HESI PHARM Q2

A client is taking famotidine (Pepcid). Which client statement should the nurse further assess because it may indicate that the client is experiencing a side effect of this drug? A."I have heartburn whenever I lie down." B."I am never hungry. I've lost weight in the past 2 weeks." C."I have a funny metallic taste in my mouth." D."I seem to be having difficulty thinking clearly."

Rationale: A common side effect of Pepcid is confusion (D). (A, B, and C) are not side effects of this medication.

A patient has been prescribed dantrolene (Dantrium). The nurse questions the order after finding that the patient also has which condition? a Parkinson's disease b Spinal cord injury c Stroke syndrome d Neuroleptic malignant syndrome

A Dantrolene is not used in the treatment of Parkinson's disease, so it would not be appropriate for this patient. Dantrolene is a skeletal muscle relaxant that is used to control spasticity in spinal cord injury, spasticity in stroke syndrome, and neuroleptic malignant syndrome; it would be appropriate for this patient.

The nurse is preparing to give ethosuximide [Zarontin]. The nurse understands that this drug is only indicated for which seizure type? a Tonic-clonic b Absence c Simple partial d Complex partial

Absence seizures are the only indication for ethosuximide. The drug effectively eliminates absence seizures in approximately 60% of patients and effectively controls 80% to 90% of cases.

Which nursing intervention is essential for the patient receiving alteplase (Activase)? a Assess for reperfusion dysrhythmias. b Monitor liver enzymes. c Administer prescribed vitamin K if bruising is observed. d Monitor blood pressure and stop the medication if blood pressure drops below 110 systolic.

Alteplase (Activase) can cause bleeding as well as reperfusion dysrhythmias. Alteplase does not directly affect liver enzymes. Vitamin K will not reverse the effects of alteplase. Vital sign changes can alert the nurse to complications; however, a blood pressure below 110 systolic is not, in itself, cause for alarm

The nurse is caring for several patients who are all being treated for hypertension. Which patient will the nurse assess first? a The patient who has been on beta blockers for 1 day b The patient who is on a beta blocker and a thiazide diuretic c The patient who has stopped taking a beta blocker due to cost d The patient who is taking a beta blocker and Lasix (furosemide)

Angiotensin-converting enzyme inhibitors prevent the breakdown of bradykinin, frequently causing a nonproductive cough. Angiotensin receptor blocking agents do not block this breakdown, thus minimizing this annoying side effect. The patient should be switched to a different medication if the side effect cannot be tolerated.

Which class of antineoplastic chemotherapy agents resembles the essential elements required for DNA and RNA synthesis and inhibits enzymes necessary for cellular function and replication? A. Alkylating agents B. Antimetabolites C. Antitumor antibiotics D.Plant alkaloids

Antimetabolites (B) exert their action by inhibiting the enzymes necessary for cellular function and replication. (A, C, and D) have a different mechanism of action.

A patient is started on warfarin (Coumadin) therapy while also receiving intravenous heparin. The patient is concerned about the risk for bleeding. What will the nurse tell the patient? a "Your concern is valid. I will call the doctor to discontinue the heparin." b "It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic." c "Because of your valve replacement, it is especially important for you to be anticoagulated. The heparin and warfarin together are more effective than one alone." d "Because you are now up and walking, you have a higher risk of blood clots and therefore need to be on both medications."

B Warfarin works by decreasing the production of clotting factors. However, it takes approximately 3 days for the body to metabolize present clotting factors and thus achieve a therapeutic anticoagulant effect. Because of this, heparin is continued until this is achieved.

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? Alpha1 Alpha2 Beta1 Beta

Beta 1 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.

What antacid is contraindicated with poor renal function a Calcium carbonate b. aluminium hydroxide c. Magnesuium hydroxide d. Maalox

C

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 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.

A calcium channel blocker has been ordered for a patient. Which condition in the patient's history is a contraindication to this medication? Hypokalemia Dysrhythmias Hypotension Increased intracranial pressure

Calcium channel blockers cause vasodilation and thus a drop in blood pressure. They are contraindicated in the presence of hypotension.

Which instruction does the nurse give to a patient for whom a centrally acting skeletal muscle relaxant has been ordered? a "Return in 1 month to have your heart and lungs checked." b "Be sure to drink at least six large glasses of water each day." c "Always take the medication on an empty stomach or at least an hour after meals." d "Avoid activities that require full mental alertness until you see how the drug affects you."

D A common adverse effect of centrally acting skeletal muscle relaxants is sedation. The extent of the sedative effect varies in individuals and can decrease with repeated exposure to the drug. Skeletal muscle relaxants do not require follow up of heart and lungs because of drug effects. There is no standard fluid requirement associated with this class of drugs. This medication may be taken with meals.

Which instruction does the nurse give to a patient who is ordered aspirin 325 mg PO bid (twice per day) for the prevention of thrombi? a Return in 4 weeks for a PT. b Report the development of ecchymoses immediately. c Expect some ringing in the ears. d Take the aspirin with breakfast and supper.

D Aspirin should be taken with meals to minimize gastric irritation. Patients who have been prescribed aspirin do not need a PT. Patients will develop ecchymoses more easily in response to trauma, and unless excessive, this does not require reporting. Ringing in the ears is not expected and must be reported because it is a sign of aspirin toxicity

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)

D Rationale: 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.

The nurse is teaching the patient being treated with an anticholinergic about dietary changes that might be necessary. What is the highest priority instruction for the patient? a "Do not drink milk while on this medication." b "Increase your intake of fatty foods while on this therapy." c "Do not eat carbohydrates with this medication." d "Increase your intake of fluids while on this medication."

D The patient should be encouraged to ingest foods high in fiber and increase fluid intake to prevent constipation. There is no need to restrict milk or carbohydrates or to increase the intake of fatty foods.

