Nursing 1105 Powerpoint Questions
Which piece of information obtained during a patient assessment is a subjective finding? A. Patient states, "I have pain in my abdomen." B. Temperature of 38.5º C C. 400 mL of clear, yellow urine D. Blood pressure of 116/74 mm Hg
Answer: A Rationale: A subjective finding is one which the nurse makes using physiologic parameters. A patient's report of pain is a subjective finding because people experience pain differently. An objective assessment is clearly measurable and consistently reportable.
In which patient would you not use a laxative? A. A patient with sudden abdominal pain of unknown cause B. A patient on bed rest, unable to move his or her bowels for 5 days C. A patient with constipation D. A patient with a colonoscopy ordered tomorrow
Answer: A Rationale: A person with abdominal pain of unknown cause could potentially be at risk for serious complications. For example, if a laxative is administered and the cause of the pain was a condition such as a bowel perforation, obstruction, or appendicitis, this could be a problem. The patient must have other more serious disorders ruled out before a laxative is administered.
A nurse is reviewing core measures in charts of patients who have been discharged following an acute MI. The nurse should ensure patients are discharged home with which medication? A. Calcium channel blocker B. Beta adrenergic blocker C. Intravenous nitroglycerin D. Amiodarone (Pacerone)
Answer: B Rationale: Beta-adrenergic blockers should be given to patients who are discharged following an MI.
Patients taking which cholesterol-lowering agent may require supplements of fat-soluble vitamins? A. Bile-acid-binding resins B. Nicotinic acid C. HMG-CoA reductase inhibitors D. Fibric acids
Answer: A Rationale: Patients taking bile-acid-binding resins may require supplements of vitamins A, D, E, and K. Patient teaching should include awareness of the symptoms of vitamin K deficiency such as bleeding gums, tarry stools, and coffee-ground emesis. They should be encouraged to take a multivitamin daily as a preventive measure.
Which drug schedule indicates drugs with the highest risk for abuse? A. Schedule I B. Schedule II C. Schedule III D. Schedule IV E. Schedule V
Answer: A Rationale: Schedule I drugs have the highest potential for abuse. They are not currently accepted for medical use in the United States.
The nurse practitioner is caring for a patient who is experiencing xerostomia. Which type of treatment does the nurse prescribe for the patient? A. Antibiotics B. Saliva substitute C. Antiviral ointment D. Surgical removal
Answer: B Rationale: Xerostomia is a lack of saliva. Its most common cause is taking certain medications, especially those that produce anticholinergic responses. Artificial saliva is helpful in simulating natural saliva and decreasing symptoms. Sucking on hard candy or frequent sips of water may also be helpful.
In the central United States, what percentage of the population is considered obese? A. 10% to 14% B. 15% to 19% C. 20% to 24% D. 25% to 29% E. Greater than or equal to 30%
Answer: D Rationale: According to the CDC, in 2007 the majority of U.S. states had an obesity rate of 25% to 29%. Only one state (Colorado) had an obesity rate less than 20%. Three states (Tennessee, Alabama, Mississippi) had a prevalence of obesity equal to or greater than 30%.
What percentage of Americans are not regularly physically active? A. 30% B. 40% C. 50% D. 60% E. 70%
Answer: D Rationale: Today, despite common knowledge that regular exercise is healthy, more than 60% of Americans are not regularly physically active and 25% are not active at all. Changes in society in the workplace and time-saving devices have made it less necessary for people to physically work or walk. These facts, along with excessive diets and other risk factors, place many Americans at a significantly higher risk for the development of cardiovascular disease and premature death.
Which drug class should not be used when a patient is taking nitrates? A. Beta-adrenergic blockers B. Calcium channel blockers C. Alpha-adrenergic blockers D. Erectile dysfunction drugs
D. Erectile dysfunction drugs
Which route of administration has the fastest rate of distribution? A. Subcutaneous B. Intramuscular C. Transcutaneous D. Intravenous
Answer: D Rationale: The IV route places the drug directly into the bloodstream and isn't slowed down by the need to first travel from the GI tract into the bloodstream.
What is a common adverse effect of aluminum-based antacids, especially when consumed in large quantities? A. Diarrhea B. Constipation C. Dyspepsia D. Flatulence
Answer: B Rationale: Aluminum-based antacids have a common adverse effect of constipation. Patients need instruction on measures to reduce constipation. Magnesium antacids commonly cause diarrhea.
Human lungs contain millions of alveolar sacs surrounded by capillaries. If these were spread out on a flat surface, what would the size of that surface compare to? A. Bowling lane B. Softball field C. Tennis court D. Football field
Answer: C Rationale: Human lungs contain 300 to 500 million alveolar sacs for gas exchange and have a surface area approximately equal to that of a tennis court.
What is a common but serious adverse effect of nonsteroidal antiinflammatory drugs (NSAIDs)? A. Increased upper GI bleeding B. Excessive drowsiness C. Antipyretic action D. Diarrhea
Answer: A Rationale: About 7% to 8% of patients experience GI bleeding after using NSAIDs, and it is a primary cause of hospitalizations caused by adverse effects of medicines. NSAIDs have also been associated with allergic reactions, including severe skin reactions and anaphylaxis, some of which occurred in patients without known prior exposure.
A patient with a history of seizures had experienced a tonic-clonic seizure in the last half hour and is now very drowsy, but arousable. The family asks if this is a concern. What is the nurse's best response? A. "This is a normal occurrence after a seizure. It's called the 'postictal state.'" B. "This is the atonic stage of a seizure." C. "This is not a normal part of a seizure. I'll notify the physician." D. "The medication she was given to stop her seizure shouldn't make her this drowsy."
Answer: A Rationale: After a tonic-clonic seizure, the person is exhausted and occasionally flaccid and may sleep for several hours. This is a predictable part of a seizure related to the time after the rapid firing of electrical activity in the brain. The victim usually has no recall of the event. The nurse must monitor the patient carefully for further seizure activity and position the patient to prevent possible aspiration.
