NURS 2042 Exam 2 questions

A patient is admitted to the emergency department. The patient's heart rate 112 beats/min. The patient is sweating profusely, has muscle tremors and is agitated. The patient says " I was depressed and I took more of the pills the doctor gave me so I would feel better." 1. What does the nurse suspect is happening with this patient? 2. What treatment does the nurse expect to implement?

1. Along w/ a full assessment, the nurse would need to ask what meds the pt is taking, how long and how much the pt is currently taking. Based on the prsesnting s/s the nurse would include serotonin syndrome as a highly possible reason for the pt's presenting sxs 2. The Tx for serotonin syndrome includes discontinuation of all SSRI's and providing supportive care to maintain homeostasis

A patient who has had an accidental overdose of tricyclic antidepressants is to receive physostigmine (Antilirium), 1.5 mg IM stat. The medication is available in a vial that contains 2 mL, with a concentration of 1 mg/mL. How much medication will the nurse draw up into the syringe for this dose?

1.5 mL

The preoperative order for an adult patient reads: "Give scopolamine, 0.7 mg IM on call for surgery." The medication is available in vials of 0.4 mg/mL. How many milliliters will the nurse administer for this dose? (Record your answer using one decimal place.)

1.8 mL

The order for chemotherapy reads: "Give asparaginase (Elspar) IV 200 units/kg/day." The patient weighs 297 lb. The pharmacy department will prepare the medication for intravenous infusion. How much drug will be given per dose?

27,000 units

A patient with a feeding tube will be receiving risperidone (Risperdal) 8 mg in 2 divided doses via the feeding tube. The medication is available in a 1 mg/mL solution. How many milliliters will the nurse administer for each dose?

4 mL per dose

The nurse is preparing to add a dose of bevacizumab (Avastin) to a patient's intravenous infusion. The infusion bag prepared by the pharmacy has 70 mg of bevacizumab in 100 mL of normal saline, and it is to infuse over 90 minutes. The nurse will set the infusion pump to what rate for this dose?

67 mL/hour (66.66 rounds to 67)

Which drug will the nurse anticipate administering to a patient experiencing benzodiazepine overdose? A. Flumazenil B. Naltrexone C. Vivitrol D. Flunitrazepam

A. Flumazenil Flumazenil is a benzodiazepine reversal agent. Flumazenil antagonizes the action of benzodiazepines on the CNS by directly competing with them for binding at the benzodiazepine receptor in the CNS and thus reversing sedation. For opioid abuse or dependence, naltrexone, an opioid antagonist, is administered. Naltrexone, which is also available as an injection called Vivitrol, works by blocking the opioid receptors so that use of opioid drugs does not produce euphoria. Flunitrazepam is a benzodiazepine.

A patient with a diagnosis of delirium tremens is admitted to the acute care facility. Which finding does the nurse expect upon assessment of the patient? A. Hyperthermia B. Hypotension C. Bradycardia D. Somnolence

A. Hyperthermia Delirium tremens are characterized by hypertensive crisis, tachycardia, agitation, and hyperthermia and may be life threatening.

You are getting ready to administer atropine sulfate and an opioid, ordered as standard preoperative medications, to a 75-year-old woman who will be undergoing minor surgery. When you check her medical history, you see that she has a history of smoking and has angle-closure glaucoma. What is your priority action at this time regarding administration of the preoperative medications? Explain your answer.

Atropine, a cholinergic-blocking drug, produces mydriasis (pupil dilation), which increases intraocular pressure. Therefore, the drug could dangerously increase intraocular pressure in this patient, possibly resulting in permanent eye damage. The nurse's priority action would be to hold the dose of the drug and immediately contact the prescriber to clarify the order. Another priority action would be to assess for any respiratory distress, including acute asthma (because of her history of smoking). These conditions would be possible contraindications for these drugs. Of course, the patient would not be undergoing surgery if she were in respiratory distress.

A patient with a diagnosis of depression is being discharged with a prescription for an MAOI. Which instruction should the nurse include for this medication? a. Avoid eating aged cheese. b. Encourage use of fiber supplements. c. Explain the symptoms of tardive dyskinesia. d. Emphasize that tremors are a common adverse effect.

Eating foods high in tyramine, including aged cheese, can cause a hypertensive crisis in patients taking MAOIs.

In preparing a patient for emergency surgery, the order was to give 0.5 mg of atropine sulfate to the patient intravenously. The vial concentration is 1 mg/mL. In the haste of this emergency situation, 5 mL of the atropine solution is given. How much atropine did the patient receive? What is the nurse's priority action at this time?

If 5 mL were given, then the patient received 5 mg of atropine. The usual IV dose for treatment of bradycardia is 0.5 to 1 mg, with a maximum total dose of 3 mg. Cholinergic-blocking drugs have a narrow therapeutic index; therefore, the difference between a therapeutic and a toxic dose is very fine. For atropine, the onset of action is immediate, and the peak effects occur in 2 to 4 minutes and last 4 to 6 hours. The patient needs to be monitored closely for cardiac effects, such as tachycardia and dysrhythmia, and for extreme delirium and agitation. The use of the cholinergic drug physostigmine as an antidote for cholinergic blocker overdose is controversial because it has the potential to produce severe adverse effects, such as seizures and cardiac asystole, and is usually reserved for the treatment of patients who show extreme delirium or agitation or who could inflict injury upon themselves. Of course, the prescriber must be notified immediately. The nurse must monitor the patient closely, especially pulse, blood pressure, level of consciousness, and heart rhythm, until the drug's effects subside.

