Pharmacology Final Chapters 41-58

The total parenteral nutrition (TPN) order reads, "Infuse TPN #2 over 24 hours." Bag #2 of TPN contains 1800 mL. At what rate will the nurse set the infusion pump? _______

75 mL/hr

A patient is receiving a nutritional supplement via an enteral feeding tube. The nurse will monitor for which common adverse effect? a. Diarrhea b. Constipation c. Fluid overload d. Heartburn

A

A patient with a partial bowel obstruction will be given a 1-week course of enteral tube feeding via a nasogastric tube. Which formulation is appropriate for this patient? a. Vivonex Plus, an elemental formulation b. Osmolite, a polymeric formulation c. Glucerna, a formulation for impaired glucose tolerance d. Polycose, a modular formulation that contains carbohydrates

A

An older adult patient needs to receive an enteral supplement to improve her overall nutritional status. When considering enteral supplements, the nurse notes that which formulation provides complex nutrients? a. Ensure Plus b. Moducal c. Propac d. Microlipid

A

The peripheral parenteral nutrition bag that has been infusing into the patient is empty, and the nurse realizes that the next bag is not ready. The nurse should immediately hang which of these intravenous solutions until the new bag arrives? a. 10% dextrose in water b. 20% dextrose in water c. 0.9% sodium chloride d. Lactated Ringer's solution

A

1. A patient with Pneumocystis jirovecii pneumonia will be receiving pentamidine (Pentam 300) as an intravenous piggyback (IVPB) dose. The medication has been added to a 100-mL bag of D5W for the infusion, and it needs to infuse over 120 minutes. The nurse will set the infusion pump to infuse at what rate for this IVPB medication? _______

ANS: DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A TOP: NURSING PROCESS: Implementation

1. There is a new order for Naproxen (Naprosyn) 250 mg PO every 6 hours. The drug is available as an oral suspension that contains 125 mg/5 mL. Identify how many milliliters will the nurse administer for 1 dose of this medication. _______

ANS: DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A TOP: NURSING PROCESS: Implementation

1. A patient will be on a tacrolimus (Prograf) infusion after receiving a liver transplant. The order reads, "Give 0.03 mg/kg/day as a continuous IV infusion." The patient weighs 159 pounds, and the medication injection solution is available in a 5-mg/mL strength. Identify how many milliliters will the nurse draw up for this infusion. (record answer using two decimal places) _______

ANS: 0.43 mL DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A TOP: NURSING PROCESS: Implementation

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

ANS: 300 mL Convert the patient's weight to kilograms: Calculate the dose of mannitol: of mannitol. Using the 25% solution, which contains 25 g of mannitol in 100 mL of solution, calculate the milliliters needed: 300 ml DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A TOP: NURSING PROCESS: Implementation

1. A patient is to receive filgrastim (Neupogen) 5 mcg/kg/day. The patient weighs 198 pounds. Identify how many micrograms of medication will this patient receive each day. _______

ANS: 450 mcg Convert pounds to kilograms: Calculate mcg/day for this patient: DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A TOP: NURSING PROCESS: Implementation

2. A patient will be receiving aldesleukin [IL-2] (Proleukin), 600,000 IU/kg every 8 hours for 14 doses. The patient weighs 220 pounds. Identify how many IU of medication will this patient receive per dose. _______

ANS: 60 million (60,000,000) IU Convert pounds to kilograms: Calculate IU/kg for this patient: DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A TOP: NURSING PROCESS: Implementation

1. A patient will be receiving monthly injections of cyanocobalamin (Nascobal). The dose is 100 mcg/month IM. The medication is available in a strength of 1000 mcg/mL. Identify how many milliliters will the nurse draw up into the syringe. (record answer using one decimal place) _______

ANS: 0.1 mL DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A TOP: NURSING PROCESS: Implementation

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

ANS: 0.8 mL

1. A patient will be taking fluconazole (Diflucan) 100 mg/day PO for 2 weeks. The patient is unable to swallow tablets, so an oral suspension that contains 10 mg/mL is available. Identify how many milliliters will the nurse administer with each dose. _______

ANS: 10 mL DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A TOP: NURSING PROCESS: Implementation

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

ANS: 19.7 mg

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

ANS: 200 ml/hr DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A TOP: NURSING PROCESS: Implementation

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

ANS: 250 ml/hr DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A TOP: NURSING PROCESS: Implementation

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

ANS: 40 mg DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A TOP: NURSING PROCESS: Implementation

1. A health care worker will be receiving hepatitis B immunoglobulin (BayHep B), 0.06 mg/kg IM now and repeated in 30 days as part of hepatitis B prophylaxis after a needle stick accident. The patient weighs 264 pounds. Identify how many milligrams will the patient receive for each dose. (record answer using one decimal place) _______

ANS: 7.2 mg DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A TOP: NURSING PROCESS: Implementation

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

ANS: A All ophthalmic drugs should be administered in the conjunctival sac. Gently use a tissue to remove excess eye medication—do not blot the eye after giving the medication. Tilt the head back before giving the eyedrops. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 918 TOP: NURSING PROCESS: Implementation

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

ANS: A Androgens used for cancer treatment, such as fluoxymesterone and testolactone, can cause menstrual irregularities, virilization of female, gynecomastia, hirsutism, acne, anxiety, headache, and nausea. The patient needs to be told of these effects before therapy begins. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 738 TOP: NURSING PROCESS: Planning

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

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

9. During assessment of a patient with osteoarthritis pain, the nurse knows that which condition is a contraindication to the use of nonsteroidal anti-inflammatory drugs (NSAIDs)? a. Renal disease b. Diabetes mellitus c. Headaches d. Rheumatoid arthritis

ANS: A Contraindications to NSAIDs include known drug allergy and conditions that place a patient at risk for bleeding, such as vitamin K deficiency, and peptic ulcer disease. Patients with documented aspirin allergy must not receive NSAIDs. Other common contraindications are those that apply to most drugs, including severe renal or hepatic disease. The other options are not contraindications. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 695 TOP: NURSING PROCESS: Assessment

8. A patient will be starting vitamin D supplements. The nurse reviews his medical record for contraindications, including which condition? a. Renal disease b. Cardiac disease c. Hypophosphatemia d. There are no contraindications to vitamin D supplements.

ANS: A Contraindications to vitamin D products include known allergy to the product, hypercalcemia, renal dysfunction, and hyperphosphatemia. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 845 TOP: NURSING PROCESS: Assessment

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

ANS: A Dark stools and blue gums are two of the possible adverse effects of bismuth subsalicylate (see Table 51-2). The other adverse effects listed may occur with the use of other antidiarrheal drugs. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 815 TOP: NURSING PROCESS: Assessment

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

ANS: A Decreased cardiac output related to the adverse effect of cardiotoxicity is a nursing diagnosis related to doxorubicin because adverse effects of doxorubicin include liver and cardiovascular toxicities. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 742 TOP: NURSING PROCESS: Nursing Diagnosis

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

ANS: A Fever and/or chills may be the first sign of an oncoming infection. Elevated white blood cell count will not occur because of the bone marrow suppression. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 729 TOP: NURSING PROCESS: Assessment

1. The nurse is reviewing conditions caused by nutrient deficiencies. Conditions such as infantile rickets, tetany, and osteomalacia are caused by a deficiency in which vitamin or mineral? a. Vitamin D b. Vitamin C c. Zinc d. Cyanocobalamin (vitamin B12)

ANS: A Infantile rickets, tetany, and osteomalacia are all a result of long-term vitamin D deficiency. The other options are incorrect. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 845 TOP: NURSING PROCESS: Assessment

8. A 30-year-old woman is in the clinic for her yearly gynecologic exam and asks the nurse about the "new vaccine that prevents HPV." She wants to receive the papillomavirus vaccine (Gardasil). Which response by the nurse is most appropriate? a. "For women, the recommended age for this vaccine is 13 to 26 years of age." b. "We will need to make sure you are not pregnant first." c. "There will be a total of three injections." d. "I will check with your health care provider and then get the first dose of the vaccine ready."

ANS: A It is important to make sure that a patient receiving Gardasil is not pregnant and that the patient knows that there are a total of three injections, but this particular patient is too old to receive the vaccine. The guidelines recommend the vaccine for women 13 to 26 years of age. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 790 TOP: NURSING PROCESS: Implementation

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

ANS: A It is now required that at least two contraceptive methods be used by sexually active women during and for 1 month after completion of therapy with isotretinoin. The other statements are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 888 TOP: NURSING PROCESS: Planning

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

ANS: A Lactulose (Enulose) produces a laxative effect but also works to reduce blood ammonia levels by converting ammonia to ammonium. Ammonium is a water-soluble cation that is trapped in the intestines and cannot be reabsorbed into the systemic circulation. This effect has proved helpful in reducing elevated serum ammonia levels in patients with severe liver disease. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 822 TOP: NURSING PROCESS: Planning

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

ANS: A Mineral oil can decrease the absorption of fat-soluble vitamins (A, D, E, and K). The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 820 TOP: NURSING PROCESS: Planning

6. The nurse is monitoring a patient who is receiving muromonab-CD3 (Orthoclone OKT3) after an organ transplant. Which effect is possible with muromonab-CD3 therapy? a. Chest pain b. Hypotension c. Confusion d. Dysuria

ANS: A Muromonab-CD3 may cause chest pain, fever, chills, tremor, gastrointestinal disturbances (nausea, vomiting, diarrhea), and other effects as noted in Table 48-2. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 773 TOP: NURSING PROCESS: Evaluation

1. During an intravenous (IV) infusion of amphotericin B, a patient develops tingling and numbness in his toes and fingers. What will the nurse do first? a. Discontinue the infusion immediately. b. Reduce the infusion rate gradually until the adverse effects subside. c. Administer the medication by rapid IV infusion to reduce these effects. d. Nothing; these are expected side effects of this medication.