All drugs are processed in the body through pharmacokinetics. What is the correct order that drugs pass through the body? A. Absorption, distribution, metabolism, excretion B. Distribution, metabolism, absorption, excretion C. Biotransformation, distribution, absorption, excretion D. Excretion, distribution, absorption, metabolism
Answer: A Rationale: All drugs go through four stages after administration, which can be remembered with the acronym ADME.
Which antifungal agent is typically employed in the treatment of systemic life-threatening fungal infections? A. Amphotericin B (Fungizone IV) B. Butenafine (Lotrimin) C. Ketoconazole (Nizoral) D. Fluconazole (Diflucan)
Answer: A Rationale: Amphotericin B is a fungistatic agent that is used in the treatment of systemic life-threatening fungal infections. It is a very effective drug, but it should not be used to treat topical fungal infections in the immunocompetent patient.
The nurse is preparing a patient's daily dose of digoxin (Lanoxin), an inotropic drug. The patient has an apical pulse of 68/min. What should the nurse do next? A. Administer the dose. B. Withhold the dose and notify the health care provider. C. Notify the health care provider and monitor the patient's vital signs. D. Recheck the pulse, making sure to count for 1 full minute.
Answer: A Rationale: Digoxin is a common drug used to treat patients with heart failure. Its action is to slow down and strengthen the heartbeat. When administering digoxin, the apical pulse must be assessed for a full minute, and if the heart rate is less than 60, the medication should be held and the physician notified.
A patient has been placed on a loop diuretic to reduce the fluid that has been accumulating in the lungs. Which statement made by the patient indicates a need for further teaching about the medication by the nurse? A. "I'll be sure to take my medication with supper." B. "I'll have a banana with my breakfast every morning." C. "I'll weigh myself each day before breakfast." D. "If my shortness of breath returns, I'll contact my physician."
Answer: A Rationale: Diuretic medications should be administered early in the day so the increased diuretic action doesn't interfere with the patient's ability to sleep. The addition of a banana per day will help offset the increased potassium loss from the loop diuretic. Increased weight over 2 to 3 days is cause for concern for fluid retention. Shortness of breath is serious, and the health care provider should be notified.
Which oral disorder is contagious? A. Fever blisters B. Xerostomia C. Mucositis D. Canker sores
Answer: A Rationale: Fever blisters or cold sores are caused by the herpes simplex type 1 virus and form at the edge of the lips or nostrils. They are contagious and spread by direct contact.
When administering sublingual nitroglycerin for emergency treatment of angina or chest pain, the nurse monitors for which common adverse effect? A. Hypertension B. Bradycardia C. Nausea D. Headache
Answer: D Rationale: Nitroglycerin is a universal vasodilator. While it is dilating the coronary arteries to provide a better oxygenated blood supply, it also dilates the rest of the body's vessels, including those in the brain. This may produce a headache.
Up to one-third of patients who take ACE inhibitors for hypertension report which symptom after beginning therapy? A. Chronic cough B. Renal failure C. Decreased white blood cells D. Swelling of the face and lips
Answer: A Rationale: Many patients taking ACE inhibitors may develop a chronic, dry, nonproductive, persistent cough thought to be due to an accumulation of bradykinin. It may appear from 1 week to 6 months after initiation of ACE inhibitor therapy. Women appear to be more susceptible than men. It may be severe enough that the patient must stop the drug and replace it with an angiotensin II receptor blocker (ARB). The cough resolves within 1 to 30 days after discontinuation of ACE inhibitor therapy
After receiving a dose of morphine for postoperative pain, a patient becomes unresponsive, with a respiratory rate of 10/minute, with shallow breathing. The nurse should anticipate administering which medication? A. Naloxone B. Nalbuphine C. Meperidine D. Pentazocine
Answer: A Rationale: Naloxone, which is an opiate antagonist. The other medications are actually opiate agonists and opiate partial agonists.
How long does the breath-freshening action of over-the-counter mouthwashes last? A. 10 to 30 minutes B. 30 to 60 minutes C. 1 to 2 hours D. 3 hours
Answer: A Rationale: Over-the-counter mouthwashes are meant to freshen breath and rinse out debris, and typically last about 10 to 30 minutes. They are not meant to be a substitute for thorough oral hygiene.
The nurse is educating a postoperative patient about the use of a patient-controlled analgesia (PCA) pump. Which statement by the patient indicates a need for further teaching? A. "I'm afraid I'll give myself too much medicine and become addicted to it." B. "I can only receive the medication every 10 minutes." C. "I'll let the nurse know if my pain doesn't improve." D. "I'll be sure to push the button to give myself pain medicine before I get up into a chair."
Answer: A Rationale: PCA delivery is a safe, effective means of pain management that gives control to the patient who is experiencing the pain and eliminates the wait for individual analgesic doses. If the patient fears addiction and is not relieving the pain, then more teaching and reinforcement need to take place
The nurse is teaching a patient about the use of a prescribed proton pump inhibitor to decrease the symptoms of GERD. Which statement made by the patient indicates a need for further teaching? A. "This medication will coat my stomach so it doesn't hurt so much." B. "This medication will lower the amount of acid in my stomach." C. "If I develop a rash, I'll let my physician know right away." D. "I'll make sure I drink plenty of fluids."
Answer: A Rationale: Proton pump inhibitors do not coat the stomach; they inhibit gastric secretion by inhibiting the gastric acid pump of the stomach's parietal cells, thereby reducing the symptoms of excess gastric acid. A rash is not common and should be reported. A diet with plenty of fluids and fiber will guard against further gastric symptoms.
Which is an important teaching point for the nurse to make to a patient taking a bulk-forming laxative? A. Drink plenty of fluids. B. Reduce fiber in the diet. C. Get plenty of sleep. D. Avoid driving while under the drug's effects.
Answer: A Rationale: Since a bulk-forming laxative absorbs fluid and expands to create more bulk for stool, it is important for the patient to drink plenty of fluids. The increase in stool causes peristalsis and bowel movements, and if the patient does not consume enough liquid, he or she will become even more constipated.
Why are the newer, nonbenzodiazepine medications for insomnia preferred over older medications? A. They interfere less with natural sleep cycles. B. They can be used safely for long-term insomnia. C. They have a longer duration of action. D. They are less expensive.