A patient has been receiving bleomycin irrigations through a chest tube for 3 days. Today he begins to have an irregular and slow heart rhythm, complains of nausea, and says, "I'm seeing yellow hazy circles around the lights." He thinks the chemotherapy is causing these problems. The nurse reviews the patient's medications and notes that he is taking digoxin (Lanoxin), lisinopril (Zestril), and simvastatin (Zocor). What is the nurse's priority action at this time? Explain your answer.

Some drugs, most notably bleomycin and doxorubicin, have been known to cause serum digoxin levels to increase. Patients receiving one of these drugs along with digoxin need to be observed for signs of digoxin toxicity. This patient may be experiencing digoxin toxicity; the nurse withholds the dose of digoxin until notifying the prescriber. Dosage reduction or the elimination of digoxin therapy may be indicated, as well as a stat order for a digoxin level.

An older adult neighbor wants to take Ginkgo (Ginkgo biloba) because he is worried about "losing his mind." He asks you if this drug would help him. He has lived alone since being widowed last year and does not have any family members in the area. What is your best answer for this neighbor? Review the Safety: Herbal Therapies and Dietary Supplements box in this chapter and other sources, if desired.

Some people use gingko as an antioxidant to prevent or treat organic brain syndrome and to enhance memory. The nurse needs to advise this gentleman to check with his prescriber before starting this herbal therapy because of potential interactions with aspirin, NSAIDs, anticoagulants, and several other drugs. In addition, gingko can cause bleeding tendencies because it inhibits platelet aggregation. He needs to be assessed for any conditions that may result in bleeding, such as peptic ulcer disease. In addition, a psychosocial evaluation would be appropriate to screen for depression. The nurse could also counsel him to seek activities that would allow for more social interactions and therefore more social stimulation so that he does not "lose his mind." An honest discussion of ways of staying busy and keeping one's mind stimulated would be helpful.

During an infusion of carmustine, a patient dislodges the intravenous catheter, and infiltration of the medication occurs. What is the nurse's priority action at this time? Explain your answer.

The following actions must be taken immediately to minimize damage to the patient. First, stop the IV infusion immediately and have another nurse notify the prescriber. However, do not remove the IV catheter. For the typical antidote, use a premixed 1:1 solution of sodium bicarbonate and sterile normal saline in a 0.5 mEq/mL solution. Inject 2 to 6 mL of this solution through the existing IV line, and give multiple subcutaneous injections into the extravasated site. The total dose must not exceed 10 mL of 0.5 mEq/mL solution. In addition, apply cold compresses to the area and elevate the limb if possible.

A patient is admitted to the hospital for major abdominal surgery, and the physician has ordered that a transdermal nicotine patch be used while the patient is hospitalized because the patient was a heavy smoker. While the patch is applied, the patient asks, "Why in the world would you want to give me nicotine when I'm trying to stop smoking?" What is the nurse's priority when answering the patient's question?

The nurse needs to explain how the expected nicotine withdrawal will affect his recovery from surgery. Nicotine withdrawal may be manifested in a hospitalized patient by irritability, restlessness, and decreases in both heart rate and blood pressure. In addition, a patient may experience severe cravings for cigarettes. During the postoperative period, the symptoms of nicotine withdrawal may mask other underlying problems, such as hypoxia or even bleeding. He will also be more comfortable if the cravings are curbed. The transdermal administration of nicotine provides nicotine without the carcinogens found in tobacco; the patches are part of a stepwise reduction in subcutaneous delivery. Over time, the nicotine dosage is gradually decreased.

A patient is receiving chemotherapy that includes the antimetabolite cytarabine. Several hours after the treatment, the patient begins to complain of shortness of breath. The nurse examines the patient and finds that his pulse rate is 118 beats/min, he has slight edema in his lower extremities, and crackles are audible over the bases of the lungs. In addition, his pulse oximetry reading is 89% (previously it was 99%) on room air. What is the nurse's immediate priority action?

The nurse needs to recognize that the patient may be experiencing cardiac or pulmonary toxicity as a result of the cytarabine therapy. The nurse needs to complete a thorough cardiac and respiratory assessment quickly, stay with the patient, and ask another nurse to notify the patient's prescriber immediately

A patient who has been newly diagnosed with myasthenia gravis has received a dose of pyridostigmine (Mestinon) in the morning, just before breakfast. She says, "Oh, I know this won't cure me, but I'm so glad that this drug makes me feel better. Will it last all day?" What is the priority when the nurse is teaching this patient about pyridostigmine?

The priority in teaching will be the importance of timing the dosing of this drug and realistic expectations. The nurse will consider that pyridostigmine (Mestinon), when taken orally, will only last up to 6 hours. Because of this relatively short duration, the beneficial effects the patient is enjoying will not last all day. It has been shown to improve muscle strength and is used in the symptomatic treatment of myasthenia gravis. Keep in mind that the drug's onset is 15 to 45 minutes. The drug's delivery needs to be timed to coincide with the patient's activities, such as eating meals.

A patient is receiving irinotecan as part of his chemotherapy regimen. He will be receiving the dose shortly and then will be sent home. The nurse is providing patient teaching before giving him the medication. What is one of the most important problems for which the patient will need to be ready once he is home? Explain the nurse's priority action.