ANS: A Once the intravenous infusion of amphotericin B has begun, vital signs must be monitored frequently to assess for adverse reactions such as cardiac dysrhythmias, visual disturbances, paresthesias (numbness or tingling of the hands or feet), respiratory difficulty, pain, fever, chills, and nausea. If these adverse effects or a severe reaction occur, the infusion must be discontinued (while the patient is closely monitored) and the prescriber contacted. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 676 TOP: NURSING PROCESS: Implementation

2. A patient has an infestation with flukes. The nurse anticipates the use of which drug to treat this infestation? a. Praziquantel (Biltricide) b. Pyrantel (Pin-X) c. Metronidazole (Flagyl) d. Ivermectin (Stromectol)

ANS: A Praziquantel is an anthelmintic that is used to kill flukes. Metronidazole is used to treat protozoal infections. The other drugs listed are used for other helminthic infestations. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 687 TOP: NURSING PROCESS: Planning

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

ANS: A Sarcomas are malignant tumors that arise from connective tissues. These tissues can be found in bone, cartilage, muscle, blood, lymphatic, and vascular tissues. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 711 TOP: NURSING PROCESS: Assessment

3. A 45-year-old man has received a series of immunizing drugs in preparation for a trip to a developing country. Within hours, his wife brings him to the emergency department because he has developed edema of the face, tongue, and throat and is having trouble breathing. The nurse suspects that, based on the patient's history and symptoms, he is experiencing which condition? a. Serum sickness b. Cross-sensitivity c. Thrombocytopenic purpura d. Adenopathy

ANS: A Serum sickness sometimes occurs after repeated injections of equine (horse)-made immunizing drugs and is characterized by edema of the face, tongue, and throat; rash; urticaria; fever; flushing; dyspnea; and other symptoms. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 787 TOP: NURSING PROCESS: Evaluation

2. A patient is about to undergo a kidney transplant. She will be given an immunosuppressant drug before, during, and after surgery to minimize organ rejection. During the preoperative teaching session, which information will the nurse include about the medication therapy? a. Several days before the surgery, the medication will be administered orally. b. The oral doses need to be taken 1 hour before meals to maximize absorption. c. Mix the oral liquid with juice in a disposable Styrofoam cup just before administration. d. Intramuscular injections of the medication will be needed for several days preceding surgery.

ANS: A Several days before transplant surgery, immunosuppressant drugs need to be taken by the oral route, if possible, to avoid intramuscular injections and the risk for infection caused by the injections. Avoid Styrofoam containers because the medication may adhere to the side of the container. These medications are taken with food to minimize gastrointestinal upset. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 778 TOP: NURSING PROCESS: Implementation

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

ANS: A Taking hypoglycemic drugs with an adsorbent such as bismuth subsalicylate may result in decreased absorption of the hypoglycemic drugs. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 816 TOP: NURSING PROCESS: Implementation

7. During interleukin drug therapy, a patient is showing signs of severe fluid retention, with increasing dyspnea and severe peripheral edema. The next dose of the interleukin is due now. Which action will the nurse take next? a. Hold the drug, and notify the prescriber. b. Give the drug, and notify the prescriber. c. Give the drug along with acetaminophen and diphenhydramine (Benadryl). d. Monitor the patient for 2 hours, and then give the drug if the patient's condition improves.

ANS: A The fluid retention that may occur with interleukin therapy is reversible; if therapy is stopped, the prescriber must be notified. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 760 TOP: NURSING PROCESS: Implementation

11. A patient calls the clinic to ask about taking a glucosamine-chondroitin supplement for arthritis. The nurse reviews the medication history and notes that there will be a concern for drug interactions if the patient is also taking medications for which disorder? a. Type 2 diabetes mellitus b. Hypothyroidism c. Hypertension d. Angina

ANS: A The glucosamine in glucosamine-chondroitin supplements may cause an increase in insulin resistance, necessitating the need for higher doses of oral hypoglycemics or insulin. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 702 TOP: NURSING PROCESS: Assessment

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

ANS: A The lowest neutrophil count reached after a course of chemotherapy is known as the nadir. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 717 TOP: NURSING PROCESS: Implementation

8. During therapy with amphotericin B, the nurse will monitor the patient for known adverse effects that would be reflected by which laboratory result? a. Serum potassium level of 2.7 mEq/L b. Serum potassium level of 5.8 mEq/L c. White blood cell count of 7000 cells/mm3 d. Platelet count of 300,000/ microliter

ANS: A The nurse needs to monitor for hypokalemia, a possible adverse effect of amphotericin B. The other options are incorrect. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 673 TOP: NURSING PROCESS: Implementation

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

ANS: A There is one unique adverse effect associated with all prostaglandin agonists—in some people with hazel, green, or bluish-brown eye color, eye color will turn permanently brown, even if the medication is discontinued. This adverse effect appears to be cosmetic only, with no known ill effects on the eye. The other medications do not have this effect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 911 TOP: NURSING PROCESS: Implementation

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

ANS: A Topical fungal infections are difficult to treat and may require prolonged therapy of several weeks to as long as 1 year. Occlusive dressings should not be applied unless recommended by the medication's manufacturer. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 889 TOP: NURSING PROCESS: Implementation

3. A patient with gout has been treated with allopurinol (Zyloprim) for 2 months. The nurse will monitor laboratory results for which therapeutic effect? a. Decreased uric acid levels b. Decreased prothrombin time c. Decreased white blood cell count d. Increased hemoglobin and hematocrit levels

ANS: A Treatment of gout with allopurinol should result in decreased uric acid levels. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 704 TOP: NURSING PROCESS: Evaluation

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

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

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

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

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

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

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

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

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

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

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

ANS: A, B, C, D, E, F Before applying eye medications, clean any debris from the eye, if needed, and have the patient tilt the head back and look up at the ceiling. Drops are placed into the conjunctival sac, and then the eye is closed gently. Pressure may be applied to the inner canthus/lacrimal sac for 1 minute to reduce systemic absorption, and any excess medication can then be removed from around the eyes. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 918 TOP: NURSING PROCESS: Implementation

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

ANS: A, B, C, F Dexamethasone (Decadron) is used to treat inflammation of the eye, eyelids, conjunctiva, and cornea, and it may also be used in the treatment of uveitis, iridocyclitis, allergic conditions, and burns and in the removal of foreign bodies. It is not indicated for infections or glaucoma. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 915 TOP: NURSING PROCESS: Planning

3. During an intravenous infusion of calcium, the nurse carefully monitors the patient for symptoms of hypercalcemia. Which are symptoms of hypercalcemia? (Select all that apply.) a. Anorexia b. Nausea and vomiting c. Diarrhea d. Constipation e. Cardiac irregularities f. Drowsiness

ANS: A, B, D, E Symptoms of hypercalcemia include anorexia, nausea, vomiting, and constipation. Long-term excessive calcium intake can result in severe hypercalcemia, which can cause cardiac irregularities, delirium, and coma. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 853 TOP: NURSING PROCESS: Implementation

2. The nurse is reviewing the information about the herpes zoster vaccine (Zostavax) before administering the dose. Which statements about the vaccine are true? (Select all that apply.) a. It is a one-time vaccine. b. The vaccine is recommended for patients 50 years of age and older. c. The vaccine is given to children to prevent chickenpox. d. It is used to prevent postherpetic neuralgia. e. It is contraindicated in patients who have already had shingles. f. The vaccine is used to prevent reactivation of the zoster virus that causes shingles.

ANS: A, B, F Zoster vaccine (Zostavax) is used to prevent shingles; it also prevents reactivation of the zoster virus that causes shingles. It is given to patients 50 years of age and older, and it is a one-time vaccine. It is not given to prevent chickenpox or given to children. It does not prevent postherpetic neuralgia, and it can be given to patients who have already had shingles. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 790 TOP: NURSING PROCESS: Implementation

1. The nurse is reviewing the history of a patient who has a new order for a nonsteroidal anti-inflammatory drug (NSAID) to treat tendonitis. Which conditions are contraindications to the use of NSAIDs? (Select all that apply.) a. Vitamin K deficiency b. Arthralgia c. Peptic ulcer disease d. Neuropathy e. Pericarditis

ANS: A, C Contraindications to NSAIDs include known drug allergy as well as conditions that place the patient at risk for bleeding, such as Vitamin K deficiency and peptic ulcer disease. NSAIDs may be used to treat arthralgia and pericarditis. Neuropathy is not a contraindication. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 695 TOP: NURSING PROCESS: Assessment

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

ANS: A, C, D, E Cisplatin can cause nephrotoxicity, ototoxicity, and peripheral neuropathy. Nephrotoxicity is manifested by rising blood urea nitrogen and creatinine levels; ototoxicity is manifested by tinnitus, hearing loss, and dizziness; peripheral neuropathy is manifested by numbness or tingling of the extremities. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 736 TOP: NURSING PROCESS: Evaluation

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

ANS: A, C, D, E Counsel patients who are taking methotrexate to expect hair loss and to report any unusual bleeding or bruising. Because of the possibility of infection, avoid areas with large crowds or gatherings. Foods that are too hot or too cold or rough in texture may be irritating to the oral mucosa. Fluid intake is to be encouraged to prevent dehydration. DIF: COGNITIVE LEVEL: Applying (Application) REF: pp. 731-732 TOP: NURSING PROCESS: Implementation

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

ANS: A, C, E Chemotherapy toxicities generally stem from the fact that chemotherapy drugs affect rapidly dividing cells—both harmful cancer cells and healthy, normal cells. Three types of rapidly dividing human cells are the cells of hair follicles, GI tract cells, and bone marrow cells. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 725 TOP: NURSING PROCESS: Implementation

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

ANS: A, C, E Some of the most common adverse effects of tretinoin are excessively red and edematous blisters, crusted skin, and temporary alterations in skin pigmentation. Itching and rosacea are not potential adverse effects. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 889 TOP: NURSING PROCESS: Implementation

1. The nurse is reviewing vitamin therapy in preparation for a nutrition class. Which statements are accurate regarding vitamin C (ascorbic acid)? (Select all that apply.) a. Vitamin C is important in the maintenance of bone, teeth, and capillaries. b. Vitamin C is essential for night vision. c. Vitamin C is important for tissue repair. d. Vitamin C is found in animal sources such as dairy products and meat. e. Vitamin C is found in tomatoes, strawberries, and broccoli. f. Vitamin C is also known as the "sunshine vitamin." g. Vitamin C deficiency is known as scurvy.