Answer: A Rationale: The drugs of choice for short-term insomnia treatment are the newer nonbenzodiazepines (zaleplon, zolpidem, eszopiclone) because of their wide margin of safety. They have less effect on stage III, IV, and REM sleep cycles. They are intended for short-term use of 7 to 10 days and are found to cause less morning drowsiness because of their rapid and shorter action
Which population is more prone to long-lasting effects of anesthetic drugs? A. Obese B. Elderly C. Infants D. Toddlers
Answer: A Rationale: The obese population is more prone to long-lasting effects of anesthetic drugs because anesthetic gases are stored in fat tissue. People with greater amounts of adipose tissue may continue to exhibit the effects of anesthesia for longer periods due to the slow release of fat-soluble anesthetics from fatty tissue.
A patient is experiencing insomnia due to anxiety about an upcoming procedure in the morning. The patient is oriented and cooperative, but restless. The nurse has reassured the patient, explained what the patient can expect the next day, and provided a relaxing backrub. Which medication would be most effective for this patient? A. Sedative B. Hypnotic C. Narcotic D. Muscle relaxant
Answer: B Rationale: A hypnotic is a drug that produces sleep, whereas a sedative quiets the patient and gives a feeling of relaxation and rest not necessarily accompanied by sleep. In this situation the patient desires to sleep. A hypnotic, an effective medication for short-term use, would help induce sleep and provide better relaxation for the next day.
How does a nursing diagnosis differ from a medical diagnosis? A. A nursing diagnosis diagnoses a disease that impairs physiologic function. B. A nursing diagnosis evaluates a patient's response to actual or potential health problems. C. A nursing diagnosis determines the rate of Medicare reimbursement. D. A nursing diagnosis does not consider potential future problems.
Answer: B Rationale: A nursing diagnosis takes the form of a three-part statement relating to a patient's response to actual or potential health problems and life processes. It is constantly changing, whereas a medical diagnosis is frequently unchanged during a patient's hospitalization.
What percentage of the North American population experiences chronic constipation? A. 10% B. 15% C. 20% D. 25%
Answer: B Rationale: According to the American College of Gastroenterology Chronic Constipation Task Force, about 15% of North Americans experience chronic constipation, which is constipation lasting longer than 3 months.
A patient reports a harsh, nonproductive cough and muscle aches that have lasted for 5 days. There is no sore throat, temperature elevation, or swollen lymph nodes, but the patient is coughing so much that sleeping at night is difficult. Which type of medication will likely be prescribed for this patient? A. Decongestant B. Antitussive C. Antibiotic D. Expectorant
Answer: B Rationale: An antitussive is a cough suppressant used to quiet a cough by acting on the cough center of the brain. It is used when the patient has a dry, hacking, nonproductive cough. Antitussives will not stop the cough completely but should decrease the frequency and suppress the severe spasms that prevent adequate rest at night.
Which common adverse effect may be seen with use of opiate agonists? A. Appetite stimulation B. Orthostatic hypotension C. Mood elevation D. Increased respirations
Answer: B Rationale: Blood pressure is likely to be affected with the use of opiate agonists. Sedation, confusion, nausea and vomiting, and constipation may also occur. Respirations can be decreased by opioids, and an antagonistic drug such as naloxone (Narcan) should be available.
To prevent future oral problems in children, when should regular oral care begin? A. At infancy, by rubbing the gums with gauze to cleanse B. When teeth first erupt C. When the child is old enough to hold a toothbrush D. When the child enters kindergarten
Answer: B Rationale: By cleansing newly erupted teeth with a gauze or very soft-bristle toothbrush, parents can begin an oral care regimen that will help to protect the child from future oral conditions.
Digoxin (Lanoxin) is a cardiac glycoside that is among the oldest medications used for heart failure. What are its two primary actions? A. Negative inotropy and negative chronotropy B. Positive inotropy and negative chronotropy C. Negative chronotropy and positive dromotropy D. Positive chronotropy and negative inotropy
Answer: B Rationale: Digoxin exhibits positive inotropic activity in that it increases the contractility of the cardiac muscle. It also exhibits a negative chronotropic activity in that it decreases the heart rate.
Which name(s) of a drug should the nurse use when teaching a patient with a new prescription? A. Trade B. Generic and trade C. Generic and chemical D. Official
Answer: B Rationale: Drug prescriptions may be filled with a trade-name drug or a generic equivalent. If the nurse teaches only one name, it may lead to confusion for the patient when he or she receives a drug with a different name.
Due to the decreased protein-binding capacity in preterm infants, what adjustment in dosage of protein-binding drugs would need to made? A. The dosage should be decreased. B. The dosage should be increased. C. The dosage should be kept at the same levels. D. Protein-binding drugs are not administered to infants.
Answer: B Rationale: Drugs that are relatively insoluble are transported in the bloodstream bound to plasma proteins (albumin and globulins). There is a decreased affinity for binding in infants, especially preterm infants. These drugs are then distributed over a wider area of the neonate's body. They will therefore require a higher dosage of these medications in order to achieve a therapeutic effect.
Which antilipemic drug acts by blocking the absorption of cholesterol from the small intestine? A. Omega-3 fatty acid (Omacor) B. Ezetimibe (Zetia) C. Gemfibrozil (Lopid) D. Rosuvastatin (Crestor)
Answer: B Rationale: Ezetimibe is the first of a new class of agents used to reduce blood lipids and the risk of atherosclerosis. It is the only class that acts directly on the digestive system by blocking the absorption of cholesterol from the small intestine. It acts to inhibit the absorption of cholesterol from bile and diet that is present in the small intestine.
A patient receiving furosemide (Lasix) for a month reports experiencing pain in the toes. The patient states it has been years since having that type of pain. What does the nurse suspect? A. Neuropathy B. Gout C. Hypokalemia D. Orthopedic injury
Answer: B Rationale: Furosemide may inhibit the excretion of uric acid, resulting in hyperuricemia. Patients who have had previous attacks of gouty arthritis are particularly susceptible to additional attacks as a result of hyperuricemia. Uric acid levels may be ordered and a medication to treat gout added to existing treatment.
