Pharmacology Exam
Which statement(s) about the neuro transmitter acetylcholine is true?
"Acetylcholine activates three cholinergic receptor subtypes."
A nurse is teaching a nursing student what is meant by "generations" of cephalosporins. Which statement by the student indicates understanding of the teaching?
"Cephalosporins have increased activity against gram-negative bacteria with each generation."
A 7-year-old child with asthma uses a daily inhaled glucocorticoid and an albuterol MDI as needed. The provider has added montelukast [Singulair] to the child's regimen. Which statement by the child's parent indicates understanding of this medication?
"I may notice mood changes in my child."
You are providing discharge teaching to a patient taking Sucralfate (Carafate). Which statement by the patient demonstrates they understand how to take this medication? (Select all that apply)
"I will continue to take this medication as a preventative therapy" "I will always take this medication on an empty stomach."
The nurse is teaching a patient how to self-administer triptan injections for migraine headaches. Which statement by the patient indicates that he needs further teaching?
"I will take this medication regularly to prevent a migraine headache from occurring."
A client with thyroid cancer has just received Iodine-131 ablative therapy. Which statement by the client indicates a need for further teaching?
"I'm ready to hold my newborn grandson now."
The nurse is teaching a client about thyroid replacement therapy. Which statement by the client indicates a need for further teaching?
"If I continue to lose weight, I may need an increased dose."
A client on anticoagulant therapy is being discharged. Which statement by the client indicates an understanding of the anticoagulants drug action?
"It should prevent my blood from clotting."
A nurse teaches a patient with diabetes mellitus about sick-day management. Which statement would the nurse include in this patient's teaching?
"Monitor your blood glucose levels at least every 4 hours while sick."
The nurse is providing education to a patient who has been prescribed both an antacid and a cimetidine [Tagamet]. Which instruction should the nurse give the patient about taking the medications?
"Take the antacid 1 hour after the ranitidine."
A nurse is teaching a client who experiences migraine headaches and is prescribed a beta-blocker. Which statement would the nurse include in this client's teaching?
"Take this drug as prescribed, even when feeling well, to prevent vascular changes associated with migraine headaches.".
The nurse determines the client needs further instruction on cimetidine (Tagamet) if which statements were made? Select all that apply.
"Taking the cimetidine with an antacid will increase its effectiveness." "I will take the cimetidine with my meals." "I'll know the medication is working if my diarrhea stops."
A pregnant patient asks the nurse whether she should continue to take her prescription for tetracycline [Sumycin] to clear up her acne. Which response by the nurse is correct?
"Tetracycline can be harmful to the baby's teeth and should be avoided."
A child with otitis media has had three ear infections in the past year. The child has just completed a 10-day course of amoxicillin [Amoxil] with no improvement. The parent asks the nurse why this drug is not working, because it has worked in the past. What will the nurse tell the patient?
"The bacteria have synthesized penicillinase."
A nurse instructs a parent about the administration schedule for Adderall XR (amphetamine/dextroamphetamine mixture) to treat the child's ADHD. The nurse determines that teaching is successful if the parent makes which statement?
"The drug should be given in the morning, before school."
A patient with a new prescription for a HMG-CoA (statin) drug is instructed to take the medication with the evening meal or at bedtime. The patient asks why it must be taken at this time of day. What is the nurses' best response?
"This timeframe correlates better with the natural diurnal rhythm of cholesterol production."
A patient who has gastroesophageal reflux disease (GERD) receives a prescription for a proton pump inhibitor (PPI) medication. What will the nurse include when teaching the patient about this drug?
"You should report any fever and cough to your provider."
A client is taking methimazole (Tapazole) for hyperthyroidism and would like to know how soon this medication will begin working. What is the nurse's best response?
"You will see some effects of this medication within 2 weeks."
A patient with gout who has increasingly frequent acute gouty attacks will begin receiving allopurinol [Zyloprim] and colchicine. The nurse will include which statement when teaching the patient about this drug regimen?
"You will take both drugs initially and then stop taking the colchicine."
A client with type 1 diabetes mellitus received regular insulin at 7:00 a.m. The client will need to be monitored for hypoglycemia at which time?
11:00am
A nurse cares for a patient who has diabetes mellitus. The nurse administers 6 units of regular insulin and 10 units of NPH insulin at 07:00. At which time would the nurse assess the patient for potential problems related to the NPH insulin?
16:00
A patient is receiving tobramycin 3 times daily. The provider has ordered a trough level with the 8:00 AM dose. The nurse will ensure that the level is drawn at what time?
