HESI & Final Pharmacology

Contraindications of digoxin administration?

- Contraindicated in pt. w/ ventricular dysrhythmias & heart block & HR below 60 or above 120 - Use w/ caution in pt. w/ renal disease, hypothyroidism, and hypokalemia. - Vomiting and diarrhea can lead to hypokalemia, which increases the risk of digoxin toxicity.

Suffix for ACE Inhbitors?

-pril

Suffix for ARBs?

-sartan

Suffix for loop diuretics?

-semide

therapeutic range for theophylline?

5-15 mcg/mL

B. "Discuss tapering the drug with the provider before conception." ***Lorazepam is Pregnancy Risk Category D, so the nurse instructs should instruct the patient to taper therapy as a means of avoiding the adverse effects of withdrawal and to prevent fetal harm. Therapy must be stopped before conception because benzodiazepines are lipid soluble and cross the placenta thereby, increasing the risk of fetal harm. To promote fetal development, the nurse instructs would instruct the patient to visit an obstetrician for folic acid and prenatal vitamin prescriptions and to eat a well-balanced diet. To help prevent a crisis, the nurse instructs would instruct the patient to develop an alternative plan for managing anxiety with the assistance of a primary health carehealthcare provider.

A female patient who takes lorazepam [Ativan] for anxiety tells the nurse that she plans to become pregnant. What is the best instruction for the nurse to give the patient? A. "Eat a well-balanced diet that includes milk." B. "Discuss tapering the drug with the provider before conception." C. "Stop taking the drug and form another plan to manage anxiety." D. "Visit an obstetrician to determine the correct dose of lorazepam during pregnancy."

B. 0900 ***Trough levels determine the lowest level between doses. Blood is drawn just before the next dose is administered when a divided dose is used or 1 hour before the next dose if a single daily dose is used.

A nurse is administering a daily dose of tobramycin at 1000. At which time should the nurse obtain the patient's blood sample to determine the trough level? A. 0800 B. 0900 C. 1130 D. 1200

B. "Agonist drugs decrease receptor activation." ***Drugs that directly activate receptors are called agonists, whereas drugs that prevent receptor activation are called antagonists. Local anesthetics are drugs that work by altering/suppressing axonal conduction.

A nurse is teaching a group of coworkers about the effects of drugs on receptors. Which comment by a coworker would need correction? A. "Agonist drugs increase receptor activation." B. "Agonist drugs decrease receptor activation." C. "Antagonist drugs decrease receptor activation." D. "Local anesthetics suppress axonal conduction."

A. relieve symptoms. ***If cancer can no longer be controlled, chemotherapy may be used to relieve disease-related symptoms or improve quality of life. This is called palliative treatment.

A patient being treated for cancer is receiving medication for palliation. The nurse understands that palliative therapy is used to A. relieve symptoms. B. kill tumor cells. C. decrease viral load. D. increase body defenses.

A. Anemia ***Celecoxib [Celebrex] is a COX-2 inhibitor that is contraindicated in patients with anemia. Celecoxib can cause an increased risk of gastrointestinal adverse effects, including bleeding, which can worsen anemia. The other conditions are not contraindications for use of the COX-2 inhibitor.

A patient has been prescribed celecoxib [Celebrex] to treat arthritis. The nurse will contact the healthcare provider if the patient shows symptoms of which condition? A. Anemia B. Cataracts C. Glaucoma D. Hyperthyroidism

B. Just before bedtime ***Oral bisacodyl is a stimulant laxative that acts within 6 to 12 hours. When given at bedtime, it produces a response the next morning. Administration at another time might produce a bowel movement at an inconvenient time, such as during a meal or in the middle of the night.

A postoperative patient is scheduled to start taking a daily oral dose of bisacodyl [Dulcolax]. When does the nurse administer the medication? A. After ambulating B. Just before bedtime C. At the evening meal D. Before the morning bath

A. "Inject this insulin with your first bite of food, because it is very fast acting." ***Lispro is a rapid-acting insulin and has an onset of action of 15 to 30 minutes with a peak action of about 2 hours, not 8 to 10 hours. Because of its rapid onset, it is administered immediately before a meal or with meals to control the blood glucose rise after meals. Lispro insulin must be combined with an intermediate- or a long-acting insulin, not regular insulin (which also is a short-duration insulin), for glucose control between meals and at night. To achieve tight glycemic control, patients must combine different types of insulin based on their duration of action.

A teaching plan for a patient who is taking lispro [Humalog] should include which instruction by the nurse? A. "Inject this insulin with your first bite of food, because it is very fast acting." B. "The duration of action for this insulin is about 8 to 10 hours, so you'll need a snack." C. "This insulin needs to be mixed with regular insulin to enhance the effects." D. "To achieve tight glycemic control, this is the only type of insulin you'll need."

B. Facial grimacing and tongue spasms ***Pseudoparkinsonism, which resembles symptoms of Parkinson's disease, is a major side effect of typical antipsychotic drugs such as fluphenazine (Prolixin). Anticholinergic medications may be used to control this side effect.

A young woman is being treated for psychosis with fluphenazine (Prolixin). Which sign would indicate the need to add an anticholinergic to the patient's medication regimen? A. A decrease in pulse and respiratory rate B. Facial grimacing and tongue spasms C. An increase in hallucinations D. A decrease in the patient's level of orientation

Examples of penicillins/antibiotics?

Ampicillin, Penicillin

C. New onset of disorientation to time and place ***Effects on the central nervous system are most likely to occur in elderly patients who have renal or hepatic impairment. Patients may experience confusion, hallucinations, lethargy, restlessness, and seizures. The remaining options are not adverse effects of cimetidine.

An 80-year-old patient with a history of renal insufficiency recently was started on cimetidine. Which assessment finding indicates that the patient may be experiencing an adverse effect of the medication? A. +3 pitting edema B. Pain with urination C. New onset of disorientation to time and place D. Heart rate changes from a baseline of 70 to 80 beats per minute (bpm) to 110 to 120 bpm

C. confusion ***Cimetidine is a histamine (H2)-receptor antagonist. Older clients are especially susceptible to central nervous system side effects of cimetidine. The most frequent of these is confusion. Less common central nervous system side effects include headache, dizziness, drowsiness, and hallucinations.

An older client recently has been taking cimetidine. The nurse monitors the client for which MOST frequent central nervous system effect of this medication? A. tremors B. dizziness C. confusion D. hallucinations

Examples of antacids?

Antacids (Maalox [Mg&Al], Mylanta [Ca])

A. renal impairment

Antacids should be used with cation in patients with: A. renal impairment B. COPD C. gastric ulcers D. dueodenal ulcers

Folic acid belongs to what class?

Anti-anemic; Vitamin (water-soluble)

Metformin belongs to what class?

Antidiabetic; Biguanides

Examples of muscle relaxers?

Baclofen, Dantrium, Cyclobenzprine

D. Stop the infusion and discard the IV solution. ***If a precipitate appears in the IV solution, that solution should be discarded.

Before administrating the dosage of a prescribed medication, the nurse observes precipitation in the intravenous (IV) solution. What is the priority nursing action? A. Verify the prescription. B. Prepare another dose to administer. C. Check the expiration date of the drug. D. Stop the infusion and discard the IV solution.

Examples of ACE Inhibitors?

Benazepril, Captopril, Enalapril

Saw Palmetto belongs to what class?

Benign prostatic hyperplasia agent

C. Producing miosis in certain eye diseases ***Cholinergic agents stimulate the pupil to constrict (miosis), thus decreasing intraocular pressure as they are direct-acting drugs. Indirect-acting drugs are used for treating patients with bradycardia. Cholinergic drugs might directly affect the bladder but not on a muscular level. They increase salivation and sweating.

Cholinergic (parasympathomimetic) drugs that stimulate muscarinic receptors are indicated for which situation? A. Preventing salivation and sweating B. Inhibiting muscular activity in the bladder C. Producing miosis in certain eye diseases D. Treating a postoperative patient who has bradycardia

Examples of antitussives?

Dextromethorphan & Tessalon

Examples of 1st generation antihistamines?

Diphenhydramine [Benadryl], Promethazine, Scopolamine

Effects of warfarin during pregnancy?

Fetal hemorrhage and teratogenesis from use during pregnancy

Examples of Selective Serotonin Reuptake Inhibitors (SSRIs)?

Fluoxetine, Paroxetine, Sertraline

Examples of loop diuretics?

Furosemide, Torsemide

Gingko Biloba, Feverfew, Garlic, Ginger belong to what classes?

Gingko: Antiplatelet agent, Garlic: lipid-lowering agent, Feverfew: vascular headache suppressant

Examples of long-acting insulin?

Glargine (Lantus)

Digoxin is used to treat?

HF, cardiogenic shock, atrial tachycardia, atrial fibrillation

Examples of anticoagulants?

Heparin, enoxaparin, warfarin, Dabigatran Etexilate

B. By length of time (rapid, short, intermediate, long)

How are different insulins categorized? A. By route B. By length of time (rapid, short, intermediate, long) C. By mechanism of action D. By color

Examples of Rapid-Acting Insulin [short-duration]?

Humalog [Lispro], Novolog [Aspart]

Examples of peripheral vasodilators?

Hydralazine, Sodium Nitroprusside

Examples of thiazide diuretics?

Hydrochlorothiazide

B. intracellular space to the extracellular space ***Hypertonic solutions, because of their increased osmolality draw fluids out of the cells and into the extracellular space.

Hypertonic solutions cause fluids to move from the: A. interstitial space to the intracellular space B. intracellular space to the extracellular space C. extracellular space to the intracellular space D. intracellular space to the interstitial space

Examples of Non-aspirin NSAIDs?

Ibuprofen, Ketorelac, Celecoxib, Naprosyn

B. Epinephrine

If a patient is having an allergic response, what med will you give histamine receptor blockers with? A. Norepinephrine B. Epinephrine C. Insulin D. Vasopressin

B. Angiotension receptor blockers (ARBs)

If the patient experiences a consistent dry cough, which medication class can we switch to? A. Benzodiazepines B. Angiotension receptor blockers (ARBs) C. Corticosteriods D. Diuretics

B. Emphysema

In which of the following conditions below do the alveolar sacs lose elasticity which can lead to "air-trapping": A. Chronic Bronchitis B. Emphysema

B. Emphysema ***Emphysema patients have a matched V/Q defect mainly due to a damaged capillary bed where there is poor ventilation (V) and poor perfusion (Q)...hence there is matched ventilation and perfusion.

In which of the following conditions below is there a matched V/Q defect? A. Chronic Bronchitis B. Emphysema

B. Assessment C. Nursing diagnosis A. Planning E. Implementation D. Evaluation ***Patient assessment is the first stage of the nursing process. The nurse validates and documents patient data during the assessment stage. The nurse formulates a nursing diagnosis by analyzing patient data. The nursing diagnosis helps the nurse to focus on the patient's chief concerns. Consequently, the nursing diagnosis helps the nurse to plan effective interventions for the patient during the planning phase. The nurse implements the planned interventions during the implementation phase. The nurse evaluates the success of patient outcomes during the evaluation phase.

In which order would the nurse apply the nursing process to ensure patient-centered collaborative care? A. Planning B. Assessment C. Nursing diagnosis D. Evaluation E. Implementation

What are two effects opiates have on the digestive system?

Increase constipation Increase billiary pressure

What are two effects opiates have on smooth muscle cells in the uritogenital system?

Increase urinary retention Decrease uterine contractions

Examples of uterine relaxants (Tocolytics)?

Indomethecin (NSAIDs) - risk of GI bleed Nifedipine (Ca Channel Blockers) relaxes muscles; ↓ BP Magnesium sulfate Terbutaune (Adrenergic agonist)

C. Rapid

Insulin aspart is a ________ acting insulin. A. Intermediate B. Long C. Rapid D. Short

Examples of TB drugs?

Isoniazid (INH), Rifampin, Ethambutol, Pyrazinamide

D. total cholesterol level ***Isotretinoin can elevate triglyceride levels. They should be measure before treatment and peridoically thereafter until the effect on the triglycerides is know.

Isotretinoin is prescribed for a client with severe acne. Before administration of this medication, the nurse anticipates that which laboratory test will be prescribed? A. K levels B. triglyceride levels C. Hemoglobin A1C D. total cholesterol level

B. uterine contractions

Julia is a mother who is receiving oxytocin therapy. The nurse must continuously evaluate: A. membrane integrity B. uterine contractions C. cervical dilation D. cervical effacement

C. increased BUN and serum creatinine levels ***The patient with acute renal failure has increased BUN and serum creatinine levels and decreased urine output.

Laboratory results associated with acute renal failure include: A. increased BUN level and decreased serum creatinine level B. decreased BUN level and increased urine output C. increased BUN and serum creatinine levels D. increased BUN level and increased urine output

B. liver failure patients

Lactulose is an osmotic laxative that is also used in: A. renal failure patients B. liver failure patients C. Cushing's disease patients D. Addison's disease patients

Examples of anti-parkinson agents?

Levodopa/Carbidopa

Tranylcypromine sulfate (Parnate), isocarboxazid (Marplan), selegiline (Emsam), phenelzine sulfate (Nardil) are examples of?

MAOIs

D. assists in neuromuscular transmission ***Magnesium acts at the myoneural junction and is vital to nerve and muscle activity.

Magnesium is an important electrolyte because it: A. helps control urine volume B. promotes the production of growth hormone C. promotes bone growth and strength D. assists in neuromuscular transmission

Examples of osmotic diuretics?

Mannitol

Examples of opioids?

Morphine, Fentanyl, Oxycodone, Hydrocodone

C. diminished deep tendon reflexes ***Deep tendon reflexes may be decreased or absent in hypokalemia. Also leg cramps may occur and respiratory muscles may be paralyzed. Signs of Hypokalemia: "7 L's" Lethargy (confusion) Low, shallow respirations (due to decreased ability to use accessory muscles for breathing) Lethal cardiac dysrhythmias Lots of urine Leg cramps Limp muscles Low BP & Heart

Neuromuscular signs and symptoms of hypokalemia include: A. Tourette's syndrome B. confusion and irritability C. diminished deep tendon reflexes D. Parkinsonian-type tremors

B. Multivitamins

Non-pharmacological techniques can help lower blood pressure. Which of the following is not considered one of these types of techniques? A. Dietary changes B. Multivitamins C. Smoking cessation D. Limiting caffeine

D. Binds to histamine 1 receptors

Once histamine is released, what does it do? A. Binds to histamine 3 receptors B. Forms basophils and mast cells C. Forms antihistamine D. Binds to histamine 1 receptors

Diphenoxylate belongs to what class?

Opioid Antidiarrheal agent

labs for warfarin?

PT & INR

Examples of proton pump inhibitors?

Pantoprazole, Lansoprazole, Omeprazole

Describe the three predominant characteristics of morphine overdose.

Pin point pupils Sedation or coma Low respiratory rate (respiratory depression)

B. Loop, thiazide, Potassium-sparing

Please list the diuretics from strongest to weakest. A. Thiazide, Potassium-sparing, Loop B. Loop, thiazide, Potassium-sparing C. Potassium-sparing, Loop, Thiazide D. Thiazide, Loop, Potassium-sparing

C. maintaining heart beat ***Potassium is vital for proper cardiac function because it plays a key role in cardiac muscle contraction and electrical conductivity. Changes in serum potassium level call for early recognition and treatment.

Potassium is responsible for: A. building muscle mass B. building bone structure and strength C. maintaining heart beat D. maintaining weight

Oral Contraceptives are used to?

Prevent pregnancy; Also useful in controlling irregular or excessive menstrual cycles.

Examples of beta blockers?

Propranolol, Metoprolol

B. fracture C. pneumonia E. acid rebound F. intestinal infection w/ C. diff

Proton pump inhibitors can increase the risk of serious adverse effects including: (select all that apply). A. H. pylori infection B. fracture C. pneumonia D. hypothyroidism E. acid rebound F. intestinal infection w/ C. diff

A. sulfonylureas (glyburide) D. biguanides (metformin - glucophage) ***Sulfonylureas are containdicated in sulfa allergy. Metformin should not be given if pt. is scheduled to have contrast dye for CT scan (could cause renal toxicity).

Prototype for oral antidiabetic drugs, is used to treat type 2 diabetes: select all that apply. A. sulfonylureas (glyburide) B. aspirin NSAIDs C. insulin D. biguanides (metformin - glucophage)

Examples of short acting insulin?

Regular Insulin

If aspirin is given to a child what could occur? List some s&s of this?

Reye syndrome (when given to children) Salicylism: tinnitus (ringing in the ears)

What are some therapeutic effects of benzodiazepines?

Seizures, anxiety, sedation

B. Emphysema and chronic bronchitis are irreversible. D. Patients with chronic bronchitis are sometimes referred to as "blue bloaters, while patients with emphysema are sometimes referred to as "pink puffers". ***Option A is wrong because patients with chronic bronchitis DON'T have the ability to fully exhale AND have limited airflow as well. Option C is wrong because SPRIOMETRY is used to diagnose chronic bronchitis and emphysema.

Select ALL the options that are TRUE about chronic bronchitis and emphysema: A. Patients with chronic bronchitis have the ability to fully exhale but have limited airflow. B. Emphysema and chronic bronchitis are irreversible. C. An incentive spirometer is used to diagnose both chronic bronchitis and emphysema. D. Patients with chronic bronchitis are sometimes referred to as "blue bloaters, while patients with emphysema are sometimes referred to as "pink puffers".

A. increased TSH, decreased T3 & T4 C. brittle hair and nails D. lethargy and fatigue F. intolerance to cold

Signs of hypothyroidism: select all that apply. A. increased TSH, decreased T3 & T4 B. increase secretion of thyroid hormone C. brittle hair and nails D. lethargy and fatigue E. restlessness and anxiety F. intolerance to cold

Examples of K-sparing diuretics?

Spironolactone

C. -tidine

Suffix for histamine 2 receptor blockers? A. -olol B. There is not one specific suffix for this class of medications C. -tidine D. -pril

A. high blood pressure D. water retention E. pulmonary edema F. heart failure ***Furosemide is used to decrease serum potassium levels in clients with hyperkalemia and it is not indicated for clients with diabetes insipidus for it already involves frequent urination.

The EMT wheeled in a vehicular accident client who is unconscious to the nearest urgent care facility, he tells the emergency room nurse that the client is on Furosemide [Lasix] as seen in his purse with his medication bottle. The nurse knows that this medication may be used to treat which of the following conditions? Select all that apply. A. high blood pressure B. hypokalemia C. diabetes insipidus D. water retention E. pulmonary edema F. heart failure

C. 75-year-old woman with liver disease ***Impaired hepatic metabolic pathways for drug and chemical degradation place (C) at greatest risk for adverse reactions to medications based on advancing age and liver disease. (A and D) have no predisposing factors, such as genetics, pathophysiologic dysfunction, or drug allergies, that would increase the risk for cumulative toxicity or adverse drug reactions. (B) is at risk for dose-related adverse reactions but is at less risk than (C).

The charge nurse is reviewing the admission history and physical data for four clients newly admitted to the unit. Which client is at greatest risk for adverse reactions to medications? A. 30-year-old man with a fracture B. 7-year-old child with an ear infection C. 75-year-old woman with liver disease D. 50-year-old man with an upper respiratory tract infection

B. This is a side effect of the medication, sit down for a while before standing up in the morning or slowly change position to prevent lightheadedness."

The client is newly prescribed with Candesartan [Atacand] tells the nurse that beginning the medication has made him feel dizzy in the morning. Which of the following would be an appropriate response by the nurse? A. "Take this medication during lunch time to decrease the symptom." B. This is a side effect of the medication, sit down for a while before standing up in the morning or slowly change position to prevent lightheadedness." C. "Stop taking this medication whenever you feel dizzy and prop your feet up with a pillow underneath." D. "Do not take the medication on days that your feel lightheaded."

D. "Ringing in the ears is an expected side effect of this medication." ***This medication can cause irreversible hearing loss and ringing in the ears should be reported to the physician by the client.

The client with Chronic Renal Failure is prescribed with Furosemide (Lasix) 20 mg od during discharge? As the nurse gives the discharge instructions, which of the following statements made by the client indicated the need for further teaching? A. "I should not forget monitoring my blood glucose when I get home." B. "I should contact my physician if I experience diarrhea" C. "I should take this medication with food." D. "Ringing in the ears is an expected side effect of this medication."

C. Facilitate a potassium restricted diet ***For clients on Furosemide, potassium rich diet is needed for the replacement of potassium losses through dieresis. All the other options are correct interventions.

The client with fluid volume excess is ordered Furosemide (Lasix) 40 mg IV every 8 hours. The following are correct nursing interventions while on this medication, except? A. Weigh client daily B. Note for blood pressure prior to administration C. Facilitate a potassium restricted diet D. Monitor intake and output

B. "It can be passed through breastmilk and may harm a nursing baby." ***Furosemide should not be used by breastfeeding mothers as it can be transferred to the baby via breastmilk.

The client with pulmonary edema newly prescribed with Furosemide [Lasix] 40 mg tablet once a day asks the nurse if it is safe to take even when breastfeeding her baby. Which of the following is the most appropriate response for this question? A. "It increases lactation the same way it increases urination." B. "It can be passed through breastmilk and may harm a nursing baby." C. "It is alright to take this medication while breastfeeding." D. "All of the above."

A. Hold the medication ***A therapeutic drug level for phenytoin is 10 to 20 mcg/mL. The nurse should hold the medication and then call the healthcare provider.

The client's serum phenytoin [Dilantin] level is 31 mcg/mL. What is the nurse's best action? A. Hold the medication B. Increase the medication dose C. Administer the medication intravenously D. Have the client continue the current regimen

B. "Thyroid drugs should not be taken to treat obesity." ***Thyroid drugs should not be taken to treat obesity. Thyroid drugs may increase the activity of oral anticoagulants. Thyroid drugs may decrease serum digitalis levels when administered concurrently. Cholestyramine decreases the absorption of thyroid drugs by binding to thyroid hormone in the gastrointestinal tract. This may reduce the absorption of both drugs.

The clinical instructor asks the nursing student about various drug interactions of thyroid drugs. Which statement by the nursing student indicates effective learning? A. "Thyroid drugs may increase serum digitalis levels." B. "Thyroid drugs should not be taken to treat obesity." C. "Thyroid drug absorption is increased by cholestyramine." D. "Thyroid drugs may decrease the activity of oral anticoagulants."

B. Superinfection ***Antibiotic therapy can destroy the normal flora of the body, which normally would inhibit the overgrowth of fungi and yeast. When the normal flora is decreased, these organisms can overgrow and cause a new infection, or superinfection.

The development of a new infection as a result of the elimination of normal flora by an antibiotic is referred to as what? A. Resistant infection B. Superinfection C. Nosocomial infection D. Allergic reaction

B. Potassium Chloride (Klor-Con) ***Spironolactone (Aldactone) is classified as a potassium-sparing diuretic (water pill). One caution when taking spironolactone is the risk of hyperkalemia if being taken with another potassium supplement or substitute. So dosage adjustment may be necessary if being taken with Potassium Chloride. There's no need for dosage adjustment if the client is taking any of the options A, C and D.

The doctor ordered spironolactone (Aldactone) to a client diagnosed with heart failure secondary to hyperaldosteronism. Which of the following medication will be a necessary reason for dosage adjustment if this medication is being taken by the client. A. Warfarin Sodium (Coumadin) B. Potassium Chloride (Klor-Con) C. Verapamil hydrochloride (Calan SR) D. Alprazolam (Xanax)

D. Use of herbs or over-the-counter medications ***The nurse will ask the patient about any herbs or other nonprescription medications taken. The patient is of Asian culture and may use herbal remedies that are not considered medications.

The emergency department nurse is documenting the medication history of an Asian immigrant. The patient denies taking any medications, but the nurse notes a bottle of capsules in the patient's bag. What information will the nurse collect next? A. Vital signs B. Insurance information C. Primary care provider name D. Use of herbs or over-the-counter medications

C. adherence. ***Adherence describes the extent to which a person's behavior matches the expectation of a certain situation. For example, if a physician writes a prescription for a medication to be taken daily, the physician has an expectation that the patient will take the medication on that schedule. The patient is practicing adherence when he follows through with the expectations.

The extent to which a patient's behavior of taking medication matches that of the medical advice given is known as: A. response. B. evaluation. C. adherence. D. implementation.

D. Intravenously over 2 to 6 hours ***Amphotericin B (Fungizone) should be administered by slow intravenous infusion.

The health care provider has ordered amphotericin B (Fungizone) for the patient. The nurse recognizes that which is the most effective way to administer this medication to the patient? A. Intravenously over 1 hour B. Orally at regular intervals C. By subcutaneous injection D. Intravenously over 2 to 6 hours

D. Guaifenesin (Robitussin) ***Guaifenesin (Robitussin) is classified as an expectorant. The other drugs listed are classified as first-generation antihistamines.

The health care provider indicates that the patient will be ordered an expectorant. Which medication does the nurse anticipate the provider will order? A. Brompheniramine maleate (DeCongest) B. Chlorpheniramine maleate (Chlor-Trimeton) C. Dexchlorpheniramine maleate (Polaramine) D. Guaifenesin (Robitussin)

C. Codeine CSS II ***Codeine CSS II is classified as an opioid antitussive. Promethazine with dextromethorphan and benzonatate (Tessalon Perles) are both nonopioid antitussives. Levocetirizine (Xyzal) is an antihistamine.

The health care provider indicates that the patient will be ordered an opioid antitussive. Which medication does the nurse anticipate the provider will order? A. Promethazine with dextromethorphan B. Benzonatate (Tessalon Perles) C. Codeine CSS II D. Levocetirizine (Xyzal)

C. Urine output ***The effectiveness of the diuresis is best measured by urine output (C). Mannitol, an osmotic diuretic, is given during cisplatin (Platinol) therapy to promote diuresis and reduce the risk of nephrotoxicity and ototoxicity associated with this chemotherapeutic agent. (A, B, and D) do not provide information about the risk for nephrotoxicity and ototoxicity related to Platinol administration.

The health care provider prescribes cisplatin (Platinol) to be administered in 5% dextrose and 0.45% normal saline with mannitol (Osmitrol) added. Which assessment parameters would be most helpful to the nurse in evaluating the effectiveness of the Osmitrol therapy? A. Oral temperature B. Blood cultures C. Urine output D. Liver enzyme levels

C. 750 mg ***The patient taking a medication every 8 hours will take it three times in a 24-hour period: 250 mg times 3 equals 750 mg for a 24-hour period.

The healthcare provider ordered lithium 250 mg PO every 8 hours for a patient experiencing acute mania. What will the patient's total dose be in 24 hours? A. 250 mg B. 500 mg C. 750 mg D. 1000 mg

30 minutes ***The medication is 100 mg in 50 mL and is ordered to run at 100 mL per hour. Since the medication is only 50 mL, the infusion would be complete in 30 minutes.

The healthcare provider ordered thiamine solution 100 mg in 50 mL IV piggyback for a patient with a history of alcohol abuse. The dose is ordered to run at 100 mL per hour. The nurse knows that the infusion will require how much time? Record your answer using a whole number. _____ minutes

antidote for acetaminophen?

acetylcysteine

Tetracyclines belong to what class?

antibiotics

Trimethoprim-sulfamethoxazole belongs to what class?

antibiotics and Sulfonamides

antidote for bradycardia?

atropine

Side effects of beta blockers?

bronchospasm/bronchoconstriction, bradycardia, causes hypoglycemic unawareness.

Doxorubicin is used for?

chemotherapy

Side effects of phenytoin?

gingival hyperplasia (reddened gums that bleed easily), sedation, N&V, nystagmus & blurred vision & diplopia, headaches, effects in pregnancy, cardiovascular effects

Interactions with calcium channel blockers?

grapefruit, digoxin, beta blockers

Side effects of loop diuretics?

hearing loss, tinnitus, ototoxicity (if administered fast), orthostatic hypotension, SJS, hypokalemia, hypocalcemia; can promote hypotension, thrombosis, and embolism; hyperglycemia, hypomagnesemia, hyperuricemia (can lead to gout attack), hyponatremia

What is a major risk with acetaminophen?

hepatotoxicity

Statins are used to treat?

hypercholesterolemia, and dyslipidemia

Cyclosporine belongs to what class?

immunosuppressant, antirheumatic

Examples of Benzodiazepines?

lorazepam, diazepam, alprazolam

antidote for hypotension?

midodrine

When should diuretics be taken?

morning

What are muscle relaxers used to treat?

multiple sclerosis

antidote for opioids?

naloxone

antidote for benzodiazepines?

romazicon [flumazenil]

Erythropoietin belongs to what class?

stimulant of RBC maturation

B. refrigerate the insulin

The home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Hummulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse should tell the client to take which action? A. freeze the insulin B. refrigerate the insulin C. store the insulin in a dark, dry place D. keep the insulin at room temperature

A. Notify the healthcare provider to discuss the reduction or withdrawal of heparin. ***Heparin-induced thrombocytopenia (HIT) is a potential immune-mediated adverse effect of heparin infusions that can prove fatal. HIT is suspected when the platelet counts fall significantly. A platelet count below 100,000/mm3 would warrant discontinuation of the heparin.

The laboratory calls to report a drop in the platelet count to 90,000/mm3 for a patient receiving heparin for the treatment of postoperative deep vein thrombosis. Which action by the nurse is the most appropriate? A. Notify the healthcare provider to discuss the reduction or withdrawal of heparin. B. Call the healthcare provider to discuss increasing the heparin dose to achieve a therapeutic level. C. Obtain vitamin K and prepare to administer it by intramuscular (IM) injection. D. Observe the patient and monitor the activated partial thromboplastin time (aPTT) as indicated.

B. Temperature of 101°F ***Sudden high fever is a symptom of neuroleptic malignant syndrome, a rare but serious complication of high-potency, first-generation antipsychotics, such as haloperidol. The other findings are potential side effects of the drug but would not necessarily need to be reported to the healthcare provider.

The nurse has just administered the first dose of haloperidol [Haldol] to a patient with schizophrenia. Which finding, if present, is the most important for the nurse to report to the healthcare provider before administering the next dose of medication? A. Dry mouth B. Temperature of 101°F C. BP of 104/72 mm Hg D. Drowsiness

B. Orthostatic hypotension ***Orthostatic hypotension is the most common adverse effect of tricyclic antidepressant therapy.

The nurse identifies which most common serious adverse effect of TCA therapy? A. Excitation B. Orthostatic hypotension C. Skin rash D. Sexual dysfunction

C. Bisacodyl [Dulcolax] ***Stimulant laxatives (bisacodyl, senna, castor oil) are most commonly abused by the general public. The nurse should discourage use of these drugs for occasional relief of constipation.

The nurse identifies which of the following as the most common type of laxative abused by the general public? A. Magnesium hydroxide [Milk of Magnesia] B. Docusate sodium [Colace] C. Bisacodyl [Dulcolax] D. Polyethylene glycol [MiraLax]

B. Bronchoconstriction ***Activation of H1 receptors in an allergic reaction causes bronchoconstriction. Vasodilation of small blood vessels and increased capillary permeability cause loss of fluid, which, if extensive, results in severe hypotension. Histamine has no effect on pupil reaction, nor does it cause sweating.

The nurse identifies which symptom as a result of activation of histamine1 (H1) by allergic reaction? A. Hypertension B. Bronchoconstriction C. Sweating D. Pupillary dilation

B. Assess the patient for medication toxicity. ***The nurse should assess for toxicity. The kidneys are responsible for the majority of drug excretion. With excretion impaired, the medication can remain in the system longer, thus increasing the chance for toxicity to develop. Because most drugs are excreted by the renal system, it would not be appropriate to hold all drugs, as some may have more benefits than risks. Decreased urinary output is not an indication that medications should be held. Medications administered via the intravenous route are still metabolized in the body.

The nurse is administering medications to a patient with kidney disease. Which is the nurse's priority action? A. Hold medications if urinary output is low. B. Assess the patient for medication toxicity. C. Administer all medications via the intravenous route. D. Hold all drugs that are excreted by the renal system.

C. Administer the medication no faster than 50 mg/min ***Intravenous phenytoin should be given no faster than 50 mg/min into a 20-gauge or larger catheter. It can only be mixed or diluted in normal saline for infusion. The medication should not be given with dextrose or given quickly through a central line.

The nurse is administering phenytoin [Dilantin] intravenously. What intervention is essential? A. Push the medication quickly through a central line B. Mix the medication in 5% dextrose with 0.9% saline C. Administer the medication no faster than 50 mg/min D. Administer the medication in a 22-gauge or smaller catheter

D. Valsartan [Exforge] ***Valsartan [Exforge] is an angiotensin II receptor blocker (ARB) that is indicated for management of hypertension. Furosemide is a loop diuretic. Eplerenone [Inspra] is an aldosterone antagonist. Enalapril is an angiotensin-converting enzyme (ACE) inhibitor.

The nurse is administering several medications at 8 AM. Which medication will decrease blood pressure by blocking angiotensin II receptor sites? A. Enalapril B. Furosemide C. Eplerenone [Inspra] D. Valsartan [Exforge]

D. Skin rash and lesions ***The nurse's priority is to monitor for hypersensitivity reactions. The most serious response to sulfonamide therapy is Stevens-Johnson syndrome, which manifests as severe reactions of the skin and mucous membranes, lesions, fever, and malaise. In rare cases, hematologic effects occur, requiring periodic blood studies.

The nurse is assessing a patient who is receiving a sulfonamide for treatment of a urinary tract infection. To monitor the patient for the most severe response to sulfonamide therapy, the nurse should assess for which condition? A. Bleeding B. Diarrhea C. Hypertension D. Skin rash and lesions

B. Skin rash and lesions ***The nurse's priority is to monitor for hypersensitivity reactions. The most serious response to sulfonamide therapy is Stevens-Johnson syndrome, which manifests as symptoms of the skin and mucous membranes, lesions, fever, and malaise. In rare cases, hematologic effects occur, requiring periodic blood studies.

The nurse is assessing a patient who is receiving a sulfonamide for treatment of a urinary tract infection. To monitor the patient for the most severe response to sulfonamide therapy, the nurse will assess for what? A. Diarrhea B. Skin rash and lesions C. Hypertension D. Bleeding

B. High-pitched cry, vomiting, and jitteriness ***Symptoms in an infant who develops withdrawal syndrome (from alcohol, barbiturates, or heroin) may include a shrill cry, vomiting, and extreme irritability.

The nurse is assessing an infant delivered by a patient who is suspected of regularly using alcohol and cocaine during her pregnancy. It is most important for the nurse to observe the infant for what? A. Lethargy, hypothermia, and weight gain B. High-pitched cry, vomiting, and jitteriness C. Depressed reflexes, jaundice, and dysphagia D. Hypotonia, absent sucking reflex, and epistaxis

C. Diverticulitis D. Abdominal pain E. Bowel obstruction ***Laxatives are contraindicated for individuals with abdominal pain, nausea, cramps, and other symptoms of appendicitis, regional enteritis, diverticulitis, and obstruction of the bowel. Laxatives should be used with caution during pregnancy and lactation. Laxatives are used to treat constipation.

The nurse is aware that laxatives are contraindicated in patients with which condition(s)? Select all that apply. A. Pregnancy B. Constipation C. Diverticulitis D. Abdominal pain E. Bowel obstruction

A. Abdominal pain B. Diverticulitis D. Bowel obstruction ***Laxatives are contraindicated for individuals with abdominal pain, nausea, cramps, and other symptoms of appendicitis, regional enteritis, diverticulitis, and obstruction of the bowel. Laxatives should be used with caution during pregnancy and lactation. Laxatives are used to treat constipation.

The nurse is aware that laxatives are contraindicated in patients with which of the following? (Select all that apply.) A. Abdominal pain B. Diverticulitis C. Constipation D. Bowel obstruction E. Pregnancy

B. gastrointestinal system. ***Metronidazole (Flagyl) acts by impairing DNA function of susceptible bacteria. This drug is used primarily to treat various disorders associated with organisms in the GI tract. It is prescribed to treat intestinal amebiasis, trichomoniasis, inflammatory bowel disease, anaerobic infections, and bacterial vaginosis and is used as perioperative prophylaxis (prevention of infection) in colorectal surgery.

The nurse is aware that most patients receiving metronidazole (Flagyl) are being treated for infections of the A. urinary tract. B. gastrointestinal system. C. integumentary system. D. reproductive system.

B. Notify the provider that the patient should not be started on heparin. ***A potential medication error is to give heparin in combination with enoxaparin.

The nurse is caring for a newly admitted patient who will begin heparin therapy. While documenting the patient's history, the nurse notes that the patient is currently undergoing treatment with enoxaparin. What is the nurse's highest priority? A. Notify the provider that the patient is at risk for an allergic reaction. B. Notify the provider that the patient should not be started on heparin. C. Notify the provider that the dosage of heparin will need to be increased. D. Notify the provider that the dosage of heparin will need to be decreased.

B. Serotonin syndrome ***Serotonin syndrome can occur within 2 to 72 hours after initiation of treatment with a selective serotonin reuptake inhibitor (SSRI). The symptoms include altered mental status, incoordination, myoclonus, hyperreflexia, excessive sweating, tremor, and fever.

The nurse is caring for a patient in the emergency department who reports the onset of agitation, confusion, muscle twitching, diaphoresis, and fever about 12 hours after beginning a new prescription for escitalopram [Lexapro]. Which is the most likely explanation for these symptoms? A. Cholinergic crisis B. Serotonin syndrome C. Depressive psychosis D. Escitalopram overdose

C. G0 A. G1 D. S B. G2 E. M ***The cell cycle consists of four major phases, named G1, S, G2, and M. G0 is the resting phase.

The nurse is reviewing the cell cycle with a cancer patient. In which order should the nurse list the steps, starting with the resting phase? A. G1 B. G2 C. G0 D. S E. M

A. Dystonia ***Dystonia, an impairment of muscle tone, is the only extrapyramidal side effect listed. The other side effects also occur but are not extrapyramidal effects.

The nurse monitors a patient taking an antipsychotic medication for extrapyramidal side effects. What should the nurse assess for in the patient? A. Dystonia B. Orthostatic hypotension C. Dry mouth and constipation D. Neuroleptic malignant syndrome

D. "I must make sure I swallow the pill whole." ***"SR" indicates that the drug is sustained release; therefore, the patient must swallow the pill intact, without chewing or crushing, which would result in a bolus effect. Grapefruit juice should be avoided, because it can inhibit intestinal and hepatic metabolism of the drug, thereby raising the drug level. Constipation, not loose stools, is a common side effect of Calan; increasing fluids and dietary fiber can help prevent this adverse effect.

The nurse provides discharge instructions to a patient prescribed verapamil [Calan] SR 120 mg PO daily for essential hypertension. Which statement by the patient indicates understanding of the medication? A. "I will take the medication with grapefruit juice each morning." B. "I should expect occasional loose stools from this medication." C. "I'll need to reduce the amount of fiber in my diet." D. "I must make sure I swallow the pill whole."

D. Decreased magnesium ***Furosemide [Lasix] increases urinary excretion of magnesium, posing a risk of magnesium deficiency. Hyperglycemia (increased glucose) and hyperuricemia (increased uric acid) are adverse effects. Furosemide [Lasix] does not affect phosphate.

The nurse reviews the laboratory values of a patient receiving furosemide [Lasix]. Which lab result indicates to the nurse that an adverse effect is occurring? A. Decreased glucose B. Decreased uric acid C. Decreased phosphate D. Decreased magnesium

A. Once a day ***A major cause of treatment failure in patients with chronic hypertension is lack of adherence to a prescribed regimen. To promote adherence, the dosing schedule should be as simple as possible, just once or twice daily dosing.

The nurse reviews the medication treatment regimen for a patient with chronic hypertension. To promote optimal medication adherence, which frequency of drug dosing should the nurse advocate for this patient? A. Once a day B. Three times a day C. Four times a day D. Every 8 hours

B. increase fluids ***Increasing fluids will help liquefy secretions and facilitate removal.

The nurse should instruct a client who is taking an expectorant to: A. restrict fluids B. increase fluids C. avoid vaporizers D. take antihistamines

B. Skin rash and loose stools ***Ampicillin's most common side effects are rash and diarrhea; both reactions occur more frequently with ampicillin than with any other penicillin. Reddened tongue and gums, digit numbness and tingling, and bruising and petechiae are not associated side effects of ampicillin.

The nurse should teach a patient to observe for which side effects when taking ampicillin? A. Bruising and petechiae B. Skin rash and loose stools C. Digit numbness and tingling D. Reddened tongue and gums

C. Block aldosterone, which lead to diuresis ***Option A is incorrect because aldactone does not cause vasodilation. Option B is incorrect because aldactone is a potassium-sparing diuretic. Option D is incorrect because aldactone does not affect ductus arteriosus. Aldosterone is a diuretic that blocks aldosterone. Use of this medication is common in children with congenital heart disease for the prevention and treatment of congestive heart failure.

The physician ordered spironolactone (aldactone) to an infant with congenital heart disease. While preparing for the administration of the medication, the nurse understands that the main purpose of the medication is to: A. Cause dilation of the blood vessels B. Prevent the secretion of potassium C. Block aldosterone, which lead to diuresis D. Preserve the patent ductus arteriosus.

C. Chronic Bronchitis ***The answer is C. "Blue bloaters" is used to describe patients with chronic bronchitis, and the term "pink puffers" is used to describe patients with emphysema.

The term" blue bloaters" is used to describe patients with? A. Pulmonary hypertension B. Left-sided heart failure C. Chronic Bronchitis D. Emphysema

D. 0.5-2.0 ng/mg ***This is the correct therapeutic range for digoxin. Every nurse should know this information.

The therapeutic drug level for digoxin is: A. 0.1-2.0 ng/mg B. 1.0-2.0 ng/mg C. 0.1-0.5 ng/mg D. 0.5-2.0 ng/mg

Amitriptyline belongs to what class?

Tricyclic Antidepressants

True

True or False: All calcium channel blockers that end with -dipine (examples: Amlodpine, Nicardipene, etc.) work only on the vessels. They will decrease the blood pressure, but will not decrease the heart rate.

False

True or False: COPD is reversible and tends to happens gradually.

False

True or False: Calcium channel blockers will increase the effectiveness of IV calcium.

True

True or False: NSAIDs work best for pain due to inflammation.

False ***Patients with emphysema experience HYPERventilation as a compensatory mechanism to help increase oxygen levels and decrease carbon dioxide levels in the body.

True or False: Patients with emphysema experience hypoventilation as a compensatory mechanism to help increase oxygen levels and decrease carbon dioxide levels in the body.

True

True or False: SSRI's work by preventing reuptake of serotonin into presynaptic nerve terminals.

True *** Patients with chronic bronchitis have a mismatched V/Q because the capillary bed works properly (this is not the case in emphysema) however ventilation is poor due to obstruction from mucous and inflammed bronchioles. So, there is poor ventilation but sufficient perfusion.....hence it is mismatched.

True or False: V/Q mismatch is found in chronic bronchitis.

False

True or false: The main mechanism of action for loop diuetics is they block the re-absorption of sodium, water, magnesium, and chloride.

A. Severe acute anaphylactic response ***Anaphylaxis related to penicillin can cause a life-threatening allergic response characterized by bronchospasm, laryngeal edema, and a precipitous drop in blood pressure. This client's ingestion of penicillin and presenting clinical picture indicates the client is having an acute reaction (A) with respiratory difficulty. (B, C, and D) are other physiologic responses to medications, but immediate action is required for a potential loss of airway, breathing, and circulation (A).

Two hours after taking the first dose of penicillin, a client arrives at the emergency department complaining of feeling ill, exhibiting hives, having difficulty breathing, and experiencing hypotension. These findings are consistent with which client response that requires immediate action? A. Severe acute anaphylactic response B. Side reaction that should resolve C. Idiosyncratic reaction D. Cumulative drug response

A. Overdose of baclofen [Lioresal] ***Baclofen [Lioresal] is used for the treatment of muscle spasms. An overdose of baclofen would result in GABA and dominant cholinergic effects. Symptoms such as dizziness, nausea, and hypotension would be observed in patients as a result of an overdose of this medication. An overdose of neostigmine [Prostigmin] can cause a cholinergic reaction and result in symptoms of nausea, abdominal cramps, excessive salivation, and sweating. An overdose of orphenadrine citrate [Norflex] would cause excitement and severe confusion leading to coma and convulsions. An overdose of pyridostigmine bromide [Mestinon] would result in cholinergic crisis manifesting in symptoms such as extreme muscle weakness, sweating, and tearing.

Upon assessing a patient who is being treated for muscle spasms, the nurse finds that the patient has hypotension, dizziness, and nausea. What should the nurse infer as the reason for these complications in the patient? A. Overdose of baclofen [Lioresal] B. Overdose of neostigmine [Prostigmin] C. Overdose of orphenadrine citrate [Norflex] D. Overdose of pyridostigmine bromide [Mestinon]

B. Increased intake of vitamin E ***High-dose vitamin E inhibits platelet aggregation, which can promote bleeding. Biotin appears devoid of toxicity; subjects given large doses experienced no adverse effects. Decreased intake of folic acid and vitamin B12 can lead to anemia.

Upon completing the patient history, which finding will cause the nurse to monitor for bleeding? A. Increased intake of biotin B. Increased intake of vitamin E C. Decreased intake of folic acid D. Decreased intake of vitamin B12

Beta blockers are used in the treatment of?

Used to decrease blood pressure and to manage heart failure, also used in glaucoma.

B. Whenever needed (PRN) as a quick-relief agent ***For patients at step 1 in the stepwise approach to managing asthma, albuterol is a short-acting beta2 agonist (SABA) used only PRN to relieve ongoing asthma attacks and prevent exercise-induced bronchospasms. No long-term control medications are taken. A patient is at a higher step than 1 in the stepwise approach if the patient requires a daily inhaled glucocorticoid or LABA or awakens at night more often than 2 days a week. For patients at steps 2 to 6, albuterol is considered a quick-relief medication taken PRN.

Using a stepwise approach to managing asthma, a nurse teaches a patient who is at step 1 to use albuterol MDI [Proventil] at which time? A. Only with a long-acting beta2 agonist (LABA) B. Whenever needed (PRN) as a quick-relief agent C. Twice daily combined with an inhaled glucocorticoid D. If nighttime awakenings occur more than 2 days a week

Oxytocin is used to?

Uterine stimulant (Oxytocics); Induces or augments labor, controls postpartum bleeding, manages an incomplete abortion

Examples of angiotensin receptor blockers?

Valsartan, Losartan

Examples of calcium channel blockers?

Verapamil, Diltiazem, Amlodipine, Nifedipine

B. Confusion, fever, muscle rigidity, and increase serum creatinine

What are some signs and symptoms of the rare, yet fatal and very serious, side effect of atypical antipsychotic called neuroletic malignant syndrome? A. Insomnia, muscular flaccidity, hyperactivity B. Confusion, fever, muscle rigidity, and increase serum creatinine C. Hypothermia and hyperkalemia D. Thrombocytopenia, anemia, fever

B. Odd facial and tongue movements (like lip smacking or puffing of cheeks)

What are symptoms of tardive dyskinesia? A. Shuffling gait B. Odd facial and tongue movements (like lip smacking or puffing of cheeks) C. An overall muscular rigidity; this is a medical emergency D. Contractures of the arms or legs

B. nausea, vomiting, and GI distress ***Aspirin most commonly produces adverse GI reactions, such as nausea, vomiting, and GI distress.

What are the most common adverse reactions to aspirin? A. increased rate and depth of respirations B. nausea, vomiting, and GI distress C. dizziness and vision changes D. bladder infection

A. It is patient-centered. B. It states the expected change. C. It is acceptable to the patient. D. It identifies components for evaluation. ***An effective goal is patient-centered as it helps to involve the patient in the decision-making process. The patient goal should be realistic and state the expected change in the patient, which will also later help to evaluate the success of the goal. The goal should be acceptable to the patient so that the patient is willing to make efforts to improve. The goal should contain components that the nurse can evaluate such as patient behavior or attitude. The nurse formulates the nursing diagnoses during the nursing diagnosis stage of the nursing process.

What are the qualities of effective goal setting? Select all that apply. A. It is patient-centered. B. It states the expected change. C. It is acceptable to the patient. D. It identifies components for evaluation. E. It helps to formulate nursing diagnoses.

A. The entire loop of Henle

What do the loop diuretics block? A. The entire loop of Henle B. Distal convoluted tubule C. Collecting duct D. Proximal convoluted tubule

C. Sodium chloride cotransporter

What do thiazide diuretics ultimately block to increase urine output? A. Distal convoluted tubule B. Proximal convoluted tubule C. Sodium chloride cotransporter D. The Circle of Willis

B. Muscle coordination/movements

What does dopamine affect / address in relation to antipsychotic meds? A. The sleep-wake cycle B. Muscle coordination/movements C. Water absorption / reabsorption D. Your pain threshold

B. Allergy symptoms (itching, increased mucous production, nasal congestion, headache)

What does histamine produce? A. Gastric upset symptoms (nausea, vomiting, diarrhea, abdominal pain) B. Allergy symptoms (itching, increased mucous production, nasal congestion, headache) C. Psychosis symptoms D. Pelvic pain / discomfort and vaginal discharge

A. Adrenal insufficiency B. Osteoporosis E. Cataracts ***Adverse effects of long-term glucocorticoid therapy include adrenal insufficiency, osteoporosis, hyperglycemia, hypokalemia, and cataracts.

What does the nurse identify as a possible adverse effect of long-term glucocorticoid therapy? (Select all that apply.) A. Adrenal insufficiency B. Osteoporosis C. Hypoglycemia D. Hyperkalemia E. Cataracts

C. Hyperkalemia

What electrolyte change should you be on the look out for when you first start ACE inhibitors on your patient? A. Hypermagnesium B. Hypokalemia C. Hyperkalemia D. Hypocalcemia

B. Knowing pharmacology ***Knowledge of pharmacology will help the nurse to understand the action of the drug and the patient's response to the drug. The better the nurse's knowledge of pharmacology, the better he or she will be able to anticipate drug responses and not simply react to them after the fact. A nursing diagnosis helps the nurse to understand the patient's needs and plan effective interventions. Monitoring drug effects occurs after drug responses have already occurred. Patient-centered care aims to involve the patient in the care process but does not address anticipation of drug responses.

What helps the nurse to anticipate drug responses in a patient? A. Monitoring drug effects B. Knowing pharmacology C. Using a nursing diagnosis D. Providing patient-centered care

D. "There is a good chance that you will become seizure free on this one medication." ***About 70% of clients become seizure free on one medication. Most clients are on the medications for life. The client should not stop the medication as increased seizures can result. If a client has seizures while on a medication, then that medication can be decreased and another one tried. It does not mean they will always have seizures.

What information is essential to teach the client who will begin taking an antiepileptic drug? A. "You will most likely not be on this medication very long." B. "If you develop seizures while on this medication, you will always have seizures." C. "If you find you cannot tolerate the drug, stop it and call your healthcare provider." D. "There is a good chance that you will become seizure free on this one medication."

C. Diphenhydramine

What is an example of a common histamine 1 receptor blocker? A. Epinephrine B. Norepinephrine C. Diphenhydramine D. Lostartan

A. Common side effects can be relieved by increasing fluid and fiber intake and sucking hard candy.

When teaching a patient about the use of tricyclic antidepressants, what will the nurse emphasize? A. Common side effects can be relieved by increasing fluid and fiber intake and sucking hard candy. B. The patient should notify the health care provider if therapeutic effects are not noted within 10 days. C. The drugs are often given with monoamine oxidase inhibitors (MAOIs) for synergistic effect. D. Dietary restrictions of beer and chocolate are needed to prevent a hypertensive crisis

B. Respiratory alkalosis ***Respiratory alkalosis is produced by hyperventilation. Deep and rapid breathing increases CO2 loss, which in turn lowers the pCO2* of blood, and thereby increases pH. * pCO2 is the partial pressure of carbon dioxide in blood.

Which acid-base imbalance is caused by hyperventilation? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

B. Administer teriparatide [Forteo]. C. Administer calcitonin [Miacalcin]. D. Administer calcium and vitamin D supplements. ***Calcium, vitamin D, bisphosphonates, calcitonin [Miacalcin], teriparatide [Forteo], and estrogen are used in the prophylaxis and treatment of osteoporosis. Aspirin and nonsteroidal anti-inflammatory drugs can lead to gastrointestinal bleeding.

Which actions should the nurse take to prevent bone loss in a patient taking long-term glucocorticoid therapy? Select all that apply. A. Administer aspirin. B. Administer teriparatide [Forteo]. C. Administer calcitonin [Miacalcin]. D. Administer calcium and vitamin D supplements. E. Administer nonsteroidal anti-inflammatory drugs.

A. Eating aged cheese ***Eating foods high in tyramine, including aged cheese, can cause a hypertensive crisis in patients taking MAO inhibitors.

Which activity should the patient be cautioned to avoid while taking an monoamine oxidase inhibitor (MAOI)? A. Eating aged cheese B. Sunbathing at the pool C. Participating in a bowling league D. Smoking a low-nicotine cigarette

B. Pinpoint pupils ***Morphine sulfate is an opioid drug used for pain management. After administration of morphine sulfate, the nurse should assess the patient's pupillary reaction to light. Pinpoint pupils, when accompanied by decreased responsiveness and respiratory depression, may indicate an overdose of morphine sulfate. Overdose of morphine sulfate does not cause blood in the urine. Increased peristalsis is not a sign of morphine sulfate overdose. Constipation due to decreased peristalsis is an adverse effect associated with morphine sulfate. Administration of opioid drugs causes urinary retention. Therefore, increased urinary output is not observed in the patient.

Which assessment finding indicates that the patient has overdosed on morphine sulfate? A. Blood in urine B. Pinpoint pupils C. Increased peristalsis D. Increased urinary output

C. Blood pressure ***Hydralazine [Apresoline] is a vasodilator that causes arteriolar dilation, decreased resistance, and decreased blood pressure. Monitoring of the blood pressure and heart rate is the highest assessment priority.

Which assessment finding is most important for the nurse to obtain before administering hydralazine [Apresoline]? A. Capillary refill B. Homans' sign C. Blood pressure D. Peripheral pulses

D. Intranasal glucocorticoids ***Intranasal glucocorticoids are the most effective drugs for preventing and treating seasonal and allergic rhinitis. They reduce nasal congestion, rhinorrhea, sneezing, nasal itching, and erythema. Antihistamines are less effective than glucocorticoids, because histamine is only one of several mediators of allergic rhinitis. Sympathomimetics relieve only nasal congestion. Antitussives are used to suppress cough.

Which class of drugs is most effective in preventing and treating seasonal and allergic rhinitis? A. Antitussives B. Oral antihistamines C. Oral sympathomimetics D. Intranasal glucocorticoids

D. Proton pump inhibitors

Which class of drugs is the most effective for suppressing secretion of gastric acid? A. Beta blockers B. H2-receptor blockers C. Antacids D. Proton pump inhibitors

A. bulk-forming

Which class of laxatives is preferred? A. bulk-forming B. surfactant C. osmotic D. stimulant

A. Potassium sparing

Which diuretic is the weakest? A. Potassium sparing B. Thiazide C. Loop D. They're all the same

B. Glucocorticoids and mineral corticoids

Which hormones do the adrenal glands secrete? A. Melatonin and thyroxine B. Glucocorticoids and mineral corticoids C. Seratonin and norepinephrine D. Vasopressin and melatonin

B. Glucocorticoids and mineral corticoids

Which hormones do the adrenal glands secrete? A. Seratonin and norepinephrine B. Glucocorticoids and mineral corticoids C. Melatonin and thyroxine D. Vasopressin and melatonin

A. Hypersecretion of parietal cells ***Hydrochloric acid, which is necessary for digestion, is secreted by the parietal cells lining the stomach. Hypersecretion of these cells causes acidity or more severe disorders. Inhibition of the proton pump reduces the hypersecretion of acid. Proteolytic enzymes such as pepsinogen, which is activated by hydrochloric acid, are secreted by the chief cells of the stomach and are responsible for the cleaving of proteins. Acetylcholine receptors also mediate the proton pump, and inhibition of these receptors helps to prevent the effects caused by a highly acidic environment.

Which increases the concentration of gastric acids? A. Hypersecretion of parietal cells B. Inhibition of proton pump activity C. Inhibition of acetylcholine receptors D. Hypersecretion of proteolytic enzymes

A. "Topical glucocorticoids pose a risk of local infection." B. "Apply in a thin film and gently rub into the affected area." C. "You may note some local irritation when using this product." D. "Avoid using any tight-fitting bandages or dressings after applying." ***It is most important that a patient understand the proper application of the prescribed topical glucocorticoid, because they vary in intensity and duration. Topical glucocorticoids can lead to local irritation and an increased risk for local infection. The medication should be applied in a thin layer to the affected area and rubbed into the skin. The medication should not be covered with a dressing or bandage, because this increases the intensity. Use of topical agents can lead to atrophy (thinning) of the epidermis and dermis.

Which instructions should the nurse give a patient who is prescribed a topical glucocorticoid for a dermatologic disorder? Select all that apply. A. "Topical glucocorticoids pose a risk of local infection." B. "Apply in a thin film and gently rub into the affected area." C. "You may note some local irritation when using this product." D. "Avoid using any tight-fitting bandages or dressings after applying." E. "Topical glucocorticoids can lead to thickening of the skin at the application site."

A. Weigh yourself daily at the same time each day. C. Notify the healthcare provider if a skin rash develops. E. Rise slowly from a lying to a sitting position. ***An adverse effect of diltiazem is heart failure. Daily weighing monitors for signs of fluid retention, which may indicate cardiac dysfunction. Chronic eczematous rash may occur, especially in older patients. Orthostatic hypotension is an adverse effect; patients must be taught to rise slowly from lying to sitting positions. Diltiazem causes vasodilation, which can cause dizziness or headache. Daily calcium supplements do not affect the action of diltiazem.

Which instructions should the nurse include when developing a teaching plan for a patient prescribed diltiazem [Cardizem] for atrial fibrillation? (Select all that apply.) A. Weigh yourself daily at the same time each day. B. The medication will not cause dizziness or headache. C. Notify the healthcare provider if a skin rash develops. D. Do not take daily oral calcium supplements. E. Rise slowly from a lying to a sitting position.

A. 0.9% sodium chloride ***Isotonic volume contraction occurs when sodium and water are lost in isotonic proportions. It may be caused by vomiting, diarrhea, kidney disease, and/or misuse of diuretics. In this situation, volume is replenished with isotonic solutions, such as normal saline (0.9% sodium chloride).

Which intravenous (IV) fluid would be most appropriate for treating isotonic volume contraction? A. 0.9% sodium chloride B. 5% dextrose and water C. 0.225% sodium chloride D. 3% sodium chloride and water

D. Distribution rates among various body systems ***Pharmacokinetics involves how the drug moves through the body, including absorption, distribution, metabolism, and excretion.

Which is included in the study of pharmacokinetics? A. Interactions among various drugs B. Adverse reactions to medications C. Physiologic effects of drugs on the body D. Distribution rates among various body systems

A. Monitor potassium level ***Monitoring potassium is especially important because hypokalemia potentiates digoxin toxicity. B and C are incorrect because these data reflect overall CV status but are not specific for digoxin. Choice D are drugs usually administered with digoxin.

Which is the MOST appropriate action for the nurse to take before administering digoxin? A. Monitor potassium level B. Assess blood pressure C. Evaluate urinary output D. Avoid giving with thiazide diuretic

B. Administer intravenous glucose. ***This patient is showing signs of hypoglycemia. In the hospital setting or when the patient is unconscious, intravenous glucose is an obvious option to treat hypoglycemia.

Which is the nurse's best action when finding a patient with type 1 diabetes mellitus unresponsive, cold, and clammy? A. Start an insulin drip. B. Administer intravenous glucose. C. Draw blood glucose level and send to the laboratory. D. Administer subcutaneous regular insulin immediately.

A. Nimodopine

Which is the only calcium channel blocker that crosses the blood brain barrier and will prevent vasospasms in the brain? A. Nimodopine B. Amlodipine C. Nicardipine D. Felodipine

B. BUN/Creatinine

Which labs should you monitor for kidney toxicity in the patient receiving cephalosporins? A. PT, PTT B. BUN/Creatinine C. Sodium and potassium D. Lactate and blood cultures

A. Tachycardia ***High doses of levothyroxine may cause thyrotoxicosis, a condition of profound excessive thyroid activity. Tachycardia is the priority assessment, because it can lead to severe cardiac dysfunction. Tremors, insomnia, and irritability are other symptoms of thyrotoxicosis and should be assessed after tachycardia.

Which manifestations should a nurse investigate first when monitoring a patient who is taking levothyroxine [Synthroid]? A. Tachycardia B. Tremors C. Insomnia D. Irritability

B. Pyrazinamide ***Pyrazinamide should be taken with food to reduce GI irritation; isoniazid and rifampin should be taken on an empty stomach while rifabutin can be taken without regard to food.

Which of the following Tuberculosis medications should be taken with food to reduce gastrointestinal distress? A. Rifampin [Rifadin] B. Pyrazinamide C. Isoniazid D. Rifabutin [Mycobutin]

C. Decrease platelet aggregation

Which of the following is NOT something cytoprotective prostoglandins do? A. Vasodilation and bronchial dilation B. Kidney protection C. Decrease platelet aggregation D. Gastric protection

D. hydrocoritsone E. fludrocortisone

Which of the following is given during adrenal insufficiency? Select all that apply. A. calcitonin B. levothyroxine C. vitamin D D. hydrocoritsone E. fludrocortisone

B. levothyroxine ***But side effects look like hyperthyroidism.

Which of the following is given during hypothyroidism? A. calcitonin B. levothyroxine C. vitamin D D. hydrocoritsone E. fludrocortisone

A. Barrel chest ***Cyanosis, V/Q mismatch, and excessive productive cough are found in chronic bronchitis.

Which of the following is most commonly found in a patient with emphysema? A. Barrel chest B. Cyanosis C. V/Q mismatch D. Excessive productive cough

B. A 35 year old female with a total cholesterol level of 100.

Which of the following patients does NOT have a risk factor for hypertension? A. A 25 year old male with a BMI of 35. B. A 35 year old female with a total cholesterol level of 100. C. A 68 year old male who reports smoking 2 packs of cigarettes a day. D. A 40 year old female with a family history of hypertension and diabetes.

C. None

Which other insulin can you mix glargine with? A. NPH B. Levamir C. None D. Novolin R / Regular

A. A patient with anuria ***If urine flow declines to a very low rate (oliguria) or ceases entirely (anuria), the infusion should be stopped. Mannitol [Osmitrol] is safe to use with diabetic patients and those with head injuries, and it may function as a prophylaxis against renal failure in patients with dehydration.

Which patient receiving mannitol [Osmitrol] should the nurse assess first? A. A patient with anuria B. A patient with dehydration C. A patient with a head injury D. A patient with diabetes mellitus

A. Fatigue B. Vomiting D. Blurred vision ***Fatigue, vomiting, and blurred vision are common noncardiac symptoms that can provide advance warning of digoxin toxicity. Muscle weakness is an early sign of hypokalemia. Constipation is not a symptom of digoxin toxicity.

Which patient symptoms should alert the nurse to be concerned about digoxin [Lanoxin] toxicity? Select all that apply. A. Fatigue B. Vomiting C. Constipation D. Blurred vision E. Muscle weakness

A. Fatigue B. Vomiting D. Blurred vision ***Fatigue, vomiting, and blurred vision are common noncardiac symptoms that can provide advance warning of digoxin toxicity. Muscle weakness is an early sign of hypokalemia. Dizziness is not a symptom of digoxin toxicity.

Which patient symptoms should cause the nurse to be concerned about digoxin [Lanoxin] toxicity? (Select all that apply.) A. Fatigue B. Vomiting C. Dizziness D. Blurred vision E. Muscle weakness

B. A patient with Chron's disease

Which patient would most benefit from corticosteroids? A. A patient with a gastric ulcer B. A patient with Chron's disease C. A patient with chronic anemia D. A patient with a broken femur

A. Patient in heart failure

Which patient would you be concerned about starting corticosteroids on? A. Patient in heart failure B. Patient with a history of schizophrenia C. Patient with gout D. Patient with a recent pelvic fracture

A. 25 ml per hour for the last 4 hours

Which patient's urinary output would you call the physician about if they are on Furosemide [Lasix]? A. 25 ml per hour for the last 4 hours B. 35 ml per hour for the last 4 hours C. 100 ml per hour for the last 4 hours D. 70 ml per hour for the last 4 hours

D. A calcium channel blocker (CCB) to an African American patient with hypertension ***CCBs and alpha and beta blockers are also effective in African American patients. In contrast, monotherapy with beta blockers or angiotensin-converting enzyme (ACE) inhibitors is less effective in blacks than in whites. Drugs recommended for treatment of hypertension in children 1 to 18 years old include ACE inhibitors, diuretics, beta blockers, and calcium channel blockers (not centrally acting alpha2 agonist or adrenergic neuron blockers).

Which prescription will the nurse administer to provide the most safe and effective care to patients with hypertension? A. An adrenergic neuron blocker to a 16-year-old with hypertension B. A beta blocker to an African American patient with hypertension C. A centrally acting alpha2 agonist to a 16-year-old with hypertension D. A calcium channel blocker (CCB) to an African American patient with hypertension

A. "Take the isoniazid on an empty stomach." C. "Notify your healthcare provider if your skin starts to turn yellow." ***Isoniazid should be taken on an empty stomach. Hepatotoxicity is an adverse effect of isoniazid so jaundice should be promptly reported. Numbness and tingling in the extremities is associated with the development of peripheral neuropathy and should be reported to the healthcare provider. Rifampin, not isoniazid, causes discoloration of body fluids. Ethambutol, not isoniazid, is associated with optic neuritis.

Which statements will the nurse include when teaching a patient about isoniazid therapy for the treatment of tuberculosis? Select all that apply. A. "Take the isoniazid on an empty stomach." B. "Use of this drug is associated with vision problems." C. "Notify your healthcare provider if your skin starts to turn yellow." D. "Your urine will turn reddish orange because of the effects of this drug." E. "Numbness or tingling in your extremities is a normal response when taking this drug."

If urine output is below ________________ renal problems could be indicated.

< 600ml/ 24 hr

Bisphosphonates (Fosamax [Alendronate]) belong to what class?

Bone resorption inhibitor (increases total bone mass)

A. Digoxin toxicity ***Halos is a hallmark sign of digoxin toxicity. B and C are incorrect because subtherapeutic digoxin levels have no such effects.

Blurred vision or halos are signs of: A. Digoxin toxicity B. Nothing related to digoxin C. Corneal side effects of digoxin

E. spironolactone ***Spironolactone is the "one" K-sparing diuretic that is a mineralocorticoid receptor antagonist that is not highly selective, and hence causes gynecomastia due to its effects on other steroid receptors.

Side effects for this particular diuretic include hyperkalemic metabolic acidosis & gynecomastia. A. acetazolamide B. amiloride C. hydrochlorothiazide D. furosemide E. spironolactone

B. -tidine ***Examples: Ranitidine, Famotidine, Cimetidine

What is the suffix for H2-receptor antagonists? A. -pril B. -tidine C. -olol D. -prazole

D. -prazole ***Examples: Omeprazole, Esomeprazole, Lansoprazole, Pantoprazole

What is the suffix for Proton Pump Inhibitors? A. -tidine B. -olol C. -pril D. -prazole

B. Hypertonic

What type of fluid would a patient with severe hyponatremia most likely be started on? A. Hypotonic B. Hypertonic C. Isotonic D. Colloid

Side effects of thiazide diuretics?

hypercalcemia, hypokalemia, hyponatremia, hyperglycemia, may raise blood lipids (metabolic syndrome), dizziness, headaches, nausea, hyperuricemia (can lead to gout attack), SJS

Side effects of K-sparing diuretics?

hyperkalemia, SJS, menstrual irregularities, erectile dysfunction, nausea, gynecomastia, tingling of hands and feet.

ACE Inhibitors and ARBs are used for treatment of?

hypertension, MI, & management of HF & CAD; good choice for diabetic's (slows progression of diabetic neuropathy)

What are calcium channel blockers used to treat?

hypertension, angina, dysrhythmias.

what causes digoxin toxicity?

hypokalemia

Side effects of nitroglycerin?

hypotension, headache, flushing/pallor, dizziness/weakness, fainting, dry mouth, reflex tachycardia

What are some of the common side effects of ACE Inhibitors?

irritating persistent cough, hyperkalemia, bleeding

Lithium belongs to what class?

mood stabilizer

s&s of digoxin toxicity?

nausea, headache, bradycardia, yellow-green halos around objects

s&s of hepatotoxicity?

nausea, vomiting, diarrhea, abdominal pain, jaundice, loss of appetite, dark-colored urine, light or clay-colored stools

s&s of phenytoin toxicity?

nystagmus, sedation, hematomas, red/black stools, headache, faintness

s&s of lithium toxicity?

persistent nausea, vomiting, severe, diarrhea

salt substitutes contain?

potassium

How long are muscle relaxers usually prescribed?

prescribed for no longer than 3 weeks

antidote for heparin?

protamine sulfate

Side effects of opioids?

"MORPHINE": Myosis Out of it (sedation) Respiratory depression Pneumonia (aspiration) & Physical dependence Hypotension (orthostatic) Infrequency (constipation/urinary retention) Nausea (vomiting) Emesis & Eupohria

Suffix for Antihyperlipidemic; HMG-CoA reductase Inhibitor?

-statin

Suffix for thaizide diuretics?

-thaizide

therapeutic range for lithium?

0.5-1.5 mEq/L

therapeutic range for digoxin?

0.5-2 ng/mL

therapeutic range for phenytoin?

10-20 mcg/mL

B. Vastus lateralis ***The preferred intramuscular site for children younger than 2 years is the vastus lateralis (B). (A, C, and D) are not preferred injection sites for the infant at 2 months of age.

A 2-month-old infant is scheduled to receive the first DPT immunization. What is the preferred injection site to administer this immunization? A. Dorsal gluteal B. Vastus lateralis C. Ventral gluteal D. Deltoid

B. Pregnancy must be avoided while taking this medication. ***Isotretinoin is teratogenic and must not be used during pregnancy. Vitamin A supplements should be avoided, oral contraceptives can be used with isotretinoin therapy, and depression can occur although it is rare.

A 22-year-old female patient is prescribed isotretinoin for severe acne. What statement will the nurse include in patient teaching? A. Vitamin A supplements can be used with this medication. B. Pregnancy must be avoided while taking this medication. C. Oral contraceptives must not be used with this medication. D. The most common adverse effect of this medication is depression.

A. Tell the caregiver that antibiotics will be ordered. ***All children younger than 6 months old should receive antibiotics for suspected AOM, regardless of diagnostic certainty or symptom severity.

A 3-month-old infant is diagnosed with acute otitis media (AOM). The caregiver asks the nurse what the most likely course of treatment will be. The nurse should do what? A. Tell the caregiver that antibiotics will be ordered. B. Inform the caregiver that most episodes of AOM resolve spontaneously. C. Provide information to the caregiver about the benefits of delaying antibiotic administration. D. Instruct the caregiver that antibiotic therapy is needed only for severe cases.

C. Menstrual irregularities ***Side of effects of spironolactone (aldactone) may include menstrual irregularities and decreased libido. Men may experience gynecomastia and impotence. Increase libido, increased facial hair, and hair loss aren't associated with taking spironolactone.

A client with unilateral adrenalectomy is taking spironolactone. Which of the following possible side effects will the nurse warn the client of? A. Hair loss B. Increase libido C. Menstrual irregularities D. Increased facial hair

B. Diazepam (Valium) ***Diazepam (Valium) (B) is the drug of choice for treatment of status epilepticus. (A, C, and D) are used for the long-term management of seizure disorders but are not as useful in the emergency management of status epilepticus.

A 6-year-old child is admitted to the emergency department with status epilepticus. His parents report that his seizure disorder has been managed with phenytoin (Dilantin), 50 mg PO bid, for the past year. Which drug should the nurse plan to administer in the emergency department? A. Phenytoin (Dilantin) B. Diazepam (Valium) C. Phenobarbital (Luminal) D. Carbamazepine (Tegretol)

B. Take and record radial pulse rate daily. ***Monitoring pulse rate is very important when taking digoxin (Lanoxin) (B). The client should be further instructed to report pulse rates below 60 or greater than 110 beats/min and to withhold the dosage until consulting with the health care provider in such a case. (A and D) are not necessary. (C) is an indication of drug toxicity, and the client should be instructed to report this immediately.

A 67-year-old client is discharged from the hospital with a prescription for digoxin (Lanoxin), 0.25 mg daily. Which instruction should the nurse include in this client's discharge teaching plan? A. Take the medication in the morning before rising. B. Take and record radial pulse rate daily. C. Expect some vision changes caused by the medication. D. Increase intake of foods rich in vitamin K.

