Pharmacology Exam IV

Chapter 46: Antiulcer Drugs

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Chapter 8: Drugs in Substance use Disorder

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Chapter 17: Stimulants

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Chapter 18: Depressants

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Chapter 19: Antiseizure Drugs

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Chapter 22: Antiphyscotics and Anxiolytics

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Chapter 23: Antidepressants and Mood Stabilizers

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Chapter 45: Gastrointestinal Tract Disorders

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The nurse is teaching a patient who has completed detoxification for alcohol use disorder who will be discharged home with a prescription for disulfiram (Antabuse). Which statement by the patient indicates understanding of the teaching? a. "Even use of mouthwash can cause serious adverse effects while I am taking this drug." b. "If I use this medication, I won't have to worry about participating in psychotherapy or counseling." c. "It is safe to take a product containing alcohol one week after the last dose of disulfiram. d. "This drug acts by blocking the pleasurable effects of alcohol."

ANS. A Disulfiram causes an unpleasant reaction if alcohol is consumed while taking the drug and can even occur with topical products containing alcohol and use of mouthwash. For disulfiram to be effective, persons with alcohol use disorder also need to participate in behavior modification, psychotherapy, and counseling. The effects of disulfiram do not wear off for up to 2 weeks after the last dose. It does not block the pleasurable effects of alcohol.

A patient is brought to the emergency department by a family member. The patient reports symptoms of paranoia and believes they are being followed. The patient presents with an elevated body temperature, elevated pulse, and high blood pressure. The nurse suspects that this patient has taken which of the following drugs? a. Alcohol b. Cocaine c. Heroin d. Oxycodone

ANS. B A stimulant psychosis can occur with cocaine use. and can present as symptoms of paranoia such as believing they are being followed or someone is trying to attack them. Cocaine users will also present with elevations in temperature, pulse, and blood pressure. These are not physical signs typically seen with substance use disorder involving alcohol, heroin or oxycodone.

A female patient with a peptic ulcer asks the nurse if misoprostol would be a good option for her because it works well for her mother. Upon review of her medication list it is noted that she takes a prenatal vitamin daily. What will the nurse do? a. Recommend use of misoprostol since it works well for her mother. b. Explain to the patient that misoprostol is contraindicated during pregnancy. c. Tell the patient to purchase misoprostol over the counter. d. Tell her that misoprostol is just another PPI and that she should just purchase a PPI that is available over the counter.

ANS. B Misoprostol is a synthetic prostaglandin analog that can be used to prevent and treat peptic ulcers, particularly in people using high doses of NSAIDs. As a prostaglandin analog, misoprostol is contraindicated during pregnancy. Misoprostol is available by prescription only.

The parent of a child who is receiving chemotherapy asks the nurse why metoclopramide is not being used to suppress vomiting. The nurse will explain that, in children, this drug is more likely to cause which adverse effect? a. Excess sedation b. Extrapyramidal symptoms c. Paralytic ileus d. Vertigo

ANS: B Metoclopramide can cause extrapyramidal symptoms, and these effects are more likely in children. Children are not more prone to sedative effects, paralytic ileus, or vertigo while taking this drug.

The nurse is counseling a patient who wants to stop smoking. Which statement by the nurse is correct? a. "Bupropion (Zyban) is effective and does not have any serious adverse effects." b. "Nicotine replacement therapies are effective and eliminate the need for behavioral therapy." c. "Varenicline (Chantix) may be used short-term for 1 to 2 months." d. "You may experience headaches, irritability, and increased appetite for several months after stopping smoking."

ANS. D Headaches and increased appetite are common during nicotine withdrawal and may last for several months. Bupropion is effective but can cause a variety of side effects. Nicotine replacement therapy does not eliminate the need for behavioral therapy. Varenicline is used for at least 3 months.

The nurse is caring for a patient who is chronically irritable and anxious and prone to violent behaviors. The patient has several teeth missing and has dental caries in the remaining teeth. The nurse suspects previous chronic use of which drug? a. Alcohol b. Cocaine c. LSD d. Methamphetamine

ANS. D Patients previously exposed to methamphetamine use will exhibit these symptoms, and the physical effects of extended methamphetamine use are notable tooth decay ("meth mouth") and dermatologic deterioration.

What does the nurse understand must occur in order to produce withdrawal syndrome? a. Intoxication b. Craving c. Drug tolerance d. Prolonged or repeated use

ANS. D Patients who use a drug repeatedly, usually for a prolonged period and/or in high doses, may experience withdrawal syndrome when the drug is stopped. Intoxication is a condition that results in disturbances in the level of consciousness, cognition, perception, judgment, behavior, and other psycho-physiologic functions. Cravings are a strong desire for a drug or for its intoxicating effects. Tolerance refers to a decrease in drug effects with repeated use.

The nurse is teaching a patient about taking a benzodiazepine to treat grief-related anxiety. Which statement by the patient indicates understanding of the teaching? a. "I may have wine with dinner to help with relaxation " b. "I may need to take this medication forever." c. *I may stop taking the medication when my symptoms go away." d. "I should try psychotherapy or a support group in addition to the medication."

ANS. D Psychotherapy or support groups should be part of therapy, with anxiolytics added as needed. Patients taking benzodiazepines should not consume alcohol. Anxiolytic medications are generally given for a limited length of time, particularly when treating grief-related anxiety. Patients should not stop the medications abruptly.

A child has been prescribed activated charcoal. What is the likely reason this is being ordered? a. Ingestion of a toxic substance b. Severe vomiting c. Nausea d. Motion sickness

ANS: A Activated charcoal is given to prevent the absorption of ingested toxic substances. Activated charcoal does not have a role in the treatment of nausea, vomiting or motion sickness.

A child is brought to the emergency department after ingestion of a toxic substance. The child is alert and conscious and is reported to have ingested kerosene 20 minutes prior. The nurse will anticipate administering a. activated charcoal. b. an anticholinergic antiemetic. c. an antihistamine. d. syrup of ipecac.

ANS: A Activated charcoal is used when patients have ingested a caustic substance or a petroleum distillate in a patient who is alert and awake. Syrup of ipecac is not recommended. An anticholinergic or antihistamine would not be indicated.

The nurse is assessing a young adult patient with schizophrenia who recently began taking fluphenazine. The patient is exhibiting spasms of facial muscles along with grimacing, and the nurse notes upward eye movements. The nurse suspects which side effect? a. Acute dystonia b. Akathisia c. Pseudoparkinsonism d. Tardive dyskinesia

ANS: A Acute dystonia can occur within days of taking typical antipsychotics, and facial muscle spasms, grimacing, and upward eye movements are characteristic of this side effect. Akathisia is characterized by restlessness, pacing, and difficulty standing still. Pseudoparkinsonism is characterized by stooped posture, pill-rolling, shuffling gait, and tremors at rest. Tardive dyskinesia manifests as protrusion and rolling of the tongue, smacking of the lips, and involuntary movement of the body and extremities.

The parent of a child who is taking amphetamine to treat attention-deficit/hyperactivity disorder(ADHD) asks the provider to recommend an over-the-counter medication to treat a cold. What will the nurse tell the parent? a. "Avoid any products containing pseudoephedrine or caffeine." b. "Never give over-the-counter medications with amphetamine." c. "Sudafed (pseudoephedrine) is a safe and effective decongestant for my child." d. "Use any over-the-counter medication from the local pharmacy."

ANS: A Amphetamine is a stimulant, so other stimulants, such as caffeine and pseudoephedrine, should be avoided to avoid additive stimulation.

A patient has been using methylphenidate to treat ADHD for several weeks. The patient is having difficulty sleeping and takes the medication twice daily before breakfast and dinner. The nurse will explain to the patient that methylphenidate... a. can cause insomnia and recommend taking the medication before breakfast and lunch b. does not often cause insomnia. c. can cause insomnia and recommend a medication to help with sleep. d. usually causes drowsiness.

ANS: A Amphetamines such as methylphenidate are CNS stimulants and can contribute to insomnia. For patients taking methylphenidate twice daily, it is recommended to take the medication 30-45 minutes before breakfast and lunch. Recommending a shit in administration time would be the best first option before staring a medication for insomnia.

An appropriate goal when teaching a patient who has diarrhea is that the patient a. will have less frequent, more formed stools. b. will not have a stool for 1 to 2 days. c.. will receive adequate intravenous fluids. d. will receive appropriate antibiotic therapy.

ANS: A An appropriate goal is that patients will have formed, less frequent stools, not an absence of stools. Receiving adequate intravenous fluids or antibiotic therapy are interventions, not goals.

A patient who takes phenytoin reports recently starting to take antacids for new-onset dyspepsia. The patient previously had a phenytoin level in the normal therapeutic range. The nurse might expect a serum phenytoin level in this patient to be in which range? a. 5 to 10 mcg/mL b. 10 to 20 mcg/mL c. 20 to 30 mcg/mL d. 30 to 50 mcg/mL.

ANS: A Antacids can decrease the effects of phenytoin by inhibiting its absorption, which would decrease serum drug levels. The therapeutic range is 10 to 20 mcg/mL, so a level lower than this may be expected in a patient who started antacids while on phenytoin

A patient who takes propantheline bromine and omeprazole for an ulcer will begin taking an antacid. The nurse will give which instruction to the patient regarding how to take the antacid? a. Take the antacid 2 hours after taking the propantheline. b. Take the antacid along with a meal. c. Take the antacid with milk. d. Take the antacid with the propantheline bromine.

ANS: A Antacids can slow the absorption of anticholinergics and should be taken 2 hours after anticholinergic administration. Antacids should be given 1 to 3 hours after a meal and should not be given with dairy products.