7:45AM
Which client is most likely to receive opioids for extended periods of time?
A client with progressive pancreatic cancer
A patient with cancer is admitted to the hospital. The nurse obtains an admission history and learns that the patient has been taking oxycodone and a nonsteroidal anti-inflammatory drug (NSAID) for a year. The patient reports a recent increase in the intensity of pain, along with a new pain described as "burning" and "shooting." The nurse anticipates that the prescriber will order:
A fentanyl transdermal patch, acetaminophen, and an adjunctive analgesic for nerve pain.
A patient is receiving instructions regarding the use of caffeine for migraine headaches. The nurse shares that caffeine should be used with caution if which of these conditions is present?
A history of peptic ulcers
A patient with stable COPD is prescribed a bronchodilator medication. Which type of bronchodilator is preferred for this patient?
A long-acting inhaled beta2 agonist
A diabetic patient has the following presentation: unresponsive to voice or touch, tachycardia, diaphoresis, and pallor. Which of the following actions by the healthcare provider is the priority?
Administer 50% dextrose IV per hypoglycemia protocol
A patient is brought to the emergency department by friends, who report finding the patient difficult to awaken. The friends report removing three fentanyl transdermal patches from the patient's arm. On admission to the emergency department, the patient is slow to respond, has pinpoint pupils and a respiratory rate of 6 breaths per minute. What is the priority nursing intervention?
Administer Naloxone (Narcan) per standing order.
Which drug does the nurse associate with the development of potentially life-threatening skin adverse effects of exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis?
Allopurinol (Zyloprim)
In monitoring a client's response to disease-modifying antirheumatic drugs (DMARDs), which assessment findings would the nurse consider acceptable responses? Select all that apply.
An increased range of motion in the affected joints 3 months into therapy Normal white blood cell, platelet, and neutrophil counts Control of symptoms during periods of emotional stress Radiological findings that show no progression of joint degeneration
A nurse obtains a health history on a client prior to administering prescribed sumatriptan succinate (Imitrex), a serotonin agonist or triptan, for migraine headaches. Which condition would alert the nurse to hold the medication and contact the healthcare provider?
Angina
A client with peptic ulcer disease asks the nurse what medications they might be prescribed for this problem. The nurse tells the client that which medications will be prescribed? Select all that apply.
Antibiotics Histamine H2-receptor blockers Proton Pump Inhibitors Antacids
When metronidazole [Flagyl] is a component of the H.pylori treatment regimen, the patient must be instructed to do what?
Avoid any alcoholic beverages
Place the examples of drugs in the order of usage according to the World Health Organization (WHO) analgesic ladder. a. Morphine, hydromorphone, acetaminophen and lorazepam b. NSAIDs and corticosteroids c. Codeine, oxycodone and diphenhydramine
B, C, A
The nurse recognizes that adrenergic drugs cause relaxation of the bronchi and bronchodilation by stimulating which type of receptors?
Beta2 adrenergic
The nurse identifies which of the following as the most common type of laxative abused by the general public?
Bisacodyl [Dulcolax]
The nurse has administered a dose of docusate. The nurse evaluates that the medication has been effective if the client experiences which finding?
Bowel movement with soft, formed stool
A drug that is used for nerve pain (neuropathy) that is also a drug used as an anti-epileptic agent is / are: (Select all that apply)
Carbamazepine (Tegretol) Gabapentin (Neurontin)
Which statement below is true regarding a catecholamine?
Catecholamines cannot cross the blood brain barrier Catecholamines must be given by parenteral route
A nurse administers medications to a patient who has asthma. Which medication classification is paired correctly with its physiologic response to the medication?
Cholinergic antagonist—causes bronchodilation by inhibiting the parasympathetic nervous system
A client with gout has begun to take allopurinol. The nurse informs the client that which medication may also be necessary during the beginning phase of medication therapy with allopurinol? Select all that apply.
Colchicine Naproxen Indomethacin
A client with a clot in the right atrium is receiving a heparin sodium infusion at 1000 units/hour and warfarin sodium 7.5 mg at 5:00 p.m. daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT), 32 seconds; international normalized ratio (INR), 1.3. The nurse should take which action based on the client's laboratory results?
Collaborate with the HCP to obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed.
A patient who has pancreatitis reports a pain level of 8 on a 1 to 10 pain scale with 10 being the most severe pain. The patient has an order for acetaminophen (Tylenol) as needed for pain, and has been taking it as ordered around the clock. Which action by the nurse is correct?