D. Administer vitamin K1 (phytonadione). ***The nurse should administer vitamin K1 (phytonadione) to the bleeding patient who is on warfarin and has an extremely elevated INR. This medication will block the vitamin K-dependent clotting factors. Increasing vitamin K can hasten the return to normal coagulation. Warfarin is given PO not IV. Protamine sulfate is an antidote to heparin therapy, not warfarin.

A bleeding patient receiving warfarin [Coumadin] has an international normalized ratio (INR) of 6. What is the nurse's best course of action? A. Stop the IV drip. B. Wait for the INR to decrease. C. Administer protamine sulfate. D. Administer vitamin K1 (phytonadione).

D. This prevents drug resistance. ***Drug resistance occurs less frequently with multiple-drug therapy than with single-drug therapy. One mechanism of resistance—cellular production of a drug transport molecule known as P-glycoprotein—can confer multiple drug resistance upon cells; activation of P-glycoprotein would make drug resistance worse. The nurse would not conclude that the patient is terminal or has an infection when combination chemotherapy is used.

A cancer patient is receiving a combination of cancer drugs. How should the nurse interpret this finding? A. The patient is terminal. B. The patient has an infection. C. This activates P-glycoprotein. D. This prevents drug resistance.

D. "It is the average number of days it takes for chemotherapy to decrease the neutrophil count to its lowest level." ***Neutropenia begins to develop a few days after dosing, and the lowest neutrophil count, called the nadir, occurs between days 10 and 14. Nadir does not mean the patient's tolerance, the time it takes the bone marrow to recover, or the maximum dose.

A cancer patient wants to know what the word nadir means. What is the nurse's best response? A. "It is the patient's tolerance to the chemotherapy's bone marrow suppressant effect." B. "It is the time it takes the bone marrow to completely recover from a dose of chemotherapy." C. "It is the maximum dose for a chemotherapy drug in reference to bone marrow suppression effects." D. "It is the average number of days it takes for chemotherapy to decrease the neutrophil count to its lowest level."

C. Administer ondansetron [Zofran]. ***Ondansetron [Zofran] will be most beneficial. Anticancer medications stimulate the chemoreceptor trigger zone and induce nausea and vomiting in chemotherapy patients. Ondansetron [Zofran] is a serotonin antagonist that prevents nausea and vomiting. Although all patients should observe regular handwashing, frequent handwashing is for the neutropenic patient. Allopurinol [Zyloprim] is for the patient with elevated levels of uric acid (hyperuricemia) from the breakdown of DNA following cell death. Lettuce should be avoided by patients with neutropenia as it contains pathogenic bacteria.

A cancer patient who is on chemotherapy reports severe nausea and vomiting. Which action would be most beneficial to the patient? A. Wash hands often. B. Administer allopurinol [Zyloprim]. C. Administer ondansetron [Zofran]. D. Wash lettuce before serving.

B. Pregnant women D. Breastfeeding women E. Children younger than 8 years ***Because they can cause permanent tooth discoloration, tetracyclines should not be given to pregnant women, breastfeeding women, or children younger than 8 years. The hearing impaired or mentally impaired are not groups directly affected by this drug unless they also are part of the other groups.

A certain group of patients should not be given tetracyclines. Which patients are of most concern? Select all that apply. A. Hearing impaired B. Pregnant women C. Mentally impaired D. Breastfeeding women E. Children younger than 8 years

B. This drug is a clot buster that dissolves clots within a coronary artery. ***t-PA, or tissue plasminogen activator, is a coronary-specific fibrinolytic agent that dissolves clots within the coronary arteries (B). This drug is not a calcium channel blocker or nitrate, which would promote vasodilation of the coronary arteries (A). This medication is not an anticoagulant, such as warfarin or heparin, which would prevent new clot formation (C). Volume expansion is not provided by an infusion of TPA and would not necessarily improve myocardial perfusion caused by an increased cardiac output in a client with coronary artery disease (D).

A client being treated for an acute myocardial infarction is to receive the tissue plasminogen activator alteplase (Activase). The nurse would be correct in providing which explanation to the client regarding the purpose of this drug? A. This drug is a nitrate that promotes vasodilation of the coronary arteries. B. This drug is a clot buster that dissolves clots within a coronary artery. C. This drug is a blood thinner that will help prevent the formation of a new clot. D. This drug is a volume expander that improves myocardial perfusion by increasing output.

A. "Avoid salt substitute" ***When taking spironolactone the client should avoid salt substitute because they contain potassium. The client should avoid potassium rich foods and supplements because spironolactone is a potassium-sparing diuretic. Sodium restriction may be continued to reduce fluid volume overload.

A client diagnosed with hypertension has been receiving spironolactone (Aldactone) which of the following health instruction should the nurse provide to the client? A. "Avoid salt substitute" B. "Take daily potassium supplements" C. "Discontinue sodium restrictions" D. "Eat foods high in potassium"

D. nausea and vomiting ***Ondansetron is an antiemetic used to treat postoperative nasuea and vomiting, as well as nausea and vomiting associated with chemotherapy. The other options are incorrect reasons for administering this medication.

A client has an as needed prescription for ondansetron. For which condition(s) should the nurse administer this medication? A. paralytic ileus B. incisional pain C. urinary retention D. nausea and vomiting

A. "If I miss a dose, I can double the dose on the next dose to catch up the missed one" ***It is very essential to take medication as prescribed. In taking spironolactone (aldactone), once you missed a dose, take it as soon as you remember, but if it is near the time for the next dose, skip the missed and resume usual dosing schedule. Do not double dose. Option B is correct, option C is correct since potatoes and tomatoes are food high in potassium which should be avoided while on this medication. Driving may not be recommended because of the possible side effect of the medication which is drowsiness, dizziness and confusion.

A client has been prescribed with spironolactone (Aldactone) for the management of hyperaldosteronism. Which of the following statement by the client indicates the need for further teaching? A. "If I miss a dose, I can double the dose on the next dose to catch up the missed one" B. "I would store this medication on a room temperature without direct sunlight" C. "I would try to avoid food such as potatoes and tomatoes" D. "I would avoid driving while on this medication"

B. heartburn ***Omeprazole is a proton pump inhibitor classified as an antiulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often called heartburn by clients. Omeprazole is not used to treat the conditions identified in options 1, 3, and 4.

A client has been taking omeprazole for 4 weeks. The ambulatory care nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom? A. diarrhea B. heartburn C. flatulence D. constipation

D. Drink eight glasses of fluid a day. ***Adequate hydration is important for all sulfa drugs because they can crystallize in the urine (D). If possible, the drug should be taken after eating to provide longer intestinal transit time (B). (A) is important for other medications, such as phenytoin (Dilantin), because of the incidence of gingival hyperplasia, and (C) is important for steroid administration, but (D) is most important to stress with this client.

A client is being discharged with a prescription for sulfasalazine (Azulfidine) to treat ulcerative colitis. Which instruction should the nurse provide to this client prior to discharge? A. Maintain good oral hygiene. B. Take the medication 30 minutes before a meal. C. Discontinue use of the drug gradually. D. Drink eight glasses of fluid a day.

A. " My mouth feels sore" ***Stomatitis caused by a thrush infection, which can cause mouth pain, is a sign of superinfection (A). (B, C, and D) are more typical side effects, rather than symptoms, of a superinfection.

A client is receiving anti-infective drug therapy for a postoperative infection. Which complaint should alert the nurse to the possibility that the client has contracted a superinfection? A. " My mouth feels sore" B. "I have a headache." C. "My ears feel plugged up." D. "I feel constipated"

A. Hold the theophylline dose and notify the health care provider. ***The therapeutic range for theophylline is 10 to 20 mcg/mL, so the theophylline dose should be held for fear of causing toxicity (A). (B, C, and D) are not indicated actions based on the reported theophylline level.

A client receives a prescription for theophylline (Theo-Dur) PO to be initiated in the morning after the dose of theophylline IV is complete. The nurse determines that a theophylline level drawn yesterday was 22 mcg/mL. Based on this information, which action should the nurse implement? A. Hold the theophylline dose and notify the health care provider. B. Start the client on a half-dose of theophylline PO. C. The theophylline dose can be initiated as planned. D. The client is not ready to be weaned from the IV to the PO route.

B. Obtain the client's blood pressure. ***To determine the most accurate response to antihypertensive therapy, baseline blood pressures should be obtained before an antihypertensive drug is administered and should be compared with orthostatic vital signs to determine whether any side effects are occurring (B). Although (A, C, and D) are required nursing actions prior to giving any drug, the therapeutic response should be determined before another dose is administered.

A client receives an antihypertensive agent daily. Which action is most important for the nurse to implement prior to administering the medication? A. Verify the expiration date. B. Obtain the client's blood pressure. C. Determine the client's history of adverse reactions. D. Review the client's medical record for a change in drug route.

B. Protamine sulfate ***Protamine sulfate (B) is the antagonist for heparin and is given for episodes of acute hemorrhage. (A, C, and D) are not heparin antagonists.

A client receiving a continuous infusion of heparin IV starts to hemorrhage from an arterial access site. Which medication should the nurse anticipate administering to prevent further heparin-induced hemorrhaging? A. Vitamin K1 (AquaMEPHYTON) B. Protamine sulfate C. Warfarin sodium (Coumadin) D. Prothrombin

A. The combination of these drugs promotes diuresis but decreases the risk of hypokalemia ***Furosemide (Lasix) is a potassium-losing diuretic. By giving it together with spironolactone (Aldactone) which is a potassium-sparing diuretic reduces the risk of electrolyte imbalance specifically hypokalemia.

A client receiving furosemide (Lasix) was also given spironolactone (Aldactone) therapy. Which of the following statement of the nurse indicates knowledge about the reason why both drugs are given together? A. The combination of these drugs promotes diuresis but decreases the risk of hypokalemia. B. A combination of two diuretics in a moderate doses is much more effective than one type in a large dose. C. Combination of these drugs increases osmolality of plasma and glomerular filtration rate. D. Combination of these drugs prevents dehydration and hypovolemia

C. Instruct the client to obtain a stool specimen to be taken to the laboratory for analysis. ***Antibiotics, such as Zyvox, can cause pseudomembranous colitis, resulting in severe watery diarrhea. The prescriber should be notified, and a stool specimen (C) should be obtained and analyzed for this complication. Severe diarrhea is not an indication of drug toxicity, so (A) is not warranted. Although gastrointestinal disturbance can be an adverse effect of Zyvox (B), a stool specimen should be obtained because the client reports the diarrhea is severe. Antidiarrheal medications (D) are contraindicated in the presence of this colitis and should not be started until this potential complication is ruled out.

A client taking linezolid (Zyvox) at home for an infected foot ulcer calls the home care nurse to report the onset of watery diarrhea. Which intervention should the nurse implement? A. Schedule appointments to obtain blood samples for drug peak and trough levels. B. Reassure the client that this is an expected side effect that will resolve in a few days. C. Instruct the client to obtain a stool specimen to be taken to the laboratory for analysis. D. Advise the client to begin taking an over-the-counter antidiarrheal agent.

D. "Your drug is a potassium-sparing diuretic, so there is no need for extra potassium" ***Spironolactone (Aldactone) is a potassium-sparing diuretic, thus, clients do not need any potassium supplement since they will be at risk of developing hyperkalemia. Even though option C is true that supplement are usually not given to with this type of diuretic, a more precise explanation with why potassium is not given is still a better response.

A client that is taking spironolactone (Aldactone) is asking for potassium supplement. Which of the following is the best response of the nurse? A. "I will call your doctor right away and let him know about your concern" B. "You are correct. I'll be back to get you what you want" C. "Potassium supplements are usually not necessary with this type of diuretic" D. "Your drug is a potassium-sparing diuretic, so there is no need for extra potassium"

A. Fatigue and muscle weakness ***Thiazide diuretics, such as HCTZ, cause potassium wasting in the urine, so the client should be instructed to report fatigue and muscle weakness (A), which are characteristic of hypokalemia. Although (B, C, and D) should be reported, they are not indicative of hypokalemia, which is a side effect of HCTZ that can cause cardiac dysrhythmias.

A client who is hypertensive receives a prescription for hydrochlorothiazide (HCTZ). When teaching about the side effects of this drug, which symptoms are most important for the nurse to instruct the client to report? A. Fatigue and muscle weakness B. Anxiety and heart palpitations C. Abdominal cramping and diarrhea D. Confusion and personality changes

B. Multiple drugs prevent the development of resistant organisms. ***A multidrug regimen is prescribed for a client with HIV and TB to prevent the development of resistance of the tubercle bacilli (B). Although antitubercular medications can inhibit some antiretrovirals (A), a multidrug regimen is needed to inhibit the proliferation of the virulent tubercle bacilli. The duration of antitubercular therapy is typically 6 to 9 months and is not shortened (C) by the use of multiple medications. A client who is receiving HIV and TB therapy is at an increased risk of adverse reactions (D) because of the complex medication regimens and complications secondary to immunosuppression.

A client with HIV who was recently diagnosed with tuberculosis (TB) asks the nurse, "Why do I need to take all of these medications for TB?" What information should the nurse provide? A. Antiretroviral medications decrease the efficacy of the TB drugs. B. Multiple drugs prevent the development of resistant organisms. C. Duration of the medication regimen is shortened. D. Potential adverse drug reactions are minimized.

D. one hour before meals and at bedtime ***Sucralfate is a gastric protectant. The medication should be scheduled for administration 1 hour before meals and at bedtime. The medication is timed to allow it to form a protective coating over the ulcer before food intake stimulates gastric acid production and mechanical irritation. The other options are incorrect.

A client with a gastric ulcer has a prescription for sucralfate 1 gram by mouth 4 times daily. The nurse should schedule the medication for which times? A. with meals and at bedtime B. every 6 hours around the clock C. one hour after meals and at bedtime D. one hour before meals and at bedtime

B. Reduction or elimination of nausea and vomiting ***Ondansetron (Zofran) is a type 3 receptor (5-HT3) antagonist that is recognized for improved control of acute nausea and vomiting associated with chemotherapy (B). 5-HT3 antagonists are most effective when administered IV prior to the induction of the chemotherapeutic agent(s). (A, C, and D) are not therapeutic actions of ondansetron (Zofran).

A client with acute lymphocytic leukemia is to begin chemotherapy today. The health care provider's prescription specifies that ondansetron (Zofran) is to be administered IV 30 minutes prior to the infusion of cisplatin (Platinol). What is the rationale for administering Zofran prior to the chemotherapy induction? A. Promotion of diuresis to prevent nephrotoxicity B. Reduction or elimination of nausea and vomiting C. Prevention of a secondary hyperuricemia D. Reduction in the risk of an allergic reaction

D. reducing vascular volume leading to a shift of fluid from the lungs into the vasculature ***Furosemide reduces vascular volume leading to a shift of fluid from the lungs into the vasculature in clients with acute pulmonary edema.

A client with acute pulmonary edema is ordered with Furosemide [Lasix] 40 mg IV q 8 hours. The nurse understands that this medication is being used for? A. dilating bronchioles B. reducing ischemic damage C. decreasing the preload of the heart D. reducing vascular volume leading to a shift of fluid from the lungs into the vasculature

D. Decreased aldosterone ***Spirinolactone (Aldactone) is the direct antagonist of aldosterone.

A client with hyperaldosteronism has been given spironolactone (Aldactone). Which of the following laboratory result finding will the nurse evaluate as a positive outcome of the medication? A. Decrease of potassium level B. Decreased ankle edema C. Decreased crackles in the lungs D. Decreased aldosterone

D. A decreased in blood pressure ***Spironolactone (Aldactone) is an antagonist of aldosterone. Reversing the effect of aldosterone by decreasing circulatory volume by inhibiting reabsorption of water and sodium. Which in turn results to decrease in blood pressure and excretion of sodium and water while retaining potassium. It has no effect in body metabolism.

A client with hyperaldosteronism has been prescribed with spironolactone (Aldactone). Which of the following indicates that the medication is effective? A. A decreased in sodium excretion B. A decreased in body metabolism C. A decreased in potassium level D. A decreased in blood pressure

B. potassium chloride

A client with hypertension has been recently discharged from the hospital due to hyperlipidemia. Before admission, he takes Accupril [Quinapril] as his maintenance medication. After discharge he has instructions to continue taking his maintenance medication together with his discharge medications, as the nurse case manager reviews the discharge medications which of the following needs the attention of the cardiologist? A. fish oil supplements B. potassium chloride C. Atorvastatin D. Clopidogrel

C. Notify the health care provider of the need to increase the dose. ***Because of prolonged use, the patient is developing tolerance to the medication and an increase in dosage may be in order. Instructing the client about opioid tolerance, while you could argue beneficial, will not help to alleviate pain. The other options are not appropriate.

A client with metastatic cancer who has been receiving fentanyl (Duragesic) for several weeks reports to the nurse that the medication is not effectively controlling the pain. Which intervention should the nurse initiate? A. Instruct the client about the indications of opioid dependence. B. Monitor the client for symptoms of opioid withdrawal. C. Notify the health care provider of the need to increase the dose. D. Administer naloxone (Narcan) per PRN protocol for reversal.

C. Dopamine in the central nervous system is increased. ***Amantadine (Symmetrel) is a dopamine-releasing agent (C); therefore, this medication increases the amount of dopamine present in the central nervous system. Although this medication is also an antiviral agent (A), the antiviral effect is not significant in the treatment of parkinsonism. (B and D) are not affected by amantadine (Symmetrel).

A client with mild Parkinsonism is started on oral amantadine (Symmetrel). Which statement accurately describes the action of this medication? A. Viral organisms that cause Parkinsonism are eliminated. B. Acetylcholine in the myoneural junction is enhanced. C. Dopamine in the central nervous system is increased. D. Norepinephrine release is reduced within the periphery.

C. vitamin A ***This drug is a derivative of vitamin A.

A client with sever acne is seen in the clinic and the HCP prescribes isotretinoin. The nurse reviews the client's medication record and would contact the HCP if the client is also taking which medication? A. digoxin B. phenytoin C. vitamin A D. furosemide

A. Carvedilol ***Carvedilol is unusual in that it can block alpha1 receptors as well as beta receptors. Reserpine is an adrenergic neuron blocker. Methyldopa is a centrally acting alpha2 agonist. Propranolol is a beta-adrenergic blocker.

A patient has a prescription for hypertension that blocks both alpha and beta receptors. Which drug will the nurse administer? A. Carvedilol B. Reserpine C. Methyldopa D. Propranolol

C. hydrochlorothiazide

A diuretic used for treatment of hypertension & heart failure that can decrease glucose tolerance, produce hypokalemia (in high doses), aggrevate gout by interfering with uric acid secretion, and produce a small rise in LDL. A. amiloride B. furosemide C. hydrochlorothiazide D. mannitol

C. Intravenous ***Intravenous drugs are absorbed more quickly than oral, subcutaneous, or topical drugs. The bioavailability for intravenous drugs is 100% and requires the most immediate evaluation of therapeutic effect.

A drug administered by which route requires the most immediate evaluation of therapeutic effect? A. Oral B. Topical C. Intravenous D. Subcutaneous

D. rivastigmine

A drug used to treat mild to moderate dementia. Should be given PO BID or transdermal patch daily. Use cautiously in COPD/ asthma. Common side effects include weakness, dizziness, and nausea. May cause wt. loss. A. donepezil B. memantine C. galantamine D. rivastigmine

A. donepezil

A drug used to treat mild to moderate to severe dementia. Can cause headache, nausea, and dizziness. The nurse should assess for bradycardia and teach the pt. to take right before bed. A. donepezil B. memantine C. galantamine D. rivastigmine

B. memantine

A drug used to treat moderate to severe dementia. Is available in immediate and extended release capsules. Nurse should assess RBCs, hemoglobin, and hematocrit. Administer lower doses if pt. has renal failure. A. donepezil B. memantine C. galantamine D. rivastigmine

B. Help control symptoms during the severe manic episode ***Antipsychotic drugs are given to help control symptoms during severe manic episodes, even if psychotic symptoms are absent. Benzodiazepines are given for their sedating effects. Antidepressants help elevate mood during manic episodes.

A family member of a patient who is experiencing a severe manic episode asks the nurse why the patient is receiving an antipsychotic medication. The nurse informs the family member that antipsychotics are used to do what in the treatment of severe manic episodes? A. Elevate mood during the severe manic episode B. Help control symptoms during the severe manic episode C. Produce sedating effects during the severe manic episode D. Reduce the amount of physical pain the patient experiences during the severe manic episode

A. Oral contraceptives may not be effective. ***Certain antibiotics, such as tetracycline (Vibramycin), decrease the effectiveness of oral contraceptives (A). (B, C, and D) do not convey accurate information related to client teaching about this medication.

A female client is receiving tetracycline (Vibramycin) for acne. Which client teaching should the nurse include? A. Oral contraceptives may not be effective. B. Drinking cranberry juice will promote healing. C. Breast tenderness may occur as a side effect. D. The urine will turn a red-orange color.

A. Advise the client to take the medication in the morning, rather than at bedtime. ***Daily doses of long-term corticosteroid therapy should be administered in the morning (A) to coincide with the body's normal secretion of cortisol. Clients receiving long-term corticosteroids need to increase their intake of calcium, which generally means an increase in dairy products (B). Corticosteroids can often cause gastrointestinal distress and should be administered with meals (C). The client has established a safe routine by taking the medication with a snack, but the routine will be more effective if done in the morning (D).

A female client who has started long-term corticosteroid therapy tells the nurse that she is careful to take her daily dose at bedtime with a snack of crackers and milk. Which is the best response by the nurse? A. Advise the client to take the medication in the morning, rather than at bedtime. B. Teach the client that dairy products should not be taken with her medication. C. Tell the client that absorption is improved when taken on an empty stomach. D. Affirm that the client has a safe and effective routine for taking the medication.

D. Develop a teaching plan for the client to self- adjust the dose of medication in response to symptoms ***Maintaining optimal dosage for cholinesterase inhibitors can be challenging for clients with myasthenia gravis. Clients should be taught to recognize signs of overmedication and undermedication so that they can modify the dosage themselves (D) based on a prescribed sliding scale. (A, B, and C) do not adequately address the client's concerns.

A female client with myasthenia gravis is taking a cholinesterase inhibitor and asks the nurse what can be done to remedy her fatigue and difficulty swallowing. What action should the nurse implement? A. Explore a plan for development of coping strategies for the symptoms with the client. B. Explain to the client that the dosage is too high, so she should skip every other dose of medication. C. Advise the client to contact her health care provider because of the development of tolerance to the medication. D. Develop a teaching plan for the client to self- adjust the dose of medication in response to symptoms

A. Avoid alcohol consumption. ***Clients should be instructed to avoid alcohol and products containing alcohol (A) while taking metronidazole (Flagyl) because of the possibility of a disulfiram (Antabuse)-like reaction. (B) helps prevent the development of Flagyl-resistant T. vaginalis. To prevent reinfection, clients should abstain from sexual contact or use a barrier contraceptive (C) while taking Flagyl, and their partner(s) should be treated concurrently (D). The most important instruction for client well-being is (A).

A female client with trichomoniasis (Trichomonas vaginalis) receives a prescription for metronidazole (Flagyl). Which instruction is most important for the nurse to include this client's teaching plan? A. Avoid alcohol consumption. B. Complete the medication regimen. C. Use a barrier contraceptive method. D. Treat partner(s) concurrently.

C. It will take longer to be absorbed. ***Enteric coating is designed to protect a drug from dissolution until it can be absorbed in the intestines. Thus, it will take longer to be absorbed, because absorption does not occur in the stomach and gastric-emptying time varies.

A patient has taken an enteric-coated medication. How would this coating affect drug absorption? A. It will not be absorbed. B. Absorption will be increased. C. It will take longer to be absorbed. D. It will avoid first-pass metabolism.

B. "I should avoid pregnancy for one month after completing 5-FU therapy." ***Teach the patient that pregnancy should be avoided for 3 to 4 months after completing antineoplastic therapy in most situations. Some sources recommend that both men and women avoid conception for 2 years after completion of treatment.

A female patient is scheduled to receive fluorouracil (5-FU) to treat colon cancer. Which statement made by the patient indicates to the nurse a need for additional teaching about 5-FU? A. "I should call the health care provider if I develop signs of infection." B. "I should avoid pregnancy for one month after completing 5-FU therapy." C. "I should not visit anyone who has the flu or a cold." D. "I should use sunscreen when I go outside during the daylight."

C. Albuterol ***Albuterol ( a SABA) is used to treat bronchospasm of asthma to promote bronchodilation. Zafirlukast (Accolate) is a leukotriene receptor antagonist and is not used for the treatment of acute asthma attacks; nedrocromil sodium (Tilade) is used as a prophylactic treatment of bronchial asthma and must be taken daily, and zileuton (Zyflo) is a leukotriene synthesis inhibitor used for prophylaxis and maintenance therapy for chronic asthma.

A home care nurse is visiting a patient with asthma who suddenly experiences an acute asthma attack. Which drug should the nurse prepare to administer? A. Zafirlukast (Accolate) B. Nedrocromil sodium (Tilade) C. Albuterol D. Zileuton (Zyflo)

A. Electrocardiogram (ECG) results ***Despite the fact that changes in all these findings are seen in hyperkalemia, ECG results should be taken priority on the grounds that changes can indicate potentially deadly arrhythmias, for example, ventricular fibrillation.

A laboratory result of a client taking spironolactone (Aldactone) for hypertension came in. Result shows a potassium level of 6 mEq/L. Which of the following will be the nurse's priority to assess: A. Electrocardiogram (ECG) results B. Bowel sounds C. Respiratory rate D. Neuromuscular function

C. Pharmacodynamic tolerance requires increased drug levels to achieve the same effect. ***Pharmacodynamic tolerance explains the client's need for an increased drug level to produce effects that formerly occurred at lower drug levels (C). Tolerance can occur with opioids (A) during shorter periods of use. Although a withdrawal syndrome can occur if the client develops a dependency (B), this does not address the client's immediate concern of drug effectiveness. Although a stable serum drug level provides effective pain management (D), the client's complaint is consistent with a tolerance to his current pain management regimen.

A male client who has chronic back pain is on long-term pain medication management and asks the nurse why his pain relief therapy is not as effective as it was 2 months ago. How should the nurse respond? A. The phenomenon occurs when opiates are used for more than 6 months to relieve pain. B. Withdrawal occurs if the drug is not tapered slowly while being discontinued. C. Pharmacodynamic tolerance requires increased drug levels to achieve the same effect. D. A consistent dosage with around-the-clock administration is the most effective.

B. Usually two to three agents are needed. ***Single-drug therapy for TB is not effective. Usually two to three drugs are needed. The total treatment plan is usually 6 to 9 months. Although unusual, resistance can occur. The patient should be taught methods to prevent and report side effects and adverse reactions to therapy.

A middle-aged adult is diagnosed with tuberculosis. Which is true of treatment for this diagnosis? A. Treatment may take about 10 days to 2 weeks. B. Usually two to three agents are needed. C. The bacteria is usually resistant to treatment therapy. D. Treatment for tuberculosis is usually without side effects.

B. taking alcohol with Ativan may increase sedative effects. ***Alcohol and other CNS depressants should not be taken with benzodiazepines because respiratory depression could result.

A nurse caring for a patient in an outpatient setting notes that the patient is currently taking lorazepam (Ativan) for anxiety and her breath smells of alcohol. The nurse reports this to the health care provider because A. taking alcohol with Ativan can be fatal. B. taking alcohol with Ativan may increase sedative effects. C. all patients using alcohol should be referred for assistance. D. Ativan and alcohol antagonize one another.

D. "Drugs can cross from mother to infant in breast milk, so it will depend on the drug you are taking." ***The nurse is aware that medications can pass in breast milk, but each medication is different. Women who take medication while breast-feeding should be assessed on a case-by-case basis, including assessment of the medication the patient is taking.

A mother of a 1-month-old infant calls the clinic and asks the nurse if the medication she is taking can be passed to her infant during breast-feeding. What is the appropriate response for this patient? A. "I will leave the doctor a message to return your call." B. "You should not take any medication while breast-feeding." C. "Only certain medications pass to infants while breast-feeding." D. "Drugs can cross from mother to infant in breast milk, so it will depend on the drug you are taking."

C. In 6 to 12 hours ***Low-dose (30 mL) milk of magnesia, an osmotic laxative, acts to retain water and soften the feces. Fecal swelling promotes peristalsis in 6 to 12 hours.

A nurse administering 30 mL of magnesium hydroxide (milk of magnesia) tells the patient to expect a bowel movement in which amount of time? A. In 1 to 3 days B. In 2 to 4 hours C. In 6 to 12 hours D. In 15 minutes to 1 hour

C. Increased pain ***Naloxone reverses the effects of narcotics. Although the patient's respiratory status will improve after administration of naloxone, the pain will be more acute.

A nurse administers naloxone [Narcan] to a postoperative patient experiencing respiratory sedation. What undesirable effect would the nurse anticipate after giving this medication? A. Drowsiness B. Tics and tremors C. Increased pain D. Nausea and vomiting

A. Omeprazole [Prilosec] ***Omeprazole causes irreversible inhibition of the proton pump, the enzyme that generates gastric acid. It is a powerful suppressant of acid secretion. Famotidine and ranitidine block histamine2 receptors on parietal cells. Misoprostol protects against ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs) by stimulating the secretion of mucus and bicarbonate to maintain submucosal blood flow.

A nurse administers which medication to inhibit an enzyme that makes gastric acid in a patient who has a duodenal ulcer? A. Omeprazole [Prilosec] B. Famotidine [Pepcid] C. Misoprostol [Cytotec] D. Ranitidine [Zantac]

B. Cimetidine [Tagamet] ***Cimetidine binds to androgen receptors, producing receptor blockade, which can cause enlarged breast tissue (gynecomastia), reduced libido, and impotence. All these effects reverse when dosing stops. Amoxicillin, metronidazole, and omeprazole are not associated with gynecomastia.

A nurse assesses a male patient who has developed gynecomastia while receiving treatment for peptic ulcers. Which medication from the patient's history should the nurse recognize as a contributing factor? A. Amoxicillin [Amoxil] B. Cimetidine [Tagamet] C. Metronidazole [Flagyl] D. Omeprazole [Prilosec]

D. Akathisia ***Haloperidol is a traditional antipsychotic medication with the adverse effects of extrapyramidal symptoms. Akathisia, or motor restlessness, is an extrapyramidal symptom. Dystonia manifests as severe spasm of the muscles of the tongue, face, neck, or back and may include upward deviation of the eyes, severe cramping, and impaired respiration. Tardive dyskinesia presents with involuntary twisting, writhing, wormlike movements of the tongue and face, lip smacking, and tongue flicking. Parkinsonism appears with bradykinesia, masklike facies, drooling, tremor, rigidity, shuffling gait, and stooped posture.

A nurse assesses a patient receiving haloperidol [Haldol]. The nurse notices that the patient is shifting in the chair, rocking back and forth, and tapping both feet constantly. What is the most accurate term to document these findings? A. Dystonia B. Tardive dyskinesia C. Parkinsonism D. Akathisia

D. Developed lithium toxicity ***Early lithium toxicity is evidenced by diarrhea, anorexia, muscle weakness, nausea, vomiting, tremors, slurred speech, and drowsiness. Later signs include blurred vision, seizures, trembling, confusion, and ataxia.

A nurse assesses a patient who takes a maintenance dose of lithium carbonate [Lithobid] for bipolar disorder. The patient complains of hand tremor, nausea, vomiting, and diarrhea. The patient's gait is unsteady. The patient most likely has done what? A. Consumed some foods high in tyramine B. Not taken the lithium as directed C. Developed tolerance to the lithium D. Developed lithium toxicity

D. Discoloration of the teeth ***Tetracycline is contraindicated in children younger than 8 years of age, because it binds to calcium in developing teeth, resulting in permanent discoloration of the teeth. Delay in long bone growth, early onset of puberty, and severe face and body acne are not adverse effects associated with tetracyclines.

A nurse assessing a patient who is 12 years old should associate which complication with the patient's receiving tetracycline as a younger child? A. Delay in long bone growth B. Early onset of puberty C. Severe face and body acne D. Discoloration of the teeth

B. Cataracts ***Cataracts are a common complication of long-term glucocorticoid therapy. To facilitate early detection, patients should undergo an eye examination every 6 months. Myopathy is muscle injury manifesting as weakness usually in the proximal muscles of the arms and legs. Long-term glucocorticoid therapy can induce a cushingoid syndrome with symptoms identical to those of naturally occurring Cushing's syndrome. Although long-term glucocorticoid therapy can cause infection, that is not the reason to recommend eye examinations every 6 months.

A nurse instructs a patient taking long-term glucocorticoid therapy to have eye examinations every 6 months. What is the nurse trying to prevent? A. Infection B. Cataracts C. Myopathy D. Cushing's syndrome

C. Assess the patient for drug toxicity. ***When two protein-bound drugs are given concurrently, they compete for protein-binding sites, thus causing more free drug to be released into circulation. In this situation, drug accumulation and possible drug toxicity can result. Also, a low serum protein level decreases the number of protein-binding sites and can cause an increase in the amount of free drug in the plasma. Drug toxicity may then result. Drug dose is prescribed according to what percentage of the drug binds to protein.

A nurse is administering two protein-bound drugs to a patient. Which is the safest course of action for the nurse to take? A. Administer the drugs with food. B. Recommend a high protein diet. C. Assess the patient for drug toxicity. D. Assess baseline liver function tests.

A. tetany ***Signs & Symptoms of Hypocalcemia "CRAMPS" Confusion Reflexes hyperactive Arrhythmias (prolonged QT interval and ST interval) Muscle spasms in calves or feet, tetany, seizures Positive Trousseau's Signs of Chvostek's

A nurse is caring for a patient who was admitted with multiple fractures and hypocalcemia. Which symptom would the nurse expect to find during an assessment of the patient with hypocalcemia? A. tetany B. flabby muscles C. irritability D. anxiety

B. Hypothyroidism ***The anterior pituitary increases production of TSH when thyroid hormone levels of T3 and T4 are reduced reflecting primary hypothyroidism. Patients may experience fatigue caused by a lowered basal metabolic rate. Thyrotoxicosis, hyperthyroidism, and Graves' disease are medical conditions indicative of excessive thyroid activity.

A nurse is caring for a patient with decreased triiodothyronine (T3) and thyroxine (T4) and elevated thyroid-stimulating hormone (TSH) levels. The nurse knows the patient is likely suffering from which condition? A. Thyrotoxicosis B. Hypothyroidism C. Graves' disease D. Hyperthyroidism

D. There is no safety evidence of this medication during pregnancy, so it should be avoided ***When working with a pregnant client, the nurse must be familiar with those situations and medications that can be harmful to the pregnant mother and/or her unborn baby. An example is corticosteroid use, which has not been shown to be safe during pregnancy. The nurse should be aware of this and counsel the client against using this type of drug.

A nurse is caring for a pregnant patient who needs treatment for rosacea. The patient asks the nurse about using topical corticosteroids for treatment. Which of the following information should the nurse provide this patient? A. The patient can safely use this type of medication B. The patient can only use this medication in areas away from the abdomen C. This medication causes teratogenic effects and should be avoided D. There is no safety evidence of this medication during pregnancy, so it should be avoided

A. At times of stress, the patient increases the glucocorticoid dose. ***Patients with adrenal insufficiency require lifelong replacement doses of glucocorticoids. Failure to increase the dosage at times of stress and illness can be life-threatening. Wearing a Medic Alert bracelet, carrying injectable and oral forms of glucocorticoid, and dividing the daily glucocorticoid dose are important for a patient taking hydrocortisone, but they are not priorities over understanding the need to increase the dose during stress.

A nurse is developing a plan of care for a patient who has Addison's disease and is taking hydrocortisone [Cortef]. Which of these outcomes should receive priority in the plan? A. At times of stress, the patient increases the glucocorticoid dose. B. The patient wears a Medic Alert bracelet at all times. C. The patient carries an injectable form and an oral form of glucocorticoid. D. The patient divides the daily dose, taking two-thirds of it in the morning and one-third in the afternoon.

B. During times of stress, the patient increases the glucocorticoid dose. ***Patients with adrenal insufficiency require lifelong replacement doses of glucocorticoids. Failure to increase the dosage at times of stress and illness can be life threatening. Wearing a medical ID bracelet, carrying injectable and oral forms of glucocorticoid, and dividing the daily glucocorticoid dose are important for a patient taking hydrocortisone, but they are not priorities over understanding the need to increase the dose during times of stress.

A nurse is developing a plan of care for a patient with Addison's disease who is taking hydrocortisone [Cortef]. Which outcome is of the highest priority for this patient's care plan? A. The patient wears a medical ID bracelet at all times. B. During times of stress, the patient increases the glucocorticoid dose. C. The patient carries an injectable form and an oral form of glucocorticoid. D. The patient divides the daily dose taking two-thirds of it in the morning and one-third in the afternoon.

B. Additive effect ***An additive effect or an increased adverse effect is said to be present when two drugs with similar actions are administered together. When given together, warfarin and aspirin can have additive effects and cause bleeding. A synergistic effect is said to be present when the effect of two drugs administered together is greater than the sum of each drug taken separately; there is nothing in the question to indicate that this has occurred. Incompatibility occurs in situations when two parenteral drugs mixed together result in the chemical deterioration of one or both of the drugs or form a precipitate. An antagonistic effect occurs when the effect of two drugs given together is lower than the sum of each drug taken separately.

A nurse is educating a patient who is prescribed warfarin. The nurse advises the patient to avoid taking aspirin and explains that taking both drugs together may cause excessive bleeding. What is this phenomenon called? A. Incompatibility B. Additive effect C. Synergistic effect D. Antagonistic effect

A. Prepare the patient for dialysis and place the patient on a cardiac monitor

A patient has a potassium level of 9.0. Which nursing intervention is priority? A. Prepare the patient for dialysis and place the patient on a cardiac monitor B. Administer Spironolactone C. Place patient on a potassium restrictive diet D. Administer a laxative

D. Disruption of the bacterial cell wall, causing lysis and death ***Amoxicillin disrupts the cell wall of H. pylori, which causes lysis and death. Inhibition of an enzyme to block acid secretion is a function of the proton pump inhibitors (PPIs). Coating of the ulcer crater as a barrier to acid is an action of sucralfate [Carafate]. Selective blockade of parietal cell histamine2 receptors is an action of the histamine2 receptor antagonists cimetidine, ranitidine, famotidine, and nizatidine.

A nurse is planning care for a patient who has peptic ulcer disease and is taking amoxicillin [Amoxil]. The nurse is aware that the action of this medication is which of the following? A. Inhibition of an enzyme to block acid secretion B. Coating of the ulcer crater as a barrier to acid C. Selective blockade of parietal cell histamine2 receptors D. Disruption of the bacterial cell wall, causing lysis and death

B. Relief of sneezing and itching ***Fexofenadine, a second-generation antihistamine, is prescribed as a first-line medication for allergic rhinitis to relieve sneezing, rhinorrhea, and nasal itching. Anticholinergic effects (dry mouth, constipation) are uncommon with second-generation antihistamines. Antihistamines are most effective when taken prophylactically. Rebound congestion develops in topical sympathomimetic agents.

A nurse is planning care for a patient who takes fexofenadine [Allegra] for allergic rhinitis. Which outcome should the nurse anticipate? A. No complaints of dry mouth B. Relief of sneezing and itching C. Use limited to allergy season D. Absence of rebound congestion

A. Black stools ***Warfarin is an anticoagulant medication that prevents blood clots. Alternatively, it may also increase the risk of bleeding. The nurse should assess for signs of bleeding in the gastrointestinal system, which could manifest as black stools.

A nurse is preparing to administer a dose of warfarin to a patient. Based on the nurse's knowledge of this drug, the nurse knows to monitor for which of the following side effects? A. Black stools B. Constipation C. Abdominal bloating D. Back pain

A. Read about the drug in a reference guide before administration ***When a nurse must give a medication that she is not familiar with, the nurse should take time to read and learn about the medication thoroughly before administering it. Drug guides are available as books or online that a nurse can access to educate herself about a drug. For the safety of the patient and the nurse, the nurse must be informed about the drug that she is administering.

A nurse is preparing to administer a medication that she has never given before. Which of the following actions should the nurse do in order to promote safety for the patient and the nurse when giving the medication? A. Read about the drug in a reference guide before administration B. Contact the physician and ask for clarification about the drug C. Give the drug slowly and double-check the record with another nurse D. Refuse to give the drug until the nurse learns more about it

A. Give the dose first thing in the morning ***Furosemide is a diuretic medication that increases excretion of excess fluid through urination. When giving this medication, the nurse should give it in the morning, as it will cause the patient to need to use the bathroom frequently. The nurse should avoid giving it in the evening, as it could disrupt sleep if the patient has to get up multiple times during the night to urinate.

A nurse is preparing to administer furosemide to a patient who is in the hospital with heart failure. Which of the following should the nurse consider when administering this medication? A. Give the dose first thing in the morning B. Do not administer the medication with meals C. Monitor the patient's temperature every 4 hours D. Decrease fluid intake to avoid excess urine secretion

B. A patient taking warfarin ***Vitamin K is not given to a patient taking warfarin, as this will interfere with the action of the warfarin. There is no contraindication to administering vitamin K for the other patients.

A nurse is reviewing the medication records for vitamin K. The nurse will hold vitamin K and call the provider regarding which patient? A. A newborn infant B. A patient taking warfarin C. A patient with celiac disease D. A patient with megaloblastic anemia

A. A patient with asthma B. A patient with a kidney transplant C. A patient with rheumatoid arthritis ***In high (pharmacologic) doses, glucocorticoids are used to treat inflammatory disorders (eg, asthma, rheumatoid arthritis) and certain cancers and to suppress immune responses in organ transplant recipients. In low (physiologic) doses, glucocorticoids are used to treat adrenocortical insufficiency. Glucocorticoids are contraindicated in patients receiving live virus vaccines.

A nurse is reviewing the medication records of patients receiving high (pharmacologic) doses of glucocorticoids. For which patients is this type of treatment appropriate? Select all that apply. A. A patient with asthma B. A patient with a kidney transplant C. A patient with rheumatoid arthritis D. A patient with a live virus vaccination E. A patient with adrenocortical insufficiency

A ***All preganglionic and postganglionic neurons of the parasympathetic nervous system release acetylcholine as their transmitter; thus, the image with acetylcholine at both synapses should be used. All preganglionic neurons release acetylcholine but postganglionic neurons can release acetylcholine, norepinephrine, or epinephrine for the sympathetic nervous system. Motor neurons are part of the somatic motor system.

A nurse is teaching a class about the parasympathetic nervous system and transmitters. Which image will the nurse use in the teaching session?

C. Preterm labor ***In women with bacterial vaginosis, antibiotics can reduce the incidence of preterm labor. Research studies suggest a simple method for preventing some preterm deliveries: early screening for and treatment of asymptomatic bacterial vaginosis. It does not affect menorrhagia, uterine atony, or uterine tachysystole.

A nurse is teaching a group of pregnant women to have early screening and treatment of asymptomatic bacterial vaginosis with antibiotics. What is the nurse trying to prevent? A. Menorrhagia B. Uterine atony C. Preterm labor D. Uterine tachysystole

B. Baroreceptor reflex ***From a pharmacologic perspective, the baroreceptor reflex is the most important feedback loop of the autonomic nervous system. This reflex is important because it frequently opposes our attempts to modify blood pressure with drugs. Autonomic tone is the steady, day-to-day influence exerted by the autonomic nervous system on a particular organ or organ system. Innervation refers to how nerves affect systems in the body and are not directly related to pharmacologic effects. Sensor and effector response are processes within every feedback loop.

A nurse is teaching a group of students about pharmacologic effects of the feedback loop on the autonomic nervous system. What will the nurse teach is the most important feedback loop? A. Autonomic tone B. Baroreceptor reflex C. Patterns of innervation D. Sensor and effector response

D. "Do not eat anything for at least 60 minutes after taking this medicine." ***After dosing, ibandronate [Boniva] requires 60 minutes before eating and 60 minutes remaining upright. Ibandronate [Boniva] can only be taken with water. Taking right before bedtime would require lying down, an action that is contraindicated for ibandronate [Boniva] for at least 60 minutes or longer.

A nurse is teaching a patient about ibandronate [Boniva]. Which information is essential to include in the teaching session? A. "Take this medicine right before bedtime." B. "Take this medicine with a full glass of milk or water." C. "Sit or stand for at least 30 minutes after taking this medicine." D. "Do not eat anything for at least 60 minutes after taking this medicine."

B. "While taking this medicine, I may be able to reduce my steroid medication." ***Montelukast is an antileukotriene agent. Combining montelukast with an inhaled glucocorticoid medication can improve asthma symptoms and thus may allow a reduction in the glucocorticoid dosage. The effects of montelukast develop slowly, so it cannot be used as a quick-relief agent. Short-acting beta2 agonists are preferred for exercise-induced asthma. Montelukast does not affect coagulation, so bleeding and bruising do not occur.

A nurse is teaching a patient about montelukast [Singulair]. Which statement by the patient would indicate that the nurse's teaching was effective? A. "I'll take a dose as soon as I feel short of breath and start to cough." B. "While taking this medicine, I may be able to reduce my steroid medication." C. "If I have nosebleeds or excessive bruising, I'll stop the medication immediately." D. "This is the priority medication for preventing exercise-induced asthma symptoms."

A. Avoid smoking. B. Avoid excessive alcohol. E. Perform regular weight-bearing exercise. ***Lifestyle measures that promote bone health are: (1) performing regular weight-bearing exercises (walking, yoga, dancing, racquet sports, weight lifting, stair climbing), (2) avoiding excessive alcohol, and (3) avoiding smoking. Adolescents need 1300 mg of calcium a day. Bone mineral density testing is not recommended for children or adolescents.

A nurse is teaching adolescents about bone health. Which information should be included in the teaching session? Select all that apply. A. Avoid smoking. B. Avoid excessive alcohol. C. Obtain 1200 mg of calcium a day. D. Have a bone mineral density test done. E. Perform regular weight-bearing exercise.

B. Reuptake of the transmitter ***5a is an image for reuptake of the transmitter into the nerve terminal; 2 is storage of the transmitter; 1 is synthesis of the transmitter; and 5b is enzymatic degradation of the transmitter.

A nurse is teaching the staff about the effects of drugs on receptor activity. The nurse is using the image in the teaching session. Which concept will the nurse teach about for 5a in the image? A. Storage of the transmitter B. Reuptake of the transmitter C. Synthesis of the transmitter D. Enzymatic degradation of the transmitter

B. Decrease in mouth pain ***Nystatin is an antifungal medication that is used for candidiasis of the skin, mouth, esophagus, intestine, and vagina. It can be administered orally and topically and will heal mouth lesions from oral candidiasis. Nystatin has no effect on nasal congestion and cough production. It does not cause urticaria.

A nurse planning care for a patient who is receiving nystatin [Mycostatin] should establish which outcome on the care plan? A. Relief of nasal congestion B. Decrease in mouth pain C. Productive cough D. Absence of urticaria

A. Alcoholic drinks ***Through several mechanisms, regular alcohol consumption while taking acetaminophen [Tylenol] increases the risk of liver injury when dosages are excessive. Therapeutic doses of acetaminophen [Tylenol] may be safe for patients who drink alcohol; however, the U.S. Food and Drug Administration (FDA) requires that acetaminophen [Tylenol] labels state an alcohol warning for patients who consume three or more drinks a day to consult their prescriber to determine whether acetaminophen [Tylenol] can be taken safely. It is not necessary to avoid leafy green foods, bananas, or dairy products when taking acetaminophen.

A nurse provides discharge instructions for a patient who is taking acetaminophen [Tylenol] after surgery. The nurse should instruct the patient to avoid which product while taking acetaminophen? A. Alcoholic drinks B. Leafy green foods C. Bananas D. Dairy products

D. "I take a megadose multivitamin daily." ***Because vitamin A is highly teratogenic, it is essential for the nurse to discuss the practice of taking megadoses of vitamins. It is important to discuss vegetarianism to ascertain that the client is obtaining necessary nutrients; however, this is not teratogenic so it is not the priority. Grapefruit juice is only a problem if the client takes drugs metabolized by enzymes inhibited by grapefruit juice. Eating ready-to-eat cereals is not a concern.

A nurse reviews the 24-hour diet and supplement intake of a woman who is in the first trimester of pregnancy. Which information creates the priority concern for the nurse to follow up with the woman? A. "I am a vegetarian." B. "I drink grapefruit juice every morning." C. "I eat a variety of ready-to-eat cereals." D. "I take a megadose multivitamin daily."

C. "It would be better to eat five or six small meals a day instead of three larger ones." ***One optimal nondrug measure, in addition to drug management, to aid patients with peptic ulcers is changing the eating pattern to more frequent, smaller meals to avoid fluctuations in intragastric pH. No evidence indicates that beverages containing caffeine promote ulcer formation or that an "ulcer diet" improves healing. Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the biosynthesis of prostaglandins, which reduce mucosal blood flow and promote the secretion of gastric acid.

A nurse should give which nonmedication instruction to a patient who has peptic ulcers? A. "Reduce your intake of caffeine-containing beverages, such as coffee and colas." B. "Take a nonsteroidal anti-inflammatory drug once a day to help with pain." C. "It would be better to eat five or six small meals a day instead of three larger ones." D. "An ulcer diet of bland foods with milk and cream products will speed healing."

B. Pseudoephedrine [Sudafed] ***Pseudoephedrine is a sympathomimetic that activates alpha1 receptors and causes vasoconstriction. Only oral agents cause widespread vasoconstriction that warrants caution in patients with hypertension. Montelukast blocks leukotrienes and has no adverse effects. Oxymetazoline spray is a topical sympathomimetic that causes rebound congestion with prolonged use. Mometasone spray is a glucocorticoid intranasal spray for which systemic side effects are rare.

A nurse should monitor more frequently the blood pressure of a patient with a history of hypertension who takes which medication for allergic rhinitis? A. Montelukast [Singulair] B. Pseudoephedrine [Sudafed] C. Oxymetazoline [Afrin spray] D. Mometasone [Nasonex spray]

C. Renal failure ***High-dose aspirin therapy should be avoided in patients taking ACE inhibitors. In susceptible patients, these medications can impair renal function when they are combined with aspirin. Liver toxicity, congestive heart failure, and hemorrhage are not effects of ACE inhibitor and aspirin interactions.

A nurse should recognize that a patient who takes an angiotensin-converting enzyme (ACE) inhibitor while also taking high-dose aspirin is at risk of developing what complication? A. Congestive heart failure B. Liver toxicity C. Renal failure D. Hemorrhage

A. Skin rash and loose stools ***Ampicillin's most common side effects are rash and diarrhea; both reactions occur more frequently with ampicillin than with any other penicillin. Reddened tongue and gums, digit numbness and tingling, and bruising and petechiae are not associated side effects of ampicillin.

A nurse should teach a patient to observe for which side effects when taking ampicillin? A. Skin rash and loose stools B. Reddened tongue and gums C. Digit numbness and tingling D. Bruising and petechiae

C. Aged cheese and Chianti ***Foods that contain tyramine can produce a hypertensive crisis in individuals taking MAOI antidepressants. Many aged foods, such as cheese, contain tyramines.

A nurse teaches a patient taking a monoamine oxidase inhibitor (MAOI) about important dietary restrictions. Which foods will the nurse caution the patient to avoid? A. Potato and corn chips B. Coffee, colas, and tea C. Aged cheese and Chianti D. Grapefruit and other citrus juices

A. Aged cheese and sherry ***Foods that contain tyramine can produce a hypertensive crisis in individuals taking MAOI antidepressants. Many aged foods contain tyramines.

A nurse teaches a patient who takes an MAOI about important dietary restrictions. Which foods will the nurse caution the patient to avoid? A. Aged cheese and sherry B. Grapefruit and other citrus juices C. Coffee, colas, and tea D. Potato and corn chips

D. Gynecomastia ***Taking spironolactone may cause body changes because of it antiandrogenic effect to the body. These body image changes are related to decreased libido, gynecomastia in males, and hirsutism in females. Since the medication is diuretic, edema and weight gain should not occur. Excitability is not associated with this medication, rather drowsiness may occur.

A nursing diagnosis for a client taking with spironolactone (aldactone) was "Disturbed body image". Which of the following assessment finding was it based upon? A. Edema B. Weight gain C. Excitability D. Gynecomastia

A. Antitussive ***Codeine provides both analgesic and antitussive therapeutic effects. Hence, it is administered to patients with pneumonia. Codeine does not have immunostimulant, immunosuppressant, or expectorant actions.

A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse, "Why am I receiving codeine? I do not need anything for pain; I need something for my cough." Which effect of codeine will the nurse discuss with the patient? A. Antitussive B. Expectorant C. Immunostimulant D. Immunosuppressant

B. "There is not nearly as much drowsiness and sedation." ***Fexofenadine [Allegra] is a second-generation antihistamine that crosses the blood-brain barrier poorly, thus producing much less sedation than first-generation medications, such as diphenhydramine [Benadryl]. Fexofenadine has no associated cardiac risks, and daily dosing is still required. Second-generation antihistamines are not less expensive, but pricing is lower now that they are available over the counter.

A patient asks a nurse, "Why should I switch to fexofenadine [Allegra] for my allergies when I've taken diphenhydramine [Benadryl] for so long?" Which response should the nurse make? A. "You'll have much less risk of cardiac problems." B. "There is not nearly as much drowsiness and sedation." C. "The biggest benefit is that the cost is so much lower." D. "The dosing is more convenient, because you take it once a week."

D. Several weeks ***The nurse instructs the patient to adhere to therapy for several weeks to determine whether escitalopram [Lexapro] will be an effective antidepressant. Escitalopram [Lexapro] is a selective serotonin reuptake inhibitor (SSRI), and a delay in therapeutic effectiveness is characteristic of SSRIs. Such drugs do not become effective in 1 week or 2 to 3 days; however, the effect occurs long before 2 to 3 months.

A patient asks the nurse how long it will take for escitalopram [Lexapro] to be completely effective. Which time frame should the nurse include in patient teaching? A. 1 week B. 2 or 3 days C. 2 or 3 months D. Several weeks

A. "Glucocorticoids influence carbohydrate, lipid, and protein metabolism." ***Glucocorticoids influence the metabolism of carbohydrates, proteins, and fats. They are produced in increasing amounts during stress. They increase sodium and glucose levels and suppress the immune system.

A patient asks the nurse to explain the action of glucocorticoids. Which statement is the nurse's best response? A. "Glucocorticoids influence carbohydrate, lipid, and protein metabolism." B. Glucocorticoids decrease serum sodium and glucose levels." C. "Glucocorticoids are produced in decreased amounts during times of stress." D. "Glucocorticoids stimulate defense mechanisms to produce immunity."

A. Phlebitis ***Phlebitis is a condition of inflammation that affects the IV site. It is often caused by irritating fluids or medications instilled into the IV. The patient with phlebitis may most likely have warm, red skin with pain traveling up the arm along the route of the vein.

A patient calls the nurse and complains about his IV site. The nurse assesses the site and notes that the skin is red and warm and the patient states that the pain travels up his arm. Which of the following potential complications of IV therapy most likely describes this situation? A. Phlebitis B. Thrombus C. Infiltration D. Circulatory overload

D. headache ***The most common adverse reaction to nitrates is headache. Nitrates dilate the blood vessels in the meningeal layers between the brain and cranium. Hypotension, dizziness, and GI distress may occur, but the likelihood varies with each patient.

A patient comes to the emergency department complaining of chest pains, which started 1 hour ago while he was mowing the lawn. Nitroglycerin was given sublingually as prescribed. Which of the following adverse reactions would be most likely to occur? A. hypotension B. dizziness C. GI distress D. headache

B. "Overuse of nasal decongestants results in rebound congestion." ***Oxymetazoline (Afrin) is an effective nasal decongestant, but overuse results in worsening or "rebound" congestion. It should not be used more than every 4 hours. To avoid future rebound congestion with nasal sprays, it is recommended that they be used for no more than 3 to 5 days.

A patient complains of worsening nasal congestion despite the use of oxymetazoline (Afrin) nasal spray every 2 hours. What is the nurse's most appropriate response? A. "Oxymetazoline is not an effective nasal decongestant." B. "Overuse of nasal decongestants results in rebound congestion." C. "Oxymetazoline should be administered every hour for severe congestion." D. "You are probably displaying an unexpected reaction to oxymetazoline."

C. St. John's wort ***Serotonin syndrome may occur with selective serotonin reuptake inhibitors (SSRIs) when they are combined with herbal products such as ginseng and St. John's wort.

A patient currently prescribed duloxetine [Cymbalta] comes to the health clinic complaining of restlessness, agitation, diaphoresis, and tremors. The nurse suspects serotonin syndrome and questions the patient regarding concurrent use of which substance? A. Gingko B. Ibuprofen C. St. John's wort D. Glucosamine chondroitin

A. Reduce the infusion rate. ***When vancomycin is infused too rapidly, histamine release may cause the patient to develop hypotension accompanied by flushing and warmth of the neck and face; this phenomenon is called red man syndrome. Diphenhydramine is not necessary if the infusion is administered slowly over at least 60 minutes. Changing the IV tubing would not help the symptoms. The patency of the IV needs to be checked before the administration is started.

A patient develops flushing, rash, and pruritus during an IV infusion of vancomycin [Vancocin]. Which action should a nurse take? A. Reduce the infusion rate. B. Administer diphenhydramine [Benadryl]. C. Change the IV tubing. D. Check the patency of the IV.

B. Reduce the infusion rate. ***When vancomycin [Vancocin] is infused too rapidly, histamine release may cause the patient to develop hypotension accompanied by flushing and warmth of the neck and face; this phenomenon is called red man syndrome. Diphenhydramine [Benadryl] is not necessary if the infusion is administered slowly over at least 60 minutes. Changing the IV tubing would not help the symptoms. The patency of the IV should be checked before the administration is started.

A patient develops flushing, rash, and pruritus during an intravenous (IV) infusion of vancomycin [Vancocin]. Which action should the nurse take? A. Change the IV tubing. B. Reduce the infusion rate. C. Check the patency of the IV. D. Administer diphenhydramine [Benadryl].

D. Place in modified Trendelenburg's position. ***Placing the patient in modified Trendelenburg's position (legs elevated) and administering intravenous (IV) fluids may help with treatment of hypotension. Atropine is administered for bradycardia and atrioventricular (AV) block, not hypotension. Overdoses can be removed from the gastrointestinal (GI) tract with gastric lavage followed by activated charcoal; however, hypotension can occur in the absence of overdose. Hypotension is not treated with cardioversion.

A patient develops hypotension after administration of verapamil. Which intervention is appropriate? A. Administer atropine. B. Perform gastric lavage. C. Assist with cardioversion. D. Place in modified Trendelenburg's position.

B. Epinephrine ***The patient is showing signs of anaphylaxis caused by a peanut allergy. Histamine1 activation plays a minor role in anaphylaxis; other substances are the principal mediators. Therefore, the drug of choice for anaphylaxis is epinephrine. The antihistamines promethazine, diphenhydramine, and hydroxyzine are effective only for symptoms of mild allergy; they may be used as adjuncts in the treatment of anaphylaxis, but they will have only limited benefit.

A patient develops hypotension, laryngeal edema, and bronchospasm after eating peanuts. Which medication should the nurse prepare to administer? A. Promethazine [Phenergan] B. Epinephrine C. Diphenhydramine [Benadryl] D. Hydroxyzine [Vistaril]

A. "This medication will help you sleep." B. "This medication will decrease irritability." C. "This medication will help decrease anxiety." ***Lorazepam is an adjunctive drug used with patients who have schizophrenia. It serves to suppress anxiety and promote sleep. In patients experiencing an acute psychotic episode, it helps to suppress anxiety and irritability. It does not specifically treat the illness or help the patient cope with the illness.

A patient diagnosed with schizophrenia has been prescribed lorazepam. What should the nurse teach as the reason for this therapy ? Select all that apply A. "This medication will help you sleep." B. "This medication will decrease irritability." C. "This medication will help decrease anxiety." D. "This medication will help you cope with your illness." E. "This medication will relieve positive symptoms of schizophrenia."

B. Take on an empty stomach. ***The medication is to be taken on an empty stomach. There is no specification for it to be taken just before bedtime or immediately upon arising in the morning.

A patient diagnosed with thyroid cancer undergoes a thyroidectomy and is prescribed levothyroxine sodium [Synthroid]. What instructions should the nurse give the patient about taking this medication? A. Take on a full stomach. B. Take on an empty stomach. C. Take immediately after arising. D. Take immediately before bedtime.

A. Limit intake of acetaminophen to less than 2000 mg/day ***Patients who drink three or more alcoholic beverages per day should limit their acetaminophen dosage to less than 2000 mg/day to prevent hepatic injury.

A patient drinks five to six alcoholic beverages per day and takes acetaminophen [Tylenol] for pain relief. The nurse should caution the patient to do what? A. Limit intake of acetaminophen to less than 2000 mg/day B. Avoid taking acetaminophen for pain C. Take acetaminophen with food to reduce the risk of liver damage D. Avoid taking any pain reliever other than acetaminophen

C. Red blood cell count ***Deficiency of cyanocobalamin (vitamin B12) manifests as megaloblastic anemia so the nurse would assess the red blood cell count first. It does not affect platelets or white blood cells (a neutrophil is a type of white blood cell).

A patient has a low level of vitamin B12. Which laboratory result should the nurse assess first? A. Platelet count B. Neutrophil count C. Red blood cell count D. White blood cell count

B. Infusion of Potassium intravenously

A patient has a potassium level of 2.0. What would you expect to be ordered for this patient? A. Potassium 30 meq IV push B. Infusion of Potassium intravenously C. An oral supplement of potassium D. Intramuscular injection of Potassium

C. Regular insulin [Novolin R] ***This patient has clinical indicators of diabetic ketoacidosis. The patient would require regular insulin [Novolin R] in its intravenous form to reduce the concentration of serum glucose. The nurse should prepare to administer regular insulin [Novolin R] because it is the only insulin that can be administered intravenously. Insulin lispro [Humalog] is a human recombinant rapid-acting insulin analogue. Insulin glargine [Lantus] is a long-acting recombinant DNA-produced insulin analogue, and it provides a constant level of insulin in the body. Insulin isophane suspension, also known as neutral protamine Hagedorn (NPH) insulin [Humulin N], is the only available intermediate-acting insulin product.

A patient has a serum glucose concentration of 375 mg/dL, urine output of 450 mL/hr, and an arterial pH of 7.1. The sliding scale requires intravenous insulin for a blood glucose concentration of more than 350 mg/dL. Which type of insulin is the nurse most likely to administer? A. Insulin lispro [Humalog] B. Insulin glargine [Lantus] C. Regular insulin [Novolin R] D. Neutral protamine Hagedorn (NPH) insulin [Humulin N]

B. Neurologic ***A severe deficiency in cyanocobalamin (vitamin B12) produces neurologic damage. While it is important to assess all systems for vitamin B12 deficiency, assessing the neurologic system is a priority.

A patient has a severe vitamin B12 deficiency. The nurse will make it a priority to assess for alterations in which system? A. Renal B. Neurologic C. Integumentary D. Gastrointestinal

C. Decrease in bleeding tendency ***Vitamin K is an essential nutrient for the synthesis of clotting factors. It also is the antidote for warfarin [Coumadin], an oral anticoagulant. Vitamin K enhances the coagulation process, thus minimizing a patient's risk for excessive bleeding. Increases in RBC indices or mental alertness or a decrease in pulse pressure is unrelated to the therapeutic effects of vitamin K.

A patient has an international normalized ratio [INR] that is elevated to an unsafe level. A nurse administers vitamin K expecting which therapeutic result? A. Decrease in pulse pressure B. Increase in mental alertness C. Decrease in bleeding tendency D. Increase in red blood cell [RBC] indices

A. Dantrolene (Dantrium) ***Treatment of NMS involves immediate withdrawal of antipsychotics, adequate hydration, hypothermic blankets, and administration of antipyretics, benzodiazepines, and muscle relaxants such as dantrolene (Dantrium). Tetrabenazine (Xenazine), used to improve symptoms of Huntington's disease, seems to be effective in treating tardive dyskinesia. Propanolol (Inderal) has been found to be effective in the treatment of akathisia. Acute dystonia may be treated with lorazepam (Ativan).

A patient has been diagnosed with neuroleptic malignant syndrome. The nurse anticipates administration of which medication to treat this patient? A. Dantrolene (Dantrium) B. Tetrabenazine (Xenazine) C. Propranolol (Inderal) D. Lorazepam (Ativan)

A. "I'll take this medication in the morning so as not to interfere with sleep." ***Levothyroxine is used to treat hypothyroidism by increasing the basal metabolism and thus wakefulness. It is administered as a once-daily dose and is a lifelong therapy. It is best taken on an empty stomach to enhance absorption.

A patient has been given instructions about levothyroxine [Synthroid]. Which statement by the patient indicates understanding of these instructions? A. "I'll take this medication in the morning so as not to interfere with sleep." B. "I'll plan to double my dose if I gain more than 1 pound per day." C. "It is best to take the medication with food so I don't have any nausea." D. "I'll be glad when I don't have to take this medication in a few months."

C. Never abruptly withdraw therapy. ***Abrupt withdrawal of glucocorticoids may cause adrenal insufficiency or an adrenal crisis. Infection should be prevented, but the use of antibiotics without a known infection is inappropriate. Eye examinations are recommended every 6 months for patients on glucocorticoid therapy. Sodium restriction may be prescribed.

A patient has been prescribed pharmacologic doses of glucocorticoids. It is most important for the nurse to teach the patient to do what? A. Increase intake of dietary sodium. B. Take antibiotics to prevent infection. C. Never abruptly withdraw therapy. D. Have an eye examination every year.

B. Pentazocine ***Pentazocine would cause the nurse to question the prescription since it is an agonist-antagonist. When administered alone, the agonist-antagonist opioids produce analgesia. However, if given to a patient who is taking a pure opioid agonist (like codeine) long term (as indicated by the mention that the patient has developed drug tolerance), these drugs can antagonize analgesia caused by the pure agonist. Morphine, levorphanol, and oxymorphone are all opioid agonists and would not cause this problem.

A patient has been receiving codeine for pain and has developed tolerance to the drug. The provider wants to change the patient's pain medication. Which prescription will the nurse question? A. Morphine B. Pentazocine C. Levorphanol D. Oxymorphone

A. Hypoglycemia ***Cushing's syndrome is manifested by hyperglycemia, glycosuria, fluid and electrolyte disturbances, osteoporosis, muscle weakness, cutaneous striations, and lowered resistance to infection. Redistribution of fat produces a "potbelly," "moon face," and "buffalo hump."

A patient has been receiving long-term prednisone therapy for treatment of rheumatoid arthritis. The chart indicates that the patient has developed Cushing's syndrome. When performing a physical assessment, the nurse anticipates finding all but which manifestation of Cushing's syndrome? A. Hypoglycemia B. Muscle weakness C. Glucosuria D. "Buffalo hump"

D. Contact the healthcare provider to discuss the medication. ***The healthcare provider should be contacted regarding the ordering of sulfamethoxazole/trimethoprim [Bactrim] for this patient, because it has not been shown to be effective in treating viral infections.

A patient has been started on a medication regimen that includes sulfamethoxazole/trimethoprim [Bactrim]. The nurse notes that the source of the patient's infection has been determined to be viral in origin. What is the nurse's highest priority action? A. Ask how the patient contracted the infection. B. Administer the medication as ordered by the provider. C. Ensure that the information is documented in the chart. D. Contact the healthcare provider to discuss the medication.

A. Monitoring for heart rate >100 beats/min ***The beta1 properties of this drug can cause increased heart rate and palpitations. The drug should not cause sedation or elevated blood pressure.

A patient has taken metaproterenol (Alupent). What is the nurse's priority action? A. Monitoring for heart rate >100 beats/min B. Telling the patient not to drive for 2 hours C. Monitoring for sedation D. Assessing for elevated blood pressure

B. Notify the healthcare provider the patient may need to be taken off the drug. ***The primary action is to notify the healthcare provider. Donezepil [Aricept] is known to cause slow heartbeat and fainting. The healthcare provider should be notified because the patient may need to be taken off the medication. The other actions can be performed after the healthcare provider is notified and the nurse is awaiting action.

A patient has been started on donepezil [Aricept]. The patient's family member notifies the nurse that the patient fainted at home. What is the highest priority action on the part of the nurse? A. Instruct the family member not to administer any further doses of the drug. B. Notify the healthcare provider the patient may need to be taken off the drug. C. Reassure the family member that this is an expected side effect of the medication. D. Instruct the family member to call if the patient continues to exhibit fainting episodes.

C. "I only have a bowel movement when I take the medicine." ***Docusate sodium is a surfactant laxative that softens stool by allowing water penetration. Chronic exposure to laxatives can diminish defecation reflexes, leading to further reliance on laxatives. Patient education is the key to reducing laxative abuse. Colon polyps, loss of tooth enamel, and tremors are unrelated to docusate sodium.

A patient has been taking docusate sodium [Colace] daily for 1 year. Which statement by the patient would indicate a complication associated with use of this drug? A. "My doctor says that I've developed colon polyps." B. "I've noticed that I'm having tremors now in my left hand." C. "I only have a bowel movement when I take the medicine." D. "The dental hygienist said I was losing the enamel on my teeth."

B. Take a stool softener E. Increase fluid intake throughout the day ***Constipation is one of the major side effects of morphine administration. It may be managed with increased intake of fluids, the use of stool softeners such as docusate sodium [Colace], or the use of stimulants such as bisacodyl [Dulcolax] or senna [Senokot]. Agents such as lactulose [Enulose], sorbitol (E420), and polyethylene glycol [Miralax] also have been proven effective. Less commonly used are bulk-forming laxatives such as psyllium [Metamucil], for which increased fluid intake is especially important to avoid fecal impactions or bowel obstructions. Adequate rest is required for a patient who has undergone surgery. It is, however, not an important part of patient teaching. The details of medication dosage are provided in the discharge summary. It is not necessary to decrease the dosage of medication. Animal protein and dairy products are not foods that should be recommended to a postoperative patient. Instead, the patient should increase the intake of foods that are high in fiber.

A patient has been taking morphine for postoperative pain. Before discharge, what patient teaching should be provided? Select all that apply. A. Increase rest periods B. Take a stool softener C. Decrease the medication dosage D. Eat more animal protein and dairy E. Increase fluid intake throughout the day

A. Isoniazid should be given 1 hour before or 2 hours after meals. B. Have periodic eye examinations as ordered by the health care provider. C. Compliance with drug regimen is essential. D. Report numbness, tingling, and burning of hands and feet. ***Isoniazid should be given 1 hour before or 2 hours after meals for better absorption. Periodic eye examinations should be done as these drugs may cause visual disturbances. Compliance with drug regimen is essential to prevent drug resistance. Numbness, tingling, or burning of hands and feet should be reported. Rifampin may turn body fluids a harmless reddish orange color.

A patient has developed active tuberculosis and is prescribed isoniazid and rifampin. Which information will the nurse include in teaching the patient about taking this drug? (Select all that apply.) A. Isoniazid should be given 1 hour before or 2 hours after meals. B. Have periodic eye examinations as ordered by the health care provider. C. Compliance with drug regimen is essential. D. Report numbness, tingling, and burning of hands and feet. E. Warn patient that rifampin may turn body fluids a harmless green color.

D. Respiratory rate ***Hypermagnesemia affects respiration before the rest of the vital signs. As the magnesium levels increase in the blood, respiratory paralysis is likely. At even higher levels, there is risk of cardiac arrest. Hypermagnesemia does not affect temperature.

A patient has hypermagnesemia from overuse of antacids. Which assessment is priority? A. Pulse B. Temperature C. Blood pressure D. Respiratory rate

A. Tremors ***Tremors are a side effect of Alupent (a beta2 adrenergic agonist), as are tachycardia, hypertension, and hyperglycemia.

A patient has just received a nebulizer treatment of metaproterenol (Alupent). It is most important for the nurse to assess the patient for the development of which side effect/adverse effect? A. Tremors B. Bradycardia C. Hypotension D. Hypoglycemia

C. Vitamin K ***The administration of vitamin K will help to reverse the action of warfarin. Coumadin interferes with vitamin K-dependent clotting factors. Administration of vitamin K will reverse this action.

A patient has overdosed on warfarin [Coumadin]. Which substance will the nurse administer to reverse the effect of warfarin? A. Aspirin B. Calcium C. Vitamin K D. Potassium

B. Seizure activity **Toxicity associated with antihistamines can produce CNS stimulation, and seizures may result. Tinnitus, lethargy, and visual disturbances are not associated with increased doses of antihistamines.

