Pharm 308 Final

The nurse is preparing to administer tolterodine tartrate (Detrol LA) to a patient who has incontinence. Which symptom would be a contraindication for this drug? a. Decreased bowel sounds b. Drooling c. Gastric upset d. Pain

ANS: A A decrease in bowel sounds could signal the beginning of paralytic ileus. Detrol is contraindicated in patients with paralytic ileus.

A patient who is newly diagnosed with HIV infection after a recent exposure calls to report fever, sore throat, myalgia, and night sweats. The nurse will notify the provider that this patient is most likely experiencing a. acute retroviral syndrome. b. AIDS. c. an increased viral load. d. an opportunistic infection.

ANS: A Acute retroviral syndrome often occurs 2 to 12 weeks after exposure and is caused by rapid viral replication that triggers an immune response, resulting in CD4 cell replacement and HIV antibody production that causes the viral load to drop. This patient is experiencing symptoms of this syndrome. AIDS is a diagnosis that indicates advanced disease. Opportunistic infection symptoms are related to the type of infection.

A patient who is intubated develops bradycardia because of vagal stimulation. Which medication will the nurse anticipate administering to treat this symptom? a. Atropine sulfate (Atropine) b. Benztropine (Cogentin) c. Bethanechol chloride (Urecholine) d. Metoclopramide (Reglan)

ANS: A Atropine is used to treat bradycardia caused by vagal stimulation.

A patient with chronic obstructive pulmonary disease (COPD) who has a persistent nonproductive cough asks about a medication that will not cause sedation. The nurse will encourage the patient to discuss which medication with the provider? a. Benzonatate HCl (Tessalon Perles) b. Dextromethorphan hydrobromide (Benylin DM) c. Guaifenesin and codeine d. Promethazine with dextromethorphan

ANS: A Benzonatate will not cause sedation and is safe for patients with COPD. Dextromethorphan is contraindicated in patients with COPD. Codeine and promethazine cause sedation.

A patient is admitted to the hospital for treatment of pneumonia after complaining of high fever and shortness of breath. The patient was not able to produce sputum for a culture. The nurse will expect the patient's provider to order a. a broad-spectrum antibiotic. b. a narrow-spectrum antibiotic. c. multiple antibiotics. d. the pneumococcal vaccine.

ANS: A Broad-spectrum antibiotics are frequently used to treat infections when the offending organism has not been identified by culture and sensitivity (C&S). Narrow-spectrum antibiotics are usually effective against one type of organism and are used when the C&S indicates sensitivity to that antibiotic. The use of multiple antibiotics, unless indicated by C&S, can increase resistance. The pneumococcal vaccine is used to prevent, not treat, an infection.

An intubated child is brought to the emergency department while having a seizure that has been progressing for 20 minutes. Which drug will the nurse anticipate administering to this patient? a. Diazepam (Valium) b. Phenobarbital (Luminal) c. Phenytoin (Dilantin) d. Valproic acid (Depakote)

ANS: A Diazepam is given to patients in status epilepticus and is administered IV. The other anticonvulsant medications do not have a rapid onset and are not used for emergencies.

The nurse is preparing to administer phenytoin (Dilantin) to a patient who has a seizure disorder. The patient appears drowsy, and the nurse notes that the last random serum drug level was 18 mcg/mL. What action will the nurse take? a. Administer the dose since the patient is not toxic. b. Contact the provider to discuss decreasing the phenytoin dose. c. Give the drug and monitor closely for adverse effects. d. Report drug toxicity to the providers.

ANS: A Drowsiness is a common side effect of phenytoin and is not cause for alarm. The patient's drug level is normal, since 10-20 mcg/mL is the therapeutic range. The nurse should administer the dose. It is not necessary to decrease the dose or monitor the patient more closely than usual.

The nurse is caring for a patient who has asthma and administers a selective beta2-adrenergic agonist to treat bronchospasm. The nurse will expect this drug to also cause which side effect? a. Increased blood glucose b. Increased blood pressure c. Increased heart rate d. Increased gastrointestinal (GI) motility

ANS: A Drugs that act on beta2 receptors activate glyconeogenesis in the liver causing increased blood glucose. Selective beta2 drugs act on beta2 receptors only and not on beta1 receptors, so they do not cause increased blood pressure or increased heart rate. Adrenergic agonists cause decreased GI motility.

A patient who has been taking theophylline at home reports having palpitations and jitteriness. What action will the nurse take? a. Ask the patient if herbal medications are used. b. Notify the provider to report theophylline toxicity. c. Recommend that the patient increase fluid intake. d. Request an order for renal function studies.

ANS: A Ephedra is a stimulant that potentiates theophylline and may increase side effects. Patients should be questioned about use of herbal medications. To determine toxicity, serum drug levels must be drawn; at this point, the patient reports symptoms of theophylline side effects. Increasing fluid intake will not alleviate symptoms. Renal function studies are not indicated.