A patient who has epilepsy will begin an anticonvulsant medication. The patient asks the nurse how long the medication will be necessary. How will the nurse respond? a. "The medication may be necessary for a lifetime." b. "The medication will be given until you are seizure free." c. "You will need to take the medication for 3 to 5 years." d. "You will take the medication as needed for seizure activity."

ANS: A Anticonvulsants are given to prevent seizures and are usually taken throughout the patient's lifetime. Stopping the medication can lead to recurrence of seizures in many patients. Some patients may attempt to stop taking the medications after 3 to 5 years of no seizure activity. Anticonvulsants are not given as needed

The nurse is teaching a group of nursing students about the use of antipsychotic drugs for antiemetic purposes. The nurse will explain that, when given as antiemetics, these drugs are given a. in smaller doses. b. less frequently. c.. with anticholinergics. d. with antihistamines.

ANS: A Antipsychotic medications are used in smaller doses when administered for antiemetic purposes.

A patient who is taking diphenoxylate with atropine to treat diarrhea asks the nurse why it contains atropine. The nurse will explain that atropine is added, in part, to a. decrease abdominal cramping. b. increase intestinal motility. c. minimize nausea and vomiting. d. provide analgesia.

ANS: A Atropine is added to decrease abdominal cramping and slow intestinal motility through its anticholinergic effects. It does not affect nausea and vomiting or pain.

The nurse is preparing a patient for surgery. The patient received a hypnotic medication the night prior and the nurse is administering midazolam and atropine. The patient asks why all of these medications are necessary. The nurse will tell the patient that they are given for which reason? a. To decrease the amount of general anesthesia needed b. To prevent the need for post-surgical pain medications c. To prolong the anesthetized state d. To speed up anesthesia induction

ANS: A Balanced anesthesia may include giving a hypnotic the night prior to surgery, premedication with an opioid analgesic or benzodiazepine plus an anticholinergic, and then a short-acting nonbarbiturate such as propofol, an inhaled gas, and a muscle relaxant as needed. One desired effect of this approach is to decrease the amount of general anesthetic needed. It may reduce postoperative nausea and vomiting, but it does not necessarily decrease drowsiness or the need for post-operative pain medications. It does not affect the duration of anesthesia, which is dependent on the length of time the inhaled gas is given, or the rate of induction.

A patient who has had a loss of interest in most activities, has experienced weight loss, and reports frequent insomnia is diagnosed with major depressive disorder and will begin taking fluoxetine daily. The patient asks about the weekly dosing that a family member follows. What will the nurse tell the patient about a weekly dosing regimen? a. It can be used after daily maintenance dosing proves effective and safe. b. It is used after a trial of tricyclic antidepressant medication fails. c. It is not effective for this type of depression and its symptoms. d. It will cause more adverse effects than daily dosing regimens.

ANS: A Before weekly dosing of fluoxetine is begun, the patient should respond to a daily maintenance dose of 20 mg/day without serious effects. It is not necessary to undergo a trial of tricyclic antidepressants (TCAs). Weekly dosing is used for this type of depression, and although it may have some adverse effects, these are not more common than with daily dosing.

A patient has begun taking buspirone 7.5 mg twice daily to treat acute anxiety and calls 1 week later to report little change in symptoms. What will the nurse tell the patient? a. "Therapeutic effects may not be evident until you have taken the medication for several weeks." b. "The provider may need to increase the dose to 15 mg twice daily." c. "Notify the provider and request an order for another anxiolytic." d. "Stop taking the drug and notify the provider that it doesn't work."

ANS: A Buspirone hydrochloride may not be effective until 1 to 2 weeks after continuous use. It is not necessary to increase the dose at this time.

The nurse is caring for a patient who reports being able to fall asleep but has difficulty staying asleep. The provider has written for a barbiturate to help with her sleep. The nurse knows that which of the following agents is an intermediate-acting barbiturate that would be most useful for sustaining sleep? a. Butabarbital b. Pentobarbital c. Secobarbital d. Temazepail

ANS: A Butabarbital is an intermediate-acting barbiturate and may be useful in some situations as a sleep sustainer to maintain long periods of sleep. It has an onset of 1 hour, so it is not useful for those who have trouble falling asleep. Pentobarbital and secobarbital are used for preoperative sedation. Temazepam is a benzodiazepine.

A college-age student is brought to the emergency department by friends after consuming caffeine tablets along with several cups of coffee and a few energy drinks. The patient is complaining of nausea and diarrhea and appears restless. The nurse understands that... a. arrhythmias and convulsions may occur. b. psychological dependence to caffeine does not occur. c. effects of the caffeine will wear off shortly due to its 1-hour half-life. d. severe adverse effects do not occur.

ANS: A Caffeine and other stimulants can cause cardiac arrhythmias and seizures. Psychological dependence to caffeine may occur. The half-life of caffeine is approximately 4 hours.

A patient who is receiving chemotherapy will be given dronabinol to prevent nausea and vomiting. The nurse will tell the patient that this drug will be given at which time? а. Before and after the chemotherapy b. During chemotherapy c. Immediately prior to chemotherapy d. 24 hours prior to chemotherapy

ANS: A Cannabinoids are indicated for use prior to and after chemotherapy. Dronabinol is given 1-3 hours prior to chemotherapy and then every 2-4 hours after.

The nurse is caring for a patient who has Zollinger-Ellison syndrome. Which medication order would the nurse question for this patient? a. Cimetidine b. Pantoprazole c. Rabeprazole d. Ranitidine

ANS: A Cimetidine is not effective for treating Zollinger-Ellison syndrome. The other medications may be used to treat Zollinger-Ellison syndrome.

An intubated child is brought to the emergency department while having a seizure that has been progressing for 20 minutes. Which drug will the nurse anticipate administering to this patient first? a. Diazepam (Valium) b. Phenobarbital (Luminal) c. Phenytoin (Dilantin) d. Valproic acid (Depakote)

ANS: A Diazepam is given to patients in status epilepticus and is administered IV. The drug has a short-term effect; other antiseizure drugs, such as phenytoin or phenobarbital, must be given during or immediately after administration of diazepam. The other anticonvulsant medications do not have a rapid onset and are not used for emergencies.

A nurse is giving a presentation on substance use disorder and is asked for examples of medications that are FDA-approved for maintenance treatment in people with alcohol use disorder (AUD). The nurse knows that all of the following are FDA-approved for the management of AUD, EXCEPT: a. methadone b. disulfiram c. acamprosate d. naltrexone

ANS: A Disulfiram, acamprosate, and naltrexone are all approved by the FDA to treat UAD. Methadone is used in the management of opioid use disorder.

The nurse is teaching a patient who is about to take a long car trip about using dimenhydrinate to prevent motion sickness. What information is important to include when teaching this patient? a. "Do not drive while taking this medication." b. "Dry mouth is a sign of toxicity with this medication." c. "Take the medication 1 to 2 hours prior to beginning the trip." d. "Take 100 mg up to 6 times daily for best effect."

ANS: A Drowsiness is a common side effect of dimenhydrinate, so patients should be cautioned against driving while taking this drug. Dry mouth is a common side effect and not a sign of toxicity. The drug should be taken 30 minutes prior to travel. The maximum recommended dose is 400 mg per day.

A patient who has recently begun taking lithium calls the clinic to report nausea, vomiting, anorexia, and hand tremor. What will the nurse do next? a. Contact the provider to obtain an order for a serum lithium level. b. Reassure the patient that these symptoms are common and transient. c. Tell the patient that the lithium dose is probably too low. d. Tell the patient to stop taking the medication immediately.

ANS: A Early symptoms of lithium toxicity include nausea, vomiting, anorexia, and tremor. The nurse should obtain an order for a lithium level to evaluate this. Patients should be encouraged to report these symptoms if they occur. Patients should never be counseled to stop the medication abruptly.

The nurse is instructing a patient who will take psyllium to treat constipation. What information will the nurse include when teaching this patient? a. The importance of consuming adequate amounts of water b. The need to monitor for systemic side effects c. The onset of action of 30 to 60 minutes after administration d. The need to use the dry form of psyllium to prevent cramping

ANS: A Insufficient fluid intake can cause the drug to solidify in the gastrointestinal tract and place the patient at risk for GI obstruction, thus counseling on ingestion of adequate amounts of water is important. Psyllium is not systemically absorbed, so it does not have systemic side effects. Onset of action for psyllium is between 10 and 24 hours. All forms of bulk forming laxatives can contribute to GI side effects such as cramping.

The nurse is preparing to administer phenytoin to an 80-year-old patient and notes the following order: IVP phenytoin 50 mg. The nurse will perform which action? a. Administer through a PICC over 2 minutes. b. Contact the provider to question the route and the dose. c. Dilute the drug in dextrose solution and infuse over 15 to 20 minutes. d. Request an order to administer the drug intramuscularly.

ANS: A It is recommended that phenytoin be administered by direct injection into a large vein via a central line or PICC. In older patients it should be infused at a rate of 25 mcg/min. The dose and the route are appropriate. Phenytoin will precipitate in dextrose solution. Intramuscular injection is very irritating to tissues and is not used.

The parent of an adolescent who has taken methylphenidate 20 mg/day for 6 months for attention-deficit/hyperactivity disorder (ADHD) brings the child to clinic for evaluation of a recent onset of nausea, vomiting, and headaches. The parent expresses concern that the child seems less focused and more hyperactive than before. What will the nurse do next? a. Ask the child whether the drug is being taken as prescribed. b. Contact the provider to discuss increasing the dose to 30 mg/day. c. Recommend taking the drug with meals to reduce gastrointestinal side effects. d. Report signs of drug toxicity to the patient's provider.