A patient has received a toxic dose of an antihistamine. It is most important for the nurse to assess the patient for what? A. Tinnitus B. Seizure activity C. Lethargy D. Visual disturbances

B. Respect the patient's right to refuse and notify the provider. ***The patient has the right to refuse a medication, and this right must be respected. The nurse should determine the cause of refusal, notify the provider, and make appropriate revisions in the nursing care plan. It is not safe to skip the dose and try to give it again after a few hours. Unwrapped medicine should never be returned to the container; agency policy usually requires it to be discarded. Forcing the patient to take a medicine is unethical and does not protect the patient's right to refuse.

A patient has refused to take his prescribed medication and is adamant that the tablet is worsening his condition. What does the nurse do? A. Mix the medication in the patient's food or drink. B. Respect the patient's right to refuse and notify the provider. C. Try to give the medication to the patient again after a few hours. D. Return the unwrapped medication to the container for safe future use.

B. Instruct the patient to avoid acidic foods such as orange juice and tomatoes. ***Lifestyle modifications such as dietary restrictions are safe during pregnancy and will not cause harm to the fetus. Misoprostol, bismuth subsalicylate, and valerian are contraindicated during pregnancy. Medications for gastric distress that may be considered during pregnancy include antacids, histamine2-receptor antagonists, and proton pump inhibitors.

A patient is 2 months pregnant and complains of gastric distress. It is most appropriate for the nurse to do what? A. Consult with the healthcare provider about a prescription for misoprostol [Cytotec]. B. Instruct the patient to avoid acidic foods such as orange juice and tomatoes. C. Suggest an over-the-counter medication such as bismuth subsalicylate [Pepto-Bismol]. D. Use an alternative therapy such as valerian as a dietary supplement.

D. Flumazenil [Romazicon] ***Oxazepam [Serax] is a benzodiazepine drug. Flumazenil [Romazicon] is an antidote for benzodiazepine overdoses. Naloxone [Narcan], naltrexone [ReVia], and nalmefene [Revex] are not antidotes for benzodiazepine overdoses.

A patient is admitted to the emergency department after an overdose of oxazepam [Serax]. Which antagonist may be used to treat this patient? A. Naloxone [Narcan] B. Naltrexone [ReVia] C. Nalmefene [Revex] D. Flumazenil [Romazicon]

A. vitamin D is fat-soluble.

A patient is admitted to the emergency department after taking high doses of vitamin B and vitamin D. The nurse is more concerned about the vitamin D because A. vitamin D is fat-soluble. B. vitamin D is water-soluble. C. vitamin D in high doses causes bleeding. D. vitamin D in low doses results in scurvy.

D. High-dose albuterol [Proventil] via nebulizer treatment ***Nebulized high-dose SABAs, such as albuterol, are administered to relieve airflow obstruction. Oral theophylline is used for maintenance therapy of chronic stable asthma, not for treatment of exacerbation. Omalizumab is a second-line agent indicated for allergy-related asthma and only when preferred options have failed. Inhaled glucocorticoids, such as mometasone furoate, are not used to abort an acute attack. During an exacerbation they are administered systemically.

A patient is admitted to the emergency department with acute severe exacerbation of asthma. Which drug should the nurse anticipate will be included in the treatment plan? A. Oral theophylline [Elixophyllin] B. Subcutaneous omalizumab [Xolair] C. Inhaled mometasone furoate [Asmanex] D. High-dose albuterol [Proventil] via nebulizer treatment

B. activated charcoal ***Activated charcoal is a general-purpose antidote that is used for various types of acute oral poisoning.

A patient is admitted to the emergency department with salicylate poisoning. Which drug should the nurse anticipate giving the patient? A. chlorpromazine B. activated charcoal C. magnesium citrate D. docisate

C. Timolol ***Timolol is a nonselective beta blocker (beta1 and beta2 receptors) and may cause worsening of bradycardia and atrioventricular (AV) block.

A patient is admitted to the hospital for treatment of symptomatic bradycardia and atrioventricular (AV) heart block. Which topical medication for the eye should the nurse withhold and discuss with the healthcare provider before administration? A. Dorzolamide B. Apraclonidine C. Timolol D. Latanoprost

D. Candesartan [Atacand] ***Candesartan is an angiotensin II receptor blocker (ARB) and thus prevents the binding of angiotensin II at its receptor sites. Quinapril is an ACE inhibitor; aliskiren is a direct renin inhibitor, and eplerenone is a selective aldosterone receptor blocker.

A patient is admitted to the hospital with a diagnosis of hypertension. The nurse understands that which medication works by preventing angiotensin II from binding with its receptor sites? A. Quinapril [Accupril] B. Aliskiren [Tekturna] C. Eplerenone [Inspra] D. Candesartan [Atacand]

A. The patient is prone to stress ulcers. ***A critically ill patient is prone to stress-related mucosal damage. Therefore, these patients should be prescribed a histamine receptor blocker or a proton pump inhibitor. The patient's stress levels can cause gastrointestinal disorders, but these drugs do not lower stress levels. The general procedures performed on the patients, such as the use of nasal tubes or feeding tubes, only increase the chances of gastrointestinal disorders. Adverse effects are specific to the type of treatment received and can be addressed by specific drugs.

A patient is admitted to the intensive care unit after a myocardial infarction. The provider has ordered drugs to prevent gastrointestinal disorders. Which is a likely reason for administering acid-controlling drugs? A. The patient is prone to stress ulcers. B. The patient's stress levels are treated by these drugs. C. The general procedures for the treatment include these drugs. D. The adverse effects of the treatment are treated by these drugs.

A. 0.9% Normal Saline

A patient is being admitted with dehydration due to nausea and vomiting. Which fluid would you expect the patient to be started on? A. 0.9% Normal Saline B. 0.33% saline C. 0.225% saline D. 5% Dextrose in 0.9% Saline

A. I will make sure I consume foods high in potassium. ***Hypokalemia is a side effect.

A patient is being discharged home on Hydrochlorothiazide (HCTZ) for treatment of hypertension. Which of the following statements by the patient indicates they understood your discharge teaching about this medication? A. I will make sure I consume foods high in potassium. B. I will only take this medication if my blood pressure is high. C. I understand a dry cough is a common side effect with this medication. D. I will monitor my glucose levels closely because this medication may mask symptoms of hypoglycemia.

B. Crystalloids are cheaper when compared to colloids D. Colloids are not as easily available ***- In some cases when a patient needs fluid volume replacement, the nurse may have the option to administer crystalloid solutions or colloid solutions. Crystalloids (lactated Ringer's, normal saline) are typically much more accessible and available; they are also cheaper and can be given in large amounts. Alternatively, colloid solutions (blood products) provide for intravascular volume expansion but they are more expensive and often require a type and crossmatch before administration.

A patient is brought into the emergency department with severe injuries. The physician orders lactated Ringer's solution to be given for fluid volume replacement. Which explanations best describe why crystalloid solutions would be used before colloid solutions in an emergent situation? Select all that apply. A. Crystalloid solutions are easier to administer B. Crystalloids are cheaper when compared to colloids C. Colloids require blood tests and cultures before administration D. Colloids are not as easily available E. Crystalloids expand fluid volume in the circulatory system, but colloids do not

D. Intravenous morphine sulfate ***When a drug is administered intravenously, it does not need to be absorbed because it is placed directly into general circulation and will have an immediate effect to decrease pain. The other medications will not have an immediate effect. Pain medications that are administered by mouth, suppository, or via a transdermal route take longer to have an effect.

A patient is complaining of pain rated 10 on a scale of 1 to 10. The nurse has several choices of pain medication to administer. Assuming there are no contraindications, which would be best for the nurse to administer at this time? A. Transdermal patch B. Tylenol suppository C. Oral morphine sulfate D. Intravenous morphine sulfate

D. nystatin (Mycostatin). ***Nystatin in oral suspension is commonly used to treat Candida infection in the mouth.

A patient is diagnosed with a Candida infection in the mouth. The nurse anticipates that the patient will be treated with A. metronidazole (Flagyl). B. amphotericin B (Fungizone). C. isoniazid (INH). D. nystatin (Mycostatin).

C. Teach the patient how to take nystatin (Mycostatin). ***Nystatin (Mycostatin) is an antifungal ointment that is used for a variety of candidal infections. The patient needs to be taught how to "swish and swallow" to treat this infection. There is no need to brush the teeth hourly or administer Valtrex, and starting an IV is an extreme measure.

A patient is diagnosed with an oral candidal infection. Which intervention is best? A. Start an IV so the patient does not have to eat by mouth. B. Instruct the patient to brush her teeth and gargle hourly. C. Teach the patient how to take nystatin (Mycostatin). D. Administer valacyclovir hydrochloride (Valtrex) and monitor lips and gums.

B. Hypotonic solutions ***When a patient experiences dehydration, he most likely has decreased fluid in the intravascular space. The nurse should administer a hypotonic solution, which will increase fluid in the blood vessels as well as draw fluid into the intravascular space to promote fluid volume.

A patient is experiencing severe nausea and vomiting; he is hospitalized for dehydration. Which of the following types of IV solutions would most likely be administered to correct this situation? A. Isotonic solutions B. Hypotonic solutions C. Hypertonic solutions D. Blood products

B. Sympathetic system ***Stimulation of the sympathetic nervous system produces the fight-or-flight response. The baroreceptor reflex regulates blood pressure.

A patient is experiencing symptoms of the fight-or-flight response. Which autonomic process stimulates this response? A. Baroreceptor reflex B. Sympathetic system C. Parasympathetic system D. Predominant tone of the organs

C. 100% ***Bioavailability is the quantity of a drug available in the body after it is administered either orally or via other routes. Bioavailability of 100% is recorded when drugs are administered intravenously directly into the bloodstream. The bioavailability of atropine is 100% because it is administered intravenously. Many drugs administered by mouth go through first-pass metabolism in the liver before beginning systemic circulation. Therefore, the bioavailability of drugs taken orally is less than 100%.

A patient is given an intravenous drug. What is the bioavailability of the drug in this patient? A. 50% B. 60% C. 100% D. 110%

A. Take with meals. ***To minimize gastrointestinal effects, oral potassium chloride should be taken with meals or a full glass of water, not sips. It is not taken with calcium or bicarbonate.

A patient is hypokalemic and taking sustained release oral potassium chloride. What should the nurse teach about taking this drug? A. Take with meals. B. Take with calcium. C. Take with bicarbonate. D. Take with sips of water.

B. "Complications from this condition can lead to pulmonary hypertension and right-sided heart failure." ***The answer is B. This is the only correct statement. Option A is wrong because smoking cessation will NOT cure the condition but it may slow down the progress of it. Option C is wrong because the patient may develop HIGH LEVELS of red blood cells due to the body trying to compensate for hypoxia. Option D is wrong because patients with COPD are stimulated to breathe due to LOW OXYGEN LEVELS rather than high carbon dioxide levels.

A patient is newly diagnosed with COPD due to chronic bronchitis. You're providing education to the patient about this disease process. Which statement by the patient indicates they understood your teaching about this condition? A. "If I stop smoking, it will cure my condition." B. "Complications from this condition can lead to pulmonary hypertension and right-sided heart failure." C. "I'm at risk for low levels of red blood cells due to hypoxia and may require blood transfusions during acute illnesses." D. "My respiratory system is stimulated to breathe due to high carbon dioxide levels rather than low oxygen levels.

B. Grapefruit juice ***Grapefruit juice can inhibit the metabolism of carbamazepine, thereby causing plasma levels to rise. Grapefruit juice may increase the peak and trough levels of carbamazepine by up to 40%.

A patient is newly prescribed carbamazepine [Tegretol] for seizure control. It is most important for the nurse to teach the patient to avoid which food? A. Tomatoes B. Grapefruit juice C. Spinach D. Kiwi fruit

C. The patient has developed thrombocytopenia. ***Chemotherapy agents have a myelosuppressive effect. A reduced platelet count (thrombocytopenia) may increase the risk of bleeding. Therefore, the nurse should instruct the patient to use a soft-bristled toothbrush and avoid activities that may increase chances of injury. Sores in the oral cavity and stomatitis cannot be treated by restricting the patient's activities; treatment may include a topical anesthetic. Anemia is a lack of red blood cells and may be treated with epoetin alfa. Neutropenia is a lack of neutrophils, making the patient prone to infections, not bleeding.

A patient is on chemotherapy. Following periodic lab work, the nurse instructs the patient to use a soft-bristled toothbrush and to avoid activities that may increase risk of injury. What is the rationale for the nurse's instructions? A. The patient has developed anemia. B. The patient has developed neutropenia. C. The patient has developed thrombocytopenia. D. The patient has developed sores in the oral cavity.

B. Decrease in blood pressure ***The therapeutic effect of ACE inhibitors is to reduce blood pressure in patients with hypertension. ACE inhibitors do not affect patients' heart rate. Dizziness and fainting are symptoms of hypotension. ACE inhibitors do not affect oxygen saturation.

A patient is prescribed lisinopril [Prinivil] 40 mg by mouth once a day for hypertension. For which therapeutic effect will the nurse monitor? A. Slowing of the heart rate B. Decrease in blood pressure C. Symptoms such as dizziness and fainting D. Pulse oximetry oxygen saturation of 100%

A. Obtain weight B. Assess lung sounds C. Administer slowly over 1-2 minutes E. Maintain accurate intake and output record ***Furosemide [Lasix] can be infused via intravenous push slowly over 1 to 2 minutes. For all patients, obtain baseline values for weight, blood pressure (sitting and supine), pulse, respirations, and electrolytes (sodium, potassium, chloride). It is appropriate to monitor intake and output for a patient receiving a diuretic. There is no need to insert an arterial line to continuously monitor the blood pressure. Also, there is no need to continuously monitor an electrocardiogram.

A patient is ordered furosemide [Lasix] to be given via intravenous push. Which interventions should the nurse perform? Select all that apply. A. Obtain weight B. Assess lung sounds C. Administer slowly over 1-2 minutes D. Monitor electrocardiogram continuously E. Maintain accurate intake and output record F. Insert an arterial line for continuous blood pressure monitoring

A. administer the bronchodilator 5 minutes before the glucocorticoid. ***When a bronchodilator and a glucocorticoid inhaler are ordered together, the bronchodilator is administered first. The nurse should then wait for 5 minutes before administering the glucocorticoid. This allows time for bronchodilation to occur so the glucocorticoid is deposited deep into the respiratory system.

A patient is ordered the following inhalers, a bronchodilator (ipratropium) and a gluco-corticoid (Beclamethasone). The nurse will A. administer the bronchodilator 5 minutes before the glucocorticoid. B. mix the drugs and administer them together. C. administer the glucocorticoid 10 minutes before the bronchodilator. D. administer the glucocorticoid immediately after the bronchodilator.

D. 5.9 mEq/L ***Sodium polystyrene sulfonate is given to patients with hyperkalemia. The normal range of serum potassium level is 3.5 to 5 mEq/L. Therefore, the nurse would expect to find the serum potassium level of the patient to be 5.9 mEq/L. A serum potassium level of 3.5 mEq/L or 4.2 mEq/L is considered in the normal range, so the enema would not be required. A serum potassium level of 2.3 mEq/L is considered a low potassium level. If sodium polystyrene sulfonate were administered to a patient with hypokalemia, the potassium level would further decrease.

A patient is prescribed a sodium polystyrene sulfonate enema. The nurse is reviewing the patient's laboratory reports. What would the nurse expect the patient's potassium level to be? A. 2.3 mEq/L B. 3.5 mEq/L C. 4.2 mEq/L D. 5.9 mEq/L

A. Inhalation ***The most preferred route of administration of albuterol [Proventil] is inhalation. Oral routes also are sometimes used. Subcutaneous, intramuscular, and intravenous routes are not suitable for administering albuterol [Proventil].

A patient is prescribed albuterol [Proventil]. The nurse is explaining the most common route of administration of albuterol [Proventil] to the patient. Which route should the nurse discuss? A. Inhalation B. Intravenous C. Intramuscular D. Subcutaneous

B. Epinephrine [Twinject] ***Amoxicillin [Amoxil] is a penicillin antibiotic. The assessment findings make it evident that the patient has a penicillin anaphylactic reaction. Difficulty breathing, wheezing, swelling of the throat or tongue, and dizziness are the symptoms of a penicillin anaphylactic reaction. In this condition, epinephrine [Twinject] should be administered to the patient immediately to block the action of penicillin. Ranitidine [Zantac] is an antacid; it helps relieve the acidity but is not helpful in treating the anaphylactic reaction. Tetracycline [Sumycin] and azithromycin [Zithromax] are antibiotics and helpful to treat antibacterial infection but are not effective in the treatment of penicillin anaphylactic reaction.

A patient is prescribed amoxicillin [Amoxil] for Helicobacter pylori infection. During the follow-up visit, the nurse observes that the patient is wheezing and has difficulty breathing, swelling of the throat, and dizziness. The nurse also notes a drop in blood pressure and a weak pulse. Which medicine would the nurse expect to be included in the patient's treatment plan? A. Ranitidine [Zantac] B. Epinephrine [Twinject] C. Tetracycline [Sumycin] D. Azithromycin [Zithromax]

D. "Take the medicine with water." ***The nurse should instruct the patient to take the antibiotic with water. Amoxicillin [Amoxil] is a penicillin antibiotic and should be taken with water to improve drug efficacy. Giving the medication with milk will interfere with drug absorption. Oral penicillin should be administered 1 hour before or 2 hours after meals to maximize absorption. It should not be administered with food as this reduces its absorption. Oral penicillin should not be administered with juice, because the latter is acidic in nature and may nullify the drug's antibacterial action.

A patient is prescribed amoxicillin [Amoxil] for the treatment of a bacterial infection. What instruction should the nurse give to the patient to improve drug efficacy? A. "Take the medicine with milk." B. "Take the medicine with food." C. "Take the medicine with juice." D. "Take the medicine with water."

B. Destroy the bacteria in the stomach that are causing ulceration.

A patient is prescribed amoxicillin and tetracycline to treat peptic ulcer disease. The nurse will instruct the patient that these medications will do what? A. Prevent GI infections that cause gastric bleeding. B. Destroy the bacteria in the stomach that are causing ulceration. C. Reduce gastric acid production and alkalize the stomach fluids. D. Reduce the secretion of pepsin in the stomach.

A. "This medication may cause drowsiness and dizziness." ***Antitussive medications also affect the central nervous system, thus causing drowsiness and dizziness. There is no reason to anticipate that the medication will cause diarrhea, abdominal cramping, tremors and anxiety, or headache and hypertension.

A patient is prescribed an antitussive medication. What is the most important instruction for the nurse to include in the patient teaching? A. "This medication may cause drowsiness and dizziness." B. "Watch for diarrhea and abdominal cramping." C. "This medication may cause tremors and anxiety." D. "Headache and hypertension are common side effects."

D. Do not take the bisacodyl with an antacid. ***Instruct patients to take oral bisacodyl no sooner than 1 hour after ingesting milk or antacids. Instruct patients to swallow the tablets intact, without crushing or chewing. Inform patients that bisacodyl suppositories may cause a burning sensation, and warn them that prolonged use can cause proctitis. Senna can cause the patient's urine to turn a harmless yellow-brown or pink.

A patient is prescribed bisacodyl. Which of the following should the nurse include in patient teaching? A. Your urine will turn yellow-brown when taking this medication. B. Crush the bisacodyl tablet and sprinkle it on your food. C. Chew the bisacodyl tablet. D. Do not take the bisacodyl with an antacid.

A. "I will take the calcium 1 hour before eating." ***Dosing of calcium with or after meals, not before, promotes absorption of the medication; therefore, further patient teaching is necessary. Calcium salts should be taken with a large glass of water. Foods to be avoided include spinach, Swiss chard, beets, bran, and whole-grain cereals. Patients should be taught the symptoms of hypercalcemia such as nausea, vomiting, constipation, urinary frequency, lethargy, and depression and should promptly notify the healthcare provider if these occur.

A patient is prescribed calcium gluconate for treatment of hypocalcemia. Which statement by the patient indicates a need for further teaching? A. "I will take the calcium 1 hour before eating." B. "I will need to avoid eating whole-grain cereals." C. "I should drink a large glass of water each time I take my calcium." D. "I will need to call my healthcare provider if I develop vomiting, constipation, or frequency of urination."

B. Bleeding ***Celecoxib may increase the anticoagulant effects of warfarin; the risk of bleeding is increased.

A patient is prescribed celecoxib [Celebrex] and warfarin [Coumadin]. The nurse should monitor the patient for what? A. Renal toxicity B. Bleeding C. Stroke symptoms D. Dysrhythmias

D. Wait at least 1 hour between administration of the two medications.

A patient is prescribed cimetidine [Tagamet] and aluminum hydroxide [Maalox] for the treatment of peptic ulcer disease. What should the nurse teach the patient to do? A. Drink an 8-ounce glass of water when taking these medications. B. Take the medications together to enhance their effectiveness. C. Take the Tagamet 2 hours before the Maalox. D. Wait at least 1 hour between administration of the two medications.

D. Serum potassium concentration ***Hypokalemia, usually diuretic induced, is the most frequent underlying cause of dysrhythmias. The nurse should monitor serum potassium concentrations. Because potassium competes with digoxin, when potassium levels are low, binding of digoxin to Na+, K+-ATPase (sodium, potassium-ATPase) increases. This increase can produce excessive inhibition of Na+, K+ -ATPase with resultant toxicity. Digoxin does not have any effect on liver enzymes, blood glucose, or serum calcium. Therefore, assessment of these parameters is not necessary before administering digoxin.

A patient is prescribed digoxin to treat heart failure. Which biochemical parameter should be assessed by the nurse to ensure safe drug administration? A. Liver enzyme concentration B. Blood glucose concentration C. Serum calcium concentration D. Serum potassium concentration

A. Dry mouth C. Constipation D. Urinary retention ***The most common responses to antihistamines are sedation and anticholinergic effects such as a dry mouth and dry nasal passages and mouth, urinary retention, and constipation.

A patient is prescribed diphenhydramine following a mild blood transfusion reaction. What adverse reaction(s) should the nurse teach the patient about this drug? Select all that apply. A. Dry mouth B. Insomnia C. Constipation D. Urinary retention E. Increased salivation

D. "Take this medication 30 to 60 minutes before meals." ***Omeprazole [Prilosec] and other proton pump inhibitors act directly on the proton pump on parietal cells and decrease acid levels. For the drug to be absorbed and show its action, it should be administered at least 30 to 60 minutes before meals. Crushing and chewing the drug will damage its enteric coating and thus should be avoided. The medication can be given by dissolving in water only when the patient has difficulty swallowing and for patients with a nasogastric tube. The medication will have no effect when taken after meals because of the presence of food.

A patient is prescribed enteric-coated omeprazole [Prilosec] for hyperacidity. What instructions should the nurse provide to the patient regarding medication administration? A. "Take the medication by chewing or crushing it." B. "Take this medication 30 to 60 minutes after meals." C. "Take the medication by dissolving it in water or milk." D. "Take this medication 30 to 60 minutes before meals."

B. Fatigue C. Dizziness D. Headache ***Some of the common adverse effects of hydralazine include fatigue, dizziness, and headache. Nausea is associated with minoxidil. Joint pain is not a common adverse effect of hydralazine.

A patient is prescribed hydralazine [Apresoline] for the treatment of essential hypertension. Which expected adverse effects should the nurse discuss with the patient? (Select all that apply.) A. Nausea B. Fatigue C. Dizziness D. Headache E. Joint pain

B. Fatigue C. Dizziness D. Headache ***Some of the common adverse effects of hydralazine [Apresoline] include fatigue, dizziness, and headache. Nausea is associated with minoxidil [Loniten]. Joint pain is not a common adverse effect of hydralazine.

A patient is prescribed hydralazine [Apresoline] for the treatment of essential hypertension. Which expected adverse effects should the nurse discuss with the patient? Select all that apply. A. Nausea B. Fatigue C. Dizziness D. Headache E. Joint pain

D. To prevent the development of oral candidiasis ***It is recommended that patients rinse their mouths immediately after use of the inhaler or nebulizer dosage forms of corticosteroids. It helps to prevent overgrowth of oral fungi and subsequent development of oral candidiasis (thrush). Nasal congestion, sore throat, and dry mouth are not side effects of corticosteroid inhaler use.

A patient is prescribed inhaled corticosteroids. Why would the nurse ask the patient to rinse his or her mouth after each dose? A. To relieve the patient's dry mouth B. To minimize the chance of nasal congestion C. To avoid chances of sore throat and infection D. To prevent the development of oral candidiasis

B. "Take the ipratropium (Atrovent) at least 5 minutes before the cromolyn (Intal)." ***When using an anticholinergic in conjunction with an inhaled glucocorticoid or cromolyn, the ipratropium should be used 5 minutes before the steroid. This causes the bronchioles to dilate so the steroid or cromolyn can get deeper into the lungs.

A patient is prescribed ipratropium (Atrovent) and cromolyn sodium (Intal). What will the nurse teach the patient? A. "Do not take these medications within 4 hours of each other." B. "Take the ipratropium (Atrovent) at least 5 minutes before the cromolyn (Intal)." C. "Administer both medications together in a metered-dose inhaler." D. "Take the ipratropium (Atrovent) only in the mornings."

C. Tomatoes D. Orange juice E. Strawberries ***Vitamin C (ascorbic acid) facilitates absorption of dietary iron. The main dietary sources of ascorbic acid are citrus fruits and juices, tomatoes, potatoes, strawberries, melons, spinach, and broccoli. Pasta is usually enriched with folate. Peanuts are high in niacin.

A patient is prescribed iron supplements. Which foods will the nurse encourage the patient to consume to increase iron absorption? Select all that apply. A. Pasta B. Peanuts C. Tomatoes D. Orange juice E. Strawberries

C. Crackles in the lungs are no longer heard ***Because ACE inhibitors promote venous dilation, they provide the therapeutic effect of reducing pulmonary congestion and peripheral edema. Absence of previously heard crackles would be an indicator of effectiveness. Edema and jugular vein distention are manifestations of heart failure. A potassium level of 3.5 mEq/L is a normal value.

A patient is prescribed lisinopril [Prinvil] as part of the treatment plan for heart failure. Which finding indicates the patient is experiencing the therapeutic effect of this drug? A. + 2 edema of the lower extremities B. Potassium level of 3.5 mEq/L C. Crackles in the lungs are no longer heard D. Jugular vein distention

D. Crackles in the lungs are no longer heard ***Because angiotensin-converting enzyme (ACE) inhibitors promote venous dilation, they provide the therapeutic effect of reducing pulmonary congestion and peripheral edema. Absence of previously heard crackles would be an indicator of effectiveness. Edema and jugular vein distention are manifestations of heart failure. A potassium level of 3.5 mEq/L is a normal value.

A patient is prescribed lisinopril [Prinvil] as part of the treatment plan for heart failure. Which finding indicates the patient is experiencing the therapeutic effect of this drug? A. Jugular vein distention B. Potassium level of 3.5 mEq/L C. + 2 edema of the lower extremities D. Crackles in the lungs are no longer heard

D. Teach the patient to avoid the abrupt cessation of treatment. ***The most important concept is to teach the patient to avoid the abrupt cessation of treatment. This could lead to a life-threatening seizure or to status epilepticus. The patient should not adjust the dose without consulting the prescriber. Although teaching the patient to take the medication with meals and teaching the patient how to avoid gingival hyperplasia are indicated, they are not the priority.

A patient is prescribed phenytoin [Dilantin] for epileptic seizures. Which of the following is the priority for patient teaching? A. Teach the patient to adjust the dose according to the presence of symptoms. B. Tell the patient to take the medication with meals. C. Inform the patient about the prevention of gingival hyperplasia. D. Teach the patient to avoid the abrupt cessation of treatment.

D. Serum creatinine levels ***Assessment of serum creatinine levels is useful for determining the kidney function that is required to prescribe H2 receptor antagonist drugs such as ranitidine [Zantac]. Monitoring blood glucose and blood pressure gives a general idea about the patient's well-being. Serum antibody levels detect possible infections in the patient.

A patient is prescribed ranitidine [Zantac] for the treatment of peptic ulcers. To ensure drug safety, what should the nurse assess before administering the drug? A. Blood glucose levels B. Blood pressure levels C. Serum antibody levels D. Serum creatinine levels

C. Potassium level of 2.4 ***The patient is hypokalemic

A patient is presenting with an orthostatic blood pressure of 80/40 when she stands up, thready and weak pulse of 58, and shallow respirations. In addition, the patient has been having frequent episodes of vomiting and nausea and is taking hydrochlorothiazide. Which of the following findings would explain the patient's condition? A. Potassium level of 7.0 B. Potassium level of 3.5 C. Potassium level of 2.4 D. None of the options are correct

C. Chronic bronchitis ***The answer is D. The key words to let you know the patient is experiencing chronic bronchitis are: cyanosis and edema in the abdomen and legs. Remember chronic bronchitis is sometimes referred to as "blue bloaters".

A patient is presenting with chronic obstructive pulmonary disease. The patient has a chronic productive cough with dyspnea on excretion. Arterial blood gases show a low oxygen level and high carbon dioxide level in the blood. On assessment, the patient has cyanosis in the lips and edema in the abdomen and legs. Based on your nursing knowledge and the patient's symptoms, you suspect the patient suffers from what type of COPD? A. Emphysema B. Pneumonia C. Chronic bronchitis D. Pneumothorax

D. Creatinine level ***Amphotericin B is toxic to cells of the kidneys. To evaluate renal injury, the plasma creatinine level should be monitored every 3 or 4 days, as well as intake and output. It is not necessary to monitor the serum protein or glucose levels or the serum pH in patients taking amphotericin B.

A patient is receiving amphotericin B. It is most important for the nurse to monitor which laboratory result? A. Serum pH B. Protein level C. Glucose level D. Creatinine level

A. Valsartan [Diovan] ***ARBs have a suffix -sartan. Valsartan [Diovan] is an ARB. Amlodipine [Norvasc] is a calcium channel blocker. Captopril [Captoen] is an ACE inhibitor with a common suffix -pril. Metroprolol [Lopressor] is a beta blocker with a common suffix -olol.

A patient is receiving an angiotensin II receptor blocker (ARB). Which does the nurse recognize as an ARB? A. Valsartan [Diovan] B. Amlodipine [Norvasc] C. Captopril [Captoen] D. Metroprolol [Lopressor]

A. Activated partial thromboplastin time (aPTT) ***The most commonly used laboratory value that monitors the effect of heparin is the activated partial thromboplastin time (aPTT).

A patient is receiving an intravenous infusion of heparin to treat a pulmonary embolism. What laboratory value will the nurse monitor to evaluate treatment with this medication? A. Activated partial thromboplastin time (aPTT) B. Prothrombin time (PT) C. Platelet count D. Hemoglobin and hematocrit

B. Cytotoxic agents ***The term cancer chemotherapy applies only to cytotoxic drugs; it does not apply to the use of hormones, biologic response modifiers, or targeted drugs.

A patient is receiving cancer chemotherapy. Which type of drug is the nurse administering? A. Targeted drugs B. Cytotoxic agents C. Biologic response modifiers D. Hormones and hormone antagonists

B. 8 days. ***Following chemotherapy administration, the time at which the blood count is at the lowest is called the nadir and typically occurs 7 to 10 days after treatment.

A patient is receiving chemotherapy for the treatment of cancer. The nurse anticipates nadir to occur in A. 2 days. B. 8 days. C. 15 days. D. 30 days.

A. "The risk of harm to the fetus is remote." ***Category A drugs are the least dangerous to the fetus.

A patient is taking a Category A drug during pregnancy. Which statement by the nurse is accurate? A. "The risk of harm to the fetus is remote." B. "The drug is safe to take during pregnancy." C. "This drug has caused congenital birth defects." D. "No controlled studies of this drug have been done in humans."

C. withhold the digoxin and notify the prescriber about your assessment findings. ***Irritability, nausea, blurred vision, and confusion are signs and symptoms of digoxin toxicity. The digoxin dose should be withheld, the prescriber notified, and the digoxin level checked. You should try to reorient the patient and prepare for possible emergency treatment pending the laboratory results.

A patient is receiving digoxin for treatment of atrial fibrillation. When you enter the room to give the medication, you find the patient irritable and complaining of nausea and blurred vision. She is also disoriented to place and time. The most appropriate action at this time is to: A. attempt to reorient the patient while helping her take the digoxin. B. return to the room later and see whether the patient will take the medication. C. withhold the digoxin and notify the prescriber about your assessment findings. D. check the medication profile for possible drug interactions after giving the digoxin to the patient.

C. Acetaminophen [Tylenol] ***The risk of gastrointestinal irritation and ulceration for a patient taking glucocorticoids is increased by concurrent use of other medications, including aspirin [Bayer] and nonsteroidal anti-inflammatory drugs such as ibuprofen [Advil] and naproxen sodium [Aleve].

A patient is receiving glucocorticoids for the treatment of rheumatoid arthritis. The patient complains of having a headache. Which ordered medication should the nurse administer? A. Aspirin [Bayer] B. Ibuprofen [Advil] C. Acetaminophen [Tylenol] D. Naproxen sodium [Aleve]

D. Ankle edema ***Peripheral edema is an adverse effect of nifedipine [Adalat CC]. Headache is an adverse effect, not backache. Diarrhea is not an adverse effect of nifedipine [Adalat CC]. Flushing occurs, not pallor.

A patient is receiving nifedipine [Adalat CC]. Which adverse effect should the nurse monitor for in this patient? A. Pallor B. Diarrhea C. Backache D. Ankle edema

B. Redness, light sensitivity, and pain ***Symptoms of a bacterial, viral, or fungal eye infection will include redness, light sensitivity, and pain.

A patient is receiving ocular injections of pegaptanib [Macugen] to treat neovascular age-related macular degeneration (ARMD). The Nurse should teach the patient to immediately report symptoms that indicate an eye infection. The symptoms of eye infection include what? A. Diplopia, nystagmus, and papilledema B. Redness, light sensitivity, and pain C. Cloudy vision with copious purulent drainage D. Fever, chills, and blurred vision

A. IV hydration and assessment of fluid status. ***The patient should be well-hydrated while taking this drug to prevent hemorrhagic cystitis (bleeding as a result of severe bladder inflammation).

A patient is receiving the alkylating drug cyclophosphamide (Cytoxan). It is most important for the nurse to provide A. IV hydration and assessment of fluid status. B. vigilant skin care and cleaning with mild soap. C. mouth care using half-strength H2O2 and a soft toothbrush. D. patient-controlled analgesia with meperidine (Demerol).

C. Renal toxicity ***The most common toxic effect of vancomycin [Vancocin] therapy is renal toxicity. Although ototoxicity may occur, it is rare. The liver and heart are not affected when vancomycin is used.

A patient is receiving vancomycin [Vancocin]. The nurse identifies what as the most common toxic effect of vancomycin therapy? A. Ototoxicity B. Hepatotoxicity C. Renal toxicity D. Cardiac toxicity

B. Presence of peripheral neuropathy ***Peripheral neuropathy is the major dose-limiting toxicity from vincristine [Oncovin]. Vincristine [Oncovin] does not cause pulmonary fibrosis; busulfan, carmustine, and bleomycin do. Significant nausea and vomiting are uncommon. In contrast to most cytotoxic anticancer drugs, vincristine causes little bone marrow suppression.

A patient is receiving vincristine [Oncovin] for cancer. Which assessment is priority? A. Presence of pulmonary fibrosis B. Presence of peripheral neuropathy C. Presence of bone marrow suppression D. Presence of severe nausea and/or vomiting

A. Blood glucose control for 24 hours ***Insulin glargine is administered as a once-daily subcutaneous injection for patients with type 1 diabetes. It is used for basal insulin coverage, not mealtime coverage. It has a prolonged duration, up to 24 hours, with no peaks. Blood glucose monitoring is still an essential component to achieve tight glycemic control.

A patient is scheduled to start taking insulin glargine [Lantus]. On the care plan, a nurse should include which of these outcomes related to the therapeutic effects of the medication? A. Blood glucose control for 24 hours B. Mealtime coverage of blood glucose C. Less frequent blood glucose monitoring D. Peak effect achieved in 2 to 4 hours

A. This medication provides blood glucose control for 24 hours. ***Insulin glargine is administered as a once-daily subcutaneous injection for patients with type 1 and type 2 diabetes. It is used for basal insulin coverage, not mealtime coverage. It has a prolonged duration, up to 24 hours, with no peaks. Blood glucose monitoring is still an essential component to achieve tight glycemic control.

A patient is scheduled to start taking insulin glargine [Lantus]. Which information should the nurse give the patient regarding this medication? A. This medication provides blood glucose control for 24 hours. B. The peak effect of this medication is achieved in 2 to 4 hours. C. This medication provides mealtime coverage of blood glucose. D. Less frequent blood glucose monitoring is required when taking this medication

D. Nausea and diarrhea ***Large doses of vitamin C can cause nausea and vomiting, headache, abdominal cramps, and the development of renal stones. Delayed healing, bone and joint pain, and loosening of the teeth are unrelated to the side effects of vitamin C; they actually are symptoms of scurvy, a deficiency of vitamin C.

A patient is scheduled to start taking vitamin C. The nurse should teach the patient to observe for which side effect? A. Delayed healing B. Bone and joint pain C. Loosening of the teeth D. Nausea and diarrhea

C. Nausea and diarrhea ***Large doses of vitamin C can cause nausea and vomiting, headache, abdominal cramps, and the development of renal stones. Delayed healing, bone and joint pain, and loosening of the teeth are unrelated to the side effects of vitamin C; they actually are symptoms of scurvy, a deficiency of vitamin C.

A patient is scheduled to start taking vitamin C. The nurse should teach the patient to observe for which side effect? A. Delayed healing B. Bone and joint pain C. Nausea and diarrhea D. Loosening of the teeth

D. Dry mouth ***First-generation H1 blockers produce adverse effects that include atropine-like properties (ie, drying of mucous membranes) and gastrointestinal effects (eg, nausea). Sedation is a pronounced side effect. H1 blockade results in the inhibition of dilator action of histamine in the periphery, which reduces flushing. Wheezing is not an adverse effect.

A patient is taking a first-generation H1 blocker for the treatment of allergic rhinitis. It is most important for the nurse to assess for which adverse effect? A. Skin flushing B. Wheezing C. Insomnia D. Dry mouth

C. Pulse rate and rhythm ***Muscle weakness and cramping are indications the patient has hypokalemia from the combination of a glucocorticoid and a loop diuretic. Checking the pulse rate and rhythm is priority because cardiotoxicity can occur. Temperature is priority to detect an infection. Stool is tested for occult blood in case of suspected bleeding. Serum potassium is a priority, rather than serum sodium.

A patient is taking a glucocorticoid and a loop diuretic. The patient reports muscle weakness and cramping. Which assessment is priority? A. Temperature B. Stool for occult blood C. Pulse rate and rhythm D. Level of serum sodium

A. liver function ***Because increased liver enzyme levels may occur in patients receiving long-term HMG-CoA therapy, liver function test results should be monitored.

A patient is taking an HMG-CoA reductase inhibitor. Which of the following tests should be performed at the start of therapy and periodically thereafter? A. liver function B. electrolyte levels C. complete blood count D. ECG

A. hypercalcemia ***Watch for signs of hypercelemia in the patient receiving calcium carbonate.

A patient is taking calcium carbonate for peptic ulcer disease. The nurse should monitor the patient for: A. hypercalcemia B. hypocalcemia C. hyperkalemia D. hypokalemia

A. hypercalcemia ***Watch for signs of hypercalcemia in the patient receiving calcium carbonate.

A patient is taking calcium carbonate for peptic ulcer disease. The nurse should monitor the patient for? A. hypercalcemia B. hypocalcemia C. hyperkalemia D. hypokalemia

C. Muscle weakness ***Muscle weakness is a sign of hypokalemia, which can occur because fludrocortisone has mineralocorticoid properties, resulting in sodium and fluid retention and potassium excretion. Syncope and weight loss do not occur because of salt and water retention. Numbness and tingling may be associated with another problem but are not related to fludrocortisone.

A patient is taking fludrocortisone [Florinef]. A nurse should recognize that the patient is at risk for developing an electrolyte imbalance if the patient reports which symptom? A. Syncope B. Weight loss C. Muscle weakness D. Numbness and tingling

B. increase fiber and fluid intake to avoid constipation. E. take the iron supplement with orange juice.

A patient is taking iron supplementation. It is most important for the nurse to instruct the patient to: (Select all that Apply) A. increase fluid intake to avoid urinary calculi. B. increase fiber and fluid intake to avoid constipation. C. increase deep breathing to avoid atelectasis. D. use sunscreen to deal with photosensitivity. E. take the iron supplement with orange juice.

A. Caffeine ***Theophylline is a methylxanthine that provides benefits through bronchodilation. It is used to reduce the frequency and severity of asthma attacks, especially those occurring at night. Caffeine also is a methylxanthine, and its pharmacologic actions may intensify the adverse effects of theophylline on the central nervous system and heart. Sources of caffeine should be avoided. It is not necessary to avoid taking cimetidine or echinacea or using sunscreen products while taking theophylline.

A patient is taking oral theophylline for maintenance therapy of stable asthma. A nurse instructs the patient to avoid using which substance to prevent a complication? A. Caffeine B. Echinacea C. Sunscreen products D. Cimetidine [Tagamet]

A. Jaundice ***Rifampin is toxic to the liver, which increases the patient's risk of hepatitis. Jaundice is a sign of liver dysfunction and should be monitored. Rifampin has no effect on the blood glucose level or deep tendon reflexes, nor does it cause a moon face.

A patient is taking rifampin [Rifadin] for active tuberculosis. Which assessment does the nurse identify as an adverse effect of the drug? A. Jaundice B. Moon face C. Absent deep tendon reflexes D. Blood glucose level of 60 mg/dL

A. Jaundice ***Rifampin is toxic to the liver, which increases the patient's risk of hepatitis. Jaundice is a sign of liver dysfunction and should be monitored. Rifampin has no effect on the blood glucose level or deep tendon reflexes, nor does it cause a moon face.

A patient is taking rifampin [Rifadin] for active tuberculosis. Which assessment does the nurse identify as an adverse effect of the drug? A. Jaundice B. Blood glucose level of 60 mg/dL C. Absent deep tendon reflexes D. Moon face

B. Avoid driving while taking valerian root. C. If you feel depressed, call your provider. D. Prolonged use can cause cardiac abnormalities. E. If you become pregnant, stop taking valerian root. ***Valerian root is generally well tolerated. However, potential adverse effects include drowsiness, dizziness, depression, dyspepsia, and pruritis; therefore, the patient should avoid driving and should alert the provider if any thoughts of depression occur. The effects of valerian root on pregnancy are not yet known, and until further study is done, its use should be avoided during pregnancy. Prolonged use can cause cardiac abnormalities, headache, or nervousness. Urinary retention is not a known side effect of valerian.

A patient is taking valerian root for the promotion of sleep. What should the nurse teach the patient about the adverse effects of valerian root? Select all that apply. A. Urinary retention can occur. B. Avoid driving while taking valerian root. C. If you feel depressed, call your provider. D. Prolonged use can cause cardiac abnormalities. E. If you become pregnant, stop taking valerian root.

C. decrease risk of infection. ***Side effects associated with orally inhaled glucocorticoids are generally local (throat irritation, hoarseness, dry mouth, coughing) rather than systemic. Oral, laryngeal, and pharyngeal fungal infections have occurred. Oropharyngeal infections may be prevented by using a spacer with the inhaler to reduce drug deposits in the oral cavity, rinsing the mouth and throat with water after each dose, and washing the apparatus daily with warm water.

A patient is using a glucocorticoid inhaler. The patient asks the nurse why he has to rinse his mouth out after using the glucocorticoid inhaler. The nurse should inform the patient that rinsing the mouth is done to A. avoid mucous membrane breakdown. B. increase hydration of the oral mucosa. C. decrease risk of infection. D. slow the development of cavities.

D. "It promotes the passage of glucose into cells for energy." ***Insulin promotes the passage of glucose into cells, where it is metabolized for energy. During or after a meal, the glucose that is ingested stimulates the pancreas to secrete insulin. Insulin stimulates the synthesis of proteins and not amino acids. Insulin stimulates the liver to convert glucose to glycogen.

A patient newly diagnosed with diabetes asks, "How does insulin normally work in my body?" Which response by the nurse is correct? A. "It stimulates the pancreas to reabsorb glucose." B. "It promotes synthesis of amino acids into glucose." C. "It stimulates the liver to convert glycogen to glucose." D. "It promotes the passage of glucose into cells for energy."

D. It promotes the passage of glucose into cells for energy. ***The hormone insulin promotes the passage of glucose into cells, where it is metabolized for energy. Insulin does not stimulate the pancreas to reabsorb glucose or synthesize amino acids into glucose. It does not stimulate the liver to convert glycogen into glucose.

A patient newly diagnosed with type 1 diabetes asks a nurse, "How does insulin normally work in my body?" The nurse explains that normal insulin has which action in the body? A. It stimulates the pancreas to reabsorb glucose. B. It promotes the synthesis of amino acids into glucose. C. It stimulates the liver to convert glycogen to glucose. D. It promotes the passage of glucose into cells for energy.

A. It promotes the passage of glucose into cells. ***The hormone insulin promotes the passage of glucose into cells where it is metabolized for energy. Insulin does not stimulate the pancreas to reabsorb glucose or synthesize amino acids into glucose. It does not stimulate the liver to convert glycogen into glucose.

A patient newly diagnosed with type 1 diabetes asks a nurse, "How does insulin normally work in my body?" The nurse should base his or her response on which understanding of the mechanism of insulin? A. It promotes the passage of glucose into cells. B. It stimulates the pancreas to reabsorb glucose. C. It stimulates the liver to convert glycogen to glucose. D. It promotes the synthesis of amino acids into glucose.

A. "This medication has a duration of action of 24 hours." ***Insulin glargine [Lantus] has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas. This medication cannot be mixed with other insulins and is not a short-acting insulin. The patient may need to receive this medication for a long time.

A patient newly diagnosed with type 2 diabetes mellitus has been ordered insulin glargine [Lantus]. Which information is essential for the nurse to teach this patient? A. "This medication has a duration of action of 24 hours." B. "This medication should be mixed with the regular insulin each morning." C. "This medication is very expensive, but you will be receiving it only a short time." D. "This medication is very short-acting. You must be sure you eat after injecting it."

A. 10 minutes before administration of the intravenous antibiotic ***Trough levels are drawn just before infusion. Peak serum drug levels should be drawn 30 to 60 minutes after the medication is infused. The nurse should document the time drug administration is started and completed and the exact time a peak and/or trough level is drawn.

A patient on antibiotic therapy needs drug trough levels drawn. Which is the most appropriate time for the nurse to draw the trough level? A. 10 minutes before administration of the intravenous antibiotic B. 60 minutes after completion of the intravenous antibiotic infusion C. 30 minutes after beginning administration of the intravenous antibiotic D. 90 minutes after the intravenous antibiotic is scheduled to be administered

B. increased risk for falls due to orthostatic hypotension. ***Orthostatic hypotension is the most common adverse reaction seen in patients treated with risperidone (Risperdal).

A patient on risperidone (Risperdal) may be at increased risk for injury due to A. increased potential for aspiration due to sedation. B. increased risk for falls due to orthostatic hypotension. C. increased risk for infection due to neutropenia. D. increased risk for suicide due to changes in thought processes.

D. Mild allergic reaction ***The symptoms are typical of those produced by hay fever, a response to plant allergens in the environment. Anaphylaxis is a severe allergic response characterized by bronchoconstriction, hypotension, and edema of the glottis. Drug suppression would be a nonreactive response to a drug and an adverse effect is an expected or common response to a particular drug.

A patient presents to the clinic with a runny nose, itchy throat, and mild inflammation after being exposed to sumac on a hiking trip. After assessing the patient, the nurse recognizes the symptoms as a result of what response? A. Anaphylaxis B. Drug suppression C. Drug adverse effect D. Mild allergic reaction

A. Acute toxicity ***Toxicity of antihistamines is common due to the availability of the drug. The presenting symptoms are classic for antihistamine poisoning. A paradoxical effect would be an unexpected reaction to a drug.

A patient presents to the emergency department with dilated pupils, flushed face, heart rate of 124 beats/min, temperature of 102.6 degrees Fahrenheit, and urinary retention. The patient's significant other reports the patient has been taking diphenhydramine for hay fever but is unaware of any other medications taken. What does the nurse suspect? A. Acute toxicity B. Adverse reaction C. Paradoxical effect D. Reaction from unknown drug

A. "Stop taking the drug and visit the clinic immediately." ***The patient may have pain in both legs due to myopathy, an adverse effect of atorvastatin [Lipitor]. It progresses to a life-threatening condition called rhabdomyolysis, which involves the breakdown of muscle proteins leading to renal failure and death. The nurse should instruct the patient to stop taking the drug and immediately visit the clinic. The nurse will not instruct the patient to continue the drug as it is a life-threatening condition and requires immediate medical attention. The nurse will instruct the patient to watch for the symptoms; rhabdomyolysis further worsens the patient's condition, leading to renal failure. Administration of niacin [Niaspan], along with atorvastatin [Lipitor], further increases the breakdown of muscle proteins and causes rhabdomyolysis. The nurse should ask the patient to stop taking the medication until confirming the cause of the leg pain.

A patient receiving atorvastatin [Lipitor] therapy to reduce high cholesterol levels calls the clinic and reports, "I am experiencing severe pain in both my legs." What is the nurse's best response? A. "Stop taking the drug and visit the clinic immediately." B. "Continue taking the drug; leg pain is a common side effect." C. "Stop taking the drug if the symptoms persist for another week." D. "Continue taking the drug along with niacin [Niaspan] and a pain killer."

B. Plant alkaloids ***The plant alkaloids damage peripheral nerve fibers and may cause reversible or irreversible neurotoxicity. Signs and symptoms of neurotoxicity include a decrease in muscular strength, numbness, tingling of fingers and toes ("stocking/glove" syndrome), constipation, and motor instability.

A patient receiving chemotherapy for the treatment of cancer experiences "stocking/glove" syndrome. The nurse identifies which drug class as most likely associated with this adverse effect? A. Antitumor antibiotics B. Plant alkaloids C. Alkylating drugs D. Hormonal agents

D. Ask whether the patient is using at least 8 ounces of fluid to prepare the psyllium. ***Bulk-forming laxatives, such as psyllium, must be given with at least 8 ounces (240 mL) of liquid, plus additional liquid each day, to prevent intestinal impaction. Another laxative may not be necessary at this time. A dosage increase and monitoring are appropriate after proper mixing of the medication has been validated.

A patient reports abdominal bloating and infrequent, small, hard stools after taking psyllium [Metamucil] for 2 weeks. Which is the nurse's priority action? A. Consult the physician about another laxative choice. B. Check the dose because an increase may be indicated. C. Ask whether the patient is toileting at the same time every day. D. Ask whether the patient is using at least 8 ounces of fluid to prepare the psyllium.

B. Pentazocine [Talwin] ***Pentazocine is an agonist-antagonist opioid. If pentazocine is given to a patient who is physically dependent on a pure opioid agonist such as morphine, withdrawal or abstinence syndrome will occur. Before an agonist-antagonist is administered, the patient should be slowly withdrawn from the opioid agonist. Promethazine is an antiemetic that may be given with opioids to reduce nausea and vomiting, but it may also result in increased constipation and urinary retention. Methylnaltrexone is a selective mu opioid antagonist indicated for opioid-induced constipation; the drug does not block opioid receptors in the CNS. Methylnaltrexone does not decrease analgesia and cannot precipitate opioid withdrawal. Dextromethorphan may increase analgesia and reduce tolerance to morphine.

A patient reports having taken morphine for the past 6 months. Which medication, if ordered by the physician, should the nurse question? A. Promethazine [Phenergan] B. Pentazocine [Talwin] C. Methylnaltrexone [Relistor] D. Dextromethorphan [Delsym]

B. Increased blood glucose levels ***Corticosteroids, while useful in the management of inflammation, can cause deleterious side effects when used long term. Corticosteroids may increase blood glucose levels, causing hyperglycemia; they may also cause such effects as facial edema, easy bruising, weight gain, osteoporosis, and high blood pressure.

A patient requires long-term systemic corticosteroid therapy for treatment of a skin disease. Which of the following effects has been associated with chronic use of corticosteroids? A. Weight loss B. Increased blood glucose levels C. Hypotension D. Hair loss

A. Ibuprofen [Motrin] ***Ibuprofen [Motrin] can block the antiplatelet effects of aspirin; therefore, patients who take low-dose aspirin to protect against myocardial infarction and thrombosis should avoid taking ibuprofen [Motrin]. It is not necessary to avoid taking zolpidem [Ambien], loratadine [Claritin], or diphenhydramine [Benadryl] while taking aspirin.

A patient takes daily low-dose aspirin for protection against myocardial infarction and stroke. Which medication will the nurse teach the patient to avoid taking with aspirin? A. Ibuprofen [Motrin] B. Zolpidem [Ambien] C. Loratadine [Claritin] D. Diphenhydramine [Benadryl]

C. Blood pressure ***The adverse effects of cholinergic therapy that stimulate muscarinic receptors include orthostatic hypotension. Hence, the nurse monitors the patient's blood pressure for early detection of hypotension. Although muscarinic poisoning is likely to cause increased lacrimal secretion, diarrhea, and urinary frequency, these problems are less important than hemodynamic changes.

A patient takes more than one cholinergic agonist that stimulates muscarinic receptors. Which parameter does the nurse make a priority to monitor to help prevent serious adverse effects of therapy? A. Lacrimation B. Bowel pattern C. Blood pressure D. Urinary pattern

D. The patient should increase fluid and fiber in the diet. ***Narcotic analgesics reduce intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can help manage this adverse effect. If increased fluid and fiber is not sufficiently effective, use of a laxative may be considered.

A patient takes oxycodone [OxyContin] 40 mg PO twice daily for the management of chronic pain. Which intervention should be added to the plan of care to minimize the gastrointestinal adverse effects? A. The patient should take an antacid with each dose. B. The patient should eat foods high in lactobacilli. C. The patient should take the medication on an empty stomach. D. The patient should increase fluid and fiber in the diet.

C. Hold the next dose of theophylline. ***The patient is displaying adverse reactions to theophylline, and her blood level should be assessed before another dose of the medication. The nurse should hold the medication.

A patient taking an oral theophylline drug is due for her next dose and has a blood pressure of 100/50 mm Hg and a heart rate of 110 bpm. The patient is irritable. What is the nurse's best action? A. Continue to monitor the patient. B. Call the health care provider. C. Hold the next dose of theophylline. D. Administer oxygen 2 L per minute via nasal cannula.

C. Chicken ***Spironolactone [Aldactone] is a potassium-sparing diuretic that could potentially cause hyperkalemia. Of the foods listed, chicken is lowest in potassium. Nuts, potatoes, dried fruits, spinach, citrus fruits, and bananas are all known to contain high levels of potassium.

A patient taking spironolactone [Aldactone] has been taught about the medication. Which menu selection indicates the patient understands teaching related to this medication? A. Nuts B. Spinach C. Chicken D. Potatoes

A. Folic acid ***Folic acid deficiency during early pregnancy can cause neural tube defects (spina bifida). All women with the potential for becoming pregnant should consume folic acid every day. Vitamin B12, riboflavin, and vitamin D are not considered as important as folic acid to supplement before a woman becomes pregnant.

A patient tells the nurse that she is thinking about becoming pregnant. The nurse teaches the patient that which vitamin should be her priority for supplementation before planning a pregnancy? A. Folic acid B. Vitamin D C. Riboflavin D. Vitamin B12

D. Folic acid ***Folic acid deficiency during early pregnancy can cause neural tube defects [spina bifida]. All women with the potential for becoming pregnant should consume folic acid every day. Vitamin B12, riboflavin, and vitamin D are not considered as important as folic acid to supplement before a woman becomes pregnant.

A patient tells the nurse that she is thinking about becoming pregnant. The nurse teaches the patient that which vitamin should be her priority for supplementation before planning a pregnancy? A. Vitamin B12 B. Riboflavin C. Vitamin D D. Folic acid

A. Dry mouth ***The most commonly reported adverse effects of ipratropium [Atrovent] therapy are caused by the anticholinergic effects of the drug and include dry mouth or throat, nasal congestion, heart palpitations, gastrointestinal distress, urinary retention, increased intraocular pressure, headache, coughing, and anxiety. Insomnia, anginal pain, and vascular headache are the adverse effects of β-adrenergic agonists.

A patient undergoing inhaled ipratropium [Atrovent] therapy visits the clinic for a follow-up visit. Which complaint would the nurse anticipate from the patient? A. Dry mouth B. Insomnia C. Anginal pain D. Vascular headache

D. Vancomycin ***Vancomycin is effective (1) (2) in treating healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA). MRSA is resistant to all penicillins and cephalosporins. The bacteria is resistant to tetracycline and clindamycin as well.

A patient was diagnosed as having healthcare-associated methicillin-resistant Staphylococcus aureus (HCA-MRSA). Which medication is most likely to be ordered for treatment? A. Amoxicillin B. Clindamycin C. Tetracycline D. Vancomycin

D. Alcoholism ***Pyrazinamide is contraindicated in patients with both liver dysfunction and gout. It should be used with caution in patients who abuse alcohol, and liver function studies should be done every 2 weeks. It is not known to cause complications in patients who have Parkinson's disease, rheumatoid arthritis, or glaucoma.

A patient who has active TB is to start a medication regimen that includes pyrazinamide. The nurse identifies a risk for complications if the patient also has which medical condition? A. Parkinson's disease B. Rheumatoid arthritis C. Glaucoma D. Alcoholism

B. Alcoholism ***Pyrazinamide is contraindicated in patients with both liver dysfunction and gout. It should be used with caution in patients who abuse alcohol, and liver function studies should be done every 2 weeks. It is not known to cause complications in patients who have Parkinson's disease, rheumatoid arthritis, or glaucoma.

A patient who has active tuberculosis (TB) is to start a medication regimen that includes pyrazinamide. The nurse identifies a risk for complications if the patient also has which medical condition? A. Glaucoma B. Alcoholism C. Parkinson's disease D. Rheumatoid arthritis

B. Shut off the heparin drip. ***The nurse's first action in the case of an aPTT of 120 seconds is to shut off the infusion of heparin. The aPTT is too high, and the patient can have spontaneous bleeding. After shutting off the drip, the nurse should instruct the patient to stay on bed rest because a fall can be fatal. The healthcare provider would need to be notified and the nurse would continue care by assessing for bleeding.

A patient who has been receiving an infusion of heparin has an activated partial thromboplastin time (aPTT) of 120 seconds. What is the nurse's first action? A. Assess for bleeding. B. Shut off the heparin drip. C. Call the healthcare provider. D. Keep the patient on bed rest.

D. Senna [Senokot] ***Stimulant laxatives are commonly used to treat opioid-induced constipation.

A patient who has been taking a long-acting morphine to treat severe pain for a few months complains of constipation. The nurse anticipates which of the following will be prescribed for the patient? A. Polycarbophil [FiberCon] B. Mineral oil C. Psyllium [Metamucil] D. Senna [Senokot]

A. Alcohol B. Opioids D. Antihistamines E. Muscle relaxants ***Because they are also central nervous system (CNS) depressants, the nurse instructs the patient to avoid alcohol, opioids, antihistamines, and muscle relaxants; when taken together with alprazolam [Xanax] they can cause significant CNS depression, including respiratory depression. Tobacco use is likely to be harmful, but it is unlikely to intensify the adverse effects of a benzodiazepine. Caffeine, a xanthine stimulant, is likely to ameliorate CNS depression associated with benzodiazepines.

A patient who has been taking alprazolam [Xanax] and has been compliant with the therapeutic regimen for 6 weeks is now complaining of adverse effects of the medication. Which substances will the nurse instruct the patient to avoid to help prevent intensification of this medication's adverse effects? Select all that apply. A. Alcohol B. Opioids C. Tobacco D. Antihistamines E. Muscle relaxants F. Caffeinated drinks

D. St. John's wort ***St. John's wort is an herb used as a medication to treat depression. It leads to serotonin syndrome when administered with other selective serotonin reuptake inhibitors, such as citalopram [Celexa]. Valerian causes central nervous system depression when used with sedatives. Saw palmetto changes the effects of hormones in oral contraceptive drugs or hormonal replacement therapies. Cranberry decreases the elimination of many medications excreted by the kidneys.

A patient who has depression is admitted to the emergency department with serotonin syndrome. The nurse learns that the patient is taking an herbal medication and citalopram [Celexa]. Which herbal medication is the patient most likely taking? A. Valerian B. Cranberry C. Saw palmetto D. St. John's wort

A. Neutralized gastric acid ***Antacids work by neutralizing, absorbing, or buffering gastric acid, which raises the gastric pH above 5. For patients with GERD, antacids can produce symptomatic relief. Increased barrier to pepsin is an effect of sucralfate [Carafate]. Reduced stomach motility is not an effect of milk of magnesia.

A patient who has gastroesophageal reflux disease (GERD) is taking magnesium hydroxide (milk of magnesia). Which outcome should a nurse expect if the medication is achieving the desired therapeutic effect? A. Neutralized gastric acid B. Reduced stomach motility C. Increased barrier to pepsin D. Reduced duodenal pH

C. Stimulation of uterine smooth muscle ***Oxytocin is a hormone used in labor induction to promote the force, frequency, and duration of uterine contractions and to stimulate the milk ejection reflex. Cervical ripening must have occurred before oxytocin is used, but this is not an effect of oxytocin.

A patient who is near term gestation is receiving oxytocin [Pitocin]. Which response should the nurse expect if the medication is having the desired therapeutic effect? A. Decreased force of uterine contraction B. Promotion of cervical ripening C. Stimulation of uterine smooth muscle D. Inhibition of milk ejection reflex

5mm ***A positive reaction on the tuberculin skin test (TST) is indicated by an area of induration (hardness) around the injection site. The decision to treat latent tuberculosis is based on the risk category and size of the induration area. Treatment is recommended for high-risk individuals, such as those with human immunodeficiency virus infection, for an induration of 5 mm. An induration of 10 mm is required to treat moderate-risk individuals. An induration of more than 15 mm is required to treat low-risk individuals.

A patient who has human immunodeficiency virus (HIV) infection has a tuberculin skin test (TST) for latent tuberculosis. The nurse assesses the result 48 hours after the injection. An induration of what size in millimeters indicates that the patient needs to be treated for latent tuberculosis? Record your answer using a whole number. _____

C. Administer the drug with an aluminum hydroxide antacid. ***Magnesium hydroxide is a rapid-acting antacid with a prominent adverse effect of diarrhea. To compensate, it usually is administered in combination with aluminum hydroxide, which promotes constipation. A reduction in dose might be necessary if the diarrhea is severe, but this is not the priority action. Increasing dietary fiber and keeping a stool count are appropriate actions to implement after adding an antacid to counteract the diarrhea effect.

A patient who has peptic ulcer disease and is receiving magnesium hydroxide (milk of magnesia) is experiencing an increased number of bowel movements. Which is the nurse's priority action? A. Ask the healthcare provider for a reduction in dose. B. Encourage the patient to increase dietary fiber. C. Administer the drug with an aluminum hydroxide antacid. D. Instruct the patient to keep an accurate stool count.

D. Administer the drug with an aluminum hydroxide antacid. ***Magnesium hydroxide is a rapid-acting antacid with a prominent adverse effect of diarrhea. To compensate, it usually is administered in combination with aluminum hydroxide, which promotes constipation. A reduction in dose might be necessary if the diarrhea is severe, but this is not the priority action. Increasing dietary fiber and keeping a stool count are appropriate actions to implement after adding an antacid to counteract the diarrhea effect.

A patient who has peptic ulcer disease and is receiving magnesium hydroxide (milk of magnesia) is experiencing an increased number of bowel movements. Which is the nurse's priority action? A. Encourage the patient to increase dietary fiber. B. Ask the healthcare provider for a reduction in dose. C. Instruct the patient to keep an accurate stool count. D. Administer the drug with an aluminum hydroxide antacid.

B. Recent heart bypass surgery ***Celecoxib [Celebrex] should be avoided in patients who have undergone recent heart bypass surgery. Because it does not inhibit COX-1, platelet aggregation is not suppressed. It does inhibit COX-2 in blood vessels, which results in increased vasoconstriction. Unimpeded platelet aggregation and increased vasoconstriction pose a higher risk of thrombotic events in patients with certain cardiovascular risk factors. Hypothyroidism, a penicillin allergy, and a positive tuberculin skin test result are not contraindications to taking celecoxib [Celebrex].

A patient who has rheumatoid arthritis is scheduled to start taking celecoxib [Celebrex]. A nurse should recognize which factor from the patient's history as a contraindication to taking this medication? A. Hypothyroidism B. Recent heart bypass surgery C. Positive tuberculin skin test result D. Allergy to penicillin

D. A therapeutic effect can be expected in another 2 to 4 weeks ***The full therapeutic effects of selective serotonin reuptake inhibitor (SSRI) therapy may take 4 to 6 weeks to occur, so this patient can anticipate experiencing a therapeutic effect in 2 to 4 more weeks. Knowing the time frame to achieve a therapeutic effect offers the patient realistic hope and provides a justification for adherence to therapy. Adverse effects can usually be managed, and relaxation exercises may provide some relief from anxiety. The patient must fulfill these tasks to get the full therapeutic effect of the medication, but it can be difficult for a patient with depression to do so. SSRIs can require considerable titration, but, because of the nature of the patient's illness, this information is unlikely to promote adherence to therapy.

A patient who has taken fluoxetine [Prozac] for 2 weeks to treat an anxiety disorder complains of dissatisfaction with the therapy. What is the best information for the nurse to include in patient education to promote adherence to the therapeutic regimen? A. This medication usually requires titration. B. The adverse effects can be managed well. C. Relaxation exercises can offer some relief. D. A therapeutic effect can be expected in another 2 to 4 weeks

A. Numbness and tingling in the fingers and toes ***Dose-related peripheral neuropathy is the most common adverse effect of isoniazid. It results from a vitamin B6 deficiency, which is corrected by taking oral supplements. Symptoms include numbness and tingling in the fingers and toes. Alopecia and flaking scalp, oral ulcers and tongue fissures, and dry skin and brittle nails are not adverse effects of isoniazid-induced vitamin B6 deficiency.

A patient who has tuberculosis is treated with isoniazid. The nurse should monitor for which symptoms, which could indicate a vitamin B6 deficiency caused by the medication? A. Numbness and tingling in the fingers and toes B. Alopecia and flaking scalp C. Dry skin and brittle nails D. Oral ulcers and tongue fissures

B. 0.9% sodium chloride ***Of the fluids listed, the only one that is isotonic is 0.9% sodium chloride. 3% sodium chloride is considered to be a hypertonic solution; 0.45% and 0.25% sodium chloride are considered to be hypotonic solutions.

A patient who has vomiting and diarrhea is ordered an isotonic intravenous fluid. Which intravenous fluid should the nurse prepare to administer? A. 3% sodium chloride B. 0.9% sodium chloride C. 0.45% sodium chloride D. 0.25% sodium chloride

D. "Take the antibiotic immediately after breast-feeding." ***Dosing immediately after breast-feeding minimizes drug concentration in milk at the next feeding.

A patient who is breast-feeding her newborn infant is prescribed an antibiotic to take after discharge. Which statement should the nurse include when providing discharge instructions? A. "Drink plenty of fluids to dilute the drug in your breast milk." B. "Take the drug at night with a full glass of water." C. "Pump your breasts, and then discard all of the milk." D. "Take the antibiotic immediately after breast-feeding."

C. Administering a beta2 adrenergic agonist ***In an acute asthmatic attack, the short-acting sympathomimetics are the first line of defense. A beta2-adrenergic agonist will provide immediate relief, while a glucocorticoid will not; there is no need to call a code.

A patient with a history of asthma is short of breath and says, "I feel like I'm having an asthma attack." What is the nurse's highest priority action? A. Calling a code B. Asking the patient to describe the symptoms C. Administering a beta2 adrenergic agonist D. Administering a long-acting glucocorticoid

C. Stimulation of uterine smooth muscle ***Oxytocin [Pitocin] is a hormone used in labor induction to promote the force, frequency, and duration of uterine contractions and to stimulate the milk ejection reflex. Cervical ripening must have occurred before oxytocin [Pitocin] is used, but this is not an effect of oxytocin.

A patient who is near term gestation is receiving oxytocin [Pitocin]. Which response should the nurse expect if the medication is having the desired therapeutic effect? A. Promotion of cervical ripening B. Inhibition of milk ejection reflex C. Stimulation of uterine smooth muscle D. Decreased force of uterine contractions

B. Listen to the patient's lungs ***Before making a recommendation, the nurse should complete a patient assessment to rule out an exacerbation of asthma because the cough may be a clinical indicator of a more serious problem in a patient who has asthma. Ipratropium [Atrovent] is an anticholinergic bronchodilator that can cause dry mucous membranes, so to loosen the secretions and facilitate expectoration, the nurse might instruct the patient to drink water. If the patient is wheezing, rescue therapy may be indicated. Dextromethorphan [Cufcure], an antitussive, is effective in eliminating a cough; however, this therapy may not be indicated, depending on the findings of the nurse's assessment.

A patient who is taking ipratropium [Atrovent] for asthma is complaining of a dry cough. Which action should the nurse implement first? A. Administer rescue therapy B. Listen to the patient's lungs C. Instruct the patient to drink water D. Administer dextromethorphan 30 mg

C. Metronidazole [Flagyl] ***Metronidazole is the treatment of choice for antibiotic-associated colitis caused by C. difficile. Rifaximin, daptomycin, and gemifloxacin are not used in the treatment of C. difficile infection.

A patient who takes multiple antibiotics starts to experience diarrheal stools. The nurse anticipates administration of which antibiotic if a stool sample tests positive for Clostridium difficile? A. Rifaximin [Xifaxan] B. Daptomycin [Cubicin] C. Metronidazole [Flagyl] D. Gemifloxacin [Factive]

B. A higher drug dose ***The bioavailability of drugs that have a high first-pass effect is less than 100% if administered via an oral route. The drug becomes inactive during its transit through the intestine and while passing through the liver. An oral formulation with the same dose as a parenteral formulation will have a decreased effect due to a lesser amount of active drug reaching the systemic circulation; therefore, a higher drug dose will be needed if an oral formulation is prescribed. An enteric coating does not prevent drug inactivation in the liver.

A patient will receive an intramuscular injection of a drug that has a high first-pass effect. The provider plans to change the drug to an oral formulation when the patient is discharged. Which type of prescription would the nurse anticipate for the patient? A. A lower drug dose B. A higher drug dose C. An enteric-coated oral formulation D. An oral formulation of the same dose

C. "I will need to have my eyes checked regularly while I am taking this drug." ***Ethambutol (Myambutol) can cause optic neuritis. Ophthalmologic examinations should be performed periodically to assess visual acuity.

A patient with Mycobacterium tuberculosis is prescribed ethambutol (Myambutol) for long-term use. Which statement by the patient indicates understanding of the instructions? A. "Dizziness, drowsiness, and decreased urinary output are common with this drug, but they will subside over time." B. "Constipation will be a problem, so I will increase the fiber and fluids in my diet." C. "I will need to have my eyes checked regularly while I am taking this drug." D. "This medication may cause my bodily secretions to turn red-orange."

B. Uncontrollable voluntary movements ***Many patients tend to have on-off phenomena when they are taking a dopamine medication such as levodopa [Parcopa]. On-off phenomena are characterized by the increase and decrease of dopamine levels. This fluctuation causes dyskinesia, in which the patient has impaired voluntary movements. Levodopa [Parcopa] does cause suicidal intentions and aggressive behavior, but this is not related to the on-off phenomenon. Levodopa [Parcopa] does not alter the respiratory rate because it does not affect pulmonary function. The on-off syndrome is related to the efficacy of the drug; it is unrelated to delusions and hallucinations.

A patient with Parkinson's disease is treated with levodopa [Parcopa]. During the follow-up visit, the nurse finds that the patient is having an on-off phenomenon caused by the medication. Which findings would likely cause the nurse to come to this conclusion? A. Sudden increase in respiratory rate B. Uncontrollable voluntary movements C. Frequent delusions and hallucinations D. Suicidal intentions and aggressive behavior

D. "Are you having vivid dreams or hallucinations?" ***Patients taking levodopa/carbidopa [Sinemet] are at increased risk for the psychiatric side effects of levodopa, including visual hallucinations, vivid dreams, nightmares, and paranoid ideation. The other questions are not directly related to problems that are likely to occur with this drug.