A patient who is about to begin chemotherapy asks the nurse when the risk of infection is highest. The nurse will tell the patient that infection risk is greatest at which point? a. A week to 10 days after each chemotherapy dose b. During the week immediately after chemotherapy c. Immediately prior to each dose of chemotherapy d. When the patient's temperature is elevated by 1° F

ANS: A Following chemotherapy administration, the time at which the blood count, including white blood cells, is lowest is typically 7 to 10 days after treatment.

A patient will begin taking albuterol (Proventil) to treat asthma. When teaching the patient about this drug, the nurse will make which recommendation? a. Report rapid or irregular heart rate. b. Drink 8 to 16 extra ounces of fluid each day. c. Monitor serum glucose daily. d. Take a calcium supplement.

ANS: A High dosages of albuterol may affect beta1 receptors, causing an increase in heart rate that could be dangerous. It is not necessary to consume extra fluids or take a calcium supplement while using this drug. Serum glucose may be elevated slightly, but this is not a concern in non-diabetic patients.

An adult patient is brought to the emergency department for treatment of an asthma exacerbation. The patient uses inhaled albuterol as needed to control wheezing. The nurse notes expiratory wheezing, tremors, restlessness, and a heart rate of 120 beats per minute. The nurse suspects that the patient has a. over-used the albuterol. b. not been using albuterol. c. taken a beta-adrenergic blocker. d. taken a monoamine oxidase (MAO) inhibitor.

ANS: A High doses of albuterol may affect beta1 receptors, causing an increase in heart rate. Patients having an asthma exacerbation may over-use their albuterol inhalers when seeking relief. Patients may have wheezing and increased heart rate during an untreated asthma exacerbation, but they will not have tremors and restlessness.

The nurse is caring for a patient who has a seizure disorder. The nurse notes that the patient has reddened gums that bleed when oral care is given. The nurse recognizes this finding as a. an adverse effect of the phenytoin. b. a drug interaction with aspirin. c. a symptom of hepatotoxicity. d. a sign of poor self-care.

ANS: A Hydantoins commonly cause gingival hyperplasia, which causes overgrowth of reddened gum tissue that bleeds easily. It is not a sign of a drug interaction or a symptom of hepatotoxicity. It does not indicate a lack of self-care.

The nurse is caring for a patient who is diagnosed with tuberculosis. The patient tells the nurse that the provider plans to order a prophylactic antitubercular drug for family members and asks which drug will be ordered. The nurse will expect the provider to order which drug? a. Isoniazid (INH) b. Pyrazinamide c. Rifampin (Rifadin) d. Streptomycin

ANS: A INH is the drug of choice for prophylactic treatment of patients who have had close contact with a patient who has tuberculosis.

A patient has been receiving an erythropoietin-stimulating agent (ESA) for 8 weeks. The nurse reviews the patient's chart and notes no increase in hemoglobin levels from 8 g/dL on week 3 of therapy. The nurse will request an order for a. a complete blood count and serum iron levels. b. an increased dose of the erythropoietin-stimulating agent. c. more frequent dosing of the ESA. d. packed red blood cell infusions.

ANS: A If there is no response, ESAs should be discontinued after 8 weeks of therapy. If a patient does not respond, iron deficiency or underlying hematologic disease should be considered and evaluated.

A patient has symptoms that are characteristic of multiple sclerosis (MS). Which diagnostic tests are likely to be ordered to aid in the diagnosis of this patient? a. Cerebrospinal fluid (CSF) immunoglobulin G and magnetic resonance imaging (MRI) b. CSF proteins and an angiography c. Serum albumin and a computed tomography (CT) scan d. Serum anti-acetylcholine antibodies and x-rays

ANS: A Laboratory tests that may suggest MS include CSF IgG and MRI.

The nurse is caring for a patient who is receiving an intravenous antibiotic. The patient has a serum drug trough of 1.5 mcg/mL. The normal trough for this drug is 1.7 mcg/mL to 2.2 mcg/mL. What will the nurse expect the patient to experience? a. Inadequate drug effects b. Increased risk for superinfection c. Minimal adverse effects d. Slowed onset of action

ANS: A Low peak levels may indicate that the medication is below the therapeutic level. They do not indicate altered risk for superinfection, a decrease in adverse effects, or a slowed onset of action.

A patient will begin taking the protease inhibitor combination Kaletra (lopinavir/ritonavir). What information will the nurse include when teaching the patient about dietary changes? a. Consume a low-cholesterol diet. b. Consume more acidic foods. c. Take the pill on an empty stomach. d. Take the pill with fatty foods.

ANS: A Protease inhibitors generally cause elevations of cholesterol and triglycerides, so patients should be counseled to consume a low-fat diet.

A parent of a child who has been taking valproic acid (Depakote) for several years calls the clinic to report a recent recurrence of seizures and states that the child is having 3 or 4 seizures per week. The nurse will perform which action? a. Ask the parent about to describe the child's drug regimen. b. Request an order for a serum valproic acid level. c. Suggest that the parent take the child to the emergency department. d. Tell the parent that the provider will increase the child's dose of Depakote.

