreased level of TSH. D. Increase in hr of sleep per night Answer Rationale: If the dose of this medication has been adequate, the nurse should see a decrease in the hr of sleep per night, as hypothyroidism causes sluggishness with increased hr of sleep.

1. A nurse is assessing a client who is taking levothyroxine. What signs and symptoms of levothyroxine overdose should the nurse be aware of? A. Hypoactive deep-tendon reflexes B. Tachycardia C. Drowsiness D. Constipation

A. Hypoactive deep-tendon reflexes Answer Rationale: Hypoactive deep-tendon reflexes are manifestations of hypothyroidism and indicate an inadequate dose of levothyroxine. CORRECT B. Tachycardia Answer Rationale: Levothyroxine overdose will result in manifestations of hyperthyroidism, which include insomnia, tachycardia, and hyperthermia. C. Drowsiness Answer Rationale: Drowsiness is a manifestation of hypothyroidism and indicates an inadequate dose of levothyroxine. D. Constipation Answer Rationale: Constipation is a manifestation of hypothyroidism and indicates an inadequate dose of levothyroxine.

28. A post surgical cancer patient is receiving morphine by means of a patient-controlled analgesia (PCA) pump. Which intervention may be required because of a potential adverse effect of this Morphine? A. Administer cough suppressant. B. Insert Foley catheter. C. Administer antidiarrheal. D. Monitor liver function tests.

B) Insert Foley catheter. Morphine can cause urinary hesitancy and urinary retention. If bladder distention or the inability to void is noted, the prescriber should be notified. Urinary catheterization may be required. Morphine acts as a cough suppressant and an antidiarrheal, so neither of those drugs would need to be administered to counteract an adverse effect of morphine. Liver toxicity is not a common adverse effect of morphine.

21. When considering what information to include in teaching about prochlorperazine (Compazine) to a patient receiving chemotherapy. The nurse will state the following: A. Check blood pressure at home on a regular basis. B. Avoid driving or any dangerous activities if dizziness or drowsiness occurs. C. Cover the head in extreme of temperatures. D. Take extra precautions to avoid heat stroke.

B. Avoid driving or any dangerous activities if dizziness or drowsiness occurs.

The patient prescribed Cytoxan returns for a follow up visit. He reports concern since he has had "unusual bowel movements" lately. How should the nurse respond? (Select All That Apply) A. All of your body functions may change while receiving any type of chemotherapy. B. Tell me more about what has changed. C. Can you describe your Bowel Movements? D. This is a common side effect of Cytoxan.

B. Tell me more about what has changed. C. Can you describe your Bowel Movements?

A patient has been prescribed fluorouracil (5-FU) for her newly diagnosed skin cancer. The nurse is providing teaching about this medication? Which of the following is included in teaching about this drug? (Select All That Apply) A. This medication is an experimental treatment for skin cancer. B. Use caution to avoid eye contact when applying medication. C. Wash hands thoroughly after application. D. This medication can be used systemically to treat adenocarcinomas and topically for skin cancer.

B. Use caution to avoid eye contact when applying medication. C. Wash hands thoroughly after application. D. This medication can be used systemically to treat adenocarcinomas and topically for skin cancer.

14. The nursing student is studying about combination chemotherapy. Which of the following is/are correct? (Select All That Apply) A. The drugs should involve drugs with differing toxicity profiles B. The drugs involved should have comparable mechanisms. C. A & D D. The drugs may be used in combination with surgical and radiation intervention E. A, B & D

C. A & D

The nurse is preparing to administer a dose of promethazine (Phenergan) IM to a 50-year-old male patient with nausea and vomiting. Which action is most important for the nurse to take? A. Administer the medication subcutaneously for fast absorption. B. Administer the medication into an arterial line to prevent extravasation. C. Administer the medication deep into the muscle to prevent tissue damage. D. Administer the medication with 0.5 mL of lidocaine to decrease injection pain.