ANS: A, C, E, G These statements are true of vitamin C. Vitamin A is essential for night vision, and vitamin D is known as the sunshine vitamin. With the exception of liver, meat and dairy products are not sources of vitamin C. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 852 TOP: NURSING PROCESS: Implementation

1. The nurse is reviewing the health history of a new patient who may need immunizations. Active immunizations are usually contraindicated in which patients? (Select all that apply.) a. Patients with a febrile illness b. Children younger than 1 year of age c. Elderly patients d. Patients who are immunosuppressed e. Those receiving cancer chemotherapy

ANS: A, D, E Contraindications to the administration of immunizing drugs include a history of reactions to or serious adverse effects resulting from the drugs, and patients who are already immunosuppressed (patients with AIDS and patients receiving chemotherapy). Immunizations are best deferred until after a febrile illness. Children younger than 1 year of age and the elderly may receive immunizing drugs. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 787 TOP: NURSING PROCESS: Assessment

1. Hydroxychloroquine (Plaquenil) is prescribed as part of malaria prophylaxis for a patient who will be traveling. The nurse will discuss which potential adverse effects with the patient? (Select all that apply.) a. Diarrhea b. Constipation c. Insomnia d. Dizziness e. Rash f. Headache

ANS: A, D, E, F Diarrhea, anorexia, nausea, vomiting, dizziness, rash, and headache are potential adverse effects of hydroxychloroquine. See Table 43-1 for other common adverse effects. The other options are not adverse effects of this drug. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 682 TOP: NURSING PROCESS: Implementation

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

ANS: A, D, E, F Indications of an oncologic emergency include fever and/or chills with a temperature higher than 100.5° F (38.1° C); new sores or white patches in the mouth or throat; changes in bladder function or patterns; dry, burning, "scratchy," or "swollen" throat; and other signs and symptoms (see Box 46-4). The prescriber must be contacted immediately if any of the listed signs or symptoms occur. Loss of hair and decreased red blood cell count (a result of bone marrow suppression) are expected effects of chemotherapy. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 744 TOP: NURSING PROCESS: Assessment

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

ANS: A, E Both Floxin Otic and Cipro HC Otic are antibacterial eardrops. Cipro HC also contains a corticosteroid. Both Cortic and Acetasol HC are antifungal products; Debrox (carbamide peroxide) is an earwax emulsifier used to loosen earwax for easier removal. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 922 TOP: NURSING PROCESS: Planning

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

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

9. Abatacept (Orencia) is prescribed for a patient with severe rheumatoid arthritis. The nurse checks the patient's medical history, knowing that this medication would need to be used cautiously if which condition is present? a. Coronary artery disease b. Chronic obstructive pulmonary disease c. Diabetes mellitus d. Hypertension

ANS: B Abatacept must be used cautiously in patients with recurrent infections or chronic obstructive pulmonary disease. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 762 TOP: NURSING PROCESS: Assessment

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

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

10. 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? a. Rheumatoid arthritis b. Gout c. Osteoarthritis d. Systemic lupus erythematosus

ANS: B Allopurinol is indicated for the treatment of gout but is not indicated for the other disorders listed. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 699 TOP: NURSING PROCESS: Assessment

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

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

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

ANS: B Although the drug exhibits many characteristics of the opiate class, physical dependence on loperamide has not been reported. All antidiarrheal drugs are orally administered. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 817 TOP: NURSING PROCESS: Planning

8. A patient is being evaluated for a possible helminthic infection. The nurse knows that which statement about anthelmintic therapy is true? a. The drugs may cause severe drowsiness. b. Anthelmintics are very specific in their actions. c. Anthelmintics are effective against broad classes of infestations. d. The drugs are used to treat protozoal infections such as intestinal amebiasis.

ANS: B Anthelmintics are very specific in their actions, and it is important to identify the cause of the infestation before beginning treatment. They are not used to treat protozoal infections, and they do not cause severe drowsiness. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 687 TOP: NURSING PROCESS: Assessment

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

ANS: B Anticholinergic drugs work to slow peristalsis by reducing the rhythmic contractions and the smooth muscle tone of the gastrointestinal tract. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 815 TOP: NURSING PROCESS: Planning

7. A patient is in the urgent care center after experiencing a black widow spider bite. The nurse prepares to give which product to treat this injury? a. Live vaccine b. Antivenins or antisera c. Tetanus immune globulin d. Active immunizing drug

ANS: B Antivenins, also known as antisera, are used to prevent or minimize the effects of poisoning by poisonous snakes and spiders. They provide the person who has been bitten with the substance needed to overcome the effects of the venom. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 786 TOP: NURSING PROCESS: Implementation

4. A 12-month-old infant has received an MMR II (measles, mumps, and rubella virus vaccine), and her mother calls the clinic that afternoon to ask about helping her fussy infant to "feel better." What will the nurse suggest? a. Apply an ice pack to the injection site. b. Apply warm compresses to the injection site. c. Observe the site for further swelling and redness. d. Bring the infant in to the emergency department for an immediate examination.

ANS: B Applying warm compresses to the injection site and using acetaminophen (not aspirin, which carries the risk for Reye's syndrome) should help to relieve the discomfort. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 794 TOP: NURSING PROCESS: Implementation

1. A patient must be treated immediately for acute organ transplant rejection. The nurse anticipates that muromonab-CD3 (Orthoclone OKT3) will be ordered. What is the priority assessment before beginning drug therapy with muromonab-CD3? a. Serum potassium level b. Fluid volume status c. Electrocardiogram d. Blood glucose level

ANS: B Assess fluid volume status because muromonab-CD3 is contraindicated in the presence of fluid overload. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 777 TOP: NURSING PROCESS: Assessment

2. If a patient is taking fluconazole (Diflucan) with an oral anticoagulant, the nurse will monitor for which possible interaction? a. Reduced action of oral anticoagulants b. Increased effects of oral anticoagulants c. Hypokalemia d. Decreased effectiveness of the antifungal drug

ANS: B Azole antifungal drugs increase the effects of oral anticoagulants. As a result, increased bleeding may occur. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 675 TOP: NURSING PROCESS: Assessment

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

ANS: B Because drug-resistant cells commonly develop, exposure to multiple drugs with multiple mechanisms and sites of action will destroy more subpopulations of cells. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 715 TOP: NURSING PROCESS: Planning

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

ANS: B Bulk-forming laxatives are the only laxatives recommended for long-term use. Stimulant laxatives are the most likely of all the laxative classes to cause dependence. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 819 TOP: NURSING PROCESS: Planning

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

ANS: B Cell cycle-nonspecific drugs kill cancer cells during any phase of the growth cycle, whereas cell cycle-specific drugs kill cancer cells during specific phases of the cell growth cycle. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 734 TOP: NURSING PROCESS: Evaluation

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

ANS: B Cisplatin may cause nephrotoxicity, and the patient's renal function must be monitored closely while on this drug. Ensuring hydration will help to prevent nephrotoxicity. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 735 TOP: NURSING PROCESS: Implementation

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

ANS: B Earwax emulsifiers are indicated for excessive earwax in the outer ear canal and are not to be used without prescription when ear drainage, tympanic membrane rupture, or significant pain or other irritation is present. Cerumen impaction may cause partial deafness in the affected ear. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 923 TOP: NURSING PROCESS: Planning

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

ANS: B Even if a patient has a known allergic reaction to a given antineoplastic medication, the urgency of treating the patient's cancer may still necessitate administering the medication and then treating any allergic symptoms with supportive medications, such as antihistamines, corticosteroids, and acetaminophen. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 717 TOP: NURSING PROCESS: Planning

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

ANS: B Fluorescein sodium is an ophthalmic diagnostic dye used to identify corneal defects and to locate foreign objects in the eye. Phenylephrine is an ocular decongestant; atropine sulfate has mydriatic and cycloplegic effects, which are useful for examining the inner eye structures; olopatadine is an ophthalmic antihistamine. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 916 TOP: NURSING PROCESS: Planning

8. A patient with multiple sclerosis will be starting therapy with an immunosuppressant drug. The nurse expects that which drug will be used? a. Azathioprine (Imuran) b. Glatiramer acetate (Copaxone) c. Daclizumab (Zenapax) d. Sirolimus (Rapamune)

ANS: B Glatiramer acetate and fingolimod are the only immunosuppressants currently indicated for reduction of the frequency of relapses (exacerbations) in a type of multiple sclerosis known as relapsing-remitting multiple sclerosis. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 771 TOP: NURSING PROCESS: Planning

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

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

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

ANS: B High-dose methotrexate is associated with bone marrow suppression, and it is always given in conjunction with the rescue drug leucovorin, which is an antidote for folic acid antagonists. Basically, leucovorin rescues the healthy cells from methotrexate. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 719 TOP: NURSING PROCESS: Implementation

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

ANS: B Hold the pinna of the ear up and back when giving eardrops to adults or children older than 3 years of age. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 924 TOP: NURSING PROCESS: Implementation

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

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

7. When monitoring a patient who is on immunosuppressant therapy with azathioprine (Imuran), the nurse will monitor which laboratory results? a. Serum potassium levels b. White blood cell (leukocyte) count c. Red blood cell count d. Serum albumin levels

ANS: B Leukopenia is a potential adverse effect of azathioprine therapy, so white blood cells need to be monitored. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 773 TOP: NURSING PROCESS: Evaluation

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

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

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

ANS: B Methylnaltrexone is approved only for terminally ill (hospice) patients who have opioid-induced constipation. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 819 TOP: NURSING PROCESS: Planning

6. A patient has an order for the monoclonal antibody adalimumab (Humira). The nurse notes that the patient does not have a history of cancer. What is another possible reason for administering this drug? a. Severe anemia b. Rheumatoid arthritis c. Thrombocytopenia d. Osteoporosis

ANS: B Monoclonal antibodies are used for the treatment of cancer, rheumatoid arthritis and other inflammatory diseases, multiple sclerosis, and organ transplantation. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 757 TOP: NURSING PROCESS: Assessment

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

ANS: B Mupirocin (Bactroban) is used on the skin for treatment of staphylococcal and streptococcal impetigo. It is used topically and intranasally to treat nasal colonization by MRSA; however, it MRSA is becoming increasingly resistant to the drug. The other options are incorrect. Acyclovir (an antiviral drug) and clindamycin are not indicated for the treatment of MRSA; clotrimazole is an antifungal drug. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 887 TOP: NURSING PROCESS: Planning

10. A patient is taking nystatin (Mycostatin) oral lozenges to treat an oral candidiasis infection resulting from inhaled corticosteroid therapy for asthma. Which instruction by the nurse is appropriate? a. "Chew the lozenges until they are completely dissolved." b. "Let the lozenge dissolve slowly and completely in your mouth without chewing it." c. "Rinse your mouth with water before taking the inhaler." d. "Rinse your mouth with mouthwash after taking the inhaler."