ANS: A Questions pertaining to medication adherence are a no-cost, non-invasive way of troubleshooting cause of decreased drug effect. The serum drug level will be assessed next. Children may need changes in doses as they grow. The child is not in status epilepticus so does not need to go to the emergency department. The dose will not be increased until the serum drug level is known.

The nurse is caring for an infant who has respiratory syncytial virus (RSV) and who will receive ribavirin. The nurse expects to administer this drug by which route? a. Inhalation b. Intramuscular c. Intravenous d. Oral

ANS: A Ribavirin is given by inhalation to treat RSV. Oral ribavirin is used to treat hepatitis C, and intravenous ribavirin is used to treat hepatitis C and Lassa fever.

The nurse is caring for a patient whose provider has just ordered a switch from atenolol (Tenormin) to reserpine. When preparing the patient to take this medication, what will the nurse do? a. Ask about herbal supplements. b. Counsel that NSAIDs are safe to take with reserpine. c. Teach about potential side effects of mood elevation and euphoria. d. Tell the patient to expect immediate therapeutic effects.

ANS: A St. John's wort may antagonize hypotensive effects of reserpine. Reserpine should not be taken with NSAIDs. Side effects include depression, not mood elevation. Therapeutic effects may take 2 to 3 weeks.

A patient who has travelled to an area with prevalent malaria has chills, fever, and diaphoresis. The nurse recognizes this as which phase of malarial infection? a. Erythrocytic phase b. Incubation phase c. Prodromal phase d. Tissue phase

ANS: A The erythrocytic phase of malarial infection occurs when the parasite invades the red blood cells and is characterized by chills, fever, and sweating.

The nurse is caring for a patient who takes low-dose erythromycin as a prophylactic medication. The patient will begin taking cefaclor for treatment of an acute infection. The nurse should discuss this with the provider because taking both of these medications simultaneously can cause which effect? a. Decreased effectiveness of cefaclor. b. Increased effectiveness of cefaclor. c. Decreased effectiveness of erythromycin. d. Increased effectiveness of erythromycin.

ANS: A The interaction of cefaclor and erythromycin will produce a decrease in the action of the cefaclor.

A patient is receiving interferon alpha (Roferon-A) subcutaneously. The patient experiences chills, fatigue, and malaise, and the nurse assesses a temperature of 102° F. The nurse will notify the provider of the temperature and will anticipate which order? a. Administer acetaminophen (Tylenol). b. Change to intravenous interferon alpha. c. Give diphenhydramine (Benadryl). d. Obtain a serum BUN and creatinine level.

ANS: A The major side effects of interferon are flulike symptoms with chills, fever, fatigue, malaise, and myalgia. Acetaminophen is given to treat this initially. Changing to an IV form does not alter the side effects. Diphenhydramine is given for nausea caused by interferon alpha. It is not necessary to obtain laboratory work when these symptoms initially occur.

The nurse is caring for a postoperative patient and notes that the patient received atropine sulfate preoperatively. Which assessment finding would prompt the nurse to notify the provider? a. Absent bowel sounds b. Drowsiness c. Dry mouth d. Heart rate of 78 beats per minute

ANS: A These are all side effects of atropine. Absent bowel sounds can indicate a paralytic ileus. The other side effects are not harmful.

The nurse is caring for a male patient with myasthenia gravis who will begin taking ambenonium chloride (Mytelase). When performing a health history, the nurse will be concerned about a history of which condition in this patient? a. Benign prostatic hypertrophy b. Chronic constipation c. Erectile dysfunction d. Upper respiratory infection

ANS: A This drug is a reversible cholinesterase inhibitor and is given to increase muscle strength. Cholinesterase inhibitors are contraindicated in patients with urinary tract obstruction.

An older patient exhibits a shuffling gait, lack of facial expression, and tremors at rest. The nurse will expect the provider to order which medication for this patient? a. Carbidopa-levodopa (Sinemet) b. Donepezil (Aricept) c. Rivastigmine (Exelon) d. Tacrine (Cognex)

ANS: A This patient is exhibiting signs of Parkinson's disease and should be treated with carbidopa-levodopa. The other drugs are used to treat Alzheimer's disease.

A patient has recently begun taking carbamazepine (Tegretol) as an adjunct medication to treat refractory seizures. The patient has a serum carbamazepine level of 18 mcg/mL. What action will the nurse take? a. Ask the patient about usual dietary preferences. b. Reassure the patient that this is a therapeutic drug level. c. Report a subtherapeutic drug dose to the provider. d. Suspect a drug-drug interaction.

ANS: A This patient's carbamazepine level is high. When taken with grapefruit juice, an interaction may occur that causes toxicity. The nurse should question the patient about food and fluid preferences. The therapeutic level is 5 to 12 mcg/mL. This is a toxic level, not subtherapeutic.

The nurse is preparing to administer methocarbamol (Robaxin) to a patient who is experiencing acute muscle spasms. The nurse notes that the patient's urine has turned black. What will the nurse do? a. Administer the next dose of methocarbamol since this is a harmless side effect. b. Contact the provider to discuss changing to cyclobenzaprine (Flexeril). c. Obtain an order for a complete blood count to evaluate blood loss. d. Request an order for liver function tests since this indicates hepatotoxicity.