A patient with Parkinson's disease who takes levodopa/carbidopa [Sinemet] comes to the clinic for a semiannual physical examination. Which question is the most important for the nurse to ask? A. "Have you had your flu vaccine?" B. "Have you noticed any swelling in your feet?" C. "Have you noticed any changes in your stool?" D. "Are you having vivid dreams or hallucinations?"

A. Creatinine levels B. Serum electrolytes C. Trough serum levels ***A patient with a Clostridium difficile infection has experienced severe diarrhea and should have serum electrolytes drawn. To mimimize the risk of renal failure associated with vancomycin, creatinine levels and serum trough should be checked. Alkaline phosphatase is a liver function test, and creatine phophokinase (CPK) is an enzyme in the heart, brain, and skeletal muscle. Abnormal results of those labs are not indicative of kidney failure or toxicity highly associated with vancomycin.

A patient with a Clostridium difficile infection is placed on vancomycin. Which labs should the nurse expect to be drawn for this patient? Select all that apply. A. Creatinine levels B. Serum electrolytes C. Trough serum levels D. Alkaline phosphatase E. Creatine phosphokinase (CPK)

B. Heparin suppresses coagulation by helping antithrombin perform its natural functions. ***Heparin is an anticoagulant that works by helping antithrombin inactivate thrombin and factor Xa, reducing the production of fibrin and thus decreasing the formation of clots.

A patient with a deep vein thrombosis receiving an intravenous (IV) heparin infusion asks the nurse how this medication works. What is the nurse's best response? A. Heparin prevents the activation of vitamin K and thus blocks synthesis of some clotting factors. B. Heparin suppresses coagulation by helping antithrombin perform its natural functions. C. Heparin works by converting plasminogen to plasmin, which in turn dissolves the clot matrix. D. Heparin inhibits the enzyme responsible for platelet activation and aggregation within vessels.

D. Blood pressure 160/94 mm Hg ***While the temperature is slightly low, it is an insignificant risk. Although the heart rate is slightly high, it does not put the patient at risk. The blood glucose level is within normal limits. An elevated blood pressure over 150/90 mm Hg puts the patient at a greater risk for hemorrhagic stroke. Given the patient's history, the primary care provider should be notified.

A patient with a history of stroke and myocardial infarction (MI) is on a daily aspirin regimen. Which of the following would alert the nurse to contact the primary healthcare provider? A. Temperature 97.9° F B. Heart rate 99 beats/min C. Blood glucose level 78 mg/dL D. Blood pressure 160/94 mm Hg

A. Vitamin A D. Vitamin D E. Vitamin E ***Vitamins are divided into two major groups: fat-soluble vitamins (A, D, E, and K) and water-soluble vitamins (vitamin C and members of the vitamin B complex).

A patient with a malabsorption disease is at risk for low levels of fat-soluble vitamins. The nurse anticipates the patient to have a deficiency of which vitamin(s)? Select all that apply. A. Vitamin A B. Vitamin B12 C. Vitamin C D. Vitamin D E. Vitamin E

A. Vitamin A D. Vitamin D E. Vitamin E F. Vitamin K ***Vitamins are divided into two major groups: fat-soluble vitamins (A, D, E, and K) and water-soluble vitamins (vitamin C and members of the vitamin B complex).

A patient with a malabsorption disease is at risk for low levels of fat-soluble vitamins. The nurse is aware that which vitamins are fat soluble? (Select all that apply.) A. Vitamin A B. Vitamin B12 C. Vitamin C D. Vitamin D E. Vitamin E F. Vitamin K

A. Spironolactone ***A Potassium-sparing diuretic

A patient with a potassium level of 2.1 has been taking Furosemide [Lasix] daily. Which medication will the patient most likely be switched to? A. Spironolactone B. None the patient will likely stay on the Lasix C. Hydrochlorothiazide D. Demadex

A. "Avoid taking the drug with grapefruit juice." B. "Notify your healthcare provider if your urine becomes discolored." D. "Notify your healthcare provider if muscle pain occurs after 3 days." ***Simvastatin [Zocor] is a HMG Co-A reductase inhibitor that causes rhabdomyolysis as an adverse effect. Grapefruit juice inhibits the enzyme CYP3A4 that is required for the metabolism of simvastatin [Zocor]. This will increase levels of the drug in the body, resulting in rhabdomyolysis. Rhabdomyolysis is associated with the breakdown of muscle proteins that are excreted in the urine, changing the color of the urine. Simvastatin [Zocor] starts acting after 3 days of administration and can cause muscle pains. These should be reported to the healthcare provider as it may progress to rhabdomyolysis if simvastatin [Zocor] administration is not stopped. Muscle pain after one day may be due to some other cause and not the drug. Taking a small dose of aspirin [Ecotrin] is suggested before taking niacin [Nicobid] to reduce the incidence of cutaneous flushing.

A patient with a serum cholesterol level of 275 mg/dL is prescribed simvastatin [Zocor]. What instructions should the nurse provide to the patient? Select all that apply. A. "Avoid taking the drug with grapefruit juice." B. "Notify your healthcare provider if your urine becomes discolored." C. "Notify your healthcare provider if muscle pain occurs within 1 day." D. "Notify your healthcare provider if muscle pain occurs after 3 days." E. "Take aspirin [Ecotrin] 30 minutes before taking simvastatin [Zocor]."

A. "Store the tablets in the original container and tightly close it after use." ***Sublingual nitroglycerin tablets should be stored moisture free at room temperature in their original container, which should be closed tightly after use. If stored correctly, the tablets should remain effective until the expiration date on the container. Sublingual nitroglycerin tablets are ineffective when swallowed whole. Effects of nitroglycerin begin in 1 to 3 minutes.

A patient with angina is being discharged with a prescription for nitroglycerin sublingual tablets. Which instruction should the nurse include? A. "Store the tablets in the original container and tightly close it after use." B. "The tablets are only good for 1 month after the container is opened." C. "Sublingual nitroglycerin tablets are also effective when swallowed whole." D. "Effects of sublingual nitroglycerin begin in 5 to 10 minutes."

C. "Use a spacer with the inhaler and rinse your mouth after each dose administration." ***Spacers are available for use with MDIs to prevent the patient from swallowing the dose and to allow for maximum delivery of medication to the lungs. Rinsing the mouth after administration is important for inhaled glucocorticoids to prevent candidiasis. Glucocorticoid inhalers are used for long-term prophylaxis of asthma, not for symptomatic relief. When two puffs are needed, an interval of at least 1 minute should separate the first puff from the second. Inhaling through the mouth just before activating the MDI is the proper technique.

A patient with asthma is scheduled to start taking a glucocorticoid medication with a metered-dose inhaler (MDI). The nurse should give the patient which instruction about correct use of the inhaler? A. "After you inhale the medication once, repeat until you obtain symptomatic relief." B. "Wait no longer than 30 seconds after the first puff before taking the second one." C. "Use a spacer with the inhaler and rinse your mouth after each dose administration." D. "Breathe in through the nose and hold for 2 seconds just before activating the inhaler."

B. "Use a spacer with the inhaler and rinse your mouth after each dose is administered." ***Spacers are available for use with MDIs to prevent the patient from swallowing the dose and to allow for maximum delivery of medication to the lungs. Rinsing the mouth after administration is important for inhaled glucocorticoids to prevent candidiasis. Glucocorticoid inhalers are used for long-term prophylaxis of asthma, not for symptomatic relief. When two inhalations are needed, an interval of at least 1 minute should separate the first inhalation from the second. Inhaling through the mouth just before activating the MDI is the proper technique.

A patient with asthma is scheduled to start taking a glucocorticoid medication with a metered-dose inhaler (MDI). The nurse should give the patient which instruction about the correct use of the inhaler? A. "After you inhale the medication once, repeat until you obtain symptomatic relief." B. "Use a spacer with the inhaler and rinse your mouth after each dose is administered." C. "Breathe in through the nose and hold for 2 seconds just before activating the inhaler." D. "Wait no longer than 30 seconds after the first inhalation before taking the second one."

A. Muscle pain and tenderness ***The statins, such as rosuvastatin [Crestor], typically are well tolerated; however, in rare cases they can cause the serious adverse effect of myopathy and rhabdomyolysis. If unexplained muscle pain and tenderness develop, the prescriber should be notified. The other effects would not likely be caused by rosuvastatin [Crestor].

A patient with cardiovascular disease is taking rosuvastatin [Crestor]. Which finding would indicate a potential adverse effect of this drug? A. Muscle pain and tenderness B. Platelet count of 100 × 103/mm3 C. Blood pressure of 140/90 mm Hg D. Wheezing and shortness of breath

A. 3% Saline ***A patient with cerebral edema would be ordered a HYPERTONIC solution to decrease brain swelling. The solution would remove water from the brain cells back into the vascular to be excreted. 3% Saline is the only hypertonic option.

A patient with cerebral edema would most likely be order what type of solution? A. 3% Saline B. 0.9% Normal Saline C. Lactated Ringer's D. 0.225% Normal Saline

D. Trimethoprim-sulfamethoxazole ***Trimethoprim-sulfamethoxazole is effective for the treatment of mild to moderate acute exacerbations of chronic bronchitis (AECB) from infectious causes. Acyclovir is an antiviral drug. Amphotericin B is an antifungal drug. Seldane is an antihistamine.

A patient with chronic bronchitis is admitted to the health care facility for treatment of a bacterial respiratory infection. Which antimicrobial will most likely be ordered for the patient? A. Seldane B. Amphotericin B C. Acyclovir D. Trimethoprim-sulfamethoxazole

B. Albuterol nebulizer [Proventil] ***The patient is retaining carbon dioxide because of an impaired forced expiratory volume, so the nurse needs to administer a bronchodilator such as albuterol [Proventil] to increase the size of the airways and permit more ventilation. Salmeterol [Serevent Diskus] is also a bronchodilator, but it is administered twice a day and is not intended as rescue therapy. Oxygen is not indicated unless the patient is also hypoxemic. Fluticasone propionate [Flovent], a glucocorticoid, may be used for patients with chronic obstructive pulmonary disease (COPD) to help reduce respiratory secretions and thereby improve oxygenation and ventilation, but it is intended as preventive therapy.

A patient with chronic obstructive pulmonary disease (COPD) is acutely hypercapneic (retaining carbon dioxide). Which respiratory therapy should the nurse administer to lower the patient's carbon dioxide concentration? A. Salmeterol [Serevent Diskus] B. Albuterol nebulizer [Proventil] C. Fluticasone propionate [Flovent] D. Oxygen via a nasal cannula, 2 L/min

D. dilate the larger airways. ***Albuterol (Proventil, Ventolin) is a selective beta2 drug that is effective for treatment and control of asthma by causing bronchodilation with long duration of action.

A patient with chronic obstructive pulmonary disease asks the nurse what the albuterol (Proventil) he is taking does. The nurse should inform the patient that albuterol is used to A. mobilize respiratory secretions. B. decrease the cough response. C. increase the work of breathing. D. dilate the larger airways.

C. Hypoventilation ***The answer is C. Patients with emphysema present with HYPERventilation. The body will try to compensate for the low oxygen blood levels and will cause the patient to hyperventilate. Remember emphysema patients are sometimes called "pink puffers". They will have a barrel chest (due to the use of accessory muscles for breathing), hyperinflation of the lungs (due to damage of the alveoli sacs and creation of air sacs), and hypercapnia (high carbon dioxide levels).

A patient with emphysema may present with all of the following symptoms EXCEPT? A. Barrel chest B. Hyperinflation of the lungs C. Hypoventilation D. Hypercapnia

D. Benzodiazepines ***First-line approved choices for generalized anxiety disorder are benzodiazepines, buspirone, and four antidepresssants: venlafaxine, paroxetine, escitalopram, and duloxetine. With the benzodiazepines, onset of relief is rapid, so it will meet the need for immediate symptom relief. In contrast, with buspirone and the antidepressants, onset is delayed.

A patient with generalized anxiety disorder needs immediate relief of symptoms. Which class of medications is the drug of choice? A. Buspirone B. Antipsychotics C. Antidepressants D. Benzodiazepines

D. hypokalemia ***Hypokalemia, which can occur with diuretic therapy may lead to digoxin toxicity.

A patient with heart failure is more likely to experience a toxic reaction to digoxin if he has concurrent: A. hyponatremia B. hyperkalemia C. hypernatremia D. hypokalemia

B. Reduced ammonia level ***Some practitioners use lactulose to reduce blood ammonia levels by forcing ammonia from the blood into the colon. Lactulose is useful for treating patients with hepatic encephalopathy. It does not result in less ascitic fluid, a normal serum sodium level, or release of glycogen stores.

A patient with hepatic encephalopathy receives lactulose. The nurse expects which therapeutic outcome if the medication is having the desired effect? A. Less ascitic fluid B. Reduced ammonia level C. Release of glycogen stores D. Normal serum sodium level

C. The patient has hepatic disease. ***Lovastatin [Mevacor] can cause an increase in liver enzymes and should not be prescribed to patients with preexisting liver disease. Statins induce cell death in malignant cells. Cell death occurs via apoptosis and lovastatin [Mevacor] concentrations are used in the treatment of leukemia. Statins slow down the progress of chronic kidney disease by reducing kidney inflammation or improving the function of kidney tissues. Statins reduce chronic obstructive pulmonary disease (COPD).Lovastatin [Mevacor] can be prescribed to the patient with leukemia, renal disease and COPD.

A patient with hypercholesterolemia is prescribed lovastatin [Mevacor]. After reviewing the patient's medical history, the nurse discovers that the medication is not safe to prescribe for the patient and reports this finding to the healthcare provider. What did the nurse find in the patient's medical history? A. The patient has leukemia. B. The patient has renal disease. C. The patient has hepatic disease. D. The patient has chronic pulmonary disease.

D. a dry cough ***The primary side effect of ACE inhibitors is a constant, irritated cough. Other side effects include nausea, vomiting, diarrhea, headache, dizziness, fatigue, insomnia, serum potassium excess, and tachycardia.

A patient with hypertension is ordered to receive an ACE inhibitor. The nurse identifies a common benign side effect of this class of medications as: A. hiccups B. flatulence C. abdominal distention D. a dry cough

C. Review the patient's urinary output before administering. ***Renal function should be assessed before and during treatment to ensure adequate output of urine. If renal failure develops, the infusion should be stopped immediately. Potassium chloride must never be administered by IV push. IV potassium chloride should be diluted before administering. The patient's potassium level should be checked, not calcium.

A patient with hypokalemia is ordered to receive an intravenous (IV) dose of potassium chloride. Which action should the nurse take? A. Administer the medication IV push. B. Administer the medication undiluted. C. Review the patient's urinary output before administering. D. Review the patient's serum calcium level before administering.

D. By producing drowsiness, lethargy, and blurred vision ***Drowsiness, lethargy, and blurred vision are adverse effects of baclofen that initially make it difficult for the patient to participate actively in rehabilitation activities. These adverse effects are most common during the early phase of therapy but subside with continued use. These effects can be reduced by starting with a small dose and gradually increasing it.

A patient with multiple sclerosis (MS) is participating in a rehabilitation program. The patient has just been started on baclofen [Lioresal] 5 mg three times a day to help manage spasticity. How will the baclofen interfere with rehabilitation activities? A. By causing gastrointestinal distress B. By impairing coordinated movements C. By reducing sensation in the extremities D. By producing drowsiness, lethargy, and blurred vision

A. Hold the dose of Furosemide [Lasix] and notify the doctor for further orders

A patient with nasogastric suctioning is experiencing diarrhea. The patient is ordered a morning dose of Furosemide [Lasix] 20mg IV. Patient's potassium level is 3.0. What is your next nursing intervention? A. Hold the dose of Furosemide [Lasix] and notify the doctor for further orders B. Administered the Furosemide [Lasix] and notify the doctor for further orders C. Turn off the nasogastric suctioning and administered a laxative D. No intervention is need the potassium level is within normal range

B. vitamin B12.

A patient with pernicious anemia most likely has a deficiency of A. iron. B. vitamin B12. C. vitamin K. D. selenium.

D. The medication may cause headaches and insomnia. ***Side effects include headache, nervousness, restlessness, insomnia, blurred vision, tremors, GI distress, and sexual dysfunction. The drug takes about 2 to 4 weeks for onset, decreases libido, and has no interaction with grapefruit juice.

A patient with reactive depression is ordered to receive fluoxetine (Prozac). Which information will the nurse include when teaching this patient? A. The medication takes effect in 1 week. B. The medication increases libido. C. The medication should be taken with grapefruit juice. D. The medication may cause headaches and insomnia.

D. Polyethylene glycol-electrolyte solution [GoLYTELY] ***GoLYTELY, an osmotic laxative, produces a watery stool in 2 to 6 hours. It is isosmotic with body fluids so it causes no fluid or electrolyte imbalance and thus can be used safely in patients with an electrolyte impairment. Magnesium salts are contraindicated in patients with renal dysfunction. Mineral oil is more useful when administered by enema for fecal impaction. Docusate sodium produces results in 1 to 3 days.

A patient with renal impairment requires bowel cleansing before a diagnostic procedure. The nurse prepares to administer which laxative? A. Mineral oil B. Docusate sodium [Colace] C. Magnesium salts (magnesium citrate) D. Polyethylene glycol-electrolyte solution [GoLYTELY]

C. "Full effects of this drug may not be seen for 4 weeks or more." ***The patient should not expect the problem to be cured quickly. The patient should be instructed that therapeutic effects may not be seen for 4 weeks or more.

A patient with schizophrenia begins a course of first-generation antipsychotic medications. What should the nurse teach the patient? A. "Assess your weight daily." B. "Your blood pressure may increase significantly. " C. "Full effects of this drug may not be seen for 4 weeks or more." D. "Call the healthcare provider if you do not feel better right away."

D. Albuterol ***The answer is D. The patient would best benefit from a SHORT-ACTING bronchodilator to help with the shortness of breath. The only short-acting bronchodilator listed is Albuterol. Spiriva is a long-acting bronchodilator. Symbicort is a combination of long-acting bronchodilator and corticosteroid. Salmeterol is a long-acting bronchodilator.

A patient with severe COPD is having an episode of extreme shortness of breath and requests their inhaler. Which type of inhaler ordered by the physician would provide the FASTEST relief for the patient based on this particular situation? A. Spiriva B. Salmeterol C. Symbicort D. Albuterol

B. a thiazide ***Combining a loop diuretic with a thiazide can produce a more potent diuresis in this setting of low GFR.

A patient with severe systolic heart failure (very low ejection fraction) and subsequent decreased renal function & low GFR may sometimes fail to respond to a loop diuretic alone (a situation commonly refered to as diuretic resistance). In this case, adding an additional diuretic that acts on an different portion of the nephron can produce a more potent diuresis. The class of diuretic that can be added to a loop diuretic to produce a more potent diuresis is: A. a carbonic anhydrase inhibitor B. a thiazide C. an aldosterone antagonist D. an inhibitor of epithelial Na channels

C. Neck and back pain ***Neck and back pain from a vertebral compression fracture may occur because of the development of osteoporosis as a result of glucocorticoid therapy. Other possible adverse effects of prednisone include hypertension, hypokalemia, and hyperglycemia.

A patient with systemic lupus erythematosus is prescribed prednisone. It is most important for the nurse to monitor the patient for what? A. Hypotension B. Elevated potassium levels C. Neck and back pain D. Hypoglycemia

A. Weight gain D. Personality changes E. Loss of bone density F. Loss of muscle mass ***The patient is at high risk for osteoporosis as a result of glucocorticoid therapy because glucocorticoids are associated with bone demineralization and loss of bone density. Weight gain (from fluid retention) and personality changes also are associated with glucocorticoid therapy. Loss of muscle mass can also be an adverse effect of glucocorticoid therapy. Glucocorticoid therapy can cause insomnia and hyperglycemia, not increased sleep or hypoglycemia.

A patient with systemic lupus erythematosus receives glucocorticoids. Which adverse effects will the nurse monitor for in this patient? Select all that apply. A. Weight gain B. Hypoglycemia C. Increased sleep D. Personality changes E. Loss of bone density F. Loss of muscle mass

D. Make sure the patient eats breakfast immediately. ***Insulin aspart [NovoLog] is a rapid-acting insulin that acts in 15 minutes or less. It is imperative that the patient eat as the insulin starts to work. The patient should have had a fingerstick blood sugar test done before receiving the medication. There is no need to check the urine. This medication is given subcutaneously.

A patient with type 1 diabetes mellitus has been ordered insulin aspart [NovoLog] 10 units at 7:00 AM. Which nursing intervention should the nurse perform after administering this medication? A. Flush the intravenous line. B. Perform a fingerstick blood sugar test. C. Have the patient void and dipstick the urine. D. Make sure the patient eats breakfast immediately.

A. Assess the prothrombin time. ***Warfarin [Coumadin] can cause blood loss in the patient; thus, it is important to assess the duration of clotting. The duration of clotting can be assessed by finding the prothrombin time. Use of partial thromboplastin time would be used to assess heparin therapy. Knowing the amount of blood lost is not required for the administration of vitamin K (phytonadione). The amount of blood lost would help determine if the patient needs a blood infusion. The white blood cell count is helpful in determining the presence of infection. This assessment is not required for a patient who is administered vitamin K (phytonadione).

A patient with warfarin [Coumadin] toxicity is prescribed vitamin K (phytonadione). Which nursing assessment ensures patient safety? A. Assess the prothrombin time. B. Assess the amount of blood lost. C. Assess the white blood cell count. D. Assess the partial thromboplastin time.

D. Administer the ordered dose of digoxin. ***Therapeutic serum digoxin levels are 0.5 to 0.8 ng/mL. The patient should receive the next dose to keep the level in therapeutic range. Because the dose is in the therapeutic range, it would not be appropriate to hold the dose, administer an antidote, or notify the provider.

A patient's serum digoxin level is noted to be 0.5 ng/mL. Which action by the nurse is appropriate? A. Notify the provider. B. Administer an antidote. C. Hold the ordered dose of digoxin. D. Administer the ordered dose of digoxin.

C. "It is important that I monitor my blood glucose levels very closely while taking this medication." ***Option A: Grapefruit contains chemicals that alter the absorption of many types of drugs including beta blockers. Therefore, the patient should always take beta blockers with water. Option B: If the patient misses a dose they should never double it. Instead, they should take it right when they remember unless the other dose is due, but they should never double the dose. Cardiac medications are dangerous and should be taken exactly as prescribed. Option D: Remember Propanolol is a type of beta blocker that is NON-SELECTIVE. Therefore, it affects various types of tissue in the body, not just cardiac tissue. So, the patient can experience cold hands and feet because it affects the arterioles by causing decreased dilation. In addition, a patient should never abruptly quit taking a beta blocker. It must be tapered off to prevent sudden cardiac death.

A patient, who has a health history of uncontrolled hypertension, coronary artery disease, and diabetes mellitus, is prescribed to take Propranolol. You have provided the patient with education about this new medication. Which statement by the patient indicates your teaching was effective? A. "I will take this medication every morning with grapefruit juice." B. "If I miss a dose, it is important that I double the next dose to prevent potential side effects." C. "It is important that I monitor my blood glucose levels very closely while taking this medication." D. "I will immediately stop taking this medication if I experience cold hands or feet."

C. "After taking the medication, sit or stand for 30 minutes." ***Oral alendronate may result in esophageal ulceration if it fails to pass completely through the esophagus and thus is not administered properly. Sitting or standing for 30 minutes after dosing is recommended to prevent prolonged contact with the esophageal mucosa. Symptoms of esophageal injury are heartburn and pain and should be reported. Because of its poor bioavailability, alendronate must be given before eating or drinking even orange juice or coffee.

A patient, who is postmenopausal, is scheduled to begin taking alendronate [Fosamax] to prevent osteoporosis. Which instruction should the nurse give the patient? A. "It will be normal to experience some heartburn." B. "Take the medication with orange juice or coffee." C. "After taking the medication, sit or stand for 30 minutes." D. "For the best absorption, take the drug while eating a meal."

A. Maintain a drug administration record. ***A written drug administration record (A) provides a consistent plan to ensure safe adherence to multiple medication dosages and times. Although (B) is an important safeguard to monitor for drug interactions, the parents should be given a tool to enhance their confidence and provide a mechanism to ensure accurate and timely medication administration without duplicating or omitting a dose. Using a written record to record medication administration allows more than one person (C) to share the responsibility of giving medications to the child. Although smaller volumes (D) ensure that all the medication is taken, it is more important to maintain an accurate administration schedule.

A pediatric client is discharged home with multiple prescriptions for medications. Which information should the nurse provide that is most helpful to the parents when managing the medication regimens? A. Maintain a drug administration record. B. Fill all prescriptions at one pharmacy. C. Allow one person to give the medications. D. Give all medications in small volumes.

A. Naloxone [Narcan] ***Naloxone is a narcotic antagonist that can reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.

A postoperative patient has an epidural infusion of morphine sulfate [Astramorph]. The patient's respiratory rate declines to 8 breaths per minute. Which medication would the nurse anticipate administering? A. Naloxone [Narcan] B. Acetylcysteine [Mucomyst] C. Methylprednisolone [Solu-Medrol] D. Protamine sulfate

D. Naloxone [Narcan] ***After surgery, naloxone may be used to reverse the excessive respiratory and central nervous system depression that can be caused by opioids.

A postoperative patient who received an intravenous infusion of morphine has a respiratory rate of 8 breaths per minute and is lethargic. Which as-needed medication should the nurse administer to the patient? A. Methadone [Dolophine] B. Nalbuphine [Nubain] C. Tramadol [Ultram] D. Naloxone [Narcan]

D. Magnesium levels are rising to dangerous level. ***Loss of deep tendon reflexes is an early sign that magnesium is rising to a dangerously high level. The medication is becoming toxic; if it was working, the contractions would decrease. The mother is experiencing toxic levels. Increasing the dose would make the situation worse.

A pregnant patient is receiving magnesium sulfate to inhibit uterine contractions. Upon assessment, the nurse observes the patient has loss of deep tendon reflexes. How should the nurse interpret this finding? A. The dose needs to be titrated upward. B. The medication is working as it should. C. The mother is about to deliver despite therapy. D. Magnesium levels are rising to dangerous level.

D. Magnesium levels are rising to dangerous levels. ***Loss of deep tendon reflexes is an early sign that magnesium is rising to a dangerously high level. The medication is becoming toxic; if it was working, the contractions would decrease. The mother is experiencing toxic levels. Increasing the dose would make the situation worse.

A pregnant patient is receiving magnesium sulfate to inhibit uterine contractions. Upon assessment, the nurse observes the patient has loss of deep tendon reflexes. How should the nurse interpret this finding? A. The dose needs to be titrated upward. B. The medication is working as it should. C. The mother is about to deliver despite therapy. D. Magnesium levels are rising to dangerous levels.

B. Determine exactly when the drug was taken. C. Determine exactly when the pregnancy began. ***When a pregnant woman has been exposed to a known teratogen, the first step is to determine exactly when the drug was taken and exactly when the pregnancy began. Other information is helpful but not necessary.

A pregnant woman has taken a drug that is a known teratogen. What steps should the nurse take to identify risks for malformation? Select all that apply. A. Determine who prescribed the medication. B. Determine exactly when the drug was taken. C. Determine exactly when the pregnancy began. D. Determine why the woman was taking the medication.

C. furosemide ***Lasix (trade name) was given the nick name "last's six" (hours) because of its short duration of action. Its a potent loop diuretic. Potent naturetic drugs have an associated side effect of hypokalemia. They also negatively affect the hair cells in the inner ear in a dose-dependent manner.

A short acting diuretic that has side effects that include hypokalemic, metabolic alkalosis & ototoxicity. A. acetazolamide B. chlorothiazide C. furosemide D. spironolactone E. triamterene

D. Decrease Na+ and water reabsorption

ACE inhibitors... A. Decrease K+ reaborption B. Increase Na+ and water reabsorption C. Increase free water in circulation D. Decrease Na+ and water reabsorption

B. Absence of jaundice ***Acetylcysteine [Mucomyst] substitutes for depleted glutathione in the reaction that removes the toxic metabolite of acetaminophen [Tylenol] (which accumulates with acetaminophen poisoning) and thereby minimizes liver damage. Severe hepatic injury may occur with acetaminophen [Tylenol] poisoning, which is manifested by jaundiced sclera and skin. The assessment of bowel sounds, breath sounds, and pedal pulses is not used to determine the therapeutic effects of acetylcysteine [Mucomyst] for the treatment of acetaminophen overdose.

After administering acetylcysteine [Mucomyst] to a patient who overdosed on acetaminophen [Tylenol], a nurse should recognize which outcome as an indicator of the therapeutic effects of acetylcysteine? A. Clear breath sounds B. Absence of jaundice C. Palpable pedal pulses D. Increased bowel sounds

C. Assessment ***Collecting information about the patient's home environment is included in the assessment phase of the nursing process. The other phases of the nursing process build on the information gathered in the assessment phase.

After an elderly patient is prescribed a drug that may cause sedation, the home health nurse checks the home environment for items that increase the risk of falls. Which phase of the nursing process is addressed in the nurse's actions? A. Planning B. Evaluation C. Assessment D. Implementation

B. Digoxin [Lanoxin] and hypokalemia ***The nurse should notify the provider when hypokalemia and a prescription for digoxin [Lanoxin] occur together. Loss of potassium is of special concern for patients taking digoxin [Lanoxin], a drug for heart failure. By lowering potassium levels, loop diuretics increase the risk of fatal dysrhythmias from digoxin [Lanoxin]. Hypouricemia and edema are not a concern; hyperuricemia is. There is no adverse interaction between hypocalcemia and living alone. Furosemide [Lasix] and spironolactone [Aldactone]can be given together, so this is not a concern.

After reviewing the chart, which findings would cause the nurse to notify the provider? A. Hypouricemia and edema B. Digoxin [Lanoxin] and hypokalemia C. Hypocalcemia and the patient lives alone D. Furosemide [Lasix] and spironolactone [Aldactone]

A. History of gout ***The provider should be notified because the patient has a history of gout. Hydrochlorothiazide [Microzide] is a thiazide diuretic, which can cause an increase in uric acid level, leading to a gout attack. A potassium of 4.0 is normal; the provider should be called when the potassium is below 3.5 mEq/L or above 5 mEq/L. The provider should be called when the urine output is less than 25 mL/hr; the patient's output is 40 mL/hr. When a patient is taking a diuretic, the output should be more than the intake because it causes diuresis.

After reviewing the chart, which information would cause the nurse to notify the provider for a patient taking hydrochlorothiazide [Microzide]? A. History of gout B. Potassium 4.0 mEq/L C. Urine output 40 mL/hr D. Output more than intake

C. Anaphylactic ***A patient may have an adverse reaction to a medication, which can occur as a result of various types of interactions, including cytotoxic response or an infection. An anaphylactic reaction is manifested as difficulty breathing and wheezing, facial edema, and flushing of the skin, which represent a hypersensitivity of the patient's body to the medication.

After starting an IV dose of sulfamethoxazole (Bactrim®), the nurse notes that the patient is having difficulty breathing, his face is flushed, and he complains of back pain. Which type of hypersensitivity reaction is this patient most likely experiencing? A. Cytotoxic B. Serum sickness C. Anaphylactic D. Infectious

A. Respiratory rate ***Monitoring the respiratory rate in all patients who are receiving morphine is a priority. If the respiratory rate is 12 or fewer breaths per minute, the nurse should withhold the medication and notify the prescriber.

After surgery, a patient has morphine prescribed for postoperative pain. It is most important for the nurse to make which assessment? A. Respiratory rate B. Heart rate C. Pain level D. Constipation

A. Respiratory rate ***Monitoring the respiratory rate in all patients who are receiving morphine is a priority. If the respiratory rate is 12 or fewer breaths per minute, the nurse should withhold the medication and notify the prescriber.

After surgery, a patient has morphine prescribed for postoperative pain. It is most important for the nurse to make which assessment? A. Respiratory rate B. Heart rate C. Pain level D. Constipation

Examples of Short-acting beta 2 Agonists (SABA) and bronchodilators?

Albuterol, Proventil

D. Gamma-aminobutyric acid (GABA) ***Alprazolam is a benzodiazepine; this class of drugs reduces anxiety by potentiating the action of GABA.

Alprazolam [Xanax] is prescribed for an adult with panic attacks. The nurse recognizes that this drug exerts its therapeutic effect by interacting with which neurotransmitter? A. Norepinephrine B. Acetylcholine C. Serotonin (5-HT) D. Gamma-aminobutyric acid (GABA)

D. Partial thromboplastin time (PTT) ***Heparin therapy is guided by changes in the partial thromboplastin time (PTT) (D). (A, B, and C) are not used to track the therapeutic effect of heparin administration.

Alteration of which laboratory finding represents the achievement of a therapeutic goal for heparin administration? A. Prothrombin time (PT) B. Fibrin split products C. Platelet count D. Partial thromboplastin time (PTT)

Vancomycin belongs to what class?

Aminoglycosides and antibiotics

C. Obtain baseline serum thyroid and liver function studies. ***Amiodarone may cause hypothyroidism or hyperthyroidism and may also injure the liver. Serum thyroid and liver function levels should be assessed before treatment with amiodarone is started and periodically during treatment. Patients who develop changes in visual acuity or peripheral vision while taking amiodarone should have an ophthalmologic evaluation, but this is not necessary before starting therapy. A dermatologic examination and TEE are not necessary before initiation of amiodarone therapy. Although patients with atrial fibrillation are at risk for mural thrombus, amiodarone therapy itself does not pose a risk of systemic embolization.

Amiodarone [Cordarone] is prescribed for a patient with atrial fibrillation. What is the most important nursing intervention before administering this medication? A. Document an ophthalmic examination was performed. B. Explain a dermatologic evaluation is needed. C. Obtain baseline serum thyroid and liver function studies. D. Maintain NPO for transesophageal echocardiogram (TEE).

C. 20 ***500 mg/X mL = 125 mg/5 mL; 125X = 2500; X = 20 mL

Amoxicillin, 500 mg PO every 8 hours, is prescribed for a client with an infection. The drug is available in a suspension of 125 mg/5 mL. How many milliliters should the nurse administer with each dose? A. 10 B. 15 C. 20 D. 25

C. "Let's discuss this effect with your prescriber. There are other drugs available to manage your blood pressure that may not have the same adverse effect." ***Many antihypertensive medications can produce adverse sexual side effects, including impotence. It is important for the nurse to listen to the patient's concerns and to avoid making value judgments. Other antihypertensive medications may manage this patient's blood pressure without causing adverse sexual effects. Reducing the undesired effects of antihypertensive medication will improve the patient's adherence.

An adult male patient is taking medication for blood pressure management. The patient states to the nurse, "I'm not going to take these drugs anymore, because they are interfering with my sex life." What is the most appropriate response by the nurse? A. "It is unfortunate these drugs can cause erectile dysfunction but managing your blood pressure is more important than your sexual performance." B. "I understand how discouraging it must be to live with this adverse effect, but you could have a stroke if you do not take your blood pressure medications." C. "Let's discuss this effect with your prescriber. There are other drugs available to manage your blood pressure that may not have the same adverse effect." D. "I am glad you told me about your experience with this common side effect. Sexual performance can be a difficult subject to discuss."

C. Ability to avoid injuring host cells ***Selective toxicity refers to an antibiotic that has the ability to injure only invading microbes, not the host. Conjugation is the process through which DNA coding for drug resistance is transferred from one bacterium to another. Antibiotics do not suppress bacterial resistance, but rather promote the emergence of drug-resistant microbes. Antibiotics that are narrow spectrum are active against only a few microbes.

An antimicrobial medication that has selective toxicity has which characteristic? A. Ability to transfer DNA coding B. Ability to suppress bacterial resistance C. Ability to avoid injuring host cells D. Ability to act against a specific microbe

D. The patient is using a calcium-based antacid. ***Renal stones may occur from the deposition of calcium from milk and calcium-based antacids. The fact that the patient takes an over-the-counter antacid explains the patient's digestive issues and low gastric pH (hyperacidity). A lower dose of antacid would not be effective for treating hyperacidity or cause renal stones. The fact that the patient drinks two glasses of milk every day is an indication that the patient can process milk.

An assessment reveals that a patient has renal calculi. During the assessment, the nurse learns that the patient has taken over-the-counter antacids for a long time. The patient also consumes two glasses of milk every day. What should the nurse infer from this information? A. The patient has high gastric pH. B. The patient is unable to process milk. C. The patient is taking a lower dose of antacid. D. The patient is using a calcium-based antacid.

D. Respirations decrease to 14 breaths/min. ***Hydromorphone (Dilaudid) is an opioid agonist-analgesic of opiate receptors that inhibits ascending pathways and can cause respiratory depression. Older adults are more sensitive to opioids so the "start low and go slow" approach should be taken (D). (A) lists common side effects of opioids, particularly the opiates, which are usually harmless and often transient . (B) is within the normal range (2 to 6 cm). The suture site may be red and swollen as an inflammatory response, but no action is required if the skin around the incision is a normal color and temperature (C).

An older client who had a colon resection yesterday is receiving a constant dose of hydromorphone (Dilaudid) via a patient-controlled analgesia (PCA) pump. Which assessment finding is most significant and requires that the nurse intervene? A. The client is drowsy and complains of pruritus. B. Pupils are 3 mm; PERRLA. C. The area around the sutures is reddened and swollen. D. Respirations decrease to 14 breaths/min.

Ferrous Sulfate belongs to what class?

Anti-anemics

Metronidazole belongs to what class?

Anti-infective, Antiprotozoals

Valerian, Kava belong to what class?

Antianxiety agent; sedative/hypnotic

Erythromycin/Clindamycin/azithromycin belong to what class?

Antibiotics; Macrolides

Carbamazepine belongs to what class?

Anticonvulsant; Mood stabilizer

Glimepiride, glipizide belongs to what class?

Antidiabetic; Sulfonylureas

Allopurinol belongs to what class?

Antigout agent, Antihyperuricemics

Gingko belongs to what class?

Antiplatelet agents, CNS stimulants (antioxidant - used to improve memory)

Acetaminophen belongs to what class?

Antipyretic, Nonopioid Analgesic (not an NSAID)

Phenytoin belongs to what class?

Antiseizure

C. Absorption A. Distribution D. Biotransformation B. Elimination ***The first step in the process of pharmacokinetics is absorption. The drug moves from the gastrointestinal tract to body fluids by passive absorption, active absorption, or pinocytosis. The absorbed drug is distributed by blood flow, the tissue's affinity for the drug, and the protein-binding effect. The distributed drug undergoes metabolism or biotransformation in various organs of the body; however, the liver is the primary site of metabolism. The kidneys filter free, unbound drugs; water-soluble drugs; and drugs that are unchanged through the process of elimination or excretion.

Arrange the processes of pharmacokinetics for parenteral drugs in the order of their occurrence. A. Distribution B. Elimination C. Absorption D. Biotransformation

A. "I can resume with my tanning sessions at least 5 days after discharge." ***Furosemide can cause photosensitivity and clients should avoid prolonged exposure to the sun, tanning booths and sunlamps.

As the nurse case manager assesses the level of understanding of a 39-year old client with hypertension on the precautions when taking Furosemide [Lasix], which of the following statements made by the client indicates a need for further teaching? A. "I can resume with my tanning sessions at least 5 days after discharge." B. "I should limit or avoid taking alcoholic beverages." C. "If the medication makes me dizzy, I should sit and wait for a while before getting up from a sitting or lying position." D. None of the above

C. "I should tell the people at the tanning salon to decrease the frequency of my sessions." ***Clients on Furosemide should avoid tanning booths for it is contraindicated when there is a possibility of photosensitivity.

As the telephonic nurse manager assesses the knowledge of the client about the management of photosensitivity while on Furosemide, which of the following statements made by the client requires further teaching? A. "I should wear sunglasses when going out on a sunny morning." B. "I should wear protective clothing when going out on a sunny day." C. "I should tell the people at the tanning salon to decrease the frequency of my sessions." D. "I should not forget to wear sunscreen when going out on a sunny day."

D. rhabdomyolysis. ***NMS symptoms include muscle rigidity, sudden high fever, altered mental status, blood pressure fluctuations, tachycardia, dysrhythmias, seizures, rhabdomyolysis, acute renal failure, respiratory failure, and coma.

Assessment findings for a patient with neuroleptic malignant syndrome (NMS) include A. bradycardia. B. hypothermia. C. muscle weakness. D. rhabdomyolysis.

Examples of Antihyperlipidemic & HMG-CoA reductase Inhibitor?

Atorvastatin, Rosuvastatin

Clozapine, Asenapine, Risperidone, Ziprasidone are examples of?

Atypical Antipsychotics

A. 3% sodium chloride ***Of the fluids listed, the only one that is hypertonic is 3% sodium chloride. Normal saline is isotonic, and both 0.25% and 0.45% sodium chloride are considered to be hypotonic.

Based on the condition of the patient, a hypertonic fluid is needed. Which intravenous fluid is most likely to be ordered by the provider? A. 3% sodium chloride B. 0.9% sodium chloride C. 0.45% sodium chloride D. 0.25% sodium chloride

Examples of glucocorticoids used in treatment of inflammatory respiratory conditions such as asthma?

Beclomethasone, Cortisone, Prednisone

C. dietary intake. ***Certain drug and food interactions with MAO inhibitors can be fatal. Foods that contain tyramine have sympathomimetic-like effects and can cause a hypertensive crisis. These types of food must be avoided by MAOI users.

Before administering an MAO inhibitor, it is most important for the nurse to assess the patient's A. sexual history. B. socioeconomic status. C. dietary intake. D. hydration status.

B. Assess the patient for allergies. ***The principal adverse effect of penicillins is allergic reaction. Penicillins are contraindicated in patients with a history of severe allergic reactions to penicillins, cephalosporins, or carbapenems. IV patency is important, as is monitoring renal function, because impairment can cause penicillins to reach toxic levels; however, these are not as important as determining allergy status.

Before administering intravenous (IV) penicillin, the nurse should do what? A. Flush the IV site with normal saline. B. Assess the patient for allergies. C. Review the patient's intake and output record. D. Determine the latest creatinine clearance result.

B. Premedicate the patient with an antipyretic, antihistamine, and antiemetic as prescribed. ***Almost all patients given intravenous amphotericin B (Fungizone) develop fever, chills, nausea and vomiting, and hypotension. Pretreatment with an antipyretic, antihistamine, and antiemetic can minimize or prevent these adverse reactions. There is no need to treat with IV potassium or administer insulin or IV dextrose.

Before administration of intravenous amphotericin B (Fungizone), what will the nurse do? A. Set up an IV solution with potassium. B. Premedicate the patient with an antipyretic, antihistamine, and antiemetic as prescribed. C. Administer insulin as prescribed to prevent severe hyperglycemia. D. Administer intravenous dextrose as prescribed to prevent severe hypoglycemia.

D. Blood pressure

Before and after the first dose of ACEs or ARBs, what's a good thing to assess on your patient? A. Peripheral pulses B. Heart rate C. Oxygen saturation D. Blood pressure

C. Vasodilatation and lower blood pressure, decreased heart rate

By blocking calcium from entering the cell (which is why they are called calcium channel blockers) and preventing muscular contraction and slow electrical impulses, what response will we see in the patient? A. Vasoconstriction and increased blood pressure and heart rate B. Conversion of heart rhythm from atrial fibrillation to normal sinus rhythm C. Vasodilatation and lower blood pressure, decreased heart rate D. Vasoconstriction of the coronary arteries

D. Sympathetic nerves to sweat glands promotes secretion of sweat E. Piloerection induced by sympathetic nerves causes heat conservation ***The sympathetic nervous system helps regulate body temperature in three ways. (1) By regulating blood flow to the skin, sympathetic nerves can increase or decrease heat loss. By dilating surface vessels, sympathetic nerves increase blood flow to the skin and thereby accelerate heat loss. Conversely, constricting cutaneous vessels conserves heat. (2) Sympathetic nerves to sweat glands promote secretion of sweat, thereby helping the body cool. (3) By inducing piloerection (erection of hair), sympathetic nerves can promote heat conservation.

By which of these ways does the sympathetic nervous system (SNS) help to regulate body temperature? Select all that apply. A. By dilating cutaneous vessels to conserve heat B. By compensating for blood loss by causing vasoconstriction C. By constricting surface vessels to increase blood flow to the skin D. Sympathetic nerves to sweat glands promotes secretion of sweat E. Piloerection induced by sympathetic nerves causes heat conservation

C. Beta1 ***Calcium channels are coupled to beta1-adrenergic receptors in the heart. For that reason, calcium channel blockers affect the heart in ways similar to the beta blockers. Both types of drugs cause a decrease in the force of contraction, heart rate, and cardiac impulse conduction.

Calcium channel blockers work by reducing calcium influx into the cells of the heart and blood vessels. Calcium channels are coupled to which type of autonomic nervous system receptors? A. Alpha1 B. Alpha2 C. Beta1 D. Beta2

C. magnesium sulfate ***Calcium gluconate is given to reverse respiratory depression in patients receiving magnesium sulfate.

Calcium gluconate is given to reverse respiratory depression caused by the administration of which drug? A. potassium B. calcium C. magnesium sulfate D. sodium bicarbonate

B. furosemide ***This patient has a low GFR. Because DM is African-American he is most "likely" to be salt sensitive and respond well to a diuretic. Since his GFR is low, a loop diuretic is the drug of choice. Loop diuretics are the most efficacious agents for producing a diuresis.

DM is a 62 year old African-American man who has had poorly controlled hypertension for the past 10 years, and now presents with signs of ankle edema, a low GFR and a serum creatinine of 2.5 mg/dL. The most effective drug for producing a diuresis and fall in blood pressure in DM is: A. amlodipine B. furosemide C. hydrochlorothiazide D. losartan E. ramipril

C. water and electrolytes ***Diuretics generally affect how much water and sodium the body excretes. At the same time, other electrolytes such as potassium can also be excreted in urine.

Diuretics affect the kidneys by altering the reabsorption and excretion of: A. water only B. electrolytes only C. water and electrolytes D. other drugs

C. water and electrolytes. ***Diuretics generally affect how much water and sodium the body excretes. At the same time, other electrolytes such as potassium can also be excreted in urine

Diuretics affect the kidneys by altering the reabsorption and excretion of: A. water only B. electrolytes only C. water and electrolytes D. other drugs

Examples of AD drugs?

Donezepil (Aricept), Memantine, Rivastigmine

B. Increase in urine output ***Intropin activates dopamine receptors in the kidney and dilates blood vessels to improve renal perfusion, so an increase in urine output (B) indicates an increase in glomerular filtration caused by increased arterial blood pressure. (A) is related to fluid retention but is not an indicator of a therapeutic response to dopamine therapy. (C) is not related to the vasopressor effect of dopamine therapy. Dopamine increases cardiac output, which increases a client's blood pressure, not (D).

Dopamine (Intropin) is administered to a client who is hypotensive. Which finding should the nurse identify as a therapeutic response? A. Gain in weight B. Increase in urine output C. Improved gastric motility D. Decrease in blood pressure

C. Apply direct pressure over the puncture site. ***Alteplase may cause bleeding, and the management of bleeding depends on its severity. Oozing at sites of cutaneous puncture can be controlled with direct pressure or a pressure dressing. If severe bleeding occurs, alteplase should be discontinued. Excessive fibrinolysis can be reversed with IV aminocaproic acid [Amicar], a compound that prevents activation of plasminogen and directly inhibits plasmin.

During administration of alteplase [Activase], the patient's IV site starts to ooze blood around the catheter. Which action by the nurse is most appropriate? A. Discontinue the infusion of alteplase. B. Assess the patient's vital signs. C. Apply direct pressure over the puncture site. D. Administer aminocaproic acid [Amicar].

A. Sucralfate (Carafate) ***Sucralfate (Carafate) (A) is used to treat duodenal ulcers and will bind with tetracycline hydrochloride (Sumycin), inhibiting this antibiotic's absorption. (B, C, and D) have no drug interaction properties that prohibit concurrent use with tetracycline hydrochloride (Sumycin).

During the initial nursing assessment history, a client tells the nurse that he is taking tetracycline hydrochloride (Sumycin) for urethritis. Which medication taken concurrently with Sumycin could interfere with its absorption? A. Sucralfate (Carafate) B. Hydrochlorothiazide (Diuril) C. Acetaminophen (Tylenol) D. Phenytoin (Dilantin)

C. tranquilizer ***Antihistamines can interact with many drugs, sometimes with life-threatening consequences. They may increase the sedative and respiratory depressant effects of CNS depressants, such as tranquilizers and alcohol.

During the nursing assessment, the patient states that he is taking digoxin, furosemide, a tranquilizer, and amoxicillin. Which medication would cause a drug interaction with the antihistamine the practitioner prescribed? A. digoxin B. furosemide C. tranquilizer D. amoxicillin

A. Decrease in level of chest pain ***Nitroglycerin reduces myocardial oxygen consumption, which decreases ischemia and reduces chest pain (A). (B, C, and D) are not expected outcomes of sublingual nitroglycerin.

Following the administration of sublingual nitroglycerin, which assessment finding indicates that the medication was effective? A. Decrease in level of chest pain B. Clear bilateral breath sounds C. Increase in blood pressure D. Increase in urinary output

D. Severe pain resulting from cancer metastasis ***Transdermal fentanyl [Duragesic] is indicated only for persistent severe pain in patients who already tolerate opioids because it can cause fatal respiratory depression in patients who are opioid naive. For this reason, the patch is not indicated for acute pain such as postoperative pain, intermittent pain, or pain that responds to a less powerful analgesic.

For which type of pain is a fentanyl [Duragesic] transdermal patch best suited? A. Pain after abdominal surgery B. Acute treatment of a migraine headache C. Lower back pain related to lumbar strain D. Severe pain resulting from cancer metastasis

A. pulled from the cells into the bloodstream, which may cause the cells to shrink ***Because the concentration of solutes in the I.V. solution is greater than the concentration of solutes in the patient's blood, a hypertonic solution may cause fluid to be pulled from the cells into the bloodstream, causing the cells to shrink.

Giving a hypertonic I.V. solution to a patient may cause too much fluid to be: A. pulled from the cells into the bloodstream, which may cause the cells to shrink B. pulled out of the bloodstream into the cells C. pushed out of the bloodstream into the extravascular spaces D. pulled from the cells into the bloodstream, which may cause the cells to increase in size

B. By decreasing ADH secretion from the pituitary gland

How do ARBs increase the water excretion and therefore decrease the circulating blood volume (which ultimately decrease blood pressure and cardiac workload)? A. By blocking ADH secretion entirely B. By decreasing ADH secretion from the pituitary gland C. Be increasing ADH secretion from the pituitary gland D. By decreasing secretion from the adrenal gland

C. Every 72 hours ***The fentanyl [Duragesic] transdermal delivery system is designed to slowly release analgesic over a 72-hour period. Fentanyl [Duragesic] patches are used for nonescalating pain and not for acute pain relief. A new patch needs to be applied every 72 hours.

How often does the nurse tell the patient to change a fentanyl [Duragesic] transdermal patch? A. Once a week B. Every 24 hours C. Every 72 hours D. When pain recurs

A. "Seek medical help for nausea and vomiting." ***Nausea and vomiting are symptoms of a cholinergic crisis due to an overdose of anticholinesterase therapy. Hence, the nurse should instruct the patient to report these symptoms immediately so that prompt action can be taken to reverse the adverse effects. The nurse should instruct the patient to take the medication before eating to strengthen the muscles involved in chewing and swallowing in order to prevent aspiration or choking. The nurse should instruct the patient to take the medication at the first sign of muscle weakness, not after meals. The medication will relieve, not cause, ptosis.

How should the nurse instruct a patient who is prescribed pyridostigmine [Mestinon]? A. "Seek medical help for nausea and vomiting." B. "Ask for help to change positions or to stand." C. "Take the medication 30 minutes after eating." D. "Lower the dose if the usual dose results in ptosis."

Levothyroxine is used to treat?

Hypothyroidism

C. impulse transmission ***Besides its role as the main extracellular cation responsible for regulating fluid balance in the body, sodium is also involved in impulse transmission in nerve and muscle fibers.

In addition to its responsibility for fluid balance, sodium is also responsible for: A. good eye sight and vitamin balance B. bone structure C. impulse transmission D. muscle mass

A. Hypotension ***Nifedipine (Procardia) reduces peripheral vascular resistance and nitrates produce vasodilation, so concurrent use of nitrates with nifedipine can cause hypotension with the initial administration of these agents (A). (B, C, and D) are not side effects of this treatment regimen.

In addition to nitrate therapy, a client is receiving nifedipine (Procardia), 10 mg PO every 6 hours. The nurse should plan to observe for which common side effect of this treatment regimen? A. Hypotension B. Hyperkalemia C. Hypokalemia D. Seizures

B. Impaired night vision ***Vitamin A plays an important role in adaptation to dim light and night blindness, which often are the first indicators of deficiency. Vitamin A is used primarily for the prevention or correction of vitamin A deficiency. Tender, bleeding gums, disturbed sleep patterns, and excessive sweating are not related to manifestations of vitamin A deficiency.

In assessing a patient with a vitamin A deficiency, the nurse should determine if the patient has which manifestation? A. Excessive sweating B. Impaired night vision C. Tender, bleeding gums D. Disturbed sleep patterns

D. Tachycardia ***A beta-agonist bronchodilator stimulates the beta receptors of the sympathetic nervous system, resulting in tachycardia, bronchodilation, hyperglycemia (if severe), and alertness.

In discharge teaching, the nurse will emphasize to a patient receiving a beta-agonist bronchodilator the importance of reporting which side effect? A. Hypoglycemia B. Nonproductive cough C. Sedation D. Tachycardia

G. All of the above ***These are all at high risk for TB infection. Other risk factors are residents or employees of high-risk congregate settings, such as nursing homes, medically underserved, low-income populations, high-risk racial or ethnic minority populations, defined locally as having an increased prevalence of TB and substance abusers - especially IV drug use.

In identifying the clients at higher risk for getting Tuberculosis, the nurse notes which of the following risk factors? Select all that apply. A. foreign-born persons from areas where TB is common B. people who inject illicit drugs C. healthcare workers who serve high-risk clients D. close contacts of known infectious TB cases E. residents of homeless shelters F. residents or employees of correctional facilities G. All of the above

D. Assess respiratory rate and depth ***Morphine sulfate can cause life-threatening respiratory depression. Although nausea can be a side effect of the drug, it will not be life threatening.

In monitoring a patient for adverse effects related to morphine sulfate, which is a priority assessment? A. Assess circulation B. Assess cough reflex C. Assess for nausea and vomiting D. Assess respiratory rate and depth

A. Tachycardia ***Increased sympathetic activity results in an increased heart rate (tachycardia), increased contractility, increased venous tone, and increased arteriolar tone (elevated blood pressure). Sympathetic stimulation also causes bronchodilation (not bradypnea) and possibly hyperglycemia.

In the failing heart, arterial pressure falls, stimulating the baroreceptor reflex to increase sympathetic nervous system activity. The nurse understands increased sympathetic activity will produce which response? A. Tachycardia B. Bradypnea C. Hypotension D. Hypoglycemia

D. Angle-closure glaucoma ***Angle-closure glaucoma is a condition in which the intraocular pressure increases due to the accumulation of aqueous humor. The aqueous humor can accumulate due to the closure of the anterior angle between the iris and the trabecular meshwork. Cataract is the loss of transparency of the lens, resulting in blurred vision. Cycloplegia is the paralysis of the ciliary muscles of the eye. Cycloplegia prevents the accommodation of the lens for variations in distance. Angioneurotic edema (angioedema) is a common adverse effect of ocular antibiotics. It is caused by swelling of the dermis and the subcutaneous tissues.

In which condition is the intraocular pressure increased due to accumulation of aqueous humor? A. Cataract B. Cycloplegia C. Angioneurotic edema D. Angle-closure glaucoma

C. A patient with a hemorrhagic stroke ***The patient contraindicated to take a low-dose aspirin is the patient with a hemorrhagic stroke. The patient with a thrombosis, deep vein thrombosis, and a heart problem would benefit from a low-dose aspirin.

In which patient would a low-dose aspirin be contraindicated? A. A patient with thrombosis B. A patient with a heart problem C. A patient with a hemorrhagic stroke D. A patient with a deep vein thrombosis

D. Increases sedation, decreases anxiety and has anticonvulsant effects

Intensifying the effect of GABA has what effect on the body? A. Decreases signs of depression in long term use B. Increases sedation, but does decreases seizure threshold C. Increases mental alertness and focus D. Increases sedation, decreases anxiety and has anticonvulsant effects

C. Furosimide

It is important to remove toxins from the kidneys when a patient is in renal failure. Which medication will do this? A. Lisinopril B. Xanax C. Furosimide D. Warfarin

D. Pedal edema ***Itraconazole [Sporanox] has negative inotropic actions and may cause a transient decrease in the ventricular ejection fraction, thus precipitating heart failure. Pedal edema is a symptom of heart failure, and the nurse should assess for it. Skin rash, hair loss, and joint pain are unrelated to the use of itraconazole.

It is most important that the nurse assess a patient taking itraconazole [Sporanox] for the development of which adverse effect? A. Hair loss B. Skin rash C. Joint pain D. Pedal edema

B. Heart failure

Like ACE inhibitors, ARBs are very effective in treating... A. Dry cough B. Heart failure C. Fluid overload D. Atrial fibrillation

A. dry mouth B. blurry vision D. constipation E. difficulty urinating H. sedation ***Cant see, cant pee, cant spit, cant sh**

List some effects of anticholinergic agents: Select all that apply. A. dry mouth B. blurry vision C. diarrhea D. constipation E. difficulty urinating F. incontinence G. hyperactivity H. sedation

Side effects of statins?

Liver impairment, Rhabdomyolysis (skeletal muscle disorder), Cataracts

A. Report vaginal itching or discharge. C. Protect skin from natural and artificial ultraviolet light. D. Avoid driving until response to medication is known. F. Use a nonhormonal method of contraception if sexually active. ***Correct selections are (A, C, D, and F). Adverse effects of tetracyclines include superinfections, photosensitivity, and decreased efficacy of oral contraceptives. Therefore, the client should report vaginal itching or discharge (A), protect the skin from ultraviolet light (C), and use a nonhormonal method of contraception (F) while on the medication. Minocycline (Minocin) is known to cause dizziness and ataxia, so until the client's response to the medication is known, driving (D) should be avoided. Tetracyclines should be taken around the clock (B) but exhibit decreased absorption when taken with antacids, so (E) is contraindicated.

Minocycline (Minocin), 50 mg PO every 8 hours, is prescribed for an adolescent girl diagnosed with acne. The nurse discusses self-care with the client while she is taking the medication. Which teaching points should be included in the discussion? (Select all that apply.) A. Report vaginal itching or discharge. B. Take the medication at 0800, 1500, and 2200 hours. C. Protect skin from natural and artificial ultraviolet light. D. Avoid driving until response to medication is known. E. Take with an antacid tablet to prevent nausea. F. Use a nonhormonal method of contraception if sexually active.

B. "Beta blockers can mask the symptoms of hypoglycemia and frequent monitoring of blood sugar can determine a hypoglycemic episode"

Mr. Craig is a 35 y/o with diabetes type 1. He has been newly prescribed with Propranolol [Inderal], how should the nurse explain why she is checking the patient's blood sugars more frequently than before? A. "Beta blockers increase blood sugars and frequent monitoring can determine hyperglycemic episode" B. "Beta blockers can mask the symptoms of hypoglycemia and frequent monitoring of blood sugar can determine a hypoglycemic episode" C. both a and b D. neither a nor b

s&s of theophylline toxicity?

N/V/D, insomnia, restlessness, if severe can lead to dysrhythmias, convulsions & cardiorespiratory collapse

Aspirin belongs to what class?

NSAID

What agent would you administer to a suspected morphine overdose patient? Be specific as to route of administration and duration of treatment.

Naloxone IV Treat with Naloxone until you are sure the effects of morphine will not come back because of the short half life of Naloxone

D. They are safe to use in children with chickenpox or influenza. ***As with aspirin, these drugs should not be given to children with chickenpox or influenza, owing to the possibility of precipitating Reye's syndrome. All other statements are true.

Nonaspirin NSAIDs differ from aspirin in all but which way? A. They cause reversible inhibition of COX, so their effects decline as soon as their blood levels decline. B. They can suppress platelet aggregation, but they are not used to prevent MI and stroke. C. They increase the risk of MI and stroke and therefore should be used in the lowest effective dosage for the shortest possible time. D. They are safe to use in children with chickenpox or influenza.

A. avoid ingesting alcohol ***Because alcohol and antihistamines have sedating properties, concurrent administration of these drugs should be avoided. Antihistamines and decongestants are often given together. Dry mouth is a common side effect, not increased saliva. Not all antihistamines last 24 hours.

Nurse Rita is giving instructions to her client who is taking antihistamine. Which of the following nurse teachings is appropriate for the client? A. avoid ingesting alcohol B. be aware that you may need to take a decongestant C. be aware that you may have increased saliva D. expect a relief in 24 hours

B. fewer functioning nephrons ***Older adults are at increased risk for electrolyte imbalances because their kidneys have fewer functioning nephrons, a decreased glomerular filtration rate, and a diminished ability to concentrate urine.

Older adults are at increased risk for electrolyte imbalances because, with age, the kidneys have: A. increased glomerular filtration rate B. fewer functioning nephrons C. increased ability to concentrate urine D. increased blood flow

D. Low oxygen level and high carbon dioxide level ***Low oxygen levels and high carbon dioxide levels (respiratory acidosis) are found in patients with chronic bronchitis and emphyesma.

Patients with chronic bronchitis and emphysema can MOST COMMONLY experience what type of acid-base imbalance? A. High oxygen level and high carbon dioxide level B. Low oxygen level and low carbon dioxide level C. High oxygen level and low carbon dioxide level D. Low oxygen level and high carbon dioxide level

A. tinnitus ***Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism) can result. Symptoms include tinnitu, dizziness, hyperpnea, and psychological disturbances. Constipation and diarrhea are not associated with salicylism.

Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client, knowing that which finding indicates the presence of systemic toxicity from this medication? A. tinnitus B. diarrhea C. constipation D. decreased respirations

D. relieve a dry cough ***An antitussive is a cough suppressant. Choices A and C describe the action of an expectorant. Choice D describes the action of decongestants.

Sam will have her exam in pharmacology tomorrow. She should be aware that antitussive is indicated to: A. encourage removal of secretions through cough B. relieve rhinitis C. control a productive cough D. relieve a dry cough

B. decreased TSH, increased T3 & T4 D. intolerance to heat E. goiter F. weight loss and muscle wasting F. restlessness and anxiety

Signs of hyperthyroidism: select all that apply. A. increased TSH, decreased T3 & T4 B. decreased TSH, increased T3 & T4 C. brittle hair and nails D. intolerance to heat E. goiter F. weight loss and muscle wasting G. lethargy and fatigue F. restlessness and anxiety

D. at least 30 minutes before exposure to the sun ***Sunscreens are most effective when applied at least 30 minutes before exposure to the sun so that they can penetrate the skin. All sunscreens should be reapplied after swimming.

The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied at which times? A. immediately before swimming B. 5 minutes before exposure to the sun C. immediately before exposure to the sun D. at least 30 minutes before exposure to the sun

B. Informing the client that he should go to the nearest urgent care facility because he is probably having a urinary tract infection. ***The client shows signs of knowledge deficit and should be assured that red-orange body secretions are a common side effect of Rifampin. The client should also be taught on which signs and symptoms he should be watching out for like signs of hepatotoxicity which is an adverse effect of Tuberculosis medications that should be reported to the healthcare provider immediately.

The client on tuberculosis treatment calls the nurse practitioner because he has noticed his urine having a red-orange tinge lately. The nurse accurately talks about the following points, except? A. Informing the client that red-orange urine and even feces, sweat and tears are a common side effect of Rifampin. B. Informing the client that he should go to the nearest urgent care facility because he is probably having a urinary tract infection. C. None of the above. D. Informing the client that he should watch out for yellowish discoloration in his eyes or skin or any unusual bleeding and to report it to the nurse practitioner or his primary care physician immediately.

C. rise slowly when getting up from a supine to a sitting position first while waiting for the light-headedness to subside prior to standing up ***To prevent light-headedness (orthostatic hypotension) which is a side effect of Furosemide, clients should gradually change positions, sleep with their head at a 10 to 20 degree angle, and drink 5 to 8 glasses of water per day.

The client recently discharged with pulmonary edema taking Furosemide 20 mg tablet twice a day tells the telephonic nurse case manager that he feels lightheaded whenever he gets up in the morning or after his afternoon nap, the nurse case manager accurately suggests which of the following appropriate interventions to address this side effect? A. do not use pillows when sleeping B. limit drinking fluid to 5 glasses per day C. rise slowly when getting up from a supine to a sitting position first while waiting for the light-headedness to subside prior to standing up D. all of the above

D. take the medication at bedtime with food ***Nausea is a side effect of ethambutol and can be prevented by taking the daily dose at bedtime and with food to decrease gastrointestinal upset. The nurse should not advise the client to discontinue the medication without the doctor's order and taking the medication during with an empty stomach or during daytime with the other medications would only make the symptoms worse.

The client undergoing treatment for tuberculosis informs the nurse that whenever he takes Ethambutol [Myambutol], he experiences nausea and vomiting. What can the nurse suggest to the client to alleviate this symptom? A. take the medication together during daytime together with the other TB medications B. take the medication on an empty stomach C. hold the medication of persistent nausea is observed D. take the medication at bedtime with food

A. headache B. fatigue C. vomiting F. tachycardia

The client who is previously taking an ACE inhibitor has been shifted to ARBs, the nurse enumerates which of the following side/adverse effects of this drug classification? Select all that apply. A. headache B. fatigue C. vomiting D. dry cough E. hypokalemia F. tachycardia

B. "It is contraindicated with your medication Furosemide for it reduces the diuretic effects of this medication." ***Ibuprofen should not be used while the client is on Furosemide for it reduces the diuretic effects of the medication. All other options are not true.

The client with hypertension asks the nurse if he can take Ibuprofen [Advil], which of the following is the appropriate response of the nurse? A. "You should take it as needed only." B. "It is contraindicated with your medication Furosemide for it reduces the diuretic effects of this medication." C. "You should take your Furosemide an hour after taking the Ibuprofen to avoid interactions." D. "Since it is an over-the-counter medication, there is no problem with you taking the medication round the clock for your muscle pain."

D. Renal impairment ***Impaired renal function may result in increased drug levels. It may also prolong the drug exposure to the tissues and cause increased drug transfer to the fetus. Epilepsy, diabetes, and hypertension do not have a direct impact on drug metabolism and excretion. However, they have indirect impacts in late stages when liver and kidneys are involved secondarily.

The dosage of a certain drug is reduced when administered to a pregnant woman with liver impairment. Which other clinical situation requires reduction in the dosage of most drugs administered during pregnancy? A. Epilepsy B. Diabetes C. Hypertension D. Renal impairment

B. Increased heart rate ***Dobutamine mimics the action of norepinephrine (NE) at receptors on the heart, thereby causing an increase in the heart's rate and force of contraction.

The drug dobutamine acts as an agonist of norepinephrine (NE) receptors. Which effect is the nurse most likely to observe in a patient receiving this medication? A. Sinus bradycardia B. Increased heart rate C. Reduced cardiac output D. Atrioventricular heart block

D. Contact the health care provider to clarify the prescription. ***Lovenox is a low-molecular-weight heparin that can only be administered subcutaneously, so the nurse should contact the health care provider to clarify the route of administration (D). (A and B) are important nursing interventions but not necessary to the administration of this medication. The client should be instructed about medication side effects (C), but this is of lower priority than obtaining a correct prescription.

The health care provider has prescribed a low-molecular-weight heparin, enoxaparin (Lovenox) prefilled syringe, 30 mg/0.3 mL IV every 12 hours, for a client following hip replacement. Prior to administering the first dose, which intervention is most important for the nurse to implement? A. Assess the client's IV site for signs of inflammation. B. Evaluate the client's degree of mobility. C. Instruct the client regarding medication side effects. D. Contact the health care provider to clarify the prescription.

B. Administer the albuterol, wait 5 minutes, administer ipratropium bromide, then beclomethasone several minutes later. ***Administering the bronchodilator albuterol (Proventil) first allows the other drugs to reach deeper into the lungs as the bronchioles dilate. Anticholinergics such as ipratropium bromide (Atrovent) also help bronchodilate, but to a lesser extent. Corticosteroids such as beclomethasone (Vanceril) do not dilate and are therefore given last.

The health care provider orders ipratropium bromide (Atrovent), albuterol (Proventil), and beclomethasone (Vanceril) inhalers for a patient. What is the nurse's best action? A. Question the order; three inhalers should not be given at one time. B. Administer the albuterol, wait 5 minutes, administer ipratropium bromide, then beclomethasone several minutes later. C. Administer each inhaler at 30-minute intervals. D. Administer beclomethasone, wait 2 minutes, administer ipratropium bromide, then albuterol several minutes later.

B. Administer the spironolactone (Aldactone) only. ***Normal potassium level is 3.5 - 5.0 mEq/L and the client has a low potassium level of 3.2 mEq/L. Furosemide (Lasix) is a potassium-losing diuretic, it should not be given to the client since client's potassium level is already low. While, spironolactone (Aldactone) is a potassium-sparring diuretic so there is no reason for it to hold, instead it should be administered.

The health care provider prescribed furosemide (Lasix) and spironolactone (Aldactone) to a client. Before administering the medication the nurse check the potassium level of the client which was 3.2 mEq/L. Besides, notifying the health care provider of the result, which of the following action should the nurse anticipate to take? A. Holding the medication administration of the spironolactone (Aldactone) B. Administer the spironolactone (Aldactone) only. C. Giving the furosemide (Lasix) only. D. Administer both the furosemide (Lasix) and spironolactone (Aldactone)

C. Myelosuppression ***Myelosuppression (C) is the highest priority complication that can potentially affect clients managed with carbamazepine (Tegretol) therapy. The client requires close monitoring for this condition by weekly laboratory testing. Hepatic function may be altered (D), but this complication does not have as great a potential for occurrence as (C). (A and B) are not typical complications of carbamazepine (Tegretol) therapy.

The health care provider prescribes carbamazepine (Tegretol) for a child whose tonic-clonic seizures have been poorly controlled. The nurse informs the mother that the child must have blood tests every week. The mother asks why so many blood tests are necessary. Which complication is assessed through frequent laboratory testing that the nurse should explain to this mother? A. Nephrotoxicity B. Ototoxicity C. Myelosuppression D. Hepatotoxicity

B. A different drug may be ordered instead. C. The dosage of the drug may be reduced. ***Due to the reduction in kidney function, the healthcare provider may choose to reduce the dosage of the medication to prevent toxicity or may put the patient on a completely different drug. There would be no reason to stop all drug therapy due to a potential problem with one drug.

The healthcare provider is considering placing the patient on memantine [Namenda]. The patient's family member tells the nurse that the patient has a history of kidney disease. Based on this information, the nurse should anticipate which action on the part of the healthcare provider? Select all that apply. A. All drug therapy will be stopped. B. A different drug may be ordered instead. C. The dosage of the drug may be reduced. D. The dosage of the drug may be increased

A. Betamethasone ***When preterm delivery cannot be prevented, administration of betamethasone, a glucocorticoid, to the pregnant patient can accelerate fetal lung development. A deficiency of lung surfactant is the primary cause of respiratory distress syndrome in premature infants. Calfactant, poractant alfa, and beractant are examples of surfactant therapy given to premature infants (not to the pregnant patient) to lower the surface tension forces that cause alveolar collapse.

The nurse administers which medication to accelerate fetal lung maturation in a pregnant patient for whom preterm delivery cannot be prevented? A. Betamethasone B. Calfactant [Infasurf] C. Beractant [Survanta] D. Poractant alfa [Curosurf]

B. A different drug may be ordered instead. C. The dosage of the drug may be reduced. ***Due to the reduction in kidney function, the healthcare provider may choose to reduce the dosage of the medication to prevent toxicity or may put the patient on a completely different drug. There would be no reason to stop all drug therapy due to a potential problem with one drug.

The healthcare provider is considering placing the patient on memantine [Namenda]. The patient's family member tells the nurse that the patient has a history of kidney disease. Based on this information, the nurse should anticipate which action on the part of the healthcare provider? Select all that apply. A. All drug therapy will be stopped. B. A different drug may be ordered instead. C. The dosage of the drug may be reduced. D. The dosage of the drug may be increased.

C. 2 ***The ordered dose is 150 mcg. The available tablets are 75 mcg. 75 multiplied by 2 equals 150. Therefore, 2 tablets is the correct dose.