Contact the prescriber and request the addition of an opioid
A patient with no known drug allergies is receiving amoxicillin [Amoxil] PO twice daily. Twenty minutes after being given a dose, the patient complains of shortness of breath. The patient's blood pressure is 100/58 mm Hg. What will the nurse do?
Contact the provider and prepare to administer epinephrine.
A nurse cares for a patient with diabetes mellitus who is prescribed metformin (Glucophage) and is scheduled for a contrast-enhanced CT. What action should the nurse take first?
Contact the provider and recommend discontinuing the metformin.
A patient admitted to the hospital has a history of peptic ulcer disease. The patient takes ranitidine [Zantac] and sucralfate [Carafate]. The patient tells the nurse that discomfort is usually controlled but that symptoms occasionally flare up. What will the nurse do?
Counsel the patient on non-drug intervention such as avoiding beverages containing alcohol
A patient who has been newly diagnosed with asthma is referred to an asthma clinic. The patient reports daily symptoms requiring short-acting beta2-agonist treatments for relief. The patient has used oral glucocorticoids three times in the past 3 months and reports awakening at night with symptoms about once a week. The nurse will expect this patient to be started on which regimen?
Daily low-dose inhaled glucocorticoid/LABA with a SABA as needed
A patient is prescribed amoxicillin and tetracycline to treat peptic ulcer disease. The nurse will instruct the patient that these medications will do what?
Destroy the bacteria in the stomach that are causing ulceration.
An unresponsive patient who has diabetes is brought to the emergency department with slow, deep respirations. Additional findings include: blood glucose 450 mg/dL (24.9 mmol/L), arterial pH 7.2 (acidosis), and urinalysis showing presence of ketones and glucose. Which of the following best describes the underlying cause of this patient's presentation?
Diabetic Ketoacidosis (DKA)
A client is being tapered off opioids and the nurse is watchful for signs of withdrawal. What is one of the first signs of withdrawal?
Diaphoresis
Which of the following is NOT a common adverse effect of opioid analgesics?
Diarrhea
Which side effect of clindamycin [Cleocin] causes the most concern and may warrant discontinuation of the drug?
Diarrhea
A patient is prescribed bisacodyl. Which of the following should the nurse include in patient teaching?
Do not take the bisacodyl with an antacid
A client receives a dose of scopolamine for nausea from motion sickness. The nurse determines that which sign or symptom later displayed by the client is a result of medication side and adverse effects?
Dry mouth
Which statement about enteracept (Enbrel), a Biologic non-TNF) Inhibitors, does the nurse identify as true?
Enteracept can cause liver injury.
A hospitalized older client with rheumatoid arthritis needs to increase activity, but is unsteady and complains of dizziness with activity. The nurse establishes the nursing diagnosis of Activity Intolerance. Which action by the nurse is most important to implement next?
Evaluate the client's medications.
A client with diarrhea for 3 days and inability to eat or drink well is brought to the emergency department (ED) by her family. She states she has been taking her diuretics for congestive heart failure (CHF). What nursing actions are indicated at this time? (Select all that apply.)
Evaluate the electrolyte levels. Initiate cardiac monitoring Assess for orthostatic hypotension.
In caring for a young child with pain, which assessment tool is the most useful?
Faces pain-rating scale
You are working near a war zone and are taking care of a soldier who has been given an irreversible cholinesterase inhibitor during warfare. What action would be the BEST thing to do first in this situation?
Give the atropine dose that has been ordered
The nurse notes in a patient's medication history that the patient is taking allopurinol (Zyloprim). Based on this finding, the nurse interprets that the patient has which disorder?
Gout
Which statement is INCORRECT about Histamine-receptor blockers?
H2 blockers decrease gastric pH
The healthcare provider is assessing the glucose level of a patient with a diagnosis of diabetes. Which of these is most helpful in evaluating this patient's long-term glucose management?
Hemoglobin A1c (Hgb A1C)
The nurse is caring for a patient with atrial fibrillation (AF). In addition to an antidysrhythmic, what medication does the nurse plan to administer?
Heparin
The prescriber's order says to administered the Loop diuretic Lasix 40 mg IV twice a day. The patient has bilateral lower extremity edema and complains of leg pain. The patient has the following morning labs: Na+ 148, K+ 2.9, and BUN 10. Which of the following is a nursing priority?