The priority is preparing the patient for the possibility of developing cholinergic diarrhea 2 to 10 days after infusion of irinotecan. This delayed diarrhea can be severe and even life threatening, and it must be treated aggressively with an antidiarrheal medication, such as loperamide. In addition, the patient must maintain adequate hydration. You must teach him what to expect, the proper dosage and schedule for the loperamide, and how to maintain hydration. In addition, he must contact his prescriber if he is unable to take in fluids.

A 68-year-old patient has been taking an SSRI antidepressant for 3 weeks. His wife calls and expresses concern because he has started to give away some of his keepsakes. What is the nurse's priority action at this time?

The priority is to watch this patient closely for suicidal ideations, which may increase during the first weeks after antidepressant therapy is started. The nurse should instruct the wife to bring her husband in for a follow-up visit immediately and not to leave him alone.

A patient has been admitted to the hospital because of a suspected overdose of a tricyclic antidepressant. What two problems are the nurse's priorities at this time?

The two priority problems that may occur after an overdose of tricyclic antidepressants are cardiac dysrhythmias and seizures, and both may lead to death. Overdoses of these medications can be lethal.

A friend has revealed to the nurse that she has used crack cocaine often in the past few months and states that even though she enjoys the sensations she can "stop at any time." What is the nurse's priority action in this situation?

This situation brings up an ethical difficulty in that a friend has confided in the nurse, yet the friend is participating in an illegal and harmful activity. First of all, she will not change her behavior unless she wants to change. The priority is the safety of the friend. The nurse can try to educate her about the dangers of taking illicit drugs, specifically the cocaine, and how an overdose or bad batch could kill her. If she wants help, the nurse can aid her in seeking professional medical care and counseling to assist with withdrawal and psychologic dependence. She also needs to realize that this will be a lifelong issue. The nurse will try to involve her family in an intervention to help her to recognize her problem.

While obtaining a medication history from a patient, the nurse notes that the patient is currently prescribed naltrexone (ReVia). The nurse should question the patient about a previous history of which substance abuse? a Opioid b Alcohol c Barbiturate d Amphetamine

a Opioid Naltrexone (ReVia), an opioid antagonist, is used to treat opioid abuse or dependence. Naltrexone works by blocking the opioid receptors so that use of opioid drugs does not produce euphoria. When euphoria is eliminated, the reinforcing effect of the drug is lost.

A patient reports severe back pain and asks the nurse for medication "to take the pain away." Nursing assessment findings on the physical examination include mydriasis, rhinorrhea, diaphoresis, lacrimation, blood pressure of 160/84 mmHg, heart rate of 116 beats/min, and respiratory rate of 24 breaths/min. Which condition would the nurse suspect? a Opioid withdrawal b Ethanol intoxication c Barbiturate overdose d Amphetamine overdose

a Opioid withdrawal Signs and symptoms associated with opioid withdrawal include drug seeking, mydriasis, piloerection, diaphoresis, rhinorrhea, lacrimation, vomiting, diarrhea, insomnia, and elevated blood pressure and pulse rate. Nurses must be alert for this behavior in patients seeking medication for subjective pain complaints, especially when accompanied by withdrawal symptoms.

Before administering tolterodine (Detrol), it is most important for the nurse to assess the patient for a history of which condition? a. Angle-closure glaucoma b. Cataracts c. Hypothyroidism d.Hyponatremia

a. Angle-closure glaucoma

The nurse is providing education about cholinergic-blocking drug therapy to an older adult patient. Which is an important point to emphasize for this patient? a. Avoid exposure to high temperatures. b. Limit liquid intake to avoid fluid overload. c. Begin an exercise program to avoid adverse effects. d. Stop the medication if excessive mouth dryness occurs.

a. Avoid exposure to high temperatures.

When doing an admission drug history, the nurse notes that the patient has a prescription for lithium (Lithobid). The nurse suspects that this patient has been diagnosed with which condition? a. Bipolar disorder b. Absence seizures c. Paranoid schizophrenia d. Obsessive-compulsive disorder

a. Bipolar disorder Lithium is a mood-stabilizing drug for the treatment of manic episodes associated with bipolar disorders.

While administering bevacizumab (Avastin), what will the nurse assess to look for drug-related toxicities? (Select all that apply.) a. Blood pressure b. Color of the skin and sclera of the eye (for jaundice) c. Blood glucose level d. Urine protein level e. Hearing f. Weight

a. Blood pressure d. Urine protein level f. Weight

A patient is experiencing stomatitis after a round of chemotherapy. Which intervention by the nurse is correct? a. Clean the mouth with a soft-bristle toothbrush and warm saline solution. b. Rinse the mouth with commercial mouthwash twice a day. c. Use lemon-glycerin swabs to keep the mouth moist. d. Keep dentures in the mouth between meals.

a. Clean the mouth with a soft-bristle toothbrush and warm saline solution.