ANS: A Urine may turn green, brown, or black in patients taking methocarbamol, and this is a harmless side effect. There is no need to change medications or order lab tests.

The nurse caring for a patient who is taking an adrenergic agent will expect which side effects? (Select all that apply.) a. Dilated pupils b. Increased heart rate c. Increase gastrointestinal motility d. Vasodilation e. Bronchospasm f. Relaxed uterine muscles

ANS: A, B, F Adrenergic agents stimulate the sympathetic nervous system, evoking the "fight or flight" response. This response increases those functions needed to respond to stress (increased heart rate to perfuse muscles, bronchodilation to increase oxygen exchange). Adrenergic drugs shunt blood away from the reproductive tract and gastrointestinal organs as these functions are not needed during a fight or flight response.

Which actions can contribute to bacterial resistance to antibiotics? (Select all that apply.) a. Frequent use of antibiotics b. Giving large doses of antibiotics c. Skipping doses d. Taking a full course of antibiotics e. Treating viral infections with antibiotics

ANS: A, C, E Frequent use of antibiotics increases the exposure of bacteria to an antibiotic and results in acquired resistance. Skipping doses of an antibiotic can lead to incomplete treatment of an infection, and the remaining bacteria may develop acquired resistance. Treating viral infections with antibiotics is unnecessary and may cause acquired resistance to develop from unneeded exposure to a drug. Infections adequately treated with an antibiotic do not result in resistance.

The nurse is caring for a patient who is receiving fluorouracil (5-FU) to treat pancreatic cancer. Which interventions are included in the nurse's plan of care for this patient? (Select all that apply.) a. Apply ice to the IV site if the patient reports pain. b. Administer antiemetics when the patient reports nausea. c. Counsel the patient to use waxed dental floss. d. Discourage visits with people who have respiratory infections. e. Offer ice chips frequently. f. Restrict to nothing by mouth during intravenous drug administration.

ANS: A, C, E If the patient reports pain at the IV site, the nurse should apply ice and notify the provider. Patients should use waxed dental floss to avoid bleeding of the gums. Ice chips help with oral pain. Antiemetics should be given prior to administration of the drug. Visitors with active infections should be restricted. Patients do not need to be NPO during the IV infusion.

A client with myasthenia gravis is experiencing a cholinergic crisis. Which symptoms are associated with this condition? (Select all that apply.) a. Bradycardia b. Rash c. Vomiting d. Fever e. Drooling f. Weakness

ANS: A, C, E, F Bradycardia, drooling, and weakness can all occur with cholinergic crisis.

A client is being treated for tuberculosis. Which medications are used to treat this condition? (Select all that apply.) a. Streptomycin sulfate b. Amoxicillin (Amoxil) c. Ethambutol (Myambutol) d. Gentamicin (Garamycin) e. Rifabutin (Mycobutin) f. Ethionamide (Trecator-SC) g. Pyrazinamide

ANS: A, C, E, F, G Streptomycin sulfate, ethambutol (Myambutol), rifabutin (Mycobutin), ethionamide (Trecator-SC), and pyrazinamide are used to treat tuberculosis. The other medications are not used.

Which diseases are caused by herpes viruses? (Select all that apply.) a. Chicken pox b. Hepatitis c. Influenza d. Mononucleosis e. Shingles

ANS: A, D, E Herpes viruses cause chicken pox, mononucleosis, and shingles.

Which antiviral medication improves symptoms of Parkinson's disease in some patients? a. Acyclovir (Zovirax) b. Amantadine HCl (Symmetrel) c. Interferon (INF) d. Zanamivir (Relenza)

ANS: B Amantadine is an antiviral drug that acts on dopamine receptors and is sometimes used to treat Parkinson's disease (PD). The other drugs listed do not work for PD patients.

A patient with cancer is receiving pegfilgrastim (Neulasta). The patient reports bone pain, which the nurse recognizes as a. a sign of cancer metastasis. b. an indication of expansion of bone marrow. c. caused by osteomyelitis. d. worsening neutropenia.

ANS: B Bone pain is common with these drugs and is caused by expansion of the bone marrow. It does not indicate metastasis. The bone pain is not due to osteomyelitis or neutropenia.

A patient who has parkinsonism will begin taking carbidopa-levodopa. What information will the nurse include when teaching this patient about this medication? a. "Call your health care provider immediately if your urine or perspiration turn a dark color." b. "Rise slowly from your bed or your chair to avoid dizziness and falls." c. "Take the drug with foods high in protein to improve drug delivery." d. "Discontinue the drug if you experience insomnia."

ANS: B Carbidopa-levodopa can cause orthostatic hypotension, so patients should be taught to take care when getting out of bed or a chair. Darkening of the urine and perspiration is a harmless side effect. Patients should take the drug with low-protein foods to improve drug transport to the CNS. Carbidopa-levodopa should not be discontinued abruptly because rebound parkinsonism may occur; insomnia is an expected adverse effect of the drug, and the patient should report this effect to his or her health care provider.