C. Administer the medication deep into the muscle to prevent tissue damage. Promethazine (Phenergan) is an antihistamine administered to relieve nausea and vomiting. Deep muscle injection is the preferred route of injection administration. This medication should not be administered into an artery or under the skin because of the risk of severe tissue injury, including gangrene. When administered IV, a risk factor is that it can leach out from the vein and cause serious damage to surrounding tissue.

A nurse is infusing cyclophosphamide. The patient ask when she will experience nausea subsequent to the administration of the medication? A. Within a few minutes B. After a several hour delay C. Both D. Neither

C. Both

The nurse is aware that cyclophosphamide in cancer management include(s): A. Cyclophosphamide as monotherapy may be curative in Burkitt's lymphoma. B. Cyclophosphamide combined with a taxane and doxorubicin may be appropriate as postsurgical adjuvant treatment for breast carcinoma. C. Both D. Neither

C. Both

8. Which one(s) of the following statements concerning cyclophosphamide is/are correct? A. Following oral absorption, cyclophosphamide is activated to a 4-hydroxy intermediate. B. Non-physiological antidiuretic hormone secretion has been noted in patients receiving cyclophosphamide, as a result, water intoxication must be considered. C. Both A & B. D. Neither A or B.

C. Both A & B.

What type of drug is dexamethasone? A. Immunosuppressant B. Opioid C. Corticosteroid D. Antibiotic

C. Corticosteroid

Which of the following should be considered when administering an infusion of amphotericin B, to minimize infusion-related adverse effects. A. Forcing of fluids during the infusion. B. Infusing the med quickly. C. Infuse the medication slowly over a long period of time. D. Discontinue the infusion after half of the bag has infused and then resuming 1 hour later

C. Infuse the medication slowly over a long period of time.

When reviewing patient charts, which of the following patients would the nurse be aware raises the risk of developing oral candidiasis? A. A 74-year-old patient who has vitamin B and C deficiencies B. A 22-year-old patient who smokes 2 packs of cigarettes per day C. A 58-year-old patient who is receiving amphotericin B for 2 days D. A 32-year-old patient who is receiving ciprofloxacin (Cipro) for 3 weeks

D. A 32-year-old patient who is receiving ciprofloxacin (Cipro) for 3 weeks Oral candidiasis is caused by prolonged antibiotic treatment (e.g., ciprofloxacin) or high doses of corticosteroids. Amphotericin B is used to treat candidiasis. Vitamin B and C deficiencies are rare but may lead to Vincent's infection. Use of tobacco products leads to stomatitis.

19. A patient receiving tamoxifen begins vomiting. The nurse administers an antiemetic. The patient asks the nurse what part of his brain makes him vomit. What area of the brain will the nurse tell the patient must be stimulated for vomiting to occur? A. Thalamus B. Hypothalamus C. Forebrain D. Chemoreceptor trigger zone (CTZ)

D. Chemoreceptor trigger zone (CTZ)

A patient received Morphine PRN Pain. Which of the following nursing actions is most important in the care of this patient? A. Monitor blood sugar. B. Monitor temperature. C. Monitor heart rate. D. Monitor respiratory rate.

D. Monitor respiratory rate. Morphine sulfate can suppress respiration and respiratory reflexes, such as cough. Patients should be monitored regularly for these effects to avoid respiratory compromise. Morphine sulfate does not affect blood sugar, heart rate, or body temperature.

4. The nurse is providing teaching to a client recently prescribed ferrous sulfate tablets twice daily for iron-deficiency anemia. The nurse includes instructions to take the medication between meals. Which of the following should be discussed? INCORRECT A) "Taking the medication between meals will help you avoid becoming constipated." Answer Rationale: Taking the medication with food can reduce the GI symptoms associated with it. However, taking the medication between meals maximizes absorption. B) "Taking the medication between meals will help you absorb the medication more efficiently." Answer Rationale: Ferrous sulfate provides the iron needed by the body to produce red blood cells. Taking iron supplements between meals helps to increase the bioavailability of the iron. INCORRECT C) "Taking the medication with food increases the risk of esophagitis." Answer Rationale: Reclining immediately after taking ferrous sulfate may lead to esophageal corrosion. Clients should remain upright for 15-30 min following administering. A) "Taking the medication between meals will help you avoid becoming constipated." B) "Taking the medication between meals will help you absorb the medication more efficiently." C) "Taking the medication with food increases the risk of esophagitis." D) "The medication can cause nausea if taken with food."

