Chapter 01: The Nursing Process and Drug Therapy

A patient tells the nurse that he likes to drink kava herbal tea to help him relax. Which statement by the patient indicates that additional teaching about this herbal product is needed?

"I will be able to drive my car after drinking this tea."

The nurse has given medication instructions to a patient receiving phenytoin (Dilantin). Which statement by the patient indicates that the patient has an adequate understanding of the instructions?

"I will need to take extra care of my teeth and gums while on this medication."

A patient calls the clinic to speak to the nurse about taking an herbal product that contains ginkgo (Ginkgo biloba) to "help my memory." He states that he has read much information about the herbal product. Which statement by the patient indicates a need for further education?

"I will take aspirin or ibuprofen (Motrin) if I have a headache."

The nurse is teaching a patient how to self-administer triptan injections for migraine headaches. Which statement by the patient indicates that he needs further teaching?

"I will take this medication regularly to prevent a migraine headache from occurring."

The wife of a patient who has been diagnosed with depression calls the office and says, "It's been an entire week since he started that new medicine for his depression, and there's no change! What's wrong with him?" What is the nurse's best response?

"It may take up to 6 weeks to notice any therapeutic effects. Let's wait a little longer to see how he does."

A patient has been taking donepezil (Aricept) for 2 weeks as part of the treatment for early stages of Alzheimer's disease. Her daughter calls the prescriber's office and is upset because "Mother has not improved one bit!" Which response by the nurse is appropriate?

"It may take up to 6weeks to see an improvement"

A 25-year-old woman is visiting the prenatal clinic and shares with the nurse her desire to go "natural" with her pregnancy. She shows the nurse a list of herbal remedies that she wants to buy so that she can "avoid taking any drugs." Which statement by the nurse is correct?

"It's important to remember that herbal remedies do not have proven safety ratings for pregnant women."

When given a scheduled morning medication, the patient states, "I haven't seen that pill before. Are you sure it's correct?" The nurse checks the medication administration record and verifies that it is listed. Which is the nurse's best response?

"Let me check on the order first before you take it."

A patient with the diagnosis of schizophrenia is hospitalized and is taking a phenothiazine drug. Which statement by this patient indicates that he is experiencing a common adverse effect of phenothiazines?

"My mouth has been so dry lately."

A 38-year-old male patient stopped smoking 6 months ago. He tells the nurse that he still feels strong cigarette cravings and wonders if he is ever going to feel "normal" again. Which statement by the nurse is correct?

"These cravings may persist for several months."

During a nursing assessment, which question by the nurse allows for greater clarification and additional discussion with the patient?

"What medications do you take?"

A patient arrives at the urgent care center complaining of leg pain after a fall when rock climbing. The x-rays show no broken bones, but he has a large bruise on his thigh. The patient says he drives a truck and does not want to take anything strong because he needs to stay awake. Which statement by the nurse is most appropriate?"

"You can take acetaminophen, also known as Tylenol, for pain, but no more than 3000 mg per day."

A patient has been taking the monoamine oxidase inhibitor (MAOI) phenelzine (Nardil) for 6 months. The patient wants to go to a party and asks the nurse, "Will just one beer be a problem?" Which advice from the nurse is correct?

"You need to avoid all foods that contain tyramine, including beer, while taking this medication."

The nurse is reviewing antiepileptic drug (AED) therapy. Which statements about AED therapy are accurate? (Select all that apply.)

-AED therapy is usually lifelong. -Consistent dosing is the key to controlling seizures. -Do not abruptly discontinue AEDs because doing so may cause rebound seizure activity.

Which are appropriate considerations when the nurse is assessing the learning needs of a patient? (Select all that apply.)

-Cultural background -Level of education -Readiness to learn -Health beliefs

The nurse is presenting information to a class of students about adrenergic drugs. Which are the effects of drugs that stimulate the sympathetic nervous system? (Select all that apply.)

-Dilation of bronchioles -Increased heart rate -Dilated pupils -Glycogenolysis

Which drugs would be affected by the first-pass effect? (Select all that apply.)

-Diphenhydramine (Benadryl) elixir -Levothyroxine (Synthroid) tablets -Esomeprazole (Nexium) capsules

A beta blocker is prescribed for a patient with angina. The nurse reviews the orders for other drugs that may interact with the beta blocker. Which drugs or drug classes are known to have an interaction with a beta blocker? (Select all that apply.)

-Diuretics -Anticholinergics -Oral hypoglycemics -Anticoagulants

A cholinergic drug is prescribed for a patient. The nurse checks the patient's medical history, knowing that this drug is contraindicated in which disorders? (Select all that apply.)

-Gastrointestinal obstruction -Bradycardia -Hypotension -Chronic obstructive pulmonary disease

The nurse is reviewing the use of central nervous system stimulants. Which of these are indications for this class of drugs? (Select all that apply.)

-Narcolepsy -Neonatal apnea -Attention deficit hyperactivity disorder (ADHD) -Appetite suppression

The nurse is preparing to administer a barbiturate. Which conditions or disorders would be a contraindication to the use of these drugs? (Select all that apply.)

-Pregnancy -Severe chronic obstructive pulmonary disease -Severe liver disease

A patient has been taking disulfiram (Antabuse) as part of his rehabilitation therapy. However, this evening, he attended a party and drank half a beer. As a result, he became ill and his friends took him to the emergency department. The nurse will look for which adverse effects associated with acetaldehyde syndrome? (Select all that apply.)

-Severe vomiting -Pulsating headache -difficulty breathing -sweating

Which statements are true regarding the elderly and pharmacokinetics? (Select all that apply.)

-The levels of microsomal enzymes are decreased. - Fat content is increased because of decreased lean body mass. -The number of intact nephrons is decreased. -Gastric pH is less acidic.

The nurse is performing an admission assessment. Which findings reflect components of a cultural assessment? (Select all that apply.)

-The patient uses aspirin as needed for pain. -The patient uses herbal tea to relax in the evenings. -The patient does not speak English. -The patient does not eat pork products for religious reasons.