A patient is receiving the antitumor antibiotic doxorubicin (Adriamycin) to treat lung cancer. The patient is experiencing shortness of breath and palpitations. The nurse is concerned that the patient has developed which condition? a. Anemia b. Cardiotoxicity c. Hypersensitivity d. Pulmonary infection

ANS: B Cardiotoxicity is a known adverse effect of this drug and is manifested in shortness of breath, edema, and palpitations.

The nurse is preparing to care for a patient who has multiple sclerosis (MS). The nurse learns that the patient receives cyclophosphamide (Cytoxan). The nurse knows that this patient is in which stage of MS? a. Acute attack phase b. Chronic, progressive phase c. End-stage phase d. Remission-exacerbation phase

ANS: B Cyclophosphamide is used to treat MS patients who are in the chronic, progressive phase.

The nurse is providing teaching for a patient who will use intranasal dexamethasone (Decadron) after discharge home from the hospital. What information is important to include when teaching this patient about this drug? a. "Dexamethasone may be used for year-round symptoms." b. "Dexamethasone should be discontinued after 30 days." c. "Dexamethasone should not be taken with antihistamines." d. "Dexamethasone should not cause systemic steroid side effects."

ANS: B Dexamethasone should not be used longer than 30 days because longer use increases the risk of systemic side effects. Dexamethasone should not be used year-round. It may be used in conjunction with antihistamines. Systemic side effects may occur.

The parents of a 3-year-old child tell the nurse that they are planning to give their child diphenhydramine (Benadryl) on a flight to visit the child's grandparents to help the child sleep during the flight. What will the nurse tell the parents about giving this drug? a. Administer 25 mg of diphenhydramine when using to induce sleep. b. Diphenhydramine may have the opposite effect and could cause agitation. c. Give the diphenhydramine about 5 minutes prior to takeoff. d. Loratadine should be used instead of diphenhydramine to minimize side effects.

ANS: B Diphenhydramine can cause excitation in some children. Parents should be advised to expect this possible side effect. The correct dose of diphenhydramine for children at this age is 6.25 mg; 25 mg would be an overdose. Oral diphenhydramine has an onset of 15 to 45 minutes. Loratadine is a second-generation antihistamine and does not cause drowsiness.

The nurse is caring for a patient who is receiving diphenhydramine. The nurse notes that the patient has not voided for 12 hours. What action will the nurse take? a. Encourage the patient to drink more fluids. b. Evaluate the bladder to check for distension. c. Request an order for an intravenous fluid bolus. d. Request an order for urinary catheterization.

ANS: B Diphenhydramine has anticholinergic effects, including urinary retention. The nurse should assess for bladder distension to determine if this is the case. Encouraging the patient to drink more fluids or giving intravenous fluids may be necessary if the patient has oliguria secondary to dehydration. Urinary catheterization is not indicated until urinary retention has been identified.

A parent expresses concern that a 5-year-old child may develop epilepsy because the child experienced a febrile seizure at age 18 months. What will the nurse tell this parent? a. "A child who has had a febrile seizure is considered to have epilepsy." b. "A small percentage of children who have febrile seizures develop epilepsy." c. "I recommend discussing prophylactic anticonvulsant drugs with the provider." d. "Treat fevers aggressively with aspirin and NSAIDs to prevent seizures."

ANS: B Epilepsy develops in 2.5% of children who have one or more febrile seizures. One febrile seizure does not cause a diagnosis of epilepsy. Prophylactic anticonvulsants are given to high-risk patients. Children should not receive aspirin for fever because of the risk of Reye's syndrome.

The nurse administers subcutaneous epinephrine to a patient who is experiencing an anaphylactic reaction. The nurse should expect to monitor the patient for which symptom? a. Bradycardia b. Decreased urine output c. Hypotension d. Nausea and vomiting

ANS: B Epinephrine can cause renal vasoconstriction and thereby reduce renal perfusion and decrease urinary output. Epinephrine causes tachycardia and elevates blood pressure. Nausea and vomiting are not expected to occur.

The nurse is caring for a patient who has been diagnosed with petit mal seizures. The nurse will anticipate teaching this patient about which antiepileptic medication? a. Carbamazepine (Tegretol) b. Ethosuximide (Zarontin) c. Phenobarbital (Luminal) d. Phenytoin (Dilantin)

ANS: B Ethosuximide is used to treat petit mal seizures. The other drugs are not used to treat petit mal seizures.

A 25 year-old female patient will begin taking phenytoin for epilepsy. The patient tells the nurse she is taking oral contraceptives (OCPs). Which response will the nurse give? a. "Continue taking OCPs because phenytoin is not safe during pregnancy." b. "You should use a backup method of contraception along with OCPs." c. "You should stop taking OCPs because of drug-drug interactions with phenytoin." d. "You should take low-dose aspirin while taking these medications to reduce your risk of stroke."