The nurse administering a cholinergic-blocking drug to a patient who is experiencing drug-induced extrapyramidal effects would assess for which therapeutic effect? a. Decreased muscle rigidity and tremors b. Increased heart rate c. Decreased bronchial secretions d. Decreased GI motility and peristalsis

a. Decreased muscle rigidity and tremors

A patient is experiencing withdrawal from opioids. The nurse expects to see which assessment finding most commonly associated with acute opioid withdrawal? a. Elevated blood pressure b. Decreased pulse c. Lethargy d. Constipation

a. Elevated blood pressure

The nurse is assessing a patient who has a prescription for dicyclomine (Bentyl). Which condition is considered a contraindication to this medication? a. GI atony b. Irritable bowel syndrome c. Overactive bladder d. Diabetes mellitus

a. GI atony

When chemotherapy with alkylating drugs is planned, the nurse expects to implement which intervention to prevent nephrotoxicity? a. Hydrating the patient with intravenous fluids before chemotherapy b. Limiting fluids before chemotherapy c. Monitoring drug levels during chemotherapy d. Assessing creatinine clearance during chemotherapy

a. Hydrating the patient with intravenous fluids before chemotherapy

Which condition does the nurse anticipate when assessing a patient with tumor lysis syndrome? a. Hyperuricemia b. Hypophosphatemia c. Hypokalemia d. Hypercalcemia

a. Hyperuricemia

The nurse is assessing a patient who has developed anemia after two rounds of chemotherapy. Which of these may be indications of anemia? (Select all that apply.) a. Hypoxia b. Fever c. Infection d. Bleeding e. Fatigue

a. Hypoxia e. Fatigue

The patient was admitted to the hospital for observation and has now recovered. Which information will the nurse include in patient teaching about SSRI's? a. It usually takes 4-6 weeks until you experience benefits from the medication. b. Avoid all foods containing tyramine. c. Stop taking the medication if you develop an upset stomach. d. Take the medication at bedtime to enhance sleep.

a. It usually takes 4-6 weeks until you experience benefits from the medication. SSRI's need 4-6 weeks to reach their max effectiveness. These meds can cause GI upsent and should be taken w/ food. SSRI's should be taken in the am to prevent sleep disturbances

The day before a third round of chemotherapy, the nurse reads that a patient's neutrophil count is 1650 cells/mm3. The nurse expects that the oncologist will follow which course of treatment? a. The chemotherapy will be started as scheduled. b. The chemotherapy will be given at a lower dosage. c. The oncologist will order a neutrophil transfusion to be given first. d. The chemotherapy will not be given today.

a. The chemotherapy will be started as scheduled.

The nurse is giving medications to a patient. Which drug or drug class, when administered with lithium, increases the risk for lithium toxicity? a. Thiazides b. levofloxacin c. calcium citrate d. Beta blockers

a. Thiazides

A patient took an accidental overdose of a cholinergic drug while at home. He comes to the emergency department with severe abdominal cramping and bloody diarrhea. The nurse expects that which drug will be used to treat this patient? a. atropine (generic) b. pilocarpine (Salagen) c. bethanechol (Urecholine) d. phentolamine (Regitine)

a. atropine (generic)

When handling and administering vesicant drugs, the nurse will: a. double flush the patient's bodily secretions in the commode. b. use sterile towels to clean up after chemotherapy spills. c. mix chemotherapeutic drugs in the patient's room. d. teach the patient how to administer parenteral chemotherapeutic drugs.

a. double flush the patient's bodily secretions in the commode.

The nurse is assessing a patient who has been taking a cholinergic drug for 3 days. The patient has flushed skin and orthostatic blood pressure changes and is complaining of abdominal cramps and nausea. The nurse recognizes that the patient is most likely experiencing a. early signs of a cholinergic crisis. b. late signs of a cholinergic crisis. c. an allergic reaction to the drug. d. expected adverse effects.

a. early signs of a cholinergic crisis.

The nurse is reading a patient's substance abuse history on admission to inpatient rehabilitation. The patient states to the nurse, "I have been increasing my drug dosage to get the same effect." What is the patient experiencing? a Addiction b Tolerance c Habituation d Physiological dependence

b Tolerance Tolerance is defined as requiring an increased amount of drugs in the system to have the same desired effect

A patient has been given a prescription for transdermal scopolamine patches (Transderm-Scōp) for motion sickness for use during a vacation cruise. The nurse will include which instructions? (Select all that apply.) a. "Apply the patch as soon as you board the ship." b. "Apply the patch 3 to 4 hours before boarding the ship." c. "The patch needs to be placed on a nonhairy area on your upper chest or upper arm." d. "The patch needs to be placed on a nonhairy area just behind your ear." e. "Change the patch every 3 days." f. "Rotate the application sites."

b. "Apply the patch 3 to 4 hours before boarding the ship." d. "The patch needs to be placed on a nonhairy area just behind your ear." e. "Change the patch every 3 days." f. "Rotate the application sites."

The nurse is explaining the differences between transdermal nicotine and nicotine gum programs. Which statement by the nurse is correct? a. "The nicotine patch will give you quick relief from cravings." b. "Chewing the gum rapidly will release an immediate dose of nicotine." c. "It seems that patients have better treatment compliance with the gum than the patch." d. "The dose of nicotine in the gum is approximately twice the dose the average smoker receives in one cigarette."

b. "Chewing the gum rapidly will release an immediate dose of nicotine." The patch system uses a stepwise reduction in subcutaneous delivery to gradually decrease the nicotine dose, and patient treatment compliance seems higher than with the gum. Acute relief from withdrawal symptoms is most easily achieved with the use of the gum because rapid chewing releases an immediate dose of nicotine. The dose is approximately half the dose the average smoker receives in one cigarette, however.