The healthcare provider orders 150 mcg of levothyroxine [Synthroid] PO every morning. The medication available is levothyroxine [Synthroid] 75 mcg tablets. How many tablets will the nurse administer? A. 0.5 B. 1 C. 2 D. 4

B. 5 mL *** Each dose will be 5 mL. The total of 20 mg is divided into two doses of 10 mg. The concentration is 2 mg/mL. Divide 10 mg by 2 mg to equal 5 mL.

The healthcare provider orders Namenda syrup 20 mg PO daily in two divided doses. The concentration available is Namenda 2 mg/mL. How many mL will the patient receive for each dose? A. 2 mL B. 5 mL C. 10 mL D. 20 mL

D. Assess IV site frequently for extravasation ***Promethazine should be administered with a large bore needle at a rate of 25 mg/min or less. The medication can cause severe local tissue injury if it extravasates, including gangrene that requires amputation.

The healthcare provider orders promethazine. What intervention is essential during intravenous (IV) administration of this medication? A. Use a small bore needle B. Administer at a rate of 50 mg/min C. Remain with the patient continuously D. Assess IV site frequently for extravasation

B. Monitor electrocardiogram. ***Monitor the electrocardiogram (ECG) continuously during IV administration of diltiazem for AV block, sudden reduction in heart rate, and prolongation of the PR or QT interval. Cardioversion is not necessary; however, have equipment for cardioversion available. Baseline laboratory studies are needed for liver and kidney function. Increased urinary output is not an adverse effect of diltiazem.

The healthcare provider prescribes an intravenous dose of diltiazem [Cardizem] for treatment of a patient with atrial fibrillation. What is the priority nursing intervention? A. Assist with cardioversion. B. Monitor electrocardiogram. C. Obtain baseline coagulation studies. D. Assess for increased urinary output.

A. "Do not start any new medications without first talking to your healthcare provider." B. "Before starting this medication a blood test will be done to check your total cholesterol level and to measure liver enzymes." E. "Lower the total fat and saturated fat in your diet by increasing your intake of fresh fruits and vegetables and whole grains." ***Lovastatin, simvastatin, and atorvastatin levels may be elevated when these drugs are combined with other drugs that inhibit CYP3A4. If these drugs are combined, caution is warranted. Before starting a statin, obtain a baseline lipid profile that includes total cholesterol and obtain baseline LFTs. The statins are taken once daily with food. It is recommended to take them with the evening meal because endogenous cholesterol synthesis increases during the night. The statins do not typically cause flushing and itching; that effect occurs with niacin. A diet low in total fat and saturated fat is recommended when antilipemic drugs are prescribed.

The healthcare provider prescribes lovastatin [Mevacor] for a patient discharged from the hospital post-myocardial infarction. Which instructions are most appropriate for the nurse to include in the patient's teaching plan? (Select all that apply.) A. "Do not start any new medications without first talking to your healthcare provider." B. "Before starting this medication a blood test will be done to check your total cholesterol level and to measure liver enzymes." C. "Take your medication in the morning, with a full glass of water for best results." D. Take one 325-mg aspirin 30 minutes before your dose to lessen the problem of flushing and itching that can occur with this drug." E. "Lower the total fat and saturated fat in your diet by increasing your intake of fresh fruits and vegetables and whole grains."

B. "Do not start any new medications without first talking to your healthcare provider." C. "Before starting this medication a blood test will be done to check your total cholesterol level and to measure liver enzymes." D. "Lower the total fat and saturated fat in your diet by increasing your intake of fresh fruits and vegetables and whole grains." ***Lovastatin [Mevacor], simvastatin [Zocor], and atorvastatin [Lipitor] levels may be elevated when these drugs are combined with other drugs that inhibit CYP3A4. Caution is warranted if these drugs are combined,. Before starting a statin, obtain a baseline lipid profile that includes total cholesterol and obtain baseline liver function tests (LFTs). The statins are taken once daily with food. It is recommended to take them with the evening meal because endogenous cholesterol synthesis increases during the night. The statins do not typically cause flushing and itching; that effect occurs with niacin [Niacor]. A diet low in total fat and saturated fat is recommended when antilipemic drugs are prescribed.

The healthcare provider prescribes lovastatin [Mevacor] for a patient discharged from the hospital post-myocardial infarction. Which instructions are most appropriate for the nurse to include in the patient's teaching plan? Select all that apply. A. "Take your medication in the morning, with a full glass of water, for best results." B. "Do not start any new medications without first talking to your healthcare provider." C. "Before starting this medication a blood test will be done to check your total cholesterol level and to measure liver enzymes." D. "Lower the total fat and saturated fat in your diet by increasing your intake of fresh fruits and vegetables and whole grains." E. "Take one 325-mg aspirin 30 minutes before your dose to lessen the problem of flushing and itching that can occur with this drug."

B. Ventricular wall thickening ***An increase in ventricular wall thickness, also called ventricular hypertrophy, is characteristic of the remodeling process during the initial phase of heart failure. The ventricles also dilate and become more spherical (less cylindric). This change in cardiac shape typically occurs after cardiac injury under the influence of the neurohormonal systems, such as the sympathetic nervous system and renin-angiotensin-aldosterone system.

The heart undergoes cardiac remodeling during the initial phase of heart failure. Which cardiac geometric change occurs during heart failure? A. Ventricular constriction B. Ventricular wall thickening C. Ventricular atrophy D. Ventricles become more cylindric

C. "You should avoid drinking alcohol when on this medication because it can increase the side effect of the medication causing further decreases in your blood pressure."

The hypertensive client taking Accupril [Quinapril] asks the nurse if he can still drink alcohol while taking this medication, the nurse appropriately responds with which of the following? A. "You should limit your alcohol intake to 24 oz per day." B. "Limitations in alcohol consumption depends on your blood pressure reading." C. "You should avoid drinking alcohol when on this medication because it can increase the side effect of the medication causing further decreases in your blood pressure." D. "As long as you are able to bring your blood pressure up after lying down with your legs elevated with two pillows, you can drink as much as 8 ox per day."

D. sodium ***Sodium is the main extracellular cation. In addition to other functions, it helps regulate fluid balance in the body.

The main extracellular cation is: A. calcium B. potassium C. bicarbonate D. sodium

C. Furosemide [Lasix] ***Furosemide (a loop diuretic) should not be taken within 4 hours prior to bedtime to prevent having to get up to urinate. Advise patient to take this drug in the morning.

The nurse adjusts the medication schedule of the client with hypertension. The following medications may be taken by the client prior to sleeping, except? A. Rosuvastatin Calcium [Crestor] B. Acetabulol [Sectral] C. Furosemide [Lasix] D. None of the above

A. It is a synthetic steroid identical to cortisol. C. It has glucocorticoid and mineralocorticoid actions. D. It is a preferred drug for adrenocortical insufficiency. ***Hydrocortisone is a synthetic steroid with a structure identical to that of cortisol. Hydrocortisone is a preferred drug for all forms of adrenocortical insufficiency. Oral hydrocortisone is ideal for chronic replacement therapy. Parenteral administration is used for acute adrenal insufficiency and to supplement oral doses during times of stress. Despite being classified as a glucocorticoid, hydrocortisone also has mineralocorticoid actions.

The nurse administering hydrocortisone to a patient recognizes which statement(s) as true regarding the medication? Select all that apply. A. It is a synthetic steroid identical to cortisol. B. It should not be given during times of stress. C. It has glucocorticoid and mineralocorticoid actions. D. It is a preferred drug for adrenocortical insufficiency. E. It is given intravenously for chronic replacement therapy.

A. Blood pressure reduction ***All angiotensin receptor blockers (ARBs), such as candesartan [Atacand], are approved for hypertension. Reduction in blood pressure equals those seen with angiotensin-converting enzyme (ACE) inhibitors. ARBs will decrease pulmonary congestion. Because ARBs promote vasodilation, the nurse expects the patient's extremities to be warm and pink from increased perfusion. In contrast to ACE inhibitors, ARBs do not cause clinically significant hyperkalemia.

The nurse administers candesartan [Atacand] to a patient. Which assessment finding should the nurse use as a clinical indicator of the therapeutic effectiveness of the medication? A. Blood pressure reduction B. Serum potassium retention C. Peripheral perfusion reduction D. Pulmonary congestion retention

C. Reduction of cardiac output ***When the blood pressure rises too high, the baroreceptor reflex causes reduction of cardiac output and vasodilation. The baroreceptor reflex works rapidly but does not have sustained action. The baroreceptors' most noticeable response is reflex tachycardia.

The nurse administers the beta blocker medication metoprolol [Lopressor] to a patient who has hypertension. This medication works on the baroreceptors when blood pressure is too high. What is another effect the nurse would expect from the baroreceptor reflex when the blood pressure is too high? A. Vasoconstriction B. Reflex bradycardia C. Reduction of cardiac output D. Sustained action of response

A. Garlic B. Ginger D. Feverfew E. Ginkgo biloba ***Several herbal products, including feverfew, Ginkgo biloba, and garlic, suppress platelet aggregation. Ginger can inhibit production of thromboxane by platelets, resulting in suppression of platelet aggregation.

The nurse collects a medication history on a patient admitted with gastrointestinal bleeding. Which herbal drugs taken by the patient likely contributed to the bleeding? A. Garlic B. Ginger C. Valerian D. Feverfew E. Ginkgo biloba

C. Postural hypotension ***The main adverse effect of cholinergic drugs in the patient is postural hypotension, which results in dizziness and fainting. This effect can be decreased by changing positions slowly when standing. These drugs do not affect muscular function, gastrointestinal function, or respiratory function. Therefore, muscle cramps, nausea or vomiting, and dyspnea are not adverse effects related to cholinergic drugs.

The nurse advises a patient who is taking cholinergic drugs to avoid standing quickly and to rise to an upright position slowly. Which complication associated with the drug is the nurse trying to prevent? A. Dyspnea B. Muscle cramps C. Postural hypotension D. Nausea and vomiting

D. Medication reconciliation ***Medication reconciliation is a process in which the nurse asks the patient to provide a list of all medications including herbal and over-the-counter drugs that the patient is currently taking. This knowledge prevents medication errors. Error reporting involves notifying the appropriate people about errors related to medication administration. Medication reconciliation helps in quality improvement. Notifying the patient is a process whereby the patient is informed about possible medication errors.

The nurse asks a patient to provide a list of all medications including herbal and over-the-counter drugs that the patient takes. Which term best describes the nurse's action? A. Error reporting B. Patient notification C. Quality improvement D. Medication reconciliation

C. Bradycardia D. Hypotension ***Hypotension and bradycardia are the adverse effects of beta-adrenergic blocker drugs, as they reduce blood pressure by causing vasodilation and decreasing cardiac output. Beta blockers also reduce the heart rate, which may cause bradycardia. Chemosis is the swelling of conjunctiva. It is the adverse effect of anti-inflammatory ophthalmic solutions. Dizziness and nervousness are adverse effects of ophthalmic anesthetics, as they cause central nervous system depression.

The nurse assesses a patient who has been prescribed beta-adrenergic blockers for the treatment of ocular hypertension. Which adverse effects should the nurse monitor in the patient? Select all that apply. A. Dizziness B. Chemosis C. Bradycardia D. Hypotension E. Nervousness

D. stop the intravenous infusion of doxorubicin. ***If extravasation occurs, stop infusion immediately. Do not remove IV device from the patient. Attempt to aspirate residual vesicant from the IV device using a small syringe and then remove the IV device. Assess the site. Notify health care provider. Apply warm packs for 15-20 minutes at least 4 times per day for first 24 hours. For peripheral extravasations elevate extremity. Tissue necrosis may occur 3 to 4 weeks after infiltration into tissue.

The nurse assesses a patient who is receiving doxorubicin intravenously. The nurse determines extravasation has occurred. The first action by the nurse is to A. attempt to aspirate residual doxorubicin from the patient's vein. B. remove the intravenous catheter. C. pack the intravenous site with ice. D. stop the intravenous infusion of doxorubicin.

B. Hematemesis ***Ibuprofen is a member of the nonaspirin first-generation nonsteroidal anti-inflammatory drugs (NSAIDs). Through inhibition of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), ibuprofen poses a risk for gastric ulceration and bleeding, which may lead to hematemesis. Ibuprofen is used to reduce inflammation, fever, and pain and therefore is effective in reducing dysmenorrhea (painful menstrual cramping). It is not known to cause hives or jaundice, which are signs of impaired liver function.

The nurse assesses a patient who takes ibuprofen [Advil] on a regular basis. Which finding does the nurse know is an adverse effect of ibuprofen [Advil] therapy? A. Hives B. Hematemesis C. Dysmenorrhea D. Jaundice

C. Hematemesis ***Ibuprofen is a member of the nonaspirin, first-generation nonsteroidal anti-inflammatory drugs (NSAIDs). Through inhibition of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), ibuprofen poses a risk for gastric ulceration and bleeding, which may lead to hematemesis (vomiting of blood). Ibuprofen is used to reduce inflammation, fever, and pain and therefore is effective in reducing dysmenorrhea (painful menstrual cramping). It is not known to cause drowsiness or jaundice.

The nurse assesses a patient who takes ibuprofen [Advil] on a regular basis. Which finding in the patient would prompt the nurse to contact the healthcare provider immediately? A. Jaundice B. Drowsiness C. Hematemesis D. Dysmenorrhea

A. Withhold the dose. ***If heart rate is less than 60 beats/min or if a change in rhythm is detected, digoxin should be withheld and the prescriber notified. Checking potassium level before giving is not a priority as the drug should not be administered with this pulse rate. Administering the drug to a patient in such a condition would reduce the patient's heart rate, causing bradycardia. Administering the drug by reducing the dose to half would worsen the condition by causing bradycardia, and the nurse should not administer a drug to a patient without the prescription of a provider.

The nurse assesses a patient's pulse before administering digoxin and notes a rate of 55 beats/min. What is the priority intervention by the nurse? A. Withhold the dose. B. Administer the drug. C. Check potassium level before giving. D. Reduce the dose to half the prescribed dose.

C. replace Furosemide with Spironolactone ***In clients with decreased potassium levels needing a diuretic, Spironolactone is a potassium-sparing diuretic that can be used in place of Furosemide.

The nurse caring for a client with heart failure has potassium levels of 2 mEq/L, she anticipates the physician to make the following changes in the client's plan of care? A. refer the client to a neurologist B. have the client's HbA1C checked C. replace Furosemide with Spironolactone D. all of the above

D. Hold the Lasix and notify the physician. ***The nurse's best action is to hold the Lasix and notify the physician. Loop diuretics, such as furosemide, can cause significant potassium loss. The normal potassium level is 3.5 to 5 mEq/L. The remaining electrolyte levels are normal. Administering the Lasix could result in a critically low potassium level. Effects of low potassium include cardiac dysrhythmias. Placing a patient on a cardiac monitor requires a physician's order and would warrant further assessment first, such as taking vital signs and asking the patient whether he or she is having any cardiac-related symptoms. Collecting a 24-hour urine specimen is not appropriate in this case.

The nurse caring for a patient taking furosemide [Lasix] is reviewing the patient's most recent laboratory results, which are: sodium, 136 mEq/L; potassium, 3.2 mEq/L; chloride, 100 mEq/L; blood urea nitrogen, 15 mg/dL. What is the nurse's best action? A. Administer Lasix as ordered. B. Place the patient on a cardiac monitor. C. Begin a 24-hour urine collection. D. Hold the Lasix and notify the physician.

A. "I will take the cimetidine with my meals." B. "I'll know the medication is working if my diarrhea stops." D. "Taking the cimetidine with an antacid will increase its effectiveness." ***Cimetidine, a histamine (H2)-receptor antagonist, helps to alleviate the symptom of heartburn, not diarrhea. Because cimetidine crosses the blood-brain barrier, central nervous system side and adverse effects, such as mental confusion, agitation, depression, and anxiety, can occur. Food reduces the rate of absorption, so if cimetidine is taken with meals, absorption will be slowed. Antacids decrease the absorption of cimetidine and should be taken at least 1 hour apart. If cimetidine is concomitantly administered with warfarin therapy, warfarin doses may need to be reduced, so prothrombin and international normalized ratio results may be followed.

The nurse determines the client needs further instruction on cimetidine if which statements were made? Select all that apply. A. "I will take the cimetidine with my meals." B. "I'll know the medication is working if my diarrhea stops." C. "My episodes of heartburn will decrease if the medication is effective." D. "Taking the cimetidine with an antacid will increase its effectiveness." E. "I will notify my health care provider if I become depressed or anxious." F. "Some of my blood levels will need to be monitored closely since I also take warfarin for atrial fibrillation."

C. Delivery is postponed for at least 24 hours. ***Nifedipine [Procardia] acts to block the entry of calcium into myometrial cells, thus suppressing preterm labor for at least 24 hours. Cervical ripening and breast engorgement are not affected. Procardia has no effect on blood glucose.

The nurse develops a plan of care for a pregnant patient receiving nifedipine [Procardia]. Which outcome should be included? A. Cervix shows softening and dilation. B. Whole blood glucose is 110 mg/dL or less. C. Delivery is postponed for at least 24 hours. D. Breasts are soft with no evidence of engorgement

A. A patient with chronic pain D. A patient who recently delivered a child E. A patient recovering from cardiac surgery ***Laxatives are used for correcting constipation associated with certain drugs, especially opioid analgesics, which would probably be used for chronic pain. By softening the stool, laxatives can reduce the painful elimination that can be associated with episiotomy and hemorrhoids associated with childbirth. In patients with cardiovascular diseases (eg, aneurysm, myocardial infarction, disease of the cerebral or cardiac vasculature), softening the stool decreases the amount of strain needed to defecate, thereby avoiding dangerous elevation of blood pressure.

The nurse expects laxatives to be ordered for which patient(s)? Select all that apply. A. A patient with chronic pain B. A patient with no bowel sounds C. A patient with acute food poisoning D. A patient who recently delivered a child E. A patient recovering from cardiac surgery

A. Creatinine C. Peak and trough D. Blood urea nitrogen (BUN) ***Tests for creatinine, the peak and trough of the medication, and blood urea nitrogen (BUN) will be ordered to monitor potential risks associated with aminoglycosides. Blood glucose would not necessarily be ordered. The creatine phophokinase test (CPK) is associated with heart muscle concerns.

The nurse explains to a patient the need for serum blood test monitoring associated with the use of aminoglycosides. Which serum blood tests will be ordered for this patient due to the use of this medication? Select all that apply. A. Creatinine B. Blood glucose C. Peak and trough D. Blood urea nitrogen (BUN) E. Creatine phophokinase test (CPK)

A. The nurse assesses the patient's needs and develops new goals. ***The nurse may sometimes find that patient goals are not met due to noncompliance with therapy. The nurse should then assess the patient's needs in an attempt to understand the problems and develop new goals to promote health. The nurse does not formulate a diagnosis after evaluating the outcome of the goals. The nurse first assesses the patient's concerns. It is not effective to inform the patient about the consequences of noncompliance as the patient may not be in control of the circumstances preventing compliance. Instead, the nurse may provide information about a generic drug that the patient can afford or inform the patient about programs that cover costs of drugs when patients cannot afford them. The nurse cannot implement new nursing interventions before assessing the patient's needs.

The nurse finds that a patient discontinued drug therapy due to an inability to afford the medications. As a result, the expected patient goals were not met. What action does the nurse take? A. The nurse assesses the patient's needs and develops new goals. B. The nurse implements new nursing interventions to meet the goals. C. The nurse formulates a nursing diagnosis for the patient's condition. D. The nurse informs the patient about the consequences of noncompliance.

C. litocaine ***This drug is commonly used as a numbing agent by dentists.

The nurse gives a cephalosporin via IM. The patient complains that this route is very painful and asks the nurse is there any way you can make it more comfortable? The nurse knows that mixing this drug with which of the following drugs would increase the comfort level of the patient? A. penicillin B. imipenem C. litocaine D. vancomycin

D. The patient took an antacid immediately following drug administration. ***Antacids raise stomach pH and bind certain drugs. The pH of the stomach affects absorption of drugs dependent on the pH of the drug. Alkaline drugs are absorbed more readily in an alkaline environment, and acidic drugs are absorbed more readily in an acidic environment. Position, drug schedule, and drug tolerance will not influence absorption.

The nurse has administered several oral medications to a patient. Which factor will influence the absorption of these medications? A. The patient must remain in a supine position. B. One of the drugs is a Schedule III medication. C. The patient has developed a tolerance to one of the drugs. D. The patient took an antacid immediately following drug administration.

B. Monitor blood pressure. ***First-dose hypotension is a serious potential adverse effect of angiotensin-converting enzyme (ACE) inhibitors such as enalapril [Vasotec]. Monitoring the blood pressure is the priority nursing intervention. If hypotension develops, the nurse will place the patient in the supine position and possibly increase intravenous fluids. The other interventions may be appropriate for this patient; however, in the hours immediately after the first dose of an ACE inhibitor, monitoring of the blood pressure is most important.

The nurse has just administered the initial dose of enalapril [Vasotec] to a newly admitted patient with hypertension. What is the priority nursing intervention over the next several hours? A. Check the heart rate. B. Monitor blood pressure. C. Auscultate lung sounds. D. Draw a potassium level.

A. Monitor blood pressure. ***First-dose hypotension is a serious potential adverse effect of ACE inhibitors, such as enalapril. Monitoring the blood pressure is the priority nursing intervention. If hypotension develops, the nurse will place the patient in the supine position and possibly increase intravenous fluids. The other interventions may be appropriate for this patient; however, in the hours immediately after the first dose of an ACE inhibitor, monitoring of the blood pressure is most important.

The nurse has just administered the initial dose of enalapril [Vasotec] to a newly admitted patient with hypertension. What is the priority nursing intervention over the next several hours? A. Monitor blood pressure. B. Check the heart rate. C. Auscultate lung sounds. D. Draw a potassium level.

C. Assess the patient's condition. ***The primary concern in any situation is patient safety. The nurse should assess the patient's condition to ensure that no harm has come to the patient. Once the patient is assessed, the nurse should notify the healthcare provider. The supervisor should also be notified. The verification of the right drug to be given is one of the first steps in the drug administration process.

The nurse has made a medication error. What is the nurse's initial action? A. Notify the shift supervisor. B. Notify the healthcare provider. C. Assess the patient's condition. D. Verify the drug that should have been given.

C. Hemorrhagic cystitis ***Hemorrhagic cystitis is the major adverse effect of cyclophosphamide (a chemotherapeutic drug) (1) (2), so the nurse hydrates the patient before infusion of the drug; the nurse is able to give a protective agent called mesna when high doses are given. Cardiotoxicity is a major adverse effect of doxorubicin. Pulmonary fibrosis is an adverse effect caused by busulfan and bleomycin. Peripheral neuropathy is an adverse effect of cisplatin and vincristine.

The nurse hydrates a patient with intravenous (IV) fluids before administering cyclophosphamide IV. Which adverse effect is the nurse trying to prevent in the patient? A. Cardiotoxicity B. Pulmonary fibrosis C. Hemorrhagic cystitis D. Peripheral neuropathy

B. Cytotoxic drugs ***Of the four major classes of anticancer drugs, the cytotoxic agents are used most often.

The nurse identifies which class of anticancer drugs as used most often in the treatment of patients? A. Targeted drugs B. Cytotoxic drugs C. Immunomodulating agents D. Biologic response modifiers

A. Lithium C. Carbamazepine E. Divalproex sodium [Depakote] ***Lithium, divalproex sodium [Valproate], and carbamazepine are the principal mood stabilizers used in the treatment of bipolar disorder. Risperidone is an antipsychotic used in the management of bipolar disorder. Venlafaxine [Effexor] is an antidepressant used in the treatment of bipolar disorder.

The nurse identifies which drug(s) as the principal mood stabilizers used in the treatment of bipolar disorder? Select all that apply. A. Lithium B. Risperidone C. Carbamazepine D. Venlafaxine [Effexor] E. Divalproex sodium [Depakote]

A. Lithium C. Divalproex sodium [Depakote] D. Carbamazepine ***Lithium, divalproex sodium [Valproate], and carbamazepine are the principal mood stabilizers used in the treatment of bipolar disorder. Risperidone is an antipsychotic used in the management of bipolar disorder. Venlafaxine [Effexor] is an antidepressant used in the treatment of bipolar disorder.

The nurse identifies which drugs as the principal mood stabilizers used in the treatment of bipolar disorder? (Select all that apply.) A. Lithium B. Risperidone C. Divalproex sodium [Depakote] D. Carbamazepine E. Venlafaxine [Effexor]

B. Lactulose ***In addition to its laxative action, lactulose can enhance intestinal excretion of ammonia. This property has been exploited to lower blood ammonia content in patients with portal hypertension and hepatic encephalopathy secondary to chronic liver disease.

The nurse identifies which of the following laxatives as having the added response of ridding the body of ammonia? A. Polyethylene glycol B. Lactulose C. Lubiprostone D. Mineral oil

B. Flumazenil [Romazicon] ***Flumazenil [Romazicon], a benzodiazepine receptor antagonist, is the treatment of choice for overdose of the benzodiazepine diazepam [Valium]. Naloxone [Narcan] is used to reverse opioid overdose. Acetylcysteine [Mucomyst] is used to reverse acetaminophen [Tylenol] overdose. Vitamin K is used to reverse warfarin toxicity.

The nurse in the emergency department is caring for a patient with a suspected overdose of diazepam [Valium]. Which agent is most likely to be administered to reverse the effects of diazepam? A. Naloxone [Narcan] B. Flumazenil [Romazicon] C. Acetylcysteine [Mucomyst] D. Vitamin K

D. Blood pressure of 80/60 mm Hg ***Blood pressure that goes below 100 mm Hg should immediately be reported to the healthcare provider, and the medication should be held. The other assessment findings are within normal limits and do not require immediate action.

The nurse is administering an antihypertensive medication. What assessment finding requires immediate action? A. Calcium level of 8 mEq/dL B. Potassium level of 5 mEq/dL C. Apical pulse of 100 beats/min D. Blood pressure of 80/60 mm Hg

A. Bronchial dilation B. Increased heart rate F. Increased force of heart contraction ***Activation of beta1 and beta2 receptors results in dilation of the bronchi, increased cardiac output (by increasing the heart rate and force of contraction); and elevation of the blood glucose level.

The nurse is administering isoproterenol, a beta1 and beta2 agonist. The nurse understands activation of these two receptors will result in which expected drug effects? Select all that apply. A. Bronchial dilation B. Increased heart rate C. Excessive drowsiness D. Decreased cardiac output E. Decreased glucose levels F. Increased force of heart contraction

C. The nurse administers carbamazepine with grapefruit juice. ***Carbamazepine is not to be given with grapefruit juice as this can lead to increased toxicity of the drug. Dilantin is adminstered IV with a filter. Gabapentin can safely be given without regard to meals. Phenobarbital elixir can be administered with fruit juice, but the oral pill form of the drug should be given with water.

The nurse is administering morning medications. Which administration technique is an error? A. The nurse administers intravenous Dilantin with a filter. B. The nurse adminsters phenobarbital elixir with fruit juice. C. The nurse administers carbamazepine with grapefruit juice. D. The nurse administers gabapentin without checking when the patient ate

D. "This therapy will dissolve the clot that caused the heart attack." ***Tenecteplase (TNKase) is a thrombolytic drug that is given to dissolve existing clots. This drug is used when a blood clot in a coronary artery causes a myocardial infarction. The other statements are not correct: The therapy will not reverse damage, decrease pain response quickly, or prevent new clots from forming.

The nurse is administering tenecteplase (TNKase) therapy to a patient experiencing an acute myocardial infarction. What will the nurse teach the patient about this therapy? A. "This therapy will quickly decrease your pain." B. "This therapy will prevent new clots from forming." C. "This therapy will reverse damage from the infarction." D. "This therapy will dissolve the clot that caused the heart attack."

B. "Take the drug in the evening." ***Cholesterol production by the liver usually occurs at night; thus, statin drugs such as atorvastatin [Lipitor] work by decreasing the cholesterol synthesis and are generally administered in the evening to reduce cholesterol production. All statins should be taken once daily during the evening meal or at bedtime. The drug need not be administered after breakfast because cholesterol level production is lesser in the mornings. Antacids may not be administered along with the drug as it doesn't cause gastric irritation. The desired therapeutic effects may not be produced if the drug is administered on an empty stomach.

The nurse is assessing a patient who has been prescribed atorvastatin [Lipitor]. What instruction should the nurse provide for the patient to ensure proper administration of the medication? A. "Take the drug after breakfast." B. "Take the drug in the evening." C. "Take the drug with an antacid." D. "Take the drug on an empty stomach."

C. Clostridium difficile test ***If the patient was previously treated with antibiotics and developed watery diarrhea, then the patient needs to be tested for Clostridium difficile (1) (2) infection. If the result of this test is positive, then the patient needs to be treated for a serious superinfection. Infections with Clostridium difficile are increasingly becoming resistant to standard therapy. Watery diarrhea is a common symptom of Clostridium difficile infection. Clostridium difficile bacteria are not present in sputum; therefore, a sputum test is not indicated. A test for Acinetobacter is not helpful in this situation because the symptoms are not suggestive of an infection caused by Acinetobacter. Culture and sensitivity testing is helpful to optimize drug selection in individual cases, but not in this situation.

The nurse is assessing a patient who has developed watery diarrhea. After checking the patient's history, the nurse finds that the patient was recently treated with antibiotics. Which further testing might be needed in this patient? A. Sputum test B. Acinetobacter test C. Clostridium difficile test D. Culture and sensitivity test

A. Naloxone hydrochloride (naracan) ***Naloxone is an opioid antidote used in opioid overdose (A) to reverse CNS and respiratory depression. Atropine (B) is used for bradycardia, intestinal hypertonicity and hypermotility, muscarinic agonist poisoning, peptic ulcer disease, and biliary colic. Vitamin K (C) is used to manage warfarin overdose and vitamin K deficiency in newborns. Flumazenil (D) reduces the sedative effects of benzodiazepines following general anesthesia or overdose.

The nurse is assessing a stuporuous client in the emergency department who is suspected of overdosing with opioids. Which agent should the nurse prepare to administer if the client becomes comatose? A. Naloxone hydrochloride (naracan) B. Atropine Sulfate C. Vitamin K D. Romazicon

D. The patient is experiencing adverse effects of the thyroid drugs. ***Anxiety, tachycardia, and insomnia are among the adverse effects of levothyroxine [Synthroid]. These adverse effects may be due to accumulation of the drug in the body; thus, they appear as symptoms of hyperthyroidism. These are not signs and symptoms of an allergic (hypersensitivity) reaction. Anxiety, tachycardia, and insomnia are not anticipated age-related symptoms. If the patient was not responding to the medication, then the patient would have decreased thyroid hormone levels, which would more likely be manifested by bradycardia and increased drowsiness or sleep.

The nurse is assessing an elderly patient who has been taking levothyroxine [Synthroid] for 6 months. The nurse finds that the patient has anxiety, tachycardia, and insomnia. What should the nurse interpret from these findings? A. The patient is hypersensitive to thyroid drugs. B. The patient has common age-related symptoms. C. The patient is not responding to the thyroid drugs. D. The patient is experiencing adverse effects of the thyroid drugs.

D. Teach the child to use a spacer. ***If a child is unable to use the inhaler, the medication will be trapped in the mouth. Using a spacer helps the medication to be deposited to the lungs.

The nurse is caring for a child who has been prescribed an inhaler for asthma control. The child is having difficulty using the inhaler. What will the nurse do? A. Tell the parent to hold the inhaler for the child. B. Ask the health care provider to switch to oral medications. C. Tell the parent that young children should not use inhalers. D. Teach the child to use a spacer.

A. Amoxicillin [Moxatag] ***Otitis media is a common disorder seen in infants and children. It is characterized by fever, discomfort (malaise), hearing defects, and sensation of fullness in the ears. However, it is also observed in adults, associated with bleeding of the tympanic membrane. Amoxicillin [Moxatag] is the first-line drug for the treatment of otitis media. Ofloxacin [Floxin Otic], ciprofloxacin [Ciprodex], and carbamide peroxide [Debrox] are not the drugs given as first-line medication in treating otitis media. Ofloxacin [Floxin Otic] and ciprofloxacin [Ciprodex] may be prescribed if the patient fails to respond to amoxicillin [Moxatag]. Carbamide peroxide [Debrox] is the drug used to soften earwax.

The nurse is caring for a child who is experiencing severe discomfort and high fever. The provider diagnoses acute otitis media. Which first-line drug will be included as a part of the treatment plan? A. Amoxicillin [Moxatag] B. Ofloxacin [Floxin Otic] C. Ciprofloxacin [Ciprodex] D. Carbamide peroxide [Debrox]

C. Dizziness ***Buspirone is an antianxiety medication with few side effects. The most common effects are dizziness, nausea, headache, nervousness, lightheadedness, and excitement. Buspirone does not cause drowsiness, risk for abuse, or weight gain.

The nurse is caring for a patient receiving buspirone [BuSpar] for the treatment of anxiety. Which symptom is most likely explained as an adverse effect of this drug? A. Diarrhea B. Risk for abuse C. Dizziness D. Weight gain

D. Carbidopa-levodopa [Sinemet] ***Tremors in the fingers, mask-like facial expressions, and bradykinesia are symptoms of parkinsonism. The patient should be prescribed anti-Parkinson's drugs such as carbidopalevodopa [Sinemet] to relieve the symptoms. This medication increases dopamine levels and reduces tremors and bradykinesia. Modafinil [Provigil] stimulates the central nervous system, is prescribed for the treatment of narcolepsy, and induces wakefulness. Bromocriptine [Parlodel] is a direct-acting dopamine agonist prescribed to younger patients. Since the patient is older, he or she will not be prescribed. Methylphenidate [Ritalin] is a stimulant prescribed for attention-deficit/hyperactivity disorder (ADHD).

The nurse is caring for a geriatric patient. During the assessment, the nurse finds that the patient has tremors in the fingers, a mask-like facial expression, and bradykinesia. Which drug would the nurse expect the primary healthcare provider to prescribe to the patient? A. Modafinil [Provigil] B. Bromocriptine [Parlodel] C. Methylphenidate [Ritalin] D. Carbidopa-levodopa [Sinemet]

C. To reduce the risk of suicide with overdose ***The SSRIs may be chosen because they have fewer side effects and are safer if an overdose occurs. However, the SSRIs can cause sexual dysfunction and weight gain, and they carry a risk of serotonin syndrome.

The nurse is caring for a group of patients being treated for depression. Why might a selective serotonin reuptake inhibitor (SSRI) be chosen over a tricyclic antidepressant (TCA)? A. To help prevent sexual dysfunction B. To prevent the risk of serotonin syndrome C. To reduce the risk of suicide with overdose D. To avoid weight gain and other gastrointestinal (GI) effects

A. To reduce the risk of suicide with overdose ***The SSRIs may be chosen because they have fewer side effects and are safer with overdose. However, the SSRIs can cause sexual dysfunction and weight gain, and they carry a risk of serotonin syndrome.

The nurse is caring for a group of patients being treated for depression. Why might an SSRI be chosen over a TCA? A. To reduce the risk of suicide with overdose B. To avoid weight gain and other gastrointestinal (GI) effects C. To help prevent sexual dysfunction D. To prevent the risk of serotonin syndrome

C. Acetylcholine ***Acetylcholine (ACh) levels naturally decline by a small percentage with age. Patients with severe AD may have ACh levels that are as much as 90% below normal. This is likely part of the explanation for the pathophysiology of AD.

The nurse is caring for a group of patients diagnosed with Alzheimer's disease (AD). Which neurotransmitter level is decreased by as much as 90% in patients with severe AD? A. Norepinephrine B. Serotonin C. Acetylcholine D. Dopamine

C. Acetylcholine ***Acetylcholine (ACh) levels naturally decline by a small percentage with age. Patients with severe AD may have ACh levels that are as much as 90% below normal. This is likely part of the explanation for the pathophysiology of AD.

The nurse is caring for a group of patients diagnosed with Alzheimer's disease (AD). Which neurotransmitter level is decreased by as much as 90% in patients with severe AD? A. Serotonin B. Dopamine C. Acetylcholine D. Norepinephrine

D. "You may be able to safely take a second-generation antihistamine." ***Second-generation antihistamines are often called non-sedating antihistamines. These may be safer for the patient to take, but the patient should still monitor for signs of excessive sedation.

The nurse is caring for a patient in the clinic who states that he is afraid of taking antihistamines because he is a truck driver. What is the best information for the nurse to give this patient? A. "Take the medication only when you are not driving." B. "Take a lower dose than normal when you have to drive." C. "You are correct; you should not take antihistamines." D. "You may be able to safely take a second-generation antihistamine."

B. Serotonin syndrome ***Serotonin syndrome can occur within 2 to 72 hours after initiation of treatment with an SSRI. The symptoms include altered mental status, incoordination, myoclonus, hyperreflexia, excessive sweating, tremor, and fever.

The nurse is caring for a patient in the emergency department who reports the onset of agitation, confusion, muscle twitching, diaphoresis, and fever about 12 hours after beginning a new prescription for escitalopram [Lexapro]. Which is the most likely explanation for these symptoms? A. Depressive psychosis B. Serotonin syndrome C. Escitalopram overdose D. Cholinergic crisis

C. Vomiting and diarrhea ***Vomiting and diarrhea can lead to hypokalemia, which increases the risk of digoxin toxicity. These symptoms, along with nausea, fatigue, and visual disturbances, also may precede digoxin toxicity and warrant further attention. The heart rate, potassium level, and digoxin level are within the normal range.

The nurse is caring for a patient prescribed digoxin [Lanoxin] for heart failure. Which finding would require immediate attention by the nurse? A. Potassium level of 3.7 mEq/L B. Digoxin level of 0.7 ng/mL C. Vomiting and diarrhea D. Heart rate of 68 beats per minute

A. Vomiting and diarrhea ***Vomiting and diarrhea can lead to hypokalemia, which increases the risk of digoxin toxicity. These symptoms, along with nausea, fatigue, and visual disturbances, also may precede digoxin toxicity and warrant further attention. A heart rate of 68 beats/min, potassium level of 3.7 mEq/L, and digoxin level of 0.7 ng/mL (0.5 to 0.8 being the optimal range) are within the normal range.

The nurse is caring for a patient prescribed digoxin [Lanoxin] for heart failure. Which finding would require immediate attention by the nurse? A. Vomiting and diarrhea B. Heart rate of 68 beats/min C. Digoxin level of 0.7 ng/mL D. Potassium level of 3.7 mEq/L

C. Distended neck veins and ankle edema ***An IV solution of 3% sodium chloride is hypertonic and may cause fluid overload. Signs of volume overload include distended neck veins and ankle edema. The blood urea nitrogen level and sodium level are normal values. Tenting of the skin and dry mucous membranes indicate volume contraction, which would not be a likely adverse effect of this therapy.

The nurse is caring for a patient receiving IV therapy with a 3% sodium chloride infusion at 75 mL/hr. The nurse should closely monitor for which adverse effect of treatment? A. Blood urea nitrogen of 22 mg/dL B. Tenting of the skin and dry mucous membranes C. Distended neck veins and ankle edema D. Sodium level of 140 mEq/L

B. Respiratory ***Pulmonary toxicity is the most serious potential adverse effect of amiodarone. It may manifest as pneumonitis or pulmonary fibrosis, with symptoms such as dyspnea, cough, and chest pain.

The nurse is caring for a patient receiving amiodarone [Cordarone]. Which body system should the nurse assess for serious adverse effects of this medication? A. Musculoskeletal B. Respiratory C. Integumentary D. Gastrointestinal

D. White blood cell (WBC) count of 2000/mm3 ***Clozapine, an atypical antipsychotic, carries a risk of fatal agranulocytosis. For this reason, the WBC count should be monitored and should be greater than 3500/mm3. Renal function (blood urea nitrogen) should not be affected by clozapine. Clozapine may cause metabolic effects, including diabetes, that would result in an increased blood glucose level (greater than 110 mg/dL). Elevated bilirubin indicates liver disease and is not commonly an adverse effect of clozapine.

The nurse is caring for a patient receiving clozapine [Clozaril]. Which assessment finding is most indicative of an adverse effect of this drug? A. Blood urea nitrogen level of 25 mg/dL B. Blood glucose level of 60 mg/dL C. Bilirubin level of 2.5 mg/dL D. White blood cell (WBC) count of 2000/mm3

C. Sexual dysfunction ***Fluoxetine [Prozac], a selective serotonin reuptake inhibitor (SSRI), does not cause anticholinergic effects, orthostatic hypotension, or cardiotoxicity, as do the tricyclic antidepressants. The most common adverse effects are sexual dysfunction, nausea, headache, and central nervous system stimulation.

The nurse is caring for a patient receiving fluoxetine [Prozac] for depression. Which adverse effect is most likely associated with this drug? A. Dry mouth B. Bradycardia C. Sexual dysfunction D. Orthostatic hypotension

A. Sexual dysfunction ***Fluoxetine [Prozac], a selective serotonin reuptake inhibitor (SSRI), does not cause anticholinergic effects, orthostatic hypotension, or cardiotoxicity, as do the tricyclic antidepressants. The most common adverse effects are sexual dysfunction, nausea, headache, and central nervous system stimulation.

The nurse is caring for a patient receiving fluoxetine [Prozac] for depression. Which adverse effect is most likely associated with this drug? A. Sexual dysfunction B. Dry mouth C. Orthostatic hypotension D. Bradycardia

D. To protect against reflex tachycardia ***Hydralazine is a vasodilator that lowers blood pressure, but it also can trigger reflex tachycardia. Beta blockers, such as propranolol, are added to the regimen to normalize the heart rate.

The nurse is caring for a patient receiving hydralazine [Apresoline]. The healthcare provider prescribes propranolol [Inderal]. The nurse knows that a drug such as propranolol often is combined with hydralazine for what purpose? A. To reduce the risk of headache B. To improve hypotensive effects C. To prevent heart failure D. To protect against reflex tachycardia

A. Swollen, tender gums B. Measles-like rash D. Unusual hair growth ***Adverse effects associated with phenytoin at therapeutic doses include mild sedation, gingival hyperplasia (swollen, tender gums), morbilliform (measles-like) rash, cardiovascular effects, and other effects, such as hirsutism (unusual hair growth) and interference with vitamin D metabolism.

The nurse is caring for a patient receiving phenytoin [Dilantin] for treatment of tonic-clonic seizures. Which symptoms, if present, would indicate an adverse effect of this drug? (Select all that apply.) A. Swollen, tender gums B. Measles-like rash C. Productive cough D. Unusual hair growth E. Nausea and vomiting

C. "I will drink grapefruit juice instead of coffee with breakfast." ***Grapefruit juice can greatly increase buspirone levels and should be avoided. The other statements are appropriate.

The nurse is caring for a patient taking buspirone [BuSpar]. Which statement by the patient indicates a need for further teaching about this drug? A. "This medication should not make me feel drowsy." B. "This medication should help me feel less anxious." C. "I will drink grapefruit juice instead of coffee with breakfast." D. "I will take my medication three times per day."

C. Aspirin (ASA) for mild headache ***Aspirin is safe to use as an analgesic with lithium. Other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can increase lithium levels by as much as 60%. Diuretics increase lithium levels by reducing the serum sodium level. Diphenhydramine has anticholinergic properties and can aggravate lithium-induced polyuria by causing urinary hesitancy.

The nurse is caring for a patient taking lithium [Lithobid]. The nurse understands that many drugs interact with lithium. Which agent is safe to administer with lithium? A. Ibuprofen [Motrin] for muscle pain B. Hydrochlorothiazide (HCTZ) for edema C. Aspirin (ASA) for mild headache D. Diphenhydramine [Benadryl] for cold symptoms

A. Toxicity ***Toxicity is the degree of detrimental physiologic effects caused by excessive drug dosing. A side effect is a nearly unavoidable secondary drug effect produced at a therapeutic dose. An allergic reaction is an immune response. An idiosyncratic effect is an uncommon drug response resulting from a genetic predisposition.

The nurse is caring for a patient who has a respiratory rate of 6 breaths/min following a large dose of pain medication. Which term most accurately describes this reaction? A. Toxicity B. Side effect C. Allergic reaction D. Idiosyncratic effect

C. Muscle spasticity ***Baclofen [Lioresal] is a muscle relaxant that is used to treat the spasticity of the muscles that occurs with multiple sclerosis. It does not specifically address muscle aching nor deterioration of muscle tissue.

The nurse is caring for a patient who has been diagnosed with multiple sclerosis. The healthcare provider opts to include baclofen [Lioresal] as part of this patient's treatment regimen. The nurse recognizes that this is an appropriate medication for this patient because the drug will treat which symptom? A. Muscle aching B. Muscle wasting C. Muscle spasticity D. Muscle deterioration

D. History, including allergies ***This drug is an antibiotic. Antibiotic allergy is one of the most common drug allergies. These allergies also have the potential to cause severe anaphylaxis and death and, therefore, have more importance than the other assessments listed.

The nurse is caring for a patient who has been prescribed cefazolin sodium [Ancef]. What is the priority nursing assessment? A. Cardiac assessment B. Neurologic assessment C. History of immunizations D. History, including allergies

B. "You can try enteric-coated aspirin." ***Gastric distress is a common problem with uncoated aspirin. Enteric-coated tablets can be used. Changing to another medication is not the first intervention in this case, and ibuprofen can also cause gastric distress. Milk may not relieve gastric distress.

The nurse is caring for a patient who states, "I probably shouldn't take aspirin. Won't it make my stomach hurt?" What is the nurse's best response to the patient? A. "Try taking the aspirin with milk." B. "You can try enteric-coated aspirin." C. "You should take ibuprofen instead." D. "I'll get you a prescription pain reliever."

A. High levels of low-density lipoproteins (LDL) ***High level of low-density lipoproteins (LDL) refers to high cholesterol levels in the blood, as LDL is almost entirely composed of cholesterol. This cholesterol is bad cholesterol, which promotes the formation of atherosclerotic plaque resulting in CHD. High-density lipoproteins (HDL) are good cholesterol, which has a cardioprotective action. Low levels of very-low-density lipoproteins (VLDL) are due to a low fat diet; however, it does not cause high cholesterol levels. Low levels of intermediate-density lipoproteins (IDL) do not increase the risk of CHD; they are useful for the production of bile acids.

The nurse is caring for a patient who has coronary heart disease (CHD). The nurse tells the patient, "Your cholesterol levels are abnormal; you are at a high risk of having a heart attack." What did the nurse discover regarding the lipoprotein levels in the patient's blood report? A. High levels of low-density lipoproteins (LDL) B. High levels of high-density lipoproteins (HDL) C. Low levels of very-low-density lipoproteins (VLDL) D. Low levels of intermediate-density lipoproteins (IDL)

B. Antagonist ***An antagonist drug is one that blocks the histamine receptors to prevent excessive gastric secretion. Drugs that produce a response are called agonists. For example, epinephrine [Adrenalin] is an agonist that stimulates beta1 and beta2 receptors. Nonspecific drugs affect various sites in the body. Bethanechol [Urecholine] is a nonspecific cholinergic drug that affects cholinergic receptors located in the eye, heart, blood vessels, stomach, bronchus, and bladder. Nonselective drugs affect various receptors. Chlorpromazine [Thorazine] acts on the norepinephrine, dopamine, acetylcholine, and histamine receptors, and a variety of responses result from action at these receptor sites.

The nurse is caring for a patient who is prescribed a drug to block the histamine receptors to prevent excessive gastric secretion. Which category of drugs does this medication belong to? A. Agonist B. Antagonist C. Nonspecific D. Nonselective

A. Monitor the patient's plasma drug level periodically. ***The therapeutic range of a drug is the range between the minimum effective concentration of the drug in the plasma to obtain the desired drug action and the minimum toxic concentration. The nurse must monitor the plasma drug level periodically to avoid drug toxicity while caring for a patient receiving a drug with a low therapeutic index, such as digoxin. Some medications, such as diphenhydramine [Benadryl], cause drowsiness as a side effect. In such cases, the nurse instructs patients not to drive after taking the medication. Some drugs bind to the protein molecules in the body. The nurse monitors serum albumin levels in patients receiving those drugs to determine the possibility of drug toxicity. Patients who are prescribed enteric-coated tablets should not eat a high-fat meal before taking the drug, as that will decrease the absorption rate of the drug.

The nurse is caring for a patient who is receiving a drug with a low therapeutic index. Which is the most important nursing intervention for this patient? A. Monitor the patient's plasma drug level periodically. B. Monitor the patient's serum albumin levels periodically. C. Instruct the patient not to drive after taking the medication. D. Instruct the patient not to take the drug after a high-fat meal.

C. Notify the healthcare provider of this information. ***Carvedilol [Coreg] should be used with caution in patients with a history of asthma. The priority for the nurse is to notify the healthcare provider of this information.

The nurse is caring for a patient who is scheduled to begin treatment with carvedilol [Coreg]. While updating the history, the patient tells the nurse that he experiences frequent attacks of asthma. What is the nurse's highest priority action? A. Expect a decreased effect from the medication. B. Expect an increased effect from the medication. C. Notify the healthcare provider of this information. D. Monitor the patient for a toxic reaction to the drug.

A. "Do not drive after taking this medication." ***First-generation antihistamines cause drowsiness. There is no evidence to indicate that the patient should force fluids, take the medication on an empty stomach, or place the medication on hold for any period of time.

The nurse is caring for a patient who is taking a first-generation antihistamine. What is the most important information for the nurse to teach the patient? A. "Do not drive after taking this medication." B. "Make sure you drink a lot of liquids while on this medication." C. "Take this medication on an empty stomach." D. "Do not take this medication for more than 2 days."

B. An allergic anaphylactic reaction ***The patient has developed an allergic anaphylactic reaction to the antibiotics. Flushing, itching, hives, anxiety, and throat and tongue swelling are symptoms associated with an allergic anaphylactic reaction. In this condition, the patient's pulse rate may become rapid and irregular. Watery diarrhea, abdominal pain, and fever are the symptoms of a Clostridium difficile infection. The administration of antibiotics to patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency leads to hemolysis. The patient has no symptoms associated with hemolysis and therefore does not have G6PD deficiency.

The nurse is caring for a patient who is taking antibiotics. The patient reports flushing, itching, hives, anxiety, and throat and tongue swelling. The nurse finds that the patient has a rapid, irregular pulse. Which condition may the patient have as a result of taking the antibiotic? A. Tolerance to the antibiotic drugs B. An allergic anaphylactic reaction C. Clostridium difficile bacterial infection D. Glucose-6-phosphate dehydrogenase (G6PD) deficiency

A. Cimetidine [Tagamet] ***Cimetidine will elevate phenytoin levels by reducing the rate at which phenytoin is metabolized. Phenytoin levels may increase to toxic levels. The use of cimetidine should generally be avoided in patients who are treated with phenytoin, because safer alternatives are available.

The nurse is caring for a patient who is taking phenytoin [Dilantin]. Which medication, if ordered by the physician, should the nurse question? A. Cimetidine [Tagamet] B. Captopril [Capoten] C. Pantoprazole [Protonix] D. Ondansetron [Zofran]

A. Document the findings and teach the patient. ***Red-orange discoloration of body fluids is a common side effect of rifampin (Rifadin), but it is not harmful and does not indicate infection. There is no need to call the health care provider, collect a urine culture, or start 24-hour urine collection.

The nurse is caring for a patient who is taking rifampin (Rifadin). The patient has a heart rate of 90 beats/min, blood pressure of 100/89 mm Hg, and red-orange urine. What is the nurse's best action? A. Document the findings and teach the patient. B. Call the health care provider. C. Collect a urine culture. D. Discard the first void and start a 24-hour urine collection.

A. Notify the provider of the new development. ***Angiotensin-converting enzyme (ACE) inhibitors prevent the breakdown of bradykinins, frequently causing a nonproductive cough. The patient should be switched to a different medication if the side effect cannot be tolerated. The cough will not subside in a few days. This is not a sign of infection but is a known side effect of ACE inhibitors. Medications will not make the cough subside.

The nurse is caring for a patient who takes an angiotensin-converting enzyme (ACE) inhibitor. If the patient develops a persistent nonproductive cough, what should the nurse do? A. Notify the provider of the new development. B. Tell the patient that the cough will subside in a few days. C. Assess the patient for other symptoms of upper respiratory infection. D. Instruct the patient to take antitussive medication until the symptoms subside.

A. Verify the patient's prescription. ***The nurse should listen and honor the patient's concerns. If the patient expresses a doubt regarding the medication, the nurse should cross-check the prescription. This helps the nurse to avoid medication errors. After cross-checking the prescription and finding the medication to be appropriate, the nurse can suggest that the patient take the medication. Many times the color of medications will be different because the pharmacy at the healthcare facility may use a different manufacturer than the one that produced the medication the patient has at home. Without confirming the medication, the nurse should not inform the patient that the new medication is prescribed. After cross-checking the prescription and finding the medication to be inappropriate, the nurse can notify the primary healthcare provider to change it.

The nurse is caring for a patient who tells the nurse, "I cannot take this medication because this tablet is white, and I take pink tablets at home." Which action is most appropriate? A. Verify the patient's prescription. B. Suggest the patient take the medication. C. Inform the patient that a new medication is prescribed. D. Notify the primary healthcare provider to change the medication.

C. Continue to assess the patient's oxygenation. ***The therapeutic theopylline level is 10 to 20 mcg/mL. The nurse should continue interventions and monitor oxygenation.

The nurse is caring for a patient with a theophylline level of 14 mcg/mL. What is the priority nursing intervention? A. Increase the IV drip rate. B. Monitor the patient for toxicity. C. Continue to assess the patient's oxygenation. D. Stop the IV for an hour then restart at lower rate.

D. The patient should have effective relief from the manic symptoms. ***There is a narrow therapeutic window between the therapeutic and toxic serum levels of lithium. A serum lithium level of 1 to 1.4 mEq/L is optimum for the treatment of acute mania. Therefore, a serum lithium level of 1.2 mEq/L indicates that the patient will have effective relief from the manic symptoms. If the serum lithium level is less than 1 mEq/L, then the patient may have persistent manic symptoms. If the lithium serum level is more than 1.5 mEq/L, then the patient may have lithium toxicity, which is characterized by impaired liver and renal functioning. The adverse effects of lithium toxicity include cardiac dysrhythmia and tremors.

The nurse is caring for a patient with acute mania who has been prescribed lithium carbonate [Lithobid]. The blood tests of the patient indicate the serum lithium level to be 1.2 mEq/L. What does the nurse interpret from this? A. The patient will have persistent manic symptoms. B. The patient may have cardiac dysrhythmia and tremors. C. The patient may have impaired liver and renal functioning. D. The patient should have effective relief from the manic symptoms.

A. Sodium level of 128 mEq/L ***The sodium level is well below the normal range of 135 to 145 mEq/L. When the serum sodium level is reduced, lithium excretion also is reduced, and lithium accumulates. Because lithium has a narrow therapeutic index, this is a dangerous situation that can result in symptoms of toxicity and even death.

The nurse is caring for a patient with bipolar disorder (BPD) who is taking lithium [Lithobid]. Which abnormal laboratory value is most essential for the nurse to communicate to the healthcare provider because this patient is taking lithium? A. Sodium level of 128 mEq/L B. Prothrombin time of 8 seconds C. Potassium level of 5.6 mEq/L D. Blood urea nitrogen level of 25 mg/dL

A. Sodium level of 128 mEq/L ***The sodium level is well below the normal range of 135 to 145 mEq/L. When the serum sodium level is reduced, lithium excretion also is reduced, and lithium accumulates. Because lithium has a narrow therapeutic index, this is a dangerous situation, which can result in symptoms of toxicity and even death.

The nurse is caring for a patient with bipolar disorder (BPD) who is taking lithium [Lithobid]. Which abnormal laboratory value is most essential for the nurse to communicate to the healthcare provider because this patient is taking lithium? A. Sodium level of 128 mEq/L B. Prothrombin time of 8 seconds C. Blood urea nitrogen level of 25 mg/dL D. Potassium level of 5.6 mEq/L

C. Spironolactone [Aldactone] ***Spironolactone is a potassium-sparing diuretic used to treat both hypertension and edema. It is a preferred drug in heart failure, because it has been shown to have a cardioprotective effect, reducing mortality in patients with heart failure.

The nurse is caring for a patient with heart failure who needs a diuretic. Which agent is likely to be chosen, because it has been shown to greatly reduce mortality in patients with heart failure A. Furosemide [Lasix] B. Hydrochlorothiazide [HydroDIURIL] C. Spironolactone [Aldactone] D. Mannitol [Osmitrol]

C. "Discontinue administering the medication." ***The presence of myoglobin in the urine indicates that the patient has rhabdomyolysis, an adverse effect of statins such as simvastatin [Zocor]. Rhabdomyolysis is characterized by the breakdown of muscle proteins and can be fatal. The primary healthcare provider would instruct the nurse to discontinue the medication. Reducing the dose of the medication to 10 mg, giving the medication before meals, or administering the medication with high amounts of fluids does not prevent rhabdomyolysis.

The nurse is caring for a patient with hypercholesterolemia who is taking 20 mg of simvastatin [Zocor] as prescribed. After a few days, the patient's urinalysis reports indicated the presence of myoglobin. What instruction would the nurse receive from the primary healthcare provider? A. "Give 10 mg of medication daily." B. "Give the medication before meals." C. "Discontinue administering the medication." D. "Give the medication with 250 mL of water."

C. Cardiac ***The most serious consequence of hyperkalemia is disruption of the electrical activity of the heart. Because hyperkalemia alters the generation and conduction of cardiac impulses, alterations in the electrocardiogram (ECG) and cardiac rhythm are usually the earliest signs that potassium levels are growing dangerously high. Assessments of lung, kidney, and abdomen are not as critical for hyperkalemia.

The nurse is caring for a patient with hyperkalemia. Which assessment is priority? A. Lung B. Kidney C. Cardiac D. Abdomen

B. Peripheral vasodilation C. Coronary vasodilation ***Verapamil causes peripheral vasodilation and coronary vasodilation, which lead to decreased blood pressure and improved coronary perfusion. It does not cause vasoconstriction and usually has little effect on the heart rate or contractility in healthy hearts.

The nurse is caring for a patient with hypertension who is receiving verapamil [Calan]. The patient has a healthy heart. What pharmacodynamic effects does the nurse expect from this drug? (Select all that apply.) A. Peripheral vasoconstriction B. Peripheral vasodilation C. Coronary vasodilation D. Increased heart rate E. Increased force of contraction

C. The nurse should administer the medication 30 minutes before meals. ***Patients with myasthenia gravis have difficulty in swallowing food. To prevent dysphagia, the nurse should administer the medication 30 minutes before meals, so the drug exerts its effects (ie, decreases dysphagia in the patient). The nurse should not avoid giving fluids such as fruit juices or fiber-rich food such as oats and beetroot, unless this is recommended by the primary healthcare provider. Administering the drug at bedtime, when the patient does not need the added boost of muscle strength, will not be helpful for the patient.

The nurse is caring for a patient with myasthenia gravis who has been prescribed cholinergic medications. Which nursing action should the nurse adopt while caring for the patient? A. The nurse should administer the medication at bedtime. B. The nurse should avoid giving oats and beetroot to the patient. C. The nurse should administer the medication 30 minutes before meals. D. The nurse should avoid giving fruit juices and corn soup to the patient.

D. Serum albumin levels ***A patient with renal failure is likely to have low serum albumin levels, resulting in fewer protein-binding sites. This can lead to an excess of free drug, which in turn causes drug toxicity. The nurse need not assess the lipid profile, as it is used to determine the risk for cardiovascular disease. The hemoglobin level is used to detect anemia. Blood glucose level is used to determine whether the patient is diabetic or has a normal blood sugar level.

The nurse is caring for a patient with renal failure who is prescribed a protein-bound drug. Which parameter in the patient must the nurse assess before administering the medication? A. Lipid profile B. Hemoglobin level C. Blood glucose level D. Serum albumin levels

B. The active drug is reduced from its original quantity. C. The drug enters the hepatic portal circulatory system. E. Prodrugs are converted to the active form before entering the systemic circulation. ***When some medications are administered orally, the drug goes from the intestinal lumen to the liver via the hepatic portal vein. This process is called the first-pass effect or hepatic first pass. First-pass metabolism takes place in the liver, where the drug is metabolized to an inactive form that is excreted. This reduces the amount of active drug. Prodrugs are converted to their active form.

The nurse is caring for an adult patient who is prescribed a medication as an injection because it has extensive first-pass metabolism. What happens when a drug is affected by first-pass metabolism? Select all that apply. A. The drug goes directly into the systemic circulation. B. The active drug is reduced from its original quantity. C. The drug enters the hepatic portal circulatory system. D. It bypasses absorption and goes directly into distribution. E. Prodrugs are converted to the active form before entering the systemic circulation.

D. The patient with atrial fibrillation with a rate of 100 ***The side effects of epinephrine include tachycardia, dysrhythmias, and palpitations. This patient should not receive epinephrine.

The nurse is caring for multiple patients on the pulmonary unit. The nurse would question the administration of prescribed epinephrine to which patient? A. The patient with a history of emphysema B. The patient with a history of type 2 diabetes C. The patient who is 16 years old D. The patient with atrial fibrillation with a rate of 100

D. Rise slowly from a sitting to standing position. ***Vasodilators place patients at increased risk of falls. Patients should also be taught that they can minimize postural (orthostatic) hypotension by avoiding abrupt transitions from a supine or seated position to an upright position. Grapefruit does not affect the metabolism of vasodilators. Wearing hats and using a straw are not necessary with vasodilators.

The nurse is caring for patients receiving vasodilators. Which instruction should the nurse give the patients to combat a common adverse effect? A. Wear a hat when outdoors. B. Avoid taking with grapefruit juice. C. Drink the oral solution through a straw. D. Rise slowly from a sitting to standing position.

D. The patient receiving mechlorethamine with pain at the IV insertion site ***Mechlorethamine (1) (2) (nitrogen mustard) is a vesicant and can cause severe local injury if it infiltrates into the tissues. Pain at the IV site is an indication of possible infiltration and needs to be addressed. Doxorubicin causes a harmless red color in urine and sweat so it is not a priority. An elevated platelet count is not a cause for concern. A patient urinating 100 mL an hour while receiving cyclophosphamide is also not a concern because this is normal urine output.

The nurse is caring for several patients receiving chemotherapy on the cancer unit. Which patient will the nurse assess first? A. The patient receiving doxorubicin who has reddish color sweat B. The patient receiving fluorouracil with an elevated platelet count C. The patient receiving cyclophosphamide who is urinating 100 mL/hr D. The patient receiving mechlorethamine with pain at the IV insertion site

C. Atrial fibrillation ***Nifedipine produces very little blockade of the calcium channels of the heart; therefore, it is ineffective for treating dysrhythmias, such as atrial fibrillation. Therapeutic uses for nifedipine include the treatment of angina pectoris, essential hypertension, and vasospastic angina.

The nurse is caring for several patients. For which patient diagnosis would a prescription for nifedipine [Adalat] be least appropriate? A. Angina pectoris B. Essential hypertension C. Atrial fibrillation D. Vasospastic angina

B. Hepatotoxicity ***In the United States, kava is promoted as a natural alternative to benzodiazepines to treat anxiety and stress. However, kava has the risk for the serious adverse effect of hepatotoxicity, which led the U.S. Food and Drug Administration (FDA) to issue a public warning in March 2002. In addition, in 2002, the Centers for Disease Control and Prevention issued a report on kava-related hepatotoxicity.

The nurse is completing an admission assessment for a patient who requires treatment of an anxiety disorder. The patient states, "I take the dietary supplement kava every day to help my anxiety and stress." The nurse understands the patient is at risk for which serious adverse effect? A. Stroke B. Hepatotoxicity C. Suicidal behavior D. Acute renal failure

A. "Be sure to call the clinic if you or your family notice increased anxiety or agitation." B. "You may have some mild sedation. Do not drive until you know how this drug will affect you." D. "It is very important to have good oral hygiene and to visit your dentist regularly." ***Patients taking an antiepileptic drug are at increased risk for suicidal thoughts and behavior beginning early in their treatment. The U.S. Food and Drug Administration (FDA) advises that patients, families, and caregivers be informed of the signs that may precede suicidal behavior and be encouraged to report these immediately. Mild sedation can occur in patients taking phenytoin, even at therapeutic levels. Carbamazepine, not phenytoin, increases the risk for hematologic effects, such as easy bruising. Phenytoin causes gingival hyperplasia in about 20% of patients who take it; dental hygiene is important. Patients receiving phenytoin should avoid alcohol and other central nervous system depressants, because they have an additive depressant effect.

The nurse is conducting discharge teaching related to a new prescription for phenytoin [Dilantin]. Which statements are appropriate to include in the teaching for this patient and family? (Select all that apply.) A. "Be sure to call the clinic if you or your family notice increased anxiety or agitation." B. "You may have some mild sedation. Do not drive until you know how this drug will affect you." C. "This drug may cause easy bruising. If you notice this, call the clinic immediately." D. "It is very important to have good oral hygiene and to visit your dentist regularly." E. "You may continue to have wine with your evening meals, but only in moderation."

D. "I will take the medication every day before breakfast." ***The enzyme that helps metabolize cholesterol is activated at night, so this medication should be taken with the evening meal (D). (A, B, and C) reflect correct information about lovastatin.

The nurse is evaluating a client's understanding of the prescribed antilipemic drug lovastatin (Mevacor). Which client statement indicates that further teaching is needed? A. "My bowel habits should not be affected by this drug." B. "This medication should be taken once a day only." C. "I will still need to follow a low-cholesterol diet." D. "I will take the medication every day before breakfast."

C. "I will use a salt substitute to lower my sodium intake." ***Salt substitutes contain potassium and may increase the risk of hyperkalemia with ACE inhibitors, such as fosinopril. The patient should not take potassium supplements or use salt substitutes. The other statements are appropriate for this patient.

The nurse is evaluating the teaching done with a patient who has a new prescription for fosinopril [Monopril]. Which statement by the patient indicates a need for further teaching? A. "I can take this medicine with breakfast each morning." B. "I will call if I notice a rash or wheals on my skin." C. "I will use a salt substitute to lower my sodium intake." D. "I will call if I develop a bothersome cough."

C. Angiotensin receptor blocker

The nurse is going over the discharge instructions with a client. The client asks for the nurse to review his new set of medications and tells her that he previously was unable to tolerate Ramipril [Altace], the nurse would check if this medication is replaced by with which type of antihypertensive? A. Calcium channel blocker B. Beta blocker C. Angiotensin receptor blocker D. Loop diuretic

C. Angioedema ***Angioedema is a strong vascular reaction involving inflammation of submucosal tissue (eg, laryngeal edema) and can result in anaphylaxis. Fatigue and a dry, nonproductive cough are adverse reactions but are not life-threatening. Diarrhea is not an adverse effect.

The nurse is instructing a patient about potential adverse effects of a prescribed angiotensin-converting enzyme (ACE) inhibitor. The nurse should instruct the patient to immediately seek medical attention if which adverse effect occurs? A. Fatigue B. Diarrhea C. Angioedema D. Dry, nonproductive cough

C. "You should discuss any plans to take herbal medications with your primary healthcare provider." ***Herbal drugs, as conventional drugs, may interact with drugs being taken for a number of conditions and/or may worsen those conditions, so decisions should be made in consultation with the primary care provider. Most herbal medications are available at a lower cost because of the low cost of production. Overall, herbal medications tend to be less expensive than conventional medications. Herbal supplements are made from natural substances, so they have fewer side effects compared to conventional medications. Herbal medications are supplied without a prescription.

The nurse is interviewing a patient who has chronic obstructive pulmonary disease (COPD). The patient wants to use herbal medications rather than conventional medications to treat a cold. Which statement made by the nurse is appropriate? A. "Herbal supplements have more side effects than conventional medications." B. "Many herbal medications are very expensive compared to conventional medications." C. "You should discuss any plans to take herbal medications with your primary healthcare provider." D. "You will need a prescription from your primary healthcare provider for herbal medications."

A. Creatinine level ***The creatinine level and other indicators of kidney function should be monitored closely due to the risk of renal failure when a patient is taking vancomycin. Electroencephalogram is used to check brain waves, alkaline phosphatase is a liver function test, and creatine phosphokinase (CPK) is an enzyme in the heart, brain, and skeletal muscle. Abnormal results of those tests or labs are not indicative of kidney failure as are creatinine levels.

The nurse is monitoring a patient on vancomycin for indications of major toxicity. Which test should be monitored closely? A. Creatinine level B. Alkaline phosphatase C. Electroencephalogram D. Creatine phosphokinase (CPK)

C. Discolored urine ***The primary and most serious adverse effect of heparin is bleeding. Bleeding can occur from any site and may be manifested in various ways, including reduced blood pressure, increased heart rate, bruises, petechiae, hematomas, red or black stools, cloudy or discolored urine, pelvic pain, headache, and lumbar pain.

The nurse is monitoring a patient receiving a heparin infusion for the treatment of pulmonary embolism. Which assessment finding most likely relates to an adverse effect of heparin? A. Heart rate of 60 beats per minute B. Blood pressure of 160/88 mm Hg C. Discolored urine D. Inspiratory wheezing

B. hyperglycemia ***Corticosteroids affect almost all body systems. Endocrine system reactions may include decreased glucose tolerance, resulting in hyperglycemia and possibly precipitating diabetes mellitus.

The nurse is monitoring a patient receiving prednisone. For which adverse reaction should the nurse monitor the patient? A. somnolence B. hyperglycemia C. hyperkalemia D. hypercalcemia

D. "Have you had any changes in your mood or anxiety level?" ***In the early phase of treatment for depression, suicide risk may increase. Patients should be monitored closely for worsening mood, unusual changes in behavior, and suicide risk. The other questions would be useful in assessing the patient for adverse effects of amitriptyline [Elavil], but assessing suicide risk is the most important intervention.

The nurse is monitoring a patient with depression in the early phase of treatment with amitriptyline [Elavil]. Which question is most important for the nurse to ask the patient? A. "Have you noticed dry mouth or blurred vision?" B. "Have you had any changes in your urine function?" C. "When was your last bowel movement?" D. "Have you had any changes in your mood or anxiety level?"

B. Anorexia C. Vomiting E. Visual disturbances ***Anorexia, vomiting, visual disturbances (blurred or yellow vision or appearance of halos around dark objects), fatigue, and nausea frequently foreshadow more serious toxicity (dysrhythmias) and should be reported immediately. Dry cough is a common side effect associated with angiotensin-converting enzyme inhibitors. Digoxin rarely causes diarrhea.

The nurse is monitoring a patient with suspected digoxin toxicity. Which assessment findings would be consistent with digoxin toxicity? Select all that apply. A. Diarrhea B. Anorexia C. Vomiting D. Dry cough E. Visual disturbances

D. Ask the patient about pain status, location, type of pain, how the pain changes with time, what makes it better, or worse, and how much it impairs the ability to function. ***Assessment before opioid administration should include: (1) asking the patient about pain status, (2) where the pain is located, (3) what type of pain is present, (4) how the pain changes with time, (5) what makes it better or worse, and (6) how much it impairs his or her ability to function. It is not as important to ask the patient about what type of medication he or she prefers, what he or she takes at home, the anxiety level, depressive state, fears, or anger.

The nurse is performing an assessment on a patient. What is essential before opioid administration? A. Ask the patient about pain status and what is preferred for pain. B. Ask the patient about pain status, anxiety level, depressive state, fears, and if there is any anger. C. Ask the patient about pain status, what type of pain medicine is taken at home, and if a pill or an injection is preferred. D. Ask the patient about pain status, location, type of pain, how the pain changes with time, what makes it better, or worse, and how much it impairs the ability to function.

B. Obtaining deep tendon reflexes ***Magnesium sulfate acts to suppress uterine contractions through inhibition of acetylcholine at the neuromuscular junction in the uterine muscle. Loss of the patellar reflex is an early indicator of high magnesium levels. Assessments of body temperature, intake and output, and contraction intensity are necessary but not as important as deep tendon reflexes.

The nurse is planning care for a patient in preterm labor who is receiving magnesium sulfate. Which nursing action is most important for this patient? A. Measuring intake and output B. Obtaining deep tendon reflexes C. Documenting body temperature D. Monitoring the intensity of contraction

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

The nurse is planning care for a patient receiving morphine sulfate [Duramorph] by means of a patient-controlled analgesia (PCA) pump. Which intervention may be required because of a potential adverse effect of this drug? A. Administering a cough suppressant B. Inserting a Foley catheter C. Administering an antidiarrheal D. Monitoring liver function tests

C. Sedation and dry mouth ***Anticholinergic effects (dry mouth, blurred vision, constipation, tachycardia, urinary retention) and sedation are potential adverse effects of the tricyclic antidepressants (TCAs), such as imipramine [Tofranil]. The most serious common adverse effect is orthostatic hypotension; therefore, a blood pressure of 160/90 mm Hg probably is not caused by this drug. Respiratory problems are not commonly associated with the TCAs.