Hold the Lasix dose and notify the prescriber of the potassium level
When considering replacement therapy options for a patient who has Adrenocortical insufficiency, the nurse should recognize that the provider will choose which of the following drugs?
Hydrocortisone
A patient with rheumatoid arthritis is experiencing sudden vision changes. Which medication found in the patient's medication list can cause retinal damage?
Hydroxychloroquine (Plaquenil)
vWhich of the following is NOT a serious adverse effect of long-term oral glucocorticoid therapy?
Hypoglycemia
Dopamine is administered to a patient who has been experiencing hypotensive episodes. Other than an increase in blood pressure, which indicator would the nurse use to evaluate a successful response to the dopamine?
Increase in urine output
A patient is taking ibuprofen 800 mg (NSAID)three times a day by mouth as treatment for OA. While taking a health history, the nurse finds out that the patient has a few beers on weekends. What concern would there be with the interaction of the alcohol and ibuprofen?
Increased chance for GI bleeding
A patient is taking ibuprofen 800 mg three times a day by mouth as treatment for OA. While taking a health history, the nurse finds out that the patient has a few beers on weekends. What concern would there be with the interaction of the alcohol and ibuprofen?
Increased chance for GI bleeding
A nurse assesses a patient with diabetes mellitus who self-administers subcutaneous insulin. The nurse notes a spongy, swelling area at the site the patient uses most frequently for insulin injection. What action would the nurse take?
Instruct the patient to rotate sites for insulin injection.
Which route of administration is preferred if immediate analgesia and rapid titration are necessary?
Intravenous (IV)
A patient with persistent, frequent asthma exacerbations asks a nurse about a long-acting beta2-agonist medication. What will the nurse tell this patient?
LABAs should be combined with an inhaled glucocorticoid.
The nurse identifies which of the following laxatives as having the added response of ridding the body of ammonia?
Lactulose
The nurse is preparing to administer prescribed medications to a client with hepatic encephalopathy. The nurse anticipates that the health care provider's prescriptions will include which medication?
Lactulose (an osmotic laxative)
Which of the following insulins have no peak but a duration of 24 hours?
Lantus (insulin glargine)
Which drugs are used to treat COPD? (Select all that apply.)
Long-acting beta2 agonists Glucocorticoids Anticholinergic medications
An older adult patient with severe gastroesophageal reflux disease (GERD) has had only minimal relief using a histamine2-receptor antagonist (H2RA). The patient is to begin taking omeprazole [Prilosec]. What will the nurse teach this patient?
Long-term therapy may be needed.
A patient has an infection caused by Pseudomonas aeruginosa.The prescriber has ordered piperacillin and amikacin, both to be given intravenously. What will the nurse do?
Make sure to administer the drugs at different times using different IV tubing.
A client reports frequent use of sodium bicarbonate to relieve heartburn after meals. The nurse should monitor the client for which condition that the client is at risk for with long-term frequent use of this medication?
Metabolic alkalosis
A patient has a prescription to take a powdered form of psyllium after discharge. The nurse should plan to include which information when teaching the client about this medication?
Mix the medication with a full glass of water or juice.
The nurse is caring for a client who is receiving a loop diuretic for treatment of heart failure. Which of these actions will be included in the plan of care? (Select all that apply.)
Monitor serum potassium Assess daily weights. Encourage consumption of citrus fruits and greens.
A patient with acute gouty arthritis requests information on the preferred drug to take to treat a painful flare-up. The nurse should recommend which medication?
Naproxen
A client with gastrointestinal hypermotility has a prescription to receive atropine sulfate. The nurse should withhold the medication and question the prescription if the client has a history of which disease process?
Narrow-angle glaucoma
A client has received a dose of dimenhydrinate (Dramamine), The nurse should observe relief of what sign or symptom to evaluate that the medication has been effective?
Nausea and vomiting
A patient has been prescribed pharmacologic doses of glucocorticoids. It is most important for the nurse to teach the patient to do what?
Never abruptly withdraw therapy.
The nurse is caring for a patient on a medical-surgical unit who has a fever of unknown origin. The prescriber has ordered a broad-spectrum antibiotic. Which intervention is the priority?
Obtaining all cultures before the antibiotic is administered (not the results of the cultures)
A client with rheumatoid arthritis is receiving Hydroxychloroquine (Plaquenil) in the recent months. The nurse tells the client to visit which of the following while on the treatment?
Ophthalmologist
A physician prescribes a Proton-Pump Inhibitor to a patient with a gastric ulcer. Which medication is considered a PPI?