Which patient illustrates a physical dependence to an opioid agonist? a Patient who requires increasing doses to receive the same amount of pain relief b Patient who maintains adequate pain relief within the prescribed range of therapy c Patient who seeks other avenues for pain relief besides the prescribed medication d Patient who experiences abstinence syndrome when the drug is abruptly discontinued

D When patients are physically dependent on opioid agonists, they will experience lacrimation, runny nose, mydriasis, restlessness, and perspiration. Requiring increasing doses to receive the same benefit illustrates drug tolerance, not physical dependence. A patient is not experiencing physical dependence if there is adequate pain relief within the prescribed range of therapy. Adjuvant therapy is often used as another mechanism to provide pain relief and is not an indication of dependence.

The nurse has completed diabetic teaching for a client who has been newly diagnosed with diabetes mellitus. Which statement by this client would indicate to the nurse that further teaching is needed? A."Regular insulin can be stored at room temperature for 30 days." B."My legs, arms, and abdomen are all good sites to inject my insulin." C."I will always carry hard candies to treat hypoglycemic reactions." D."When I exercise, I should plan to increase my insulin dosage."

Exercise helps facilitate the entry of glucose into the cell, so increasing insulin doses with exercise would place the client at high risk for a hypoglycemic reaction (D). (A, B, and C) reflect accurate statements about the use of insulin and management of hypoglycemic reactions.

What is the nurse's best action when finding a patient with type 1 diabetes mellitus unresponsive, cold, and clammy? a Administer subcutaneous regular insulin immediately. b Administer glucagon. c Start an insulin drip. d Draw blood glucose level and send to the laboratory.

Glucagon stimulates glycogenolysis, raising serum glucose levels. The patient is showing signs of hypoglycemia.

When developing a written nursing care plan for a client receiving chemotherapy for treatment of cancer, the nurse writes, "Assess each voiding for hematuria." The administration of which type of chemotherapeutic agent would prompt the nurse to add this intervention? A.Vincristine (Oncovin) B.Bleomycin sulfate (Blenoxane) C.Chlorambucil (Leukeran) D.Cyclophosphamide (Cytoxan)

Hemorrhagic cystitis is the characteristic adverse reaction of cyclophosphamide (Cytoxan) (D). Administration of (A, B, and C) does not typically cause hemorrhagic cystitis.

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

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.

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?"

Rationale: 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.

The nurse is administering the early morning dose of insulin aspart (NovoLog), 5 units subcutaneously, to a client with diabetes mellitus type 1. The client's fingerstick serum glucose level is 140 mg/dL. Considering the onset of insulin aspart (NovoLog), when should the nurse ensure that the client's breakfast be given? A. 5 minutes after subcutaneous administration B. 30 minutes after subcutaneous administration C. 1 to 2 hours after administration D. Any time because of a flat peak of action

Rationale: Insulin aspart is a very rapidly acting insulin, with an onset of 5 to 15 minutes. Insulin aspart (NovoLog) should be administered when the client's tray is available (A). Insulin aspart (NovoLog) peaks in 45 minutes to 1½ hours (B and C) and has a duration of 3 to 4 hours. The client should have eaten to ensure absorption of the meal so that serum glucose levels will coincide with the peak. Insulin glargine (Lantus) has a flat peak of action (D) and is usually given at bedtime.

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.

Rationale: 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 nurse is instructing a patient who has been prescribed ropinirole (Requip) for treatment of early symptoms of Parkinson's disease. How does the nurse instruct the patient to take this medication? One hour before meals Between meals On an empty stomach With food

Ropinirole should be taken with food or milk to reduce gastric irritation. Ropinirole may cause gastric irritation and should not be taken 1 hour before meals, between meals, or on an empty stomach.

What is the appropriate order of mixing two types of insulin in one syringe? a Long acting insulin should be drawn up before short acting. b Long acting insulin should be drawn up before intermediate acting. c Short acting insulin should be drawn up before intermediate acting. d Either long acting or short acting insulin can be drawn up first; the order does not matter.

Short acting insulin should be drawn up before longer acting insulin. Long acting insulin should not be drawn up first. The order in which insulin is drawn up does matter, and should be done properly in order to prevent potential insulin overdosage.

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)

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).

A patient who has been taking warfarin (Coumadin) is admitted with coffee-ground emesis. What can the nurse anticipate being prescribed for this patient? a Vitamin E b Vitamin K c Protamine sulfate d Calcium gluconate

Vitamin K is the antagonist for warfarin

A client who has constipation is prescribed a bisacodyl suppository. The nurse explains that bisacodyl does what? a. Acts on smooth intestinal muscle to gently increase peristalsis b. Absorbs water into the intestines to increase bulk and peristalsis c. Lowers surface tension and increases water accumulation in the intestines d. Pulls hyperosmolar salts into the colon and increases water in the feces to increase bulk

a

The nurse is caring for a patient recovering from a myocardial infarction. Which drug does the nurse anticipate will be ordered for the patient to prevent straining during a bowel movement? a Docusate sodium (Colace) b Methylnaltrexone bromide (Relistor) c Polyethylene glycol (MiraLAX) d Psyllium (Metamucil)

a

Which causes acid bound syndrome? a Calcium carbonate b. aluminium hydroxide c. Magnesuium hydroxide d. Maalox

a

A patient with cardiac decompensation is receiving dobutamine as a continuous infusion. The patient's blood pressure has increased from 100/80 mm Hg to 130/90 mm Hg. What is the nurse's priority action? a Assess hourly blood pressure readings. b Assess the patient's ECG and slow the infusion. c Assess the patient's respiratory rate and measure ABGs. d Assess the patient's I&O and decrease IV fluids.

a The major therapeutic effect of dobutamine is to increase cardiac output. Cardiac output is reflected in the patient's heart rate, blood pressure, and urine output. An increase in blood pressure is the expected therapeutic effect.

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.

a 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.

The nurse assesses a patient taking phenytoin (Dilantin) and finds gingival hyperplasia. What is the nurse's priority action? a Instruct the patient on oral hygiene. b Call for a consult with a dentist. c Call the health care provider. d Hold the next dose of the drug.

a A side effect of phenytoin (Dilantin) is overgrowth of gum tissue. This can be minimized by frequent oral hygiene. If oral hygiene efforts do not improve gum condition, a consult with a dentist is recommended. Since this is an expected side effect, there is no indication to notify the health care provider or to hold the next dose.