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

0.088 mg

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

0.3mL 1mg:1mL (1x X)=(1x 0.3) 1x=0.3 x=0.3mL

An agitated patient is to receive an intravenous dose of diazepam (Valium). The order reads, "Give diazepam, 2 mg, IV push, now. Repeat in 15 minutes if needed." Identify how many milliliters will the nurse administer for this dose. The medication vial contains 5 mg/mL. _______

0.4mL 5mg: 1mL (5x X)=(1x2) 5x=2 x=0.4mL

A patient is to receive codeine, 40 mg subcutaneously, every 6 hours as needed for pain. The solution is available in a concentration of 30 mg/mL. Identify how many milliliters of codeine will be drawn up for this dose. (record answer to one decimal place) _______

1.3 mL 30 mg: 1mL 40 mg x mL (30 x X) = (40 x 1), 30x=40 x= 1.3 mL

A 9-year-old child will be receiving carbamazepine (Tegretol) suspension, 200 mL daily. The medication is available in a strength of 100 mg/5 mL. Identify how many milliliters will the nurse give to the patient for each dose. _______

10 mL 100mg=5 mL: 200mg=xmL (100 x X)=(5 x 200): 100x=1000 x=10mL

The prescriber writes this order, "Give amantadine (Symmetrel) 100 mg per PEG tube twice a day." The medication is available in a liquid form with a concentration 50 mg/5 mL. Identify how many milliliters will the nurse give with each dose. _______

10 mL 50mg: 5mL (50 x X)=(5x100) 50x=500 x=10mL

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

125 mcg

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

125 mg

A patient is to receive midazolam (Versed) 2 mg IV push over 2 minutes just before an endoscopy procedure. The medication is available in a strength of 1 mg/mL. Identify how many milliliters of medication will the nurse draw up into the syringe for this dose. _______

2 mL (1 x X)= (1 x 2) 1x=2 x=2mL

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

2 tablets (3.125 x X)=(1x6.25) 3.125x=6.25 x=2

A 7-year-old child will be receiving amoxicillin (Amoxil) 80 mg/kg/day in two divided doses. The child weighs 55 pounds. The medication, once reconstituted, is available as an oral suspension of 50 mg/mL. Identify how many milliliters will the child receive per dose. _______

20 mL

The order reads, "Give atomoxetine (Strattera) 0.5 mg/kg/day once daily in the morning before school." The child weighs 88 pounds. Identify how many milligrams will be administered per dose. _______

20 mg 88 pounds / 2.2= 40 kg 0.5mg/kg/day x 40 kg= 20mg/day

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

3 tablets

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

5mL 2mg:1mL (2 x X)=(1 x 10) 2x=10x x=5mL

A patient is to receive a penicillin intramuscular (IM) injection in the ventrogluteal site. The nurse will use which angle for the needle insertion?

90 degrees

The nurse is reviewing medication errors. Which situation is an example of a medication error?

A patient receives a double dose of a medication because the nurse did not cut the pill in half.

The nurse is assessing a patient for contraindications to drug therapy with acetaminophen (Tylenol). Which patient should not receive acetaminophen?

A patient with a history of liver disease

During the development of a new drug, which would be included in the study by the researcher to prevent any bias or unrealistic expectations of the new drug's usefulness?

A placebo

During an admission assessment, the nurse discovers that the patient does not speak English. Which is considered the ideal resource for translation?

A translator who does not know the patient

When the nurse teaches a skill such as self-injection of insulin to the patient, what is the best way to set up the teaching/learning session?

After demonstrating the procedure, allow the patient to do several return demonstrations.

The nurse recognizes that it is not uncommon for an elderly patient to experience a reduction in the stomach's ability to produce hydrochloric acid. This change may result in which effect?

Altered absorption of weakly acidic drugs

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

Anticoagulants

The nurse reads in the patient's medication history that the patient is taking buspirone (BuSpar). The nurse interprets that the patient may have which disorder?

Anxiety disorder

The nurse is writing a nursing diagnosis for a plan of care for a patient who has been newly diagnosed with type 2 diabetes. Which statement reflects the correct format for a nursing diagnosis?

Anxiety related to a new drug therapy, as evidenced by statements such as "I'm upset about having to test my blood sugars."

When administering a neuromuscular blocking drug, the nurse needs to remember which NURSINGTB.COM principle?

Artificial mechanical ventilation is required because of paralyzed respiratory muscles.

A 60-year-old patient is on several new medications and expresses worry that she will forget to take her pills. Which action by the nurse would be most helpful in this situation?

Assisting the patient with obtaining and learning to use a calendar or pill container

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

Asthma

A patient has had an overdose of an intravenous cholinergic drug. The nurse expects to administer which drug as an antidote?

Atropine sulfate

A patient is undergoing major surgery and asks the nurse about a living will. He states, "I don't want anybody else making decisions for me. And I don't want to prolong my life." The patient is demonstrating which ethical term?

Autonomy

The nurse recognizes that adrenergic drugs cause relaxation of the bronchi and bronchodilation by stimulating which type of receptors?

Beta2 adrenergic

The patient is receiving two different drugs. At current dosages and dosage forms, both drugs are absorbed into the circulation in identical amounts. Which term is used to identify this principle?

Bioequivalent

When monitoring a patient who is taking a low-dose cholinergic drug, the nurse will watch for which cardiovascular effect?

Bradycardia

A patient has been given a prescription for levodopa-carbidopa (Sinemet) for her newly diagnosed Parkinson's disease. She asks the nurse, "Why are there two drugs in this pill?" The nurse's best response reflects which fact?

Carbidopa prevents the breakdown of levodopa in the periphery

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

Cognitive

Vicodin (acetaminophen/hydrocodone) is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication? (Select all that apply.)

Constipation Lightheadedness Urinary retention Itching

The nurse is preparing to administer dopamine. Which is the correct technique for administering dopamine?