ANS: B Nystatin may be given orally in the form of lozenges, or troches, which need to be slowly and completely dissolved in the mouth for optimal effects; tablets are not to be chewed or swallowed whole. The other options are incorrect. Patients taking an inhaled corticosteroid must rinse their mouths with water thoroughly after taking the inhaler. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 676 TOP: NURSING PROCESS: Planning

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

ANS: B Ocular antibiotics may cause local inflammation, burning, stinging, urticaria, and dermatitis. These effects are transient. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 912 TOP: NURSING PROCESS: Implementation

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

ANS: B Patients who are neutropenic and susceptible to infections need to adhere to a low-microbe diet by washing fresh fruits and vegetables and making sure foods are well cooked. The other options are correct. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 729 TOP: NURSING PROCESS: Implementation

1. When monitoring a patient's response to interferon therapy, the nurse notes that the major dose-limiting factor for interferon therapy is which condition? a. Diarrhea b. Fatigue c. Anxiety d. Nausea and vomiting

ANS: B Patients who receive interferon therapy may experience flu-like symptoms: fever, chills, headache, malaise, myalgia, and fatigue. Fatigue is the major dose-limiting factor for interferon therapy. Patients taking high dosages become so exhausted that they are commonly confined to bed. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 754 TOP: NURSING PROCESS: Evaluation

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

ANS: B Patients with allergies to sulfonamide drugs must not receive silver sulfadiazine. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 888 TOP: NURSING PROCESS: Assessment

5. A patient with late-stage HIV infection also has Pneumocystis jirovecii pneumonia. The nurse anticipates treatment with which medication for this pneumonia? a. Ivermectin (Stromectol) b. Atovaquone (Mepron) c. Praziquantel (Biltricide) d. Metronidazole (Flagyl)

ANS: B Pentamidine and atovaquone are used for the treatment of pneumonia caused by P. jirovecii. The other options are not used for this pneumonia. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 684 TOP: NURSING PROCESS: Planning

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

ANS: B Potential contraindications to the use of otic preparations include perforated eardrum. The other options are potential indications for eardrops. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 924 TOP: NURSING PROCESS: Assessment

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

ANS: B Povidone-iodine, a widely used antiseptic, cannot be used in patients who are allergic to iodine or have shellfish allergies. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 894 TOP: NURSING PROCESS: Assessment

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

ANS: B Proparacaine (Alcaine) and tetracaine are used as a local anesthetic for ocular surgery or other procedures. The other drugs are used for glaucoma. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 916 TOP: NURSING PROCESS: Planning

6. A patient with an intestinal infection that is positive for the Giardia lamblia organism will be taking an antiprotozoal drug. The nurse will include which information in the teaching plan for this patient? a. The urine may become dilute and pale during therapy. b. Taking the medications with food reduces gastrointestinal upset. c. The medications should be taken on an empty stomach. d. The drugs may be discontinued once the diarrhea subsides.

ANS: B Taking these drugs with food reduces gastrointestinal upset. Antiprotozoal drugs may cause the urine to turn dark. These drugs should be administered for the prescribed length of time to ensure complete eradication of the infection. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 690 TOP: NURSING PROCESS: Implementation

5. When administering cyclosporine, the nurse notes that allopurinol is also ordered for the patient. What is a potential result of this drug interaction? a. Reduced adverse effects of the cyclosporine b. Increased levels of cyclosporine and toxicity c. Reduced uric acid levels d. Reduced nephrotoxic effects of cyclosporine

ANS: B The allopurinol may cause increased levels of cyclosporine, and toxicity may result. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 774 TOP: NURSING PROCESS: Planning

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

ANS: B The dried juice of the leaves of the aloe plant contains anthranoids, which give aloe a laxative effect when taken orally. The topical application of the plant juice has been known for years to help the healing of wounds. Common adverse effects include diarrhea, nephritis, abdominal pain, and dermatitis when used topically. Potential drug interactions include digoxin, antidysrhythmics, diuretics, and corticosteroids. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 892 TOP: NURSING PROCESS: Implementation

6. A nurse is working in an immunization clinic. A new colleague asks, "When is the first dose of the diphtheria, tetanus, and acellular pertussis (DtaP, Daptacel) given?" The nurse knows that this series is started at what age? a. At birth b. 6 weeks c. 3 months d. 1 year

ANS: B The first dose of the series of three injections is given at 6 weeks of age. The other options are incorrect. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 788 TOP: NURSING PROCESS: Assessment

3. A patient is on vitamin D supplemental therapy. The nurse will monitor for which signs of toxicity during this therapy? a. Tinnitus b. Anorexia c. Diarrhea d. Hypotension

ANS: B The toxic effects of vitamin D are those associated with hypertension, such as weakness, fatigue, headache, anorexia, dry mouth, metallic taste, nausea, vomiting, abdominal cramps, ataxia, and bone pain. If not recognized and treated, these symptoms can progress to impairment of renal function and osteoporosis. The other options listed are not signs of vitamin D toxicity. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 845 TOP: NURSING PROCESS: Assessment

9. The nurse is preparing to administer morning medications to a patient who has been newly diagnosed with tuberculosis. The patient asks, "Why do I have to take so many different drugs?" Which response by the nurse is correct? a. "Your prescriber hopes that at least one of these drugs will work to fight the tuberculosis." b. "Taking multiple drugs reduces the chance that the tuberculosis will become drug resistant." c. "Using more than one drug can help to reduce side effects." d. "Using multiple drugs enhances the effect of each drug."

ANS: B The use of multiple medications reduces the possibility that the organism will become drug resistant. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 662 TOP: NURSING PROCESS: Assessment

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

ANS: B There have been case reports of suicide and suicide attempts in patients receiving isotretinoin. Instruct patients to report immediately to their prescribers any signs of depression. Follow-up treatment may be needed, and simply stopping the drug may be insufficient. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 888 TOP: NURSING PROCESS: Assessment

6. A patient with a history of alcohol abuse has been admitted for severe weakness and malnutrition. The nurse will prepare to administer which vitamin preparation to prevent Wernicke's encephalopathy? a. Vitamin B3 (niacin) b. Vitamin B1 (thiamine) c. Vitamin B6 (pyridoxine) d. Folic acid

ANS: B Thiamine is necessary for the treatment of a variety of thiamine deficiencies, including Wernicke's encephalopathy. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 848 TOP: NURSING PROCESS: Planning

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

ANS: B Tretinoin may cause increased redness and drying, and the patient needs to avoid weather extremes, ultraviolet light, and abrasive cleansers. Certain foods do not need to be avoided. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 889 TOP: NURSING PROCESS: Planning

2. The nurse is preparing a plan of care for a patient undergoing therapy with vitamin A. Which nursing diagnosis is appropriate for this patient? a. Impaired tissue integrity related to vitamin deficiency b. Risk for injury related to night blindness caused by vitamin deficiency c. Impaired physical mobility (muscle weakness) related to vitamin deficiency d. Acute confusion related to vitamin deficiency

ANS: B Vitamin A deficiency causes night blindness, so risk for injury is an appropriate nursing diagnosis. The other nursing diagnoses are not appropriate for patients receiving vitamin A. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 857 TOP: NURSING PROCESS: Nursing Diagnosis

7. A patient with a severe fungal infection has orders for voriconazole (Vfend). The nurse is reviewing the patient's medical record and would be concerned if which assessment finding is noted? a. Decreased breath sounds in the lower lobes b. History of cardiac dysrhythmias c. History of type 2 diabetes d. Potassium level of 4.0 mEq/L

ANS: B Voriconazole is contraindicated when co-administered with certain other drugs metabolized by the cytochrome P-450 enzyme 3A4 (e.g., quinidine) because of the risk for inducing serious cardiac dysrhythmias. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 675 TOP: NURSING PROCESS: Assessment

10. A newly admitted patient has orders for a zinc supplement. The nurse reviews the patient's medical history and concludes that the zinc is ordered for which reason? a. To treat pellagra b. To aid in wound healing c. To treat osteomalacia d. As an antidote for anticoagulant overdose

ANS: B Zinc plays a crucial role in the enzymatic metabolic reactions involving both proteins and carbohydrates. This makes it especially important for normal tissue growth and repair. It therefore also has a major role in wound healing. Vitamin B3 (niacin) is used to treat pellagra; vitamin D is used to treat osteomalacia; and vitamin K is used as an antidote for anticoagulant overdose. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 856 TOP: NURSING PROCESS: Planning

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

2. The patient asks the nurse about taking large doses of vitamin C to improve her immunity to colds. "It's just a vitamin, right? What can happen?" Which responses by the nurse are correct? (Select all that apply.) a. "Vitamin C is harmless because it is a water-soluble vitamin." b. "Large doses of vitamin C can cause nausea, vomiting, headache, and abdominal cramps." c. "Keep in mind that if you suddenly stop taking these large doses, you might experience symptoms similar to scurvy." d. "Studies have shown that vitamin C has little value in preventing the common cold." e. "Vitamin C acidifies the urine, which can lead to the formation of kidney stones." f. "Large doses of vitamin C may delay wound healing."

ANS: B, C, D, E Vitamin C is usually nontoxic unless excessive dosages are consumed. Large doses (megadoses) can produce nausea, vomiting, headache, and abdominal cramps, and they acidify the urine, which can result in the formation of kidney stones. Furthermore, individuals who discontinue taking excessive daily doses of ascorbic acid can experience scurvy-like symptoms. Studies have shown that megadoses of vitamin C have little or no value as prophylaxis against the common cold. Vitamin C is required for several important metabolic activities, including collagen synthesis and the maintenance of connective tissue and tissue repair. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 852 TOP: NURSING PROCESS: Implementation

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

ANS: B, C, D, F Cautious use of laxatives is recommended in the presence of these: acute surgical abdomen; appendicitis symptoms, such as abdominal pain, nausea, and vomiting; intestinal obstruction; and undiagnosed abdominal pain. Oral laxatives must not be used with fecal impaction; mineral oil enemas are indicated for fecal impaction. The other options are indications for laxative use. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 820 TOP: NURSING PROCESS: Assessment

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

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

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

ANS: B, C, E, F Fluorouracil may be applied with gloves or clean fingertips, but if fingertips are used, the medication must be washed off thoroughly after application. The medication may cause photosensitivity, as well as local swelling, scaling, burning, and tenderness. The medication is applied twice daily. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 894 TOP: NURSING PROCESS: Implementation

1. During therapy with hematopoietic drugs, the nurse will monitor the patient for which adverse effects? (Select all that apply.) a. Hypotension b. Edema c. Diarrhea d. Black, tarry stools e. Nausea and vomiting f. Headache

ANS: B, C, E, F Potential adverse effects of hematopoietic drugs include edema, anorexia, nausea, vomiting, diarrhea, dyspnea, fever, and headache. See Table 47-1 for a complete list. The other options are not adverse effects of these drugs. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 752 TOP: NURSING PROCESS: Evaluation

2. A patient has started azathioprine (Imuran) therapy as part of renal transplant surgery. The nurse will monitor for which expected adverse effect of azathioprine therapy? (Select all that apply.) a. Tremors b. Leukopenia c. Diarrhea d. Thrombocytopenia e. Hepatotoxicity f. Fluid retention