ANS: A Nausea, vomiting, and headaches can occur with drug withdrawal, along with a recurrence of symptoms. The nurse should ask the child about how they are taking the medication. Methylphenidate should be taken 30 to 45 minutes before meals, not with meals.

The parent of a young adult who has schizophrenia is concerned that the patient spits out pills that are given. The nurse will suggest contacting the patient's provider to discuss which intervention? a. Changing to a liquid or injectable form of the mediation b. Providing a home health nurse to supervise medication administration c. Teaching the patient the importance of taking the medication d. Instruct the parent to administer another dose if they suspect the first dose wasn't swallowed

ANS: A Noncompliance is common with antipsychotic medications. If patients spit out or hide pills, a liquid or injectable form can be considered. A home health nurse is costly and unnecessary. Teaching the patient the importance of the medication is essential, but not always effective if the patient does not want to take their medication. It is important not to double up on doses, so administering extra doses when it is suspected a dose was spit out would not be advised.

The nurse is preparing to administer paroxetine to a 70-year-old patient. The nurse understands that this patient may require a. a decreased dose. b. an increased dose. c. every other day dosing. d. more frequent dosing.

ANS: A Older adults usually need a lower dose of antidepressants.

A patient who has major depressive disorder has been taking fluoxetine 20 mg daily for 3 months and reports improved mood, less fatigue, and an increased ability to concentrate. The patient's side effects have diminished with continued use. The only complaint from the patient is regarding the number of medications she takes daily. What will the nurse counsel this patient to discuss with the provider? a. Changing to once-weekly dosing b. Decreasing the dose to 10 mg daily c. Discontinuing the medication d. Increasing the dose to 30 mg daily

ANS: A Once patients have demonstrated control of symptoms with decreased side effects on the maintenance dose of 20 mg daily, patients may be considered for once-weekly dosing. The 20-mg dose is maintenance dosing, so decreasing or increasing the dose is not indicated. Patients should not stop taking the medication abruptly.

The nurse is teaching a patient who will begin taking alprazolam. What information will the nurse include when teaching this patient? a. "Avoid alcohol while taking this drug." b. "You don't have to worry about drug interactions with this medication." c. "Unlike other anxiety medications this medication is not a scheduled substance." d."Consuming grapefruit juice decreases alprazolam levels."

ANS: A Patients who are taking benzodiazepines should avoid alcohol. Alprazolam can interact with many medications and so drug interaction screening should be performed. Alprazolam is a controlled substance (CSS: IV), and consumption of grapefruit juice can increase alprazolam levels.

The nurse is preparing to assist with blood collection on a newly admitted patient who has been taking phenytoin for several years. the provider has ordered a complete blood count and liver function tests. Which other blood test will the nurse discuss with the provider? a. Blood glucose b. Coagulation studies c. Renal function tests d. Serum electrolytes

ANS: A Patients who have taken hydantoins for long periods might have an elevated blood sugar that results from the drug inhibiting the release of insulin. The nurse should discuss this test with the provider.

The nurse is caring for a patient who has a seizure disorder being treated with phenytoin. The nurse notes that the patient has reddened gums that bleed when brushing. The nurse recognizes this finding as... a. an adverse effect of the phenytoin. b. likely due to a drug interaction with aspirin. c. a symptom of hepatotoxicity. d. a sign of poor self-care.

ANS: A Phenytoin commonly causes gingival hyperplasia, which causes overgrowth of reddened gum tissue that bleeds easily. It is not a sign of a drug interaction or a symptom of hepatotoxicity. It does not indicate a lack or self-care.

A parent of a child who has been taking valproic acid (Depakote) for several years calls the clinic to report a recent recurrence of seizures and states that the child is having three or four seizures per week, but is not currently seizing. The nurse will perform which action first? a. Ask the parent to describe the child's drug regimen. b. Request an order for a serum valproic acid level. c. Suggest that the parent take the child to the emergency department. d. Tell the parent that the provider will increase the child's dose of Depakote.

ANS: A Questions pertaining to medication adherence are a no-cost, non-invasive way of troubleshooting cause of decreased drug effect. The serum drug level will be assessed next. Children may need changes in doses as they grow. The child is not in status epilepticus so does not need to go to the emergency department. The dose will not be increased until the serum drug level is known.

A patient has been taking sertraline 20 mg/mL oral concentrate, 2 mL daily for several months and reports being unable to sleep well. The patient's depressive symptoms are well managed on the current dose. What will the nurse do next? a. Ask the patient what time of day the medication is taken. b. Counsel the patient to take the medication at bedtime. c. Recommend asking the provider about weekly dosing. d. Suggest that the patient request a lower dose.

ANS: A Selective serotonin reuptake inhibitors (SSRIs) can cause nervousness and insomnia. Patients can minimize these effects by taking the drug in the morning. The nurse should assess this with this patient. Taking the medication at bedtime will only increase the insomnia. Requesting a lower dose or changing to weekly dosing is not the best initial course of action in this scenario.

The nurse is teaching a parent about methylphenidate to treat attention-deficit/hyperactivity disorder (ADHD). Which statement by the parent indicates understanding of the teaching? a. "I should consult a pharmacist when giving my child OTC medications." b. "I will only give my child diet soft drinks while administering this medication." c. "Medication therapy means that behavioral therapy will not be necessary." d. "Weight gain is a common side effect of this medication."

ANS: A Since many OTC medications contain stimulants, parents should consult a pharmacist or the provider before giving them in combination with methylphenidate. Diet soft drinks often contain caffeine, a stimulant, and should be avoided with methylphenidate use. Behavioral therapy remains an essential part of the treatment for ADHD. Weight loss is common.

The nurse is caring for an older adult patient who is receiving a first dose of flurazepam as a sedative-hypnotic medication. What intervention will be included in the nurse's plan of care for this patient? a. Instituting a bed alarm system to prevent falls b. Reassuring the patient that nightmares are not a usual effect c. Reporting a urine output greater than 1500 mL/day d. Teaching the patient that this drug may be used for 6 to 8 weeks

ANS: A The nurse should use a bed alarm for older patients and younger patients receiving a hypnotic for the first time. Patients may experience vivid dreams and nightmares. Urine output should be greater than 1500 ml/day, so this does not warrant reporting. This drug should be used short-term.

A patient arrives in the emergency department with dehydration. The patient reports taking fluphenazine to treat schizophrenia. The nurse notes rigid muscles and an altered mental status. The patient has a temperature of 103.6 F, a heart rate of 98 beats per minute, and a blood pressure of 90/58 mm Hg. The nurse will anticipate administering which medication' a. Dantrolene b. Haloperidol c. Propranolol d. Tetrabenazine

ANS: A The patient is exhibiting signs of neuroleptic malignant syndrome (NMS). Muscle relaxants, such as dantrolene, are usually given. Haloperidol is used to treat psychosis. Propranolol is used for treating akathisia. Tetrabenazine is sometimes used to treat symptoms of tardive dyskinesia.

The nurse is preparing to administer phenytoin (Dilantin) to a patient who has a seizure disorder. The nurse notes that the last random serum drug level was 18 mcg/mL. What action will the nurse take? a. Administer the dose since the patient's labs do not indicate toxic phenytoin levels. b. Contact the provider to discuss decreasing the phenytoin dose. c. Contact the provider and discuss increasing the phenytoin dose. d. Report drug toxicity to the providers.

ANS: A The patient's drug level is considered within the desired therapeutic range of 10 to 20 mcg/mL. The nurse should administer the dose as written. It is not necessary to decrease the dose or increase the dose based on this serum level.

The nurse is checking an 8-year-old child who has attention-deficit/hyperactivity disorder (ADHD) into a clinic for an annual well-child visit. The child takes methylphenidate HCI. Which assessments are especially important for this child? a. Respiratory rate and oxygen saturation b. Height, weight, and blood pressure c. Measures of fine- and gross-motor development d. Blood glucose

ANS: B Methylphenidate may cause growth suppression, so the child's height and weight should be assessed. Methylphenidate may also increase blood pressure, so the nurse should pay careful attention to changes in blood pressure.

A nurse performs a medication history on a newly admitted patient. The patient reports taking amitriptyline 75 mg at bedtime for 6 weeks to treat depression. The patient reports having continued fatigue, lack of energy, and no improvement in mood. The nurse will contact the provider to discuss which intervention? a. Beginning to down-taper the amitriptyline b. Changing to a morning dose schedule c. Giving the amitriptyline twice daily d. Increasing the dose of amitriptyline

ANS: A The response to tricyclic antidepressants (TCAs) should occur after 2 to 4 weeks of therapy. If there is no improvement at that time, the TCA should be gradually withdrawn and an agent from another class should be prescribed. TCAs should never be stopped abruptly. TCAs cause fatigue and drowsiness, so they should be given at bedtime. Changing the dose or the dosing schedule is not the best approach in this scenario.

Cough and cold products are also used for substance abuse. Which of the following contains the two most commonly misused cough and cold products? a. Dextromethorphan and promethazine-codeine b. Dextromethorphan and phenylephrine c. Promethazine-codeine and phenylephrine d. Dextromethorphan and guaifenesin

ANS: A The two most frequently misused cough and cold products are dextromethorphan and promethazine-codeine cough syrup.

A patient reports having three to four stools, which are sometimes hard, per week. The patient states that this represents less bowel movements than normal for her. The nurse will perform which action? a. Recommend increased intake of fluids and dietary fiber. b. Request an order for a stimulant laxative as needed. c. Request an order for a stool softener. d. Request an order for magnesium citrate.