Pantoprazole
A young adult woman will begin using an inhaled glucocorticoid to treat asthma. The nurse will teach this patient about the importance of which action?
Participating in weight-bearing exercises on a regular basis
A patient with gout has not experienced relief with conventional drug therapy. The nurse anticipates which agent will be prescribed for the patient?
Pegloticase
A nurse is caring for a patient who takes an ACE inhibitor and an ARB medication who will begin taking TMP/SMZ to treat a urinary tract infection. Which serum electrolyte will the nurse expect to monitor closely?
Potassium
A nurse administers quinidine sulfate to a patient with atrial fibrillation. The nurse should assess the electrocardiogram (ECG) tracing knowing that quinidine sulfate has what effect on the ECG?
Prolongation of the QT interval
A 17 year-old high school athlete with a history of asthma comes to your clinic seeking a preventative medication for migraine headaches. Which of the following would be contraindicated?
Propranolol (Inderal)
Intravenous heparin therapy is prescribed for a client. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit?
Protamine sulfate
A patient who takes nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis asks a nurse what can be done to prevent ulcers. The nurse will recommend asking the provider about using which medication?
Proton pump inhibitors
A nurse assesses a patient after administering a prescribed beta-blocker. Which assessment would the nurse expect to find?
Pulse decreased from 100 to 80 beats/min
A patient is admitted for diabetic ketoacidosis (DKA), and an IV drip titrated to maintain blood glucose levels between 120 and 200 is ordered (intravenous infusion). The only insulin that would be administered IV is:
Regular insulin
A patient who has been taking a long-acting morphine to treat severe pain for a few months complains of constipation. The nurse anticipates which of the following will be prescribed for the patient?
Senna [Senokot]
A client receiving propranolol (Inderal) as a preventative for migraine headaches is experiencing side effects after taking the drug. Which side effect is of greatest concern to the nurse?
Slow heart rate
A patient is prescribed allopurinol for chronic tophaceous gout. The patient develops a rash. What is the priority intervention by the nurse?
Stop the medication and assess the patient for liver and kidney failure.
A client with type 2 diabetes controlled with Metformin is recovering from surgery. The primary health care provider has placed the client on insulin in addition to the metformin. What is the nurse's best response about why the client needs to take insulin?
Stress, such as surgery, increases blood glucose levels. You'll need insulin to control your blood glucose temporarily."
A patient diagnosed with type 2 diabetes mellitus is admitted to the medical unit with pneumonia. The patient's oral antidiabetic medication has been discontinued and the patient is now receiving insulin for glucose control. Which of the following statements best explains the rationale for this change in medication?
Stress-related states such as infections increase risk of hyperglycemia
A client has just been prescribed with Methotrexate (Trexall) for the treatment of rheumatoid arthritis who did not respond to any other treatment. An important reminder for the client is to?
Strict hand washing.
Which medication is used to promote gastric ulcer healing by providing a protective barrier?
Sucralfate
Jane is a 67 year-old woman with a history of mild hypertension and classic angina pectoris. She is seeking treatment for migraine headaches of moderate intensity. Her headaches are preceeded by bilateral light flashes and dizziness that last about 10 minutes prior to the onset of pain. Her headaches are also frequently accompanied by photophobia, severe nausea and occasional vomiting. What medication would be contraindicated for acute treatment of Jane's headaches?
Sumatriptan
A 23 year old woman with a history of depression comes to your clinic seeking relief for a severe migraine headache that began 20 minutes ago. She is currently taking the SSRI (selective serotonin repute inhibitor) Citalopram for her depression and an estrogen/progesterone combined oral contraceptive. What medication would you avoid using for her acute treatment?
Sumatriptan (Imitrex)
A patient who has been taking gentamicin for 5 days reports a headache and dizziness. What will the nurse do?
Suspect ototoxicity and notify the prescriber
A nurse is caring for an intubated patient who is receiving pancuronium (Pavulon) for neuromuscular blockade. The patient's eyes are closed, and the patient is not moving any extremities. The patient's heart rate is 76 beats per minute, and the blood pressure is 110/70 mm Hg. The nurse caring for this patient will do what?
Talk to the patient while giving care and explain all procedures.
A patient with asthma is prescribed triamcinolone acetonide [Azmacort]. What should the nurse do?
Teach the patient to use a spacer to prevent a fungal infection.
A patient will begin taking hydroxychloroquine [Plaquenil] for rheumatoid arthritis. The patient is currently taking high-dose NSAIDs and methotrexate. What will the nurse teach the patient?