A patient is scheduled to have lunch at 1200. The nurse will administer the pyridostigmine (Mestinon) at what time for optimal therapeutic effect? a. 1100 b. 1130 c. 1200 d. 1230

b. 1130

A patient with Alzheimer's disease accidentally took 2 weeks' worth of a cholinergic medication. He is brought to the emergency department, is going into shock, and experiencing severe hypotension and vomiting. The nurse will expect which initial treatment? a. Administration of physostigmine b. Administration of atropine c. Administration of epinephrine d.Cardiovascular support with dopamine

b. Administration of atropine

In caring for a patient experiencing ethanol withdrawal, the nurse expects to administer which medication or medication class as treatment for this condition? a. lithium (Eskalith) b. Benzodiazepines c. buspirone (BuSpar) d. Antidepressants

b. Benzodiazepines

Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) both function by which mechanism? a. Decrease the catecholamine release into the blood b. Block the reuptake of neurotransmitters at nerve endings c. Inhibit an enzyme that stops the action of neurotransmitters d Stimulate areas of the brain associated with mental alertness

b. Block the reuptake of neurotransmitters at nerve endings The SSRIs block the reuptake of serotonin. The TCAs block the reuptake of norepinephrine and serotonin. The monoamine oxidase inhibitors (MAOIs) inhibit the MAO enzyme that stops the actions of neurotransmitters such as dopamine, serotonin, and norepinephrine. Amphetamines stimulate areas of the brain associated with mental alertness.

A patient prescribed lorazepam (Ativan) for the treatment of anxiety states, "I feel drowsy all the time, and it's interfering with every aspect of my life." The nurse knows that a better drug therapy option for this patient is which anxiolytic medication? a. Alprazolam (Xanax) b. Buspirone (BuSpar) c. Chlordiazepoxide (Librium) d. Hydroxyzine hydrochloride salt (Vistaril)

b. Buspirone (BuSpar) Buspirone (BuSpar) has the advantage of having fewer adverse effects such as sedation and lack of dependency potential. All of the other options are sedatives as well as anxiolytics.

Which laboratory test should be monitored closely to assess for a potential life-threatening adverse effect to clozapine (Clozaril)? a. Liver function studies b. Complete blood count c. Immunoglobulin levels d. Glomerular filtration rate

b. Complete blood count Patients taking clozapine must be monitored for the life-threatening adverse effect of agranulocytosis, evidenced by a severe reduction in the number of white blood cells.

A patient who is taking disulfiram as part of an alcohol treatment program accidentally takes a dose of cough syrup that contains a small percentage of alcohol. The nurse expects to see which symptom as a result of acetaldehyde syndrome? a. Lethargy b. Copious vomiting c. Hypertension d. No ill effect because of the small amount of alcohol in the cough syrup

b. Copious vomiting

A patient experiencing ethanol withdrawal is beginning to show severe manifestations of delirium tremens. The nurse will plan to implement which interventions for this patient? (Select all that apply.) a. Doses of an oral benzodiazepine b. Doses of an intravenous benzodiazepine c. Restraints if the patient becomes confused, agitated, or a threat to himself or others d. Thiamine supplementation e. Oral disulfiram (Antabuse) treatment f. Monitoring in the intensive care unit

b. Doses of an intravenous benzodiazepine c. Restraints if the patient becomes confused, agitated, or a threat to himself or others d. Thiamine supplementation f. Monitoring in the intensive care unit

When assessing for adverse effects of cholinergic-blocking drug therapy, the nurse would expect to find that the patient complains of which drug effect? a. Diaphoresis b. Dry mouth c. Diarrhea d. Urinary frequency

b. Dry mouth

The nurse is assessing a patient who has experienced severe neutropenia after chemotherapy and will monitor for which possible signs of infection? (Select all that apply.) a. Elevated WBC count b. Fever c. Nausea d. Sore throat e. Chills

b. Fever d. Sore throat e. Chills

The nurse is teaching a patient about the possible adverse effects of donepezil (Aricept) for Alzheimer's disease. Which of these are possible adverse effects? (Select all that apply.) a. Constipation b. GI upset c. Drowsiness d. Dizziness e. Blurred vision

b. GI upset c. Drowsiness d. Dizziness

The nurse is reviewing the use of bethanechol (Urecholine) in a patient who is experiencing postoperative urinary retention. Which statement best describes the mechanism of action of bethanechol? a. It causes decreased bladder tone and motility. b. It causes increased bladder tone and motility. c. It increases the sensation of a full bladder. d. It causes the sphincters in the bladder to become tighter.

b. It causes increased bladder tone and motility.

Bevacizumab (Avastin) is an angiogenesis inhibitor. Which statement correctly describes the mechanism of action of an angiogenesis inhibitor? a. It inhibits the formation of blood cells. b. It inhibits the creation of new blood vessels in the tumor mass. c. It interferes with the synthesis of DNA in the cancer tumor. d. It causes cell death by inhibiting enzymes.

b. It inhibits the creation of new blood vessels in the tumor mass.

A patient has been admitted to the emergency department after a suspected overdose of benzodiazepines mixed with alcohol. The patient is lethargic and cannot speak. The nurse expects which immediate measures to be implemented? (Select all that apply.) a. Prepare to administer naloxone (Narcan). b. Prepare to administer flumazenil. c. Monitor the patient for convulsions. d. Prepare for potential respiratory arrest. e. Apply restraints.

b. Prepare to administer flumazenil. c. Monitor the patient for convulsions. d. Prepare for potential respiratory arrest.

The nurse is caring for a patient who becomes severely nauseated during chemotherapy. Which intervention is most appropriate? a. Encourage light activity during chemotherapy as a distraction. b. Provide antiemetic medications 30 to 60 minutes before chemotherapy begins. c. Provide antiemetic medications only upon the request of the patient. d. Hold fluids during chemotherapy to avoid vomiting.

b. Provide antiemetic medications 30 to 60 minutes before chemotherapy begins.