Continuous IV infusion with an infusion pump

A patient is suffering from tendonitis of the knee. The nurse is reviewing the patient's medication administration record and recognizes that which adjuvant medication is most appropriate for this type of pain?

Corticosteroid

During the immediate postoperative period, the Post Anesthesia Care Unit nurse is assessing a patient who had hip surgery. The patient is experiencing tachycardia, tachypnea, and muscle rigidity, and his temperature is 103° F (39.4° C). The nurse will prepare for what immediate treatment?

Dantrolene (Dantrium) injection, a skeletal muscle relaxant

The nurse is setting up a teaching session with an 85-year-old patient who will be going home on anticoagulant therapy. Which educational strategy would reflect consideration of the age-related changes that may exist with this patient?

Develop large-print handouts that reflect the verbal information presented.

Drug transfer to the fetus is more likely during the last trimester of pregnancy for which reason?

Enhanced blood flow to the fetus

A hospitalized patient is experiencing a severe anaphylactic reaction to a dose of intravenous penicillin. Which drug will the nurse expect to use to treat this condition?

Epinephrine

A patient has experienced insomnia for months, and the physician has prescribed a medication to help with this problem. The nurse expects which drug to be used for long-term treatment of insomnia?

Eszopiclone (Lunesta), a nonbenzodiazepine sleep aid

The nurse has been monitoring the patient's progress on a new drug regimen since the first dose and documenting the patient's therapeutic response to the medication. Which phase of the nursing process do the actions illustrate?

Evaluation

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

Excretion

An 83-year-old woman has been given a thiazide diuretic to treat mild heart failure. She and her daughter should be told to watch for which problems?

Fatigue, leg cramps, and dehydration

The nurse is presenting a substance-abuse lecture for teenage girls and is asked about "roofies." The nurse recognizes that this is the slang term for which substance?

Flunitrazepam

The nurse is administering an IV push medication through an IV lock. After injecting the medication, which action will be taken next?

Flushing the lock

The nurse notes in a patient's medication history that the patient is taking pilocarpine (Pilocar). Based on this finding, the nurse interprets that the patient has which disorder?

Glaucoma

A 50-year-old man who has been taking phenobarbital for 1 week is found very lethargic and unable to walk after eating out for dinner. His wife states that he has no other prescriptions and that he did not take an overdose—the correct number of pills is in the bottle. The nurse suspects that which of these may have happened?

He drank a glass of wine.

A patient is being treated for ethanol alcohol abuse in a rehabilitation center. The nurse will include which information when teaching him about disulfiram (Antabuse) therapy?

He needs to know about the common over-the-counter substances that contain alcohol.

Carbidopa-levodopa (Sinemet) is prescribed for a patient with Parkinson's disease. The nurse informs the patient that which common adverse effects can occur with this medication?

Heart palpitations, hypotension, urinary retention

A 10-year-old patient will be started on methylphenidate hydrochloride (Ritalin) therapy. The nurse will perform which essential baseline assessment before this drug is started?

Height and weight

A 38-year-old man has come into the urgent care center with severe hip pain after falling from a ladder at work. He says he has taken several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol). The nurse is aware that the most serious toxic effect of acute acetaminophen overdose is which condition?

Hepatic necrosis

A patient is recovering from abdominal surgery, which he had this morning. He is groggy but complaining of severe pain around his incision. What is the most important assessment data to consider before the nurse administers a dose of morphine sulfate to the patient?

His respiratory rate

A patient will be discharged with a 1-week supply of an opioid analgesic for pain management after abdominal surgery. The nurse will include which information in the teaching plan?

How to prevent constipation

A patient is undergoing abdominal surgery and has been anesthetized for 3 hours. Which nursing diagnosis would be appropriate for this patient?

Impaired gas exchange related to central nervous system depression produced by general anesthesia

A patient has been treated with antiparkinson medications for 3 months. What therapeutic responses should the nurse look for when assessing this patient?

Improved ability to perform activities of daily living

During an assessment, the patient tells the nurse that he eats large amounts of garlic for its cardiovascular benefits. Which drug or drug class, if taken, would have a potential interaction with the garlic?

Insulin

The nurse is discussing gene therapy in a continuing education class. Which is the best definition of eugenics?

Intentional selection, before birth, of genotypes that are considered more desirable than others

During initial rounds, the nurse notes that a dobutamine infusion has extravasated into the forearm of a patient. After stopping the infusion, the nurse follows standing orders and immediately injects phentolamine (Regitine) subcutaneously in a circular fashion around the extravasation site. What is the mechanism of action of the phentolamine in this situation?

It increases blood flow to the ischemic site by vasodilation to prevent tissue damage.

A patient has a new order for a catechol ortho-methyltransferase (COMT) inhibitor as part of treatment for Parkinson's disease. The nurse recognizes that which of these is an advantage of this drug class?

It is associated with fewer wearing-off effects.

Ramelteon (Rozerem) is prescribed for a patient with insomnia. The nurse checks the patient's medical history, knowing that this medication is contraindicated in which disorder?

Liver disease

The nurse is assessing the medication history of a patient with a new diagnosis of Parkinson's disease. Which condition is a contraindication for the patient, who will be taking tolcapone (Tasmar)?

Liver failure

A patient in a rehabilitation center is beginning to experience opioid withdrawal symptoms. The nurse expects to administer which drug as part of the treatment?

Methadone

When discussing dosage calculation for pediatric patients with a clinical pharmacist, the nurse notes that which type of dosage calculation is used most commonly in pediatric calculations?

Milligram per kilogram of body weight formula

The nurse is giving an intravenous dose of phenytoin (Dilantin). Which action is correct when administering this drug?

Mix the drug with normal saline, and give it as a slow IV push.

A patient is being prepared for an oral endoscopy, and the nurse anesthetist reminds him that he will be awake during the procedure but probably will not remember it. What type of anesthetic technique is used in this situation?

Moderate sedation

A patient is receiving a dose of edrophonium (Tensilon). The nurse recognizes that this drug is given to determine the diagnosis of which disease?