ANS: B, D, E Leukopenia is an expected adverse effect of azathioprine therapy, as are thrombocytopenia and hepatotoxicity. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 773 TOP: NURSING PROCESS: Evaluation

1. The nurse follows which procedures when giving intravenous (IV) cyclosporine? (Select all that apply.) a. Administering it as a single IV bolus injection to minimize adverse effects b. Using an infusion pump to administer this medication c. Monitoring the patient for potential delayed adverse effects, which may be severe d. Monitoring the patient closely for the first 30 minutes for severe adverse effects e. Checking blood levels periodically during cyclosporine therapy f. Performing frequent oral care during therapy

ANS: B, D, E, F Cyclosporine is infused intravenously with an infusion pump, not as an IV bolus. Monitor the patient closely for the first 30 minutes for adverse effects, especially for allergic reactions, and monitor blood levels periodically to ensure therapeutic, not toxic, levels of the medication. Perform oral hygiene frequently to prevent dry mouth and subsequent infections. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 778 TOP: NURSING PROCESS: Implementation

1. The nurse is administering an amphotericin B infusion. Which actions by the nurse are appropriate? (Select all that apply.) a. Administering the medication by rapid IV infusion b. Discontinuing the drug immediately if the patient develops tingling and numbness in the extremities c. If adverse effects occur, reducing the IV rate gradually until they subside d. Using an infusion pump for IV therapy e. Monitoring the IV site for signs of phlebitis and infiltration f. Administering premedication for fever and nausea g. Knowing that the intravenous solution for amphotericin B will be cloudy h. Knowing that muscle twitching may indicate hypokalemia

ANS: B, D, E, F If the patient develops tingling and numbness in the extremities (paresthesias), discontinue the drug immediately. An infusion pump is necessary for the infusion, and the nurse will monitor the IV site for signs of phlebitis and infiltration. Premedication to reduce the adverse effects of fever, malaise, and nausea may be ordered. The IV solution must be clear and without precipitates; and muscle weakness, not twitching, may indicate hypokalemia. The medication must be administered at the rate recommended and stopped, not slowed, if adverse reactions occur. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 673 TOP: NURSING PROCESS: Implementation

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

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

1. The nurse is providing patient teaching for a patient who is starting antitubercular drug therapy. Which of these statements should be included? (Select all that apply.) a. "Take the medications until the symptoms disappear." b. "Take the medications at the same time every day." c. "You will be considered contagious during most of the illness and must take precautions to avoid spreading the disease." d. "Stop taking the medications if you have severe adverse effects." e. "Avoid alcoholic beverages while on this therapy." f. "If you notice reddish-brown or reddish-orange urine, stop taking the drug and contact your doctor right away." g. "If you experience a burning or tingling in your fingers or toes, report it to your prescriber immediately." h. "Oral contraceptives may not work while you are taking these drugs, so you will have to use another form of birth control."

ANS: B, E, G, H Medications for tuberculosis must be taken on a consistent schedule to maintain blood levels. Medication therapy for tuberculosis may last up to 24 months, long after symptoms disappear, and patients are infectious during the early part of the treatment. Compliance with antitubercular drug therapy is key, so if symptoms become severe, the prescriber should be contacted for an adjustment of the drug therapy. The medication must not be stopped. Because of potential liver toxicity, patients on this drug therapy must not drink alcohol. Discoloration of the urine is an expected adverse effect, and patients need to be warned about it beforehand. Burning or tingling in the fingers or toes may indicate that peripheral neuropathy is developing, and the prescriber needs to be notified immediately. A second form of birth control must be used because antitubercular drug therapy makes oral contraceptives ineffective. DIF: COGNITIVE LEVEL: Applying (Application) REF: pp. 667-668 TOP: NURSING PROCESS: Implementation

9. A patient has received a prescription for a 2-week course of antifungal suppositories for a vaginal yeast infection. She asks the nurse if there is an alternative to this medication, saying, "I don't want to do this for 2 weeks!" Which is a possibility in this situation? a. A single dose of a vaginal antifungal cream. b. A one-time infusion of amphotericin B. c. A single dose of a fluconazole (Diflucan) oral tablet. d. There is no better alternative to the suppositories.

ANS: C A single oral dose of fluconazole may be used to treat vaginal candidiasis. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 674 TOP: NURSING PROCESS: Planning

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

ANS: C All categories of laxatives share the same general contraindications and precautions, including avoidance in cases of drug allergy and the need for cautious use in the presence of these: acute surgical abdomen; appendicitis symptoms such as abdominal pain, nausea, and vomiting; fecal impaction (mineral oil enemas excepted); intestinal obstruction; and undiagnosed abdominal pain. The other options are possible indications for laxatives. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 820 TOP: NURSING PROCESS: Implementation

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

ANS: C Alosetron must be discontinued immediately if constipation or signs of ischemic colitis occur. The other options are incorrect. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 823 TOP: NURSING PROCESS: Implementation

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

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

6. A 6-year-old child who has chickenpox also has a fever of 102.9° F (39.4° C). The child's mother asks the nurse if she should use aspirin to reduce the fever. What is the best response by the nurse? a. "It's best to wait to see if the fever gets worse." b. "You can use the aspirin, but watch for worsening symptoms." c. "Acetaminophen (Tylenol) should be used to reduce his fever, not aspirin." d. "You can use aspirin, but be sure to follow the instructions on the bottle."

ANS: C Aspirin is contraindicated in children with flu-like symptoms because the use of this drug has been strongly associated with Reye's syndrome. This is an acute and potentially life-threatening condition involving progressive neurologic deficits that can lead to coma and may also involve liver damage. Acetaminophen is appropriate for this patient. The other responses are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 698 TOP: NURSING PROCESS: Implementation

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

ANS: C Before trying another product, ensure that he is performing the regimen correctly. Because he only mentioned shampooing, ensure that after each shampoo he is using a nit comb to remove nits, or eggs, from the hair shafts. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 893 TOP: NURSING PROCESS: Evaluation

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

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

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

ANS: C Bulk-forming drugs increase water absorption, which results in greater total volume (bulk) of the intestinal contents. Bulk-forming laxatives tend to produce normal, formed stools. Their action is limited to the gastrointestinal tract, so there are few, if any, systemic effects. However, they need to be taken with liberal amounts of water to prevent esophageal obstruction and fecal impaction. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 820 TOP: NURSING PROCESS: Implementation

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

ANS: C Cardiac toxicity may occur, so frequent checking of heart and breath sounds is necessary and daily weights need to be recorded (with reporting of an increase of 2 pounds or more in 24 hours or 5 pounds or more in 1 week). DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 743 TOP: NURSING PROCESS: Assessment

6. A patient is infected by invasive aspergillosis, and the medical history reveals that the patient has not been able to tolerate several antifungal drugs. The nurse anticipates an order for which medication to treat this infection? a. Fluconazole (Diflucan) b. Micafungin (Mycamine) c. Caspofungin (Cancidas) d. Nystatin (Mycostatin)

ANS: C Caspofungin is used for treating severe infection by Aspergillus species (invasive aspergillosis) in patients who are intolerant of or refractory to other drugs. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 674 TOP: NURSING PROCESS: Planning

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

ANS: C Common adverse effects of linaclotide (Linzess) are diarrhea, abdominal pain, and flatulence. Elevated blood glucose levels, chest pain, and chronic constipation are not adverse effects of linaclotide. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 823 TOP: NURSING PROCESS: Assessment

1. A patient who has a helminthic infection has a prescription for pyrantel (Antiminth). Which is one of the common adverse effects that the patient may experience while on this therapy? a. Vertigo b. Seizures c. Diarrhea d. Insomnia

ANS: C Diarrhea and abdominal pain are some of the possible gastrointestinal effects of pyrantel. See Table 43-11 for other adverse effects. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 688 TOP: NURSING PROCESS: Implementation

8. A patient who has started drug therapy for tuberculosis wants to know how long he will be on the medications. Which response by the nurse is correct? a. "Drug therapy will last until the symptoms have stopped." b. "Drug therapy will continue until the tuberculosis develops resistance." c. "You should expect to take these drugs for as long as 24 months." d. "You will be on this drug therapy for the rest of your life."

ANS: C Drug therapy commonly lasts for 24 months if consistent drug therapy has been maintained. The other options are incorrect. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: pp. 666-667 TOP: NURSING PROCESS: Implementation

5. A patient who has received chemotherapy has a steadily decreasing white blood cell count. The chemotherapy will end on Tuesday afternoon. The oncologist has mentioned that a colony-stimulating factor will be started soon. The nurse knows that the appropriate time to start this medication is when? a. While the patient is still receiving chemotherapy b. Two hours after the chemotherapy ends c. Wednesday afternoon, 24 hours after the chemotherapy ends d. In 2 to 4 days, after the white blood cells have reached their nadir

ANS: C Drugs that are given to enhance the activity of bone marrow cells interfere directly with the action of myelosuppressive cancer therapy. For this reason, therapy with colony-stimulating factors usually begins 24 hours after the chemotherapy has been completed. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 752 TOP: NURSING PROCESS: Planning

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

ANS: C Drugs used to reduce intraocular pressure include osmotic diuretics such as mannitol, which is given intravenously. Tobramycin and bacitracin are antibiotics; ketorolac has anti-inflammatory actions. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 911 TOP: NURSING PROCESS: Planning

7. The nurse is reviewing antimalarial drug therapy with a patient and instructs the patient to watch for and report which potential adverse reactions? a. Drowsiness b. Insomnia c. Visual disturbances d. Constipation

ANS: C Encourage the patient to contact the prescriber if there is unresolved nausea, vomiting, profuse diarrhea, or abdominal pain and to report immediately any visual disturbances, dizziness, or respiratory difficulties. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 690 TOP: NURSING PROCESS: Implementation

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

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

4. When monitoring patients on antitubercular drug therapy, the nurse knows that which drug may cause a decrease in visual acuity? a. Rifampin (Rifadin) b. Isoniazid (INH) c. Ethambutol (Myambutol) d. Streptomycin

ANS: C Ethambutol may cause a decrease in visual acuity or even blindness resulting from retrobulbar neuritis. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 664 TOP: NURSING PROCESS: Assessment

2. A patient is taking the nonsteroidal anti-inflammatory drug indomethacin (Indocin) as treatment for pericarditis. The nurse will teach the patient to watch for which adverse effect? a. Tachycardia b. Nervousness c. Nausea and vomiting d. Dizziness