What information will the nurse teach the patient who is considering stopping the antiepileptic drug phenytoin? a "You may go into status epilepticus." b "You may have an acute withdrawal." c "You will have severe hypotension." d "You may become confused and delirious."

a Abrupt withdrawal of antiepileptic drugs can cause the development of status epilepticus. However, stopping phenytoin should not result in acute withdrawal, severe hypotension, or confusion.

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

a 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

Which type of insulin has the most rapid onset and shortest duration of action? a Aspart (Novolog) b Glargine (Lantus) c Regular (Humulin R) d Extended insulin zinc suspension (Humulin U, Ultralente)

a Aspart's onset of action is within 10 minutes of injection with a peak in 1 to 2 hours. Aspart is the fastest acting of the insulins. Glargine and extended insulin zinc suspension are long acting insulins. Regular insulin takes 30 minutes to start acting and peaks in 2.5 to 5 hours.

How do centrally acting anticholinergics help control symptoms in Parkinson's disease? a By blocking cholinergic receptors b By activating dopaminergic receptors c By preventing destruction of dopamine in the CNS d By increasing the synthesis of dopamine

a By blocking the cholinergic receptors, anticholinergics reduce the severity of tremors and drooling associated with Parkinson's disease. Anticholinergics do not activate dopamine receptors. Anticholinergics decrease tremors and drooling associated with Parkinson's disease but do not prevent the destruction of dopamine producing cells in the CNS. Anticholinergics have no effect on the synthesis of dopamine.

What is a priority nursing diagnosis for a patient taking an antihypertensive medication? a Alteration in cardiac output related to effects on the sympathetic nervous system b Knowledge deficit related to medication regimen c Fatigue related to side effects of medication d Alteration in comfort related to nonproductive cough

a Circulation is always a priority over fatigue, pain, and knowledge deficit.

While obtaining a patient history, the nurse notes that the patient has been prescribed ethosuximide (Zarontin). What is the nurse's primary assessment? a Assess patient for absence seizures. b Assess patient for panic attacks. c Assess patient for migraines. d Assess patient for tonic-clonic seizures.

a Ethosuximide (Zarontin) is the first-line drug of choice to treat absence seizures. It does not treat panic attacks, migraines, or tonic-clonic seizures.

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.

a 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.

A teaching plan for a patient who is taking lispro [Humalog] should include which instruction by the nurse? Correct 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."

a 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 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]

a 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 patient is starting on an angiotensin converting enzyme (ACE) inhibitor. Which assessment does the nurse include in the patient's care plan? a Close observation after the initial dose until blood pressure stabilizes in 2 to 3 hours b Intake and output during the first 48 hours of therapy c Electrolyte studies every third day until stable in the normal range d Blood sugar levels weekly for the first 3 months of treatment

a Orthostatic hypotension occurs in some patients, particularly those also taking diuretics, when ACE inhibitor therapy is begun. As a result, patients should be observed closely for at least 2 hours after the initial dose of an ACE inhibitor, and for at least an additional hour until blood pressure has stabilized. Blood pressure should be monitored in the supine and standing positions. It is not necessary to monitor intake and output for starting a patient on ACE inhibitors. Individuals on ACE inhibitors may develop hyperkalemia; however, individuals do not require such close monitoring of electrolytes. ACE inhibitors have no effect of blood sugar levels.

When evaluating the effectiveness of succinimides, for which factor does the nurse collect data? a Occurrence of petit mal (absent) seizures b Patient's sleep pattern c Presence or absence of muscle spasms d Large bowel function

a Succinimides are used for the control of absence (petit mal) seizures. Therefore, when evaluating the effectiveness of the therapy, it is essential to gather information about the occurrence of these seizures. Succinimides can cause drowsiness but do not affect sleep patterns. Succinimides do not affect muscle function or large bowel function.

The nurse is caring for several patients. For which patient diagnosis would a prescription for nifedipine [Adalat] be least appropriate? Angina pectoris Essential hypertension Atrial fibrillation Vasospastic angina

a fib 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.

A patient with hypertension has suffered a heart attack. Which agent does the nurse anticipate will be ordered by the health care provider? a Beta adrenergic blocker b Diuretic c Central acting alpha 2 agonists d Angiotensin II receptor antagonists (ARB)

a. Beta adrenergic blocker They block the beta receptors in the heart and reduce heart rate, cardiac output, and blood pressure, and are used to treat hypertension in addition to other cardiac conditions.

The nurse is caring for a patient whose seizures are characterized by a 10- to 30-second loss of consciousness and mild, symmetric eye blinking. Which seizure type does this most closely illustrate? Tonic-clonic Absence Atonic Myoclonic

absent b This scenario accurately describes absence seizures. Tonic-clonic seizures present with convulsions and muscle rigidity followed by muscle jerks. Patients may experience urinary incontinence and loss of consciousness. Atonic seizures cause sudden loss of muscle tone. Myoclonic seizures present with sudden muscle contractions that last but a second.

The nurse is caring for a patient who has diabetes and hypertension. Which medication is most likely to be prescribed to treat this patient's hypertension? a Hydrochlorothiazide [HCTZ] b Enalapril [Vasotec] c Propranolol [Inderal] d Methyldopa [Aldomet]

b

Which needle length and gauge should the nurse choose to administer subcutaneous heparin? a 1/2 inch; 20 gauge b 5/8 inch; 25 gauge c 1 1/2 inch; 18 gauge d 1 inch; 26 gauge

b

Which statement demonstrates to the nurse that the client understands instructions regarding the use of histamine2-receptor antagonists? a. "Since I am taking this medication, it is all right for me to eat spicy foods." b. "Smoking decreases the effects of this medication, so I should look into cessation programs." c. "I should take this medication 1 hour after each meal in order to decrease gastric acidity." d. "I should decrease bulk and fluids in my diet to prevent diarrhea." b. "Smoking decreases the effects of this medication, so I should look into cessation programs."

b

Which statement made by the patient indicates understanding of teaching related to a new prescription for atenolol [Tenormin]? a "I will increase my fluids to prevent constipation." b "I will not stop taking this medication abruptly." c "I will take the first dose of this medicine at night." d "I will wear sunscreen and a hat when I work in the sun."

b Atenolol is a beta blocker and can cause rebound cardiac excitation if withdrawn abruptly. Patients should carry an adequate supply when traveling. It does not commonly cause constipation, first-dose hypotension, or photosensitivity.