ANS: B Female patients who take oral contraceptives and anticonvulsants should be advised to use a backup method of contraception because of reduced effectiveness of OCPs. Patients should be cautioned to consult with a provider if considering pregnancy because of the teratogenic effects of anticonvulsants. Patients should not stop taking OCPs and do not need to take precautions against stroke.

A patient who is receiving cancer chemotherapy has been ordered to receive epoetin alfa (Procrit) 150 units/kg 3 times weekly. The nurse reviews the patient's chart and notes a hemoglobin level of 10.1 g/dL. The nurse will perform which action? a. Administer the medication as ordered. b. Hold the dose and notify the provider. c. Reduce the dose by 25%. d. Request an order for an increased dose.

ANS: B For patients receiving cancer chemotherapy, erythropoietin-stimulating agents should not be initiated at a hemoglobin level greater than or equal to 10 g/dL.

A patient who is taking acyclovir (Zovirax) to treat an oral HSV-1 infection asks the nurse why oral care is so important. The nurse will tell the patient that meticulous oral care helps to a. minimize transmission of disease. b. prevent gingival hyperplasia. c. reduce viral resistance to the drug. d. shorten the duration of drug therapy.

ANS: B Good oral care can prevent gingival hyperplasia in patients with HSV-1.

A patient who has a nonproductive cough will begin taking guaifenesin to help with secretions. When teaching this patient about the medication, the nurse will provide which instruction? a. "Avoid driving or using heavy machinery." b. "Drink extra water while taking the medication." c. "Monitor urine output closely." d. "Take with an oral antihistamine for better effects."

ANS: B Guaifenesin is an expectorant, and patients taking this medication should be advised to increase fluid intake to at least 8 glasses of water per day. (Remember to assess for contraindications to increasing fluid intake [e.g., heart failure, kidney failure with dialysis, etc.].) Guaifenesin does not cause drowsiness or urinary retention. Antihistamines will dry secretions, making them harder to expectorate.

A patient is being treated with isoniazid (INH), rifampin, and pyrazinamide in phase I of treatment for tuberculosis. The organism develops resistance to isoniazid. Which drug will the nurse anticipate the provider will order to replace the isoniazid? a. Ciprofloxacin (Cipro) b. Ethambutol (Myambutol) c. Kanamycin d. Streptomycin sulfate

ANS: B If there is bacterial resistance to isoniazid, the first phase may be changed to ethambutol, rifampin, and pyrazinamide. Ciprofloxacin, kanamycin, and streptomycin are not generally first-line antitubercular drugs.

A patient is diagnosed with histoplasmosis and will begin taking ketoconazole. What information will the nurse include when teaching this patient about this medication? a. "Take the medicine twice daily." b. "Take the medication with food." c. "You may consume small amounts of alcohol." d. "You will not need lab tests while taking this drug."

ANS: B Ketoconazole should be taken with food. It is administered once daily. Patients taking antifungals should not consume alcohol. Antifungals can cause liver and renal toxicity, so patients will need lab monitoring.

The nurse is teaching a group of nursing students about multiple sclerosis (MS). Which statement by the nurse is correct? a. "MS is characterized by degeneration of neurons and nerves in the brain and spinal cord." b. "MS is characterized by lesions or plaques on myelin sheaths of nerves." c. "MS is characterized by neuritic plaques and neurofibrillary tangles in the CNS." d. "MS is characterized by weak muscles and decreased nerve impulses caused by decreased ACh."

ANS: B MS is characterized by lesions on myelin sheaths of nerves.

A patient who has asthma is diagnosed with hypertension. The nurse understands that which drug will be safe to give this patient? a. Pindolol (Visken) b. Metoprolol (Lopressor) c. Nadolol (Corgard) d. Propranolol (Inderal)

ANS: B Metoprolol is a selective adrenergic blocker that has a greater affinity for receptors that decrease heart rate and blood pressure and is less likely to cause bronchospasm. The other adrenergic blockers are not selective and can cause bronchoconstriction.

A patient is diagnosed with epilepsy and asks the nurse what may have caused this condition. The nurse explains that epilepsy is most often a. caused by head trauma. b. idiopathic in origin. c. linked to a stroke. d. related to brain anoxia.

ANS: B Of all seizure cases, 75% are primary, or idiopathic, with no known cause. The remaining are secondary and may be related to head trauma, stroke, or anoxic events

The nurse is caring for a patient who has myasthenia gravis (MG) and is receiving pyridostigmine bromide (Mestinon). The nurse notes ptosis of both eyelids and observes that the patient has difficulty swallowing. What action will the nurse perform next? a. Contact the provider to request an order for atropine sulfate. b. Contact the provider to request an order for edrophonium chloride (Tensilon). c. Report signs of cholinergic crisis to the provider. d. Report signs of myasthenic crisis to the provider.

ANS: B Overdosing and underdoing of AChE inhibitors have similar symptoms: muscle weakness, dyspnea, and dysphagia. Edrophonium may be used to diagnose MG or to distinguish between myasthenic crisis and cholinergic crisis since it is a very short-acting AChE inhibitor. When given, if the symptoms are alleviated, the cause is myasthenic crisis; if symptoms worsen, it is cholinergic crisis. Since patients can have similar symptoms, the nurse cannot report one or the other to the provider without more information.