That an eye exam is necessary at the beginning of therapy with this drug
A nurse instructs a parent about the administration schedule for Adderall XR (amphetamine/dextroamphetamine mixture) to treat the child's ADHD. The nurse determines that teaching is successful if the parent makes which statement?
The drug should be given in the morning before school.
A patient is receiving intravenous gentamicin. A serum drug test reveals toxic levels. The dosing is correct, and this medication has been tolerated by this patient in the past. Which could be a probable cause of the test result?
The patient is taking another medication that binds to serum albumin.
During therapy with a beta blocker, the patient notices that she has swollen feet, has gained 3 pounds within 2 days, feels short of breath even when walking around the house, and has been dizzy. The nurse suspects that which of these is occurring?
The patient may be developing heart failure
A patient recently began receiving clindamycin [Cleocin] to treat an infection. After 8 days of treatment, the patient reports having 10 to 15 watery stools per day. What will the nurse tell this patient?
The patient should stop taking the clindamycin now and contact the provider immediately.
A client is taking large doses of acetylsalicylic acid (ASA) for rheumatoid arthritis. Which assessment findings indicate that the client is experiencing ototoxicity as a result of the medication?
Tinnitus, hearing loss, dizziness, and ataxia
A patient has had three gouty flare-ups in the past year. Which drug class will the nurse expect the provider to order for this patient?
Urate-lowering drugs
The nurse is caring for a client with a diagnosis of gout. Which laboratory value would the nurse expect to note in the client?
Uric acid level of 9.0 mg/dL
Loop diuretics have all of the following potential adverse effects except:
Urinary Retention
Which information should the nurse include when teaching a patient about inhaled glucocorticoids?
Use of a spacer can minimize side effects.
A client has a new prescription for metoclopramide (Reglan). On review of the chart, the nurse identifies that this medication can be safely administered with which condition?
Vomiting following cancer chemotherapy
A patient with asthma is prescribed albuterol [Proventil], 2 puffs 3 times a day. The nurse should teach the patient to do what?
Wait 1 minute between puffs from the inhaler
A patient is prescribed cimetidine [Tagamet] and aluminum hydroxide [Maalox] for the treatment of peptic ulcer disease. What should the nurse teach the patient to do?
Wait at least 1 hour between administration of the two medications.
A patient tells the nurse that the oral drug that has been prescribed has caused a lot of stomach discomfort in the past. What will the nurse ask the prescriber?
Whether an enteric-coated form of the drug is available
A patient is prescribed lovastatin [Mevacor]. The nurse will teach the patient to take the medication at which time?
With the evening meal
A child with an ear infection is not responding to treatment with amoxicillin [Amoxil]. The nurse will expect the provider to order:
amoxicillin-clavulanic acid [Augmentin].
A patient newly diagnosed with PUD reports taking low-dose aspirin (ASA) for prevention of cardiovascular disease. The nurse learns that the patient drinks 2 to 3 cups of coffee each day and has a glass of wine with dinner 3 or 4 nights per week. The patient eats three meals a day. The nurse will counsel this patient to:
change the meal pattern to five or six smaller meals per day
A patient with post-operative pain who has been receiving an opioid analgesic reports having pain at a new location even though the previous pain is well controlled. The nurse will contact the provider to discuss:
complication such as infection or deep vein thrombus.
A patient with gout has been treated with allopurinol (Zyloprim) for 2 months. The nurse will monitor laboratory results for which therapeutic effect?
decreased uric acid levels
A patient is beginning therapy with oral methotrexate [Rheumatrex] for rheumatoid arthritis. The nurse will teach this patient about the importance of:
having routine renal and hepatic function tests.
An older adult patient with chronic obstructive pulmonary disease (COPD) develops bronchitis. The patient has a temperature of 39.5°C. The nurse will expect the provider to:
order empiric antibiotics while waiting for sputum culture results
The nurse is caring for a patient who is receiving vancomycin [Vancocin]. The nurse notes that the patient is experiencing flushing, rash, pruritus, and urticaria. The patient's heart rate is 120 beats/min, and the blood pressure is 92/57 mm Hg. The nurse understands that these findings are consistent with:
red man syndrome
The nurse has been caring for a patient who has been taking antibiotics for 3 weeks. Upon assessing the patient, the nurse notices the individual has developed oral thrush. What describes the etiology of the thrush?
superinfection
Your patient is taking levodopa (Dopar), and you have been conducting an analysis of the patient's diet. You find that she eats three times the recommended amount of protein at each meal. Your best response to this is to tell her:
that too much dietary protein could make the levodopa less effective.