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.

b 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.

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 Take the medication on a full stomach. b Change positions slowly. c The drug may cause the urine to be very dilute. d Carbidopa has many adverse effects.

b 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.

The nurse is developing a teaching plan for a patient prescribed carbidopa-levodopa (Sinemet). What information does the nurse use as a basis for the teaching plan? a Carbidopa decreases levodopa's conversion in the periphery, increasing the amount of levodopa available to cross the blood-brain barrier. b Carbidopa increases levodopa's conversion in the periphery, enhancing the amount of dopamine available to the brain. c Giving both drugs together minimizes side effects. d Carbidopa crosses the blood-brain barrier to increase the metabolism of levodopa to dopamine in the brain.

b Adding carbidopa to levodopa decreases the breakdown of levodopa in the periphery, increasing the amount available to cross the blood-brain barrier and decreasing the extrapyramidal side effects caused by dopamine in the periphery.

A patient with GERD for whom antacids have been prescribed asks the nurse how these drugs work. The nurse's response is based on which action of antacids? a Gastric acid secretion is inhibited. b Gastric acid is neutralized. c There is increased thickness of the gastric mucus. d Gastric mucosa is desensitized to the effects of acid.

b Antacids lower the acidity of gastric secretions by buffering the hydrochloric acid to a lower hydrogen ion concentration. Antacids do not inhibit gastric acid secretion; histamine receptor antagonists and gastric acid pump inhibitors do this. Antacids do not increase the thickness of the gastric mucus and do not desensitize the mucosa.

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

b 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.

The nurse is caring for a patient receiving propranolol [Inderal]. Which clinical finding is most indicative of an adverse effect of this drug? a A heart rate of 100 beats per minute b Wheezing c A glucose level of 180 mg/dL d Urinary urgency

b Beta blockers, such as propranolol, are known to cause bronchoconstriction, which could manifest as wheezing. Other adverse effects could include bradycardia, atrioventricular (AV) heart block, heart failure, rebound cardiac excitation, inhibition of glycogenolysis, and potential central nervous system (CNS) effects.

Which laboratory value does the nurse monitor in a patient taking glimepiride (Amaryl) for blood sugar control? a Sedimentation rate b Complete blood count (CBC) c Creatinine levels d Triglyceride levels

b Blood dyscrasias may be seen in patients taking glimepiride, so it is important to monitor CBC levels. Clinical manifestations include sore throat, fever, purpura, jaundice, or excessive and progressively increasing weakness. Glimepiride does not affect sedimentation rate, creatinine levels, or triglyceride levels.

A patient who has received an initial dose of an opiate partial agonist reports feeling clammy, dizzy, and nauseated. What does the nurse do next? a Obtains an order for an antidote b Has the patient rest in a supine position c Gives a glass of orange juice or other glucose source d Administers an antiemetic

b Clamminess, dizziness, and nausea, as well as vomiting, dry mouth, and sweating, are expected adverse effects of partial opiate agonists. They are most likely to occur with the first dose and can be reduced by keeping the patient supine. An antidote or antiemetic is not necessary if the symptoms can be controlled by remaining in a supine position. Glucose would not be given because the symptoms are not caused by hypoglycemia.

Which is the most appropriate action for the nurse who is told that a patient typically takes his glipizide with food? a Immediately check the patient's blood glucose level. b Inform the patient that it is better to take the medication 30 minutes before a meal. c Inform the patient that the medication must be taken 15 minutes after a meal. d Immediately call the health care provider.

b Food inhibits the absorption of glipizide (Glucotrol), the only sulfonylurea agent that should be given 30 minutes before a meal. The blood glucose level does not have to be taken right away. The medication is not to be taken after a meal. The health care provider does not have to be called; the nurse should intervene.

What is the expected action of heparin when used to treat deep vein thrombosis (DVT)? a Inhibit platelet coagulation b Prevent clot formation c Dissolve existing thrombi d Increase PT

b Heparin prevents formation of thrombi by speeding the action of antithrombin III, which neutralizes thrombin; activated factors IXa, Xa, XI, and XII; and plasmin. It also inhibits activation of factor VII, preventing soluble fibrin clots from becoming insoluble. Heparin does not inhibit platelet coagulation, and it has no fibrinolytic activity and cannot lyse thrombi. Heparin does not inhibit platelet coagulation or increase PT.

The nurse is caring for several patients prescribed propranolol [Inderal]. In which patient condition is propranolol [Inderal] contraindicated? a Cardiac dysrhythmias b Hypertension c Diabetes d Angina

b Propranolol inhibits glycogenolysis and thus can produce hypoglycemia, which can cause problems in patients with diabetes. It also suppresses tachycardia, which is an important warning sign of hypoglycemia in patients with diabetes. It is safe to use propranolol in dysrhythmias, hypertension, and angina.b

A patient received 15 units of regular (Humulin R) insulin at 7:00 AM. At what time does the patient experience the greatest risk for hypoglycemia from this dose of insulin? a 8:00 AM b 10:00 AM c 2:00 PM d 4:00 PM

b Regular insulin peaks within 3 hours of administration. The time of 8:00 AM is too early to experience the greatest risk for hypoglycemia from this dose of insulin. 2:00 PM and 4:00 PM are incorrect as well; regular insulin peaks before these times.

A patient who has been prescribed selegiline (Eldepryl) as part of a medication regimen for Parkinson's disease asks how it will help parkinsonism. How does the nurse respond? a "It decreases the production of acetylcholine." b "It slows the deterioration of dopamine producing cells." c "It speeds up the metabolism of dopamine." d "It enhances the dopaminergic activity of nerve cells."

b Selegiline is used to slow the progression of Parkinson's disease by possibly slowing the deterioration of dopaminergic nerve cells. Selegiline does not affect the production of acetylcholine or the speed of metabolism of dopamine. Selegiline does not enhance dopaminergic activity. This is accomplished by drugs such as amantadine, carbidopa levodopa, and entacapone.