A patient receiving chemotherapy is experiencing severe bone marrow suppression. Which nursing diagnosis is most appropriate at this time? a. Activity intolerance b. Risk for infection c. Disturbed body image d. Impaired physical mobility

b. Risk for infection

What is another approved and indicated use for the antidepressant bupropion (Zyban)? a. Nocturnal enuresis b. Smoking cessation c. Tourette's syndrome d. Orthostatic hypotension

b. Smoking cessation Zyban is a sustained-release form of bupropion that is useful in helping patients to quit smoking.

Before administering lithium to a patient, it is most important for the nurse to assess which laboratory value? a. Blood sugar b. Sodium c. Urine osmolality d. Potassium

b. Sodium Lithium may become toxic if the pt has hyponatremia

When patients are taking SSRI's for the first time for depression, which is most important to monitor for during the first few weeks of therapy? a. Hypertensive crisis b. Suicidal thoughts c. Convulsions d. Orthostatic hypotension

b. Suicidal thoughts It takes 4-6 weeks to work, the nurse would continue to assess for suicidal thoughts

The nurse is teaching a patient about treatment with an SSRI antidepressant. Which teaching considerations are appropriate? (Select all that apply.) a. The patient should be told which foods contain tyramine and instructed to avoid these foods. b. The patient should be instructed to use caution when standing up from a sitting position. c. The patient should not take any products that contain the herbal product St. John's wort. d. This medication should not be stopped abruptly. e. Drug levels may become toxic if dehydration occurs. f. The patient should be told to check with the prescriber before taking any over-the-counter medications

b. The patient should be instructed to use caution when standing up from a sitting position. c. The patient should not take any products that contain the herbal product St. John's wort. d. This medication should not be stopped abruptly f. The patient should be told to check with the prescriber before taking any over-the-counter medications

A patient diagnosed with depression is being discharged with a prescription for TCAs after no improvement of symptoms on an SSRI. Which instruction should the nurse include about this new medication? a. There are no drug or food contraindications with this medication. b. There is a risk of toxicity when this medication is taken with alcohol. c. Take St. John's wort every day to minimize the adverse effects of the medication. d. This drug does not cause problems with sleep, constipation, or low blood pressure.

b. There is a risk of toxicity when this medication is taken with alcohol. There is an increased risk of toxicity with TCAs when taken with alcohol and a high rate of morbidity.

The nurse is caring for a patient who has been taking clozapine (Clozaril) for 2 months. Which laboratory test(s) should be performed regularly while the patient is taking this medication? a. Platelet count b. WBC count c. Liver function studies d. Renal function studies

b. WBC count

The nurse is teaching a class about the effects of alcohol. Long-term excessive use of alcohol is associated with which of these problems? (Select all that apply.) a. Coronary artery disease b. Wernicke's encephalopathy c. Polyneuritis d. Seizures e. Cirrhosis of the liver f. Korsakoff's psychosis

b. Wernicke's encephalopathy c. Polyneuritis e. Cirrhosis of the liver f. Korsakoff's psychosis

During treatment for withdrawal from opioids, the nurse expects which medication to be ordered? a. amphetamine (Dexedrine) b. clonidine (Catapres) c. diazepam (Valium) d. disulfiram (Antabuse)

b. clonidine (Catapres)

While teaching a patient who is about to receive cyclophosphamide (Cytoxan) chemotherapy, the nurse will instruct the patient to watch for potential adverse effects, such as a. cholinergic diarrhea. b. hemorrhagic cystitis. c. peripheral neuropathy. d. ototoxicity.

b. hemorrhagic cystitis.

When giving intravenous cholinergic drugs, the nurse must watch for symptoms of a cholinergic crisis, such as: (Select all that apply.) a. peripheral tingling. b. hypotension. c. dry mouth. d. syncope. e. dyspnea. f. tinnitus.

b. hypotension d. syncope. e. dyspnea.

The nurse is giving a dose of bethanechol (Urecholine) to a postoperative patient. The nurse is aware that contraindications to bethanechol include: a. bladder atony. b. peptic ulcer. c. urinary retention. d. hypothyroidism.

b. peptic ulcer.

An unresponsive young adult is taken to the emergency department by friends. The friends tell the nurse, "We were too scared to call 911 because we were at a party popping roofies." Which medication would the nurse expect to administer to this patient? a Naloxone (Narcan) b Naltrexone (ReVia) c Flumazenil (Romazicon) d Chlordiazepoxide (Librium)

c Flumazenil (Romazicon) A benzodiazepine that has gained popularity as a recreational drug is flunitrazepam. The drug is known as roofies among young people. Flumazenil (Romazicon) can be used to acutely reverse the sedative effects of benzodiazepines. Naloxone (Narcan) is used to treat opiate overdosage. Naltrexone (ReVia) is used to treat opioid abuse, and chlordiazepoxide (Librium) is used to treat ethanol withdrawal.