Myasthenia gravis

For which cultural group must the health care provider respect the value placed on preserving harmony with nature and the belief that disease is a result of ill spirits?

Native Americans

During a busy night shift, a new nurse administered an unfamiliar medication without checking it in a drug handbook. Later that day, the patient had a severe reaction because he has renal problems, which was a contraindication to that drug. The nurse may be liable for which of these?

Nursing negligence

The nurse is preparing to give an injection to a 4-year-old child. Which intervention is age appropriate for this child?

Offer a brief, concrete explanation of the procedure at the patient's level and with the parent or caregiver present.

A patient has been treated for lung cancer for 3 years. Over the past few months, the patient has noticed that the opioid analgesic is not helping as much as it had previously and more medication is needed for the same pain relief. The nurse is aware that this patient is experiencing which of these?

Opioid tolerance

For accurate medication administration to pediatric patients, the nurse must take into account which criteria?

Organ maturity

A patient is taking an alpha blocker as treatment for benign prostatic hyperplasia. The nurse will monitor for which potential drug effect?

Orthostatic hypotension

A patient is receiving gabapentin (Neurontin), an anticonvulsant, but has no history of seizures. The nurse expects that the patient is receiving this drug for which condition?

Pain associated with peripheral neuropathy

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

Palliative therapy

A patient wants to take a ginseng dietary supplement. The nurse instructs the patient to look for which potential adverse effect?

Palpitations and anxiety

A patient who has had abdominal surgery has been discharged on a cholinergic drug to assist in increasing gastrointestinal peristalsis. The nurse will teach this patient to look for which therapeutic effect?

Passage of flatus

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

Pharmacologic reaction

A member of an investigational drug study team is working with healthy volunteers whose participation will help to determine the optimal dosage range and pharmacokinetics of the drug. The team member is participating in what type of study?

Phase I

The nurse is reviewing the dosage schedule for several different antiepileptic drugs (AEDs). Which antiepileptic drug allows for once-a-day dosing?

Phenobarbital

When an adrenergic drug stimulates beta1-adrenergic receptors, the result is an increased force of contraction, which is known as what type of effect?

Positive inotropic

The nurse is reviewing facts about pharmacology for a review course. The term legend drug refers to which item?

Prescription drugs

A patient is taking flurazepam (Dalmane) three to four nights a week for sleeplessness. She is concerned that she cannot get to sleep without taking the medication. What nonpharmacologic measures should the nurse suggest to promote sleep for this patient?

Providing a quiet environment

Which activity BEST reflects the implementation phase of the nursing process for the patient who is newly diagnosed with hypertension?

Providing education on keeping a journal of blood pressure readings

When taking a telephone order for a medication, which action by the nurse is most appropriate?

Repeat the order to the prescriber before hanging up the telephone.

The nurse is assessing a patient who has been admitted to the emergency department for a possible opioid overdose. Which assessment finding is characteristic of an opioid drug overdose?

Respiration rate of 6 breaths/min

The patient is to receive oral guaifenesin (Mucinex) twice a day. Today, the nurse was busy and gave the medication 2 hours after the scheduled dose was due. What type of problem does this represent?

Right Time

When giving medications, the nurse will follow the rights of medication administration. The rights include the right documentation, the right reason, the right response, and the patient's right to refuse. Which of these are additional rights? (Select all that apply.)

Right drug Right route Right dose Right time Right patient

A patient is recovering from a minor automobile accident that occurred 1 week ago. He is taking cyclobenzaprine (Flexeril) for muscular pain and goes to physical therapy three times a week. Which nursing diagnosis would be appropriate for him?

Risk for injury related to decreased sensorium

The nurse is reviewing the food choices of a patient who is taking a monoamine oxidase inhibitor ( MAOI). Which food choice would indicate the need for additional teaching?

Salami and Swiss cheese sandwich

The nurse is aware that confusion, forgetfulness, and increased risk for falls are common responses in an elderly patient who is taking which type of drug?

Sedatives

A patient has a new prescription for tamsulosin (Flomax) as treatment for benign prostatic hyperplasia. The nurse is checking his current medication list and will contact the prescriber regarding a potential interaction if the patient is also taking which drug?

Sildenafil (Viagra), an erectile dysfunction medication

A 29-year-old male patient is admitted to the intensive care unit with the following symptoms: restlessness, hyperactive reflexes, talkativeness, confusion and periods of panic and euphoria, tachycardia, and fever. The nurse suspects that he may be experiencing the effects of taking which substance?

Stimulants

A patient who has been diagnosed with Sjögren's syndrome will be given cevimeline for the treatment of xerostomia. The nurse will monitor for what therapeutic effect?

Stimulation of salivation

The nurse will be injecting a drug into the fatty tissue of the patient's abdomen. Which route does this describe?

Subcutaneous

The nurse is aware that adrenergic drugs produce effects similar to which of these nervous systems?

Sympathetic nervous system

A patient has been taking the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft) for about 6 months. At a recent visit, she tells the nurse that she has been interested in herbal NURSINGTB.COM therapies and wants to start taking St. John's wort. Which response by the nurse is appropriate?

Taking St. John's wort with Zoloft may cause severe interactions and is not recommended."

When assessing patients in the preoperative area, the nurse knows that which patient is at a higher risk for an altered response to anesthesia?

The 82-year-old patient who is to have gallbladder removal

When reviewing the mechanism of action of a specific drug, the nurse reads that the drug works by selective enzyme interaction. Which of these processes describes selective enzyme interaction?

The drug binds to an enzyme molecule and inhibits or enhances the enzyme's action with the normal target cell.

During a routine appointment, a patient with a history of seizures is found to have a phenytoin (Dilantin) level of 23 mcg/mL. What concern will the nurse have, if any?

The drug level is at a toxic level, and the dosage needs to be reduced.

A 22-year-old patient has been taking lithium for 1 year, and the most recent lithium level is 0.9 mEq/L. Which statement about the laboratory result is correct?