The nurse is planning care for a patient taking imipramine [Tofranil]. Which finding, if present, would most likely be an adverse effect of this drug? A. Blood pressure of 160/90 mm Hg B. Insomnia and diarrhea C. Sedation and dry mouth D. Tachypnea and wheezing

C. Fluid volume deficit ***Acute adrenal insufficiency (adrenal crisis) is characterized by hypotension, dehydration, weakness, lethargy, and gastrointestinal (GI) symptoms of nausea and vomiting. Rapid replacement of fluid, salt, and glucocorticoids is essential to prevent shock and death. Comfort, nutrition, and activity are important to address once fluid balance has been restored.

The nurse is planning care for a patient with signs of acute adrenal insufficiency. What is the priority nursing diagnosis? A. Altered comfort B. Altered nutrition C. Fluid volume deficit D. Activity intolerance

A. Decrease the oral secretions. ***Atropine sulfate (Atropine), an anticholinergic agent, is given to decrease oral secretions during a surgical procedure (A). (B, C, and D) are not actions of anticholinergic agents.

The nurse is preparing a child for transport to the operating room for an emergency appendectomy. The anesthesiologist prescribes atropine sulfate (Atropine), IM STAT. What is the primary purpose for administering this drug to the child at this time? A. Decrease the oral secretions. B. Reduce the child's anxiety C. Potentiate the opioid effects D. Prevent possible peritonitis

B. Risk for infection ***Corticosteroids depress the immune system, placing the client at risk for infection (B). Although (A, C, and D) reflect diagnostic statements that may be applicable to this client, only (B) is directly related to the administration of this medication.

The nurse is preparing a plan of care for a client receiving the glucocorticoid methylprednisolone (Solu-Medrol). Which nursing diagnosis reflects a problem related to this medication that should be included in the care plan? A. Ineffective airway clearance B. Risk for infection C. Deficient fluid volume D. Impaired gas exchange

A. Metabolic syndrome ***Olanzapine [Zyprexa] is approved for monotherapy of acute mania in patients with bipolar disorder. This drug has a high risk of metabolic effects, and patients should be taught about assessing for potential weight gain, diabetes, and dyslipidemia.

The nurse notes olanzapine [Zyprexa] on a patient's drug history upon admission. The nurse should plan to teach the patient about which disorder? A. Metabolic syndrome B. Paranoid schizophrenia C. Obsessive-compulsive disorder D. Schizophrenia positive symptoms

B. suppress the release of histamine and other mediators from the mast cells. ***Leukotriene modifiers are used in the treatment of patients with asthma to suppress the release of histamine and other mediators from the mast cells. In the treatment of patients with COPD, bronchodilators such as sympathomimetics, parasympatholytics, and methylxanthines are used to assist in opening narrowed airways; expectorants are used to loosen mucus from the airways, and antibiotics may be prescribed to prevent serious complications from bacterial infection.

The nurse is preparing class for patients with asthma. The nurse will inform the patients that leukotriene modifiers are used in the treatment of asthma to A. assist in opening narrowed airways. B. suppress the release of histamine and other mediators from the mast cells. C. loosen mucus from the airways. D. prevent serious complications from bacterial infections.

C. Potassium chloride 10 mEq in 100 mL IV over 1 hour ***IV potassium must be diluted (never given IV push) and infused slowly, at a rate no faster than 10 mEq/hr. Faster infusions of potassium can lead to cardiac toxicity.

The nurse is preparing to administer IV potassium to a patient with hypokalemia. Which prescription is the most appropriate? A. Potassium chloride 30 mEq in 100 mL IV over 1 hour B. Potassium chloride 10 mEq in 100 mL IV over 30 minutes C. Potassium chloride 10 mEq in 100 mL IV over 1 hour D. Potassium chloride 10 mEq IV push over 1 minute

A. Analyze heart rate and rhythm. ***Before giving digoxin, the nurse will assess the heart rate and rhythm. The dosage will be held and the prescriber notified if the heart rate is below 60 beats per minute or if the cardiac rhythm has changed. Digoxin can cause bradycardia and electrical changes in the heart.

The nurse is preparing to administer a daily dose of digoxin [Lanoxin]. What is the priority nursing intervention? A. Analyze heart rate and rhythm. B. Assess for Homans' sign. C. Check blood pressure. D. Palpate the pedal pulses.

D. Analyze heart rate and rhythm. ***Before giving digoxin [Lanoxin], the nurse should assess heart rate and rhythm. The dosage will be held and the prescriber notified if the heart rate is below 60 beats/min or if the cardiac rhythm has changed. Digoxin [Lanoxin] can cause bradycardia and electrical changes in the heart.

The nurse is preparing to administer a daily dose of digoxin [Lanoxin]. What is the priority nursing intervention? A. Check blood pressure. B. Palpate the pedal pulses. C. Assess for Homans' sign. D. Analyze heart rate and rhythm.

D. The nurse administers enoxaparin [Lovenox] intramuscularly to a patient. ***The nurse should not administer an anticoagulant intramuscularly as this would cause a high risk of bleeding into the muscle and a large hematoma to form at the injection site. The other medications can be administered via the routes listed.

The nurse is preparing to administer an anticoagulant to a patient. Which action, if observed, is in error? A. The nurse administers heparin subcutaneously to a patient. B. The nurse administers warfarin [Coumadin] orally to a patient. C. The nurse administers dabigatran [Pradaxa] orally to a patient. D. The nurse administers enoxaparin [Lovenox] intramuscularly to a patient.

B. Notify the healthcare provider and delay drug administration. ***Respiratory depression is a side effect of opioid analgesia. Therefore, because the patient's respiratory rate is below normal, the nurse should withhold the morphine and notify the healthcare provider.

The nurse is preparing to administer an injection of morphine to a patient. Assessment notes a respiratory rate of 10 breaths/min. Which action will the nurse perform? A. Administer a smaller dose and record the findings. B. Notify the healthcare provider and delay drug administration. C. Hold the drug, record the assessment, and recheck in 1 hour. D. Administer the prescribed dose and notify the healthcare provider.

A. Give the medication. ***Determine heart rate and rhythm prior to administration. If heart rate is less than 60 beats/min or if a change in rhythm is detected, withhold digoxin and notify the healthcare provider.

The nurse is preparing to administer an oral dose of digoxin [Lanoxin]. The apical pulse rate is 64. What nursing action is most appropriate? A. Give the medication. B. Obtain a serum digoxin level. C. Notify the healthcare provider. D. Assess for signs of digoxin toxicity.

A. Give the medication. ***Determine heart rate and rhythm prior to administration. If heart rate is less than 60 beats/min or if a change in rhythm is detected, withhold digoxin and notify the healthcare provider.

The nurse is preparing to administer an oral dose of digoxin [Lanoxin]. The apical pulse rate is 64. Which nursing action is most appropriate? A. Give the medication. B. Obtain a serum digoxin level. C. Notify the healthcare provider. D. Assess for signs of digoxin toxicity.

B. Ensure the patency of the IV site. C. Tell the patient the urine turns red. D. Place the patient on a cardiac monitor. ***Doxorubicin [Adriamycin] is an antitumor antibiotic with cardiotoxic adverse effects. Cardiac activity may be assessed with a monitor, because acute dysrhythmias and electrocardiographic (ECG) changes can occur within minutes of administration. The medication imparts a harmless red color to urine. IV patency is critical, because doxorubicin [Adriamycin] is a vesicant and can cause significant local tissue injury if extravasation occurs. It is not necessary to infuse normal saline for 24 hours before administration or give a diuretic after the infusion.

The nurse is preparing to administer doxorubicin [Adriamycin] intravenously (IV) to a patient with breast cancer. Which actions should the nurse take? Select all that apply. A. Give a diuretic after the infusion. B. Ensure the patency of the IV site. C. Tell the patient the urine turns red. D. Place the patient on a cardiac monitor. E. Infuse normal saline for the preceding 24 hours.

C. Potassium chloride 10 mEq in 100 mL IV over 1 hour ***IV potassium must be diluted (never given IV push) and infused slowly, at a rate no faster than 10 mEq/hr. Faster infusions of potassium can lead to cardiac toxicity.

The nurse is preparing to administer intravenous (IV) potassium to a patient with hypokalemia. Which prescription is the most appropriate? A. Potassium chloride 10 mEq IV push over 1 minute B. Potassium chloride 30 mEq in 100 mL IV over 1 hour C. Potassium chloride 10 mEq in 100 mL IV over 1 hour D. Potassium chloride 10 mEq in 100 mL IV over 30 minutes

D. oral anticoagulants ***Cimetidine may increase the blood levels of oral anticoagulants by reducing their metabolism in the liver and excretion.

The nurse understands that which drug or drug type may interact with the H2-receptor antagonist cimetidine? A. hormonal contraceptives B. antilipemic agents C. digoxin D. oral anticoagulants

D. It has more hazardous side effects and drug interactions. ***Phenelzine [Nardil], a monoamine oxidase inhibitor (MAOI), is considered a second- or third-line treatment because of the risk of triggering hypertensive crisis when the patient eats foods high in tyramine. Also, an increased incidence of drug-drug interactions is seen with phenelzine. Phenelzine does not pose an increased risk for suicide, psychoses, or parkinsonism, and it is as effective as the tricyclic and selective serotonin reuptake inhibitor (SSRI) antidepressants.

The nurse is preparing to administer phenelzine [Nardil] to a patient with depression. Why is this drug considered a second- or third-line agent in the treatment of depression? A. It increases the risk of suicide in the early phase. B. It is less effective than the tricyclic antidepressants. C. It increases the risk of psychoses and parkinsonism. D. It has more hazardous side effects and drug interactions.

D. It has more side effects and drug interactions. ***Phenelzine [Nardil], a monoamine oxidase inhibitor (MAOI), is considered a second- or third-line treatment because of the risk of triggering hypertensive crisis when the patient eats foods high in tyramine. Also, an increased incidence of drug-drug interactions is seen with phenelzine. Phenelzine does not pose an increased risk for suicide, psychoses, or parkinsonism, and it is as effective as the tricyclic and SSRI antidepressants.

The nurse is preparing to administer phenelzine [Nardil] to a patient with depression. Why is this drug considered a second- or third-line agent in the treatment of depression? A. It increases the risk of suicide in the early phase. B. It is less effective than the tricyclic antidepressants. C. It increases the risk of psychoses and parkinsonism. D. It has more side effects and drug interactions.

C. 2 ***The ordered dose is 400 mg, and the available tablets are 200 mg. 200 mg × 2 tablets equals the 400-mg ordered dose.

The nurse is preparing to administer quetiapine extended release 400 mg PO every day as ordered. The available medication is quetiapine 200-mg extended-release tablets. How many tablets should the nurse administer? A. 0.5 B. 1 C. 2 D. 4

C. Evaluate the patient's overall knowledge related to the diagnosis and medication. ***The highest priority nursing action for this patient is to evaluate the patient's overall knowledge related to his diagnosis and medications. Knowing what the patient already knows provides a foundation for additional teaching. Questioning does not indicate a risk for medication noncompliance. Reassurance of monitoring does not address the patient's concerns for learning about the diagnosis and medications. Determining coping skills, while important, does not address the patient's questions.

The nurse is providing care for a newly admitted patient. The patient has many questions about the admission diagnosis and medication. What should be the highest priority nursing action for this patient? A. Determine the patient's coping skills for dealing with his diagnosis. B. Reassure the patient that nurses will monitor for adverse effects to medication. C. Evaluate the patient's overall knowledge related to the diagnosis and medication. D. Document that the patient displays a risk for medication noncompliance due to knowledge deficit.

A. Avoid ingesting any alcohol or acetaminophen (Tylenol). ***Combining hepatotoxic drugs, such as acetaminophen and alcohol, increases the risk of liver damage, so (A) is an important discharge instruction. Although clients who receive hepatotoxic drugs should be screened for any changes in serum liver function test (LFT) results, (B) is not indicated. Rest is advantageous during an infectious process, but activity restriction (C) is unnecessary. A client who is receiving a hepatotoxic drug should report any hepatotoxic symptoms, such as jaundice, dark urine, or light-colored stools, but an increased appetite (D) does not need medical attention.

The nurse is providing discharge instructions to a client who has received a prescription for an antibiotic that is hepatotoxic. Which information should the nurse include in the instructions? A. Avoid ingesting any alcohol or acetaminophen (Tylenol). B. Schedule a follow-up visit for a liver biopsy in 1 month. C. Activities that are strenuous should be avoided. D. Notify the health care provider of any increase in appetite.

B. "I will limit my alcohol to one drink per day." ***Alcohol can intensify the hypotensive effects of nitrates, so the patient should avoid alcohol. Patients develop tolerance to nitrates rather quickly. Patients receiving transdermal nitrates are recommended to have 10 to 12 hours of patch-free time each evening. Sildenafil [Viagra] and other drugs for erectile dysfunction also can cause significant hypotension with nitroglycerin and are contraindicated. Nitroglycerin causes orthostatic hypotension; therefore, patients should change positions slowly.

The nurse is providing discharge teaching for a patient with a new prescription for a nitroglycerin transdermal patch. Which statement by the patient indicates a need for further teaching? A. "I will remove my patch at bedtime each evening." B. "I will limit my alcohol to one drink per day." C. "I will not use Viagra as long as I am on nitroglycerin." D. "I will move slowly when changing positions."

D. "Confirm with your healthcare provider that any herbs you take will not interact with prescribed medications." ***The highest priority teaching point is that the patient should seek education and confirm with a healthcare provider that any herbs taken will not have an adverse effect if taken with prescribed medications.

The nurse is providing education to a group of patients interested in complementary medicine. Which teaching point should the nurse include as priority education for the group? A. "Understand the use of any herb before taking it." B. "Stop taking any herb if you note any adverse effects." C. "Read the directions and labels of all herbs before taking." D. "Confirm with your healthcare provider that any herbs you take will not interact with prescribed medications."

A. Hypokalemia ***Low potassium levels enhance the effects of neuromuscular blocking agents, so the health care provider should be informed of the client's hypokalemia (A). (B, C, and D) are of concern but do not enhance the effects of neuromuscular blocking agents.

The nurse is reviewing a client's laboratory results before a procedure in which a neuromuscular blocking agent is a standing order. Which finding should the nurse report to the health care provider? A. Hypokalemia B. Hyponatremia C. Hypercalcemia D. Hypomagnesemia

B. Assessing lithium levels every other week

The nurse is reviewing a patient's medication history and notes that the patient recently began taking lithium (Lithibid). What intervention is a priority for this patient? A. Monitoring for the recurrence of seizure activity B. Assessing lithium levels every other week C. Asking the patient if they have ringing in the ears D. Monitoring the patient's intake and output

A. Platelets 95,000/mm3 ***A platelet count of less than 100,000/mm3 indicates thrombocytopenia. This significantly increases the patient's risk of bleeding. Heparin should be withheld. In addition, thrombocytopenia at the onset of heparin therapy confounds the ability of the healthcare team to detect heparin-induced thrombocytopenia. The INR, aPTT, and potassium levels are all within normal limits.

The nurse is reviewing laboratory data before initiating a patient's heparin infusion. Which finding requires immediate action? A. Platelets 95,000/mm3 B. Potassium 3.5 mEq/L C. International normalized ratio (INR) of 1 D. Activated partial thromboplastin time (aPTT) of 37 seconds

A. Release of renin B. Increased heart rate D. Increased AV conduction velocity ***Beta1 receptors are located in the heart and the kidney. The response to receptor activation will result in increased heart rate, increased force of contraction of heart, increased AV conduction velocity, and release of renin. It is beta2 receptors that result in dilation of arterioles.

The nurse is reviewing medications that act as beta1 receptors. Which of these are responses to beta1 receptor activation? Select all that apply. A. Release of renin B. Increased heart rate C. Dilation of arterioles D. Increased AV conduction velocity E. Decreased force of contraction of heart

D. Oral forms of drugs must pass through the liver first, where more of the dose is metabolized. ***Oral doses of medication are usually larger than parenteral doses to compensate for the first-pass effect in the liver after oral administration (D), which metabolizes more of the drug's dose before affecting its therapeutic response. Although recommended dose ranges for adults should be individualized, a client's pain should be controlled at discharge, not (A or C). (B) is inaccurate information to convey to the client.

The nurse is reviewing prescribed medications with a female client who is preparing for discharge. The client asks the nurse why the oral dose of an opioid analgesic is higher than the IV dose that she received during hospitalization. Which response is best for the nurse to provide? A. A higher dose of analgesic medication may be needed after discharge. B. An error in the dose calculation may have occurred when the prescribed dose was converted. C. The doses should be the same unless the pain is not well controlled. D. Oral forms of drugs must pass through the liver first, where more of the dose is metabolized.

B. Itching and pain D. Secretion of mucus F. Increased capillary permeability ***Histamine1 release promotes vasodilation not vasoconstriction. Increased capillary permeability occurs, which produces edema. Bronchoconstriction occurs, not bronchodilation. Itching and pain are produced as a result of sensory nerve responses. Histamine1 release is associated with secretion of mucus. Secretion of gastric acid is a histamine2 response.

The nurse is reviewing the actions of histamine1 release in the allergic response. The nurse recalls that which of the following effects can be caused by histamine1 release? Select all that apply. A. Bronchodilation B. Itching and pain C. Vasoconstriction D. Secretion of mucus E. Secretion of gastric acid F. Increased capillary permeability

A. Reports sore throat ***Sore throat is a sign of neutropenia in a patient receiving an angiotensin-converting enzyme (ACE) inhibitor. Neutropenia, with its associated risk of infection, is a rare but serious complication. Calcium channel blockers (CCB), verapamil, and hydrochlorothiazide can be used safely in patients with bronchial asthma, a condition that precludes the use of beta2-adrenergic antagonists. ACE inhibitors can benefit patients with diabetic nephropathy, slowing the progression of renal disease. ACE inhibitors can cause severe renal insufficiency in patients with bilateral renal artery stenosis or stenosis in the artery to a single remaining kidney; however, this patient has no history of this.

The nurse is reviewing the chart for a patient who has been receiving an angiotensin-converting enzyme (ACE) inhibitor for 4 days. Which finding would cause the nurse to hold the ACE inhibitor until evaluated by the patient's primary care provider? A. Reports sore throat B. Has bronchial asthma C. Diabetic with nephropathy D. No history of renal artery stenosis

A. Hypertension ***The primary indication for hydrochlorothiazide is hypertension, a condition for which thiazides are often the drugs of first choice. Hydrochlorothiazides are used for the other conditions, but the primary indication is hypertension.

The nurse is reviewing the home medication list with the patient. The nurse recognizes that hydrochlorothiazide is used primarily for which condition? A. Hypertension B. Edema C. Diabetes insipidus D. Protection against postmenopausal osteoporosis

B. Clopidogrel [Plavix] 75 mg daily ***For patients who lack risk factors for GI bleeding, combined use of clopidogrel with a PPI, such as omeprazole, may reduce the effects of clopidogrel without offering any real benefits and thus should be avoided. This is due to inhibition of CYP2C19, which converts the drug to its active form. Nothing in the question indicates that the patient is at risk for GI bleeding. The other options are not cause for concern.

The nurse is reviewing the prescriber's orders and notes that omeprazole [Prilosec] has been ordered for a patient admitted with acute coronary syndrome (ACS). The nurse should be concerned if this medication is combined with which medication noted on the patient's record? A. Aspirin 81 mg daily B. Clopidogrel [Plavix] 75 mg daily C. Heparin 5000 units subQ every 12 hours D. Metoprolol 50 mg every 8 hours

B. Stimulation of sympathetic nerves to veins causes vasoconstriction. ***Stimulation of sympathetic nerves to arteries and veins causes vasoconstriction; stimulation to the heart causes increased cardiac output, and stimulation to the adrenal medulla causes vasoconstriction in vascular beds.

The nurse is reviewing the sympathetic nervous system (SNS) effects on the heart and blood vessels. Which statement is correct regarding the effect of SNS stimulation? A. Stimulation of sympathetic nerves to arteries causes vasodilation. B. Stimulation of sympathetic nerves to veins causes vasoconstriction. C. Stimulation of sympathetic nerves to the heart decreases cardiac output. D. Stimulation of sympathetic nerves to the adrenal medulla causes increased heart rate.

A. "Hypertension is a risk factor for stroke." C. "Hypertension is a risk factor for heart failure." E. "Hypertension is a risk factor for cardiovascular disease." ***Hypertension is a risk factor for cardiovascular disease, stroke, and heart failure. It is not a risk factor for emphysema or diabetes.

The nurse is teaching the patient why hypertension must be treated. What information should be included in the teaching plan? Select all that apply. A. "Hypertension is a risk factor for stroke." B. "Hypertension is a risk factor for diabetes." C. "Hypertension is a risk factor for heart failure." D. "Hypertension is a risk factor for emphysema." E. "Hypertension is a risk factor for cardiovascular disease."

C. Instruct the laboratory to draw the trough immediately before the next scheduled dose. ***The best time to draw a trough is the closest time to the next administration (C). (A) will provide a peak level. (B) will not provide the most accurate trough level. The medication is given before peak and trough levels are obtained (D).

The nurse is scheduling a client's antibiotic peak and trough levels with the laboratory personnel. What is the best schedule for drawing the trough level? A. Give the dose of medication, and call the laboratory to draw the trough STAT. B. Arrange for the laboratory to draw the trough 1 hour after the dose is given. C. Instruct the laboratory to draw the trough immediately before the next scheduled dose. D. Give the first dose of medication after the laboratory reports that the trough has been drawn.

B. A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L ***Lithium levels above 1.5 mEq/L should be reported, because this level may indicate impending serious toxicity. The other findings may be side effects of the drugs the patients are taking, but they are not priority problems.

The nurse is seeing several patients in the outpatient clinic today. Which patient most requires the nurse's immediate attention? A. A female patient with BPD who takes valproic acid [Depakene] and who reports nausea and vomiting B. A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L C. A male patient with depression who takes fluoxetine [Prozac] and who reports sexual dysfunction D. A female patient with schizophrenia who takes haloperidol [Haldol] and who has a blood pressure of 102/72 mm Hg

A. A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L ***Lithium levels above 1.5 mEq/L should be reported because this level may indicate impending, serious toxicity. The other findings may be side effects of the drugs the patients are taking, but they are not priority problems.

The nurse is seeing several patients in the outpatient clinic. Which patient most requires the nurse's immediate attention? A. A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L B. A male patient with depression who takes fluoxetine [Prozac] and who reports sexual dysfunction C. A female patient with schizophrenia who takes haloperidol [Haldol] and who has a blood pressure of 102/72 mm Hg D. A female patient with bipolar disorder (BPD) who takes valproic acid [Depakene] and who reports nausea and vomiting

A. withdraws the NPH insulin first

The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching? A. withdraws the NPH insulin first B. withdraws the regular insulin first C. injects air into NPH insulin vial first D. injects an amount of air equal to the desired dose of insulin into each vial

A. "The SNS regulates control of vision." ***Regulation of vision control is a function of the parasympathetic nervous system. The cardiovascular system, body temperature, and acute stress response are all regulated by the sympathetic nervous system.

The nurse is teaching a group of coworkers about the functions of the sympathetic nervous system (SNS). Which statement by a coworker would require correction? A. "The SNS regulates control of vision." B. "The SNS regulates body temperature." C. "The SNS regulates the acute stress response." D. "The SNS regulates the cardiovascular system."

C. Exposure to allergen F. Production of immunoglobulin E A. Antibodies attach to mast cells and basophils B. Reexposure to the allergen E. Antibody binds with allergen D. Histamine is released ***Antibodies are generated following exposure to specific allergens. Once made, the antibodies become attached to the outer surface of mast cells and basophils. When the individual is reexposed to the allergen, the allergen becomes bound by the antibodies. Binding of the allergen to adjacent antibodies creates a bridge between those antibodies. This bridging process mobilizes intracellular calcium. The calcium, in turn, causes the histamine-containing storage granules to fuse with the cell membrane and release their contents into the extracellular space.

The nurse is teaching a group of coworkers the process of the allergic release of histamine. In which order will the nurse present the steps of this process? A. Antibodies attach to mast cells and basophils B. Reexposure to the allergen C. Exposure to allergen D. Histamine is released E. Antibody binds with allergen F. Production of immunoglobulin E

C. Increased heart rate E. Release of renin from kidneys ***Beta1 receptors are located in the heart and the kidney. Cardiac beta 1 receptors have great therapeutic significance. Activation of these receptors increases heart rate, force of contraction, and velocity of impulse conduction through the atrioventricular node. Activation of beta 1 receptors in the kidney causes release of renin into the blood. Relaxation of the uterus and dilation of bronchi is a function of Beta2, and penile ejaculation is a function of alpha1 receptors.

The nurse is teaching a group of nurses the significance of beta1 receptor activation. What are the responses of this activation? Select all that apply. A. Penile ejaculation B. Dilation of bronchi C. Increased heart rate D. Relaxation of the uterus E. Release of renin from kidneys

C. "Read food labels and reduce your intake of saturated fats." ***An increase in dietary cholesterol intake does not produce a large increase in blood cholesterol because of the body's feedback system. When cholesterol intake increases, endogenous production decreases. However, because the body uses dietary saturated fats to make cholesterol, an increase in saturated fat intake can produce a significant increase in blood cholesterol levels. To lower blood cholesterol, it is most important to lower saturated fat intake. Although red meat and pork should be limited, it is not necessary to eliminate them from the diet. Sodium intake is not directly related to lowering cholesterol levels.

The nurse is teaching a group of patients about dietary approaches to reduce cholesterol levels. Which statement is most important to include in the teaching? A. "Lower your cholesterol to 300 mg/day." B. "Eliminate red meat and pork from your diet." C. "Read food labels and reduce your intake of saturated fats." D. "Reduce salt consumption to keep your sodium intake to 2400 mg/day."

B. Furosemide may increase blood glucose levels ***Furosemide is administered with caution in clients with diabetes mellitus because it can increase blood glucose levels. It does not cause anuria.

The nurse knows to take caution in giving Furosemide [Lasix] to clients with diabetes mellitus because: A. Furosemide may cause anuria in a client with diabetes mellitus B. Furosemide may increase blood glucose levels C. Furosemide may cause hypoglycemia D. None of the above

A. The nurse will obtain a translator to assist with teaching. ***The nurse should arrange a translator while interacting with the patient who has a language barrier. It helps the patient to effectively understand all teaching regarding precautions and the frequency of drug administration. The nurse should clearly explain the instructions before asking the patient to read the black box warning as patients might not understand some of the instructions. The nurse should arrange for a translator rather than asking the patient to call the healthcare provider. The healthcare provider may not be able to properly convey the instructions given by the nurse. The nurse's teaching techniques, such as how to provide a self-injection of insulin therapy, will not help the patient understand the complete drug information. The nurse should demonstrate the technique in the presence of a translator so the patient can follow the instructions of the nurse.

The nurse is teaching a patient about his medications. The nurse notes that the patient has difficulty understanding instructions because of a language barrier. Which action will help the patient understand the instructions? A. The nurse will obtain a translator to assist with teaching. B. The nurse will instruct the patient to read the black box warnings. C. The nurse will advise the patient to call the provider for more information. D. The nurse will demonstrate how to administer the medication and provide written information.

A. "Do not take more than 4000 mg per day." E. "Watch over-the-counter medications for acetaminophen in the product to prevent an overdose." ***Over-the-counter medication such as cold medications can contain acetaminophen, which could increase the dosage. The maximum daily dosage is 4000 mg. While drinking alcohol increases the risk for liver damage, the recommendation is to decrease the dosage to 2000 mg for those individuals who drink more than three alcoholic beverages per day. Undernourished individuals should decrease the dosage to no more than 3000 mg per day.

The nurse is teaching a patient about the appropriate dose for acetaminophen. What should the nurse include? Select all that apply. A. "Do not take more than 4000 mg per day." B. "Undernourished patients should not take acetaminophen." C. "Drinking alcohol and taking acetaminophen will cause death." D. "There are no risks associated with acetaminophen consumption." E. "Watch over-the-counter medications for acetaminophen in the product to prevent an overdose."

A. It maintains the body temperature. C. It regulates the cardiovascular system. D. It implements the "fight-or-flight" reaction. ***The functions of the sympathetic nervous system include regulating the cardiovascular system, implementing the fight-or-flight reaction, and maintaining the body temperature. The sympathetic nervous system dilates bronchial smooth muscles. The parasympathetic nervous system is responsible for controlling the amount of gastric secretions.

The nurse is teaching a patient about the functions of the sympathetic nervous system related to a prescribed medication. What should the nurse tell the patient about the functions of this system? Select all that apply. A. It maintains the body temperature. B. It alters the secretion of gastric juices. C. It regulates the cardiovascular system. D. It implements the "fight-or-flight" reaction. E. It constricts the bronchial smooth muscles.

C. "Increase your fluid intake in order to decrease viscosity of secretions." ***Expectorant drugs are used to decrease viscosity of secretions and allow them to be more easily expectorated. Increasing fluid intake helps this action.

The nurse is teaching a patient about the use of an expectorant. What is the most important instruction for the nurse to include in the patient teaching? A. "Restrict your fluids in order to decrease mucus production." B. "Take the medication once a day only, at bedtime." C. "Increase your fluid intake in order to decrease viscosity of secretions." D. "Increase your fiber and fluid intake to prevent constipation."

C. Anticoagulants prevent clots from forming. ***The patient needs to understand that anticoagulants will prevent new clots from forming but will not dissolve clots that are already formed. Anticoagulants inhibit clotting by acting on clotting factors and do not alter platelets or drug metabolism.

The nurse is teaching a patient about therapy with anticoagulants. What is essential information to include in the teaching plan? A. Anticoagulants dissolve clots. B. Anticoagulants alter platelet function. C. Anticoagulants prevent clots from forming. D. Anticoagulants interfere with drug metabolism.

B. "Our goal is to reduce your seizures to an extent that helps you live a normal life." ***Epilepsy is treated successfully with medication in most patients. However, the dosages needed to completely eliminate seizures may cause intolerable side effects. Neurosurgery is indicated only for patients in whom medication therapy is unsuccessful.

The nurse is teaching a patient newly diagnosed with epilepsy about her disease. Which statement made by the nurse best describes the goals of therapy with antiepilepsy medication? A. "With proper treatment, we can completely eliminate your seizures." B. "Our goal is to reduce your seizures to an extent that helps you live a normal life." C. "Epilepsy medication does not reduce seizures in most patients." D. "These drugs will help control your seizures until you have surgery."

C. Avoid potassium salt substitutes. D. A persistent dry cough may occur. E. Report difficulty in breathing immediately. ***Salt substitutes contain potassium and may increase the risk of hyperkalemia with ACE inhibitors. A persistent, dry, nonproductive cough may develop. Angioedema includes edema of the tongue, glottis, and pharynx that may cause difficulty breathing which requires immediate medical attention. Captopril [Capoten] must be taken at least one hour before meals. A sore throat and fever are not expected adverse effects. ACE inhibitors can lower white cell count and decrease the body's ability to fight an infection. Early signs of infection include fever and sore throat.

The nurse is teaching a patient prescribed captopril [Capoten] for the treatment of hypertension. Which instructions should the nurse include? (Select all that apply.) A. Take the medication with food. B. Expect a sore throat and fever. C. Avoid potassium salt substitutes. D. A persistent dry cough may occur. E. Report difficulty in breathing immediately.

A. Nausea B. Malaise C. Jaundice D. Vomiting ***Drug toxicity is an adverse drug reaction in which certain drugs are toxic to specific organs. Signs and symptoms of liver toxicity include jaundice, dark urine, light-colored stools, nausea, vomiting, malaise, abdominal discomfort, and loss of appetite.

The nurse monitors for adverse effects in a patient prescribed isoniazid for the treatment of tuberculosis. Which signs and symptoms would alert the nurse to the presence of drug-induced liver toxicity? Select all that apply. A. Nausea B. Malaise C. Jaundice D. Vomiting E. Cloudy urine

A. Expect a persistent dry cough. D. Avoid potassium salt substitutes. E. Report difficulty in breathing immediately. ***Salt substitutes contain potassium and may increase the risk of hyperkalemia with angiotensin-converting enzyme (ACE) inhibitors. A persistent, dry, nonproductive cough may develop. Angioedema includes edema of the tongue, glottis, and pharynx that may cause difficulty breathing, which requires immediate medical attention. Captopril [Capoten] must be taken at least one hour before meals. A sore throat and fever are not expected adverse effects. ACE inhibitors can lower white cell count and decrease the body's ability to fight an infection. Early signs of infection include fever and sore throat.

The nurse is teaching a patient prescribed captopril [Capoten] for the treatment of hypertension. Which instructions should the nurse include? Select all that apply. A. Expect a persistent dry cough. B. Take the medication with food. C. Expect a sore throat and fever. D. Avoid potassium salt substitutes. E. Report difficulty in breathing immediately.

A. "This medication may cause some sexual side effects. Let your healthcare provider know about this if it occurs." B. "When you stop taking this medication, you should not withdraw it abruptly." E. "Let your family or your healthcare provider know if you experience a worsening mood, agitation, or increased anxiety." ***Citalopram [Celexa] and other SSRIs can cause sexual side effects that patients may be hesitant to report. SSRIs should be withdrawn slowly to prevent dizziness, headache, dysphoria, and/or other symptoms of withdrawal. The SSRIs do not generally cause orthostatic hypotension or drowsiness. All antidepressants initially increase the risk of suicide, and patients should be monitored for worsening mood and other signs of suicide risk.

The nurse is teaching a patient who has a new prescription for citalopram [Celexa]. Which statement is appropriate to include in the teaching plan? (Select all that apply.) A. "This medication may cause some sexual side effects. Let your healthcare provider know about this if it occurs." B. "When you stop taking this medication, you should not withdraw it abruptly." C. "You will need to move slowly from a sitting to a standing position to prevent dizziness from low blood pressure." D. "This medication often causes drowsiness. You should take it at bedtime." E. "Let your family or your healthcare provider know if you experience a worsening mood, agitation, or increased anxiety."

C. "I will call my doctor if I begin having menstrual irregularities." ***Spironolactone is a potassium-sparing, aldosterone-blocking diuretic. As such, it can cause endocrine effects, such as gynecomastia, menstrual irregularities, impotence, hirsutism, and deepening of the voice. Patients taking spironolactone should avoid salt substitutes because they contain potassium, and high-potassium foods should be avoided with this drug. Ideally, all diuretics should be taken in the morning to prevent nocturia.

The nurse is teaching a patient who has a new prescription for spironolactone [Aldactone]. Which statement by the patient indicates that the teaching was effective? A. "I will use salt substitutes to lower my sodium intake." B. "I will increase my intake of foods that are high in potassium." C. "I will call my doctor if I begin having menstrual irregularities." D. "I will take this medication at bedtime each evening."

D. "I will take the dose only in the morning." ***To minimize nocturia, hydrochlorothiazide [Microzide] should not be taken late in the day. Taking the dose only in the morning indicates teaching was successful. Diuretics are to be taken in the morning because they cause urination at night (nocturia) and subsequent loss of sleep when taken late in the afternoon or night. Limiting oats is not necessary for a diuretic. Instructing the patient to not eat melons or grapes is not appropriate for diuretic teaching. Hydrochlorothiazide does not cause anemia; therefore, an iron supplement is not needed.

The nurse is teaching a patient who has been prescribed hydrochlorothiazide [Microzide]. Which statement from the patient indicates a correct understanding of the teaching? A. "I will limit my intake of oats." B. "I will not eat melons or grapes." C. "I will take iron supplements every day." D. "I will take the dose only in the morning."

B. "I will rise slowly when changing from a sitting to a standing position." ***Vasodilators may cause postural hypotension and reflex tachycardia. Patients should be taught to move slowly when changing positions to prevent dizziness.

The nurse is teaching a patient who has just been prescribed a vasodilator. Which statement by the patient indicates that the teaching was effective? A. "I can take this medication in the morning to reduce nighttime urination." B. "I will rise slowly when changing from a sitting to a standing position." C. "My heart rate may slow down with this drug. I will call if my pulse is below 60." D. "I need to increase my intake of fluids and foods that are high in fiber."

A. "I will rise slowly when changing from a sitting to a standing position." ***Vasodilators may cause postural hypotension and reflex tachycardia. Patients should be taught to move slowly when changing positions to prevent dizziness.

The nurse is teaching a patient who has just been prescribed a vasodilator. Which statement by the patient indicates that the teaching was effective? A. "I will rise slowly when changing from a sitting to a standing position." B. "I need to increase my intake of fluids and foods that are high in fiber." C. "I can take this medication in the morning to reduce nighttime urination." D. "My heart rate may slow down with this drug. I will call if my pulse is below 60."

A. Sweating B. Headache F. Tachycardia ***The effects of hypoglycemia are largely attributable to stimulation of the central nervous system because low blood glucose stresses the body. When hypoglycemia occurs, the sympathetic nervous system responds in an attempt to increase blood glucose. Clinical indicators of hypoglycemia mimic sympathetic nervous system stimulation; they include headaches, diaphoresis (sweating), tachycardia, palpitations, and anxiety.

The nurse is teaching a patient who has type 1 diabetes mellitus how to prevent hypoglycemia. Which clinical indicators of hypoglycemia should the nurse identify for the patient and family? Select all that apply. A. Sweating B. Headache C. Polyphagia D. Weight loss E. Dehydration F. Tachycardia

A. "When it is time to discontinue this drug, you will need to taper it off slowly." ***Alprazolam [Xanax] is a benzodiazepine for which abrupt discontinuation can precipitate withdrawal symptoms. Patients should withdraw the drug gradually over several weeks. The other statements are not related to alprazolam [Xanax].

The nurse is teaching a patient with a new prescription for alprazolam [Xanax]. Which statement is the most appropriate to include in the teaching plan? A. "When it is time to discontinue this drug, you will need to taper it off slowly." B. "Protect your skin from the sun to prevent rash and exaggerated sunburn." C. "Increase your intake of fluid and high-fiber foods to prevent constipation." D. "Take this medication on an empty stomach at least 2 hours after meals."

C. "With the first patch, it will take about 24 hours before you feel the full effects." ***Full analgesic effects can take up to 24 hours to develop with fentanyl patches. Most patches are changed every 72 hours. Fentanyl has the same adverse effects as other opioids, including respiratory depression. Patients should avoid exposing the patch to external heat sources, because this may increase the risk of toxicity.

The nurse is teaching a patient with cancer about a new prescription for a fentanyl [Sublimaze] patch, 25 mcg/hr, for chronic back pain. Which statement is the most appropriate to include in the teaching plan? A. "You will need to change this patch every day, regardless of your pain level." B. "This type of pain medication is not as likely to cause breathing problems." C. "With the first patch, it will take about 24 hours before you feel the full effects." D. "Use your heating pad for the back pain. It will also improve the patch's effectiveness."

A. "I will increase my intake of fluid and foods high in fiber." C. "I will call my healthcare provider if I notice swelling in my ankles." ***Verapamil often causes constipation and can also cause peripheral edema. Patients should take measures to prevent constipation and should call about new symptoms of peripheral edema. Patients taking verapamil should not experience photosensitivity, hyperkalemia, or increased bruising and bleeding.

The nurse is teaching a patient with essential hypertension who has a new prescription for verapamil [Calan]. Which statements by the patient indicate that the teaching was effective? (Select all that apply.) A. "I will increase my intake of fluid and foods high in fiber." B. "I should stay out of direct sunlight to prevent exposing my skin to the sun." C. "I will call my healthcare provider if I notice swelling in my ankles." D. "I need to avoid salt substitutes and potassium supplements." E. "I may notice easy bruising and bleeding with this drug."

D. "Take this medicine on an empty stomach in the morning, at least 30 to 60 minutes before eating." ***Patients who are prescribed thyroid replacements or antithyroid drugs should be advised to take the medicine on an empty stomach in the morning, at least 30 to 60 minutes before eating. This helps enhance the absorption of the drug. Taking the medication twice a day after meals may reduce the therapeutic effectiveness of the medication and cause adverse effects. A patient needs to avoid eating foods that may reduce thyroid hormone production and reduce the effectiveness of the medication. Therefore, the nurse should not give false information that the patient need not follow dietary restrictions. This medication should be taken with water rather than orange juice, as it helps enhance the disintegration and absorption of the drug.

The nurse is teaching safe administration of medication to a patient who has been prescribed levothyroxine [Levoxyl]. Which statement should the nurse include in the teaching session? A. "Take this medication with 250 mL of orange juice." B. "Always take the medication three times a day, after meals." C. "There are no dietary restrictions while taking this medication." D. "Take this medicine on an empty stomach in the morning, at least 30 to 60 minutes before eating."

B. "When I am traveling for work I will take lower doses." ***To mimic normal cortisol secretion, patients can take the entire daily dose in the morning immediately after waking. If this schedule results in afternoon or evening fatigue, patients may split the dosage, taking two-thirds in the morning and one-third around 4:00 in the afternoon. Stress, such as travel for work, may require an increase in medication.

The nurse is teaching the patient about oral steroid therapy for chronic adrenal insufficiency. Which statement by the patient indicates a need for further teaching? A. "I can take my full dose in the morning." B. "When I am traveling for work I will take lower doses." C. "I understand that I shouldn't experience many adverse effects." D. "I can break up my dose and take some in the afternoon if I get tired."

D. "When I am traveling for work I will take lower doses." ***To mimic normal cortisol secretion, patients can take the entire daily dose in the morning, immediately after waking. If this schedule results in afternoon or evening fatigue, patients may split the dosage, taking two-thirds in the morning and one-third around 4:00 in the afternoon. Stress, such as travel for work, may require an increase in medication.

The nurse is teaching the patient about oral steroid therapy. Which statement by the patient indicates a need for further teaching? A. "I can take my full dose in the morning." B. "I can break up my dose and take some in the afternoon if I get tired." C. "I understand that I shouldn't experience many adverse effects." D. "When I am traveling for work I will take lower doses."

B. "This medication will help prevent the inflammatory response of my allergies." ***Beclomethasone diproprionate (Beconase) is a steroid spray administered nasally. It is used to prevent allergy symptoms. Its effect is localized, and therefore the patient does not have systemic side effects with normal use and does not have to worry about weaning off the medication as with oral corticosteroids. Because the medication has a localized effect, it will not produce the changes in blood sugar that would be generated by systemic steroids.

The nurse is teaching the patient on the use of beclomethasone diproprionate (Beconase). Which statement by the patient indicates an understanding of the teaching? A. "I will need to taper off the medication to prevent acute adrenal crisis." B. "This medication will help prevent the inflammatory response of my allergies." C. "I will need to monitor my blood sugar more closely because it may increase." D. "I need to take this medication only when my symptoms get bad."

C. "If I notice my skin turning yellow or feel any nausea, I'll notify my healthcare provider." ***Itraconazole may cause liver injury, and although a causal link has not been identified, patients need to be informed about symptoms to report. These include jaundice, nausea, and right upper abdominal pain. It is not necessary to take diphenhydramine, wear sunscreen, or avoid citrus products while taking itraconazole.

The nurse is teaching the patient scheduled to start taking itraconazole [Sporanox]. Which statement by the patient would indicate understanding of the teaching? A. "It's important to remember to wear sunscreen while taking this medicine." B. "I'll avoid citrus foods, such as oranges and grapefruits, while taking this medication." C. "If I notice my skin turning yellow or feel any nausea, I'll notify my healthcare provider." D. "I'll take diphenhydramine [Benadryl] before this medication so I don't have a reaction."

8 minutes ***The nurse administers IV phenytoin no faster than 50 mg/min to reduce the risk of cardiovascular collapse. Calculation: (1 min/50 mg) × 400 mg = 400 ÷ 50 = 8 minutes.

The nurse needs to administer phenytoin [Dilantin] 400 mg IV bolus to a patient. At a minimum, over how many minutes should the nurse administer this dose? Record your answer using a whole number. _____ minutes

B. The nurse will call the healthcare provider. ***If the nurse cannot understand all components of a drug order, the nurse needs to call the healthcare provider who wrote the order. There is no substitute for talking to the healthcare provider to explain the order; however, part of any assessment includes looking up the name of the medication and asking the patient what medications were taken at home. The pharmacy could be called with general questions, but the person who wrote the order is the one who needs to be contacted whenever there is confusion or misunderstanding.

The nurse is unable to read the drug name on a medication order. What action will the nurse perform first? A. The nurse will call the pharmacy. B. The nurse will call the healthcare provider. C. The nurse will look up the generic name of the medication. D. The nurse will ask the patient what medications he or she was taking at home.

A. Mannitol [Osmitrol] ***Intracranial pressure (ICP) that has been elevated by cerebral edema can be reduced with mannitol [Osmitrol]. The drug lowers ICP because its presence in the blood vessels of the brain creates an osmotic force that draws edematous fluid from the brain into the blood. Metolazone [Zaroxolyn] and hydrochlorothiazide [Microzide] are thiazide-like diuretics; spironolactone [Aldactone] is a potassium-sparing diuretic; they are of little benefit in reducing cerebral edema.

The nurse is working in the emergency department when a patient with a head injury develops increased intracranial pressure. Which drug would the nurse anticipate administering? A. Mannitol [Osmitrol] B. Metolazone [Zaroxolyn] C. Spironolactone [Aldactone] D. Hydrochlorothiazide [Microzide]

B. The development of opioid dependence is rare when opioids are used for acute pain. ***The development of dependence on or addiction to opioids as a result of clinical exposure is extremely rare. In fact, some estimate that only 25% of patients receive doses of opioids that are sufficient to relieve suffering. Only about 8% of the population is estimated to be prone to drug abuse. Morphine is a drug of abuse, but this fact is not helpful in guiding clinical practice. A patient-controlled analgesia (PCA) pump provides the most consistent pain relief, better than PRN and fixed-dosing schedules.

The nurse is working on a postoperative unit in which pain management is part of routine care. Which statement is the most helpful in guiding clinical practice in this setting? A. At least 30% of the U.S. population is prone to drug addiction and abuse. B. The development of opioid dependence is rare when opioids are used for acute pain. C. Morphine is a common drug of abuse in the general population. D. The use of PRN (as needed) dosing provides the most consistent pain relief without risk of addiction.

B. Diazepam [Valium] ***Diazepam [Valium] is known for being used to treat anxiety and muscle spasm and spasticity. Temazepam [Restoril] and quazepam [Doral] are used to treat insomnia. Clonazepam [Klonopin] is used to treat seizures and anxiety.

The nurse is working with a patient who asks for medication for anxiety and a drug to relieve muscle spasms. Which benzodiazepine does the nurse anticipate will be ordered for the patient? A. Quazepam [Doral] B. Diazepam [Valium] C. Temazepam [Restoril] D. Clonazepam [Klonopin]

C. "Cholinesterase inhibitors do not cure AD or slow the progression of the disease." ***Cholinesterase inhibitors do not cure AD or slow the progression of the disease. There are three cholinesterase inhibitor medications. Memantine is not a cholinesterase inhibitor. Cholinesterase inhibitors are not very effective. Unlike donepezil, which cause reversible inhibition of AChE, rivastigmine causes irreversible inhibition.

The nurse is working with a student in the care of a patient with AD. Which statement by the student demonstrates an understanding of the cholinesterase inhibitor medications used for AD? A. "There are four cholinesterase inhibitor medications available to treat AD. They are galantamine, rivastigmine, donepezil, and memantine." B. "Cholinesterase inhibitors are very effective in treating AD." C. "Cholinesterase inhibitors do not cure AD or slow the progression of the disease." D. "All of the cholinesterase inhibitors cause reversible inhibition of AChE."

C. "Cholinesterase inhibitors do not cure AD or slow the progression of the disease." ***Cholinesterase inhibitors do not cure AD or slow the progression of the disease. There are three cholinesterase inhibitor medications. Memantine is not a cholinesterase inhibitor. Cholinesterase inhibitors are not very effective. Unlike donepezil, which causes reversible inhibition of AChE, rivastigmine causes irreversible inhibition.

The nurse is working with a student in the care of a patient with Alzheimer's disease (AD). Which statement by the student demonstrates an understanding of the cholinesterase inhibitor medications used for AD? A. "Cholinesterase inhibitors are very effective in treating AD." B. "All of the cholinesterase inhibitors cause reversible inhibition of AChE." C. "Cholinesterase inhibitors do not cure AD or slow the progression of the disease." D. "There are four cholinesterase inhibitor medications available to treat AD. They are galantamine, rivastigmine, donepezil, and memantine."

A. Cleansing and maintenance of extracellular fluid volume ***Most diuretics block sodium and chloride reabsorption, thus affecting the maintenance of extracellular fluid volume.

The nurse knows that diuretics mostly affect which function of the kidneys? A. Cleansing and maintenance of extracellular fluid volume B. Maintenance of acid-base balance C. Excretion of metabolic waste D. Elimination of foreign substances

C. Kidneys ***The kidneys are responsible for maintaining and regulating volume and osmolality. This is not the responsibility of the liver, blood vessels, or heart.

The nurse knows that which organ is primarily responsible for maintaining fluid volume and osmolality? A. Liver B. Heart C. Kidneys D. Blood vessels

C. It reduces the activity of factor Xa more than the activity of thrombin. ***Enoxaparin acts primarily on factor Xa and also, but to a lesser degree, on thrombin. Unfractionated heparin equally reduces the action of thrombin and factor Xa. Fondaparinux [Arixtra] causes selective inhibition of factor Xa. Low-molecular-weight (LMW) heparins, such as enoxaparin, have greater bioavailability and a longer half-life than unfractionated heparin.

The nurse knows that which statement is accurate for enoxaparin [Lovenox]? A. It equally reduces the activity of thrombin and factor Xa. B. It has selective inhibition of factor Xa and no effect on thrombin. C. It reduces the activity of factor Xa more than the activity of thrombin. D. It has a lower bioavailability and shorter half-life than unfractionated heparin.

C. Airway maintenance ***An overdose of baclofen [Lioresal] can cause respiratory depression as a result of excessive central nervous system depression so the nurse has to maintain an open airway with the use of oxygen and a bag for ventilation. General supportive therapy and seizure therapy, including cardiac monitoring, gastric lavage, and fluid therapy, are instituted to maintain vital functions until the depressant effects of baclofen [Lioresal] wear off. An antidote to baclofen [Lioresal] does not exist. Although comfort measures are usually appropriate, the nurse's priority is the maintenance of vital functions.

The nurse notes that a patient has taken an excessive dose of baclofen [Lioresal]. Which action does the nurse implement immediately? A. Comfort measures B. Seizure precautions C. Airway maintenance D. Antidote preparation

C. Phlebitis of the vein used for the antibiotic has developed. ***IV cephalosporins may cause thrombophlebitis. To minimize this, the injection site should be rotated, and a dilute solution should be administered slowly. An allergic response would be shown as itching, redness, and swelling. Infiltration would show as a pale, cool, and puffy IV site. Infection would show as purulent discharge, tenderness, and redness.

The nurse observes a red streak and palpates the vein as hard and cordlike at the intravenous (IV) site of a patient receiving cefepime [Maxipime]. Which assessment should the nurse make about the IV site? A. The drug has infiltrated the extravascular tissues. B. An allergic reaction has developed to the drug solution. C. Phlebitis of the vein used for the antibiotic has developed. D. Local infection from bacterial contamination has occurred.

C. Erythromycin ***Erythromycin increases the levels of buspirone 5- to 13-fold. Garlic, ginseng, and St. John's wort are not included in the medications that increase the effects of buspirone.

The nurse obtains a medication history from a patient diagnosed with generalized anxiety disorder who is prescribed buspirone. The nurse recognizes that teaching is needed when the nurse notes that the patient is taking which medication with buspirone? A. Garlic B. Ginseng C. Erythromycin D. St. John's wort

A. A patient with liver cirrhosis B. A patient with kidney disease C. A patient with a nutritional deficiency ***Patients who are on protein-bound drugs must have adequate levels of protein components, such as albumin and globulin. Patients with liver cirrhosis have low serum albumin levels, resulting in fewer protein-binding sites. This leads to excess free drugs, causing drug toxicity. Patients with kidney disease have low serum albumin levels and renal dysfunction; both lead to drug toxicity. Patients with nutritional deficiencies due to old age or malnutrition have low serum albumin levels, also resulting in excess free drugs and leading to drug toxicity. A patient who has had gastric surgery will have decreased absorption in the pharmaceutic phase of drug action. A patient with peripheral vascular disease will have decreased distribution of the drug to the extremities.

The nurse obtains a patient's history to identify factors that may affect drug pharmacokinetics. Which patients who are on protein-bound drugs are most likely to experience drug toxicity? Select all that apply. A. A patient with liver cirrhosis B. A patient with kidney disease C. A patient with a nutritional deficiency D. A patient who has had gastric surgery E. A patient with peripheral vascular disease

C. Decrease in mouth pain ***Nystatin is an antifungal medication that is used for candidiasis of the skin, mouth, esophagus, intestine, and vagina. It can be administered orally and topically and will heal mouth lesions from oral candidiasis. Nystatin has no effect on nasal congestion and cough production. It does not cause urticaria.

The nurse planning care for the patient receiving nystatin [Mycostatin] should establish which outcome on the care plan? A. Productive cough B. Absence of urticaria C. Decrease in mouth pain D. Relief of nasal congestion

C. Decreased blood pressure ***High-ceiling loop diuretics, such as furosemide, are the most effective diuretic agents. They produce more loss of fluid and electrolytes than any others. A sudden loss of fluid can result in decreased blood pressure. When blood pressure drops, the pulse probably will increase rather than decrease. Lasix should not affect respirations or temperature. The nurse should also closely monitor the patient's potassium level.

The nurse plans to closely monitor for which clinical manifestation after administering furosemide [Lasix]? A. Decreased pulse B. Decreased temperature C. Decreased blood pressure D. Decreased respiratory rate

A. Thirty minutes after the dose is administered ***Peak drug serum levels are achieved 30 minutes after the IV administration of aminoglycosides, so (A) is the optimum time to get a peak level. (B, C, and D) are not appropriate times associated with peak levels for gentamicin.

The nurse plans to draw blood samples for the determination of peak and trough levels of gentamicin sulfate (Garamycin) in a client receiving IV doses of this medication. When should the nurse plan to obtain the peak level? A. Thirty minutes after the dose is administered B. Immediately before giving the next dose C. When the next electrolyte levels are drawn D. Sixty minutes after the dose is administered

A. Dilation of the pupil ***Anticholinergic medications produce mydriasis (dilation of the pupil) and cycloplegia (paralysis of the ciliary muscle). These actions facilitate diagnosis of and surgery for ophthalmic problems. Numbing of the eye, constriction of the iris, and drainage of aqueous humor are not therapeutic effects of anticholinergic agents.

The nurse prepares a patient for an intraocular examination by administering a topical anticholinergic agent intended to achieve which outcome? A. Dilation of the pupil B. Numbing of the eye C. Constriction of the iris D. Drainage of aqueous humor

C. In the morning after breakfast ***Bisacodyl suppositories act rapidly (in 15 to 60 minutes). They can be given at any time, but for patient convenience, they should not be given at bed time to avoid disrupting sleep. For convenience and patient ease, a fast acting laxative should not be given before a meal, which could cause the urge to have a bowel movement during the meal.

The nurse prepares to administer a bisacodyl suppository to a patient who has not had a bowel movement in several days. When should the nurse administer the PRN medication? A. In the evening before bed B. In the afternoon before lunch C. In the morning after breakfast D. In the morning before breakfast

B. Ask the patient, "When was your last menstrual period?" ***Category X means that the drug will be harmful to the fetus if the patient is pregnant. The patient may not know whether she is pregnant; therefore, asking her when her last menstrual period occurred gives the nurse a better indication of whether the patient might be pregnant.

The nurse prepares to administer a newly prescribed medication to a 22-year-old woman. The insert in the medication package states, "Pregnancy Category X." Select the nurse's best action. A. Assume that the patient is pregnant. B. Ask the patient, "When was your last menstrual period?" C. Assess the patient for a history of sexually transmitted disease. D. Ask the patient, "Have you been sexually active during the past year?"

C. Apply pressure to the inner aspects of the eye during and after administration. ***Timolol [Timoptic] is a beta-adrenergic blocking agent. Systemic absorption should be minimized to reduce the risk of bronchospasm. Applying pressure to the inner aspects of the eye during and after administration reduces systemic absorption. This action is particularly important for a patient with a history of asthma. Giving a bronchodilator inhaler, keeping the patient upright, and waiting 30 minutes between administrations to each eye are incorrect actions to take with a patient who has asthma and is receiving timolol [Timoptic].

The nurse prepares to administer timolol [Timoptic] eye drops to a patient who has asthma. Which action should the nurse take when applying the eye drops? A. Give the patient a bronchodilator inhaler before administering the eye drops. B. Keep the patient in an upright sitting position for 3 hours after administration. C. Apply pressure to the inner aspects of the eye during and after administration. D. Administer the drops to one eye; wait 30 minutes, and then apply them to the other eye.

D. Antagonist ***An antagonist is a drug that prevents receptor activation. A selective drug has only the desired response but may not activate receptors. An agonist is a molecule that activates receptors. A potent drug requires a lower dose to achieve its effect.

The nurse prepares to give a drug that will prevent receptor activation. Which term would describe this drug? A. Potent B. Agonist C. Selective D. Antagonist

A. Calcium-containing antacids cause constipation. C. Aluminum-containing antacids cause constipation. D. Antacids neutralize the acid present in the stomach. ***Both calcium- and aluminum-containing antacids cause constipation as an adverse effect. Antacids neutralize the excess acid secreted in the stomach by forming salts. Agents protective against ulcers, such as sucralfate [Carafate], form a mucous barrier in the stomach; the antacids do not. Antacids can only neutralize the acid secreted in the stomach; they cannot influence the secretion of acids. Magnesium-containing antacids reduce the effect of constipation resulting from aluminum- and calcium-containing antacids.

The nurse provides a patient with educational materials about antacids. Which statements about antacids are appropriate? Select all that apply. A. Calcium-containing antacids cause constipation. B. Antacids form a protective barrier in the stomach. C. Aluminum-containing antacids cause constipation. D. Antacids neutralize the acid present in the stomach. E. Magnesium-containing antacids cause constipation. F. Antacids decrease the secretion of acid in the stomach.

B. This medication will be 50% eliminated in 12 hours . ***The half-life (T½) of a drug is the time it takes for one-half of the drug concentration to be eliminated. Metabolism and elimination affect the half-life of a drug. For example, with liver or kidney dysfunction, the half-life of the drug is prolonged; thus, less of the drug is metabolized and eliminated. When a drug is taken continually, drug accumulation may occur.

The nurse reads that the half-life of the medication being administered is 12 hours. Which interpretation should guide the nurse's care of this patient? A. The medication will not work for the first 12 hours. B. This medication will be 50% eliminated in 12 hours . C. The patient will require two doses of the medication before there is an effect. D. The medication will be administered every 6 hours to maintain consistent blood levels.

B. "I can stop this drug after 3 weeks if I feel better." ***Lorazepam should not be discontinued abruptly, but gradually, over a period of several days. Caffeine and alcohol should be avoided when taking lorazepam, a benzodiazepine. This drug should not be taken during pregnancy because of possible teratogenic effects.

The nurse realizes more medication teaching is necessary when the 30-year-old patient taking lorazepam (Ativan) states A. "I must stop drinking coffee and colas." B. "I can stop this drug after 3 weeks if I feel better." C. "I must stop drinking alcoholic beverages." D. "I should not become pregnant while taking this drug."

A. Continue as planned, because the level is within normal limits. ***The therapeutic range for phenytoin is 10 to 20 mcg/mL. Because this level is within normal limits, the nurse would continue with the routine plan of care.

The nurse receives a laboratory report indicating that the phenytoin [Dilantin] level for the patient seen in the clinic yesterday is 16 mcg/mL. Which intervention is most appropriate? A. Continue as planned, because the level is within normal limits. B. Tell the patient to hold today's dose and return to the clinic. C. Consult the prescriber to recommend an increased dose. D. Have the patient call 911 and meet the patient in the emergency department.

A. Continue as planned, because the level is within normal limits. ***The therapeutic range for phenytoin is 10 to 20 mcg/mL. Because this level is within normal limits, the nurse would continue with the routine plan of care.

The nurse receives a laboratory report indicating that the phenytoin [Dilantin] level for the patient seen in the clinic yesterday is 16 mcg/mL. Which intervention is most appropriate? A. Continue as planned, because the level is within normal limits. B. Tell the patient to hold today's dose and return to the clinic. C. Consult the prescriber to recommend an increased dose. D. Have the patient call 911 and meet the patient in the emergency department.

A. Treating a viral infection C. Using dosing that results in a superinfection ***Common misuses of antibiotics include (1) treatment of a viral infection, which results in exposure of the patient to the risks of the medication without providing any benefits; and (2) improper dosing (dosing that is too high results in superinfection). Basing treatment on sensitivity reports, treating fever in an immunodeficient patient, and using surgical drainage as an adjunct to antibiotic therapy are examples of the proper use of antimicrobial therapy.

The nurse recognizes which of the following as examples of the improper use of antibiotic therapy? Select all that apply. A. Treating a viral infection B. Basing treatment on sensitivity reports C. Using dosing that results in a superinfection D. Treating fever in an immunodeficient patient E. Using surgical drainage as an adjunct to antibiotic therapy

D. Digoxin immune Fab antibody fragments ***When digoxin overdose is especially severe (normal range is 0.5-0.8 ng/mL), digoxin levels can be lowered using digoxin immune Fab antibody fragments. Potassium supplements are helpful when hypokalemia is present, not hyperkalemia. Giving digoxin would make the situation worse. Although the patient has dysrhythmias, quinidine should not be used as it causes plasma levels of digoxin to rise. Rather, phenytoin and lidocaine are most effective.

The nurse reviews a patient's laboratory values and observes a digoxin level of 2.5 ng/mL and a potassium level of 5.9 mEq/L. Upon physical assessment, the patient begins to experience changes in heart rate and rhythm (dysrhythmias). Which drug should the nurse be prepared to administer? A. Digoxin B. Quinidine C. Potassium supplements D. Digoxin immune Fab antibody fragments

A. Once a day ***A major cause of treatment failure in patients with chronic hypertension is lack of adherence to a prescribed regimen. To promote adherence, the dosing schedule should be as simple as possible, just once or twice daily dosing

The nurse reviews the medication treatment regimen for a patient with chronic hypertension. To promote optimal medication adherence, which frequency of drug dosing should the nurse advocate for this patient? A. Once a day B. Every 8 hours C. Four times a day D. Three times a day

B. The nurse should obtain a prescriber order to administer the phenytoin at 9:30 AM daily. ***Sucralfate can impede the absorption of phenytoin; therefore, a period of 2 hours should separate these drugs. The nurse should consult the prescriber for a time administration change. Based on this information, it is not appropriate to administer the drugs as ordered, switch the phenytoin to the IV form, or administer the phenytoin with the sucralfate.

The nurse reviews the patient's medication record and notes the following: sucralfate [Carafate] 1 gram orally four times daily before meals (7:30 AM, 11:30 AM, and 4:30 PM) and at bedtime (10:00 PM); phenytoin [Dilantin] 200 mg orally daily at 8:00 AM. Which modifications, if any, should be made to the medication regimen? A. The medications can be administered as ordered. B. The nurse should obtain a prescriber order to administer the phenytoin at 9:30 AM daily. C. The nurse should obtain a prescriber order for intravenous phenytoin to avoid a drug interaction. D. The nurse should administer the phenytoin with the 7:30 AM dose of sucralfate [Carafate], because this is more time efficient.

B. The pH of the stomach C. Form of drug preparation D. Presence of food in the stomach ***Because of multiple factors, the rate and extent of drug absorption following oral administration can be highly variable. Factors that can influence absorption include food in the gut, gastric and intestinal pH, solubility and stability of the drug, gastric emptying time, coadministration of other drugs, and special coatings on the drug preparation.

The nurse should be aware that which factors will affect the absorption of orally administered medications? Select all that apply. A. Time of day B. The pH of the stomach C. Form of drug preparation D. Presence of food in the stomach E. Patient position upon intake of medication

A. "Use sunscreen when you are outside." B. "If you have diarrhea more than five times a day, notify your healthcare provider." C. "Avoid using this drug if you are pregnant." ***Nausea and vomiting may occur. The patient should not stop taking the medication; rather, the healthcare provider should be notified so that an alternative plan can be discussed. The other three instructions should be included in the patient teaching.

The nurse should include which instructions when teaching a patient about tigecycline therapy? (Select all that apply.) A. "Use sunscreen when you are outside." B. "If you have diarrhea more than five times a day, notify your healthcare provider." C. "Avoid using this drug if you are pregnant." D. "Stop taking the drug if you experience nausea." E. "Stop taking the drug if you experience vomiting."

A. "You cannot mix this insulin with any other insulin in the same syringe." ***Insulin glargine [Lantus] is a long-acting insulin with a duration of action up to 24 hours. It should not be mixed with any other insulins. The insulin is not fast acting.

The nurse should include which statement when teaching a patient about insulin glargine [Lantus]? A. "You cannot mix this insulin with any other insulin in the same syringe." B. "You should inject this insulin just before meals because it is very fast acting." C. "You can mix this insulin with neutral protamine Hagedorn (NPH) insulin to enhance its effects." D. "The duration of action for this insulin is approximately 8 to 10 hours, so you will need to take it twice a day."

C. "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." D. "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." ***Acetaminophen [Tylenol] is used to treat fever and pain. It is not an antiinflammatory drug. The most serious side effect of acetaminophen therapy is liver failure; therefore, the healthcare provider should be notified if indications of jaundice are seen, such as yellowing of the skin or sclera. Acetaminophen therapy has no antiplatelet activity; therefore, it is not used to prevent heart attack or stroke. Routine use of acetaminophen may blunt the immune response to vaccines; therefore, it should be avoided as routine treatment for vaccine-associated fever and pain.

The nurse should include which statement(s) when teaching a patient about the use of acetaminophen [Tylenol]? Select all that apply. A. "Use of this drug can prevent heart attack and stroke." B. "The most common side effect of treatment with this drug is kidney failure." C. "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." D. "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." E. "Acetaminophen is a useful drug for the treatment of inflammation such as rheumatoid arthritis."

A. Digoxin toxicity ***Digoxin levels have an inverse relationship with potassium levels. Because hydrochlorothiazide can lower potassium levels, combined use of hydrochlorothiazide and digoxin poses a risk for elevated digoxin levels and ensuing digoxin toxicity.

The nurse should monitor for which adverse effect after administering hydrochlorothiazide [HydroDIURIL] and digoxin [Lanoxin] to a patient A. Digoxin toxicity B. Decreased diuretic effect C. Dehydration D. Heart failure

B. A 6-year old patient with Haemophilus influenzae ***Tetracycline is contraindicated in children younger than 8 years old because it can cause permanent discoloration of the teeth. It would not be prescribed to treat influenza. Tetracycline is not contraindicated for patients diagnosed with diabetes mellitus, hypertension, or rickettsiae.

The nurse should question the prescription of tetracycline for which patient? A. A 40-year-old patient diagnosed with rickettsiae B. A 6-year old patient with Haemophilus influenzae C. A 60-year-old patient with a history of hypertension D. A 45-year-old patient with a history of diabetes mellitus

B. Hepatitis ***In 2002, the Food and Drug Administration (FDA) issued a consumer warning letter regarding the risk of liver toxicity with the use of kava. Therefore, the nurse should question and teach a patient with a history of hepatitis about this risk. Kava may actually prove beneficial to patients with anxiety, hypertension, or cardiovascular disease because its therapeutic action is the reduction of stress.

The nurse should question the use of kava in a patient with a history of which condition? A. Anxiety B. Hepatitis C. Hypertension D. Cardiovascular disease

B. Benzodiazepines ***Neuroleptics cause central nervous system depression that can be intensified with benzodiazepines.

The nurse should teach a patient who is prescribed a neuroleptic to avoid what other medications? A. Aspirin B. Benzodiazepines C. Antidiarrheal medications D. Non-steroidal anti-inflammatory drugs

B. The patient is walking with a staggering gait. D. The patient complains of double vision. E. The nurse observes rapid back-and-forth movement of the patient's eyes. ***Manifestations of phenytoin toxicity can occur when plasma levels are higher than 20 mcg/mL. Nystagmus (back-and-forth movement of the eyes) is a common indicator of toxicity, as are ataxia (staggering gait), diplopia (double vision), sedation, and cognitive impairment. Hirsutism (excess hair growth in unusual places) and gingival hyperplasia (swollen, tender, bleeding gums) are adverse effects of phenytoin.

The nurse suspects that a female patient is experiencing phenytoin toxicity if which manifestation is noted? (Select all that apply.) A. The patient complains of excessive facial hair growth. B. The patient is walking with a staggering gait. C. The patient's gums are swollen, tender, and bleed easily. D. The patient complains of double vision. E. The nurse observes rapid back-and-forth movement of the patient's eyes.

A. Regulation of gastric glands B. Regulation of bronchial glands C. Regulation of the blood vessels D. Regulation of muscles of the bronchi ***Functions of the ANS include regulation of the heart, gastric glands, bronchial glands, muscles of the bronchi, and the blood vessels.

The nurse teaches a group of student nurses the overall primary functions of the autonomic nervous system (ANS). Which of these are functions of the ANS? Select all that apply. A. Regulation of gastric glands B. Regulation of bronchial glands C. Regulation of the blood vessels D. Regulation of muscles of the bronchi E. Regulation of the skeletal muscle movement

C. Clindamycin ***Patients on clindamycin should promptly report any diarrhea to their healthcare provider since clindamycin can cause potentially fatal Clostridium difficile diarrhea. Diarrhea can be a side effect of most antibiotics such as linezolide, doxycycline, and minocycline but does not have the same risk as clindamycin for Clostridium difficile.

The nurse teaches a patient to promptly report any diarrhea to the healthcare provider. Which drug is the patient likely being prescribed? A. Linezolide B. Doxycycline C. Clindamycin D. Minocycline

B. yellowish discoloration of the skin ***A yellowish discoloration of the skin might be indicative of jaundice. Peripheral neuritis can be observed as numbness, tingling or burning sensations in the extremities.

The nurse teaches the client about signs and symptoms to watch out for when taking Tuberculosis medications. The following indicates peripheral neuritis, except? A. burning sensation in the extremities B. yellowish discoloration of the skin C. numbness of the feet D. tingling of fingers

A. weighing during the same time everyday C. keeping a record of his daily weight D. using the same scale every day E. weighing after urinating F. weighing with the same amount of clothing ***The client should weigh himself at the same time each day, after urinating, before eating, using the same scale with the same amount of clothing and keeping a record of it to show his physician on his follow up visit.

The nurse teaches the client with heart failure taking Furosemide to weigh himself daily. She enumerates the proper way of doing this as: Select all that apply. A. weighing during the same time everyday B. weighing after breakfast C. keeping a record of his daily weight D. using the same scale every day E. weighing after urinating F. weighing with the same amount of clothing

B. Increase fluid intake. ***The nurse should teach the patient taking sulfamethoxazole the importance of increasing fluid intake to reduce crystalluria. The other answers do not affect crystalluria caused by sulfonamides.

The nurse teaches the patient taking sulfamethoxazole the importance of which action to reduce crystalluria? A. Avoid red meat. B. Increase fluid intake. C. Increase intake of fruits and vegetables. D. Avoid milk and other foods high in calcium.

A. Headache C. Dizziness D. Tachycardia ***The primary adverse effects of nitroglycerin are headache; orthostatic hypotension, which can lead to dizziness; and reflex tachycardia.

The nurse understands patients receiving nitroglycerin are at risk for which adverse effects? (Select all that apply.) A. Headache B. Wheezing C. Dizziness D. Tachycardia E. Bradycardia

B. Low-density lipoprotein (LDL) ***Cholesterol is the primary core lipid of low-density lipoproteins (LDLs), which are responsible for carrying cholesterol to tissues outside the liver. Of all the lipoproteins, LDLs are the most significant contributors to coronary atherosclerosis. When pharmacologic agents are used to lower cholesterol, the primary goal is to reduce elevated LDL levels.

The nurse understands that cholesterol is carried through the blood by lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis? A. Apolipoprotein B-100 B. Low-density lipoprotein (LDL) C. High-density lipoprotein (HDL) D. Very-low-density lipoprotein (VLDL)

C. Low-density lipoprotein (LDL) ***Cholesterol is the primary core lipid of LDLs, which are responsible for carrying cholesterol to tissues outside the liver. Of all the lipoproteins, LDLs are the most significant contributors to coronary atherosclerosis. When pharmacologic agents are used to lower cholesterol, the primary goal is to reduce elevated LDL levels.