The spouse of a patient newly diagnosed with mild, unilateral symptoms of Parkinson's disease (PD) asks the nurse what, besides medication, can be done to manage the disease. The nurse will a. counsel the spouse that parkinsonism is a normal part of the aging process in some people. b. recommend exercise, nutritional counseling, and group support to help manage the disease. c. tell the spouse that the disease will not progress if mild symptoms are treated early. d. tell the spouse that medication therapy can be curative if drugs are begun in time.

ANS: B PD is a progressive disorder. Nonpharmacologic measures can lessen symptoms and help patients and families cope with the disorder. Although the aging process may contribute to the development of PD, it is not necessarily a normal part of aging. Treatment may slow the progression but does not arrest or cure the disease.

A female patient who takes phenytoin for epilepsy becomes pregnant. The nurse will notify the patient's provider and will anticipate that the provider will take which action? a. Add valproic acid (Depakote) for improved seizure control. b. Change the medication to phenobarbital (Luminal). c. Closely monitor this patient's serum phenytoin levels. d. Discontinue all anticonvulsant medications.

ANS: B Phenytoin has serious teratogenic effects, so women who are pregnant should not take it. Phenobarbital is typically used because possible teratogenic effects are less pronounced. Teratogenicity increases with multiple anticonvulsants.

The nurse is preparing to administer an intravenous polymyxin antibiotic. The patient reports dizziness along with numbness and tingling of the hands and feet. The nurse will perform which action? a. Administer the drug since these are harmless side effects. b. Hold the drug and notify the provider of these adverse reactions. c. Obtain an order for an oral form of this medication. d. Request an order for serum electrolytes.

ANS: B Polymyxins can cause nephrotoxicity and neurotoxicity. This patient has signs of neurotoxicity, so the nurse should notify the provider. These effects are generally reversible when the drug is discontinued. It is not correct to administer the drug when these symptoms are present. Polymyxins are not absorbed orally. Serum electrolytes are not indicated.

The nurse receives an order to administer a purine nucleoside antiviral medication. The nurse understands that this medication treats which type of virus? a. Hepatitis virus b. Herpes virus c. HIV d. Influenza virus

ANS: B Purine nucleosides, such as acyclovir, are used to treat herpes simplex viruses 1 and 2, herpes zoster virus, varicella-zoster virus, and cytomegalovirus.

A patient who is taking metronidazole (Flagyl) reports reddish-brown urine. Which action will the nurse take? a. Obtain an order for BUN and creatinine levels. b. Reassure the patient that this is a harmless effect. c. Request an order for a urinalysis. d. Test her urine for occult blood.

ANS: B Reddish-brown urine is a harmless side effect of metronidazole and is not cause for concern.

A patient has recently begun taking phenytoin (Dilantin) for a seizure disorder. The nurse notes a reddish-brown color to the patient's urine. Which action will the nurse take? a. Ask the provider to order a serum drug level. b. Reassure the patient that this is a harmless side effect. c. Report possible thrombocytopenia to the provider. d. Request an order for a urinalysis and creatinine clearance.

ANS: B Reddish-brown urine is a harmless side effect of phenytoin. The nurse should reassure the patient. It is not necessary to order a serum drug level or renal function studies. It is not a symptom of thrombocytopenia.

The nurse is performing an admission assessment on a patient who has recently begun taking reserpine. The patient reports using St. John's wort. The nurse anticipates that the patient will have a. hypotension. b. hypertension. c. bradycardia. d. tachycardia.

ANS: B St. John's wort antagonizes the hypotensive effects of reserpine, causing hypertension.

A patient will begin taking streptomycin as part of the medication regimen to treat tuberculosis. Before administering this medication, the nurse will review which laboratory values in the patient's medical record? a. Complete blood count (CBC) with differential white cell count b. Blood urea nitrogen (BUN) and creatinine c. Potassium and magnesium levels d. Serum fasting glucose

ANS: B Streptomycin can cause significant renal toxicity.

The patient has been ordered treatment with rimantadine (Flumadine). The patient has renal impairment. The nurse anticipates what change to the dose of medication? a. Increased b. Decreased c. Unchanged d. Held

ANS: B The dosage of the medication will be decreased when the patient has renal impairment.

A patient who has completed the first phase of a three-drug regimen for tuberculosis has a positive sputum acid-bacilli test. The nurse will tell the patient that a. drug resistance has probably occurred. b. it may be another month before this test is negative. c. the provider will change the pyrazinamide to ethambutol. d. there may be a need to remain in the first phase of therapy for several weeks.

ANS: B The goal is for the patient's sputum test to be negative 2 to 3 months after the therapy. The positive test does not indicate drug resistance. The provider will not change the drugs or keep the patient in the first phase longer than planned.