ANS: A This patient is having stools that are within the normal range for frequency, but she does state that she generally has more frequent bowel movements. Nonpharmacologic measures, such as increased intake of fluids and dietary fiber, should be used first to help soften stools.

A patient describes having vivid dreams to the nurse. The nurse understands that these occur during which stage of sleep? a. Rapid eye movement (REM) sleep b. Stage 2 non rapid eye movement sleep c. Stage 3 non rapid eve movement sleep d. Stage 4 non rapid eye movement sleep

ANS: A Vivid dreams occur during REM sleep.

A patient is taking rabeprazole 20 mg per day to treat a duodenal ulcer. After 10 days of treatment, the patient reports that the pain has subsided. The nurse will counsel the patient to a. continue the medication for up to 4-8 total weeks of treatment. b. reduce the medication dose by half. c. stop taking the medication. d. take the medication every other day.

ANS: A With treatment, ulcer pain may subside earlier, but the healing process may take 1 to 2 months Patients should be counseled to take the drug for the length of time prescribed. Reducing the dose or taking less frequently is not recommended.

A patient who is taking amitriptyline reports constipation and dry mouth. The patient notes that these side effects are a nuisance, but not severe. The nurse will give the patient which instruction? a. Increase fluid intake. b. Notify the provider. c. Request another antidepressant. d. Stop taking the medication immediately.

ANS: A Constipation and dry mouth are common side effects of tricyclic antidepressants (TCAs), and patients should be taught to manage these symptoms. There is no need to notify the provider or to switch medications unless the side effects become too uncomfortable. Patients should not stop taking TCAs abruptly.

A patient has recently begun taking carbamazepine (Tegretol) as an adjunct medication to treat refractory seizures. The patient has a serum carbamazepine level of 18 mcg/mL. Which of the following would be the most appropriate next step? a. Ask the patient about usual dietary preferences. b. Reassure the patient that this is a therapeutic drug level. c. Report a sub-therapeutic drug dose to the provider. d. Discontinue the carbamazepine.

ANS: A This patient's carbamazepine level is high. When taken with grapefruit juice, an interaction may occur that results in toxic levels of carbamazepine. The nurse should question the patient about food and fluid preferences. the therapeutic level is 4 to 12 mcg/mL. This is a toxic level, not sub-therapeutic. It would not be appropriate to discontinue therapy at this time.

A patient who recently began having mild symptoms of gastroesophageal reflux disease (GERD) is reluctant to take medication. What non-pharmacological measures will the nurse recommend to minimize this patient's symptoms? (Select all that apply.) a. Avoiding hot, spicy foods b. Avoiding tobacco products c. Drinking a glass of red wine with dinner d. Eating a snack before bedtime e. Taking ibuprofen with food f. Using a small pillow for sleeping g. Wearing tight-fitted clothing

ANS: A, B, E Hot, spicy foods aggravate gastric upset, tobacco increases gastric secretions, and ibuprofen on an empty stomach increases gastric secretions, so patients should be taught to avoid these actions. Alcohol should be avoided since it increases gastric secretions. Eating at bedtime increases reflux, as does laying relatively flat to sleep, or wearing tight-fitted clothing.

The nurse is teaching a patient about foods to avoid when taking isocarboxazid. Which foods will the nurse instruct the patient to avoid? (Select all that apply.) a. Bananas b. Bread c. Eggs d. Red wine e. Sausage f. Yogurt

ANS: A, D, E, F Aged cheeses and wines are the chief foods that are prohibited. Any food containing tyramine, which has sympathomimetic effects, can cause a hypertensive crisis. This includes bananas, red wine, sausage, and yogurt.

A patient who has a history of migraine headaches is diagnosed with bipolar disorder. The nurse might expect the provider to order which medication for this patient to help treat both conditions? a. Carbamazepine b. Divalproex c. Lamotrigine d. Lithium citrate

ANS: B All of these medications may be used to treat bipolar disorder, but divalprox also carries an indication for migraine prophylaxis.

A patient who has been taking a monoamine oxidase (MAO) inhibitor for several months will begin taking amoxapine instead of the MAO inhibitor. The nurse will counsel the patient to begin taking the amoxapine a. along with the MAO inhibitor for several months. b. at least 14 days after discontinuing the MAO inhibitor. c. the day after the last dose of the MAO inhibitor. d. while withdrawing the MAO inhibitor over several weeks.

ANS: B Amoxapine is an atypical antidepressant that should not be taken with MAO inhibitors and should not be used within 14 days of taking a MAO inhibitor.

Children who experience nightmares have these during which stage of sleep? a. Early morning sleep b. Non rapid eye movement (NREM) sleep c. Rapid eye movement (REM) sleep d. Sleep induction

ANS: B Nightmares that occur in children take place during NREM sleep.

The nurse is caring for a patient who has unexplained, recurrent vomiting and who is unable to keep anything down. Until the cause of the vomiting is determined, the nurse will anticipate administering which medications? a. Antibiotics and antiemetics b. Intravenous fluids and electrolytes c. Nonprescription antiemetics d. Prescription antiemetics

ANS: B Antiemetics can mask the underlying cause of vomiting and should not be used until the cause is determined unless vomiting is so severe that dehydration and electrolvte imbalance occur. Nonpharmacologic measures, such as fluid and electrolyte replacement, should be used. Antibiotics are only used if an infectious cause is determined.

The nurse is working in a neonatal intensive care unit and is caring for an infant who is experiencing multiple periods of apnea and bradycardia. Which of the following drugs could be used to treat neonatal apnea? a. Albuterol b. Caffeine citrate c. Doxapram d. Methylphenidate

ANS: B Caffeine citrate is indicated for use in newborns with respiratory distress. the other drugs listed are not used for this purpose.

A patient who is about to begin taking the atypical antipsychotic medication clozapine is concerned about side effects. What information will the nurse include when teaching the patient about this medication? a. "The most common side effects with this medication include dry mouth, constipation, and urinary retention." b. "Some common side effects that you may experience are dizziness, drowsiness, and constipation." c. "You will not experience extrapyramidal side effects with this medication." d. "You will not need frequent lab work while taking this medication."

ANS: B Dizziness, sedation, tachycardia, orthostatic hypotension, and constipation are common side effects that can be seen with clozapine. Anticholinergic side effects are less likely than with typical (first generation) antipsychotics. Extrapyramidal side effects can occur, even though they are less likely. Clozapine can cause agranulocytosis, so patients who are taking this drug require frequent monitoring.

A patient has been taking risperidone for 2 weeks. The patient reports drowsiness and headache. What will the nurse do? a. Counsel the patient to request changing to aripiprazole. b. Explain to the patient that these are common side effects of the medication. c. Suggest that the patient have serum glucose testing. d. Suggest that these may be signs of agranulocytosis.

ANS: B Drowsiness and headaches are common side effects of atypical (second generation) antipsychotics. It would be appropriate to counsel the patient to discuss the severity of these side effects with their provider. Changing to aripiprazole may not improve the symptoms, since this drug is in the same drug class. These symptoms do not indicate altered serum glucose levels or agranulocytosis.

A patient who has been diagnosed with both major depression disorder and fibromyalgia. Which of the following medications can be used to treat both conditions? a. Selegiline b. Duloxetine c. Esketamine d. Bupropion

ANS: B Duloxetine is an SNRI medication that can be used clinically to treat major depression, diabetic neuropathy, fibromyalgia, generalized anxiety disorder, and chronic musculoskeletal pain.

The nurse is teaching a patient who will be discharged home on a typical (first generation) antipsychotic medication to treat schizophrenia. Which statement by the patient indicates a need for further teaching?" a. I should not drink alcohol while taking this medication." b. "I should use a heating pad to treat muscle spasms while taking this medication. c. "I should use sunscreen while taking this medication." d. "I will need frequent blood tests while taking this medication.

ANS: B Dystonia can cause muscle spasms and should be reported to the provider, who can prescribe medications to treat this adverse effect. Patients should not drink alcohol, should use sunscreen, and will need close monitoring of lab values while taking these medications.

A parent expresses concern that a 5-year-old child may develop epilepsy because the child experienced a febrile seizure at age 18 months. What will the nurse tell this parent? a. "A child who has had a febrile seizure is considered to have epilepsy." b. "A small percentage of children who have febrile seizures develop epilepsy." c. "I recommend discussing prophylactic anticonvulsant drugs with the provider." d. "Treat fevers aggressively with aspirin and NSAIDs to prevent seizures."

ANS: B Epilepsy develops in approximately 2.5% of children who have one or more febrile seizures. One febrile seizure does not always result in epilepsy. Prophylactic anticonvulsants are given to high-risk patients. Children should not receive aspirin for fever because of the risk of Reye's syndrome.

The nurse is caring for a patient who has been diagnosed with absence seizures. The nurse will anticipate teaching this patient about which antiepileptic medication? a. Carbamazepine (Tegretol) b. Ethosuximide (Zarontin) c. Phenobarbital (Luminal) d. Phenytoin (Dilantin)

ANS: B Ethosuximide, which belongs to the succinimide drug group, is used to treat absence seizures. the other drugs are not used to treat absence seizures.

A 25-year-old female patient will begin taking phenytoin for epilepsy. the patient tells the nurse she is taking oral contraceptives (OCPs). Which response will the nurse give? a. "Continue taking OCPs because phenytoin is not safe during pregnancy.' b. "You should use a backup method of contraception along with OCPs." c. "You should stop taking OCPs because of drug-drug interactions with phenytoin." d. "You should take low dose aspirin while taking these medications to reduce your risk of stroke."