The nurse understands that cholesterol is carried through the blood by lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis? A. Very-low-density lipoprotein (VLDL) B. Apolipoprotein B-100 C. Low-density lipoprotein (LDL) D. High-density lipoprotein (HDL)

D. oral anticoagulants ***Cimetidine may increase the blood levels of oral anticoagulants by reducing their metabolism in the liver and excretion.

The nurse understands that which drug or drug type may interact with the H2-receptor antagonist cimetidine? A. hormonal contraceptives B. antilipemic agents C. digoxin D. oral anticoagulants

C. "This medication will prevent the inflammation that causes your asthma attack." ***Antileukotriene agents block the inflammatory response of leukotrienes and thus the trigger for asthma attacks. Response to these drugs is usually noticed within 1 week. They are not used to treat an acute asthma attack.

The nurse will include which information regarding the use of antileukotriene agents such as zafirlukast (Accolate) in the patient teaching? A. "Take the medication as soon as you begin wheezing." B. "It will take about 3 weeks before you notice a therapeutic effect." C. "This medication will prevent the inflammation that causes your asthma attack." D. "Increase fiber and fluid in your diet to prevent the side effect of constipation."

C. "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." D. "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." ***Acetaminophen [Tylenol] is used to treat fever and pain. It is not an anti-inflammatory drug. The most serious side effect of acetaminophen therapy is liver failure; therefore, the healthcare provider should be notified if indications of jaundice are seen, such as yellowing of the skin or sclera. Acetaminophen therapy has no antiplatelet activity; therefore, it is not used to prevent heart attack or stroke. Routine use of acetaminophen may blunt the immune response to vaccines; therefore, it should be avoided as routine treatment for vaccine-associated fever and pain.

The nurse will include which statements when teaching a patient about the use of acetaminophen [Tylenol]? (Select all that apply.) A. "Acetaminophen is a useful drug for the treatment of inflammation, such as a rheumatoid arthritis." B. "The most common side effect of treatment with the drug is kidney failure." C. "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." D. "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." E. "Use of this drug can prevent heart attack and stroke."

A. Antacids ***Antacids do not act through receptors. Antacids neutralize gastric activity by direct chemical interaction with stomach acid.

The nursing student learns that not all drugs produce effects by binding to a receptor. Which drugs do not act through receptors? A. Antacids B. Analgesics C. Antihistamines D. Steroid hormones

C. prevention of gastric ulcers caused by long-term NSAIDs therapy

The only approved GI indication for Misoprostol is: A. GERD B. PUD C. prevention of gastric ulcers caused by long-term NSAIDs therapy D. prevention of gastric ulcers caused by chemotherapy

D. "Take the medication when you eat your meal or shortly after a meal." ***When the medication order says to administer a drug with food, it means to administer a drug with food or shortly after a meal. To administer a drug on an empty stomach means to administer it at least 1 hour before a meal or 2 hours after.

The patient asks what it means when a medication order says to administer a drug "with food." How will the nurse reply? A. "Take the medication before the meal." B. "Take the medication 2 hours after a meal." C. "Take the medication 1 hour before the meal." D. "Take the medication when you eat your meal or shortly after a meal."

C. Preparation before a colonoscopy ***Magnesium oxide/anhydrous citric acid/sodium picosulfate [Prepopik] is approved for preparation of colonoscopy in adults. Sodium picosulfate is a stimulant laxative and the magnesium oxide and citric acid combine to form magnesium citrate, an osmotic laxative. Prepopik is given in a split dose regimen. The first dose is taken the evening before the colonoscopy and the second dose the next morning prior to the procedure.

The patient has an order for magnesium oxide/anhydrous citric acid/sodium picosulfate [Prepopik] to be given in two doses. The nurse knows that this medication is used for which indication? A. Prevention of constipation B. Treatment of constipation C. Preparation before a colonoscopy D. Preparation before an abdominal surgery

C. Miconazole nitrate (Monistat, Micatin) ***Miconazole nitrate (Monistat, Micatin) can be ordered to treat candidiasis. Other drugs that can treat candidiasis include Terconazole (Terazol-3) & Butoconazole nitrate (Femstat). The other drugs listed can be used to treat tinea pedis, corporis, and cruris.

The patient has been diagnosed with candidiasis. The nurse recognizes that the patient is most likely to be ordered which drug? A. Sulconazole (Exelderm) B. Haloprogin (Halotex) C. Miconazole nitrate (Monistat, Micatin) D. Tolnaftate (Aftate)

D. Sertaconazole (Ertaczo) ***Of the drugs listed, the patient is most likely to be treated with sertaconazole (Ertaczo). The other drugs treat candidiasis.

The patient has been diagnosed with tinea pedis. The nurse recognizes that the patient is most likely to be ordered which drug? A. Terconazole (Terazol-3) B. Miconazole nitrate (Monistat, Micatin) C. Butoconazole nitrate (Femstat) D. Sertaconazole (Ertaczo)

A. "Inject this insulin with meals because it is very fast acting." ***Lispro is a fast-acting insulin and has an onset action of 15 to 30 minutes with a peak action of about 2 hours, not 8 to 10 hours. Because of its rapid onset, it is administered immediately before a meal or with meals to control the blood glucose rise after meals. Lispro insulin must be combined with an intermediate- or a long-acting insulin, not regular insulin (which also is a short-duration insulin), for glucose control between meals and at night. To achieve tight glycemic control, patients must combine different types of insulin based on their duration of action.

The patient has been prescribed lispro [Humalog] for treatment of type 1 diabetes mellitus. The nurse should give the patient which instruction? A. "Inject this insulin with meals because it is very fast acting." B. "This insulin needs to be mixed with regular insulin to enhance the effects." C. "To achieve tight glycemic control, this is the only type of insulin you'll need." D. "The duration of action for this insulin is about 8 to 10 hours, so you'll need a snack."

A. Ensure that protamine sulfate is readily available at all times. ***Protamine sulfate must be kept readily available because it is the antidote for an overdose of heparin. Although it is important to monitor the patient's lab values, teach about limiting foods high in vitamin K and administer a loading dose prior to beginning the maintenance IV dose.

The patient is being treated with a continuous intravenous infusion of heparin. What is the nurse's highest priority? A. Ensure that protamine sulfate is readily available at all times. B. Ensure that the patient's laboratory values are monitored correctly. C. Ensure that a loading dose was initially administered when treatment began. D. Ensure that the patient is taught dietary restrictions while on the medication.

D. Assess blood urea nitrogen and creatinine. ***Amphotericin B is considered highly toxic and can cause nephrotoxicity and electrolyte imbalance, especially hypokalemia and hypomagnesemia (low serum potassium and magnesium levels). Urinary output, blood urea nitrogen, and serum creatinine levels need to be closely monitored.

The patient is being treated with intravenous amphotericin B. What is the nurse's primary intervention? A. Encourage patient to drink at least a liter of fluid per shift. B. Assess the IV site for infiltration. C. Administer with dextrose. D. Assess blood urea nitrogen and creatinine.

A. Garlic D. Ginger root E. Gingko biloba ***Garlic, ginger root, and gingko biloba can increase the risk of bleeding in patients receiving anticoagulants or antiplatelet drugs. Valerian and echinacea do not interfere with Coumadin therapy.

The patient is prescribed warfarin [Coumadin] to treat deep vein thrombosis. The nurse is teaching the patient about dietary supplements that have the potential to interfere with Coumadin therapy. What herbs should the nurse include in the teaching? Select all that apply. A. Garlic B. Valerian C. Echinacea D. Ginger root E. Gingko biloba

D. Creatinine level ***Amphotericin B is toxic to kidney cells. To evaluate renal injury, the plasma creatinine level should be monitored every 3 or 4 days, as well as intake and output. It is not necessary to monitor the serum protein, glucose levels, or serum pH in patients taking amphotericin B.

The patient is receiving amphotericin B. It is most important for the nurse to monitor which laboratory result? A. Serum pH B. Protein level C. Glucose level D. Creatinine level

C. Potassium ***Renal injury from amphotericin B may cause severe hypokalemia. Serum potassium levels should be monitored more frequently and potassium supplements given to correct low plasma levels. Furosemide, insulin, and vitamin K do not prevent any adverse effects of amphotericin B.

The patient is receiving amphotericin B. The nurse identifies which medication as useful in preventing adverse effects of amphotericin B? A. Insulin B. Vitamin K C. Potassium D. Furosemide [Lasix]

D. 50 mg of diphenhydramine [Benadryl] and 650 mg of acetaminophen ***Almost all patients given intravenous amphotericin B develop fever, chills, and nausea. Pretreatment with diphenhydramine and an analgesic, such as acetaminophen, can minimize or prevent these adverse effects. It is not beneficial to administer calcium gluconate, insulin, or famotidine as pretreatment.

The patient is scheduled to receive intravenous amphotericin B. Which medication should the nurse administer as pretreatment before the infusion? A. 10 units of regular insulin intravenously B. 20 mg famotidine [Pepcid] in 50 mL of 5% dextrose C. 1 g of calcium gluconate in 100 mL of normal saline D. 50 mg of diphenhydramine [Benadryl] and 650 mg of acetaminophen

A. Monitoring patient for potential chest pain ***Nonselective adrenergic agonist bronchodilators stimulate beta1 receptors in the heart and beta2 receptors in the lungs. Stimulation of beta1 receptors can increase heart rate and contractility, increasing oxygen demand. This increased oxygen demand may lead to angina or myocardial ischemia in patient with coronary artery disease. Cautious use of these agents is indicated if the patient has coronary artery disease.

The patient is taking a nonselective adrenergic agonist bronchodilator and has a history of coronary artery disease. What is a priority nursing intervention? A. Monitoring patient for potential chest pain B. Monitoring blood pressure continuously C. Assessing daily for hyperkalemia D. Assessing 12-lead ECG each shift

B. Benzonatate [Tessalon] ***Benzonatate (an Antitussive) suppresses cough by reducing the sensitivity of respiratory stretch receptors (components of the cough reflex pathway). Acetylcysteine reacts directly with mucus to make it more watery and is administered by inhalation treatment. Guaifenesin is an expectorant (promotes the secretion of sputum by the air passages). Fluticasone furoate is an intranasal glucocorticoid used to treat the clinical manifestations of allergic rhinitis.

The patient presents to the urgent care clinic complaining of a persistent, productive cough. Which medication should the nurse anticipate the provider would prescribe? A. Guaifenesin [Mucinex] B. Benzonatate [Tessalon] C. Acetylcysteine [Mucomyst] D. Fluticasone furoate [Veramyst]

D. Antagonistic ***When the patient is known to have a morphine overdose, naloxone is known to have an antagonistic effect since each drug will cancel the effect of the other.

The patient received an overdose of morphine. Naloxone is given to block the narcotic response. What is the effect achieved when naloxone is administered known as? A. Additive B. Negative C. Synergistic D. Antagonistic

C. "You should be on the drugs for at least 6 months." ***Between 6 months and 1 year is sufficient time for prevention of active tuberculosis. Because the tuberculosis mycobacterium is slow-growing, shorter lengths of time may not sufficiently eradicate the organism.

The patient states that she has been prescribed prophylactic medication for tuberculosis for a period of 4 weeks. What is the nurse's best response? A. "Let me teach you about the medications." B. "We do not use medications prophylactically for tuberculosis." C. "You should be on the drugs for at least 6 months." D. "You should be on the medications for only 2 weeks."

A. Superinfection ***Antibiotic therapy can destroy the normal flora of the body, which normally would inhibit the overgrowth of fungi and yeast. When the normal flora are decreased, these organisms can overgrow and cause a new infection, or superinfection. The patient's symptoms are not indicative of an allergic reaction or resistant infection. Nosocomial infections are infections patients get in the hospital, not at home.

The patient taking antibiotics for strep throat presents to the outpatient clinic to report vaginal candidiasis. The nurse should use which term to describe this phenomenon? A. Superinfection B. Allergic reaction C. Resistant infection D. Nosocomial infection

B. Administer guaifenesin. ***The patient needs an expectorant (promotes the secretion of sputum by the air passages, used especially to treat coughs). This medication will help the patient cough the fluid out of her lungs. Dextromethorphan and fluticasone will not help the patient expectorate. There is no information about the patient's fluid intake, so hourly fluids may be too much.

The patient tells the nurse that she has a cold, is coughing, and feels like she has fluid in her lungs. What action will the nurse anticipate performing next? A. Administer dextromethorphan. B. Administer guaifenesin. C. Encourage the patient to drink fluids hourly. D. Administer fluticasone (Flonase).

D. "Do you know what the tea is made of? We want to be sure that none of its ingredients will react poorly with your new medications." ***The nurse should be concerned about what is in the tea as this may interact with the medication. Patients may derive both psychologic and physical benefits from taking traditional remedies, but it is essential to ensure that the traditional remedies do not interfere with the action of the conventional medications the patient has been prescribed. Because patients may achieve health benefits or psychologic comfort from their traditional remedies, they should not be told that the remedies are forbidden or useless; however, they should be instructed not to continue the remedies until it has been determined that the remedies will not affect the action of the patient's conventional medications.

The patient tells the nurse, "I have brought along the tea that I drink every day. My family has been drinking this kind of tea for generations because it promotes good health and long life. I hope I can continue drinking this tea while I am on my new medications." What is the nurse's best response? A. "You should not use any kind of traditional remedy while you are taking this new medication." B. "If you have been drinking this tea every day, then you should continue drinking it to maintain your health." C. "Traditional remedies have no health benefits. You should stop drinking the tea; it's a waste of time and money." D. "Do you know what the tea is made of? We want to be sure that none of its ingredients will react poorly with your new medications."

D. Numbness and tingling in the fingers and toes ***Dose-related peripheral neuropathy is the most common adverse effect of isoniazid. It results from a vitamin B6 deficiency, which is corrected by taking oral supplements. Symptoms include numbness and tingling in the fingers and toes. Alopecia and flaking scalp, oral ulcers and tongue fissures, and dry skin and brittle nails are not adverse effects of isoniazid-induced vitamin B6 deficiency.

The patient who has tuberculosis is treated with isoniazid. The nurse should monitor for which symptoms that could indicate a vitamin B6 deficiency caused by the medication? A. Dry skin and brittle nails B. Alopecia and flaking scalp C. Oral ulcers and tongue fissures D. Numbness and tingling in the fingers and toes

B. Beta1 C. Nicotinic ***Beta1 receptors affect the heart by increasing the heart rate. Nicotinic receptors release epinephrine, which can increase heart rate. Alpha1 receptors are present on veins and on arterioles in many capillary beds. Activation of alpha1 receptors in blood vessels produces vasoconstriction, which can increase cardiac output and blood pressure, but not heart rate. Dopamine causes vasodilation, which decreases heart rate. Muscarinic receptors decrease heart rate.

The patient with a heart rate of 48 beats/min has been prescribed a medication to increase heart rate. The nurse recalls that which activated receptors can increase heart rate? Select all that apply. A. Alpha1 B. Beta1 C. Nicotinic D. Dopamine E. Muscarinic

D. Analyze the patient's serum thyroid-stimulating hormone levels. ***Drug efficacy is assessed by monitoring the thyroid-stimulating hormone [1] [2] (TSH) levels. The nurse will also monitor other thyroid tests, if ordered, and will assess for symptom improvement. Anxiety and palpitations would indicate a hyperthyroid state, which could occur with drug accumulation or excess. The other items, while important, do not address monitoring for a euthyroid (normal) state.

The primary healthcare provider prescribes a thyroid replacement drug to a patient with hypothyroidism. How should the nurse monitor for return to a euthyroid state? A. Assess for anxiety and palpitations. B. Verify the medication history of patient and family. C. Evaluate the patient's knowledge of thyroid therapy. D. Analyze the patient's serum thyroid-stimulating hormone levels.

B. Renal function ***Vancomycin [Vancocin] is a tricyclic glycopeptide, which causes nephrotoxicity. Therefore, the nurse should check the patient's renal function before administering vancomycin [Vancocin]. Renal impairment may lead to severe toxicity. The dosing frequency of vancomycin [Vancocin] is dependent on renal function. Therefore, it is important to check the patient's renal function. Vancomycin [Vancocin] does not affect skin integrity, blood glucose concentration, or red blood cell counts; therefore, the nurse need not check these in the patient.

The primary healthcare provider prescribes vancomycin [Vancocin] to a patient who has a streptococcal infection. What should the nurse assess to ensure safe administration of the drug? A. Skin integrity B. Renal function C. Red blood cell count D. Blood glucose concentration

A. The patient has developed tolerance. ***Tolerance can be defined as a state in which a larger dose is required to produce the same response that could formerly be produced with a smaller dose. The provider did not switch drugs, just the dose so cross-tolerance cannot occur. Cross-tolerance exists among the opioid agonists (eg, oxycodone, methadone, fentanyl, codeine, and heroin). Accordingly, individuals tolerant to one of these agents will be tolerant to all the others. The patient has developed a tolerance so an overdose is unlikely. The provider did not stop the drug, so abstinence syndrome cannot occur. Abstinence syndrome will occur if drug use is abruptly stopped.

The provider has to increase the fentanyl dose for a patient who has been taking fentanyl long term to achieve pain relief. What will the nurse communicate to the oncoming shift? A. The patient has developed tolerance. B. The patient has developed cross-tolerance. C. The patient will probably experience an overdose. D. The patient will probably experience an abstinence syndrome.

B. Angiotensin II ***Angiotensin II is a potent vasoconstrictor. It participates in all the pathways regulated by the renin-angiotensin-aldosterone system. Angiotensin I is a precursor to angiotensin II; angiotensin III is formed by degradation of angiotensin II and is less potent. Renin catalyzes the conversion of angiotensinogen to angiotensin I.

The renin-angiotensin-aldosterone system plays an important role in maintaining blood pressure. Which compound in this system is most powerful at raising the blood pressure? A. Angiotensin I B. Angiotensin II C. Angiotensin III D. Renin

B. Drug properties ***Drug properties have a direct correlation to the safety or potential harm of drug therapy during pregnancy, and nurses working in prenatal settings need to be aware of information related to drug properties.

The safety or potential harm of drug therapy during pregnancy relates to which factor? A. Fetal sex B. Drug properties C. Diet of the mother D. Maternal blood type

True

True or False: If a patient has used benzodiazepines consistently for a long period of time and suddenly stops, they will most likely experience withdrawal symptoms or a paradoxical response.

D. On a consistent, daily basis ***Glucocorticoid medications are the first-line therapy for asthma to reduce symptoms of inflammation. They should be taken for prophylaxis on a daily basis. Therapeutic effects develop slowly, so these drugs cannot be taken to abort an asthma attack or in an emergency. They are most effective when administered on a fixed schedule, not PRN.

To achieve therapeutic effectiveness, a nurse teaches a patient with chronic asthma to use an inhaled glucocorticoid medication according to which schedule? A. Only in an emergency B. 2 weeks on, 2 weeks off C. To abort an asthma attack D. On a consistent, daily basis

A. 2-3 weeks

To avoid the occurrence of serotonin syndrome, how long should patients wait when switching antidepressant meds? A. 2-3 weeks B. 6-8 weeks C. 48 hours D. 6 hours

C. Compare the client's blood pressure before and after the client takes the medication. ***Therapeutic effects are the expected or predictable physiologic responses to a medication. An antihypertensive medication is administered to lower blood pressure, so to determine if the therapeutic effect has been achieved, the nurse should compare the client's blood pressure before and after the client takes the medication (C). (A and B) provide data related to the side effect of hypotension, which may occur following the administration of an antihypertensive medication. (D) provides useful data but does not evaluate the medication's effectiveness.

To evaluate whether the administration of an antihypertensive medication has caused a therapeutic effect, which action should the nurse implement? A. Ask the client about the onset of any dizziness since taking the medication. B. Measure the client's blood pressure while the client is lying, sitting, and then standing. C. Compare the client's blood pressure before and after the client takes the medication. D. Interview the client about any past or recent history of high blood pressure.

A. Directly watch the patient take the medication. B. Teach the patient about intermittent-dose therapy. D. Teach the patient about the need for long-term treatment. ***In patients with TB, nonadherence is the most common reason for treatment failure, relapse, and increased medication resistance. Because treatment is necessary for at least 6 months, directly observed therapy (DOT) is a standard of care, as is intermittent dosing. Multiple medication regimens are needed to prevent drug resistance. Education about the length of treatment and the regimen is essential to compliance. A signed consent form does not increase patient compliance.

To promote treatment adherence in a patient with tuberculosis (TB), the nurse will include which intervention(s)? Select all that apply. A. Directly watch the patient take the medication. B. Teach the patient about intermittent-dose therapy. C. Use a single medication to keep the treatment simple. D. Teach the patient about the need for long-term treatment. E. Use a signed consent form to enhance patient compliance

True

True or False: Celeocoxib has been prescribed to your patient. You are an awesome nurse and know that this is the only NSAID that only blocks Cox-2 and not both Cox-1 and Cox-2. This means that you don't need to be concerned about kidney failure, prolonged bleeding, and stomach upset.

True

True or False: Corticosteriods are a synthetic form of steroids.

True ***D5W is classified as a ISOTONIC fluid BUT after adminstration the body metabolizes the dextrose and the fluid left over is a hypotonic solution.

True or False: D5W solutions are sometimes considered a hypotonic solution as well as an isotonic solution because after the body metabolizes the dextrose the solution acts as a hypotonic solution.

True

True or False: Diltiazem and Verapamil will work both on the heart and vessels (and therefore will also decrease the heart rate).

True

True or False: Hyperinflation of the lungs leads to diaphragm flattening.

False ***HYPOTONIC fluids cause shifting of water from the extracellular space to the intracellular space.

True or False: Isotonic fluids cause shifting of water from the extracellular space to the intracellular space.

True

True or False: Most patients with hypertension are asymptomatic.

D. Stomach

Where are histamine 2 receptors located? A. Peripheral vascular bed B. Pancreas C. Lungs D. Stomach

A. Cloudy

What color is NPH? A. Cloudy B. Clear / yellow C. Clear D. Amber

C. Dopamine melatonin, and serotonin

What do antipsychotics block in the brain? A. Dopamine, serotonin and the adrenergic receptors B. Melatonin C. Dopamine melatonin, and serotonin D. The adrenergic receptors

D. They block aldosterone in the collecting ducts

What do potassium-sparing diuretics ultimately block to increase urine output? A. Distal convoluted tubule B. The Circle of Willis C. Sodium chloride cotransporter D. They block aldosterone in the collecting ducts

C. Cardiac function E. Infusion site for infiltration ***Doxorubicin [Doxil] is cardiotoxic so cardiac function must be assessed regularly; giving dexrazoxane and ACE inhibitors may protect the heart. Because of its vesicant properties, doxorubicin can cause severe local injury if extravasation occurs; thus, the infusion site must be assessed. Doxorubicin has no effect on pancreas activity; asparaginase can cause pancreas injury. The drug has no effect on thyroid activity, so it is not necessary to examine thyroid function.

What does the nurse assess for in a patient who is receiving doxorubicin [Doxil]? Select all that apply. A. Blood in urine B. Thyroid function C. Cardiac function D. Pancreas function E. Infusion site for infiltration

B. "Use birth control while on this medication." ***The nurse should tell the young woman to use birth control while on the medication as an increased incidence of fetal defects occurred in those who took phenytoin while pregnant.

What information should the nurse include in the care plan of a young woman who has been prescribed phenytoin [Dilantin]? A. "Take your blood pressure daily." B. "Use birth control while on this medication." C. "Do not take this medication with grapefruit juice." D. "If your weight increases, call your healthcare provider."

A. Hypertensive crisis

What is a major side effect of MAOI's? A. Hypertensive crisis B. Guillan-Barre Syndrome C. Hypoxia D. Ischemic bowel

D. The inability to rest or relax

What is akathisia (an extrapyramidal symptom)? A. Spasms of the facial muscles B. Shuffling gait C. Spasms of the back muscles D. The inability to rest or relax

C. constipation

What is an adverse effect of sucralfate? A. diarrhea B. infection C. constipation D. insomnia

C. Angiotension II

What is an angiotension receptor blocker actually blocking? A. Renin B. Angiotension C. Angiotension II D. Angiotension I

A. They are more prone for suicide tendencies

What is an essential thing to remember when a patient is started on any antidepressant? A. They are more prone for suicide tendencies B. It drastically decreases their appetite C. If they notice worsening symptoms, it is okay to take an additional tablet prior to notifying the physician D. They may have severe periods of mania

C. A chemical mediator of inflammation in allergic response

What is histamine? A. A chemical mediator of cellular injury B. Another name for white blood cells C. A chemical mediator of inflammation in allergic response D. Gastric secretions

C. Higher degree of selectivity ***Selectivity is one of the most desirable qualities a drug can have. Many neuropharmacologic drugs are highly selective, because the nervous system works through multiple receptors to regulate processes under its control.

What is the advantage of patients having multiple types of receptors to regulate bodily functions? A. Lower therapeutic index B. Improved maximal efficacy C. Higher degree of selectivity D. Reduction of side effects and toxicity

C. Protamine sulfate ***Protamine sulfate is an antidote to severe heparin overdose.

What is the antidote for heparin? A. Ferrous sulfate B. Atropine sulfate C. Protamine sulfate D. Magnesium sulfate

B. "This combination promotes urine output but decreases the risk of low potassium." ***Spironolactone [Aldactone] is a potassium-sparing diuretic; furosemide [Lasix] causes potassium loss. Giving these together minimizes electrolyte imbalance. It is not accurate to state that the drug combination prevents dehydration and loss of fluid volume or that it increases the osmolality of plasma and the glomerular filtration rate. Stating that giving two different diuretics is more effective than a large dose of one is not accurate.

What is the best information for the nurse to provide to a patient who is receiving spironolactone and furosemide therapy? A. "This combination prevents dehydration and loss of fluid volume." B. "This combination promotes urine output but decreases the risk of low potassium." C. "Using two drugs increases the osmolality of plasma and the glomerular filtration rate." D. "Moderate doses of two different diuretics are more effective than a large dose of one."

B. To validate and document patient data ***The main purpose of the assessment phase is to validate subjective and objective patient data and to document it. Important methods of data collection are the patient interview, medical and drug-use histories, the physical examination, observation of the patient, and laboratory tests. The planning phase involves setting goals for the patient's recovery. The nurse implements the appropriate nursing interventions during the implementation phase. The nurse evaluates the success of patient outcomes during the evaluation phase.

What is the main purpose of the assessment phase of the nursing process? A. To set goals for the patient's recovery B. To validate and document patient data C. To use appropriate nursing interventions D. To evaluate the success of patient outcomes

C. To determine if patient outcomes are met ***The main purpose of the evaluation phase of the nursing process is to determine the success of patient outcomes. The conclusions drawn during evaluation provide the basis for modifying nursing interventions and the drug regimen. The nurse may need to assess patient needs and revise the nursing interventions if patient outcomes are not met. The nurse analyzes the patient's symptoms during the nursing diagnosis phase. The nurse determines the best interventions for the patient during the planning phase. The nurse obtains objective data from the patient during the assessment phase.

What is the main purpose of the evaluation phase of the nursing process? A. To analyze the patient's symptoms B. To obtain objective data from the patient. C. To determine if patient outcomes are met D. To determine the best interventions for the patient

B. Sexual dysfunction

What is the main side effect of SSRI? A. Weight gain B. Sexual dysfunction C. Kidney failure D. Hypertensive crisis

C. Notify the healthcare provider of nausea, vomiting, and visual changes. ***Verapamil can raise digoxin blood serum levels, increasing the risk of digoxin toxicity. Symptoms of digoxin toxicity may include nausea, vomiting, and visual changes. Increase intake of oral fluids and high-fiber food to decrease the adverse effect of constipation. An apical pulse should be taken for a full minute prior to administering digoxin. Verapamil and digoxin can cause bradycardia not tachycardia.

What is the most appropriate nursing consideration for a patient who is prescribed verapamil [Calan] and digoxin [Lanoxin]? A. Restrict intake of oral fluids and high-fiber food. B. Take an apical pulse for 30 seconds before administration. C. Notify the healthcare provider of nausea, vomiting, and visual changes. D. Hold the medications if the heart rate is greater than 110 beats per minute.

D. Helicobacter pylori ***AKA H. pylori.

What is the most common cause of peptic ulcers? A. parasite's B. surgical C. food being digested D. Helicobacter pylori

B. Loratadine has fewer sedative effects. ***Loratadine (Claritin) does not affect the central nervous system and therefore is nonsedating. There is insufficient evidence to indicate that loratadine (Claritin) can cause dysrhythmias, can act as a bronchodilator, or cause gastrointestinal upset than other comparable medications.

What is the most important thing for the nurse to teach a patient who is switching allergy medications from diphenhydramine (Benadryl) to loratadine (Claritin)? A. Loratadine can potentially cause dysrhythmias. B. Loratadine has fewer sedative effects. C. Loratadine has increased bronchodilating effects. D. Loratadine causes less gastrointestinal upset.

C. Promote potassium retention and sodium excretion ***Spironolactone (Aldactone) belongs to a classification of drugs known as potassium-sparing diuretic. It promotes discharge of salt and water through the urine while retaining potassium.

What is the pharmacologic mechanism of action of Spironolactone (Aldactone)? A. Stimulate potassium excretion and sodium retention B. Increase potassium and sodium excretion C. Promote potassium retention and sodium excretion D. Promote potassium, sodium and water excretion

C. To develop an individualized care plan ***The main purpose of formulating nursing diagnoses is to develop an individualized care plan. This is possible because the nursing diagnoses help the nurse to understand the chief concerns of the patient. The nurse validates the subjective patient data to formulate an accurate nursing diagnosis. The nurse organizes the patient data in a framework so that it is easily accessible to other healthcare members. The nurse assesses the patient's learning needs to evaluate the requirement for further learning.

What is the purpose of formulating nursing diagnoses? A. To organize data in a framework B. To validate subjective patient data C. To develop an individualized care plan D. To understand the patient's educational needs

A. NSAIDs

What is the second most common causes of peptic ulcers? A. NSAIDs B. H. pylori C. virus D. food being digested

C. Pharmacodynamics ***Pharmacodynamics is the study of what drugs do to the body. Pharmacokinetics is the study of drug movement throughout the body. Pharmacotherapeutics is the use of drugs to diagnose, prevent, or treat disease or to prevent pregnancy. Pharmacology is the study of drugs in humans.

What is the term for the study of how drugs influence the body? A. Pharmacology B. Pharmacokinetics C. Pharmacodynamics D. Pharmacotherapeutics

B. Alprazolam [Xanax] ***The approved first-line choices are benzodiazepines, and alprazolam [Xanax] is a benzodiazepine. Trazodone and phenelzine are monoamine oxidase inhibitors (MAOIs). Amoxapine is a tricyclic antidepressant.

What medication would the nurse anticipate a provider prescribing for treatment of generalized anxiety disorder? A. Phenelzine [Nardil] B. Alprazolam [Xanax] C. Trazodone [Desyrel] D. Amoxapine [Asendin]

B. GABA

What neurotrasmitter to benzodiazepines intensify the action of? A. Melatonin B. GABA C. Endorphin D. Histamine

D. St. John's wort ***St. Johns wort has been shown to decrease serum montelukast (Singulair) levels. The other substances do not interact with montelukast.

What over-the-counter product will the nurse instruct the patient to avoid when taking montelukast (Singulair)? A. Acetaminophen (Tylenol) B. Echinacea C. Diphenhydramine (Benadryl) D. St. John's wort

B. alcohol ***This could cause a Disulfiram-type reaction which includes s&s of facial flushing, sweating, severe headache, slurred speech.

What should a patient taking Metronidazole avoid? A. NSAIDs B. alcohol C. antibiotics D. grape juice

B. benzodiazipines or cogentin ***Signs of extrapyrdaminal syndrome: acute dystonia, akathisa (can stay still), pseudoparkinsonism syndrome (ridgid), tardive dyskinesia (rolling of tongue).

What should extrapyramidal syndrome be treated with? A. chlorpromazine B. benzodiazipines or cogentin C. lithium or phenytoin

C. Renal function ***As metformin [Glucophage] is excreted by the kidneys, it is necessary to assess the patient's renal function. If the patient's kidneys are not able to excrete the drug, it will accumulate in the patient's system, thereby causing lactic acidosis. One of the adverse effects of metformin [Glucophage] is weight loss, not weight gain. Headaches are not caused by metformin [Glucophage]. Cholesterol levels may be high in some diabetic patients but can be treated with medications and lifestyle changes.

What should the nurse assess in a patient who is prescribed metformin [Glucophage] for treatment of type 2 diabetes? A. Headache B. Weight gain C. Renal function D. Cholesterol level

C. Urinary output D. Blood pressure ***The nurse should assess urinary output and blood pressure within an hour after administering a diuretic. Neurologic status should not change. Weight is not the best way to monitor a diuretic given for hypertension. Heart rate is not a measure of diuretic effectiveness.

What should the nurse assess within an hour after administering a diuretic? Select all that apply. A. Weight B. Heart rate C. Urinary output D. Blood pressure E. Neurologic status

C. "Wear sunblock and protective clothing when you are outdoors." D. "Check your pulse daily and report excessive slowing to your healthcare provider immediately." E. "Immediately notify your healthcare provider of shortness of breath, cough, or chest pain." ***Patients frequently experience photosensitivity reactions while taking amiodarone. To reduce this risk, patients should avoid sunlamps and wear sunblock and protective clothing when outdoors. Excessive slowing of the heart rate may indicate that the patient is experiencing sinus bradycardia or an AV block. Dyspnea, cough, and chest pain may indicate pulmonary toxicity. Grapefruit juice should be avoided, because it may increase amiodarone levels and thus the risk of toxicity. Gastrointestinal side effects of amiodarone can be reduced by taking the drug on a full stomach.

What should the nurse include in the discharge teaching for a patient prescribed amiodarone [Cordarone]? (Select all that apply.) A. "Take amiodarone with grapefruit juice." B. "Take the medication on an empty stomach." C. "Wear sunblock and protective clothing when you are outdoors." D. "Check your pulse daily and report excessive slowing to your healthcare provider immediately." E. "Immediately notify your healthcare provider of shortness of breath, cough, or chest pain."

A. "Do not chew or crush the tablet." ***Enteric-coated tablets disintegrate in the alkaline medium of the small intestine. Patients should be instructed not to chew or crush enteric-coated tablets because they will then be absorbed in the acidic medium of the stomach rather than in the small intestine. An enteric-coated tablet will not dissolve if it is placed under the tongue. The tablet must not be dissolved in water or milk to prevent alteration of the time and place of absorption. The patient should not eat a high-fat meal before taking the tablet because this will cause a delay in absorption.

What should the nurse teach a patient who is prescribed enteric-coated tablets? A. "Do not chew or crush the tablet." B. "Place the tablet under the tongue." C. "Dissolve the tablet in water or milk." D. "Eat a high-fat meal before taking the medication."

A. Avoid alcohol. C. Keep hard candy nearby. D. Take frequent sips of fluid. ***Hard candy and frequent sips of fluid can minimize the adverse effects of dry mouth. Taking antihistamines with food, not on an empty stomach helps with gastrointestinal disturbances. Fruit juice decreases absorption rates of some antihistamines. Avoiding alcohol will prevent an increase in drowsiness often experienced with antihistamines.

What should the nurse teach the patient to help minimize adverse effects of antihistamine administration? Select all that apply. A. Avoid alcohol. B. Take with orange juice. C. Keep hard candy nearby. D. Take frequent sips of fluid. E. Take on an empty stomach.

A. Planning nursing interventions to meet patient goals ***The nurse will understand the patient's chief concerns after formulating the nursing diagnosis. The nurse then proceeds to the planning phase during which the nurse plans interventions that will meet the patient goals. The nurse will implement nursing interventions for health promotion during the implementation phase. The implementation phase will also include patient teaching, which will optimize the patient's health status. The nurse will evaluate the effectiveness of the nursing interventions during the last phase of the nursing process.

What step of the nursing process occurs after the nurse formulates a nursing diagnosis from patient assessment data? A. Planning nursing interventions to meet patient goals B. Implementing nursing interventions for health promotion C. Evaluating the effectiveness of the nursing interventions D. Undertaking patient teaching to optimize patient health status

C. Liquefying and loosening of bronchial secretions ***Acetylcysteine is a mucolytic drug used to liquefy and loosen bronchial secretions in order to enhance their expectoration.

What will the nurse expect to find that would indicate a therapeutic effect of acetylcysteine (Mucomyst)? A. Decreased cough reflex B. Decreased nasal secretions C. Liquefying and loosening of bronchial secretions D. Relief of bronchospasms

C. "Pyridoxine (vitamin B6) will prevent numbness and tingling that can occur when taking isoniazid." ***Isoniazid (INH) can cause neurotoxicity. Pyridoxine (vitamin B6) is the drug of choice to prevent this adverse reaction. It is not an antiinfective agent and thus will work to destroy the mycobacterium or prevent drug resistance. Vitamin C is not taken with this drug; the drug is appropriate for most patients, and INH with pyridoxine is not multidrug therapy.

What will the nurse teach a patient who is taking isoniazid (INH)? A. "You will need to take vitamin C to potentiate the action of INH." B. "You should not be on that drug. I will check with the health care provider." C. "Pyridoxine (vitamin B6) will prevent numbness and tingling that can occur when taking isoniazid." D. "Multidrug therapy is necessary to prevent the occurrence of resistant bacteria."

C. Respiratory involvement/compromise

What's the difference between allergic and anaphylactic response? A. Unrelenting abdominal pain B. Extreme excitability C. Respiratory involvement/compromise D. Excessive diaphoresis

B. swell ***Hypotonic crystalloid are less concentrated than extracellular fluids, so they move from the bloodstream into the cell and cause the cell to expand with fluid.

When a hypotonic crystalloid solution is infused into the blood stream, it causes the cells to: A. shrink B. swell C. release chloride D. release potassium

A. electrolyte loss B. cirrhosis C. severe renal disease E. ototoxicity

When administering Furosemide [Lasix], the nurse should know which of the following conditions that are contraindicated for this medication. Select all that apply. A. electrolyte loss B. cirrhosis C. severe renal disease D. heart failure E. ototoxicity F. hypertension

B. Pulmonary Edema

When administering a hypertonic solution the nurse should closely watch for? A. Signs of dehydration B. Pulmonary Edema C. Fluid volume deficient D. Increased Lactate level

A. ECG ***The ECG is the most important parameter to assess. B, C, and D need to be monitored, but the ECG is the most important.

When administering an antiarrhythmic agent, which of the following assessment parameters is the most important for the nurse to evaluate? A. ECG B. Pulse rate C. Respiratory rate D. Blood pressure

C. Short intervals over time ***Phase-specific agents are toxic to cells that are passing through a particular phase of the cell cycle. To be effective, phase-specific agents must be present as cancer cells cycle through the specific phase in which the drugs act. These agents must be present for an extended time and often are administered by prolonged intravenous infusion or in multiple doses at short intervals over an extended time. Phase-specific agents may not be as effective if given just on the first day of the month, 1 day every 12 weeks, or at the end of the treatment.

When administering phase-specific anticancer medications, which schedule is used to achieve maximum therapeutic effectiveness? A. At the end of treatment B. One day every 12 weeks C. Short intervals over time D. The first day of the month

C. Histamine

When an allergen is present, basophils and mast cells respond by releasing what? A. Glucose B. Antihistamine C. Histamine D. Insulin

A. Angiotension converting enzyme

When angiotension I goes to the lungs through the blood stream, what is the enzyme called? A. Angiotension converting enzyme B. Renin C. Antidiuretic hormone D. Angiotension II

C. Drowsiness ***Morphine sulfate depresses the central nervous system, resulting in drowsiness. It also causes a decrease in gastrointestinal motility leading to constipation. Morphine sulfate can cause constipation, not increased bowel sounds. This effect is helpful in treating diarrhea. Morphine sulfate does not cause insomnia. It is an opioid and causes drowsiness.

When assessing a patient for adverse effects of morphine sulfate, which finding would a nurse expect? A. Diarrhea B. Insomnia C. Drowsiness D. Increased bowel sounds

A. Nausea C. Urinary retention D. Decreased peristalsis E. Delayed gastric emptying ***Morphine sulfate causes a decrease in gastrointestinal motility (delayed gastric emptying and decreased peristalsis). This leads to constipation, not diarrhea. Morphine can also cause urinary retention and nausea.

When assessing a patient for adverse effects related to morphine sulfate, which effects would the nurse expect to find? Select all that apply. A. Nausea B. Diarrhea C. Urinary retention D. Decreased peristalsis E. Delayed gastric emptying

A. Osteoporosis B. Moon face C. Glycosuria E. Mood swings ***Cushing's syndrome results from excess secretion of adrenocorticotropic hormone (ACTH), and these effects result in manifestations such as redistribution of fat to the face and belly, excess blood sugar, mood changes, and calcium loss from bone. Ketoacidosis does not occur.

When assessing a patient who has Cushing's syndrome, a nurse associates which clinical manifestations with this disorder? (Select all that apply.) A. Osteoporosis B. Moon face C. Glycosuria D. Ketonuria E. Mood swings

A. The contraction of those muscles or electrical activity

When calcium enters the cell, what does it cause? A. The contraction of those muscles or electrical activity B. Hyperkalemia C. The relaxation of muscles and inhibition of electrical activity D. Hypocalcemia

A. When SSRIs are taken with MAOI's and TCAs

When can Serotonin Syndrome occur? A. When SSRIs are taken with MAOI's and TCAs B. When SSRIs are taken with green leafy vegetables C. When SSRI's are taken on an empty stomach D. When SSRIs are suddenly stopped

C. Digoxin and lithium

Which 2 meds can cause a toxicity effect with diuretics? A. Warfarin and heparin B. Celexa and Ativan C. Digoxin and lithium D. Diclegis and Penicillin

D. Aspirin

Which NSAID is salicylism associated with? A. Diclofenac B. Naproxen C. Ibprofen D. Aspirin

B. Hypertonic

_______ solutions cause cell dehydration and help increase fluid in the extracellular space. A. Hypotonic B. Hypertonic C. Isotonic D. Osmosis

C. Low serum potassium level ***Hypokalemia (C) predisposes the client on digoxin to digoxin toxicity, which usually presents as abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, and atrioventricular (AV) dissociation. Assessment of serum potassium levels with prompt correction of hypokalemia are important interventions for the client taking digoxin. (A, B, and D) are not relevant.

When caring for a client on digoxin (Lanoxin) therapy, the nurse knows to be alert for digoxin (Lanoxin) toxicity. Which finding would predispose this client to developing digoxin toxicity? A. Low serum sodium level B. High serum sodium level C. Low serum potassium level D. High serum potassium level

A. hypokalemia. ***Patients taking amphoterocin B should be assessed for the development of hypokalemia.

When caring for a patient receiving amphotericin B, it is most important for the nurse to assess the patient for the development of A. hypokalemia. B. hypernatremia. C. hypocalcemia. D. hypermagnesemia.

C. hypokalemia ***Watch for signs of hypokalemia in a patient receiving hydrochlorothiazide

When caring for a patient taking hydrochlorothiazide, you should monitor the patient for: A. hypertension B. hypernatremia C. hypokalemia D. hypoglycemia

C. hypokalemia ***Watch for signs of hypokalemia in a patient receiving hydrochlorothiazide.

When caring for a patient taking hydrochlorothiazide, you should monitor the patient for: A. hypertension B. hypernatremia C. hypokalemia D. hypoglycemia

B. After 5 hours

When do you need look for signs/symptoms of hypoglycemia after giving regular insulin? A. 1 hour later B. After 5 hours C. Within 15 minutes D. 24 hours later

D. Increased secretion of acid in the stomach

When histamine is released and binds to the histamine 2 receptors in the stomach, what is the result? A. Gastric bleeding B. Immediate emesis C. Significantly increased gastric emptying time D. Increased secretion of acid in the stomach

B. Superinfection ***Antibiotic therapy can destroy the normal flora of the body, which typically inhibit the overgrowth of fungi and yeast. When the normal flora are decreased, these organisms can overgrow and cause superinfections. When normal flora is destroyed, hypersensitivity, rebound toxicity, and organ toxicity do not result.

When instructing a patient about antibiotic therapy, the nurse explains that normal flora are disturbed during antibiotic therapy when which condition occurs? A. Organ toxicity B. Superinfection C. Hypersensitivity D. Rebound toxicity

B. Increase the IV and oral fluid intake. ***Cyclophosphamide [Cytoxan] is an alkylating agent with adverse effects of dose-limiting bone marrow suppression and hemorrhagic cystitis. Bladder injury can be minimized by maintaining adequate hydration through increased fluid intake. It is not necessary to monitor the patient for laryngeal stridor and tetany, palpate pedal pulses, or give an antidiarrheal medication with cyclophosphamide [Cytoxan].

When planning care for a patient who is receiving cyclophosphamide [Cytoxan], which intervention is most important for the nurse to include to prevent complications of cyclophosphamide [Cytoxan] therapy? A. Give an antidiarrheal medication. B. Increase the IV and oral fluid intake. C. Palpate for pedal pulses every 2 hours. D. Monitor for laryngeal stridor and tetany.

A. Yogurt ***When taking monamine oxidase inhibitors (MAOIs), patients should avoid cheese, red wine, beer, liver, bananas, yogurt, and sausage.

When providing dietary teaching for a patient taking monamine oxidase inhibitors (MAOIs), the nurse should teach the patient to avoid which food? A. Yogurt B. Avocado C. Grapefruit D. Potato chips

B. Assess respiratory status and breath sounds often. ***The client should be assessed often for signs of respiratory complications (B). The client with myasthenia gravis is at greatest risk for life-threatening respiratory complications because of the weakness of the diaphragm and ancillary respiratory muscles caused by the disease process. Cholinergic agents used to reduce muscle weakness can also cause hypersalivation, increased respiratory secretions, and possible bronchoconstriction. Although (A, C, and D) reflect helpful interventions, they do not have the priority of (B) in caring for the client with myasthenia gravis.

When providing nursing care for a client receiving pyridostigmine bromide (Mestinon) for myasthenia gravis, which nursing intervention has the highest priority? A. Monitor the client frequently for urinary retention. B. Assess respiratory status and breath sounds often. C. Monitor blood pressure each shift to screen for hypertension. D. Administer most medications after meals to decrease gastrointestinal irritation.

B. call the practitioner if losing more than 2 lb (0.9 kg) per day ***A weight loss of more than 2 lb (0.9 kg) per day indicates excessive diuresis.

When teaching a patient about diuretics, you should tell the patient to: A. take the drug in the evening B. call the practitioner if losing more than 2 lb (0.9 kg) per day C. eat a high-sodium diet D. avoid sun exposure for several hours after taking the medication to prevent a photosensitivity reaction

D. "Avoid exposure to direct sunlight." ***The patient should be taught to avoid direct sunlight. The patient should be taught that INH should be administered 1 hour before or 2 hours after meals. Pyridoxine (vitamin B6) is used with INH therapy to decrease peripheral neuropathy. Rifampin use causes the urine to turn a red-orange color.

When teaching a patient about isoniazid (INH) and rifampin drug therapy, which statement will the nurse include? A. "Take isoniazid with meals." B. "Double the amount of vitamin C in your diet to prevent the peripheral neuropathy associated with isoniazid therapy." C. "Notify the primary health care provider immediately if your urine turns a red-orange color." D. "Avoid exposure to direct sunlight."

A. lorazepam ***Benzodiazepines used to treat anziety include lorazepam, alprazolam, chlordiazepoxide, hydrochloride, clonazepam, clorazepate dipotassium, diazepam, halazepam, and oxazepam.

Which benzodiazepine is used primarily to treat anxiety? A. lorazepam B. estazolam C. triazolam D. flurazepam

A. "Do not stop the medication abruptly." ***The medication cannot be stopped abruptly as this can cause rebound hypertension. The medication should not be taken with an antacid as this may delay absorption. The patient is typically tired at the beginning of therapy and should not stop the medication. Using a hot tub or staying in hot water for long periods is not recommended.

When teaching a patient about the drug metoprolol, what information will the nurse include in the teaching plan? A. "Do not stop the medication abruptly." B. "Stop the medication if you feel tired." C. "If you have gastric upset, take the medication with an antacid." D. "Use a hot tub daily to help vasodilation so that the medication will work more effectively."

D. "Most people infected with Mycobacterium tuberculosis are asymptomatic." E. "Most people infected with Mycobacterium tuberculosis harbor dormant bacteria for life if they do not receive drug therapy." ***Most people infected with M. tuberculosis are asymptomatic and harbor dormant bacteria for life if they do not receive drug therapy. Treatment of tuberculosis usually lasts 6 months to 2 years. Isoniazid can cause peripheral neuropathy by depleting vitamin B6. Ethambutol, not rifampin, can cause optic neuritis.

When teaching a patient about tuberculosis, the nurse should include which statement(s)? Select all that apply. A. "Rifampin can cause optic neuritis." B. "Treatment of tuberculosis lasts 3 months." C. "Isoniazid can cause peripheral neuropathy by depleting vitamin B12." D. "Most people infected with Mycobacterium tuberculosis are asymptomatic." E. "Most people infected with Mycobacterium tuberculosis harbor dormant bacteria for life if they do not receive drug therapy."

D. use an additional form of birth control if you are taking certain antibiotics. ***Advise the patient taking hormonal contraceptives to use an additional form of birth control if she is also taking certain antibiotics because antibiotics may decrease the effectiveness of hormonal contraceptives.

When teaching a patient how to take hormonal contraceptives, which of the following instructions should you give? A. take the drug in the morning. B. if you miss a dose, skip it and take it the next day. C. if you miss one menstrual period, stop taking the drug and take a pregnancy test. D. use an additional form of birth control if you are taking certain antibiotics.

A. First trimester ***During the first trimester of pregnancy, the fetus is at greatest risk for drug-induced developmental defects. During this period, the fetus undergoes rapid cell proliferation, and the skeleton, muscles, limbs, and visceral organs are developing at their most rapid rate.

When teaching a pregnant patient about the effects of medication on the fetus, the nurse should recognize that the greatest harm from maternally ingested medications occurs during which time period? A. First trimester B. Third trimester C. Second trimester D. Birthing process

C. increasing the depth and rate of respiration ***The brain's respiratory center initially causes an increase in respiratory rate. It then causes an increase in respiratory depth in an effort to blow off excess carbon dioxide.

When the body senses hypoxemia or hypercapnia, the brain's respiratory center responds by: A. slowing down the respiratory rate B. decreasing the heart rate C. increasing the depth and rate of respiration D. increasing the heart rate

C. Isotonic

When the cell presents with the same concentration on the inside and outside with no shifting of fluids this is called? A. Hypotonic B. Hypertonic C. Isotonic D. Osmosis

A. sodium ***The kidneys reabsorb sodium and excrete potassium when aldosterone is secreted.

When the hormone aldosterone is secreted, the kidneys reabsorb: A. sodium B. potassium C. magnesium D. calcium

B. Vasoconstriction, increased blood pressure

When the sympathetic activity is increased by the presence of angiotension converting enzyme, what is the effect on the body? A. Decreased level of consciousness B. Vasoconstriction, increased blood pressure C. Vasodilation, decreased blood pressure D. Decreased blood volume

A. In the evening ***The liver produces the majority of cholesterol during the night. Thus, it is best to give HMG-CoA reductase inhibitors (statins), which work to decrease this synthesis, during the evening so that blood levels are highest coinciding with this production. Since this drug has a tendency to elevate the liver enzyme level, it may not be advisable to take the drug on an empty stomach. Since the liver produces the majority of cholesterol during the night, it is not ideal to give the drug during breakfast. An antacid is generally given to prevent stomach upset.

When will the nurse administer hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins)? A. In the evening B. With breakfast C. With an antacid D. On an empty stomach

C. It easier for the heart to pump blood because the blood pressure has been decreased

When you block the ACE, a decrease in vasoconstriction results, therefore making.. A. It so there is more free water in the intravascular space B. It so there is a steady increase in serum sodium C. It easier for the heart to pump blood because the blood pressure has been decreased D. The contraction of heart to be less intense

C. It goes up

When you block the ACE, what happens to the potassium level? A. It goes around and around B. It goes down C. It goes up D. It stays the same

A. Clear / regular

When you mix regular insulin and NPH, which do you draw up first? A. Clear / regular B. Cloudy / NPH

B. Cloudy / NPH

When you mix regular insulin and NPH, which do you draw up second? A. Clear / regular B. Cloudy / NPH

C. Inflammatory prostaglandins

Whenever there is tissue injury, arachidonic acid is converted into ... A. Serotonin B. Monoamine oxidase enzymes C. Inflammatory prostaglandins D. Histamine

B. SA node, AV node, cardiac myocytes, and vascular smooth muscle

Where are calcium channels? A. corpus callosum, Circle of Willis, ponse B. SA node, AV node, cardiac myocytes, and vascular smooth muscle C. Pulmonary bed, cardiac myocytes D. renal capsule, renal cortex, and cortical nephrons

C. Metabolic acidosis ***Principal causes of metabolic acidosis are chronic renal failure, loss of bicarbonate during severe diarrhea, and metabolic disorders that result in overproduction of lactic acid (lactic acidosis) or ketoacids (ketoacidosis). Metabolic acidosis may also result from poisoning by methanol and certain medications (eg, aspirin and other salicylates).

Which acid-base imbalance is caused by chronic renal failure, loss of bicarbonate during severe diarrhea, or metabolic disorders that result in overproduction of lactic acid? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

A. Respiratory acidosis ***Respiratory acidosis results from retention of CO2 secondary to hypoventilation. Reduced CO2 exhalation raises plasma pCO2, which in turn causes plasma pH to fall.

Which acid-base imbalance is caused by retention of CO2 secondary to hypoventilation? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

D. Metabolic alkalosis ***Metabolic alkalosis is characterized by increases in both the pH and bicarbonate content of plasma. Causes include excessive loss of gastric acid (through vomiting or suctioning) and administration of alkalinizing salts (eg, sodium bicarbonate).

Which acid-base imbalance is characterized by increases in both the pH and bicarbonate content of plasma? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

C. Hold the vitamin and consult the prescriber. ***Vitamin D is contraindicated in patients with hypercalcemia, a clinical manifestation of hyperparathyroidism. The prescriber should be consulted about the patient's most recent calcium level and clinical symptoms. Checking deep tendon reflexes, giving milk, and asking about NSAID use are unnecessary actions to take in the administration of vitamin D.

Which action should a nurse take when preparing to administer vitamin D to a patient diagnosed with hyperparathyroidism? A. Assess deep tendon reflexes. B. Give the vitamin with 8 ounces of milk. C. Hold the vitamin and consult the prescriber. D. Determine whether the patient takes nonsteroidal anti-inflammatory drugs (NSAIDs).

A. Break the tablet in half so it is easier to swallow. C. Allow the tablet to dissolve in water before administering it. D. Administer the tablet with sips of water 1 hour before meals. ***Sucralfate acts through a compound that is a sticky gel, which adheres to an ulcer crater, creating a barrier to back-diffusion. The drug is best taken on an empty stomach. The tablet form should not be crushed because crushing it could reduce the effectiveness of the drug. Sucralfate tablets are large and difficult to swallow but can be broken or dissolved in water prior to ingestion. Sucralfate acts under mildly acidic conditions; antacids raise the gastric pH above 4 and may interfere with the effects of sucralfate.

Which administration technique(s) would be appropriate when giving a sucralfate [Carafate] tablet to a patient with a duodenal ulcer? Select all that apply. A. Break the tablet in half so it is easier to swallow. B. Administer the tablet with an antacid for maximum benefit. C. Allow the tablet to dissolve in water before administering it. D. Administer the tablet with sips of water 1 hour before meals. E. Crush the tablet into a fine powder before mixing it with water.

A. Alopecia B. Stomatitis C. Neutropenia ***Bone marrow suppression (leukopenia, neutropenia, thrombocytopenia, and anemia), stomatitis, and alopecia are common adverse reactions to antineoplastic drugs. Urinary retention and hypertension are not expected side effects.

Which adverse effects will the nurse monitor for in a patient receiving chemotherapy? Select all that apply. A. Alopecia B. Stomatitis C. Neutropenia D. Hypertension E. Urinary retention

D. It may take 1 to 2 weeks before you have any benefits from taking the medication. ***The effectiveness of lithium may not be evident until 1 to 2 weeks after the start of therapy. The patient should be taught to maintain adequate sodium intake and to avoid crash diets that affect physical and mental health. Lithium levels are maintained by taking the drug on a daily basis. The patient should be taught to take lithium with meals to decrease gastric irritation.

Which advice will the nurse include when teaching the patient about lithium therapy? A. Take the drug on an empty stomach. B. Eliminate all sodium from your diet. C. Stop taking the lithium when you feel better. D. It may take 1 to 2 weeks before you have any benefits from taking the medication.

A. Morphine [Duramorph] ***Morphine is a strong opioid agonist and as such has the highest likelihood of causing respiratory depression. Pentazocine, a partial agonist, and hydrocodone, a moderate to strong agonist, may cause respiratory depression, but they do not do so as often or as seriously as morphine. Nalmefene, an opioid antagonist, would be used to reverse respiratory depression with opioids.

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

B. Na HCO3

Which antacid is useful in the treatment of acidosis and elevated pH to promote excretion of acidic drugs after overdose? A. Ca carbonate B. Na HCO3 C. Al hydroxide D. Mg hyrdoxide

D. ipratropium bromide ***Inhaled ipratropium bromide is an anticholinergic agent used as a bronchodilator in patients with COPD.

Which anticholinergic agent is used to treat patients with COPD? A. atropine B. guaifenesin C. budesonide D. ipratropium bromide

A. Tremors C. Tachycardia D. Palpitations ***Albuterol [Proventil] is used for the treatment of asthma. If albuterol [Proventil] is used in larger dosages, then dose-related adverse effects may be seen. These effects may develop as the drug loses its beta2-specific actions. Therefore, the beta1 receptors are stimulated, resulting in tremors, tachycardia, palpitations, nausea, and increased anxiety. Albuterol [Proventil] does not affect skin integrity; therefore, it does not cause skin rashes. Albuterol [Proventil] does not affect insulin metabolism; therefore, it does not cause hypoglycemia.

Which are adverse effects of albuterol [Proventil]? Select all that apply. A. Tremors B. Skin rashes C. Tachycardia D. Palpitations E. Hypoglycemia

B. Rivastigmine [Exelon] ***All these drugs have the potential to cause GI distress, including nausea, vomiting, anorexia, and weight loss. Rivastigmine is thought to have the highest probability of producing these effects. Memantine (NMDA) is not a cholinesterase inhibitor.

Which cholinesterase inhibitor has the highest incidence of adverse gastrointestinal (GI) effects? A. Donepezil [Aricept] B. Rivastigmine [Exelon] C. Galantamine [Reminyl] D. Memantine [NMDA]

A. Reduction of LDLs B. Elevation of HDLs C. Stabilization of the plaque in coronary arteries D. Reduction of risk of cardiovascular events ***The statin drugs have many benefits, the most important being reduction of LDLs. They also promote an increase in HDLs, stabilization of atherosclerotic plaque, and reduced inflammation at the plaque site. Among other benefits, they also slow progression of coronary artery calcification. The statins reduce the overall risk of cardiovascular events. They can have serious adverse effects on the liver, but these are relatively rare.

Which are beneficial effects that can be derived from simvastatin [Zocor] and other drugs in this class? (Select all that apply.) A. Reduction of LDLs B. Elevation of HDLs C. Stabilization of the plaque in coronary arteries D. Reduction of risk of cardiovascular events E. Improvement of liver function

A. Lispro [Humalog] B. Aspart [NovoLog] C. Glulisine [Apidra] ***Lispro [Humalog], Aspart [NovoLog], and Glulisine [Apidra] are rapid-acting insulins that have an onset of action of 15 minutes. Regular insulin [Humulin R] is a short-acting insulin that has an onset of action of 30 to 60 minutes. Glargine [Lantus] is a long-acting insulin, which is dosed every 12 hours depending on the patient's glycemic response.

Which are rapid-acting insulins that can be administered to patients with diabetes mellitus? Select all that apply. A. Lispro [Humalog] B. Aspart [NovoLog] C. Glulisine [Apidra] D. Glargine [Lantus] E. Regular insulin [Humulin R]

C. Black, tarry stools ***Black, tarry stools may indicate bleeding higher up in the gastrointestinal tract. This is a serious side effect that requires immediate intervention. Headaches, nonproductive coughs, and palpitations are not usually side effects of NSAID therapy.

Which assessment finding in a patient taking nonsteroidal anti-inflammatory drugs (NSAIDs) requires immediate intervention? A. Headache B. Palpitations C. Black, tarry stools D. Nonproductive cough

A. Pregnancy is at 44 weeks' gestation ***As a rule, induction should be reserved for pregnancy that has continued beyond term (ie, beyond 42 weeks). Placenta previa is a contraindication for induction. The likelihood of trauma is especially high in cases of cephalopelvic disproportion, so oxytocin [Pitocin] is contraindicated. Oxytocin [Pitocin] is indicated for the induction of labor in a post-term patient, but the patient must have a soft cervix.

Which assessment finding indicates a patient is a suitable candidate for oxytocin [Pitocin] therapy? A. Pregnancy is at 44 weeks' gestation B. No cervical ripening at 42 weeks' gestation C. Radiographic confirmation of cephalopelvic disproportion D. Vaginal bleeding at 38 weeks' gestation from placenta previa

C. Menstrual bleeding decreases. ***NSAIDs are effective in treating menorrhagia, as they inhibit cyclooxygenase (COX) and thereby suppress production of prostaglandin, which decreases excessive bleeding. Softening the cervix is accomplished by dinoprostone [Prepidil] and misoprostol [Cytotec]. Tocolytic drugs stop preterm labor. Oxytocic or uterotonic drugs increase uterine contractions.

Which assessment finding indicates a therapeutic effect for a patient taking nonsteroidal anti-inflammatory drugs (NSAIDs) for menorrhagia? A. Cervix softens. B. Labor is stopped. C. Menstrual bleeding decreases. D. Uterine contraction force increases.

D. Pain has decreased from a 6 to a 1 on a scale of 10. ***Prostaglandins are produced in response to activation of the arachidonic acid pathway. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen work by blocking cyclooxygenase, the enzyme responsible for conversion of arachidonic acid into prostaglandins. Decreasing the synthesis of prostaglandins results in decreased pain and inflammation. The length of the PTT, the bleeding time, and the increased extremity circulation are not therapeutic effects of the medication.

Which assessment finding indicates that the nonsteroidal anti-inflammatory drug has been effective? A. PTT is 100 seconds. B. Patient's bleeding time is prolonged. C. Patient has increased circulation to his legs. D. Pain has decreased from a 6 to a 1 on a scale of 10.

C. Blood pressure ***Hydralazine is a vasodilator that causes arteriolar dilation, decreased resistance, and decreased blood pressure. Monitoring of the blood pressure and heart rate is the highest assessment priority.

Which assessment finding is most important for the nurse to obtain before administering hydralazine [Apresoline]? A. Peripheral pulses B. Homans' sign C. Blood pressure D. Capillary refill

D. Decreased intracranial pressure (ICP) ***Intracranial pressure (ICP) that has been elevated by cerebral edema can be reduced with mannitol [Osmitrol]. The drug lowers ICP because its presence in the blood vessels of the brain creates an osmotic force that draws edematous fluid from the brain into the blood. Mannitol [Osmitrol] has no significant effect on the excretion of potassium and other electrolytes. Mannitol [Osmitrol] will decrease intraocular pressure (IOP).

Which assessment indicates to the nurse that a therapeutic effect of mannitol [Osmitrol] has been achieved? A. Increased calcium B. Decreased potassium C. Increased intraocular pressure (IOP) D. Decreased intracranial pressure (ICP)

D. Respiratory rate ***The most serious side effect of narcotic analgesics is respiratory depression. This is the priority for the nurse to monitor. The other assessments should also be made; however, a decrease in respiratory rate is the highest priority for the nurse to address.

Which assessment is most important for the nurse to monitor in a patient receiving an opioid analgesic? A. Heart rate B. Mental status C. Blood pressure D. Respiratory rate

A. Pulse ***It is crucial to measure the patient's pulse before administering digoxin because digoxin causes a decrease in heart rate. In fact, if the heart rate is below 60, digoxin cannot be given. Respiratory rate is not a priority before administration of digoxin because it does not cause respiratory depression. Blood pressure is not as important as pulse because digoxin increases the strength of cardiac contractions. Weight in kilograms is not necessary before administering digoxin.

Which assessment is most important for the nurse to obtain prior to administering digoxin to a patient with heart failure? A. Pulse B. Blood pressure C. Respiratory rate D. Weight in kilograms

D. Takes with grapefruit juice ***If the patient consumes grapefruit juice, it can raise the levels of diltiazem [Cardizem] and verapamil [Calan]. The other drinks (tea, apple juice, lemonade) can be used by the patient when taking diltiazem [Calan] as they have no significant interaction.

Which behavior by a patient indicates more teaching is needed about taking diltiazem [Cardizem]? A. Takes with tea B. Takes with lemonade C. Takes with apple juice D. Takes with grapefruit juice

D. H2-receptor antagonists ***This class of meds promotes healing by suppressing secretion of gastric acid.

Which class of antiulcer drugs are the first-choice drugs in the treatment of gastric and duodenal ulcers? A. antacids B. PPIs C. NSAIDs D. H2-receptor antagonists

B. Beta blocker and ACE inhibitor ***Beta blockers and ACE inhibitors, as well as aldosterone antagonists, are the drug classes recommended for initial therapy of hypertension after an MI. Diuretics and calcium channel blockers are not part of initial therapy for hypertension after an MI.

Which classes of medications are prescribed as initial therapy for hypertension after a myocardial infarction (MI)? A. Diuretic and beta blocker B. Beta blocker and ACE inhibitor C. ACE inhibitor and calcium channel blocker D. Diuretic and calcium channel blocker

D. Increased bronchial secretion ***By preventing the breakdown of acetylcholine by cholinesterase, cholinesterase inhibitors increase muscarinic receptor activation. This causes an increase in secretions from the pulmonary system. Muscarinic stimulation also causes contraction of smooth muscle in the bronchi, increases bladder tone (but relaxes urinary sphincters promoting urination), and slows the heart rate.

Which clinical indicators should the nurse monitor when a patient takes a cholinesterase inhibitor? A. Urinary retention B. Increased heart rate C. Decreased gastric secretion D. Increased bronchial secretion

D. "If I develop a chronic cough, I need to notify my provider." ***A patient on therapy with an angiotensin-converting enzyme (ACE) inhibitor such as enalapril should report a nonproductive chronic cough, as this is a potential side effect. There is no treatment other than to change the medication therapy. The patient should not double the dose of an antihypertensive. Ringing in the ears in not a concern for ACE inhibitors and the patient need not avoid the sun.

Which comment by a patient indicates correct understanding about the use of enalapril? A. "If I feel tired, I should double the dose." B. "I cannot go out in the sun while on this therapy." C. "I should stop the drug if I have ringing in my ears." D. "If I develop a chronic cough, I need to notify my provider."

B. Sore throat ***Sore throat is an adverse effect associated with intranasal glucocorticoids such as beclomethasone. More common adverse effects include drying of the nasal mucosa and a burning or itching sensation. Sneezing and runny nose are two of the symptoms of allergic rhinitis for which intranasal glucocorticoids are used. Rebound congestion is an adverse effect of intranasal sympathomimetics.

Which complaint indicates that a patient is experiencing an adverse effect of beclomethasone [Beconase AQ] nasal spray? A. Sneezing B. Sore throat C. Runny nose D. Rebound congestion

A. "Avoid crowds." D. "Wear an identification bracelet." E. "Keep an emergency supply of glucocorticoids on hand." ***To ensure appropriate care in emergencies, patients should carry an identification card or bracelet to inform emergency personnel of their glucocorticoid needs. In addition, patients should always have an emergency supply of glucocorticoids on hand. By suppressing host defenses (immune responses and phagocytic activity of neutrophils and macrophages), glucocorticoids can increase susceptibility to infection and the patient should avoid crowds. Calcium should be increased and sodium decreased.

Which discharge information will the nurse share with the patient who will be taking long-term glucocorticoid therapy? Select all that apply. A. "Avoid crowds." B. "Restrict calcium intake." C. "Increase sodium intake." D. "Wear an identification bracelet." E. "Keep an emergency supply of glucocorticoids on hand."

D. "Avoid use of nonsteroidal anti-inflammatory drugs." ***The risk of ulceration is increased by concurrent use of other ulcerogenic drugs, such as aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). Food high in potassium should be consumed and foods high in sodium should be restricted.

Which discharge teaching for a patient receiving glucocorticoids will the nurse include in the teaching session? A. "Eat foods high in sodium." B. "Avoid foods high in potassium." C. "Use aspirin for headache, if needed." D. "Avoid use of nonsteroidal anti-inflammatory drugs."

B. Potassium-sparing diuretics

Which diuretic excretes sodium and water, and re-absorbs potassium? A. All of them reabsorb potassium B. Potassium-sparing diuretics C. Loop diuretics D. Thaizide diuretics

B. Intranasal C. Intraocular D. Transdermal ***Drugs administered through intranasal, intraocular, and transdermal routes circumvent first-pass metabolism because they are absorbed and distributed before they go to the liver for metabolism. First-pass metabolism occurs when drugs first go to the liver and much of the dose is metabolized before being absorbed into the systemic circulation and distributed to the site of action. Drugs administered orally or via a nasogastric tube are subjected to first-pass metabolism.

Which drug administration routes avoid first-pass metabolism in the liver? Select all that apply. A. Oral B. Intranasal C. Intraocular D. Transdermal E. Nastrogastric tube

C. Fluoxetine [Prozac] E. Sertraline [Zoloft] ***Fluoxetine [Prozac] and sertraline [Zoloft] are selective serotonin reuptake inhibitors. Bupropion [Wellbutrin] is an atypical antidepressant. Imipramine [Tofranil] is a tricyclic antidepressant. Desvenlafaxine [Pristiq] is a serotonin/norepinephrine reuptake inhibitor (SNRI).

Which drug does the nurse identify as a selective serotonin reuptake inhibitor? (Select all that apply.) A. Bupropion [Wellbutrin] B. Imipramine [Tofranil] C. Fluoxetine [Prozac] D. Desvenlafaxine [Pristiq] E. Sertraline [Zoloft]

D. Beta-adrenergic blocker ***Beta-adrenergic blockers block the initial sympathetic response to hypoglycemia; therefore, the patient may not exhibit the initial symptoms of nervousness, diaphoresis, and sweating that typically alert the patient to the onset of hypoglycemia. Aspirin increases glucose tolerance by stimulating insulin secretion. Thiazide diuretics worsen insulin sensitivity. There are no known interactions of codeine and insulin.

Which drug interacts with insulin and increases the risk for unrecognized hypoglycemia in a patient? A. Aspirin B. Codeine C. Thiazide diuretics D. Beta-adrenergic blocker

C. Metronidazole (Flagyl) ***The patient taking metronidazole should avoid alcohol and alcohol-containing medications for at least 48 hours after treatment is completed. Drug interaction with alcohol may produce a disulfiram reaction (facial flushing, severe headache, tachycardia, palpitations, hypotension, dyspnea, sweating, slurred speech, abdominal cramps, nausea, and vomiting).

Which drug is associated with disulfiram reaction? A. Atovaquone (Mepron) B. Streptomycin C. Metronidazole (Flagyl) D. Ampheritocin B

D. thiazide diuretics ***Hyperglycemia may occur if glyburide is taken with a thiazide diuretic.

Which drug or drug type would likely cause hyperglycemia if taken with glyburide? A. procainamide B. cimetidine C. warfarin D. thiazide diuretics

A. Weak acid drugs B. Lipid-soluble drugs E. Large nonionized particles ***Weak acid drugs, such as aspirin, pass through the gastric membrane, as they are less ionized in the gastric acid of the stomach. Lipid-soluble drugs pass through the gastric membrane easily because the membrane is mainly composed of lipids and proteins. Large nonionized particles do not have a positive or negative charge and can pass through the membrane. Water-soluble drugs pass through the membrane only if they bind with a carrier, which may be an enzyme or protein. It is difficult for large ionized particles to pass through the membrane.

Which drugs are absorbed quickly across the gastric membranes? Select all that apply. A. Weak acid drugs B. Lipid-soluble drugs C. Water-soluble drugs D. Large ionized particles E. Large nonionized particles

B. Minocycline D. Doxycycline E. Demeclocycline ***Doxycycline, minocycline, and demeclocycline are part of the tetracycline group of antibiotics. Linezolide and clindamycin are other bacteriostatic inhibitors of protein synthesis and not part of the tetracycline group.