A patient presents with a runny nose, sneezing, congested throat, chills, and fever. What chemical in the body is responsible for these symptoms? A. Antibodies B. Histamine C. Potassium D. Acetylcholine
Answer: B Rationale: Histamine is a chemical present in granules in body tissues. When an allergen invades the body, it triggers the release of histamine that dilates capillaries, increases blood flow to the area, and allows fluid to accumulate and leak out of cell membranes. It is actually protective in nature and tries to wash out the offending allergen.
A health care provider will not prescribe the oral hypoglycemic agent tolbutamide (Orinase) to a patient who has an allergy to which drug? A. Insulin B. Sulfa C. Penicillin D. Ibuprofen
Answer: B Rationale: If a patient is allergic to sulfa, then he or she would not be prescribed tolbutamide because it is a first-generation oral sulfonylurea drug. Taking the drug could cause a dangerous allergic reaction.
To maintain optimum nutrition, from which type of nutrient should a diabetic patient obtain the majority of his or her calories? A. Protein B. Carbohydrates C. Fats D. Vitamins
Answer: B Rationale: It is generally recommended that the diabetic patient consume 1500 to 2000 calories daily, with 45% to 65% of the calories from carbohydrates, 10% to 35% from protein, and 20% to 35% from fat.
What is the foundation for the clinical practice of nursing? A. Assessment B. Nursing process C. Planning D. Evaluation E. Implementation
Answer: B Rationale: It takes all parameters of the nursing process, which include assessment, diagnosis, planning, implementation, and evaluation, to encompass the full care of a patient.
A patient who is reporting dizziness and nausea is found to have an inner ear infection. In addition to antibiotics, which drug will likely be recommended? A. Diphenhydramine (Benadryl) B. Meclizine (Bonamine) C. Dexamethasone (Decadron) D. Chlorpromazine (Largactil)
Answer: B Rationale: Meclizine (Bonamine) is advised for this patient for its antiemetic and anticholinergic actions and for its ability to alleviate motion sickness.
A patient undergoing chemotherapy for cancer has developed significant mucositis. Which technique may bring relief to the patient? A. Frequent oral rinses with commercial mouthwash B. Use of viscous lidocaine C. Regular toothbrushing D. Sucking on hard candy
Answer: B Rationale: Mucositis is very common and usually follows chemotherapy by about 5 to 7 days. Viscous lidocaine can provide an anesthetic action in the mouth. It may be used before meals to assist with better nutritional intake owing to the decrease in pain produced by the gel. Commercial mouthwashes contain alcohol, which can further irritate oral mucosa. Regular toothbrushes should not be used when acute mucositis is present because of further irritation. Hard candy also irritates the inflamed tissue.
A nurse is attending a backyard picnic of an older neighbor when the nurse notices the neighbor is holding the chest and looking pale and diaphoretic. The neighbor is reaching for a second nitroglycerin tablet from the bottle and places it under the tongue. An ambulance has already been summoned, but the location is a rural area. What other measure does the nurse initiate? A. Have the neighbor walk to the house to lie down. B. Have the neighbor chew an aspirin tablet. C. Perform a physical assessment. D. Have the neighbor take the cardiac prescription drugs that are scheduled for that evening.
Answer: B Rationale: Nitroglycerin has the action of dilating narrowed blood vessels to provide a greater amount of oxygenated blood to the cardiac muscle. The patient may take one tablet sublingually every 5 minutes for a total of three. In the meantime, the event has activated an increase in the rate of platelet aggregation. Aspirin decreases the rate of platelet aggregation and possible clot formation, thereby further decreasing the patient's risk for a heart attack.
A nurse encounters a patient having a seizure. Which action is correct? A. Placing the patient's arms in restraints B. Placing a padded towel under the patient's head C. Placing the patient in a sitting position D. Placing a padded tongue blade between the patient's teeth
Answer: B Rationale: Placing a padded towel under the patient's head protects the patient from injury. Placing restraints, sitting the patient up, or placing a tongue blade in the mouth would actually increase the risk for injury.
The non-rapid eye movement (NREM) phase of sleep is divided into four stages. Which stage accounts for the largest amount of normal sleep time for an adult? A. I B. II C. III D. IV
Answer: B Rationale: Stage II comprises about 50% of normal sleep time. Stage I only accounts for 2% to 5% of sleep. Stage III is a transition from the lighter to deeper sleep state of stage IV. Stage IV sleep comprises 10% to 15% of sleep time in young healthy adults but diminishes as a person ages.
What are the "big three" adverse effects associated with antimicrobial therapy? A. Skin rash, nausea, diarrhea B. Nausea, vomiting, diarrhea C. Vomiting, constipation, lethargy D. Sun sensitivity, diarrhea, allergic reaction
Answer: B Rationale: The "big three" adverse effects are nausea, vomiting, and diarrhea. If they occur, the nurse must obtain a thorough history regarding new or existing health issues, as well as determine how soon after starting therapy the symptoms began.
Which range of systolic blood pressure is classified as prehypertension? A. 110 to 119 B. 120 to 139 C. 130 to 149 D. 140 to 159
Answer: B Rationale: The category of prehypertension (systolic 120 to 139, diastolic 80 to 89) was added to the classification system in the JNC 7 report in 2003 because of the very high likelihood of people with a blood pressure in this range of having a heart attack, heart failure, stroke, and/or kidney disease. People within this range are in need of increased education and lifestyle modification to gain control of their blood pressure to prevent cardiovascular disease.
A patient is experiencing a severe headache and pressure over the eyes. The patient feels congested but has no temperature elevation, and there is a history of sinus infection. Which agent does the nurse anticipate the health care provider might order? A. Expectorant B. Decongestant C. Antitussive D. Antibiotic
Answer: B Rationale: The headache and pressure could likely be due to congestion. A decongestant could reduce the swelling and resulting symptoms. The patient's normal temperature would rule out infection, and no cough is present.