The nurse is providing care for a patient in the emergency department who reports a headache and weakness and is noted to have cardiac dysrhythmias on the electrocardiogram. The patient is talkative, restless, anxious, and asking to leave the emergency department. The nurse suspects that the patient might be taking which abuse substance? a Opioids b Alcohol c Stimulants d Depressants

c Stimulants Stimulants of abuse include amphetamines and often are related to anxiety, talkativeness, headaches, weakness, restlessness, and cardiac dysrhythmias

The family of a patient who has recently been diagnosed with Alzheimer's disease is asking about the new drug prescribed to treat this disease. The patient's wife says, "I'm so excited that there are drugs that can cure this disease! I can't wait for him to start treatment." Which reply from the nurse is appropriate? a. "The sooner he starts the medicine, the sooner it can have this effect." b. "These effects won't be seen for a few months." c. "These drugs do not cure Alzheimer's disease. Let's talk about what the physician said to expect with this drug therapy." d. "His response to this drug therapy will depend on how far along he is in the disease process."

c. "These drugs do not cure Alzheimer's disease. Let's talk about what the physician said to expect with this drug therapy."

Which statement does the nurse include when teaching a patient about disulfiram (Antabuse) therapy? a. "Disulfiram (Antabuse) will cure your alcoholism if you take it as directed." b. "If you drink alcohol after taking disulfiram (Antabuse), your blood pressure will get very high." c. "You cannot drink alcohol for at least 3 or 4 days after taking disulfiram (Antabuse)." d. "If you miss a dose of disulfiram (Antabuse), double the dose the next time it is due."

c. "You cannot drink alcohol for at least 3 or 4 days after taking disulfiram (Antabuse)." The rationale for the use of disulfiram (Antabuse) is that patients know that if they are to avoid the devastating experience of acetaldehyde syndrome, they cannot drink for at least 3 or 4 days after taking disulfiram. Disulfiram (Antabuse) does not cure alcoholism; blood pressure gets very low if alcohol is consumed with disulfiram (Antabuse), and patients should follow the prescribed dosing schedule and not double a dose.

A 60-year-old woman asks the nurse about taking ginkgo to help with her memory. The patient has a history of arthritis, type 2 diabetes, thyroid disease, and hypertension. She is currently taking NSAIDs for arthritis, oral antidiabetic medications, thyroid replacement hormone, and a beta blocker for blood pressure. What potential adverse effect from the gingko would be of most concern for this patient? a. Stomach upset b. Diarrhea c. Bleeding d. Drowsiness

c. Bleeding

During treatment with doxorubicin (Adriamycin), the nurse must monitor closely for which potentially life-threatening adverse effect? a. Nephrotoxicity b. Peripheral neuritis c. Cardiomyopathy d. Ototoxicity

c. Cardiomyopathy

A pregnant woman has been diagnosed with cancer and is meeting with her oncologist to plan treatment. Which statement about chemotherapy and pregnancy is true? a. She will have to wait until the baby is born before starting chemotherapy. b. The greatest risk of fetal harm from chemotherapy is during the third trimester. c. Chemotherapy treatment during the second or third trimester poses less risk to the fetus. d. Chemotherapy is unsafe during pregnancy, but radiation therapy is safe in low doses

c. Chemotherapy treatment during the second or third trimester poses less risk to the fetus.

The nurse is caring for a patient who received chemotherapy 24 hours ago. The patient's white blood cell count is 4,400 mcL. Which symptom, if experienced by the patient, should the nurse report to the prescriber immediately? a. Fatigue b. Diarrhea c. Fever d. Nausea and vomiting

c. Fever

The nurse is presenting a seminar on substance abuse. Which drug is the most commonly used illicit drug in the United States? a. Crack cocaine b. Heroin c. Marijuana d. Methamphetamine

c. Marijuana

A patient who is prescribed duloxetine (Cymbalta) comes to the medical clinic complaining of restlessness, sweating, and tremors. The nurse suspects serotonin syndrome and questions the patient regarding concurrent use of which herbal product or dietary supplement? a. Zinc b. Vitamin E c. St. John's wort d. Glucosamine chondroitin

c. St. John's wort Serotonin syndrome may occur with SSRIs when they are combined with herbal products such as St. John's wort.

If extravasation of an antineoplastic medication occurs, which intervention will the nurse perform first? a. Apply cold compresses to the site while elevating the arm. b. Inject subcutaneous doses of epinephrine around the IV site every 2 hours. c. Stop the infusion immediately while leaving the catheter in place. d. Inject the appropriate antidote through the IV catheter.

c. Stop the infusion immediately while leaving the catheter in place.

After a patient has been treated for depression for 4 weeks, the nurse calls the patient to schedule a follow-up visit. What concern will the nurse assess for during the conversation with the patient? a. Weakness b. Hallucinations c. Suicidal ideation d. Difficulty with urination

c. Suicidal ideation

The nurse is assessing a patient for possible substance abuse. Which assessment finding indicates possible use of amphetamines? a. Lethargy and fatigue b. Cardiovascular depression c. Talkativeness and euphoria d. Difficulty swallowing and constipation

c. Talkativeness and euphoria

The nurse is reviewing the orders for a newly admitted patient and sees an order for edrophonium (Tensilon). The nurse expects that this drug is ordered for which reason? a. To reduce symptoms and delay the onset of Alzheimer's disease b. To treat the symptoms of myasthenia gravis c. To aid in the diagnosis of myasthenia gravis d. To reverse the effects of nondepolarizing neuromuscular blocking drugs after surgery

c. To aid in the diagnosis of myasthenia gravis

Glycopyrrolate (Robinul) and an opioid are administered to a patient before surgery in the preoperative area. The anticholinergic is used to a. potentiate the action of the opioid. b. assist the patient in retaining urine during surgery. c. control secretions during surgery. d. prevent nausea.

c. control secretions during surgery.