The lithium level is therapeutic.

The nurse is administering drugs to neonates and will consider which factor may contribute the most to drug toxicity?

The liver is not fully developed.

The nurse will plan to use the Z-track method of intramuscular (IM) injections for which situation?

The medication is known to be irritating to tissues.

When treating patients with medications for Parkinson's disease, the nurse knows that the wearing-off phenomenon occurs for which reason?

The medications begin to lose effectiveness against Parkinson's disease.

A patient has been selected as a potential recipient of an experimental drug for heart failure. The nurse knows that when informed consent has been obtained, it indicates which of these?

The patient has had the study's purpose, procedures, and the risks involved explained to him.

During therapy with a beta blocker, the patient notices that she has swollen feet, has gained 3 pounds within 2 days, feels short of breath even when walking around the house, and has been dizzy. The nurse suspects that which of these is occurring?

The patient may be developing heart failure.

During discharge patient teaching, the nurse reviews prescriptions with a patient. Which statement is correct about refills for an analgesic that is classified as Schedule C-III?

The patient may have no more than five refills in a 6-month period.

Chlorpromazine (Thorazine) is prescribed for a patient, and the nurse provides instructions to the patient about the medication. The nurse includes which information?

The patient needs to wear sunscreen while outside because of photosensitivity.

The nurse is performing an assessment of a newly admitted patient. Which is an example of subjective data?

The patient reports that he uses the herbal product ginkgo.

The nurse is assessing a newly admitted 83-year-old patient and determines that the patient is experiencing polypharmacy. Which statement most accurately illustrates polypharmacy?

The patient uses multiple medications simultaneously.

An elderly patient with a new diagnosis of hypertension will be receiving a new prescription for an antihypertensive drug. The nurse expects which type of dosing to occur with this drug therapy?

The patient will receive the lowest possible dose at first, and then the dose will be increased as needed.

When administering drugs, the nurse remembers that the duration of action of a drug is defined as which of these?

The time period at which a drug's concentration is sufficient to cause a therapeutic response

The nurse is reviewing a list of scheduled drugs and notes that Schedule C-I drugs are not on the list. Which is a characteristic of Schedule C-I drugs?

They are used only with approved protocols.

The drug nalbuphine (Nubain) is an agonist-antagonist (partial agonist). The nurse understands that which is a characteristic of partial agonists?

They have a lower dependency potential than agonists.

A patient taking entacapone (Comtan) for the first time calls the clinic to report a dark discoloration of his urine. After listening to the patient, the nurse realizes that what is happening in this situation?

This is a harmless effect of the drug.

A patient has been taking haloperidol (Haldol) for 3 months for a psychotic disorder, and the nurse is concerned about the development of extrapyramidal symptoms. The nurse will monitor the patient closely for which effects?

Tremors and muscle twitching

When adding medications to a bag of intravenous (IV) fluid, the nurse will use which method to mix the solution?

Turning the bag or bottle gently from side to side

The nurse is developing a care plan for a patient who is taking an anticholinergic drug. Which nursing diagnosis would be appropriate for this patient?

Urinary retention

The nurse is administering parenteral drugs. Which statement is true regarding parenteral drugs?

a. Parenteral drugs bypass the first-pass effect.

After administering an intradermal (ID) injection for a skin test, the nurse notices a small bleb at the injection site. The best action for the nurse to take at this time is to:

do nothing

During a teaching session about self-monitoring while taking a beta blocker at home, the nurse has taught the patient to take his apical pulse daily for 1 minute. If the pulse rate decreases to less than 60 beats/min, the nurse will instruct the patient to:

notify his prescriber.

When teaching a patient about taking a newly prescribed antiepileptic drug (AED) at home, the nurse will include which instruction?

"Regular, consistent dosing is important for successful treatment."

A patient has been taking an AED for several years as part of his treatment for partial seizures. His wife has called because he ran out of medication this morning and wonders if he can go without it for a week until she has a chance to go to the drugstore. What is the nurse's best response?

"Stopping this medication abruptly may cause withdrawal seizures. A refill is needed right away."

A 58-year-old man has had a myocardial infarction (MI), has begun rehabilitation, and is ready for discharge. He is given a prescription for metoprolol (Lopressor) and becomes upset after reading the patient education pamphlet. "I don't have high blood pressure—why did my doctor give me this medicine?" Which explanation by the nurse is correct?

"Studies have shown that this medication has greatly increased survival rates in patients who have had a heart attack."

When given an intravenous medication, the patient says to the nurse, "I usually take pills. Why does this medication have to be given in the arm?" What is the nurse's best answer?

"The action of the medication will begin sooner when given intravenously."

A patient has been taking temazepam (Restoril) for intermittent insomnia. She calls the nurse to say that when she takes it, she sleeps well, but the next day she feels "so tired." Which explanation by the nurse is correct?

"These drugs affect the sleep cycle, resulting in daytime sleepiness."

A patient has just been told that she has the genetic markers for a severe type of breast cancer. After the patient meets with the physician, the patient's daughter asks the nurse, "What did the doctor tell my mother? She seems upset." What is the nurse's best response?

"This is information that your mother will need to discuss with you."

A 14-year-old patient has been treated for asthma for almost 4 months. Two weeks ago, she was given salmeterol as part of her medication regimen. However, her mother has called the clinic to report that it does not seem to work when her daughter is having an asthma attack. Which response by the nurse is appropriate?

"This medication is indicated for prevention of bronchospasms, not for relief of acute symptoms."

The patient has been taking an over-the-counter (OTC) acid-reducing drug because he has had "stomach problems" for several months. He tells the nurse that the medicine helps as long as he takes it, but once he stops it, the symptoms return. Which statement by the nurse is the best advice for this patient?

"Using this drug may relieve your symptoms, but it does not address the cause. You should be seen by your health care provider."

Which statements are true regarding pediatric patients and pharmacokinetics? (Select all that apply.)