INCORRECT A) "Taking the medication between meals will help you avoid becoming constipated." Answer Rationale: Taking the medication with food can reduce the GI symptoms associated with it. However, taking the medication between meals maximizes absorption. B) CORRECT "Taking the medication between meals will help you absorb the medication more efficiently." Answer Rationale: Ferrous sulfate provides the iron needed by the body to produce red blood cells. Taking iron supplements between meals helps to increase the bioavailability of the iron. INCORRECT C) "Taking the medication with food increases the risk of esophagitis." Answer Rationale: Reclining immediately after taking ferrous sulfate may lead to esophageal corrosion. Clients should remain upright for 15-30 min following administering. INCORRECT D) "The medication can cause nausea if taken with food." Answer Rationale: Taking ferrous sulfate with food can reduce the GI symptoms associated with it. However, taking the medication between meals maximizes absorption.

9. When instructing a client about Vitamin D, what information should be included as a trigger for formation of the vitamin in the body? A) Calcium B) Exposure to sunlight C) Vitamin A depletion D) Weight-bearing exercise

INCORRECT A) Calcium Answer Rationale: Calcium does not trigger the formation of vitamin D in the body. CORRECT B) Exposure to sunlight Answer Rationale: Exposure to sunlight triggers the formation of vitamin D in the body. INCORRECT C) Vitamin A depletion Answer Rationale: Vitamin A depletion does not trigger the formation of vitamin D in the body. INCORRECT D) Weight-bearing exercise Answer Rationale: Weight-bearing exercises do not trigger the formation of vitamin D in the body.

6. When teaching a client with chronic kidney disease about the new prescription for epoetin alfa. Which of the following dietary supplements should be included in the daily regimen? A) Sodium B) Iron C) Protein D) Potassium

INCORRECT A) Sodium Answer Rationale: The client who has chronic kidney disease is at risk for hypernatremia and should eat a low-sodium diet. B) CORRECT Iron Answer Rationale: Epoetin alfa is a synthetic form of erythropoietin, a substance produced by the kidneys that stimulates the bone marrow to produce red blood cells. Increased iron is needed for the production of hemoglobin and red blood cells by the bone marrow. INCORRECT C) Protein Answer Rationale: The client who has chronic kidney disease is at risk for uremia and should eat a low-protein diet. INCORRECT D) Potassium Answer Rationale: The client who has chronic kidney disease is at risk for hyperkalemia and should eat a low-potassium diet.

8. Which of the following foods is a reliable source of Vitamin B12 for a pregnant client who states she is vegan? A) Tempeh B) Algae C) Sea vegetables D) Sunflower Seeds

INCORRECT A) Tempeh Answer Rationale: Tempeh and other fermented foods contain a form of vitamin B12 that the body cannot use; therefore, it is an unreliable source of vitamin B12. INCORRECT B) Algae Answer Rationale: Algae and other fermented foods contain a form of vitamin B12 that the body cannot use; therefore, it is an unreliable source of vitamin B12. INCORRECT C) Sea vegetables Answer Rationale: Sea vegetables can provide a source of iodine to a client who is vegan; however, it is an unreliable source of vitamin B12. CORRECT D) Sunflower Seeds Answer Rationale: Sunflower seeds is fortified with vitamin B12 and is a reliable source of vitamin B12.

5. A nurse is planning a menu for a client who has folic acid deficiency anemia. The nurse is aware of the need for additional teaching when the client states which of the following foods are high in folate? ANSWERS - Select All That Apply. A) ½ cup of asparagus B) ¼ cup of olives C) 4 slices of roast beef D) 1 cup part-skim mozzarella cheese

INCORRECT A) ½ cup of asparagus Answer Rationale: A half cup of asparagus contains 132 mcg of folate. CORRECT B) ¼ cup of olives Answer Rationale: Olives are not a source folic acid. CORRECT C) 4 slices of roast beef Answer Rationale: Roast beef is not a source of folic acid. INCORRECT D) 1 cup part-skim mozzarella cheese Answer Rationale: A cup of part-skim mozzarella cheese contains 36 mcg of folic acid.