To decrease the risk of cardiovascular disease in patients, which measure is recommended by health care professionals? A. Increase intake of saturated fats B. Increase HDL cholesterol levels C. Increase triglyceride levels D. Increase LDL cholesterol levels
Answer: B Rationale: The latest report from the Academy of Sciences (2002) stresses the importance of balancing diet with physical activity to improve circulation, increase HDL levels, and burn calories. Most dietary fat should be unsaturated.
A patient reports postoperative pain, and the nurse administers morphine (a narcotic analgesic) intravenously to ease the pain. Fifteen minutes later, the nurse notes that the patient is very drowsy, respirations are slow and shallow, and oxygen saturation is low. The nurse administers another drug that decreases the action of the morphine. What is this effect called? A. Displacement B. Antagonistic C. Interference D. Synergistic
Answer: B Rationale: The morphine had a greater-than-desired effect on the patient. Because the drug was given intravenously, it is impossible to remove the drug from the patient's bloodstream. Therefore, the nurse does the next best thing and administers another drug that interferes with the action of the first, otherwise known as an antagonistic effect. The result is a decrease in the action of the original drug. The second drug is sometimes referred to as the antidote to the first
A patient has presented to the emergency department reporting feeling short of breath. What other symptom alerts the nurse that the patient may be in heart failure? A. Lungs clear to auscultation B. 2+ ankle edema C. BP 118/74 mm Hg D. Stable weight
Answer: B Rationale: The presence of significant ankle edema indicates possible heart failure when coupled with crackles in the lungs, weight gain of 2 or more pounds in 2 days, and chest pain or shortness of breath. These symptoms develop because the heart is not pumping strongly enough to pull excess fluid into the bloodstream.
Which type of topical drug is more readily absorbed by infants? A. Fat-soluble B. Water-soluble C. Emollient D. Protective
Answer: B Rationale: Topical administration with percutaneous absorption is usually quite effective in infants because the outer layer of skin is not fully developed. Because the skin is more fully hydrated at this age, water-soluble drugs are absorbed more readily.
A nurse is seeing a 20-year-old female patient for a case of severe acne, and she mentions that she is taking a prescribed tetracycline antibiotic. Which statement indicates that the patient is in need of more education? A. "I make sure I take my tetracycline between meals." B. "My boyfriend and I don't usually use protection when having sex." C. "I always wear sunscreen outdoors, and I don't stay in the direct sun too long." D. "I was a little nauseated when I started the medication, but now I feel fine."
Answer: B Rationale: Women who may become pregnant, are pregnant, or are breastfeeding must not take tetracyclines due to the risk of permanently staining the child's developing tooth enamel. An effective form of birth control must be used. Tetracyclines may interfere with the contraceptive activity of oral contraceptives, so the patient should be encouraged to use an additional barrier form of birth control. Because tetracyclines are affected by dairy products, antacids, calcium, magnesium, and iron, doses must be carefully spaced between meals. Mild nausea is fairly common, but short-lived. Photosensitivity is common while taking this drug, so skin must be protected.
How many hours of sleep per night is thought to be optimal for good health? A. 5 to 6 B. 6 to 7 C. 7 to 8 D. 8 to 9
Answer: C Rationale: A normal sleep duration of 7 to 8 hours per night is thought to be optimal for good health. Studies show that a reduced amount of sleep is associated with overweight and obesity, metabolic syndrome, and cardiovascular disease. Individuals who sleep less than 5 hours a night have a threefold increased risk of heart attacks.
A clinical judgment that a person is more susceptible to a particular problem than others in the same situation is defined as which type of nursing diagnosis? A. Actual B. Wellness C. Risk/high risk D. Syndrome
Answer: C Rationale: A risk/high-risk nursing diagnosis is supported by risk factors that increase a patient's vulnerability beyond that of the same population. The patient can be at risk or at high risk for a particular problem.
The health care provider has ordered the use of an inhaler for an 8-year-old patient newly diagnosed with asthma. To use the inhaler correctly, what does the nurse instruct the patient to do? A. Exhale slowly while pressing the release button of the inhaler B. Use the inhaler whenever the patient feels the airway tighten C. Use a spacer between the inhaler and lips to control the medication D. When taking two puffs of medication, take the second immediately after the first
Answer: C Rationale: A spacer is helpful with older or younger patients with questionable coordination to help contain the medication and allow it to be inhaled into the lungs. It is important to first exhale, then inhale slowly as the inhaler button is pushed. When taking multiple puffs, the patient should wait at least 10 seconds before the next puff. The patient must be taught the correct frequency of drug use and not to overuse the drug.
A patient reports severe abdominal pain that occurs approximately 45 to 60 minutes after eating. The patient notes that eating dairy products or drinking milk alleviates the pain but eating Mexican food or drinking alcohol worsens the condition. The health care provider orders x-rays to be done in several days, but in the meantime, which type of drug will likely be recommended? A. Antiflatulent B. Anticholinergic C. Antacid D. Laxative
Answer: C Rationale: An antacid is advised for this patient, whose symptoms indicate probable peptic ulcer disease or GERD. While waiting for the x-rays that will be used to confirm the diagnosis, an antacid will raise the pH of gastric contents and reduce the irritation of inflamed tissue.
Which patient has the greatest percentage of body water? A. Older adult B. Middle-aged person C. Infant D. Toddler
Answer: C Rationale: An infant has a total body water percentage of 74%, whereas a premature infant has an even higher percentage at 83%. As we age, our total percentage of body water decreases and our percentage of total body fat increases.
Although the mechanism of seizure activity is not well-understood, what is the major action of anticonvulsants? A. Lowering the seizure threshold B. Increasing the effect of gamma-aminobutyric acid (GABA) C. Raising the seizure threshold D. Increasing the excitability of brain cell firing
Answer: C Rationale: Anticonvulsant medications have a direct effect on the seizure threshold and raise it to decrease the number of seizures. They have less effect on the actual erratic brain impulses that cause the seizures.
What is the action of antihistamines? A. Block production of histamine B. Create drowsiness to mask symptoms C. Occupy the receptor sites for histamine D. Prevent nasal congestion
Answer: C Rationale: Antihistamines do not affect the production of histamine. They work to occupy the receptor sites for histamine and block them, preventing histamine from creating symptoms. Adequate amounts of fluid must be maintained. They do not prevent nasal congestion, so a decongestant may still be necessary. The drowsiness that is produced is a common adverse effect.