ANS: B Female patients who take oral contraceptives and anticonvulsants should be advised to use a backup method of contraception because of reduced effectiveness of OPs. Patients should be cautioned to consult with a provider if considering pregnancy because of the teratogenic effects of anticonvulsants. Patients should not stop taking OCPs and do not need to take precautions against stroke in the absence of other risk factors.

The nurse is teaching a child and a parent about taking methylphenidate to treat attention-deficit/hyperactivity disorder (ADHD). Which statement by the parent indicates understanding of the teaching? a. "I should give this drug to my child at bedtime." b. "My child should avoid products containing caffeine." c. "The drug should be stopped immediately if my child develops aggression." d. "We should monitor my child's weight since weight gain is common."

ANS: B Methylphenidate is a stimulant, so other stimulants such as caffeine should be avoided. The medication should be taken in the morning. Patients should be taught not to stop the drug abruptly to avoid withdrawal symptoms. Weight loss is common.

A patient is diagnosed with epilepsy and asks the nurse what may have caused this condition. The nurse explains that epilepsy is most often a. caused by head trauma b. of unknown origin c. linked to a stroke. d. related to brain anoxia

ANS: B Of all seizure cases, 75% are considered to be primary, or idiopathic, with no known cause. the remaining are secondary and may be related to head trauma, stroke, or anoxia.

The nurse is discussing smoking cessation with a nurse colleague who smokes. Which statement indicates a readiness to quit smoking? a. "I don't smoke around my children or inside the house." b. "I want to stop smoking, but I will need help to do it." c. "I will quit so my coworkers will stop harassing me about it." d. "If I cut down gradually, I should be able to quit."

ANS: B Patients exhibit readiness when they state a desire to quit along with a request for professiona assistance. Other factors discussed, such as children or coworkers, do not necessarily indicate a desire to quit.

A patient asks the nurse the best way to prevent traveler's diarrhea. The nurse will provide which recommendation to the patient? a. "Ask your provider for prophylactic antibiotics." b. "Drink bottled water and eat only well-cooked meats." c. "Eat fresh, raw fruits and vegetables." d."Take loperamide (Imodium) every day."

ANS: B Patients traveling to areas with potential traveler's diarrhea should be counseled to drink bottled water and eat meats that are well cooked. Prophylactic antibiotics are not recommended. Patients should eat cooked, washed fruits and vegetables. Loperamide is not recommended for use as a prophylactic agent.

The preoperative nurse is caring for a patient who is to receive a peripheral nerve block using bupivacaine. The nurse will explain that the patient receiving this local anesthetic... a. may need to lie flat 6 to 8 hours after surgery. b. may require less narcotic medication. c. may have a prolonged hospital stay to monitor for respiratory distress. d. may be at great risk for allergic reaction.

ANS: B Patients who have had a peripheral nerve block with bupivacaine are likely to require less narcotic medication. They are allowed increased mobility as compared to the client with general anesthesia. The local anesthetic carries little risk of respiratory distress and the amide structure lends to less risk of allergic reaction.

A patient who is taking chlorpromazine calls the clinic to report having reddish-brown urine. What action will the nurse take? a. Notify the provider and request orders for creatinine clearance and BUN levels. b. Reassure the patient that this is a harmless side effect of this medication c. Tell the patient to come to the clinic for a urinalysis. d. Tell the patient to discard any drug on hand and request a new prescription.

ANS: B Phenothiazines, such as chlorpromazine, can cause a harmless pink or red-brown urine discoloration. There is no need to evaluate renal function with creatinine clearance, BUN, or urinalysis. The discoloration does not indicate that the medication has expired.

A female patient who takes phenytoin for epilepsy becomes pregnant. The nurse will notify the patient's provider and will anticipate that the provider will take which action? a. Add valproic acid (Depakote) for improved seizure control. b. Discontinue the phenytoin and discuss alternative options to manage her epilepsy. c. Closely monitor this patient's serum phenytoin levels d. Discontinue all anticonvulsant medications.

ANS: B Phenytoin has serious teratogenic effects, so women who are pregnant should not take it. Valproic acid is known to cause major congenital malformations in infants in 4% to 8% of women who take the drug; it should be avoided also. Teratogenicity increases with multiple anticonvulsants.

A patient has recently begun taking phenytoin (Dilantin) for a seizure disorder. The nurse notes a reddish-brown color to the patient's urine. Which action will the nurse take? a. Ask the provider to order a serum drug level. b. Reassure the patient that this is a harmless side effect. c. Report possible thrombocytopenia to the provider. d. Request an order for a urinalysis and creatinine clearance.

ANS: B Reddish-brown urine is a harmless side effect of phenytoin. The nurse should reassure the patient. It is not necessary to order a serum drug level or renal function studies. It is not a symptom of thrombocytopenia

A patient has been taking paroxetine 20 mg per day for 2 weeks and reports a decrease in libido. Which action will the nurse take? a. Counsel the patient to take the medication with food. b. Reassure the patient that this side effect can often decrease over time. c. Suggest that the patient discuss a lower dose with the provider. d. Tell the patient to stop taking the drug and contact the provider.

ANS: B Sexual side effects can occur with paroxetine and other SSRIs, but often improves or ceases after 1 to 4 weeks of use. Taking the medication with food will not improve this side effect. Lowering the dose is not indicated. Patients should not abruptly stop taking SSRIs. If the patient continues to have sexual side effects after continued use, they should discuss this with their provider to determine if an alternative treatment is appropriate.

A patient who has been instructed to use a liquid antacid medication to treat gastrointestinal upset asks the nurse about how to take this medication. What information will the nurse include when teaching this patient? a. All antacids can be taken safely with renal insufficiency. b. Take 60 minutes after meals and at bedtime. c. Take with at least 8 ounces of water to improve absorption. d. Take with milk to improve effectiveness.

ANS: B Since maximum acid secretion occurs after eating and at bedtime, antacids should be taken 1 to 3 hours after eating and at bedtime. Taking antacids with meals slows gastric emptying time and causes increased gastrointestinal (GI) secretions. Aluminum salt antacids can accumulate in renal insufficiency and lead to toxicity. Patients should use 2 to 4 ounces of water when taking to ensure that the drug enters the stomach; more than that will increase gastric emptying time. If possible, antacids should not be taken with milk or foods

The nurse is providing teaching for a patient who will begin taking zolpidem tartrate (Ambien) 10 mg at bedtime as a sleep aid. Which statement by the patient indicates understanding of the teaching? a. "I should take this medication with food to avoid stomach upset." b. "I will take this medication at bedtime." c. "If this medication is not effective, I may increase the dose to 15 mg." d. "Tolerance and physical dependence do not occur with this medication."

ANS: B Zolpidem is a non-benzodiazepine sleep aid. It should be taken 30 minutes before desired sleep. rood decreases the absorption, so it should be taken on an empty stomach. The maximum recommended dose is 10 mg. Tolerance and physical dependence may occur.

The nurse is preparing to administer loxapine 50 mg to a patient who has schizophrenia. The patient has been taking this medication twice daily for 15 months. The nurse notes smacking lip movements and involuntary movements of all extremities. Which initial action by the nurse would be most appropriate? a. Administer the medication as ordered to treat these symptoms of psychosis. b. Hold the dose and notify the provider of these symptoms. c. Request an order for an anticholinergic medication such as benztropine. d. Suggest that the provider increase the dose to 125 mg twice daily.

ANS: B Tardive dyskinesia manifests as protrusion and rolling of the tongue, smacking of the lips, and involuntary movement of the body and extremities and is a serious adverse effect of antipsychotic medications. The provider should be notified, so the drug can be stopped and a different medication ordered. These are not symptoms of psychosis. Anticholinergic medications are used to combat acute dystonia. Increasing the dose of this medication would potentially exacerbate these adverse effects.

The parent of an 18-month-old toddler calls the clinic to report that the child has vomited 5 times that day. The nurse determines that the child has had three wet diapers in the past 6 hours. What will the nurse recommend for this child? a. Administering an OTC antiemetic medication such as diphenhydramine b. Giving frequent, small amounts of Pedialyte c. Keeping the child NPO until vomiting subsides d. Taking the child to the emergency department for IV fluids

ANS: B The child is not dehydrated as evidenced by adequate wet diapers, so nonpharmacologic measures, such as oral fluids, are recommended. OTC antiemetics are not recommended unless dehydration occurs. Intravenous fluids are given when dehydration is present.

The nurse is preparing to administer a dose of lithium to a patient who has been taking the drug as maintenance therapy to treat bipolar disorder. The nurse assesses the patient and notes tremors and confusion. The patient's latest serum lithium level was 2 mEg/L. Which action will the nurse take? a. Administer the dose. b. Hold the dose and notify the provider. c. Request an order for a higher dose. d. Request an order for a lower dose.

ANS: B The patient has symptoms of lithium toxicity, and the serum drug level is in the toxic range. The nurse should hold the dose and notify the provider.

A patient who takes thioridazine to treat schizophrenia is noted to be restless and fidgety and is pacing around the room. The nurse caring for this patient will perform which action? a. Contact the provider to discuss changing to benztropine. b. Notify the provider of these symptoms and request an order for lorazepam. c. Question the patient about adherence to the drug regimen. d. Recognize that patients with schizophrenia normally present in this fashion.

ANS: B The patient is exhibiting signs of akathisia and should be treated with an antianxiety drug. Benztropine is an anticholinergic used to combat acute dystonia. These are not signs of psychosis, so it is not necessary to question whether or not the patient is taking the medication.