A patient with asthma will be using a metered-dose inhaler (MDI) for delivery of an inhaled medication. The provider has ordered 2 puffs to be given twice daily. It is important for the nurse to teach this patient that:
the patient should wait 1 minute between puffs.
Benign prostatic hypertrophy (BPH) symptoms may be treated with an adrenergic antagonist such as tamsulosin (Flomax) because:
these agents block alpha1 receptors to reduce contraction of smooth muscle in the bladder neck and prostatic capsule.
A client with hypertension is started on verapamil (Calan), a calcium channel blocker. What teaching does the nurse provide for this client?
"Avoid grapefruit juice."
A patient who takes oral theophylline [Theochron] twice daily for chronic stable asthma develops an infection and will take ciprofloxacin. The nurse will contact the provider to discuss:
reducing the theophylline dose
The clinic nurse is providing instructions to a client with hypertension who will be taking captopril. Which statement by the client indicates a need for further instruction?
"I need to drink at least 4 quarts (4 liters) of water daily."
A patient with chronic congestive heart failure has repeated hospitalizations in spite of ongoing treatment with hydrochlorothiazide [HydroDIURIL] (diuretic). The prescriber has ordered spironolactone [Aldactone] (diuretic) to be added to this patient's drug regimen, and the nurse provides education about this medication. Which statement by the patient is correct?
"I need to stop taking potassium supplements."
A nursing professor is teaching a class about a medication that alters the parasympathetic nervous system functions. To evaluate understanding, the nurse asks the students to describe which functions the parasympathetic nervous system regulates. Which of the following statements represent functions that are primarily regulated by the parasympathetic nervous system:
"The digestive functions of the body"
A patient with stable COPD receives prescriptions for an inhaled glucocorticoid and an inhaled short acting beta2-adrenergic agonist. Which statement by the patient indicates understanding of this medication regimen?
"The glucocorticoid is used as prophylaxis to prevent exacerbations."
The nurse is overseeing a nursing student who is administering medications to a group of clients receiving treatment for pulmonary embolism. The nurse recognizes the student understands safety and administration of anticoagulant therapy when the student makes which of these statements?
"Therapy with warfarin (Coumadin) is effective when the INR is between 2 and 3."
A nursing student asks the nurse why the provider has ordered a combination product containing an opioid analgesic and an NSAID for a patient who has cancer. Which response by the nurse is correct?
"There is increased pain relief with the combination than when either product is used alone."
A patient has just received a prescription for fluticasone/salmeterol [Advair Diskus]. What will the nurse include as part of the teaching for this patient about the use of this device?
"You do not need good hand-lung coordination to use this device."
The nurse instructs a patient on how to correctly use an inhaler with a spacer. In which order would these steps occur?1. "Press down firmly on the canister to release one dose of medication."2. "Breathe in slowly and deeply."3. "Shake the whole unit vigorously three or four times."4. "Insert the mouthpiece of the inhaler into the nonmouthpiece end of the spacer."5. "Place the mouthpiece into your mouth, over the tongue, and seal your lips tightly around the mouthpiece."6. "Remove the mouthpiece from your mouth, keep your lips closed, and hold your breath for at least 10 seconds."
4, 3, 5, 1, 2, 6
An older adult patient who has cancer and Alzheimer's disease is crying but shakes his or her head "no" when asked about pain. The prescriber has ordered morphine sulfate 2 to 4 mg IV every 2 hours PRN pain. It has been 4 hours since a dose has been given. What will the nurse do?
Administer 4 mg of morphine and monitor this patient's verbal and nonverbal responses.
A patient is brought to the emergency department by friends, who report finding the patient difficult to awaken. The friends report removing three fentanyl transdermal patches from the patient's arm. On admission to the emergency department, the patient is slow to respond, has pinpoint pupils and a respiratory rate of 6 breaths per minute. The nurse recognizes the priority intervention as:
Administer Naloxone (Narcan) per standing order.
When titrating an analgesic to manage pain, what is the priority goal?
Administer smallest dose that provides relief with the fewest side effects.
A client with diabetic neuropathy reports a burning, electrical-type in the lower extremities that is not responding to NSAIDs. You anticipate that the physician will order which adjuvant medication for this type of pain?
Amitriptyline (Elavil)
A patient has a long history of hypertension. Which category of medications would the nurse expect to be ordered to avoid chronic kidney disease (CKD)?