A patient is receiving an intravenous heparin drip. Which laboratory value requires immediate action by the nurse? a Platelet count of 150,000 b Activated partial thromboplastin time (aPTT) of 120 seconds c INR of 1.0 d Blood urea nitrogen (BUN) level of 12 mg/dL

b The aPTT value of 120 seconds is too prolonged. The heparin drip should be shut off for an hour. The typical aPTT normal reference range for a patient on anticoagulant therapy is 30 to 85 seconds (range may vary slightly depending on the laboratory used). The normal range for BUN is 7 to 20 mg/dL, and the normal platelet range is 150,000 to 450,000.

The nurse administers lispro (Humalog) as ordered at 12:30 PM. At what time is the patient's response to the drug best evaluated? a 12:45 PM b 2:00 PM c 4:00 PM d 6:15 PM

b The effectiveness of lispro given at 12:30 PM would best be evaluated at 2:00 PM because it reaches its peak 1 to 2 hours after administration. At 12:15 PM, only 15 minutes have passed; this amount of time does not give the best information on the effectiveness of the drug because it is just starting to work.

Which measurement is the best indicator of how well an antiseizure medication is working? a Serum drug levels b Frequency and duration of seizures c Liver enzymes d Urinary output

b The frequency and duration of seizures is the best indicator of how well a medication is working. All patients with a seizure disorder should keep a diary of seizure activity. Blood level measurements of medications indicate if the medication is within a therapeutic range, but the patient may still continue to have seizures. Although measuring liver enzymes is important with several antiseizure medications, it does not indicate how well the medication is controlling seizure activity. Measuring urinary output does not indicate how well a medication is controlling seizure activity.

The nurse monitors a patient for which potential complication associated with the continued use of saline cathartics? a Impaired absorption of fat soluble vitamins b Fluid and electrolyte imbalance c Irritable bowel syndrome d Development of a rectal fistula

b b Saline cathartics act by pulling water into the large bowel. With continued use, this causes dehydration and electrolyte imbalance. Prolonged use of lubricant laxatives can lead to impaired absorption of fat soluble vitamins. Irritable bowel syndrome is not a complication of saline cathartics. A rectal fistula is not a complication of saline cathartics.

The nurse is reviewing the medication history of a patient who has been prescribed ticlopidine (Ticlid). The health care provider is contacted when the nurse finds that the patient is also taking which agent? a Folic acid b Ginkgo biloba c Niacin d Saw palmetto

b ginkgo biloba and danshen increase the risk for bleeding as a result of decreased platelet aggregation, and are contraindicated with ticlopidine. Folic acid, niacin, and saw palmetto do not increase the risk of bleeding and are therefore not contraindicated with ticlopidine.

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 noticed any swelling in your feet?" b "Are you having vivid dreams or hallucinations?" c "Have you noticed any changes in your stool?" d "Have you had your flu vaccine?"

b 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.

Which assessment is most important for the client who is taking stimulant laxatives? a. Monitor bowel elimination daily. b. Monitor intake and output. c. Monitor signs and symptoms of fluid and electrolyte imbalance. d. Monitor heart rate and blood pressure every 4 hours.

c

Which client needs immediate intervention? a. Client taking aluminum-containing antacids with complaints of reflux. b. Client taking calcium-containing antacids who is hypocalcemic. c. Client taking magnesium-containing antacids who has renal failure. d. Client taking antacids who is older than 70 years.

c

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

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 Correct d Valproic acid [Depacon] 250 mg in 100 mL of normal saline infused IV over 60 minutes

c First line of drugs for status epilepticus

Which patient best illustrates the ceiling effect? a Patient who requires a higher dose of medication to receive pain relief b Patient who experiences lacrimation, runny nose, and perspiration c Patient who receives an increasing dosage of medication and does not receive increased pain relief, but does experience an increased incidence of adverse effects d Patient who cannot function properly without taking the opiate, even though he or she is not experiencing pain.

c A patient who does not receive higher analgesic effects from higher doses of medication is experiencing the ceiling effect. The patient in option A is experiencing drug tolerance. The patient in option B is experiencing withdrawal symptoms. The patient in option D is addicted to the opioid agonist.

The nurse is reviewing the history of a patient taking heparin. The health care provider is contacted when the nurse discovers the patient has which condition? a Diabetes mellitus b Hypertension c Peptic ulcer disease d MI

c A patient with peptic ulcer disease is at increased risk of gastrointestinal bleeding if taking heparin. The use of heparin should not be used in patients with peptic ulcer disease. Diabetes mellitus, hypertension, and MI are not contraindications for taking heparin.

For which adult patient does the nurse hold an order for an opioid agonist? a Patient who continually reports pain although there are no physical symptoms b Patient whose pulse rate is 75 c Patient whose respiratory rate is 10 d Patient who is experiencing constipation from opioid use

c A respiratory rate of 10 may indicate respiratory depression; the opioid agonist should be held and the prescriber notified. Pain is a very subjective symptom. If a patient is reporting the need for pain medication, the medication should not be held. A pulse rate of 75 is normal for an adult and is not an indication that an opioid agonist should be held. Constipation is not a reason to hold an opioid. If the patient remains constipated, he or she can be treated with a laxative.

What information will the nurse teach the patient who has been prescribed an alpha glucosidase inhibitor? a "This medication will stimulate pancreatic insulin release." b "This medication will increase the sensitivity of insulin receptor sites." c "This medication will delay the absorption of carbohydrates from the intestines." d "This medication cannot be used in combination with other antidiabetic agents."

c Alpha glucosidase is an enzyme necessary for the absorption of glucose from the GI tract. Inhibiting this enzyme inhibits glucose absorption, delaying rises in postprandial serum glucose levels.

Which factor does the nurse check for when evaluating the effectiveness of baclofen (Lioresal)? a Presence of bowel sounds b Increase in urinary output c Relief of muscle spasm d Decrease in inflammation

c Baclofen is a skeletal muscle relaxant. Its therapeutic effect would be measured by the decrease in muscle spasms. Baclofen does not affect bowel sounds, smooth muscles (which would affect bladder function and urinary output), or the inflammatory process.