A patient is being started on a new drug that has been used safely by many people for years. The patient has no known allergies, and the nurse administers the drug correctly. Suddenly the patient experiences a cardiac arrest. What is this type of reaction called? A. Allergic B. Mutagenic C. Idiosyncratic D. Therapeutic
Answer: C Rationale: Because the drug was a known safe drug and the patient had no known reason not to receive it, the response to the drug in this case was totally unexpected, or idiosyncratic. An allergic response is typically preceded by such reactions as rash, hives, tingling, or swelling.
Which administration strategy can a patient implement to reduce flushing, the most common adverse effect of niacin therapy? A. Take on an empty stomach B. Take with acetaminophen C. Take with meals D. Take at bedtime
Answer: C Rationale: Flushing is common at the beginning of niacin therapy, especially when using immediate-release forms of medication. Tolerance does develop quickly. Administering the medication with food will reduce the symptoms. Taking aspirin or ibuprofen 30 minutes before the dose has also been found to be helpful.
Hydantoins are a common anticonvulsant used to control partial and generalized tonic-clonic seizures. Which assessment finding in a patient receiving a hydantoin does the nurse report to the health care provider? A. Gingival hyperplasia B. Drowsiness and fatigue C. Elevated blood glucose D. Drug blood levels within therapeutic range
Answer: C Rationale: Hydantoins have an increased risk of common adverse effects such as drowsiness and gingival hyperplasia. The patient should be taught how to manage these symptoms. It is important for the patient on hydantoins to have blood levels of the drug drawn to determine if the current dosing is adequate. Serious adverse effects are hyperglycemia, blood dyscrasias, skin reactions, or elevated liver enzymes.
Which ethnic group tends to have the highest incidence of hypertension? A. Caucasian B. Asian C. African American D. Hispanic
Answer: C Rationale: In every age group, the incidence of hypertension is higher for African Americans than whites of both genders. In every cultural group, there is an increased incidence of hypertension when coupled with obesity, elevated blood lipids, and inactivity.
What percent of the U.S. population suffers from gastroesophageal reflux disease (GERD), or heartburn, on a daily basis? A. 1% to 2% B. 2% to 3% C. 5% to 7% D. 8% to 10%
Answer: C Rationale: In the United States, 5% to 7% of the population suffers daily from GERD, a very common stomach disorder.
How many years on average does it take for a drug to be brought to market from the time of its conception? A. 2 to 3 B. 4 to 7 C. 8 to 15 D. 12 to 18
Answer: C Rationale: It takes 8 to 15 years and can cost up to $1 billion to get a drug to market. This amount of time and money is necessary to adequately test the drug for safety before releasing it to the general population.
The nurse is teaching a patient about metoclopramide (Reglan) therapy. Which patient statement indicates to the nurse that the patient has a correct understanding of the therapy? A. "This drug will slow down the acid being produced in my stomach." B. "By coating my stomach, this medication will reduce my stomach upset." C. "This medication will make my digestive system move faster." D. "I'll be able to return to my job as a truck driver tomorrow."
Answer: C Rationale: Metoclopramide acts as a gastric stimulant and reduces nausea and gastric reflux. Common adverse effects include drowsiness, fatigue, lethargy, and dizziness
Which antiemetic is especially helpful in treating nausea and vomiting resulting from chemotherapy? A. Chlorpromazine (Thorazine) B. Trimethobenzamide (Tigan) C. Ondansetron (Zofran) D. Prochlorperazine (Compazine)
Answer: C Rationale: Ondansetron, a serotonin antagonist, is especially effective in combating the nausea associated with chemotherapy and postoperative vomiting.
When a person uses a topical decongestant frequently, then stops taking the drug and notices even more congestion occurring, what is this phenomenon called? A. Allergy B. Idiosyncrasy C. Rebound effect D. Extrapyramidal reaction
Answer: C Rationale: Overuse of topical decongestants may lead to a rebound of nasal secretions known as rhinitis medicamentosa. It's important for patients to understand medication instructions and not self-medicate beyond what was ordered.
A patient is being treated with an intranasal corticosteroid. Which severe adverse effect does the nurse teach the patient about? A. Nasal irritation B. Sneezing C. Bronchospasm D. Nasal stuffiness
Answer: C Rationale: Significant coughing or associated bronchospasm when taking intranasal corticosteroids must be reported to the health care provider, and the drug should be discontinued. The other symptoms are common and would not require discontinuing therapy.
A patient has been recently diagnosed with heart failure due to systolic dysfunction. She asks the nurse to explain the disease process to family members. The best explanation is: A. "The heart rate is failing to keep up with the body's needs." B. The patient has developed dysrhythmias that have failed to respond to medication." C. "The heart does not have adequate force to pump all needed blood." D. "The left ventricle fails to relax enough between beats to fill with blood."
Answer: C Rationale: Systolic heart failure results when the heart lacks sufficient force to pump all the blood to meet the body's oxygenation needs. Diastolic heart failure is caused by "stiffness" and the inability to relax enough between contractions to allow adequate filling. Heart rate and rhythm issues are not indicators of systolic heart failure.
Approximately what percentage of the U.S. population has diabetes? A. 4% B. 6% C. 8% D. 9%
Answer: C Rationale: The Centers for Disease Control and Prevention (CDC) estimate that the prevalence of diabetes in the general population is approximately 7.8% (23.6 million people, 5.7 million of whom are undiagnosed).
Which entity is responsible for monitoring drug safety in the United States? A. Drug Enforcement Agency (DEA) B. Department of Justice (DOJ) C. U.S. Food and Drug Administration (FDA) D. World Health Organization (WHO)
Answer: C Rationale: The FDA is responsible for overseeing drug and cosmetic manufacture and promotion to determine their safety before allowing them to be released to the public.
A person who has smoked 1½ packs of cigarettes for 30 years has a pack-year history of how many years? A. 20 B. 30 C. 45 D. 55
Answer: C Rationale: The amount of time a person has spent smoking is usually recorded in pack-years. The number of years of smoking is multiplied by the number of packs of cigarettes smoked per day.