14. What additional information regarding black cohosh that should be included? A. "Black cohosh helps relieve headache pain." B. "Black cohosh should not be taken during pregnancy." C. "Black cohosh is a stimulant." D. "Black cohosh increases the risk for bleeding."

INCORRECT A. "Black cohosh helps relieve headache pain." Answer Rationale: Black cohosh has no analgesic effect to relieve headache pain; however, feverfew is known to alleviate migraine headaches when taken prophylactically. CORRECT B. "Black cohosh should not be taken during pregnancy." Answer Rationale: Black cohosh has estrogenic properties and should not be taken during pregnancy. INCORRECT C. "Black cohosh is a stimulant." Answer Rationale: Black cohosh does not act as a stimulant; however, ephedra acts as a stimulant and can increased heart rate and elevated blood pressure. CORRECT D. "Black cohosh increases the risk for bleeding." Answer Rationale: Black cohosh does not affect bleeding time; however, garlic decreases platelet aggregation and can increase the risk for bleeding.

13. A nurse is completing discharge teaching to a patient. Which of the following information is a use for black cohosh? A. "Black cohosh is used to alleviate menopausal symptoms." B. "Black cohosh helps relieve nocturia." Answer Rationale: C. "Black cohosh is used to treat the common cold." D. "Black cohosh can help to reduce arthritis pain."

INCORRECT A. "Black cohosh is used to alleviate menopausal symptoms." Answer Rationale: Black cohosh may relieve menopausal symptoms, such as hot flashes, by suppressing the release of luteinizing hormone. B. "Black cohosh helps relieve nocturia." Answer Rationale: Saw palmetto may help relieve urinary and prostate symptoms, such as nocturia, by suppressing inflammation. INCORRECT C. "Black cohosh is used to treat the common cold." Answer Rationale: Echinacea may help boost the immune system and thus prevent or treat the common cold. INCORRECT D. "Black cohosh can help to reduce arthritis pain." Answer Rationale: Capsicum is derived from red peppers and is an ingredient in topical preparations that treat arthritis pain. Capsicum may reduce the pain of inflammation by interfering with substance P, which transmits pain impulses.

15. When preparing a presentation about Echinacea, which of the following information should the nurse include? A. "Echinacea is used to treat vertigo." B. "Echinacea boosts the immune system." C. "Echinacea increases the ability to walk further distances for clients who have PAD." D. "Echinacea blocks testosterone receptors."

INCORRECT A. "Echinacea is used to treat vertigo." Answer Rationale: Ginger root is used to treat vertigo associated with motion sickness, morning sickness, seasickness and general anesthesia. CORRECT B. "Echinacea boosts the immune system." Answer Rationale: The nurse should include in the teaching that echinacea may help boost the immune system. INCORRECT C. "Echinacea increases the ability to walk further distances for clients who have PAD." Answer Rationale: Ginkgo biloba can increase the client's ability to walk further distances by decreasing pain in the lower extremities. INCORRECT D. "Echinacea blocks testosterone receptors." Answer Rationale: Saw palmetto may help blocks testosterone receptors.

In addition to the above, the nursing student understands the following information about ginkgo biloba should be included in teaching a client? A. "Ginkgo biloba relieves pain and inflammation of the mouth B. "Ginkgo biloba can improve senile dementia." C. "Ginkgo biloba may enhance wound healing." D. "Ginkgo biloba can help reduce feelings of restlessness."

INCORRECT A. "Ginkgo biloba relieves pain and inflammation of the mouth." Answer Rationale: St. John's wort may be beneficial in treating oral inflammation and pain. INCORRECT B. "Ginkgo biloba can improve senile dementia." Answer Rationale: Ginkgo biloba may improve senile dementia by improving blood flow due to ginkgo-induced vasodilation. INCORRECT C. "Ginkgo biloba may enhance wound healing." Answer Rationale: Echinacea is an herbal preparation that can enhance wound healing by stimulating the T-lymphocyte proliferation and proinflammatory enzymes. CORRECT D. "Ginkgo biloba can help reduce feelings of restlessness." Answer Rationale: Valerian may reduce feelings of restlessness by increasing the amount of gamma-aminobutyric acid (GABA) at the synapses in the CNS.