Which type of laxative may be ordered to control diarrhea from intestine irritating substances? a Saline laxatives b Lubricant laxatives c Bulk forming laxatives d Stimulant laxatives

c Bulk forming laxatives may be used for diarrhea by absorbing the irritating substance, thus allowing its removal from the bowel during defecation. Saline cathartics act by pulling water into the large bowel. With continued use, this causes dehydration and electrolyte imbalance. Saline laxatives, along with lubricant laxatives and stimulant laxatives, are not given to decrease diarrhea.

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 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.

A nurse is preparing to administer enoxaparin sodium (Lovenox) to a patient for prevention of deep vein thrombosis. Which is an essential nursing intervention? a Draw up the medication in a syringe with a 22-gauge, 1½-inch needle. b Utilize the Z-track method to inject the medication. c Administer the medication into subcutaneous tissue. d Rub the administration site after injecting.

c Enoxaparin (Lovenox) is a low-molecular-weight heparin that is administered subcutaneously. The site should not be rubbed after injection, and the Z-track method also should never be used to administer enoxaparin sodium (Lovenox). The use of 22-gauge, 1½-inch needle is more appropriate for administration of an IM injection.

The nurse is reviewing instructions for a patient prescribed oral famotidine (Pepcid) for treatment of a duodenal ulcer. The nurse reinforces with the patient that ranitidine should be administered at which time? a One hour before meals b On an empty stomach c With food d One to 2 hours after meals

c Famotidine should be given with food or at bedtime. Famotidine should not be given 1 hour before meals, on an empty stomach, or 1 to 2 hours after meals.

The patient taking intravenous gentamycin has elevated blood urea nitrogen (BUN). What is the nurse's best course of action? a Have the patient increase fluid intake. b Monitor peak and trough levels. c Hold the medication. d Insert a Foley catheter.

c Gentamycin has a high potential for nephrotoxicity and is thus contraindicated in patients with elevated renal function tests such as BUN and creatinine. The nurse should hold the medication and call the health care provider. Increasing fluids will not decrease the patient's BUN.

The nurse is monitoring phenytoin (Dilantin) being infused intravenously at 55 mg/min. What action will the nurse take next? a Continue to monitor the infusion. b Have the drug changed to PO. c Decrease the infusion and assess blood pressure. d Increase the infusion.

c Infusing phenytoin (Dilantin) at rates >50 mg/min can cause severe hypotension or cardiac dysrhythmias. The infusion should not be increased nor discontinued.

A patient with type 1 diabetes mellitus has been ordered insulin aspart (Novolog) 10 units at 7:00 AM. What nursing intervention will the nurse perform after administering this medication? a Perform a fingerstick blood sugar test. b Have the patient void and dipstick the urine. c Make sure the patient eats breakfast immediately. d Flush the IV.

c Insulin aspart (Novolog) is a rapid-acting insulin that acts in 15 minutes or less. It is imperative that the patient eat as it 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.

The health care provider prescribes lansoprazole (Prevacid) for a patient. Which assessment indicates to the nurse that the medication has had a therapeutic effect? a The patient has no diarrhea. b The patient has no gastric pain. c The patient has no esophageal pain. d The patient is able to eat.

c Lansoprazole (Prevacid) is a proton pump inhibitor that is effective in suppressing gastric acid secretions. An absence of esophageal pain would be an indication that the patient does not have reflux esophagitis.

A patient has been prescribed a laxative. The nurse questions the order after finding that the patient is experiencing which situation or symptom? a Decreased fiber intake b Decreased fluid intake c Abdominal pain d Defecating hard stools

c Laxatives should not be given to a patient who is experiencing abdominal pain because this may increase the pain. It is inappropriate for this individual to take a laxative.

A patient starting on metformin (Glucophage) informs the nurse that he runs 5 miles a day. Which adverse reaction to metformin is of most concern the nurse? a Increased low density lipoprotein (LDL) levels b Increased abdominal pain c Lactic acidosis d Increased hyperglycemia with exercise

c Malaise, myalgias, respiratory distress, and hypotension are symptoms of lactic acidosis, which is a rare, but lethal, side effect of metformin. A gradual onset of these symptoms may be an early indication of developing lactic acidosis. Metformin has been shown to produce a modest decrease in LDL levels. Abdominal pain, gas, and diarrhea are usually mild and tend to resolve with continued therapy. Exercise will decrease blood glucose levels, not increase them.

The nurse administers NPH insulin at 8 AM. What intervention is essential for the nurse to perform? a Assess the patient for hyperglycemia by 10 AM. b Monitor fingerstick at 2 PM. c Make sure patient eats by 5 PM. d Administer the insulin via IV pump.

c NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia. The patient needs to eat by 5 PM. The patient would not be at high risk for hypoglycemia at 10 AM. A fingerstick is not necessary at 2 PM. The insulin should not be routinely administered IV.

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

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

What is the goal of pharmacologic therapy in the treatment of Parkinson's disease? a To increase the amount of acetylcholine at the presynaptic neurons b To reduce the amount of dopamine available in the substantia nigra c To balance cholinergic and dopaminergic activity in the brain d To block dopamine receptors in presynaptic and postsynaptic neurons

c Parkinson's disease results from a decrease in dopaminergic (inhibitory) activity, leaving an imbalance with too much cholinergic (excitatory) activity. With an increase in dopamine, the neurotransmitter activity becomes more balanced, and symptoms are controlled.

The nurse teaches a patient taking selegiline (Eldepryl) to avoid which food? a Popcorn b Oranges c Cheese d Bananas

c Patients should avoid food and beverages with a high tyramine content, such as cheese, because rare cases of hypertensive crisis reactions have occurred. Popcorn, oranges, and bananas have not been shown to affect the effects of selegiline.