- The levels of microsomal enzymes are decreased. - Perfusion to the kidneys may be decreased and may result in reduced renal function. -First-pass elimination is reduced because of the immaturity of the liver. -Gastric emptying is slowed because of slow or irregular peristalsis.

A patient who has been taking a selective serotonin reuptake inhibitor (SSRI) is complaining of "feeling so badly" when he started taking an over-the-counter St. John's wort herbal product at home. The nurse suspects that he is experiencing serotonin syndrome. Which of these are symptoms of serotonin syndrome? (Select all that apply.)

-Agitation -Tremors -Sweating

The nurse is monitoring a patient who is experiencing severe ethanol withdrawal. Which are signs and symptoms of severe ethanol withdrawal? (Select all that apply.)

-Agitation -Tremors -Systolic blood pressure higher than 200 mm Hg

When assessing the medication history of a patient with a new diagnosis of Parkinson's disease, which conditions are contraindications for the patient who will be taking carbidopa-levodopa? (Select all that apply.)

-Angle-closure glaucoma -History of malignant melanoma -Concurrent use of monoamine oxidase inhibitors (MAOIs)

The barbiturate phenobarbital is prescribed for a patient with epilepsy. While assessing the patient's current medications, the nurse recognizes that interactions may occur with which drugs? (Select all that apply.)

-Antihistamines -Opioids -Anticoagulants -Oral contraceptives

The nurse is reviewing the concept of drug polymorphism. Which factors contribute to drug polymorphism? (Select all that apply.)

-Inherited factors -The patient's diet and nutritional status -The patient's health beliefs and practices

The nurse is preparing to administer dexmedetomidine (Precedex) to a patient. Which is an appropriate indication for dexmedetomidine? (Select all that apply.)

-Procedural sedation -Surgeries of short duration -Sedation of mechanically ventilated patients

A patient has a new prescription for phentermine (Ionamin) as part of the treatment for weight loss. Which information will the nurse include when teaching this patient about a stimulant such as phentermine? (Select all that apply.)

-Take this medication in the morning -This drug is taken along with supervised exercise and suitable diet. -Use mouth rinses, sugarless gum, or hard candies to minimize dry mouth. -Avoid foods that contain caffeine, such as coffee, tea, and colas.

The nurse is reviewing the criteria for over-the-counter drugs. Which criteria for over-the- counter status in the United States are accurate? (Select all that apply.)

-The drug must be easy to use. -The consumer must be able to monitor the drug's effectiveness. -The drug must have a low potential for abuse.

The nurse is performing an assessment of a patient. Which assessment findings may indicate a higher risk for genetic disorders? (Select all that apply.)

-The patient's mother was diagnosed with breast cancer at 33 years of age. -The patient's sister has a history of both renal and lung cancer. -The patient has two uncles and a grandparent who have been diagnosed with Alzheimer's disease

Which statements are true regarding the selective serotonin reuptake inhibitors (SSRIs)? (Select all that apply.)

-Therapeutic effects may not be seen for about 4 to 6 weeks after the medication is started. -If the patient has been on an MAOI, a 2- to 5-week or longer time span is required before beginning an SSRI medication.

A nurse is providing teaching for a patient who will be taking varenicline (Chantix) as part of a smoking-cessation program. Which teaching points are appropriate for a patient taking this medication? (Select all that apply.)

-Use caution when driving because drowsiness may be a problem. -Notify the prescriber immediately if feelings of sadness or thoughts of suicide occur.

The nurse is conducting a class for senior citizens about the use of over-the-counter (OTC) drugs. Which statements are true regarding the use of OTC drugs? (Select all that apply.)

-Use of OTC drugs may delay treatment of serious ailments. -OTC drugs may relieve symptoms without addressing the cause of the problem. -Patients may misunderstand product labels and use the drugs improperly.

The nurse can prevent medication errors by following which principles? (Select all that apply.)

-Use two patient identifiers before giving medications. -Do not give a medication that another nurse has drawn up in a syringe. -Minimize the use of verbal and telephone orders.

The patient is complaining of a headache and asks the nurse which over-the-counter medication form would work the fastest to help reduce the pain. Which medication form will the nurse suggest?

A powder

A patient is receiving instructions regarding the use of caffeine. The nurse shares that caffeine should be used with caution if which of these conditions is present?

A history of peptic ulcers

The nurse notes in the patient's medication history that the patient is taking cyclobenzaprine (Flexeril). Based on this finding, the nurse interprets that the patient has which disorder?

A musculoskeletal injury

Which nursing diagnosis is appropriate for the patient who has just received a prescription for a new medication?

Deficient knowledge related to newly prescribed drug therapy

A 57-year-old woman being treated for end-stage breast cancer has been using a transdermal opioid analgesic as part of the management of pain. Lately, she has been experiencing breakthrough pain. The nurse expects this type of pain to be managed by which of these interventions?

Administering an immediate-release opioid

A 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually awakening, he requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is very lethargic and his respirations are shallow, with a rate of 7 per minute. The nurse prepares for which priority action at this time?

Administration of naloxone (Narcan)

Before beginning a patient's therapy with selective serotonin reuptake inhibitor (SSRI) antidepressants, the nurse will assess for concurrent use of which medications or medication class?

Anticoagulants

The nurse is administering a stat dose of epinephrine. Epinephrine is appropriate for which situation?

Cardiac arrest

A patient has been admitted to the emergency department with a suspected overdose of a tricyclic antidepressant. The nurse will prepare for what immediate concern?

Cardiac dysrhythmias

A patient is experiencing diastolic heart failure. The nurse expects which beta blocker to be ordered for this patient?

Carvedilol (Coreg)

The nurse is monitoring a patient who is in the 26th week of pregnancy and has developed gestational diabetes and pneumonia. She is given medications that pose a possible fetal risk, but the potential benefits may warrant the use of the medications in her situation. The nurse recognizes that these medications are in which U.S. Food and Drug Administration pregnancy safety category?

Category D

Before administering any medication, what is the nurse's priority action regarding patient safety?