During therapy with the cytotoxic antibiotic bleomycin, the nurse will assess for a potentially serious adverse effect by monitoring a. blood urea nitrogen and creatinine levels. b. cardiac ejection fraction. c. respiratory function. d. cranial nerve function.

c. respiratory function.

During the assessment of a patient about to receive a cholinergic-blocking drug, the nurse will determine whether the patient is taking any drugs that may potentially interact with the anticholinergic, including: a. opioids, such as morphine sulfate. b. antibiotics, such as penicillin. c. tricyclic antidepressants, such as amitriptyline. d. anticonvulsants, such as phenobarbital.

c. tricyclic antidepressants, such as amitriptyline.

When working with a patient who is neutropenic, the nurse identifies which as the most effective measure to prevent the patient from developing an infection? a. Administer prophylactic antibiotics. b. Stop administration of the chemotherapeutic drug. c.Perform hand hygiene. d.Vaccinate the patient to prevent bacterial infection.

c.Perform hand hygiene.

Which statement by the patient indicates the need for additional teaching on phenothiazine (Thorazine) drug therapy? a. "I need to change positions slowly to prevent dizziness." b. "I will call my health care provider for abnormal tongue movements" 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 relax me."

d. "It is okay to take this drug with a small glass of wine to help relax me." Drinking alcohol with phenothiazines puts the patient at risk for increased central nervous system depression.

Several months later, the patient returns to the health care providers office for a follow-up regarding the use of the SSRI. The patient tells the nurse that he is feeling better and stopped taking the SSRI yesterday. The patient doesn't plan on taking the medication again. When talking with the patient, which knowledge should guide the nurse's response? a. Drug dependency will develop, so it's appropriate to stop therapy after a few months. b. Drug therapy must be stopped as soon as the patient feels better to avoid serotonin syndrome. c. The patient is the best person to determine when the drug therapy should end. d. A possible 1-2 month taper period is indicated to prevent adverse effects of abrupt drug discontinuation.

d. A possible 1-2 month taper period is indicated to prevent adverse effects of abrupt drug discontinuation. A taper period of 1-2 months may be needed to prevent serotonin discontinuation sundrome w/ sxs like: dizziness, diarrhea, worsening of the depressive mood disorder. Serotonin syndrome is a result of taking too much serotonin altering medication. The pt and provider should work together to determine the optimal time for discontinuation. There is no evidence of drug dependency assoc w/ the use of SSRI's

A patient who is receiving chemotherapy with cisplatin (Platinol) has developed pneumonia. The nurse would be concerned about nephrotoxicity if which type of antibiotic was ordered as treatment for the pneumonia at this time? a. Penicillin b. Sulfa drug c. Fluoroquinolone d. Aminoglycoside

d. Aminoglycoside

The nurse is giving a cholinergic-blocking drug and will assess the patient for which contraindications to these drugs? a. Chronic bronchitis b. Peptic ulcer disease c. Irritable bowel syndrome d. Benign prostatic hyperplasia

d. Benign prostatic hyperplasia

A patient who has been taking lithium for 6 months has had severe vomiting and diarrhea from a gastrointestinal flu. The nurse will assess for which potential problem at this time? a. Anxiety b. Chest pain c. Agitation d. Dehydration

d. Dehydration

The nurse is monitoring a patient taking an antipsychotic medication for extrapyramidal symptoms. Which clinical finding indicates an adverse effect of this drug? a. Dry mouth and constipation b. Blood pressure of 80/50 mm Hg c. Presence of myoglobin in the blood d. Muscle cramps of the head and neck

d. Muscle cramps of the head and neck Dystonia, or sudden and painful muscle spasms, is the only extrapyramidal adverse effect listed. The other adverse effects also occur but are not extrapyramidal effects.

What atypical antipsychotic medication should the nurse anticipate the health care provider prescribing for treatment of refractory schizophrenia? a. Phenelzine (Nardil) b. Prazodone (Desyrel) c. Amoxapine (Asendin) d. Risperidone (Risperdal)

d. Risperidone (Risperdal) Risperidone is effective for schizophrenia, including negative symptoms. The other medications listed are antidepressants

Patient teaching for a patient receiving an MAOI would include instructions to avoid which food product? a. Orange juice b. Milk c. Shrimp d. Swiss cheese

d. Swiss cheese

When providing teaching for a patient who is prescribed an SSRI, which statement will the nurse include? a. The SSRI will work faster than the older tricyclic antidepressants. b. The SSRI will have an immediate beneficial effect on the patient's depression symptoms. c. The SSRI will not work well for severe causes of depression. d. The SSRI may take several weeks to have a beneficial effect.

d. The SSRI may take several weeks to have a beneficial effect. It can take up to 4-6 weeks to see the full response

Which finding would the nurse anticipate when assessing a patient with an atropine overdose? a. Moist skin b. Miosis c. Bradycardia d. Urinary retention

d. Urinary Retention

Which cytotoxic antibiotic does the nurse identify as most likely to cause pulmonary fibrosis? a. plicamycin b. mitoxantrone c. mitomycin d. bleomycin

d. bleomycin

The nurse monitors a patient who is experiencing thrombocytopenia from severe bone marrow suppression by looking for a. severe weakness and fatigue. b. elevated body temperature. c. decreased skin turgor. d. excessive bleeding and bruising.

d. excessive bleeding and bruising.