A patient taking warfarin (Coumadin) asks for an aspirin for a headache. What is the nurse's best action? a Administer 650 mg of acetylsalicylic acid (ASA) and reassess pain in 30 minutes. b Teach the patient of potential drug interactions with anticoagulants. c Explain to the patient that ASA is contraindicated and administer ibuprofen as ordered. d Explain that the headache is an expected side effect and will subside shortly.

c Patients taking an anticoagulant should not use medications that would further increase the risk of bleeding, which includes aspirin as well as ibuprofen. Aspirin should not be administered to the patient taking other anticoagulants, unless it is ordered specifically as a low-dose daily therapy. Ibuprofen is not the best choice of medication for the patient receiving Coumadin. Tylenol (acetaminophen) would be preferred for pain relief. Headache is not an expected side effect of Coumadin therapy.

A patient with Parkinson's disease who has been positively responding to drug treatment with levodopa/carbidopa [Sinemet] suddenly develops a relapse of symptoms. Which explanation by the nurse is appropriate? a "You have apparently developed resistance to your current medication and will have to change to another drug." b "This is an atypical response. Unfortunately, there are no other options of drug therapy to treat your disease." c "This is called the 'on-off' phenomenon. Your healthcare provider can change your medication regimen to help diminish this effect." d "You should try to keep taking your medication at the current dose. These effects will go away with time."

c Patients who have been taking levodopa/carbidopa for a period of time may experience episodes of symptom return. Adding other medications to the drug regimen can help minimize this phenomenon.

Which instruction about clopidogrel [Plavix] should the nurse include in the discharge teaching for a patient who has received a drug-eluting coronary stent? a "Constipation is a common side effect of clopidogrel, so take a stool softener daily." b "If you see blood in your urine or black stools, stop the clopidogrel immediately." c "Check with your healthcare provider before taking any over-the-counter medications for gastric acidity." d "Keep the amounts of foods containing vitamin K, such as mayonnaise, canola and soybean oil, and green, leafy vegetables, consistent in your diet."

c Proton pump inhibitors (PPIs), such as omeprazole [Prilosec], and CYP2C1 inhibitors, such as cimetidine [Tagamet], can be purchased over the counter to treat heartburn. However, patients taking clopidogrel should consult their healthcare provider before using them. PPIs and CYP2C1 inhibitors can reduce the antiplatelet effects of clopidogrel. Diarrhea (5% incidence), not constipation, is a side effect of clopidogrel. Patients should immediately contact their healthcare provider if signs of bleeding occur, such as bloody urine, stool, or emesis. The drug should not be stopped until the prescriber advises it, because this could lead to coronary stent restenosis. Consistency of vitamin K intake is indicated while taking warfarin [Coumadin].

The patient has been diagnosed with Legionnaires' disease. Which drug does the nurse anticipate the provider will order? a Daptomycin (Cubicin) b Lincomycin (Lincocin) c Erythromycin (E-Mycin) d Azithromycin (Zithromax)

c The drug of choice for treatment of Legionnaires' disease is erythromycin (E-Mycin).

A patient presents to the emergency department with symptoms of acute myocardial infarction. After a diagnostic workup, the healthcare provider prescribes a 15-mg IV bolus of alteplase (tPA), followed by 50 mg infused over 30 minutes. In monitoring this patient, which finding by the nurse most likely indicates an adverse reaction to this drug? a Urticaria, itching, and flushing b Blood pressure of 90/50 mm Hg c Decreasing level of consciousness d Potassium level of 5.5 mEq/L

c The greatest risk with this drug is bleeding, with intracranial bleeding being the greatest concern. A decreasing level of consciousness indicates intracranial bleeding. Alteplase does not cause an allergic reaction or hypotension. Thrombolytic agents, such as alteplase, do not typically cause an elevated potassium level.

A patient is receiving vancomycin [Vancocin]. The nurse identifies what as the most common toxic effect of vancomycin therapy? a Ototoxicity b Hepatotoxicity c nephrotoxicity d Cardiac toxicity

c 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 with diabetes is started on phenytoin (Dilantin) for partial seizures. What does the nurse closely monitor in this individual? a Blood pressure b Hypoglycemia c Hyperglycemia d Weight loss

c The patient should be monitored for hyperglycemia because phenytoin has the potential to elevate blood glucose levels, particularly during the early weeks of therapy. Phenytoin does not have an effect on blood pressure. Phenytoin has not been shown to decrease blood glucose levels or cause weight loss in patients with diabetes.

The health care provider has prescribed lansoprazole (Prevacid) for the patient. Within 30 minutes of receiving the first dose of the medication, the patient experiences shortness of breath and develops a rash on his skin. What does the nurse expect that the patient is experiencing? a Unexpected side effect of the medication b Toxic level of the medication c Allergic reaction to the medication d Typical side effect of the medication

c The patient's symptoms are indicative of an allergic reaction to the medication.

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

c 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.

In developing a plan of care for a patient receiving morphine sulfate, which nursing diagnosis is a priority? a Nausea b Risk for Injury related to central nervous system side effects c Impaired Gas Exchange related to respiratory depression d Constipation related to gastrointestinal side effects Incorrect

c Using Maslow's hierarchy of needs and the ABCs of prioritization, Impaired Gas Exchange is a priority.

The nurse is assessing a patient receiving valproic acid [Depakene] for potential adverse effects associated with this drug. What is the most common problem with this drug? a Increased risk of infection b Reddened, swollen gums c Nausea, vomiting, and indigestion d Central nervous system depression

c Valproic acid is generally well tolerated. Gastrointestinal effects, which include nausea, vomiting, and indigestion, are the most common problems but tend to subside with use and can be lessened by taking the medication with food. Valproic acid does not cause hematologic effects resulting in an increased risk of infection, nor does it cause gingival hyperplasia. It causes minimal sedation.