Checking the patient's identification using two identifiers

A patient was diagnosed with pancreatic cancer last month, and has complained of a dull ache in the abdomen for the past 4 months. This pain has been gradually increasing, and the pain relievers taken at home are no longer effective. What type of pain is the patient experiencing?

Chronic pain

A patient has a 9-year history of a seizure disorder that has been managed well with oral phenytoin (Dilantin) therapy. He is to be NPO (consume nothing by mouth) for surgery in the morning. What will the nurse do about his morning dose of phenytoin?

Contact the prescriber for another dosage form of the medication.

During a period of time when the computerized medication order system was down, the prescriber wrote admission orders, and the nurse is transcribing them. The nurse is having difficulty transcribing one order because of the prescriber's handwriting. Which is the best action for the nurse to take at this time?

Contact the prescriber to clarify the order.

The medication order reads, "Give ondansetron (Zofran) 4 mg, 30 minutes before beginning chemotherapy to prevent nausea." The nurse notes that the route is missing from the order. What is the nurse's best action?

Contact the prescriber to clarify the route of the medication ordered.

The nurse is asking a patient about his family history as part of an assessment. Which component is included in an effective family history?

Covering at least three generations of family history

When a patient is receiving a second-generation antipsychotic drug, such as risperidone (Risperdal), the nurse will monitor for which therapeutic effect?

Decreased paranoia and delusions

When evaluating a patient who is taking orlistat (Xenical), which is an intended therapeutic effect?

Decreased weight

A patient is experiencing status epilepticus. The nurse prepares to give which drug of choice for the treatment of this condition?

Diazepam (Valium)

A patient who has received some traumatic news is panicking and asks for some medication to help settle down. The nurse anticipates giving which drug that is most appropriate for this situation?

Diazepam (Valium)

While a patient is receiving drug therapy for Parkinson's disease, the nurse monitors for dyskinesia, which is manifested by which finding?

Difficulty in performing voluntary movements

The nurse is reviewing a list of verbal medication orders. Which is the proper notation of the dose of the drug ordered?

Digoxin 0.125 mg

A patient is to receive acetylcysteine (Mucomyst) as part of the treatment for an acetaminophen (Tylenol) overdose. Which action by the nurse is appropriate when giving this medication?

Disguising the flavor with soda or flavored water

A 22-year-old nursing student has been taking NoDoz (caffeine) tablets for the past few weeks to "make it through" the end of the semester and exam week. She is in the university clinic today because she is "exhausted." What nursing diagnosis may be appropriate for her?

Disturbed sleep pattern

When reviewing the various schedules of controlled drugs, the nurse knows that which description correctly describes Schedule II drugs?

Drugs with high potential for abuse that have accepted medical use

The teaching for a patient who is taking tamsulosin (Flomax) to reduce urinary obstruction due to benign prostatic hyperplasia will include which of these?

Get up slowly from a sitting or lying position.

The nurse is trying to give a liquid medication to a -year-old child and notes that the medication has a strong taste. Which technique is the best way for the nurse to give the medication to this child?

Give the medication with a spoonful of ice cream.

The nurse is reviewing the applications of gene therapy. Which drug is manufactured as a result of indirect gene therapy?

Human insulin

A patient has been taking selegiline (Eldepryl), 20 mg/day for 1 month. Today, during his office visit, he tells the nurse that he forgot and had a beer with dinner last evening, and "felt awful." What did the patient most likely experience?

Hypertension

The nurse is teaching a 16-year-old patient who has a new diagnosis of type 1 diabetes about blood glucose monitoring and the importance of regulating glucose intake. When developing a teaching plan for this teenager, which of Erikson's stages of development should the nurse consider?

Identity versus role confusion

A patient has been taking naltrexone (ReVia) as part of the treatment for addiction to heroin. The nurse expects that the naltrexone will have which therapeutic effect for this patient?

If opioid drugs are used while taking naltrexone, euphoria is not produced; thus, the opioid's desired effects are lost.

A patient is brought to the emergency department for treatment of a suspected overdose. The patient was found with an empty prescription bottle of a barbiturate by his bedside. He is lethargic and barely breathing. The nurse would expect which immediate intervention?

Implementing measures to maintain the airway and support respirations

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

Impotence

An adrenergic agonist is ordered for a patient in shock. The nurse will note that this drug has had its primary intended effect if which expected outcome occurs?

Increased cardiac output

When a patient is taking an adrenergic drug, the nurse expects to observe which effect?

Increased heart rate

The U.S. Food and Drug Administration has issued a warning for users of antiepileptic drugs. Based on this report, the nurse will monitor for which potential problems with this class of drugs?

Increased risk of suicidal thoughts and behaviors

During a fishing trip, a patient pierced his finger with a large fishhook. He is now in the emergency department to have it removed. The nurse anticipates that which type of anesthesia will be used for this procedure?

Infiltration of the puncture wound with lidocaine

A patient calls the clinic to ask about taking cranberry dietary supplement capsules because a friend recommended them. The nurse will discuss which possible concern when a patient is taking cranberry supplements?

It may reduce elimination of drugs that are excreted by the kidneys.

When admitting a patient with a suspected diagnosis of chronic alcohol use, the nurse will keep in mind that chronic use of alcohol might result in which condition?

Korsakoff's psychosis

While monitoring a patient who had surgery under general anesthesia 2 hours ago, the nurse notes a sudden elevation in body temperature. This finding may be an indication of which problem?

Malignant hyperthermia

The nurse is providing teaching regarding drug therapy to the husband of a woman with Alzheimer's disease. She was diagnosed 3 months ago, has mild memory loss, and will be receiving donepezil (Aricept). What is the drug's expected action?

May help to improve the mood and decrease confusion

The patient is asking the nurse about current U.S. laws and regulations of herbal products. According to the Dietary Supplement and Health Education Act of 1994, which statement is true?

Medicinal herbs are viewed as dietary supplements.

The nurse is reviewing herbal therapies. Which is a common use of the herb feverfew?