A patient asks the nurse about taking over-the-counter sleeping aids. the nurse will tell the patient that the active ingredient in these products is often a(n) a. antiemetic b. antihistamine c. barbiturate. d. benzodiazepine.

ANS: B The primary ingredient in OTC sleep aids is typically an antihistamine such as diphenhydramine, not barbiturates or benzodiazepines. Melatonin can also be purchased as an over-the-counter product.

A patient with a peptic ulcer has been diagnosed with H. pylori. The provider has ordered lansoprazole, clarithromycin, and metronidazole. The patient asks the nurse why two antibiotics are needed. The nurse will explain that two antibiotics a. allow for less toxic dosing. b. combat bacterial resistance. c. have synergistic effects. d. improve acid suppression.

ANS: B The use of two antibiotics when treating H. pylori peptic ulcer disease helps to combat bacterial resistance because H. pylori develops resistance rapidly. Giving two antibiotics, in this case, is not to reduce the dose or to cause synergistic effects. Antibiotics do not affect acid production.

A patient reports difficulty falling asleep most nights and is constantly fatigued. The patient does not want to take medications to help with sleep. What non-pharmacologic measure will the nurse recommend? a. "Exercise in the evening to promote bedtime fatigue." b. "Get out of bed at the same time each morning." c. "Have a glass of wine at bedtime to help you relax." d. "Take daytime naps to minimize daytime fatigue."

ANS: B To promote sleep, patients should be advised to arise at a specific time each morning to establish a routine. Patients should avoid strenuous exercise before bedtime. Patients should not consume alcohol 6 hours before bedtime. Patients should avoid taking daytime naps.

A male patient has been taking venlafaxine 37.5 mg daily for 2 weeks and reports an increase in blood pressure. The nurse understands that this is due to which of the following? a. Increased serotonin levels b. Increased norepinephrine levels c. Increased dopamine levels d. Increased acetylcholine levels

ANS: B Venlafaxine is a serotonin norepinephrine reuptake inhibitor (SNRI). By reducing norepinephrine reuptake, norepinephrine levels are increased which can result in an increase in blood pressure.

A patient who has been diagnosed with social anxiety disorder will begin taking venlafaxine. The nurse knows that venlafaxine is classified as which of the following? a. Selective serotonin reuptake inhibitor (SSRI) b. Serotonin norepinephrine reuptake inhibitor (SNRI) c. Tricyclic antidepressant (TCA) d. Benzodiazepine

ANS: B Venlafaxine is classified as an SNRI. Other examples of SNRIs include duloxetine, levomilnacipran, and desvenlafaxine.

Which antacid is most likely to cause acid rebound? a. Aluminum hvdroxide b. Calcium carbonate c. Magnesium hydroxide d. Magnesium trisilicate

ANS: B While calcium carbonate is most effective among the listed antacids in neutralizing acid, a significant amount can be systemically absorbed and can cause acid rebound. The other antacids do not have significant svstemic absorption.

A patient who has been taking zolpidem (Ambien) for several weeks reports being drowsy and having difficulty performing tasks at work most mornings. The nurse suspects that which drug effects have occurred? a. Substance use disorder b. Hangover c. Tolerance d. Withdrawal

ANS: B While less common than with barbiturates or benzodiazepines, nonbenzodiazepine hypnotics like zolpidem can also contribute to hangover (residual sedation) effects. Excess sedation would not be an indication of substance use disorder with zolpidem. Tolerance refers to a reduced drug effect requiring larger amounts of drug to get thedesired effect. Withdrawal occurs when stopping thedrug causes symptoms that can only be alleviated by taking thedrug.

A patient is brought to the emergency department with decreased respirations and somnolence. The nurse notes a heart rate of 60 beats per minute and a blood pressure of 80/58 mm Hg. The patient is known to take alprazolam to treat anxiety. Which medication will the nurse anticipate the provider to order? a. Benztronine b. Flumazenil c.Lorazepam d. Propranolol

ANS: B Flumazenil is a benzodiazepine receptor antagonist used to treat overdose of benzodiazepines. This patient is unconscious and has bradycardia and hypotension, so the antagonist medication is indicated. Benztropine is an anticholinergic used to treat acute dystonia in patients taking phenothiazines. Lorazepam is a benzodiazepine and would only intensify the symptoms Propranolol is a beta blocker used to treat akathisia in patients taking phenothiazines.

The nurse is caring for a 7-year-old child who has difficulty concentrating and completing tasks and who cannot seem to sit still. Which diagnostic test may be ordered to assist with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) in this child? a. Computerized tomography (CT) of the head b. Electrocardiogram (ECG) c. Electroencephalogram (BEG) d. Magnetic resonance imaging (MRI) of the brain

ANS: C A child with ADHD may have abnormal EEG findings. CT, MRI, and ECG tests are not diagnostic for ADHD.

The nurse is teaching a group in the community about substance use disorder. Which statement by the nurse is correct? a. "cravings always disappear after long periods of abstinence by the person addicted to drugs." b. "abuse and dependence are synonymous terms, describing reliances on illicit substances." c. "substance use disorder occurs when recurrent use causes clinically and functionally significant impairment." d. "excessive caffeine use is a classic example of substance use disorder."

ANS: C ANS: C Substance use disorder occurs when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairments. Cravings may diminish after long abstinence but do not disappear completely. The terms "abuse" and "dependence" are no longer recommended for use due to the violence and stigma associated with the term "abuse" and the ambiguity of the term "dependence." Excessive caffeine use is not considered a substance use disorder.

The parent of an obese 10-year-old child asks the nurse about medications to aid in weight loss. Which response by the nurse is correct? a. "Anorexiants are often used to 'jump start' a weight loss regimen in children." b. "Children are able to use over-the-counter anorexiants on a long-term basis." c. "Children under 12 years of age should not use weight loss drugs." d. "Side effects of anorexiants occur less often in children."

ANS: C Anorexiants should not be given to children under age 12 years

A patient who experiences motion sickness when flying asks the nurse the best time to take over-the-counter antiemetic medications to prevent motion sickness for a 0900 flight. The nurse will instruct the patient to take the medication at which time? a. As needed, at the first sign of nausea b. At 0700, before leaving for the airport c. At 0830, just prior to boarding the plane d. When seated, just prior to takeoff

ANS: C Antiemetics have a general onset of action of 30 minutes. The patient should be instructed to take the medication a half hour prior to takeoff. These products are ideally used prior to the onset of motion sickness, not used as needed.

A patient who is taking fluphenazine to treat psychosis is experiencing symptoms of acute dystonia. While performing a medication history, the nurse learns that the patient takes herbal medications. Which herbal supplement would be of concern? a. Ginkgo b. Ginseng c. Kava kava d. St John's wort

ANS: C Kava kava may increase the risk and severity of dvstonia when taken with flushenazine.

A patient who takes a monoamine oxidase (MAO) inhibitor asks the nurse about taking over-the-counter medications to treat cold symptoms. Which medication will the nurse counsel the patient to avoid while taking a MAO inhibitor? a. Diphenhydramine b. Guaifenesin c. Pseudoephedrine d. Saline nasal spray

ANS: C MAO inhibitors can cause hypertensive crises, which can be fatal when taken with sympathomimetic drugs such as pseudoephedrine.

A patient reports difficulty staying awake during the daytime despite getting adequate sleep every night and is diagnosed with narcolepsy. Which medication will the nurse expect the provider to order for this patient? a. Caffeine b. Albuterol c. Modafinil d. Theophylline

ANS: C Modafinil is given to treat narcolepsy.

A patient is brought to the emergency department after ingesting an overdose of an opioid medication several hours prior. The patient has a respiratory rate of 6 to 10 breaths per minute and is unconscious. The nurse will prepare to perform which action? a. Administer disulfiram. b.Administer flumazenil (Romazicon). c. Administer naloxone (Narcan). d. Administer IM thiamine.

ANS: C Naloxone is the drug of choice in the treatment of respiratory depression associated with opioid overdose. Flumazenil is the antidote for benzodiazepine overdose. Disulfiram is used for the treatment of alcohol use disorder (AUD). Administration of thiamine is recommended in patients with AUD to prevent neurological damage associated with thiamine deficiency.

The nurse is teaching a patient who will be discharged home with naltrexone after treatment for opioid use disorder. What information will the nurse include in the teaching for this patient? a. "This drug will eliminate your cravings." b. "You may take this drug once weekly." c. "Naltrexone blocks the pleasurable effects of opioids." d. "If you discontinue this drug abruptly, you will likely experience withdrawal symptoms."

ANS: C Naltrexone acts by blocking the pleasurable effects of opioids. Naltrexone is used in patients who are abstinent. It can precipitate withdrawal when given to patients currently using opioids, but abrupt discontinuation in a patient not currently taking opioids will not result in withdrawal symptoms. This drug does not control cravings, and it is taken once daily orally or as a monthly injection.

A patient who is unconscious arrives in the emergency department with clammy skin and constricted pupils. The nurse assesses a respiratory rate of 8 to 10 breaths per minute. The paramedics report obvious signs of substance use in the patient's home. The nurse suspects that this patient is likely experiencing an overdose of which substance? a. Alcohol b. LSD c. An opioid d. Methamphetamine

ANS: C Opioid overdose is characterized by constricted pupils and respiratory depression.

A patient who is diagnosed with peptic ulcer disease has been started on a regimen that includes famotidine 40 mg daily at bedtime. The patient calls the clinic 2 days later to report no relief from discomfort. What action will the nurse take? a. Contact the provider to discuss changing to cimetidine. b. Notify the provider to discuss increasing the dose. c. Reassure the patient that it may take 1 to 2 weeks to notice an improvement in symptoms. d. Suggest that the patient split the medication into twice daily dosing.