A patient with a history of Parkinson's disease treated with selegiline [Eldepryl] has returned from the operating room after an open reduction of the femur. Which physician order should the nurse question? a Decaffeinated tea, gelatin cubes, and ginger ale when alert b Docusate 100 mg orally daily c Meperidine 50 mg IM every 4 hours as needed for pain d Acetaminophen 650 mg every 6 hours as needed for temperature

c causes fatal hypertensive crisis

The nurse is caring for clients on the pulmonary unit. Which client should not receive epinephrine if ordered? a. The client with a history of emphysema b. The client with a history of type 2 diabetes c. The client who is 16 years old d. The client with atrial fibrillation with a rate of 100

d

When a client complains of pain accompanying a peptic ulcer, why should an antacid be given? a. Antacids decrease GI motility. b. Antacids decrease gastric acid secretion. c. Aluminum hydroxide is a systemic antacid. d. Antacids neutralize HCl and reduce pepsin activity.

d

Which instruction does the nurse give to a patient for whom a centrally acting skeletal muscle relaxant has been ordered? a "Return in 1 month to have your heart and lungs checked." b "Be sure to drink at least six large glasses of water each day." c "Always take the medication on an empty stomach or at least an hour after meals." d "Avoid activities that require full mental alertness until you see how the drug affects you."

d A common adverse effect of centrally acting skeletal muscle relaxants is sedation. The extent of the sedative effect varies in individuals and can decrease with repeated exposure to the drug. Skeletal muscle relaxants do not require follow up of heart and lungs because of drug effects. There is no standard fluid requirement associated with this class of drugs. This medication may be taken with meals.

Parkinsonism is an imbalance of which two central nervous system (CNS) neurotransmitters? a Gamma-aminobutyric acid (GABA) and dopamine b Gamma-aminobutyric acid (GABA) and catechol o methyltransferase (COMT) c Acetylcholine and COMT d Acetylcholine and dopamine

d Acetylcholine activity is increased and dopamine production is decreased in Parkinson's disease. Dopamine is decreased in Parkinson's disease, but GABA is not altered in parkinsonism. GABA and COMT are not altered in Parkinson's disease. Acetylcholine activity is increased, but COMT is not altered in Parkinson's disease.

The nurse is teaching the patient about atenolol [Tenormin]. Which statement by the patient indicates a correct understanding of the nurse's instruction? a "I will need to wait for 6 months and then stop this medication." b "One missed dose will not affect my blood pressure." c "I may experience occasional chest pain and discomfort." d "I will not stop taking this drug without the approval of my healthcare provider."

d Atenolol is a beta blocker and can cause rebound cardiac excitation if withdrawn abruptly. To decrease the risk of rebound excitation the dose should be tapered over 1 or 2 weeks. Patients should carry an adequate supply when traveling.

An intravenous (IV) bolus of phenytoin (Dilantin) is administered with the patient under electrocardiographic (ECG) monitoring because of the risk of which occurrence? a Myocardial infarction b Bundle branch block c Atrial fibrillation d Bradycardia

d Bradycardia is a risk when phenytoin is administered intravenously. Therefore, it is administered slowly at a rate not exceeding 25 to 50 mg/min and with the patient under ECG monitoring. If bradycardia occurs, boluses are stopped until the heart rate returns to normal. A myocardial infarction. bundle branch block, and atrial fibrillation are not associated with the IV administration of phenytoin.

A patient has been prescribed acarbose (Precose). The nurse plans to instruct the patient about which adverse effect? a Anxiety b Fever c Weight gain d Diarrhea

d Diarrhea may be caused by the metabolism of carbohydrates in the large intestine that were blocked from metabolism in the small intestine by acarbose. This side effect is usually mild and tends to resolve with continued therapy. Encourage the patient not to discontinue therapy without first consulting a health care provider. Anxiety is not an adverse effect of acarbose, and acarbose does not cause fever or weight gain.

How does the nurse teach a patient to take selegiline (Eldepryl)? a Every 6 hours to ensure maintenance of therapeutic blood levels b One hour before or 2 hours after meals to increase absorption c At bedtime to increase therapeutic effects d At breakfast and lunch to decrease the potential for insomnia

d Selegiline may cause insomnia, which can be minimized by taking the medication early in the day. This regimen could cause overdosing of selegiline. Selegiline may be taken with meals. Selegiline should not be given at night because it may cause insomnia.

A patient taking phenytoin (Dilantin) has started attending college and reports frequently drinking alcohol with friends. What does the nurse monitor for in this patient? a Clinical manifestations of phenytoin toxicity b Hyperglycemia c Hypertension d Increased seizure activity

d The chronic use of alcohol and phenytoin will decrease blood levels of phenytoin and increase the potential for seizure activity. The combination of phenytoin and alcohol does not cause phenytoin toxicity, affect blood glucose levels, or increase blood pressure.

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.

d 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.

The patient is currently on a treatment regimen that includes selegiline (Eldepryl) therapy. What information is most important for the nurse to teach the patient about this medication? a "This medication will cure your disease." b "This medication is used when other drugs do not work." c "This medication blocks breakdown of dopamine." d "You will need to restrict your intake of certain foods and drinks."

d This medication may inhibit monoamine oxidase (MAO)-A, an enzyme that promotes metabolism of tyramine in the gastrointestinal tract. If not metabolized, ingestion of foods high in tyramine, such as aged cheese, red wine, and bananas, can cause a hypertensive crisis. This is the most important information the nurse needs to teach the patient.

Which clinical manifestations of hypoglycemia does the nurse instruct a patient with diabetes to recognize? a Confusion, irritability, and vomiting b Increased heart rate, abnormal breathing, and fruity odor to the breath c Weakness, increased heart rate, and hot dry skin d Hunger, double vision, and apprehension

d Clinical manifestations of hypoglycemia include headache, nausea, weakness, hunger, decreased coordination, general apprehension, sweating, and blurred or double vision. Confusion, irritability, and vomiting are not clinical manifestations of hypoglycemia. Increased heart rate, abnormal breathing, fruity odor to the breath, weakness, increased heart rate, and hot dry skin are not all symptoms of hypoglycemia.

The nurse knows that there is an increased risk of ototoxicity in a patient receiving an aminoglycoside if which level is high? Concentration Trough Peak Dose

trough When trough levels remain elevated, aminoglycosides are unable to diffuse out of inner ear cells, thus exposing the cells to the medication for an extended time. Prolonged exposure (ie, high trough levels), rather than brief exposure to high levels, underlies cellular injury.