Migraine headaches

A patient is going home with a new prescription for the beta-blocker atenolol (Tenormin). The nurse will include which content when teaching the patient about this drug?

Never stop taking this medication abruptly.

The nurse is reviewing the mechanism of action of cholinergic drugs. The undesired effects of cholinergic drugs come from the stimulation of which receptors?

Nicotinic

An 18-year-old basketball player fell and twisted his ankle during a game. The nurse will expect to administer which type of analgesic?

Nonopioid analgesic, such as indomethacin (Indocin)

A factory worker has been admitted to the emergency department after an industrial accident involving organophosphate insecticides. The nurse will prepare to administer which drug?

Physostigmine (Antilirium)

The nurse needs to administer insulin subcutaneously to an obese patient. Which is the proper technique for this injection?

Pinching the skin at the injection site, and then inserting the needle to below the tissue fold at a 90-degree angle

When administering medication by IV bolus (push), the nurse will occlude the IV line by which method?

Pinching the tubing just above the injection port

Place the phases of the nursing process in the correct order, with 1 as the first phase and 5 as the last phase. (Select all that apply.)

Planning Evaluation Assessment Implementation Nursing Diagnoses

The nurse is conducting a smoking-cessation program. Which statement regarding drugs used in cigarette-smoking-cessation programs is true?

Rapid chewing of the nicotine gum releases an immediate dose of nicotine.

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

Sedatives

While monitoring a depressed patient who has just started SSRI antidepressant therapy, the nurse will observe for which problem during the early time frame of this therapy?

Self-injury or suicidal tendencies

A cholinergic drug is prescribed for a patient with a new diagnosis of myasthenia gravis, and the nurse provides instructions to the patient about the medication. What is important to include in the teaching?

Take the medication 30 minutes before eating to improve swallowing and chewing.

The nurse is monitoring a patient who has been taking carbamazepine (Tegretol) for 2 months. Which effects would indicate that autoinduction has started to occur?

The drug levels for carbamazepine are lower than expected.

When administering a new medication to a patient, the nurse reads that it is highly protein bound. Assuming that the patient's albumin levels are normal, the nurse would expect which result, as compared to a medication that is not highly protein bound?

The duration of action of the medication will be longer.

The nurse is explaining the Human Genome Project to colleagues. Which of these is the main purpose of the Human Genome Project?

To describe the entire genome of a human being.

A patient is taking gabapentin (Neurontin), and the nurse notes that there is no history of seizures on his medical record. What is the best possible rationale for this medication order?

The medication is used for the treatment of neuropathic pain.

A patient is on a low-dose dobutamine drip for heart failure. She had been feeling better but now has a sense of tightness in her chest, palpitations, and a bit of anxiety. Her heart rate is up to 110 per minute, and her blood pressure is 150/98 mm Hg (increased from previous readings of 86 per minute and 120/80 mm Hg). What is the nurse's immediate concern for this patient?

The medication may be causing a worsening of a pre-existing cardiac disorder.

A 6-year-old boy has been started on an extended-release form of methylphenidate hydrochloride (Ritalin) for the treatment of attention deficit hyperactivity disorder (ADHD). During a follow- up visit, his mother tells the nurse that she has been giving the medication at bedtime so that it will be "in his system" when he goes to school the next morning. What is the nurse's appropriate evaluation of the mother's actions?

The medication should be given 4 to 6 hours before bedtime to diminish insomnia.

The nurse is assessing an elderly Hispanic woman who is being treated for hypertension. During the assessment, what is important for the nurse to remember about cultural aspects?

The nurse's assessment needs to include gathering information regarding religious practices and beliefs regarding medication, treatment, and healing.

The nurse is assigned to a patient who is newly diagnosed with type 1 diabetes mellitus. Which statement BEST illustrates an outcome criterion for this patient?

The patient will demonstrate correct blood glucose testing technique.

The nurse is developing a care plan for a patient who will be self-administering insulin injections. Which statement reflects a measurable outcome?

The patient will demonstrate the proper technique of self-administering insulin injections.

A patient who started taking orlistat (Xenical) 1 month ago calls the clinic to report some "embarrassing" adverse effects. She tells the nurse that she has had episodes of "not being able to control my bowel movements." Which statement is true about this situation?

The patient will need to restrict fat intake to less than 30% to help reduce these adverse effects.

When the nurse considers the timing of a drug dose, which factor is appropriate to consider when deciding when to give a drug?

The patient's last meal

Phenytoin (Dilantin) has a narrow therapeutic index. The nurse recognizes that this characteristic indicates which of these?

The safe and the toxic plasma levels of the drug are very close to each other.

The nurse is reviewing pharmacology terms for a group of newly graduated nurses. Which sentence defines a drug's half-life?

The time it takes for one half of the original amount of a drug to be removed from the body

A patient has been taking phenobarbital for 2 weeks as part of his therapy for epilepsy. He tells the nurse that he feels tense and that "the least little thing" bothers him now. Which is the correct explanation for this problem?

This drug causes deprivation of REM sleep and may cause the inability to deal with normal stress.

The nurse is reviewing medications used for depression. Which of these statements is a reason that selective serotonin reuptake inhibitors (SSRIs) are more widely prescribed today than tricyclic antidepressants?

Tricyclic antidepressants cause serious cardiac dysrhythmias if an overdose occurs.

The patient is experiencing chest pain and needs to take a sublingual form of nitroglycerin. Where does the nurse instruct the patient to place the tablet?

Under the tongue

When a patient is taking an anticholinergic such as benztropine (Cogentin) as part of the treatment for Parkinson's disease, the nurse should include which information in the teaching plan?

Use artificial saliva, sugarless gum, or hard candy to counteract dry mouth.

The nurse has an order to administer an intramuscular (IM) immunization to a 2-month-old child. Which site is considered the best choice for this injection?

Vastus lateralis

Nurses have the ethical responsibility to tell the truth to their patients. What is this principle known as?

Veracity