Which is the most favorable lipid level? A. Elevated low-density lipoprotein (LDL) B. Decreased high-density lipoprotein (HDL) C. Elevated HDL D. Elevated triglycerides
Answer: C Rationale: The combination of elevated LDL and triglycerides and decreased HDL levels greatly increase one's risk of developing metabolic syndrome and many types of cardiovascular disease. Treatment of dyslipidemia is generally to lower the triglycerides and LDL and raise HDL.
For what reason is a patient who is using transdermal nitroglycerin patch instructed to remove the patch at bedtime and apply a new one in the morning? A. To avoid allergic response B. To prevent overdosage C. To prevent tolerance D. To prevent the patient from forgetting to remove the patch in the morning
Answer: C Rationale: Tolerance develops fairly quickly when nitroglycerin is applied for 24 hours daily. By removing it from the skin during the night when activity levels are low, the patient has less need for the effects of the drug.
What important information does a nurse provide to a patient prescribed rifampin (Rifadin) to treat tuberculosis? A. "Medication should be taken with food to reduce irritation to the stomach." B. "Oral contraceptives are not affected by the drug." C. "This medication will turn body secretions a reddish-orange color." D. "Any nausea and vomiting must be reported to your health care provider immediately."
Answer: C Rationale: Urine, feces, saliva, sputum, sweat, and tears may be tinged a reddish-orange color while taking rifampin. The changes are harmless and temporary, though it may permanently discolor soft contact lenses. Rifampin must be taken between meals. Oral contraceptives may be affected by rifampin so an alternate method of birth control must be used. Nausea and vomiting are common adverse reactions and should go away over time.
Therapeutic levels of drugs are important to maintain in order to avoid the complications of being over- or undermedicated. If a drug level of 0.5 to 2 ng/mL is considered therapeutic, a drug level of 0.45 ng/mL is considered to be what? A. Toxic B. Therapeutic C. Subtherapeutic D. Tolerant
Answer: C Rationale: Drugs are therapeutic when maintained within the normal range for the drug. In this example, the level is below that which is indicated for the drug, or subtherapeutic. A subtherapeutic level would require increasing the dose in order for the patient to achieve the maximum benefit of the drug.
A patient has a history of emphysema and has been coughing for a prolonged period after waking in the morning. The patient is having difficulty clearing the thickened mucus from the lungs. Which type of medication does the nurse anticipate will be ordered for this patient? A. Diuretic B. Antibiotic C. Antitussive D. Mucolytic
Answer: D Rationale: A mucolytic drug will cause the mucus in the patient's lungs to separate and liquefy, thereby reducing viscosity. This allows for easier removal of secretions by coughing, percussion, and postural drainage. An antitussive would only retain secretions and increase the risk of a respiratory infection. There is no clear indication for the use of antibiotics in this patient.
A patient has been taking a beta blocker for several months to control hypertension and has no medications left. She calls the clinic on Friday to request a refill, but the physician has left the clinic for the weekend. The nurse should: A. ask the patient to call back early Monday morning. B. tell the patient to try to have a stress-free weekend. C. tell the patient to avoid salt over the weekend. D. contact the on-call physician for a refill approval.
Answer: D Rationale: Abrupt withdrawal of a beta blocker can possibly result in an MI. The nurse should contact the physician for a refill approval.
Which source of information is best for the nurse to obtain drug information? A. Physicians' Desk Reference (PDR) B. Nursing journals C. United States Pharmacopeia (USP) and National Formulary (NF) D. Electronic databases
Answer: D Rationale: All can be sources of drug information, but keeping information current is extremely important. Reliable electronic databases can provide the most up-to-date information to health care providers, unlike printed resources that are published only periodically.
Which medication is in the new class of antibiotics known as cyclic lipopeptide antibiotics? A. Metronidazole (Flagyl) B. Clindamycin (Cleocin) C. Chloramphenicol (Chloromycetin) D. Daptomycin (Cubicin)
Answer: D Rationale: Daptomycin is in the new class of antibiotics known as the cyclic lipopeptide antibiotics.
Which adverse effect of benzodiazepines is considered serious? A. Drowsiness B. Dizziness C. Blurred vision D. Elevated liver enzymes
Answer: D Rationale: Drowsiness, dizziness, and blurred vision are common adverse effects noted from benzodiazepines. The appearance of any liver dysfunction, blood dyscrasias, or marked behavioral disturbances is serious and should be reported to the health care provider immediately.
A patient is diagnosed with hypertension. What is the initial recommendation for this patient likely to be? A. Beta-adrenergic blocking agent B. Diuretic C. Angiotensin-converting enzyme (ACE) inhibitor D. Diet and exercise
Answer: D Rationale: Education should begin first to attempt to reduce modifiable risk factors. The patient should be reevaluated in about 2 months to see if blood pressure has been lowered. If it has not, drug therapy may be necessary.
A patient with a history of heart failure is prescribed furosemide (Lasix). Several days after the aggressive diuretic therapy started, the patient began to exhibit confusion, tremors, muscle cramps, and nausea. What does the nurse suspect? A. Heart failure B. Hyperkalemia C. Renal failure D. Hypokalemia
Answer: D Rationale: Furosemide is a potent loop diuretic and has a very effective action in excreting significant amounts of fluid along with sodium, chloride, potassium, and other electrolytes. The most common severe adverse effect is hypokalemia that may lead to dangerous cardiac dysrhythmias.
The nurse notes these assessment findings in a patient during a routine examination: obese with an enlarged, fatty abdomen; hypertension; hyperglycemia; and hyperlipidemia. What does the nurse suspect the patient has developed? A. Liver failure B. Electrolyte imbalance C. Kidney failure D. Metabolic syndrome
Answer: D Rationale: Having a body mass index (BMI) greater than 25 indicates obesity. Central obesity is having the majority of weight in the abdomen. Elevated blood pressure and blood sugar are also classic signs of metabolic syndrome. People with central obesity and two of four other criteria are said to have metabolic syndrome.