A nurse is completing discharge teaching regarding glucosamine to a client. What information should be included in the teaching? A. "Glucosamine is used to treat viral infections." B. "Glucosamine can help relieve urinary frequency." C. "Glucosamine can suppress joint inflammation." D. "Glucosamine can help relieve hot flashes."

INCORRECT A. "Glucosamine is used to treat viral infections." Answer Rationale: Echinacea is used orally to treat viral infections, such as influenza. INCORRECT B. "Glucosamine can help relieve urinary frequency." Answer Rationale: Saw palmetto may help relieve urinary frequency by anti-inflammatory effects. CORRECT C. "Glucosamine can suppress joint inflammation." Answer Rationale: The nurse should include in the teaching that glucosamine suppresses joint inflammation and cartilage degradation by stimulating the activity of chondrocytes. INCORRECT D. "Glucosamine can help relieve hot flashes." Answer Rationale: Black cohosh may relieve menopausal symptoms, such as hot flashes, by suppressing the release of luteinizing hormone.

1. A nurse is teaching a client who has a new prescription for ferrous sulfate. Which of the following statements by the client indicates need for additional teaching? A. "I will expect the color of my urine to be amber." B. "I should not expect any changes in color of stools." C. "I should expect increased bruising." D. "I will not get as many infections."

INCORRECT A. "I will expect the color of my urine to be amber." Rationale: The color of the urine is an indication of how concentrated or diluted the urine is and may be affected by food and medications; however, ferrous sulfate does not affect the color of the urine. B. CORRECT "I should not expect any changes in color of stools." Rationale: Ferrous sulfate is an iron supplement used to treat clients who have iron deficiency anemia. An expected adverse effect of this medication is black, tarry stools. INCORRECT C. "I should expect increased bruising." Rationale: Ferrous sulfate does not impact clotting factors or platelets, so the client should not expect increased bruising. INCORRECT D. "I will not get as many infections."

21. Which of the following information should the nurse include in the teaching a patient about St. John's wort? A. "St. John's wort interfere with early diagnosis prostate cancer." B. "St. John's wort potentiates an anti-inflammatory effect." C. "St. John's wort can interfere with the hypoglycemic effects of a client's antidiabetic medication." D. "St. John's wort has been known to cause photophobia."

INCORRECT A. "St. John's wort interfere with early diagnosis prostate cancer." Answer Rationale: Saw palmetto can result in falsely low prostate-specific antigen levels, which might mean a delay in diagnosing prostate cancer in some INCORRECT B. "St. John's wort potentiates an anti-inflammatory effect." Answer Rationale: Chamomile has anti-inflammatory properties and may provide relief from GI and upper respiratory tract inflammatory diseases. INCORRECT C. "St. John's wort can interfere with the hypoglycemic effects of a client's antidiabetic medication." Answer Rationale: Black cohosh can potentiate the hypoglycemic effects of antidiabetic medication. CORRECT D. "St. John's wort has been known to cause photophobia." Answer Rationale: The nurse should teach the client that St. John's wort may cause photophobia; therefore, the client should wear protective clothing, sun screen, and sun-glasses when outside.

3. When providing teaching to a client who reports taking gingko biloba, what adverse effects would be important for the nurse to include? A. Bad breath B. Decreased alertness C. May notice increased bleeding. D. Breast enlargement

INCORRECT A. Bad breath Rationale: Bad breath is not an expected adverse effect of gingko biloba. INCORRECT B. Decreased alertness Rationale: Decreased alertness is not an expected adverse effect of ginkgo biloba; however, ginkgo biloba can cause headache, dizziness, and vertigo. CORRECT C. May notice increased bleeding. Rationale: Gingko biloba is an herbal medication used by clients to improve age-related memory loss as well as to decrease leg pain in clients with peripheral arterial disease (PAD). Although gingko biloba is generally well-tolerated, it may suppress coagulation. There have been reports of spontaneous bleeding in clients taking this herbal medication. Clients should be instructed to discontinue use and report increased bleeding, such as nosebleeds, bleeding gums, any cuts that do not stop bleeding, to their provider. INCORRECT D. Breast enlargement Rationale: Breast enlargement is not an expected adverse effect of ginkgo biloba.