ANS: C Gastrointestinal effects include dyspepsia, heartburn, epigastric distress, nausea, vomiting, anorexia, abdominal pain, and others. See Table 44-2 for the other adverse effects of nonsteroidal anti-inflammatory drugs (NSAIDs). The other options are not adverse effects of NSAIDs. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 685 TOP: NURSING PROCESS: Implementation

10. A patient is receiving hydroxychloroquine therapy but tells the nurse that she has never traveled out of her city. The nurse knows that a possible reason for this drug therapy is which condition? a. Lyme disease b. Toxoplasmosis c. Systemic lupus erythematosus d. Intestinal tapeworms

ANS: C Hydroxychloroquine, which is used for malaria, also possesses anti-inflammatory actions and has been used to treat rheumatoid arthritis and systemic lupus erythematosus. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 681 TOP: NURSING PROCESS: Assessment

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

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

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

ANS: C If extravasation is suspected, administration of the drug must be stopped immediately but the IV catheter left in place and the appropriate antidote instilled through the existing IV tube, after which the needle may be removed. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 736 TOP: NURSING PROCESS: Implementation

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

ANS: C In addition to producing hematologic adverse effects, irinotecan has been associated with severe diarrhea, known as cholinergic diarrhea, which may occur during infusions. Delayed diarrhea may occur 2 to 10 days after infusion of irinotecan. It is recommended that this condition be treated with atropine unless use of that drug is strongly contraindicated. This diarrhea can be severe and even life threatening. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 723 TOP: NURSING PROCESS: Evaluation

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

ANS: C Indications for the direct- and indirect-acting miotics include open-angle glaucoma, angle-closure glaucoma, ocular surgery, and convergent strabismus. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 906 TOP: NURSING PROCESS: Planning

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

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

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

ANS: C Lipid pneumonia may occur if the oral mineral oil is accidentally aspirated into the respiratory tract. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 820 TOP: NURSING PROCESS: Implementation

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

ANS: C Long-term use of laxatives may lead to dependency. Patients need to be taught that daily bowel movements are not necessary for bowel health. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 819 TOP: NURSING PROCESS: Implementation

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

ANS: C Methotrexate interacts with weak organic acids, such as aspirin, and can lead to toxicity by displacing the methotrexate from protein-binding sites. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 720 TOP: NURSING PROCESS: Implementation

2. A patient asks about his cancer treatment with monoclonal antibodies. The nurse tells him that which is the major advantage of treating certain cancers with monoclonal antibodies? a. They will help the patient improve more quickly than will other antineoplastic drugs. b. They are more effective against metastatic tumors. c. Monoclonal antibodies target certain tumor cells and bypass normal cells. d. There are fewer incidences of opportunistic infections with monoclonal antibodies.

ANS: C Monoclonal antibodies can target cancer cells specifically and have minimal effects on healthy cells, unlike conventional cancer treatments. As a result, there are fewer adverse effects when compared to traditional antineoplastic therapy. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 755 TOP: NURSING PROCESS: Planning

1. The nurse is reviewing the therapeutic effects of nonsteroidal anti-inflammatory drugs (NSAIDs), which include which effect? a. Anxiolytic b. Sedative c. Antipyretic d. Antimicrobial

ANS: C NSAIDs have antipyretic effects but not the other effects listed. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 693 TOP: NURSING PROCESS: Planning

2. The nurse is reviewing principles of immunization. What type of immunization occurs when antibodies pass from mother to infant during breastfeeding or through the placenta during pregnancy? a. Artificial active immunization b. Attenuating immunization c. Natural passive immunization d. Artificial passive immunization

ANS: C Natural passive immunization occurs when antibodies are transferred from the mother to her infant in breast milk or through the bloodstream via the placenta during pregnancy. Artificial active immunization causes an antigen-antibody response and stimulates the body's defenses to resist any subsequent exposures. Passive immunization is conferred by bypassing the host's immune system and injecting the person with antiserum or concentrated antibodies obtained from other humans or animals; this gives the host direct means of fighting off an invading microorganism. The host's immune system therefore does not have to manufacture these antibodies. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 784 TOP: NURSING PROCESS: Planning

4. The nurse is administering one of the lipid formulations of amphotericin B. When giving this drug, which concept is important to remember? a. The lipid formulations may be given in oral form. b. The doses are much lower than the doses of the older drugs. c. The lipid formulations are associated with fewer adverse effects than the older drugs. d. There is no difference in cost between the newer and older forms.

ANS: C Newer lipid formulations of amphotericin B have been developed in an attempt to decrease the incidence of its adverse effects and increase its efficacy. However, the lipid formulations are more costly. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 673 TOP: NURSING PROCESS: Implementation

7. Niacin is prescribed for a patient who has hyperlipidemia. The nurse checks the patient's medical history, knowing that this medication is contraindicated in which disorder? a. Renal disease b. Cardiac disease c. Liver disease d. Diabetes mellitus

ANS: C Niacin, unlike certain other B-complex vitamins, has additional contraindications besides drug allergy. They include liver disease, severe hypotension, arterial hemorrhage, and active peptic ulcer disease. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 849 TOP: NURSING PROCESS: Assessment

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

ANS: C Octreotide (Sandostatin) is used for the management of a cancer-related condition called carcinoid crisis and treatment of the severe diarrhea caused by vasoactive intestinal peptide-secreting tumors (VIPomas). The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 740 TOP: NURSING PROCESS: Planning

4. A patient who has received chemotherapy has a critically low platelet count. The nurse expects which drug or drug class to be used to stimulate platelet cell production? a. Filgrastim (Neupogen) b. Interferons c. Oprelvekin (Neumega) d. Epoetin alfa (Epogen)

ANS: C Oprelvekin (Neumega) stimulates bone marrow cells, specifically megakaryocytes, which eventually form platelets. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 753 TOP: NURSING PROCESS: Planning

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

ANS: C Otitis media is rarely treated with over-the-counter medications and commonly follows an upper respiratory tract infection in children. Hearing deficits may occur if prompt therapy is not started. Common symptoms include pain, fever, malaise, and a sensation of fullness in the ear. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 922 TOP: NURSING PROCESS: Implementation

2. A patient who has been taking isoniazid (INH) has a new prescription for pyridoxine. She is wondering why she needs this medication. The nurse explains that pyridoxine is often given concurrently with the isoniazid to prevent which condition? a. Hair loss b. Renal failure c. Peripheral neuropathy d. Heart failure

ANS: C Pyridoxine (vitamin B6) may be beneficial for isoniazid-induced peripheral neuropathy. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 687 TOP: NURSING PROCESS: Implementation

5. A sanitation worker has experienced a needle stick by a contaminated needle that was placed in a trash can. The employee health nurse expects that which drug will be used to provide passive immunity to hepatitis B infection? a. Haemophilus influenzae type b (Hib) b. Varicella virus vaccine (Varivax) c. Hepatitis B immunoglobulin (BayHep B) d. Hepatitis B virus vaccine (inactivated) (Recombivax HB)

ANS: C Recombivax HB promotes active immunity to hepatitis B infection in people who are considered to be at high risk for potential exposure to the virus, whereas hepatitis B immunoglobulin provides passive immunity for the prophylaxis and postexposure treatment of people exposed to hepatitis B virus or HBs-Ag-positive materials, such as blood, plasma, or serum. Hib and Varivax vaccines are not appropriate for this situation. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 791 TOP: NURSING PROCESS: Implementation

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

ANS: C Saline laxatives such as magnesium hydroxide (MOM) produce a watery stool, usually within 3 to 6 hours of ingestion. Bulk-forming laxatives such as psyllium do not produce a bowel movement rapidly. Stool softeners such as docusate salts do not cause patients to defecate; they simply soften the stool to ease its passage. Magnesium oxide tablets are used as magnesium supplements, not as laxatives. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 822 TOP: NURSING PROCESS: Planning

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

ANS: C Special spill kits are employed to clean up even the smallest chemotherapy spills. These precautions are necessary to protect the health care provider from the cytotoxic effects of these drugs. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 741 TOP: NURSING PROCESS: Implementation

7. The nurse is reviewing the medication administration record of a patient who is taking isoniazid (INH). Which drug or drug class has a significant drug interaction with isoniazid? a. Pyridoxine (vitamin B6) b. Penicillins c. Phenytoin (Dilantin) d. Benzodiazepines

ANS: C Taking INH with phenytoin will cause decreased metabolism of the phenytoin, leading to increased drug effects. Pyridoxine is often given with isoniazid to prevent peripheral neuropathy. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 664 TOP: NURSING PROCESS: Implementation

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

ANS: C The oral anticoagulant warfarin is more likely to cause increased bleeding times or bruising when co-administered with adsorbents. This is thought to be because the adsorbents bind to vitamin K, which is needed to make certain clotting factors. Vitamin K is synthesized by the normal bacterial flora in the bowel. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 815 TOP: NURSING PROCESS: Implementation

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

ANS: C Wax emulsifiers such as carbamide peroxide work to loosen the cerumen for easier removal. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 923 TOP: NURSING PROCESS: Assessment

6. The nurse is counseling a woman who will be starting rifampin (Rifadin) as part of antitubercular therapy. The patient is currently taking oral contraceptives. Which statement is true regarding rifampin therapy for this patient? a. Women have a high risk for thrombophlebitis while on this drug. b. A higher dose of rifampin will be necessary because of the contraceptive. c. Oral contraceptives are less effective while the patient is taking rifampin. d. The incidence of adverse effects is greater if the two drugs are taken together.

ANS: C Women taking oral contraceptives and rifampin need to be counseled about other forms of birth control because of the impaired effectiveness of the oral contraceptives during concurrent use of rifampin. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 668 TOP: NURSING PROCESS: Implementation

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

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

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

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

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

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

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

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

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

ANS: C, D, E Remove cerumen before instillation by irrigation, not with cotton-tipped swabs. The drops must be at room temperature; cold drops may cause dizziness or other discomfort. Hold the pinna of the ear up and back when giving eardrops to adults or children older than 3 years of age. Massage the tragus area after instillation to encourage flow through the ear canal. A small cotton ball may be inserted gently into the ear canal to keep the drug in place, but do not force or jam it into the ear canal. Gentle massage to the tragus area of the ear (not the earlobe) may also help to increase coverage of the medication after it is given. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 924 TOP: NURSING PROCESS: Implementation

2. A 75-year-old woman has been given a nonsteroidal anti-inflammatory drug (an NSAID for the treatment of rheumatoid arthritis. The nurse is reviewing the patient's medication history and notes that which types of medications could have an interaction with the NSAID? (Select all that apply.) a. Antibiotics b. Decongestants c. Anticoagulants d. Beta blockers e. Diuretics f. Corticosteroids

ANS: C, E, F Anticoagulants taken with NSAIDs may cause increased bleeding tendencies because of platelet inhibition and hypoprothrombinemia. NSAIDs taken with diuretics may cause reduced hypotensive and diuretic effects. NSAIDs taken with corticosteroids may cause increased ulcerogenic effects. See Table 44-5. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 697 TOP: NURSING PROCESS: Planning

5. A patient has been taking antitubercular therapy for 3 months. The nurse will assess for what findings that indicate a therapeutic response to the drug therapy? a. The chronic cough is gone. b. There are two consecutive negative purified protein derivative (PPD) results over 2 months. c. There is increased tolerance to the medication therapy, and there are fewer reports of adverse effects. d. There is a decrease in symptoms of tuberculosis along with improved chest x-rays and sputum cultures.