ANS: C Patients taking histamine blockers can expect abdominal pain to decrease after 1 to 2 weeks of drug therapy. Cimetidine is not as potent as ranitidine and interacts with many medications through the cytochrome P450 system. 40 mg at bedtime is the recommended dose.

The nurse is caring for a patient in the post-anesthesia care unit who has received a spinal anesthetic. Which action will the nurse perform? a. Ambulate the patient as soon as consciousness returns. b. Elevate the head of the bed to a semi-Fowler's position. c. Have the patient lay flat for 6 to 8 hours after the surgery. d. Turn the patient from side to side every 15 minutes.

ANS: C Patients who have had spinal anesthesia should remain flat for 6 to 8 hours to decrease the likelihood of losing spinal fluid, causing a headache.

A patient reports experiencing flatulence and abdominal distension to the nurse. Which over-the-counter medication will the nurse recommend? a. Famotidine b. Magnesium hydroxide c. Simethicone d. Calcium carbonate

ANS: C Simethicone is an antigas agent. The other products do not help with gas relief.

Which of the following is NOT generally considered a side effect of nicotine replacement? a. Tachycardia b. Dizziness c. Somnolence d. Dyspepsia

ANS: C Tachycardia, dizziness, and dyspepsia are side effects that can occur with nicotine replacement therapies. Nicotine replacement therapy is also associated with insomnia. Somnolence is not considered a common side effect of nicotine replacement products

A patient arrives in the emergency department complaining of difficulty breathing, dizziness, sweating, and heart palpitations. The patient reports having had similar episodes previously due to stress at work. The nurse will expect the provider to order which medication? a. Flumazenil b. Haloperidol c. Lorazepam d. Propranolol

ANS: C The patient is exhibiting signs of acute anxiety, so the anxiolytic lorazepam would be the appropriate agent of those listed to be administered. Flumazenil is a benzodiazepine receptor antagonist, given for overdose of benzodiazepines. Haloperidol is given for acute psychosis. Propranolol is a beta blocker, used to treat akathisia in patients taking phenothiazines.

A family member of a patient who has been taking fluphenazine for 3 months calls to report that the patient is exhibiting agitation and restlessness. The nurse learns that the patient's delusional thinking and hallucinations have stopped since taking the medication. The nurse will perform which action? a. Reassure the family member that tolerance to these side effects will subside over time. b. Remind the family member that complete drug effects may not occur for several more weeks c. Suggest that the family member contact the provider to discuss an order for a medication to help with the agitation and restlessness. d. Tell the family member to withhold the medication and notify the patient's provider.

ANS: C The patient is exhibiting signs of akathisia and should be considered for treatment with a benzodiazepine. Patients usually do not experience tolerance to these drug side effects. The patient is experiencing resolution of symptoms. Discontinuing antipsychotics abruptly may lead to worsening of schizophrenia symptoms.

A woman who is 2 months pregnant reports having morning sickness every day and asks if she can take any medications to treat this problem. The nurse will recommend that the patient try which intervention first? a. Discuss a possible need for intravenous fluids with her provider. b. Contacting the provider to discuss prescribing a prescription antiemetic. c. Use nonpharmacologic measures, such as eating crackers or dry toast. d. Take over-the-counter antiemetics such as diphenhydramine

ANS: C To minimize risk to the fetus, the nurse should first recommend nonpharmacologic measures such as drinking flat soda or weak tea or eating crackers or dry toast. If this is not effective, intravenous fluids may become necessary depending on the severity of vomiting and dehydration. Pregnant women should consult with their provider before taking prescription or over-the-counter antiemetics.

The nurse is caring for a patient in the post-anesthesia care unit and notes that the patient received isoflurane to induce anesthesia. When will the nurse expect the patient to recover consciousness? a. Immediately b. In 15 to 30 minutes c. In 1 hour d. In several hours

ANS: C Upon discontinuation of isoflurane, recovery of consciousness usually occurs in approximately 1 hour.

The nurse is performing a health history on a patient who is ordered to begin therapy with valproic acid (Depakote) to treat epilepsy. Which aspect of the patient's medical history will cause the nurse to be concerned? a. Chronic obstructive pulmonary disease b. Gastrointestinal disease c. Liver disease d. Renal disease

ANS: C Valproic acid can elevate liver enzymes and contribute to hepatotoxicity. Patients with a history of liver disease should use valproic acid with caution and receive appropriate liver monitoring.

The nurse assesses a patient who is taking lithium and notes a large output of clear, dilute urine. The nurse suspects which cause for this finding? a. Cardiovascular complications b. Expected lithium side effects c. Increased mania d. Lithium toxicity

ANS: D An increased output of dilute urine is a sign of lithium toxicity.

During balanced anesthesia, which type of medication is given while the surgery is performed? a. Anticholinergics b. benzodiazepines c. Hypnotics d. Inhaled anesthetic

ANS: D An inhaled anesthetic is given to induce anesthesia and is maintained throughout the surgical procedure. The other medications are given prior to anesthesia induction

A woman who is pregnant is taking an anticonvulsant medication to treat a seizure disorder. The nurse will ensure that the patient takes which dietary supplement toward the end of her pregnancy? a. Vitamin D b. Iron c. Vitamin C d. Vitamin K

ANS: D Anticonvulsants act as inhibitors of vitamin K and can contribute to hemorrhage in infants shortly after birth. Women taking these drugs should receive vitamin K within the last week to 10 days of their pregnancies.

The nurse is caring for a patient who is taking chlorpromazine HCI 75 mg BID to treat schizophrenia. A family member tells the nurse that the patient's agitation, hallucinations, and delusions have improved with use of the drug, but the patient continues to withdraw from social interaction and won't bathe unless reminded to do so. The nurse will tell the family member that... a. all symptoms will eventually resolve over time with this medication. b. the patient may need an increased dose of their current antipsychotic medication. c. these results may indicate that the patient does not have schizophrenia. d. they should consider discussing changing the chlorpromazine to an atypical antipsychotic.

ANS: D Chlorpromazine is a typical (first generation) antipsychotic medication; drugs in this class manage positive symptoms rather than the negative symptoms of withdrawal and poor self-care. It is not likely that the negative symptoms will improve over time with this medication. Atypical (second generation) antipsychotics can help with both positive and negative symptoms, so it would be worthwhile discussing a change in medication to see if the patient's negative symptoms could be improved. Increasing the dose will not improve control of negative symptoms. This patient exhibits signs of schizophrenia.

The nurse is caring for an older adult who is receiving diphenoxylate with atropine to treat severe diarrhea. The nurse will monitor this patient closely for which effect? a. Bradycardia b. Fluid retention c. Urinary incontinence d. Respiratory depression

ANS: D Diphenoxylate is an opioid agonist and can cause respiratory depression. Children and older adults are more susceptible to this effect. It contains atropine, so it will increase heart rate and potentially contribute to urinary retention. It does not contribute to fluid retention.

The nurse is providing teaching to the parents of a 5-year-old child who will begin taking phenytoin (Dilantin). What information will the nurse include when teaching these parents about their child's medication? a. "Drug interactions are uncommon with phenytoin." b. "There are very few side effects associated with this drug." c. "The therapeutic range of phenytoin is between 15 and 45 mcg/mL." d. "Your child may need a higher dose than is usually used in adults."

ANS: D Drug dosage for phenytoin is age related, and children, who have a rapid metabolism, may need higher doses than those used for newborns and adults. Phenytoin has many drug interactions and many side effects. the therapeutic range is 10 to 20 mcg/mL.

A patient will begin taking the antiepileptic drug ethosuximide (Zarontin). Ethosuximide works by which of the following mechanisms? a. Suppressing sodium influx b. Increasing GABA activity c. Decreasing GABA activity d. Suppressing calcium influx

ANS: D Ethosuximide works by suppressing calcium influx. Other seizure medications work by suppressing sodium influx and increasing GABA activity. Decreasing GABA activity would increase seizure activity

A patient has been taking famotidine 20 mg BID to treat an ulcer but continues to have pain. The provider has ordered pantoprazole 40 mg per day. The patient asks why the new drug is necessary, since it is more expensive. The nurse will explain that pantoprazole a. can be used for long-term therapy. b. does not interact with other drugs. c. has fewer medication side effects. d. is more potent than famotidine.

ANS: D Famotidine is a histamine (H) blocker. When patients fail therapy with these agents, proton pump inhibitors, which can inhibit gastric acid secretion up to 90% greater than the H2 blockers, are used. Pantoprazole is not for long-term treatment and has drug interactions and drug side effects, as do all other medications.

The nurse is preparing to administer intramuscular haloperidol to a patient who has schizophrenia. What action will the nurse perform? a. Massage the site after injecting the medication to ensure complete absorption. b. Teach the patient to return every week to receive medication doses c. Use a small-bore needle when injecting the medication. d. Use the Z-track method and inject the medication into deep muscle tissue.

ANS: D Haloperidol is a viscous liquid and should be injected deep into muscle tissue using a Z-track method. The injection site should not be massaged. Injections of long-term preparations of haloperidol are given every 2 to 4 weeks. Nurses should use a large-bore needle when injecting haloperidol.

The nurse is caring for a patient under treatment for alcohol intoxication. The nurse notes that the patient's serum alcohol level is 400 mg/dL. The patient is awake and conversational even though this is a potentially lethal dose. The nurse recognizes this as alcohol a. withdrawal syndrome b. dependence. c. craving. d. tolerance.