. A nursing student is studying the adverse effects of using garlic, ginger, and ginkgo biloba. Which of the following is an adverse effect of these supplements? A. Increased effects of antidepressant medications B. Increased effects of oral anticoagulants Answer Rationale: C. Decreased effects of antianxiety D. Decreased effects of antirejection

INCORRECT A. Increased effects of antidepressant medications Answer Rationale: St. John's wort is an example of an herbal product that can increase the effects of antidepressants. CORRECT B. Increased effects of oral anticoagulants Answer Rationale: The nurse should include that garlic, ginger, and ginkgo biloba can all interfere with the effects of oral anticoagulants and thus increase the risk of bleeding. INCORRECT C. Decreased effects of antianxiety medications Answer Rationale: Caffeine can reduce the effectiveness of antianxiety medications. INCORRECT D. Decreased effects of antirejection medication Answer Rationale: Echinacea can reduce the effectiveness of antirejection medication.

2. A nurse is preparing to initiate a transfusion of packed RBC for a client who has anemia. Which of the following describes the correct actions for to nurse take? A. Leave the client 5 min after beginning the transfusion. . B. Infuse the transfusion over 2-4 hours. C. Check the client's vital signs every 15 minutes during the transfusion. D. Flush the blood tubing with dextrose 5% in water. .

INCORRECT A. Leave the client 5 min after beginning the transfusion. Rationale: The nurse should remain with the client for 15 to 30 min after the start of the transfusion to monitor for a reaction, which usually occurs during the first 50 mL of the transfusion. CORRECT B. Infuse the transfusion over 2-4 hours. Rationale: The transfusion should infuse in 2 to 4 hr to prevent fluid overload. INCORRECT C. Check the client's vital signs every 15 minutes during the transfusion. Rationale: The nurse should check the client's vital signs every 15 min at the start of the transfusion, then every 1 hr to monitor for a transfusion reaction. INCORRECT D. Flush the blood tubing with dextrose 5% in water. Rationale: The nurse should flush the blood tubing with 0.9% sodium chloride to prevent hemolysis of the blood.

The patient ask how his newly prescribed cyclophosphamide (Cytoxan) will be administered? How does the nurse respond? (Select All That Apply) A. Your doctor will determine how your medication will be given. B. Cyclophosphamide (Cytoxan) can be given by a number of different routes, which are dependent upon the dosage, the condition being treated, and the purpose it is being used for. C. The most common routes are through a vein by injection or infusion (intravenous, IV) or orally in a tablet form. D. Cyclophosphamide (Cytoxan) is approved to be give by shot in the muscle, in the abdomen or even in the lining of the lung (intrapleural).

Rational: A, B, C, D are all correct.

11. A nurse is preparing discharge teaching regarding what vitamins promote healing in a patient with a wound. Select the appropriate vitamins to be included in teaching. A. Vitamin A B. Vitamin K C. Vitamin D D. Vitamin C E. Vitamin B12

Vitamin A is correct. Vitamin A is important for tissue synthesis, wound healing, and immune function. Vitamin K is correct. Vitamin K functions as an enzyme in the synthesis of prothrombin and other proteins required for normal blood clotting. Vitamin D is incorrect. Vitamin D functions in maintaining serum levels of calcium and phosphorus, but has no specific role in wound healing. Vitamin C is correct. Vitamin C is important for capillary formation, tissue synthesis, and wound healing. Vitamin B12 is correct. Vitamin B12 assists in the development of red blood cells, maintenance of nerve function, and is needed for cell maintenance and tissue synthesis.