ANS: D A therapeutic response to antitubercular therapy is manifested by a decrease in the symptoms of tuberculosis, such as cough and fever, and by weight gain. The results of laboratory studies (culture and sensitivity tests) and the chest radiographic findings will be used to confirm the clinical findings of resolution of the infection. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 667 TOP: NURSING PROCESS: Evaluation

10. Aldesleukin [IL-2] (Proleukin) is prescribed for a patient. The nurse reviews the patient's medication list and would note a potential drug interaction if which drug class is also ordered? a. Anticoagulants b. Antiepileptic drugs c. Oral hypoglycemic drugs d. Antihypertensive drugs

ANS: D Aldesleukin, when given with antihypertensives, can produce additive hypotensive effects. The other responses are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 760 TOP: NURSING PROCESS: Assessment

3. The nurse is preparing an infusion of amphotericin B for a patient who has a severe fungal infection. Which intervention is appropriate regarding the potential adverse effects of amphotericin B? a. Discontinuing the infusion immediately if fever, chills, or nausea occur b. Gradually increasing the infusion rate until the expected adverse effects occur c. If fever, chills, or nausea occur during the infusion, administering medications to treat the symptoms d. Before beginning the infusion, administering an antipyretic and an antiemetic drug

ANS: D Almost all patients given the drug intravenously experience fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea and vomiting, and headache. For this reason, pretreatment with an antipyretic (acetaminophen), antihistamines, and antiemetics may be conducted to decrease the severity of the infusion-related reaction. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 672 TOP: NURSING PROCESS: Implementation

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

ANS: D Apply a thin layer of medication with a sterile, gloved hand to clean and débrided wounds. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 888 TOP: NURSING PROCESS: Implementation

8. A patient who has a history of coronary artery disease has been instructed to take one 81-mg aspirin tablet a day. The patient asks about the purpose of this aspirin. Which response by the nurse is correct? a. "Aspirin is given reduce anxiety." b. "It helps to reduce inflammation." c. "Aspirin is given to relieve pain." d. "It will help to prevent clot formation."

ANS: D Aspirin can reduce platelet aggregation; low doses of aspirin (81 to 325 mg once daily) are used for thromboprevention. Higher doses are required for pain relief, reduction of inflammation, and reduction of fever. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 697 TOP: NURSING PROCESS: Planning

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

ANS: D Bacitracin is applied topically for the treatment of local skin infections caused by susceptible aerobic and anaerobic gram-positive organisms, which can lead to impetigo. Spinosad (Natroba) is used for pediculosis; nystatin is an antifungal drug; and acyclovir is an antiviral drug. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 887 TOP: NURSING PROCESS: Assessment

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

ANS: D Because this patient has an elevated PT/INR, he cannot receive surgical débridement because of concerns about excessive bleeding. Collagenase is useful for patients taking anticoagulants and for those in whom surgery is contraindicated; it selectively removes necrotic tissue but does not harm normal tissue. Cadexomer iodine is not appropriate for a wound with necrotic tissue. Betadine is used as a skin cleanser; biafine is indicated for radiation dermatitis. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 895 TOP: NURSING PROCESS: Planning

4. The nurse is teaching a patient who is taking colchicine for the treatment of gout. Which instruction will the nurse include during the teaching session? a. "Fluids should be restricted while on colchicine therapy." b. "Take colchicine with meals." c. "The drug will be discontinued when symptoms are reduced." d. "Call your doctor if you have increased pain or blood in the urine."

ANS: D Colchicine may cause renal effects; therefore, these symptoms must be reported immediately. The drug is taken on an empty stomach for better absorption, and fluids should be increased unless contraindicated. Successful treatment depends upon continuing the medication as ordered. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 704 TOP: NURSING PROCESS: Implementation

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

ANS: D Concurrent use of corticosteroids, such as dexamethasone and ophthalmic antimicrobials, may cause immunosuppression that may make it more difficult to eliminate the eye infection. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 912 TOP: NURSING PROCESS: Assessment

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

ANS: D Consuming small, frequent meals with nutritional supplements, and maintaining a bland diet help to improve nutrition during antineoplastic therapy. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 729 TOP: NURSING PROCESS: Planning

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

ANS: D Corticosteroids, such as hydrocortisone, are commonly used in combination with otic antibiotics to reduce the inflammation and itching associated with ear infections. Antibiotics do not eliminate fungal infections. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 922 TOP: NURSING PROCESS: Planning

7. A patient has used enteric aspirin for several years as treatment for osteoarthritis. However, the symptoms are now worse and she is given a prescription for a nonsteroidal anti-inflammatory drug and misoprostol (Cytotec). The patient asks the nurse, "Why am I now taking two pills for arthritis?" What is the nurse's best response? a. "Cytotec will also reduce the symptoms of your arthritis." b. "Cytotec helps the action of the NSAID so that it will work better." c. "Cytotec reduces the mucous secretions in the stomach, which reduces gastric irritation." d. "Cytotec may help to prevent gastric ulcers that may occur in patients taking NSAIDs."

ANS: D Cytotec inhibits gastric acid secretions and stimulates mucous secretions; it has proved successful in preventing the gastric ulcers that may occur in patients taking NSAIDs. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 695 TOP: NURSING PROCESS: Implementation

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

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

5. The nurse will prepare to give which preparation to a newborn upon arrival in the nursery after delivery? a. Vitamin B1 (thiamine) b. Vitamin D (calciferol) c. Folic acid d. Vitamin K (AquaMEPHYTON)

ANS: D Deficiency in vitamin K can be seen in newborns because of malabsorption attributed to inadequate amounts of bile. AquaMEPHYTON is given as a single intramuscular dose for infants upon arrival in the nursery. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 847 TOP: NURSING PROCESS: Implementation

5. The nurse is reviewing instructions for vaginal antifungal drugs with a patient. Which statement by the nurse is an appropriate instruction regarding these drugs? a. "The medication can be stopped when your symptoms are relieved." b. "Discontinue this medication if menstruation begins." c. "Daily douching is part of the treatment for vaginal fungal infections." d. "Abstain from sexual intercourse until the treatment has been completed and the infection has resolved."

ANS: D Female patients taking antifungal medications for the treatment of vaginal infections need to abstain from sexual intercourse until the treatment has been completed and the infection has resolved. The medication needs to be taken for as long as prescribed. Instruct patients to continue to take the medication even if they are actively menstruating. Douching is not an appropriate intervention. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 677 TOP: NURSING PROCESS: Implementation

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

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

4. The nurse is counseling a patient about calcium supplements. Which dietary information is appropriate during this teaching session? a. "Take oral calcium supplements with meals." b. "There are no drug interactions with calcium products." c. "Avoid foods that are high in calcium, such as beef, egg yolks, and liver." d. "Be sure to eat foods high in calcium, such as dairy products and salmon."

ANS: D Foods high in calcium include dairy products, fortified cereals, calcium-fortified orange juice, sardines, and salmon. Patients can be encouraged to add dietary sources of calcium to their diets. Oral-dosage forms of calcium need to be given 1 to 3 hours after meals. Calcium salts will bind with tetracycline and quinolone antibiotics and result in an insoluble complex. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 843 |pp. 857-858 TOP: NURSING PROCESS: Implementation

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

ANS: D Give eardrops at room temperature. If the pharmacy indicates that the drug is to be refrigerated, it should be taken out of the refrigerator up to 1 hour before it is to be instilled so that it can warm up to room temperature. They are not to be placed in the microwave or soaked in hot water; eardrops that are overheated may lose potency. Administration of solutions that are too cold may cause a vestibular reaction that includes vomiting and dizziness. If the solution has been refrigerated, allow it to warm to room temperature. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 924 TOP: NURSING PROCESS: Implementation

1. Two patients arrive at the clinic; one is a young boy with sickle cell anemia, and another is a 57-year-old woman with early stages of Hodgkin's disease. The nurse notices that both patients need the same vaccine. What vaccine would that be? a. Varicella virus vaccine (Varivax) b. Herpes zoster vaccine (Zostavax) c. Hepatitis B virus vaccine, inactivated (Recombivax HB) d. Haemophilus influenzae type b (Hib) vaccine

ANS: D H. influenzae type b conjugate vaccine is usually given to patients with one of these disorders: sickle cell anemia, an immunodeficiency syndrome, Hodgkin's disease, and others. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 788 TOP: NURSING PROCESS: Assessment

8. The nurse is administering an interferon and will implement which intervention? a. Giving the medication with meals b. Monitoring daily weights c. Limiting fluids while the patient is taking this medication d. Rotating sites if administered subcutaneously

ANS: D Interferon is given parenterally (not orally), and injection sites need to be rotated. Fluids need to be increased during interferon therapy. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 766 TOP: NURSING PROCESS: Implementation

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

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

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

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

9. Cyclosporine is prescribed for a patient who had an organ transplant. The nurse will monitor the patient for which common adverse effect? a. Nausea and vomiting b. Fever and tremors c. Agitation d. Hypertension

ANS: D Moderate hypertension may occur in as much as 50% of patients taking cyclosporine. The other options are potential adverse effects of other immunosuppressant drugs. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 777 TOP: NURSING PROCESS: Evaluation

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

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

1. The nurse is discussing adverse effects of antitubercular drugs with a patient who has active tuberculosis. Which potential adverse effect of antitubercular drug therapy should the patient report to the prescriber? a. Gastrointestinal upset b. Headache and nervousness c. Reddish-orange urine and stool d. Numbness and tingling of extremities

ANS: D Patients on antitubercular therapy should report experiencing numbness and tingling of extremities, which may indicate peripheral neuropathy. Some drugs may color the urine, stool, and other body secretions reddish-orange, but this is not an effect that needs to be reported. Patients need to be informed of this expected effect. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 668 TOP: NURSING PROCESS: Implementation

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

ANS: D Polyethylene glycol is a very potent laxative that induces total cleansing of the bowel and is most commonly used before diagnostic or surgical bowel procedures. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 822 TOP: NURSING PROCESS: Planning

9. A patient is experiencing the exoerythrocytic phase of malaria. The nurse expects which drug to be used for this patient? a. Quinine b. Chloroquine (Aralen) c. Mefloquine (Lariam) d. Primaquine

ANS: D Primaquine is one of the few antimalarial drugs that can destroy the malarial parasites while they are in their exoerythrocytic phase. The other drugs are effective during the erythrocytic, or blood, phase. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 683 TOP: NURSING PROCESS: Assessment

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

ANS: D Probiotics work by replenishing bacteria that may have been destroyed by antibiotic therapy, thus restoring the balance of normal flora and suppressing the growth of diarrhea-causing bacteria. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 815 TOP: NURSING PROCESS: Implementation

4. A woman is traveling to a country where she will be at high risk for malarial infection. What will the nurse teach her regarding prophylactic therapy with hydroxychloroquine (Plaquenil)? a. Hydroxychloroquine is better absorbed and has fewer adverse effects if taken on an empty stomach. b. The drug is started 3 weeks before exposure but can be discontinued once she leaves the area. c. The medication is taken only when she observes mosquito bites because it can have toxic effects if taken unnecessarily. d. The drug is usually started 1 to 2 weeks before traveling to endemic areas and is continued for 4 weeks after leaving the area.