Which drugs are part of the tetracycline group of antibiotics? Select all that apply. A. Linezolide B. Minocycline C. Clindamycin D. Doxycycline E. Demeclocycline

B. Tremor C. Irritability D. Sweating E. Confusion ***Early symptoms of hypoglycemia involve the central nervous system, as the brain needs a constant supply of glucose to function. Hence confusion, irritability, tremors, and sweating are symptoms seen in patients. When these symptoms occur, the family should have the patient immediately ingest a fast-acting carbohydrate source such as glucagon, milk, or juice. Coma occurs if the patient's glucose levels are not restored.

Which early symptoms of hypoglycemia should the nurse instruct a patient's family to treat with a fast-acting carbohydrate source? Select all that apply. A. Coma B. Tremor C. Irritability D. Sweating E. Confusion

A. Hypokalemia

Which electrolyte imbalance should you watch out for in a patient being administered corticosteroids? A. Hypokalemia B. Hyponatremia C. Hyperkalemia D. Hypercalcemia

A. Hypokalemia

Which electrolyte imbalance should you watch out for in a patient taking corticosteroids? A. Hypokalemia B. Hyperkalemia C. Hypercalcemia D. Hyponatremia

A. potassium ***Furosemide causes electrolyte imbalances such as hypokalemia, hypocalcemia and hypomagnesemia.

Which electrolyte is commonly decreased when a client takes Furosemide [Lasix] 40 mg tab BID? A. potassium B. phosphate C. iron D. sodium

D. Monoamine oxidase enzyme

Which enzyme in the brain do MAOI's inhibit? A. Protease B. Acetylcholinerterase C. Catalase D. Monoamine oxidase enzyme

C. Client education ***The client's educational level (C) is the most important factor when planning teaching to ensure a client's compliance with taking a prescribed drug. (A and D) are physiologic responses that do not relate to a client's compliance. Although maturity level and age (B) contribute to compliance, the client's basic understanding of instructions, which is best indicated by educational level, is more significant.

Which factor is most important to ensure compliance when planning to teach a client about a drug regimen? A. Genetics B. Client age C. Client education D. Absorption rate

B. Relief of chronic pain is best obtained by administering analgesics around the clock. ***Studies have demonstrated that for chronic pain such as pain due to cancer, analgesics administered around-the-clock rather than on an as-needed basis provide the optimal pain relief. Narcotic analgesics have a potential for addiction, but pain management is more important. A rating of 3 on the pain scale indicates effective pain relief.

Which factor will the nurse consider while planning pharmacologic therapy for a patient with pain? A. Analgesics should be administered as needed to minimize adverse effects. B. Relief of chronic pain is best obtained by administering analgesics around the clock. C. Patients should request analgesics when the pain level reaches a 3 on a scale of 1 to 10. D. Narcotic analgesics should not be used for more than 24 hours because of the risk of addiction.

B. Tachycardia D. Hypoglycemia E. Hyperbilirubinemia ***Terbutaline [Brethine] can cause tachycardia and hypoglycemia because of fetal hyperinsulinemia. Hyperbilirubinemia also occurs. Diarrhea can occur in the fetus with indomethacin [Indocin]. Hypokalemia is a maternal side effect, while hypocalcemia is a fetal effect.

Which fetal side effects may be observed if a patient is taking terbutaline [Brethine] for preterm labor? Select all that apply. A. Diarrhea B. Tachycardia C. Hypokalemia D. Hypoglycemia E. Hyperbilirubinemia

B. Uterine contractions lasting longer than 1 minute ***Oxytocin [Pitocin] is a uterine stimulant used in the induction of labor. During infusion, constant maternal and fetal monitoring is needed, because elevation of uterine pressure above 15 to 20 mm Hg and contractions longer than 1 minute require the infusion to be stopped. Absence of a change in the baseline fetal heart rate and a maternal heart rate of 90 to 110 beats per minute are not evidence of pronounced alterations that indicate an adverse event.

Which finding in a patient receiving an oxytocin [Pitocin] infusion should be reported to the physician immediately? A. Resting uterine pressure below 15 mm Hg B. Uterine contractions lasting longer than 1 minute C. Maternal heart rate of 90 to 110 beats per minute D. Absence of change in the baseline fetal heart rate

B. Excessive bruising ***Levothyroxine intensifies the effect of warfarin, an anticoagulant that increases the patient's risk for bleeding. The warfarin dose may need to be reduced. Bruising, weight loss, and shortness of breath are not effects associated with interactions of levothyroxine and warfarin.

Which finding in a patient taking levothyroxine [Synthroid] and warfarin [Coumadin] would require follow-up by a nurse? A. Cardiac dysrhythmias B. Excessive bruising C. Weight loss of 5 kg D. Shortness of breath

A. warfarin C. insulin D. oral hypoglycemics

Which of the following are drugs whose effects are DECREASED by oral contraceptives? Select all that apply. A. warfarin B. methotrexate C. insulin D. oral hypoglycemics E. benzodiapines

A. milk of magnesia C. miralax

Which of the following are examples of osmotic laxatives? Select all that apply. A. milk of magnesia B. Bisacodyl [Dulcolax] C. miralax D. docusate sodium

A. Excessive bruising ***Levothyroxine intensifies the effect of warfarin, an anticoagulant that increases the patient's risk for bleeding. The warfarin dose may need to be reduced if there is excessive bruising. Cardiac dysrhythmias, weight loss, and shortness of breath are not effects associated with interactions of levothyroxine and warfarin.

Which finding in a patient taking levothyroxine [Synthroid] and warfarin [Coumadin] would require follow-up by a nurse? A. Excessive bruising B. Weight loss of 5 kg C. Shortness of breath D. Cardiac dysrhythmias

B. chocolate ***The patient taking antituberular therapy should avoid fish (such as tuna) and products containing tyramine (such as aged cheese, beer, and chocolate) because the drug has some MAO inhibitor activity.

Which food should the patient receiving antitubercular therapy avoid? A. red wine B. chocolate C. coffee D. eggs

A. Cheese ***Certain foods can interact with MAO inhibitors and produce serve reactions. The most serious reactions involve tyamine-rich foods, such as red wine, aged cheese, smoked meats, and fave beans.

Which food should the patient taking an MAO inhibitor avoid? A. Cheese B. Apples C. Carrots D. Beer

B. To postpone delivery D. To inhibit uterine contractions ***Tocolytic therapy is used to inhibit uterine contractions in preterm labor and delay delivery to provide additional time for the fetus in the womb. Oxytocic drugs induce labor, inhibit uterine contractions, and control postpartum hemorrhage.

Which goals does the nurse add to the care plan for a patient receiving tocolytic therapy? Select all that apply. A. To induce labor B. To postpone delivery C. To promote cervical ripening D. To inhibit uterine contractions E. To control postpartum hemorrhage

B. I will need to take this for the rest of my life. ***For treatment to be effective, medication must be taken lifelong. It is difficult to convince people who are feeling good to take drugs that may make them feel worse. Some people may decide that exposing themselves to the negative effects of therapy today is paying too high a price to avoid the adverse consequences of hypertension at some indefinite time in the future. Patients must understand that drugs do not cure hypertension—they only control symptoms.

Which information from the patient will most likely promote adherence to the medication regimen? A. I feel good even without my medication. B. I will need to take this for the rest of my life. C. I can take these drugs to cure my hypertension. D. I hope this will prevent complications in the future.

A. "Use sunscreen and protective clothing when outdoors." ***Tetracyclines are bacteriostatic antibiotics; photosensitivity and severe sunburn are common adverse effects. A full course of antibiotics must always be taken. Blood studies are not necessary for therapeutic levels. Absorption decreases after ingestion of chelates such as calcium and magnesium, so doses should be given 2 hours before or 2 hours after ingestion of milk products.

Which instruction should a nurse include in the discharge teaching for a patient who is to start taking tetracycline? A. "Use sunscreen and protective clothing when outdoors." B. "You'll need to return to the clinic for weekly blood work." C. "You may stop taking the pills when you begin to feel better." D. "Take the medication with yogurt or milk so you won't have nausea."

B. "Use sunscreen and protective clothing when outdoors." ***Tetracyclines are bacteriostatic antibiotics; photosensitivity and severe sunburn are common adverse effects. A full course of antibiotics must always be taken. Blood studies are not necessary for therapeutic levels. Absorption decreases after ingestion of chelates, such as calcium and magnesium, so doses should be given 2 hours before or 2 hours after ingestion of milk products.

Which instruction should a nurse include in the discharge teaching for a patient who is to start taking tetracycline? A. "You may stop taking the pills when you begin to feel better." B. "Use sunscreen and protective clothing when outdoors." C. "You'll have to come back to the clinic for weekly blood work." D. "Take the medication with yogurt or milk so you won't have nausea."

C. "Do not take your metformin on the day of the test." ***Angiography uses iodinated (iodine-containing) radiologic contrast media, which interact with metformin [Glucophage] and may cause acute renal failure or lactic acidosis. Hence, the nurse should instruct the patient to discontinue the drug on the day of the test. To prevent any adverse effects, metformin [Glucophage] can be taken 48 hours after the test. Chances of renal failure after the test only occur if metformin is taken during the test. Blood glucose levels are regularly evaluated in diabetic patients, but it is not a priority in this case.

Which instruction should the nurse give when a patient receiving metformin [Glucophage] therapy will undergo angiography? A. "There are chances of renal failure after the test." B. "Your blood glucose levels need to be reevaluated." C. "Do not take your metformin on the day of the test." D. "You can take the medication an hour after the test."

C. "Hold your breath for 10 seconds if you can after you inhale the medication." ***Holding the breath for 10 seconds allows the medication to be absorbed in the bronchial tree rather than be immediately exhaled.

Which instruction will the nurse include when teaching a patient about the proper use of metered-dose inhalers? A. "After you inhale the medication once, repeat until you obtain relief." B. "Make sure that you puff out air repeatedly after you inhale the medication." C. "Hold your breath for 10 seconds if you can after you inhale the medication." D. "Hold the inhaler in your mouth, take a deep breath, and then compress the inhaler."

A. "Take the medication with a glass of grapefruit juice each morning." ***Grapefruit juice can inhibit the metabolism of carbamazepine, possibly leading to increased plasma drug levels; therefore, it should be avoided. Carbamazepine can inhibit renal excretion of water by promoting increased secretion of antidiuretic hormone. Weight gain and swollen extremities can be a sign of water retention and should be reported to the physician. Nausea, vomiting, and indigestion are common adverse effects of valproic acid, and the patient should be made aware of them. Liver function studies are monitored for patients taking valproic acid because of the risk of liver toxicity.

Which instruction would be inappropriate to include in the teaching plan for a patient being started on carbamazepine [Tegretol]? A. "Take the medication with a glass of grapefruit juice each morning." B. "Notify the physician if you are gaining weight or your legs are swollen." C. "Nausea, vomiting, and indigestion are common side effects of carbamazepine." D. "Have liver function tests performed on a routine basis."

C. "Notify your healthcare provider if you develop a rash." D. "Notify your healthcare provider if you develop diarrhea." ***Severe diarrhea should be reported, because it may indicate the development of C. difficile infection. Any indication of an allergic reaction, including a rash, should be reported to the healthcare provider. Cephalosporins may enhance bleeding tendencies, so drugs such as aspirin that may promote bleeding should be avoided. Cephalosporins may be taken with food, and they are safe to take if a patient has lactose intolerance.

Which instructions should the nurse include when teaching a patient about cephalosporin therapy? Select all that apply. A. "Take aspirin if you develop a headache." B. "Cephalosporins may not be taken with food." C. "Notify your healthcare provider if you develop a rash." D. "Notify your healthcare provider if you develop diarrhea." E. "Do not take cephalosporins if you have lactose intolerance."

C. Administering it by slow IV push ***The priority is to administer Dilantin slowly to prevent irritation to veins. Monitoring side effects, flushing the tubing, and monitoring serum drug levels are all interventions that are done after administering the drug. The priority is the first intervention, which is proper administration of the medication.

Which intervention is a priority in the administration of intravenous (IV) Dilantin therapy? A. Monitoring for side effects B. Monitoring serum drug levels C. Administering it by slow IV push D. Flushing the tubing after administration

A. Monitor uterine contractions. C. Monitor fetal heart rate (FHR). E. Assess maternal blood pressure. ***During the infusion, constant monitoring is required. The mother should be monitored for blood pressure, pulse rate, and uterine contractility (frequency, duration, and intensity). The fetus should be monitored for heart rate and rhythm. Oxytocin [Pitocin] is administered IV with an infusion pump, starting at 0.5 to 2 milliunits/min or for the high-dose regimen: 6 milliunits/min, then both are increased, as needed. Unlike pulse and blood pressure, temperature does not have to be monitored.

Which interventions should the nurse implement for a patient who is receiving oxytocin [Pitocin] therapy to induce labor? Select all that apply. A. Monitor uterine contractions. B. Administer 0.5 to 2 mg orally. C. Monitor fetal heart rate (FHR). D. Assess maternal temperature. E. Assess maternal blood pressure.

B. Hypotension

Which is not a symptom of serotonin syndrome? A. Confusion B. Hypotension C. Tremors D. Anxiety

D. Parenteral formulation improves adherence for acutely psychotic patients. ***The primary benefit of administering a parenteral form of an antipsychotic agent is that patient adherence to therapy improves because fewer doses are required to achieve therapeutic effectiveness. It is very effective when used for acutely psychotic patients. Parenteral antipsychotic agents are long-acting medications. Route of administration does not have much effect on the drug's effectiveness or duration of action.

Which is the most important benefit of a parenteral formulation of an antipsychotic medication? A. Patient consent for treatment is avoided. B. Parenteral administration is faster than oral administration. C. Parenteral formulation is more effective than oral formulations. D. Parenteral formulation improves adherence for acutely psychotic patients.

A. Grapefruit juice

Which juice should you tell your patient to avoid when taking calcium channel blockers because it infers with their efficacy? A. Grapefruit juice B. Tomato juice C. Pineapple juice D. Orange juice

D. Hyperglycemia ***Like the loop diuretics, the thiazides can elevate plasma levels of glucose. The thiazides, like the loop diuretics, can cause retention of uric acid, thereby elevating plasma uric acid (hyperuricemia). Like the loop diuretics, the thiazides can cause hypokalemia from excessive potassium excretion. Thiazides promote renal calcium retention, causing an increase in calcium, not hypocalcemia.

Which laboratory result should the nurse monitor for in a patient receiving hydrochlorothiazide [Microzide]? A. Hyperkalemia B. Hypouricemia C. Hypocalcemia D. Hyperglycemia

B. International normalized ratio (INR) ***Clarithromycin is a macrolide similar to erythromycin and can inhibit hepatic metabolism of medications such as warfarin and theophylline. The INR is the blood test used to evaluate warfarin ranges. The aPTT is the blood test used in monitoring heparin. The platelet count and ESR are not affected by clarithromycin.

Which laboratory result should the nurse monitor more frequently when a patient is receiving clarithromycin [Biaxin] and warfarin [Coumadin]? A. Platelet count B. International normalized ratio (INR) C. Erythrocyte sedimentation rate (ESR) D. Activated partial thromboplastin time (aPTT)

C. Serum electrolytes ***Serum sodium levels need to be monitored in patients taking lithium. Lithium tends to deplete sodium. Lithium must be used with caution, if at all, by patients taking diuretics.

Which laboratory test is most important for the nurse to monitor when a patient is receiving lithium (Lithobid)? A. Urinalysis B. Serum glucose C. Serum electrolytes D. Complete blood count

B. Thyroid-stimulating hormone (TSH) levels ***TSH levels do not require monitoring. However, because of the potential for adverse effects, such as anemia (hemoglobin and hematocrit), leukopenia (WBC count), thrombocytopenia (platelet count), and liver impairment (ALT and AST), these laboratory tests should be monitored.

Which laboratory value does NOT require monitoring for a patient receiving treatment with methotrexate [Rheumatrex] for psoriasis? A. White blood cell (WBC) count B. Thyroid-stimulating hormone (TSH) levels C. Platelet count and hemoglobin/hematocrit level D. Alanine and aspartate aminotransferase (ALT and AST) levels

B. "Reduce the amount of alcohol you consume." D. "Incorporate daily physical exercise into your life." E. "Decrease the amount of carbohydrates in your diet." ***Alcohol is limited because it is broken down into simple carbohydrates and can elevate the patient's blood glucose levels. The patient should perform physical exercises every day to help lower glucose levels. The nurse should advise the patient to decrease the amount of carbohydrates in the diet to lower blood glucose levels. Potassium and sodium are restricted in cardiac patients. Adequate rest is required for respiratory patients to prevent respiratory complications due to physical activity.

Which lifestyle changes should the nurse instruct a patient to implement in order to successfully manage diabetes mellitus? Select all that apply. A. "Restrict potassium and sodium in your diet." B. "Reduce the amount of alcohol you consume." C. "Include rest periods between physical activities." D. "Incorporate daily physical exercise into your life." E. "Decrease the amount of carbohydrates in your diet."

A. Insulin glargine [Lantus] ***Insulin glargine [Lantus] has a duration of action of 24 hours with no peaks, mimicking natural, basal insulin secretion by the pancreas. Insulin aspart [NovoLog] is a rapid-acting human insulin analog used to lower blood glucose, which has a different dosage. Regular insulin [Humulin R] has its duration of action of 6 to 10 hours, with a peak plasma concentration of 2.5 hours. Ultralente insulin [Humulin U] has an active duration of 28 hours.

Which long-acting insulin mimics natural, basal insulin with its duration of 24 hours? A. Insulin glargine [Lantus] B. Insulin aspart [NovoLog] C. Regular insulin [Humulin R] D. Ultralente insulin [Humulin U]

D. Furosemide

Which loop diuretic do many physicians use to treat HTN? A. Etozoline B. Bumetanide C. Torasemide D. Furosemide

B. Unstable body temperature ***One function of the hypothalamus is the regulation of body temperature, and a tumor that compresses the hypothalamus would impair this function. Regulation of mood swings, respiratory rate, and heart rate are not functions of the hypothalamus.

Which manifestation would the nurse most clearly associate with a tumor of the hypothalamus? A. Mood swings B. Unstable body temperature C. Irregular respirations D. Increased heart rate

D. ACE Inhibitors, ARBS, Renin Antagonist

Which med classes does the RAAS system address specifically? A. Anticoagulants, ARBs, corticosteroids B. Beta Blockers, ACE inhibitors, anticoagulants C. Histamine 1 and 2 receptor blockers, atypical antipsychotics, ACE inhibitors D. ACE Inhibitors, ARBS, Renin Antagonist

A. oral anticoagulant ***Allopurinol potentiates the effects of oral anticoagulants.

Which medication interacts with allopurinol? A. oral anticoagulant B. antihistamines C. cardiac glycosides D. antidiabetic agents

A. oral anticoagulants ***Allopurinol potentiates the effects of oral anticoagulants.

Which medication interacts with allopurinol? A. oral anticoagulants B. antihistamines C. cardiac glycosides D. antidiabetic agents

D. Diltiazem [Cardizem] ***Nifedipine, amlodipine, and isradipine, which are dihydropyridine calcium channel blockers, cause less risk of constipation than diltiazem and verapamil.

Which medication is most likely to cause the side effect of constipation? A. Nifedipine [Adalat] B. Amlodipine [Norvasc] C. Isradipine [DynaCirc] D. Diltiazem [Cardizem]

D. Sucralfate

Which medication is used to promote gastric ulcer healing by providing a protective barrier? A. Cimetidine B. Misoprostol C. Omeprazole D. Sucralfate

A. Naloxone [Narcan] ***Naloxone is the opioid antagonist that will reverse the effects, both adverse and therapeutic, of opioid analgesics. Acetylcysteine is the antidote for acetaminophen overdose. Methylprednisolone is a glucocorticoid that is used as an antiinflammatory. Flumazenil, a benzodiazepine antidote, can be used to acutely reverse the sedative effects of benzodiazepines.

Which medication is used to reverse life-threatening complications caused by an opioid analgesic? A. Naloxone [Narcan] B. Flumazenil [Romazicon] C. Acetylcysteine [Mucomyst] D. Methylprednisolone [Solu-Medrol]

C. Lorazepam [Ativan] 0.1 mg/kg IV at a rate of 2 mg/min ***Intravenous benzodiazepines, such as lorazepam or diazepam, are used for abrupt termination of convulsive seizure activity. Lorazepam is preferred over diazepam because of its longer effects. Once seizures have been stopped with a benzodiazepine, phenytoin may be administered for long-term suppression. Phenytoin and valproic acid are not benzodiazepines.

Which medication should the nurse anticipate administering to a patient in convulsive status epilepticus to halt seizure activity? A. Phenytoin [Dilantin] 200 mg IV over 4 minutes B. Phenobarbital 30 mg IM C. Lorazepam [Ativan] 0.1 mg/kg IV at a rate of 2 mg/min D. Valproic acid [Depacon] 250 mg in 100 mL of normal saline infused IV over 60 minutes

C. Norepinephrine and serotonin

Which neurotransmitter(s) do tricyclic antidepressants prevent reuptake of? A. Histamine B. Melatonin C. Norepinephrine and serotonin D. Epinephrine

A. Risk for falls ***First-generation antipsychotic agents commonly produce sedation in the early days of treatment. This can pose a risk for the older adult. In addition, these agents can cause orthostatic hypotension, further increasing the risk for falls. The nurse should teach the patient to rise slowly and to be careful of these effects.

Which nursing diagnosis has the highest priority for an older adult patient who has received a first-generation antipsychotic? A. Risk for falls B. Risk for infection C. Risk for acute confusion D. Sleep pattern disturbance

E. All of the above

Which of the following agents would increase sedation caused by morphine? A. ethanol B. diazepam C. chlorpromazine D. clomipramine E. All of the above

B. donepezil C. memantine D. galantamine E. rivastigmine

Which of the following are Alzheimer's drugs? Select all that apply. A. hydrocoritsone B. donepezil C. memantine D. galantamine E. rivastigmine

B. Pyrazinamide E. Rifabutin [Mycobutin] F. Ethambutol [Myambutol] ***These drugs are included in the First-line agents for Tuberculosis together with Isoniazid. Streptomycin, Cycloserine and Capreomycin sulphate belong to second-line agents together with Amikacin, Ciprofloxacin, Ethionamide, Kanamycin, Moxifloxacin and Kevofloxacin.

Which of the following are considered as first-line medications for Tuberculosis? Select all that apply. A. Capreomycin sulfate [Capastat sulfate] B. Pyrazinamide C. Streptomycin D. Cycloserine [Seromycin] E. Rifabutin [Mycobutin] F. Ethambutol [Myambutol]

A. Indomethecin C. Terbutaline E. Nifedipine F. Magnesium sulfate

Which of the following are drugs classified as Tocolytics? Select all that apply. A. Indomethecin B. Oxytocin C. Terbutaline D. Phosphorus E. Nifedipine F. Magnesium sulfate

A. Spironolactone B. Doxycycline D. Tetracycline ***Cycloplegics are used to paralyze ciliary muscles in the eye. Anti-histamines are used for to relieve symptoms of allergies.

Which of the following are drugs used to treat acne? Select all that apply. A. Spironolactone B. Doxycycline C. Cycloplegics D. Tetracycline E. Anti-histamines

A. glucocorticoids B. vitamin A derivative's E. vitamin D analogues F. methotrexate G. cyclosporine

Which of the following are drugs used to treat psoriasis? Select all that apply. A. glucocorticoids B. vitamin A derivative's C. sunscreen D. tetracycline E. vitamin D analogues F. methotrexate G. cyclosporine

A. menopausal hormone replacement B. acne control D. contraception

Which of the following are therapeutic uses of estrogen? Select all that apply. A. menopausal hormone replacement B. acne control C. treatment of psoriasis D. contraception

C. Drug levels ***Knowing drug levels (peak and trough) is the only way to ensure there is enough drug in the body to work. Other choices do not demonstrate drug effect.

Which of the following blood tests will tell the nurse that an adequate amount of drug is present in the blood to prevent arrhythmias? A. Serum chemistries B. Complete blood counts C. Drug levels D. None of the above

D. An 80-year-old client with CHF ***Extremely old clients are at greater risk for digitalis toxicity. Remember when it comes to adversity, the very old and very young are always at highest risk.

Which of the following clients is at greatest risk for digital toxicity? A. A 25-year-old client with congenital heart disease B. A 50-year-old client with CHF C. A 60-year-old client after myocardial infarction D. An 80-year-old client with CHF

A. Hypotonicity

Which of the following conditions can lead to cell lyses if not properly monitored? A. Hypotonicity B. Hypertonicity C. Isotonicity D. None of the options are correct

D. treats severe fungal infections

Which of the following describes the medication Amphotericin B? A. used to treat tuberculosis and has severe side effects of blurred vision B. used to promote labor C. is an antibiotic used to treat acne D. treats severe fungal infections

B. Decreased peripheral vascular resistance ***One of the effects of calcium channel blockers is to decrease peripheral vascular resistance. A, C, and D describe the opposite effects of calcium channel blockers.

Which of the following effects of calcium channel blockers causes a reduction in blood pressure? A. Increased cardiac output B. Decreased peripheral vascular resistance C. Decreased renal blood flow D. Calcium influx into cardiac muscles

A. Tinnitus

Which of the following happens with salicytism? A. Tinnitus B. Photophobia C. Nausea D. Diarrhea

D. pyrazinamide

Which of the following has a side effect that is a severe medical condition causing acute pain in several joints of the body? A. rifampin B. isoniazid C. ethambutol D. pyrazinamide

B. D5W ***Hypertonic fluids include 3% Saline, 5% Saline, 10% Dextrose in Water (D10W), 5% Dextrose in 0.9% Saline, 5% Dextrose in 0.45% saline, & 5% Dextrose in Lactated Ringer's. D5W is isotonic.

Which of the following is NOT a hypertonic fluid? A. 3% Saline B. D5W C. 10% Dextrose in Water (D10W) D. 5% Dextrose in Lactated Ringer's

D. Barrel chest ***Barrel chest is most commonly found in patients with emphysema.

Which of the following is NOT a sign and symptom of chronic bronchitis? A. Productive cough B. Shortness of breath C. Cyanosis D. Barrel chest

A. Positive Chvostek's sign ***Chvostek's sign is a sign of hypocalcemia or hypomagnesemia. Signs of hyperkalemia include "7 L's": Lethargy (confusion) Low, shallow respirations (due to decreased ability to use accessory muscles for breathing) Lethal cardiac dysrhythmias Lots of urine Leg cramps Limp muscles Low BP & Heart

Which of the following is NOT a symptom of hyperkalemia? A. Positive Chvostek's sign B. Decreased blood pressure C. Muscle twitches/cramps D. Weak and slow heart rate

D. Metoprolol ***Metoprolol is a beta blocker used to treat heart conditions. Albuterol, Spirvia, and Theophylline are types of bronchodilators which are used to treat chronic bronchitis & emphysema.

Which of the following is NOT a treatment for chronic bronchitis or emphysema? A. Albuterol B. Spirvia C. Theophylline D. Metoprolol

A. Attention deficit hyperactivity disorder

Which of the following is NOT an indication for benzodiazepines? A. Attention deficit hyperactivity disorder B. Anxiety C. Alcohol withdrawal D. Seizures

C. Heart rate below 60 ***The apical heart rate must be monitored during therapy with digoxin, and the drug held for pulse below 60 and above 120. Remember that digoxin lowers the heart rate; therefore, the choice that reflects a low heart rate is the best selection.

Which of the following is a contraindication for digoxin administration? A. Blood pressure of 140/90 B. Heart rate above 80 C. Heart rate below 60 D. Respiratory rate above 20

B. smoking ***Smoking, most especially cigarette smoking, remains to be the most significant risk factor of COPD as well as its combination with a chronic airway disease, such as asthma. Long-term exposure to lung irritants such as air pollution, chemical fumes, or dust may also contribute to COPD.

Which of the following is a major risk factor for developing chronic obstructive pulmonary disease (COPD)? A. family history B. smoking C. chronic disease of liver D. sedentary lifestyle

C. bisacodyl [dulcolax] ***Works in 6-12 hours if given my mouth. As a suppository, can work within minutes. Stimulates peristalsis and increases water and electrolyte absorption in GI tract.

Which of the following is an example of a stimulant laxative? A. milk of magnesia B. lactulose C. bisacodyl [dulcolax] D. docusate sodium

B. Fluconazole ***Fluconazole is an example of an antifungal medication that may be given when a patient is infected with a type of fungus. Fluconazole is most commonly used to treat yeast infections caused by Candida, including vaginal yeast infections in women and thrush in the mouths of infants.

Which of the following is an example of an antifungal medication? A. Nitrofurantoin B. Fluconazole C. Azithromycin D. Levofloxacin

D. Decreased urine output ***Lasix is a diuretic medication that can be given to induce elimination of excess fluid from the body. Lasix is typically used when a patient has excess fluid because of such diseases as heart failure or when pulmonary edema is present. Lasix should not be used when a patient has decreased urine output as a method to get the patient to urinate.

Which of the following is considered a contraindication for administration of Furosemide [Lasix®]? A. 4+ pitting edema in the lower extremities B. Hypertension C. Facial swelling D. Decreased urine output

A. calcitonin ***Calcitonin is a hormone that decreases plasma levels of Ca+.

Which of the following is given during hyperparathyroidism? A. calcitonin B. levothyroxine C. vitamin D D. hydrocoritsone E. fludrocortisone

C. vitamin D ***Vitamin D is a hormone that increases plasma Ca+ levels.

Which of the following is given during hypoparathyroidism? A. calcitonin B. levothyroxine C. vitamin D D. hydrocoritsone E. fludrocortisone

A. beta2 adrenergic agonists C. oral corticosteroids D. anticholinergics F. inhaled corticosteroids ***A, C, D, F are used in managing symptoms of COPD clients. Leukotriene modifiers have no published studies that have provided conclusive evidence that they may benefit patients with COPD.

Which of the following medications may be used in managing COPD symptoms? Select all that apply. A. beta2 adrenergic agonists B. leukotriene modifiers C. oral corticosteroids D. anticholinergics E. protein derivatives F. inhaled corticosteroids

B. Patient with increased intracranial pressure ***This patient would need a HYPERtonic solution.

Which of the following patients would not be a candidate for a hypotonic solution? A. Patient with Diabetic Ketoacidosis B. Patient with increased intracranial pressure C. Patient experiencing Hyperosmolar Hyperglycemia D. All of the options are correct

D. A patient becomes pregnant despite her use of hormonal contraceptives because she has taken an anticonvulsant medication ***An adverse drug reaction is any undesired effect that occurs when a patient takes a normal and standard dose of the medication. If a nurse forgets to give a medication or a patient takes the wrong amount and suffers the consequences, it is not an adverse event. Alternatively, a patient who takes hormonal contraceptives as prescribed and still becomes pregnant suffers an adverse event.

Which of the following situations is an example of an adverse drug interaction? A. A patient develops dyspnea and facial swelling after taking an antibiotic B. A patient becomes dizzy and falls when the nurse forgets to administer his morning insulin C. A patient develops hypokalemia with an extra dose of a diuretic D. A patient becomes pregnant despite her use of hormonal contraceptives because she has taken an anticonvulsant medication

A. Mannitol cannot be given orally. B. Mannitol can cause edema. D. Diuresis begins in 30 to 60 minutes after administration. ***Mannitol does not diffuse across the GI epithelium and cannot be transported by the uptake systems that absorb dietary sugars. Accordingly, to reach the circulation, the drug must be given parenterally. Diuresis begins in 30 to 60 minutes and persists 6 to 8 hours. Mannitol can leave the vascular system at all capillary beds except those of the brain. When the drug exits capillaries, it draws water along, causing edema. Mannitol is used in prophylaxis of renal failure. Mannitol is an osmotic diuretic, not a loop diuretic.

Which of the following statements about mannitol [Osmitrol] are correct? (Select all that apply.) A. Mannitol cannot be given orally. B. Mannitol can cause edema. C. Mannitol can cause renal failure. D. Diuresis begins in 30 to 60 minutes after administration. E. Mannitol is a loop diuretic.

A. "I may hold off on taking my daily water pill if I am feeling fine." ***One should not discontinue taking Furosemide if he feels improved without the knowledge of the attending physician.

Which of the following statements made by a client with hypertension taking Furosemide [Lasix] indicates a need for further teaching? A. "I may hold off on taking my daily water pill if I am feeling fine." B. "I should inform my physician if I feel ringing in my ears." C. "If I miss taking a dose, I should take it as soon as I remember or I should skip it if it is almost time for my next dose." D. None of the above

A. Cardiovascular, brain, kidney, eyes

Which of the following systems of the body are affected by hypertension? A. Cardiovascular, brain, kidney, eyes B. Cardiovascular, gastrointestinal, reproductive, and kidney C. Brain, respiratory, kidney, cardiovascular D. None of the options are correct

C. D10W ***A hypertonic solution is one that contains a greater amount of solutes when compared to plasma. As a result, when the nurse administers a hypertonic solution, fluid will flow out of the cell and into the extracellular space. An example of a hypertonic solution is D10W.

Which of the following types of IV fluids is an example of a hypertonic solution? A. 0.45% sodium chloride B. Lactated Ringer's C. D10W D. 0.9% sodium chloride

C. Supplements additional doses at times of stress ***Adrenal suppression can be profound with oral glucocorticoid use. It is a priority that patients take supplemental oral or intravenous doses at times of stress; failure to do so can be fatal. Alternate-day dosing, using a peak flowmeter, and minimizing bone loss with vitamin D and calcium intake are important; however, they are not as important as supplemental doses of glucocorticoid at times of stress.

Which outcome should a nurse establish as a priority for a patient taking an oral glucocorticoid for long-term treatment of asthma? A. Increases the daily intake of vitamin D and calcium B. Records daily peak expiratory flow rates C. Supplements additional doses at times of stress D. Uses alternate-day therapy to reduce adverse effects

D. Respiratory rate of 12 to 24 breaths/min ***Codeine, an opioid analgesic that acts through the central nervous system, effectively suppresses the frequency and intensity of cough. However, it also can suppress respiration, and overdose can be fatal. Doses are small (one tenth of those needed to relieve pain), so orientation and peripheral effects are minimal.

Which outcome would be most appropriate for a nurse to establish for a patient with a cough who takes an antitussive with codeine? A. Warm, dry, pink skin B. Effective, productive cough C. Oriented to time, place, and person D. Respiratory rate of 12 to 24 breaths/min

C. Respiratory rate of 12 to 24 breaths per minute ***Codeine, an opioid analgesic that acts through the CNS, effectively suppresses the frequency and intensity of cough. However, it also can suppress respiration, and overdose can be fatal. Doses are small (one tenth those needed to relieve pain), so orientation and peripheral effects are minimal.

Which outcome would be most appropriate for a nurse to establish for a patient with a cough who takes an antitussive with codeine? A. Warm, dry, pink skin B. Oriented to time, place, and person C. Respiratory rate of 12 to 24 breaths per minute D. Effective productive cough

C. Activated partial thromboplastin time (aPTT) ***The laboratory value that measures heparin's therapeutic anticoagulation time is the aPTT (C). (A) should be checked before the administration of digoxin. (B) is valuable information but not a parameter measured for heparin therapy. (D) is evaluated during anticoagulation therapy using sodium warfarin (Coumadin).

Which parameter is most important for the nurse to check prior to administering a subcutaneous injection of heparin? A. Heart rate B. Urinary output C. Activated partial thromboplastin time (aPTT) D. Prothrombin time (PT) and international normalized ratio (INR)

B. Absence of chest pain ***Calcium channel blockers (CCBs) are given for angina, so an absence of chest pain is a therapeutic effect as is decreased blood pressure and dysrhythmias. Dizziness may be a side effect of the medication. Decreased swelling is not a therapeutic effect of CCBs; in fact, some may cause peripheral edema. Eczematous eruptions are an adverse effect of CCBs in older patients.

Which patient assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker (CCB)? A. Absence of dizziness B. Absence of chest pain C. Decreased swelling in the ankles D. Decreased eczematous eruptions

C. A patient in the ICU on a ventilator

Which patient could use a histamine 2 receptor? A. Patient in same day surgery center for a routine inguinal hernia repair B. A patient on a med-surg floor bridging from heparin to Coumadin C. A patient in the ICU on a ventilator D. A child at an outpatient wellness visit

C. Patient taking oral contraceptives to prevent pregnancy ***Oral contraceptives decrease the effects of warfarin; therefore, warfarin doses may need to be increased. Acetaminophen and cimetidine increase the effects of warfarin. Prednisone increases the risk of bleeding.

Which patient does the nurse identify as most likely needing an increased dose of warfarin [Coumadin] to have the same anticoagulant effect? A. Patient taking acetaminophen [Tylenol] for back pain B. Patient taking cimetidine [Tagamet] to prevent gastric ulcers C. Patient taking oral contraceptives to prevent pregnancy D. Patient taking prednisone [Deltasone] for rheumatoid arthritis

A. A patient with Cushing's syndrome taking Furosemide [Laxis] 20 mg IV twice a day ***Cushing's has a side effect of hypokalemia and Furosemide is a diuretic that does NOT hold on to potassium. Therefore this patient would be hypokalemic and would be at increased risk for digoxin toxicity.

Which patient is at a potential risk for Digoxin toxicity? A. A patient with Cushing's syndrome taking Furosemide [Laxis] 20 mg IV twice a day B. A patient with a calcium level of 8.9 C. A patient with a potassium level of 3.8 D. A patient presenting with painful muscle spasms and positive Trousseau's sign

C. Patient with Addison's Disease

Which patient is at risk for hyperkalemia? A. Patient with Parathyroid cancer B. Patient with Cushing's Syndrome C. Patient with Addison's Disease D. Patient with breast cancer

B. The patient with an elevated creatinine level ***Losartan [Cozaar] has been shown to be beneficial in patients with hypertension and heart failure. Patients with renal or hepatic dysfunction should be assessed carefully due to the potential for toxicity and increased side effects. An elevated creatinine level is an indication of renal dysfunction. The other findings are not.

Which patient receiving losartan [Cozaar] should be monitored closely while receiving this therapy? A. The patient with constipation B. The patient with an elevated creatinine level C. The patient with a heart rate of 90 beats/min D. The patient with a potassium level of 3.4 mEq/L

B. Patient with ringing in ears

Which patient who has recently started Furosemide [Lasix] would you be most concerned about? A. Patient with increased urine output B. Patient with ringing in ears C. Patient with nocturia D. Patient with decreased work of breathing

A. Hallucinations C. Restless activity D. Chaotic thinking E. Defective insight ***Positive symptoms of schizophrenia include psychotic behaviors such as hallucinations. They also include conceptual disorganization such as chaotic thinking and poor insight. Agitation or restless activity is also a positive symptom. Negative symptoms include catatonia characterized by agitation and muscle rigidity and social withdrawal.

Which phenomena should the nurse recognize as positive symptoms of schizophrenia? Select all that apply. A. Hallucinations B. Muscle rigidity C. Restless activity D. Chaotic thinking E. Defective insight F. Social withdrawal

D. An effect that mimics the natural neurotransmitter for that receptor ***Receptor activation is an effect on receptor function equivalent to that produced by the natural neurotransmitter at a particular synapse. Activation of a receptor may slow down or speed up the process, depending on the function of that particular receptor. Activation does not have to do with improving receptor function or sensitivity.

Which phrase best describes activation of a receptor? A. An effect that improves the function of the receptor B. An effect that causes the receptor to be more sensitive C. An effect that causes the physiologic process to speed up D. An effect that mimics the natural neurotransmitter for that receptor

D. Parenteral thiamine to a patient with suspected Wernicke-Korsakoff syndrome ***If Wernicke-Korsakoff syndrome (thiamine deficiency) is suspected, parenteral thiamine should be administered immediately. Taking high-dose folic acid to reduce cancer risk is ineffective and should be discouraged. High doses of beta-carotene (vitamin A) were associated with an increase in lung cancer for smokers, and high doses of vitamin E were associated with an increase in prostate cancer and stroke.

Which prescription will the nurse recognize as appropriate? A. Parenteral vitamin E for a patient with prostate cancer B. Folate supplements orally to a patient for cancer prevention C. Vitamin A supplements orally to a patient who smokes three packs a day D. Parenteral thiamine to a patient with suspected Wernicke-Korsakoff syndrome

A. "Are you having difficulty hearing?" ***Complications of gentamicin sulfate (Garamycin) therapy include ototoxicity, nephrotoxicity, and neurotoxicity. Determining if the client is hard of hearing (A) prior to initiation of this aminoglycoside will be helpful as the treatment progresses and ototoxicity is identified as a possible complication. Information obtained in (B, C, and D) are important elements of any medical history, but they do not have the priority of (A) when assessing for complications of aminoglycoside therapy.

Which question should the nurse ask a client prior to the initiation of treatment with IV infusions of gentamicin sulfate (Garamycin)? A. "Are you having difficulty hearing?" B. "Have you ever been diagnosed with cancer?" C. "Do you have any type of diabetes mellitus?" D. "Have you ever had anemia?"

A. Do you use any herbal supplements during the day? B. How many alcoholic drinks do you consume in a day? E. How often do you take over-the-counter products for common ailments? ***When eliciting a patient's drug history, the nurse should ask questions related to the use of herbal supplements, alcohol, and over-the-counter (OTC) drugs. Asking questions about herbal supplements helps the nurse to know whether the patient needs to change any current drugs or whether any teaching is needed for safe use. All can cause interactions with selected drugs. Alcohol may affect the metabolism of many OTC drugs and herbs; therefore, it is important to know whether the patient takes alcohol with these drugs. The frequency of OTC drugs is important to decide whether the patient is using them safely. Asking about family and friends and food preferences may not be helpful in describing the patient's use of OTC medications.

Which questions will a nurse ask in order to obtain information that is important for the medication history? Select all that apply. A. Do you use any herbal supplements during the day? B. How many alcoholic drinks do you consume in a day? C. What kind of food do you prefer to eat when dining out? D. How often do you visit your family members and friends? E. How often do you take over-the-counter products for common ailments?

A. Weight B. Lipid profile C. Fasting blood glucose ***Risperidone [Risperdal] can cause metabolic effects such as weight gain, diabetes, and dyslipidemia. The nurse should assess weight, blood glucose levels, and lipid levels.

Which should the nurse assess to determine whether a patient has metabolic effects from risperidone [Risperdal] therapy? Select all that apply. A. Weight B. Lipid profile C. Fasting blood glucose D. Complete blood count E. Kidney function studies

A. Cataracts B. Osteoporosis D. Hypokalemia E. Adrenal insufficiency ***Adverse effects of long-term glucocorticoid therapy include cataracts, osteoporosis, hypokalemia, adrenal insufficiency, and hyperglycemia.

Which should the nurse identify as possible adverse effects of long-term glucocorticoid therapy? Select all that apply. A. Cataracts B. Osteoporosis C. Hypoglycemia D. Hypokalemia E. Adrenal insufficiency

D. Distention of neck veins ***Patients should be monitored for signs of fluid overload (distention of neck veins, peripheral or pulmonary edema). Tetany is a sign of hypomagnesemia. Weakness is a sign of hypokalemia. Hypotension is a sign of hypermagnesemia.

Which sign should the nurse monitor for after administering a hypertonic saline solution to a patient who has severe hypotonic contraction? A. Tetany B. Weakness C. Hypotension D. Distention of neck veins

B. Abdomen ***The abdomen has the most consistent absorption capacity because muscular movements do not affect the blood flow to subcutaneous tissue as much. The deltoid is used for immunization of children and adults. The vastus lateralis is used for immunization of infants. The gluteus maximus is not recommended for injections because of its close proximity to the sciatic nerve and major blood vessels.

Which site should be used for injecting insulin for the most consistent absorption? A. Deltoid B. Abdomen C. Vastus lateralis D. Gluteus maximus

B. The drug should be discontinued slowly. ***When discontinuing TCAs such as amitriptyline (Elavil), the drug should be gradually decreased to avoid withdrawal symptoms such as nausea, vomiting, anxiety, and akathisia. TCAs are given at night to minimize problems caused by their sedative action. The onset of the antidepressant effect of amitriptyline is 1 to 4 weeks. Orthostatic hypotension is a common side effect of amitriptyline (Elavil).

Which statement about amitriptyline (Elavil) does the nurse identify as being true? A. The drug is administered first thing in the morning. B. The drug should be discontinued slowly. C. The onset of antidepressant effect is 48 hours. D. Hypertension is a frequent side effect of this drug.

C. "When I start to feel better, I will cut the dose of my medication in half." ***The drug should be taken exactly as ordered. Antipsychotics do not cure the mental illness but do alleviate symptoms. Compliance with drug regimen is extremely important.

Which statement by a patient indicates that more teaching on phenothiazine therapy for the treatment of psychosis is needed? A. "It might take 6 weeks or more for the drug to take effect." B. "I will get up slowly from a seated position." C. "When I start to feel better, I will cut the dose of my medication in half." D. "I will avoid exposure to direct sunlight."

D. "I'll report any problems with blurred vision or being able to determine colors." ***Ethambutol can cause optic neuritis resulting in disturbance of color discrimination and blurred vision. Symptoms resolve when the medication is discontinued. Orthostatic hypotension, constipation, and discoloration of urine are not known adverse effects of ethambutol.

Which statement by a patient taking ethambutol [Myambutol] indicates understanding of adverse effects of the drug? A. "I will get up slowly when sitting to prevent me from getting dizzy." B. "I'll increase the fiber and liquids in my diet to prevent constipation." C. "I'll immediately report any red-orange urine to my healthcare provider." D. "I'll report any problems with blurred vision or being able to determine colors."

C. "I'll report any problems with blurred vision or determining colors." ***Ethambutol can cause optic neuritis, resulting in disturbance of color discrimination and blurred vision. Symptoms resolve when the medication is discontinued. Orthostatic hypotension, constipation, and discoloration of urine are not known adverse effects of ethambutol.

Which statement by a patient taking ethambutol [Myambutol] indicates understanding of adverse effects of the drug? A. "I will get up slowly when sitting to prevent me from getting dizzy." B. "I'll increase the fiber and liquids in my diet to prevent constipation." C. "I'll report any problems with blurred vision or determining colors." D. "I'll immediately report any red-orange urine to my healthcare provider."

A. "Folic acid deficit can cause spina bifida." ***The patient should realize that loss of folic acid can cause spina bifida in the developing fetus as well as other neural tube defects. The patient should continue dosing as scheduled and should not double the dose if a dose is missed. Anemia is not the only risk, as there are various risks to the fetus.

Which statement indicates that a pregnant patient has understood the nurse's discharge teaching regarding folic acid? A. "Folic acid deficit can cause spina bifida." B. "Anemia is the only risk from no folic acid." C. "Folic acid does not absorb without vitamin B12." D. "I will double my dose if I forget to take it the day before."

C. "I will take the medication only when I need it." ***Oral hypoglycemic agents must be taken on a daily scheduled basis to maintain euglycemia and prevent long-term complications of diabetes. When alcohol is ingested with certain oral hypoglycemic drugs, the hypoglycemic effect can be intensified. The patient may experience fatigue and loss of appetite as side effects of the medication, and these should be reported to the healthcare provider. The patient needs to closely monitor blood sugar.

Which statement indicates that the patient needs additional teaching on oral hypoglycemic agents? A. "I will monitor my blood sugar daily." B. "I will limit my alcohol consumption." C. "I will take the medication only when I need it." D. "I will report symptoms of fatigue and loss of appetite.

B. "I need to take this drug with food to minimize gastrointestinal distress." ***Taking this medication with food will help minimize gastrointestinal upset. Ketoconazole (Nizoral) should not be taken with coffee, tea, or acidic fruit juices. Additionally, it needs to be taken at least 2 hours before or after the ingestion of alkaline products or antacids.

Which statement indicates to the nurse that the patient understands the medication instructions regarding ketoconazole (Nizoral) for treatment of candidiasis? A. "I will take this medication with orange juice for better absorption." B. "I need to take this drug with food to minimize gastrointestinal distress." C. "I can take this medication with antacids if it causes gastrointestinal discomfort." D. "I can expect my skin to turn yellow from taking this drug."

D. An important way to minimize adverse drug-drug interactions is to avoid detrimental interactions by taking a thorough drug history from the patient and to minimize the number of drugs the patient receives. ***The only true and accurate statement regarding minimizing adverse drug-drug interactions is to avoid detrimental interactions by taking a thorough drug history from the patient and to minimize the number of drugs the patient receives. The most obvious way to minimize adverse drug-drug interactions is to decrease, not increase, the number of drugs a patient receives. A great way to minimize adverse drug-drug interactions is to have the patient, rather than a family member, tell you what drugs he or she takes at home. An important way to avoid adverse drug-drug interactions is to get a thorough drug history, not just the prescription drugs the patient has taken over the past 2 weeks.

Which statement is accurate when discussing how to minimize adverse drug-drug interactions? A. The most obvious way to minimize adverse drug-drug interactions is to increase the number of drugs a patient receives. B. An important way to avoid adverse drug-drug interactions is to get a list of prescribed drugs the patient has taken over the past 2 weeks. C. A great way to minimize adverse drug-drug interactions is to have a family member tell you what drugs he or she thinks the patient takes at home. D. An important way to minimize adverse drug-drug interactions is to avoid detrimental interactions by taking a thorough drug history from the patient and to minimize the number of drugs the patient receives.

A. "You need to notify your doctor if you have a sore throat and fever." ***Agranulocytosis (the absence of granulocytes to fight infection) is the most serious toxicity associated with methimazole. Sore throat and fever may be the earliest signs. Nausea, muscle soreness, and headache and dizziness are other adverse effects of methimazole that are not as serious as agranulocytosis.

Which statement is the most important for a nurse to make to a patient who is taking methimazole? A. "You need to notify your doctor if you have a sore throat and fever." B. "Another medication can be given if you experience any nausea." C. "You may experience some muscle soreness with this medicine." D. "Headache and dizziness may occur but not very frequently."

A. "I need to change positions slowly to prevent dizziness." C. "I will need to wear sunscreen and protective clothing when outdoors." E. "I should call my provider if I notice any uncontrollable movements of my tongue." ***Phenothiazines have the risk for several adverse effects, such as early extrapyramidal reactions, acute dystonia, parkinsonism, and akathisia. In addition, sedation, orthostatic hypotension, anticholinergic effects, gynecomastia, galactorrhea, and menstrual irregularities can result. Tardive dyskinesia (TD), neuroleptic malignant syndrome (NMS), convulsions, and agranulocytosis are side effects that are rarer. Patients should change position slowly to prevent dizziness, wear sunscreen and protective clothing due to dermatologic side effects with the sun, and notify their healthcare provider if they notice uncontrolled movements. Alcohol should not be taken with these medications. While some of these drugs are older, they have quite a few potential side effects.

Which statement made by a patient demonstrates understanding of patient teaching regarding phenothiazine drug therapy? Select all that apply. A. "I need to change positions slowly to prevent dizziness." B. "This is an older drug and has very few risks of side effects." C. "I will need to wear sunscreen and protective clothing when outdoors." D. "It is okay to take this drug with a small glass of wine to help me relax." E. "I should call my provider if I notice any uncontrollable movements of my tongue."

A. "I'm glad I can still have a glass or two of wine at dinner." ***Alcohol can intensify the central nervous system (CNS) depressant effects of baclofen; therefore, further instruction is needed if the patient states that it is okay to have wine at dinner. The statement regarding difficult with urinating indicates that the patient understands that urinary retention is a potential side effect. Baclofen should not be discontinued abruptly, because this can lead to hallucinations, paranoid ideation, and seizures. Patients should discuss withdrawal of baclofen with their healthcare provider, because it should be done over 1 to 2 weeks. Allergy medications should be evaluated by the healthcare provider to determine whether they contain antihistamines, which intensify the depressant effects.

Which statement made by a patient indicates a need for further discharge instruction about baclofen [Lioresal]? A. "I'm glad I can still have a glass or two of wine at dinner." B. "If I develop any difficulty urinating, I will call my physician." C. "I'll contact my healthcare provider when I feel I no longer need the medication." D. "I'll need to check with my healthcare provider before taking my allergy medications."

A. You want to decrease the inflammatory response, but the same hormone actually also increases blood sugar as well so by decreasing the inflammatory response you are also increasing glucose

Why do corticosteroids increase blood sugar? A. You want to decrease the inflammatory response, but the same hormone actually also increases blood sugar as well so by decreasing the inflammatory response you are also increasing glucose B. They contain large amounts of glucose C. They inhibit insulin receptors D. They inhibit the pancreas from secreting insulin

A. Change positions slowly. ***Postural hypotension is common early in treatment, so the patient should be instructed to change positions slowly. Administration with meals should be avoided, if possible, because food delays the absorption of the levodopa component. If the patient is experiencing side effects of nausea and vomiting, administration with food may need to be considered. The levodopa component in Sinemet may darken the color of the urine. Carbidopa has no adverse effects of its own.

Which statement should the nurse include in the teaching plan for a patient being started on levodopa/carbidopa [Sinemet] for newly diagnosed Parkinson's disease? A. Change positions slowly. B. Carbidopa has many adverse effects. C. Take the medication on a full stomach. D. The drug may cause the urine to be very diluted.

A. "A harmless side effect will be a red-orange discoloration of body fluids." ***Red-orange discoloration of body fluids is a common side effect of rifampin, but it is not harmful. Rifampin does not cause peripheral neuropathy. It does reduce the effectiveness of oral contraceptives, so a nonhormonal form of birth control should be considered. All antitubercular agents need to be taken at least 6 to 24 months to eradicate the slow-growing mycobacterium.

Which statement should the nurse include when teaching a patient about rifampin [Rifadin]? A. "A harmless side effect will be a red-orange discoloration of body fluids." B. "Take vitamin B6 to relieve numbness and tingling in the fingers and toes." C. "Treatment length for the medication is 3 times per day for an 8-week period." D. "Oral contraception is the preferred method of birth control when using rifampin."

A. "A harmless side effect will be a red-orange discoloration of body fluids." ***Red-orange discoloration of body fluids is a common side effect of rifampin, but it is not harmful. Rifampin does not cause peripheral neuropathy. It does reduce the effectiveness of oral contraceptives, so a nonhormonal form of birth control should be considered. All antitubercular agents need to be taken at least 6 to 24 months to eradicate the slow-growing mycobacterium.

Which statement should the nurse include when teaching a patient about rifampin [Rifadin]? A. "A harmless side effect will be a red-orange discoloration of body fluids." B. "Oral contraception is the preferred method of birth control when using rifampin." C. "Take vitamin B6 to relieve numbness and tingling in the fingers and toes." D. "Treatment length for the medication is 3 times per day for an 8-week period."

A. It is a synthetic steroid identical to cortisol. B. It is a preferred drug for adrenocortical insufficiency. C. It has glucocorticoid and mineralocorticoid actions. ***Hydrocortisone is a synthetic steroid with a structure identical to that of cortisol. Hydrocortisone is a preferred drug for all forms of adrenocortical insufficiency. Oral hydrocortisone is ideal for chronic replacement therapy. Parenteral administration is used for acute adrenal insufficiency and to supplement oral doses at times of stress. Despite being classified as a glucocorticoid, hydrocortisone also has mineralocorticoid actions.

Which statements about hydrocortisone are correct? (Select all that apply.) A. It is a synthetic steroid identical to cortisol. B. It is a preferred drug for adrenocortical insufficiency. C. It has glucocorticoid and mineralocorticoid actions. D. It is given IV for chronic replacement therapy. E. It should not be given during times of stress.

B. Levothyroxine can be given by IV but is usually taken orally. C. Levothyroxine brands should not be changed if possible. E. Levothyroxine can affect the metabolism of other medications. ***Levothyroxine is almost always administered by mouth. Oral doses should be taken once daily on an empty stomach (to enhance absorption). Dosing is usually done in the morning, at least 30 to 60 minutes before breakfast. Maintain patients on the same brand-name levothyroxine product. Intravenous administration is used for myxedema coma and for patients who cannot take levothyroxine orally. Levothyroxine affects the metabolism of other medications, including warfarin.

Which statements about levothyroxine [Synthroid] are correct? (Select all that apply.) A. Levothyroxine should be taken with food. B. Levothyroxine can be given by IV but is usually taken orally. C. Levothyroxine brands should not be changed if possible. D. Levothyroxine should be taken at night to avoid adverse effects. E. Levothyroxine can affect the metabolism of other medications.

C. The first sign of impending vestibular damage is headache. D. Ototoxicity is largely irreversible. E. Use of aminoglycosides for less than 10 days is recommended to avoid ototoxicity. ***The risk of ototoxicity with aminoglycoside use is related primarily to excessive trough levels. The first sign of impending vestibular damage is headache. The first sign of cochlear damage is tinnitus. The other two statements are true.

Which statements about ototoxicity and aminoglycosides does the nurse identify as true? (Select all that apply.) A. The risk of ototoxicity is related primarily to excessive peak levels. B. The first sign of impending cochlear damage is headache. C. The first sign of impending vestibular damage is headache. D. Ototoxicity is largely irreversible. E. Use of aminoglycosides for less than 10 days is recommended to avoid ototoxicity.

A. Vancomycin is the most widely used antibiotic in U.S. hospitals. B. Vancomycin is effective in the treatment of Clostridium difficile infection. C. Vancomycin is effective in the treatment of MRSA infections. ***Patients who are allergic to penicillin are able to take vancomycin. The major toxicity of vancomycin therapy is kidney failure. The other three statements are true.

Which statements about vancomycin [Vancocin] does the nurse identify as true? (Select all that apply.) A. Vancomycin is the most widely used antibiotic in U.S. hospitals. B. Vancomycin is effective in the treatment of Clostridium difficile infection. C. Vancomycin is effective in the treatment of MRSA infections. D. Patients who are allergic to penicillin are also allergic to vancomycin. E. The major toxicity of vancomycin therapy is liver failure.

C. They act directly on the proton pump. ***Erosive esophagitis is a condition in which irritation is caused by acid in the esophagus. PPIs directly inhibit the hydrogen-potassium-ATPase pump, thus reducing the release of hydrogen ions that form acid. Food digestion and absorption are unaltered by these drugs. About 90% of acid secretion is stopped within 24 hours of administration, bringing relief to the patient. PPIs inhibit only the proton pump of parietal cells and reduce only gastric acids.

Why are proton pump inhibitors (PPIs) used in the treatment of patients with bleeding due to erosive esophagitis? A. They affect the absorption of food. B. They do not alter the levels of acid. C. They act directly on the proton pump. D. They inhibit the proton pumps in all cells of the digestive system.

A. Hypotonic

________ fluids remove water from the extracellular space into the intracellular space. A. Hypotonic B. Hypertonic C. Isotonic D. Colloids

D. "There is a more rapid renal excretion of medications during pregnancy." E. "The serum and tissue concentrations of the medications decrease during pregnancy." ***The serum and tissue concentrations of medications decrease during pregnancy because of an alteration in the clearance of the medications. There is also a more rapid excretion of medications during pregnancy due to an increased glomerular filtration rate and an increase in renal perfusion. The expanded maternal circulating blood volume during pregnancy results in the dilution of medications. There is reduced gastrointestinal motility due to the hormonal changes during pregnancy. For some drugs, hepatic metabolism increases during pregnancy.

Which statements by a student nurse about the effect of pregnancy on medication action indicate effective learning? Select all that apply. A. "There is increased gastrointestinal motility during pregnancy." B. "The liver decreases metabolism of medications during pregnancy." C. "The maternal circulating blood volume concentrates the medications." D. "There is a more rapid renal excretion of medications during pregnancy." E. "The serum and tissue concentrations of the medications decrease during pregnancy."

A. "Drugs taken by lactating women can be excreted in breast milk." C. "Most drugs can be detected in milk, but concentrations are usually too low to cause harm." D. "If drug concentrations in milk are high enough, a pharmacologic effect can occur in the infant." ***Drugs taken by lactating women can be excreted in breast milk. Most drugs can be detected in milk, but concentrations are usually too low to cause harm. If drug concentrations in milk are high enough, a pharmacologic effect can occur in the infant, raising the possibility of harm. Unfortunately, very little systematic research has been done on this issue. Although nearly all drugs can enter breast milk, the extent of entry varies greatly.

Which statements should the nurse include when educating a breast-feeding patient about her medications? Select all that apply. A. "Drugs taken by lactating women can be excreted in breast milk." B. "There is a lot of research regarding drugs taken by lactating women." C. "Most drugs can be detected in milk, but concentrations are usually too low to cause harm." D. "If drug concentrations in milk are high enough, a pharmacologic effect can occur in the infant." E. "Nearly all drugs can enter breast milk, and the extent of entry is the same for all drugs.

C. Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. ***Drawing up the regular insulin into the syringe first prevents accidental mixture of neutral protamine Hagedorn (NPH) insulin into the vial of regular insulin, which could cause an alteration in the onset of action of the regular insulin. The medications do not have to be in separate syringes and can be administered together. The Z-track method is an intramuscular technique that is not used with insulin.

Which technique is most appropriate regarding mixing insulin when a patient must administer 30 units regular insulin and 70 units neutral protamine Hagedorn (NPH) insulin in the morning? A. Use the Z-track method for administration. B. Draw the medication into two separate syringes but inject into the same spot. C. Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. D. Administer these insulins at least 10 minutes apart, so you will know when they are working

A. regular ***Use regular insulin in a patient with circulatory collapse, DKA, or hyperkalemia.

Which type of insulin would the nurse expect to administer to a patient with DKA? A. regular B. intermediate-acting C. long-acting D. ultra-long-acting

B. Tocolytics ***Tocolytics cause uterine relaxation and are used to decrease uterine muscle contractions in preterm labor. The oxytocic drugs, also known as uterotonic drugs, stimulate uterine contraction and are contraindicated in preterm pregnancy. Tranexamic acid [Lysteda] is used to treat menorrhagia, not preterm labor.

Which type of medication will the nurse expect to administer to a patient in preterm labor? A. Oxytocics B. Tocolytics C. Uterotonics D. Teratogens

D. Gastrointestinal upset/issues and kidney toxicity

While cephalosporins do not decrease WBCs, RBCs, and platelets like penicillin does, they do cause what two important side effects? A. Profound fluid retention and subsequent heart failure B. Hyperglycemia and hepatoxocity C. Hyponatremia and hyperkalemia D. Gastrointestinal upset/issues and kidney toxicity

B. Antibiotics are prescribed to treat a viral infection D. Patients stop taking an antibiotic after they feel better ***Not completing a full course of antibiotic therapy can allow bacteria that have been exposed to the antibiotic (but not killed) to adapt their physiology to become resistant to that antibiotic. The same thing can occur when bacteria are exposed to antibiotics in the environment or when antibiotics are erroneously used to treat a viral infection.

While instructing a patient about antibiotic therapy, the nurse explains to the patient that bacterial resistance to antibiotics can occur when what happens? Select all that apply. A. Antibiotics are taken with water or juice B. Antibiotics are prescribed to treat a viral infection C. Antibiotics are taken with ascorbic acid (vitamin C) D. Patients stop taking an antibiotic after they feel better E. Antibiotics are prescribed according to culture and sensitivity reports

B. "What supplements do you take, and how often do you take them?" ***A goal of the admission interview is to determine what medications, including herbs, the patient takes, as this may affect the patient's treatment or interfere with medications. The patient does not need to stop herbal supplements before being admitted to the hospital. The nurse does not have to ask the patient's opinion about herbal supplements. Rather than asking if the healthcare provider is aware, the nurse should specifically ask what herbal supplements the patient uses.

While performing an admission interview, which question would be the most appropriate for the nurse to ask the patient concerning the use of herbal supplements? A. "What is your opinion about herbal supplements?" B. "What supplements do you take, and how often do you take them?" C. "Is your healthcare provider aware of the herbal supplements you take?" D. "Are you aware that you must stop all herbal supplements before being admitted?"

Side effects of anticoagulants?

bleeding, thrombocytopenia, hypotension

D. You want to decrease the inflammatory response, but the same hormone actually also increases blood sugar as well so by decreasing the inflammatory response you are also increasing glucose

Why do corticosteroids increase blood sugar? A. They inhibit the pancreas from secreting insulin B. They contain large amounts of glucose C. They inhibit insulin receptors D. You want to decrease the inflammatory response, but the same hormone actually also increases blood sugar as well so by decreasing the inflammatory response you are also increasing glucose

D. The highest dose needed to produce a therapeutic effect is close to the lethal dose. ***A low therapeutic index indicates that the high doses needed to produce therapeutic effects in some people may be large enough to cause death. A high therapeutic index is more desirable, because the average lethal dose is higher than the therapeutic dose. Low variability of responses to a drug is not the definition of a low therapeutic index.

Why does the nurse monitor the patient closely after administering a drug with a low therapeutic index? A. There is a low variability of responses to this drug. B. The average lethal dose of the drug is much higher than the therapeutic dose. C. The dose required to produce a therapeutic response in 50% of patients is low. D. The highest dose needed to produce a therapeutic effect is close to the lethal dose.

A. Because it's not blocking the ACE that's located in the lungs, it's blocking the next step (Angiotension II) of the Renin Angiotension Aldosterone system

Why doesn't an ARB cause a dry cough (like ACE inhibitors do)? A. Because it's not blocking the ACE that's located in the lungs, it's blocking the next step (Angiotension II) of the Renin Angiotension Aldosterone system B. Because they don't cause as large of a drop in circulating blood volumn C. Because of the increase in the ADH secretion D. Because it's not blocking the ACE that's located in the lungs, it's blocking the next step (Renin) of the Renin Angiotension Aldosterone system

B. Because the ACE is located in the lungs, which increases the bradykinins in the lungs (which is an inflammatory agent)

Why is a dry cough a common side effect of ACE inhibitors? A. Because the pulmonary artery experiences mild vasoconstriction B. Because the ACE is located in the lungs, which increases the bradykinins in the lungs (which is an inflammatory agent) C. Because of a decrease in circulating volume to the pulmonary bed D. Because an increase in hemoglobin increases the blood volume in the pulmonary bed, therefore causing circulatory congestion and subsequently a dry cough

D. Because blocking the ACE increases the K+ reabsorption as well, which increases the serum potassium level

Why is an increased potassium level something to watch for when starting an ACE inhibitor? A. Because blocking the ACE decreases the K+ reabsorption as well, which increases the serum potassium level B. Because this medication causes people to crave an excessive amount of bananas, which is B-A- N-A- N-A- S! C. Because there is potassium in the medication D. Because blocking the ACE increases the K+ reabsorption as well, which increases the serum potassium level

A. Because it decreases the platelet aggregation

Why is aspirin typically prescribed for people at risk for a stroke or myocardial infarction? A. Because it decreases the platelet aggregation B. Because it increases the platelet aggregation C. Because it decreases afterload D. Because decreases preload

A. IV administration is irreversible. ***The intravenous (IV) route allows precise control over levels of drug in the blood and results in rapid onset of action. Absorption of IV medication is instantaneous and complete. Once a drug has been injected, there is no turning back; the drug is in the body and cannot be retrieved.

Why should the nurse follow safe medication administration for intravenous (IV) medications? A. IV administration is irreversible. B. The IV route results in a delayed onset of action. C. Control over the levels of drug in the body is unpredictable. D. The IV route can result in delayed absorption of the medication.

D. Because the decrease in the immune response can impede the healing process

Why would you be concerned about wound healing in a patient on chronic corticosteriods? A. Because they produce electrolyte imbalances, which decrease cardiac output, which decrease healing time B. Because they can cause skin lesions C. Because the increase in the immune response speeds up the healing process so fast that complete healing frequently does not occur D. Because the decrease in the immune response can impede the healing process

B. Because the decrease in the immune response can impede the healing process

Why would you be concerned about wound healing in a patient on chronic corticosteriods? A. Because they produce electrolyte imbalances, which decrease cardiac output, which decrease healing time B. Because the decrease in the immune response can impede the healing process C. Because they can cause skin lesions D. Because the increase in the immune response speeds up the healing process so fast that complete healing frequently does not occur

D. To decrease the over-stimulated inflammatory response

Why would you want to give a corticosteroid to a patient in sepsis? A. To restore electrolyte imbalances B. To increase cardiac output C. To increase the lactate level D. To decrease the over-stimulated inflammatory response

D. To decrease the over-stimulated inflammatory response

Why would you want to give a corticosteroid to a patient in sepsis? A. To increase the lactate level B. To increase cardiac output C. To restore electrolyte imbalances D. To decrease the over-stimulated inflammatory response

B. to take only the specific drugs prescribed for acute bronchospasm, usually a short-acting beta2-adrenergic agonist such as albuterol. ***Short-acting beta2-adrenergic agonists are used in the treatment of acute bronchospasm. Long-acting agents are not effective in acute attacks. To prevent exercise-induced asthma, medication should be taken 30 to 60 minutes before exercise.

You are instructing a patient with asthma about the use of bronchodilators. You should teach the patient: A. to take the medication 4 hours before exercise to prevent exercise-induced bronchospasm. B. to take only the specific drugs prescribed for acute bronchospasm, usually a short-acting beta2-adrenergic agonist such as albuterol. C. to double the dose of the medication in the event of a missed dose. D. that long-acting beta2-adrenergic agonists, such as salmeterol, are effective in the treatment of acute asthma attacks.

A. This is known as Trousseau's Sign and is present in patients with hypocalemia ***Patient's with hypokalemia may present with a positive Trousseau's and Chvostek sign.

You are taking a patient's blood pressure manually. As you pump up the cuff above the systolic pressure for a few minutes you notice that the patient develop a carpal spasm. Which of the following is true? A. This is known as Trousseau's Sign and is present in patients with hypocalemia B. This is known as Trousseau's Sign and is present in patients with hypercalemia C. This is known as Chvostek's Sign D. The patient is having a normal nervous response to an inflating blood pressure cuff that is inflated above the systolic pressure

A. gynecomastia ***Gynecomastia, impotence and BPH have all been reported with the use of spironolactone because it also affects other steroid receptors (in addition to blocking the mineralocorticoid receptor to blunt the effects of aldosterone). Such effects have not been reported with eplerenone because it is more selective for the mineralocorticoid receptor, and is virtually inactive on androgen & progesterone receptors.

Your 60 year old male hypertensive patient who had an MI a year ago is now showing signs of CHF. You therefore add spironolactone to his drug regimen. What side effect should you warn him about? A. gynecomastia B. hypokalemia C. lupus D. ototoxicity E. uricemia

D. Antibiotics

Your patient has a urinary tract infection. What will the physician order to treat this? A. Beta-blockers B. ACE inhibitors C. Antivirals D. Antibiotics

C. Antibiotics and bronchodilators

Your patient has bacteria pneumonia. Two kinds of medications that will be very important for their recovery and treatment will be: A. NSAIDs and nitro compounds B. Benzodiazepines and ACE inhibitors C. Antibiotics and bronchodilators D. Vasopressin and insulin

A. Bananas or other potassium containing foods due to potential for hyopkalemia

Your patient has been put on Furosemide [Lasix]. Which food would they increase in their diet and why? A. Bananas or other potassium containing foods due to potential for hyopkalemia B. Green leafy vegetables to increase Vitamin K due to increased bleeding risks C. Animal proteins due to protein loss via urine D. Salty foods to increase sodium due to potential for hyponatremia

D. Corticosteroid injections

Your patient with osteoarthritis has tried many different pain medications. The physicians told her she is going to get a shot of something to address this unrelenting pain and inflammation. What medication do you think he/she is talking about? A. IM morphine B. Vitamin K injections C. IM ibuprofen D. Corticosteroid injections

labs for heparin?

aPTT

Nitroglycerin is used for?

angina pectoris (chest pain)

St. John's Wort belongs to what class?

anti-depressant

Amoxicillin belongs to what class?

anti-infectives, antiulcer agents

Amphotericin B belongs to what class?

antifungal

Haloperidol belongs to what class?

antipsychotic

Methotrexate belongs to what class?

antirheumatic; immunosuppressant

s&s of heparin toxicity?

bleeding

s&s of warfarin toxicity?

bleeding

What is a major side effect of NSAIDs?

bleeding and gastric irritation

antidote for hypoglycemia?

dextrose

antidote for digoxin?

digiband [digoxin immune fab]

ACE Inhibitors are not as effective in African Americans. What should the nurse administer along with the ACE Inhibitor to increase its effect?

diuretic

Beta blockers are not as effective in African Americans. What should the nurse administer along with the beta blocker to increase its effect?

diuretic

antidote for anaphlaxis?

epinephrine

Estrogen is used to?

used in menopausal hormone replacement, contraception, acne

antidote for warfarin?

vitamin K

Thiamine B1 belongs to what class?

water-soluble vitamin