ANS: D Intoxication is a state of being influenced by a drug or other substance and may be a very small amount in the drug-naive person or a potentially lethal amount in the chronic user. This person has developed tolerance to alcohol and is able to have a potentially lethal amount without severe effects. Withdrawal syndrome describes a group of symptoms that occur upon cessation or reduction of use of a drug that has been used repeatedly. Dependence describes physical need for the drug such that when the drug is stopped, withdrawal symptoms occur. Craving refers to a strong desire for a drug or for the intoxicating effects of that drug.

The nurse is performing a medication history on a patient who reports taking lorazepam for the past 6 months to treat an anxiety disorder. The patient states that the medication is not working as well as it previously did. The nurse will a. contact the provider to discuss changing to another benzodiazepine. b. tell the patient to double their dose. c. suspect worsening of the anxiety disorder. d. understand that the patient has likely developed tolerance to this drug.

ANS: D Long-term use of benzodiazepines is discouraged because tolerance can develop within weeks or months. Changing to another benzodiazepine will likely not change this, and it would be inappropriate to recommend that the patient double their dose without further evaluation. This does not indicate worsening of the underlying disorder.

A patient who has been diagnosed with depression asks why the provider has not ordered a monoamine oxidase (MAO) inhibitor to treat the disorder. The nurse will explain to the patient that MAO inhibitors a. are more expensive than other antidepressants. b. are no longer approved for treating depression c. can cause profound hypotension. d. require strict dietary restrictions.

ANS: D MAO inhibitors have many food and drug interactions that can be fatal, and patients must adhere to strict dietary restrictions while taking these drugs. They are not more expensive than the newer antidepressants. They remain approved for treating depression. MAO inhibitors can cause profound hypertension in the presence of excess tyramine consumption.

An elderly patient reports using magnesium hydroxide frequently to treat acid reflux. The nurse should notify the patient's provider to request an order for which laboratory tests? a. Liver enzymes and serum calcium b. Liver enzymes and serum magnesium c. Renal function tests and serum calcium d. Renal function tests and serum magnesium

ANS: D Magnesium hydroxide carries a risk of hypermagnesemia, especially with decreased renal function. Older patients have an increased risk of poor renal function, so this patient should especially be evaluated for hypermagnesemia.

The nurse provides teaching for a patient who will begin taking lithium. Which statement by the patient indicates understanding of the teaching? a. "I may drink tea or cola but not coffee." b. "I may stop taking the drug when mania symptoms subside." c. "I should consume a sodium-restricted diet." d. "I should drink 1 to 2 liters of fluid each day."

ANS: D Patients taking lithium should be encouraged to maintain adequate fluid intake of 1 to 2 L/day as maintenance. Patients should not drink any caffeine-containing drinks, including tea and cola. Patients must continue taking lithium even when symptoms subside, or else symptoms will recur. It is not necessary to consume a sodium-restricted diet.

A patient asks the nurse about using loperamide to treat infectious diarrhea. Which response will the nurse give? a. "Loperamide results in many central nervous system (CNS) side effects." b. "Loperamide has no effect on infectious diarrhea." c. "Loperamide is taken once daily." d. "Loperamide can be used to treat diarrheal symptoms but may also slow the exit of the infectious organisms from the GI tract."

ANS: D Patients with infectious diarrhea should be cautioned about using loperamide since slowing transit through the intestines may prolong the exposure to the infectious agent. Loperamide causes less CNS depression than other antidiarrheals. It is taken multiple times per day as needed.

The nurse is performing a medication history on a patient who plans to begin using phentermine HCL. The nurse knows which of the following to be true about use of phentermine? a. It is used short-term for the treatment of obesity. b. Use of phentermine can result in tachycardia. c. Phentermine is a controlled substance. d. All or the above.

ANS: D Phentermine is indicated for short-term use to treat obesity. Phentermine is a controlled substance (schedule IV), and patients can experience tachycardia with use.

The nurse provides teaching for a patient who will begin taking phenytoin. Which statement by the patient indicates understanding of the teaching? a. "If I develop a rash, I should take diphenhydramine to control the itching." b. "If I experience bleeding gums, I should stop taking the medication immediately." c. "Most people develop diabetes while taking this medication d. "I should not be alarmed if my urine turns reddish-brown."

ANS: D Phenytoin can cause reddish-brown colored urine. Patients should be counseled to report a rash to the provider because it could be a serious adverse reaction. Bleeding gums are common, but patients should never stop taking anticonvulsants abruptly, or they may develop seizures. Changes in blood glucose may occur but do not necessarily result in diabetes.

The nurse is caring for a patient who has postoperative nausea and vomiting. The surgeon has ordered promethazine. Which aspect of this patient's health history would be of concern? a. Asthma b. Diabetes c. GERD d. Glaucoma

ANS: D Promethazine is contraindicated in patients with glaucoma since it is an anticholinergic medication. It should be used with caution in patients with asthma. The other two conditions are not concerning with this medication.

The nurse is caring for a patient who will begin taking omeprazole 20 mg per day for 4 to 8 weeks to treat gastrosophageal reflux disease esophagitis. The nurse learns that the patient takes digoxin. The nurse will contact the provider for orders to a. decrease the dose of omeprazole. b. increase the dose of digoxin. c. a increase the omeprazole to 60 mg per day. d. monitor for digoxin toxicity.

ANS: D Proton pump inhibitors can enhance the effects of digoxin, so patients should be monitored for digoxin toxicity. Changing the dose of either medication is not indicated prior to obtaining lab results that indicated elevated digoxin levels.

Which of the following agents is classified as a melatonin receptor agonist? a. Temazepam b. Zolpidem c. Butabarbital d. Ramelteon

ANS: D Ramelteon is a sedative-hypnotic agent and is classified as a melatonin agonist. This is the first prescription hypnotic agent approved by the FDA that is not classified as a controlled substance.

An older adult has difficulty falling asleep. The nurse understands that which sedative hypnotic is most appropriate for this patient? a. Butabarbital b. Furazepam c. Secobarbital d. Temazepam

ANS: D Short- to intermediate-acting benzodiazepines such as temazepam are recommended for older adults and are considered safer than barbiturates and long-acting benzodiazepines.

The nurse performs a preoperative assessment on a patient and asks about drug and alcohol use. The patient asks why this information is important. The nurse will explain that patients who consume increased amounts of alcohol... a. may have a prolonged postoperative recovery time. b. may not be eligible for surgery. c. may not receive inhaled gases for anesthesia. d. may require changes in the type and dose of anesthesia required.

ANS: D The type and amount of anesthetics may need to be adjusted if patients consume large amounts of alcohol, uses illicit drugs, as well as for those who smoke or who are pregnant. These questions are asked prior to surgery so providers can plan for this.

A patient with a long history of alcohol use disorder is admitted to the hospital for detoxification. In addition to medications needed to treat withdrawal symptoms, the nurse will anticipate the possible need to give which of the following intramuscularly? a. Dopamine to restore blood pressure b. Fluid boluses to treat dehydration c. Glucose to prevent hypoglycemia d. Thiamine to treat nutritional deficiency

ANS: D Thiamine is often given to people with alcohol use disorder to prevent neurologic damage (Wernicke encephalopathy). Other treatments are given as indicated based on patient presentation and needs.

A patient who has been taking nizatidine continues to have pain associated with a peptic ulcer. A noninvasive breath test is negative. Which treatment does the nurse expect the provider to order for this patient? a. Adding an over-the-counter antacid to the patient's drug regimen b. A dual drug therapy regimen c. Amoxicillin, clarithromycin, and omeprazole d. Lansoprazole instead of nizatidine

ANS: D This patient does not have H. pylori ulcer disease, so dual and triple drug therapy with antibiotics is not indicated. Patients who fail treatment with a histamine blocker should be changed to a proton pump inhibitor (PPI) such as lansoprazole. PPIs tend to inhibit gastric acid secretion up to 90% greater than the histamine antagonists.

A patient who has been taking a benzodiazepine as a sleep aid for several months wishes to stop taking the medication. The nurse will suggest that the patient taper the dose gradually to avoid which effect? a. Depression b. Hangover c. Hypnotic rebound d. Withdrawal

ANS: D Tolerance to benzodiazepines can occur, which means that abrupt cessation can result in withdrawal symptoms such as tremors and muscle twitching. A hangover is residual drowsiness that occurs the day after taking a hypnotic.

The nurse is teaching a patient who will begin taking doxepin to treat depression. Which statement by the patient indicates a need for further teaching? a. "I should expect improvement in my depressive symptoms within 2 to 4 weeks." b. "I should increase fluids and fiber while taking this medication to avoid constipation." c. "I should take care when rising from a sitting to standing position." d. "I will take the medication in the morning before breakfast."

ANS: D Tricyclic antidepressants (TCAs) should begin to show effects within 2 to 4 weeks. Tricyclic antidepressants are known to cause orthostatic hypotension and constipation, so patients should be counseled on how to prevent and manage these side effects. TCAs should be taken at bedtime because of their tendency to cause drowsiness

A patient who has symptoms of peptic ulcer disease will undergo a test that requires drinking a liquid containing 13C urea and breathing into a container. The nurse will explain to the patient that this test is performed to a. assess the level of hydrochloric acid. b. detect H. pylori antibodies. c. measure the pH of gastric secretions. d. test for the presence of H. pylori.

ANS: D When H. pylori is suspected, a noninvasive test is performed by administering 13C urea, which, in the presence of H. pylori, will release 13CO. The test does not measure the amount of HCI acid or the pH and does not detect H. pylori antibodies.