ANS: D Prophylaxis of malaria with hydroxychloroquine is usually started 1 to 2 weeks before exposure and continued for 4 weeks after the person has left the area. The medication should be taken with food to decrease gastrointestinal upset. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 683 TOP: NURSING PROCESS: Implementation

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

ANS: D Restasis can be used together with artificial tears if the drugs are given 15 minutes apart. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 917 TOP: NURSING PROCESS: Implementation

3. The nurse will assess the patient for which potential contraindication to antitubercular therapy? a. Glaucoma b. Anemia c. Heart failure d. Hepatic impairment

ANS: D Results of liver function studies (e.g., bilirubin level, liver enzyme levels) need to be assessed because isoniazid and rifampin may cause hepatic impairment; severe liver dysfunction is a contraindication to these drugs. In addition, the patient's history of alcohol use needs to be assessed. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 662 TOP: NURSING PROCESS: Assessment

5. A patient asks about using minoxidil (Rogaine) for hair thinning. Which statement about minoxidil is accurate? a. The product is applied once daily in the morning. b. Systemic absorption of topically applied minoxidil is rare. c. Results may be seen as soon as 2 weeks after beginning therapy. d. Systemic absorption may cause tachycardia, fluid retention, and weight gain.

ANS: D Results of minoxidil therapy may not be seen for 4 months after beginning therapy. The product is applied twice daily, morning and evening, and systemic effects may result because of absorption. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 893 TOP: NURSING PROCESS: Implementation

10. A patient newly diagnosed with tuberculosis (TB) has been taking antitubercular drugs for 1 week calls the clinic and is very upset. He says, "My urine is dark orange! What's wrong with me?" Which response by the nurse is correct? a. "You will need to stop the medication, and it will go away." b. "It's possible that the TB is worse. Please come in to the clinic to be checked." c. "This is not what we usually see with these drugs. Please come in to the clinic to be checked." d. "This is an expected side effect of the medicine. Let's review what to expect."

ANS: D Rifampin, one of the first-line drugs for TB, causes a red-orange-brown discoloration of urine, tears, sweat, and sputum. Patients need to be warned about this side effect. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 668 TOP: NURSING PROCESS: Assessment

3. A patient who is being treated for malaria has started therapy with quinine and tetracycline. He asks the nurse why he is on an antibiotic when malaria is caused by a parasite. Which response by the nurse is correct? a. "The tetracycline prevents reinfection by the malarial parasite." b. "The antibiotic is combined with quinine to reduce the side effects of the quinine." c. "An antibacterial drug prevents the occurrence of superinfection during antimalarial therapy." d. "The two drugs are more effective against malaria when given together."

ANS: D The combination of quinine and tetracycline takes advantage of their synergistic protozoacidal effects. The other responses are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 681 TOP: NURSING PROCESS: Implementation

4. The nurse is preparing to administer an injection of monoclonal antibodies. Which additional drug will the nurse administer to minimize adverse reactions to the monoclonal antibodies? a. A nonsteroidal anti-inflammatory drug b. A benzodiazepine c. An opioid pain reliever d. A corticosteroid

ANS: D The monoclonal antibodies basiliximab and daclizimab have a tendency to cause the allergy-like reaction known as cytokine release syndrome, which can be severe and even involve anaphylaxis. In an effort to avoid or alleviate this problem, it is recommended that an injection of a corticosteroid, such as methylprednisolone, be administered before the injection of monoclonal antibodies. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 773 TOP: NURSING PROCESS: Implementation

5. A mother brings her toddler into the emergency department and tells the nurse that she thinks the toddler has eaten an entire bottle of chewable aspirin tablets. The nurse will assess for which most common signs of salicylate intoxication in children? a. Photosensitivity and nervousness b. Tinnitus and hearing loss c. Acute gastrointestinal bleeding d. Hyperventilation and drowsiness

ANS: D The most common manifestations of chronic salicylate intoxication in adults are tinnitus and hearing loss. Those in children are hyperventilation and CNS effects, such as dizziness, drowsiness, and behavioral changes. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 696 TOP: NURSING PROCESS: Implementation

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

ANS: D The normal range for neutrophils is above 1500 cells/mm3. If neutrophils are decreased to levels of less than 500 cells/mm3 (neutropenia), there is risk for severe infection. Chemotherapy will be held until the count returns toward normal levels. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 744 TOP: NURSING PROCESS: Evaluation

3. A patient has an order for cyclosporine (Sandimmune). The nurse finds that cyclosporine-modified (Neoral) is available in the automated medication cabinet. Which action by the nurse is correct? a. Hold the dose until the prescriber makes rounds. b. Give the cyclosporine-modified drug. c. Double-check the order, and then give the cyclosporine-modified drug. d. Notify the pharmacy to obtain the Sandimmune form of the drug.

ANS: D The nurse must double-check the formulation before giving cyclosporine. Cyclosporine-modified products (such as Neoral or Gengraf) are interchangeable with each other but are not interchangeable with Sandimmune. In this case, the nurse must obtain the Sandimmune form of the drug from the pharmacy. The other options are incorrect. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 778 TOP: NURSING PROCESS: Implementation

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

ANS: D The symptoms of stomatitis consist of pain or burning in the mouth, difficulty swallowing, taste changes, viscous saliva, dryness, cracking, and fissures, with or without bleeding mucosa. Teach patients to avoid consuming foods containing citric acid and foods that are hot or spicy or high in fiber. Assessing stools is important but is not related to stomatitis, and aspirin must not be used during this therapy. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 731 TOP: NURSING PROCESS: Implementation

9. A patient accidentally took an overdose of the anticoagulant warfarin (Coumadin), and the nurse is preparing to administer vitamin K as an antidote. Which statement about vitamin K is accurate? a. The vitamin K dose will be given intramuscularly. b. The patient will take oral doses of vitamin K after the initial injection. c. The vitamin K cannot be given if the patient has renal disease. d. The patient will be unresponsive to warfarin therapy for 1 week after the vitamin K is given.

ANS: D When vitamin K is used as an antidote to warfarin therapy, the patient becomes unresponsive to warfarin for approximately 1 week after vitamin K administration. The use of vitamin K products is contraindicated in patients who are in the last few weeks of pregnancy and in patients with severe hepatic disease. Vitamin K is given subcutaneously and not intramuscularly when used to reverse warfarin effects. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 847 TOP: NURSING PROCESS: Implementation

3. During a patient's therapy with interleukins, the nurse monitors the patient for capillary leak syndrome. Which assessment finding, if present, would indicate this problem? a. Bradycardia b. A dry cough c. Bruising on the skin d. A sudden, 15-pound weight gain

ANS: D With capillary leak syndrome, the capillaries lose their ability to retain vital colloids, and these substances migrate into the surrounding tissues, resulting in massive fluid retention. As a result, heart failure, myocardial infarction, and dysrhythmias may occur. The other options do not reflect capillary leak syndrome. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 760 TOP: NURSING PROCESS: Assessment

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

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

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

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

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

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

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

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

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

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

A woman has been receiving both radiation and chemotherapy for her cancer. Lately, she has developed anorexia caused by the treatments, so she needs short-term nutrition supplementation. The nurse anticipates that the physician will initiate which therapy? a. Central total parenteral nutrition b. Peripheral parenteral nutrition c. Oral nutritional supplements with meals d. Nasogastric enteral supplementation

B

The nurse is preparing to administer medications to a patient who is receiving a feeding via a gastric tube. When reviewing the patient's medication list, the nurse notes a potential concern about a food-drug interaction if which medication is listed? a. Multivitamin solution b. Phenytoin (Dilantin) c. Metoclopramide (Reglan) d. Warfarin (Coumadin)

B

When monitoring a patient who has been receiving peripheral parenteral nutrition for more than 3 weeks, the nurse will watch for which potential complication? a. Diarrhea b. Phlebitis c. Hypernatremia d. Hypoglycemia

B

The nurse is administering a parenteral nutrition infusion to a patient. The nurse will implement which measures to prevent infection? (Select all that apply.) a. Change the intravenous tubing set every 72 hours. b. Change the intravenous tubing set every time a new bag is added to the infusion. c. Use a 1.2-micron filter with each tubing set. d. Monitor the patient's temperature every shift during the infusion. e. Report any increase in the patient's temperature over 100° F (37.8° C).

B, C, E

A patient with type 2 diabetes will be receiving a nasogastric tube feeding for a few days. The nurse expects which type of formula to be used? a. Jevity b. Ensure Plus c. Glucerna d. Polycose

C

A patient has been receiving total parenteral nutrition. Upon assessment, the nurse notes these assessment findings: blood pressure 150/92 mm Hg (elevated from previous readings); pulse rate 110 beats/min and weak; pitting edema on both ankles; and new-onset confusion. The nurse suspects that the patient is experiencing which condition? a. Infection b. Hypoglycemia c. Hyperglycemia d. Fluid overload

D

During the night shift, a patient's total parenteral nutrition (TPN) infusion ran out, and the nurse discovered that there was no TPN solution on hand to continue the infusion. The pharmacy is closed and will not reopen for 5 hours. The nurse will have to implement measures to prevent which consequence of abruptly discontinuing TPN infusions? a. Dehydration b. Hyperglycemia c. Dumping syndrome d. Rebound hypoglycemia

D