What is the action of insulin? A. Enhancing the conversion of glycogen to glucose B. Promoting the conversion of protein to amino acid chains C. Releasing fatty acids from adipose tissue D. Transporting glucose through the cell membrane
Answer: D Rationale: Insulin is necessary to transport glucose through the cell membrane. Cells require glucose for energy, and insulin is necessary in order to facilitate the inflow of glucose.
The nurse administers an antidiarrheal medication to a patient who is experiencing significant diarrhea. Which other measure may be taken to improve the patient's condition? A. Increase fiber in the patient's diet B. Encourage the use of a laxative C. Increase the patient's level of activity D. Increase the patient's fluid intake
Answer: D Rationale: It is important to increase the patient's intake of fluids because diarrhea intensifies the loss of fluids and important electrolytes. Laxatives, increased fiber consumption, and increased activity level will each intensify the diarrhea.
What is the action of saline laxatives? A. Stimulating peristalsis through contact with the intestinal mucosa B. Softening the fecal mass, allowing for easier passage of contents C. Absorbing water into the stool mass and then expanding, promoting peristalsis D. Promoting peristalsis by drawing water from blood plasma to increase the volume of the intestinal contents
Answer: D Rationale: Saline laxatives attract water and electrolytes from blood plasma and other tissues into the intestine using hypertonic solutions that draw water into the bowel and distend it, which promotes peristalsis and leads to a bowel movement.
A low-dose sedative-hypnotic agent may be prescribed for a patient with which condition? A. Dizziness B. Combative behavior C. Hallucinations D. Inability to sleep
Answer: D Rationale: Short-term sedative-hypnotic medications may be useful for insomnia (inability to sleep), but general nursing measures should always be used first. Patients experiencing more serious symptoms such as combativeness or hallucinations would require more aggressive medication therapy. Dizziness is treated with antinausea or antihistamine drugs.
What percentage of our daily total caloric intake should be limited to carbohydrates? A. 25% B. 35% C. 50% D. 60%
Answer: D Rationale: The National Cholesterol Education Program (NCEP) recommends that carbohydrates should be limited to 60% of our total dietary intake. Limiting carbohydrate amounts and consuming more complex carbohydrates can help reduce obesity and cardiovascular risk factors, especially if combined with a regular exercise program.
Which drug class should not be used when a patient is taking nitrates? A. Beta-adrenergic blockers B. Calcium channel blockers C. Alpha-adrenergic blockers D. Erectile dysfunction drugs
Answer: D Rationale: The action of erectile dysfunction drugs is to dilate blood vessels. If these drugs and nitrates are used together, it could cause dangerously low blood pressure and loss of consciousness.
Which is a common finding with combination diuretic products? A. They are a part of the initial diuretic therapy. B. They increase the risk of hypokalemia. C. Little follow-up is needed after the initial treatment. D. They increase the risk of hyperkalemia and hyponatremia.
Answer: D Rationale: The goal of combination products is to promote diuresis and antihypertensive effect while maintaining normal serum potassium levels. Patients receiving a combination product are at risk for adverse effects resulting from any of the component drugs. Many cases of hyperkalemia and hyponatremia have been reported after the use of combination products.
When the nurse administers a 50-mg dose of a drug with a half-life of 6 hours, how many milligrams will remain in the body at 24 hours? A. 25 mg B. 12.5 mg C. 6.25 mg D. 3.13 mg E. 1.56 mg
Answer: D Rationale: The half-life of a drug is the time required for 50% of the drug to be eliminated from the body. In this example at 24 hours, 6.25% or 3.13 mg of the drug would remain in the body.
A patient who is suffering from postoperative nausea vomited 20 minutes after arriving in the recovery room and now is retching. Additionally, the patient is dizzy and lightheaded and has a very slow pulse. What is the patient experiencing? A. Anticipatory nausea and vomiting B. Autonomic nervous system response C. Motion sickness D. Vasovagal response
Answer: D Rationale: The symptoms are describing a vasovagal response. When a person vomits, retches, or bears down to have a bowel movement, it stimulates the vagus nerve. The heart rate slows down temporarily and the person experiences dizziness and possible loss of consciousness.
Where is the vomiting center of the body located? A. Stomach B. Inner ear C. Brain D. Medulla
Answer: D Rationale: The vomiting center of the brain is located in the medulla. It coordinates the vomiting reflex among the organs and tissues involved: the stomach, muscles, nerves, sphincters, pharynx, throat, and saliva.
A patient is undergoing milrinone (Primacor) therapy. Which severe adverse reaction does the nurse promptly report to the health care provider? A. Nausea B. Vomiting C. Abdominal discomfort D. Thrombocytopenia
Answer: D Rationale: Thrombocytopenia is a decrease in the amount of platelets that are integral to appropriate blood clotting. A decrease in platelets results in an increased risk of abnormal bleeding, so the nurse should notify the physician immediately if a low platelet count is assessed. The other symptoms are common adverse effects that are usually brief and subside spontaneously. A dosage decrease may also decrease symptoms.
Which is an independent nursing action? A. Orders medications based on the patient's medical diagnosis B. Orders laboratory tests depending on the medications ordered C. Chooses an alternate route for medications if indicated D. Verifies the correct route of medication administration
Answer: D Rationale: Verification of the correct route of administration is an independent nursing action that is required as part of the "six rights" of administration. Ordering drugs or labs and changing a route of administration are not within the scope of practice for a nurse.
Which form of medication is more easily administered for the toddler who requires a course of antibiotics? A. Enteric B. Capsules C. Tablets D. Liquid
Answer: D Rationale: Very small children are not able to swallow solids such as tablets or capsules. They should receive medications carefully measured in a calibrated dropper or oral syringe.
Certain factors place us at risk for development of cardiovascular disease. Which one is a nonmodifiable risk factor? A. Weight B. Smoking C. Cholesterol level D. Blood pressure E. Family history
Answer: E Rationale: Each of the above factors is significant in the development of cardiovascular disease. By keeping them in normal range, we significantly decrease our personal risk for the development of cardiovascular disease. However, the things we cannot change are our age, gender, family history, and personal history.