Angiotensin-converting enzyme (ACE) inhibitor
What is the best way to schedule medication for a client with constant pain?
Around-the-clock
A patient who uses an inhaled glucocorticoid for chronic asthma calls the nurse to report hoarseness. What will the nurse do next?
Ask whether the patient is rinsing the mouth after each dose.
The nurse is caring for a client who is receiving a loop diuretic for treatment of heart failure. Which of these actions will be included in the plan of care? (Select all that apply.)
Assess daily weights. Encourage consumption of citrus fruits and greens. Monitor serum potassium.
A first day postoperative client on a PCA pump reports that the pain control is inadequate. What is the first action you should take?
Assess the pain for location, quality, and intensity.
A patient with a history of heart failure and hypertension is in the clinic for a follow-up visit. The patient is on lisinopril (Prinivil) and warfarin (Coumadin). The patient reports new-onset cough. What action by the nurse is most appropriate initial intervention?
Assess the patient's lung sounds and oxygenation.
A patient who has developed opioid tolerance will experience which effect?
decreased analgesic effect
A patient asks the nurse what can be given to alleviate severe, chronic cancer pain of several months' duration. The patient has been taking oxycodone [OxyContin] and states that it is no longer effective. The nurse will suggest discussing which medication with the provider?
Fentanyl [Duragesic] transdermal patch
A patient is receiving Interferon Beta for treatment of multiple sclerosis. As the nurse you will stress the importance of?
Hand hygiene to avoid infection
The prescriber's order says to administered the diuretic Lasix 40 mg IV twice a day. The patient has bilateral lower extremity edema and complains of leg pain. The patient has the following morning labs: Na+ 148, K+ 2.9, and BUN 10. Which of the following is a nursing priority?
Hold the Lasix dose and notify the prescriber of the potassium level
A patient with asthma is admitted to an emergency department with a respiratory rate of 22 breaths per minute, a prolonged expiratory phase, tight wheezes, and an oxygen saturation of 90% on room air. The patient reports using fluticasone [Flovent HFA] 110 mcg twice daily and has used 2 puffs of albuterol [Proventil HFA], 90 mcg/puff, every 4 hours for 2 days. The nurse will expect to administer which drug?
Intravenous glucocorticoids, nebulized albuterol and ipratropium, and oxygen
A nurse is administering morphine sulfate to a postoperative patient. Which is NOT an appropriate routine nursing actions when giving this drug?
Monitoring the patient's blood pressure closely for hypertension
A child is receiving a combination albuterol/ipratropium [DuoNeb] inhalation treatment. The patient complains of a dry mouth and sore throat. What will the nurse do?
Reassure the patient that these are expected side effects.
What are the results of using glucocorticoid drugs to treat asthma? (Select all that apply.)
Reduced bronchial hyperreactivity Reduced edema of the airway Increased responsiveness to beta2-adrenergic agonists
Prior to administering a client's daily dose of digoxin, the nurse reviews the client's laboratory data and notes the following results: serum calcium 9.8 mg/dL serum magnesium 1.0 mEq/L serum potassium 4.1 mEq/L serum creatinine 0.9 mg/dL Which result should alert the nurse that the client is at risk for digoxin toxicity?
Serum magnesium level
Which medication should be used for asthma patients as part of step 1 management?
Short-acting beta2 agonists
A factory worker has been admitted to the emergency department after an industrial accident involving organophosphate insecticides. The nurse knows insecticides belong to which class of potentially toxic drugs?
acetylcholinesterase inhibitors
When monitoring a patient who is taking a low-dose cholinergic drug, the nurse will watch for which cardiovascular effect?
bradycardia
An adrenergic agonist is ordered for a patient in cardiogenic shock. The nurse will note that this drug has had its primary intended effect if which expected outcome occurs?
increased cardiac output
When a patient is taking an adrenergic drug, the nurse expects to observe which effect?
increased heart rate
The mechanism of action for carbidopa (Lodosyn), used in the treatment of Parkinson's disease is:
increasing availability of levodopa available to the CNS by reducing its breakdown
A patient with chronic pain has been receiving morphine sulfate but now has decreased pain. The prescriber changes the medication to ketolorac [Toradol]. The nurse will monitor the patient for:
nausea and sweating.
When an adrenergic drug stimulates beta1-adrenergic receptors, the result is an increased force of contraction, which is known as what type of effect?
positive inotropic
The nurse is aware that adrenergic drugs produce effects similar to which of these nervous systems?
sympathetic nervous system