The nurse administers bethanechol (Urecholine) to a patient to treat urinary retention. After 30 minutes, the patient voids 800 mL of urine and reports having a loose stool but no cramping or gastrointestinal pain. The patient's blood pressure is 110/70 mm Hg. The nurse will perform which action? a. Notify the provider of bethanechol adverse effects. b. Record the urine output and the blood pressure and continue to monitor. c. Request an order for intravenous atropine sulfate. d. Suggest another dose of bethanechol to the provider.

ANS: B The patient is exhibiting desired effects and mild side effects of bethanechol, so the nurse should record information and continue to monitor the patient. There is no need to notify the provider, give an antidote, or repeat the dose.

A nurse whose last flu vaccine was 1 year prior is exposed to the influenza A virus. The occupational health nurse will administer which medication? a. Acyclovir (Zovirax) b. Amantadine HCl (Symmetrel) c. Influenza vaccine d. Oseltamivir phosphate (Tamiflu)

ANS: B The primary use for amantadine is prophylaxis against influenza A. Acyclovir is used to treat herpes virus. Oseltamivir phosphate (Tamiflu) is to be taken once flu symptoms appear.

The nurse is caring for a patient who will begin taking atenolol (Tenormin). What information will the nurse include when teaching the patient about taking this medication? a. The drug must be taken twice daily. b. The patient must rise slowly from a chair or bed. c. The medication is safe to take during pregnancy. d. Use NSAIDs as needed for mild to moderate pain.

ANS: B The side effects commonly associated with beta blockers include bradycardia, hypotension, and dizziness. Patients should be instructed to use caution when rising from a sitting or lying position to avoid orthostatic hypotension. Atenolol may be taken once daily. Atenolol is contraindicated in the pregnant patient. NSAIDs decrease the effects of beta blockers and should be avoided.

A patient with HIV infection has been receiving antiretroviral therapy for 2 months. At the initiation of treatment, the patient had a viral load (VL) of 60 copies/mL and a CD4 count of 450 cells/mm3. Today's lab results reveal a VL of 20 copies/mL and a CD4 cell count of 800 cells/mm3. How will the nurse interpret the patient's results? a. A drug-resistant strain is likely. b. The patient is progressing as expected. c. The patient's treatment goals have been met. d. Treatment failure has occurred.

ANS: B The treatment goal would be a VL of < 20 copies/mL and a CD4 cell count between 800 and 1200 cells/mm3. This goal should be achieved in 16 to 24 weeks. Since this patient has shown improvement, progress has been made, and treatment should continue. A drug-resistant strain is not likely to respond to therapy. Treatment failure is not evident.

The nurse is caring for a patient who is receiving intravenous theophylline. The patient complains of headache and nausea. The nurse will contact the provider to a. change the medication to an oral theophylline. b. obtain an order for a serum theophylline level. c. request an order for an analgesic medication. d. suggest an alternative methylxanthine medication.

ANS: B Theophylline has a narrow therapeutic index and a risk for severe symptoms with toxic levels. When patients report symptoms of theophylline adverse effects, a serum drug level should be obtained. Giving an oral theophylline would only compound the problem if the patient has a toxic drug level. Analgesics may be used, but only after toxicity is ruled out. Adding a different methylxanthine will compound the symptoms and will likely result in drug interaction or unwanted synergism.

A patient who has cancer is about to begin chemotherapy. The patient asks the nurse why two chemotherapeutic agents are being used instead of just one. Which response by the nurse is correct? a. "The drugs may be given in less toxic doses if two drugs are used." b. "Two agents used together can have synergistic effects." c. "Use of two drugs will increase tumorcidal activity in the G0 phase of the cell." d. "Using two agents will shorten the length of time chemotherapy is needed."

ANS: B Using two or more chemotherapeutic agents can have a synergistic effect. Combination therapy typically uses two drugs with different dose-limiting toxicities, but the use of more than one drug does not allow for using less toxic doses. Combination therapy allows cell kill in all phases of the cell cycle. Combination therapy does not shorten the length of time chemotherapy is needed.

Cholinergic drugs have specific effects on the body. What are the actions of cholinergic medications? (Select all that apply.) a. Dilate pupils b. Decrease heart rate c. Stimulate gastric muscle d. Dilate blood vessels e. Dilate bronchioles f. Increase salivation g. Constrict pupils

ANS: B, C, D, F, G Decreasing heart rate, stimulating gastric muscles, dilating blood vessels, increasing salivation, and constricting pupils are actions of the cholinergic drugs.

A patient who has seasonal allergies with a runny nose during the daytime reports increasing nighttime symptoms of coughing and sneezing that are interfering with sleep. The provider recommends diphenhydramine (Benadryl) at bedtime. What information will the nurse include when teaching the patient about this medication? a. "Avoid fluids at bedtime to prevent urinary retention." b. "This will help clear your daytime symptoms, too." c. "You should be able to sleep better when you take this medication." d. "You should take this medication on an empty stomach."

ANS: C A side effect of diphenhydramine is drowsiness. Patients whose nighttime symptoms clear should be able to sleep better, especially with drowsiness side effects. Avoiding fluids does not prevent urinary retention. The half-life of diphenhydramine is short, so drug effects will not last through the next day. There is no need to take the medication on an empty stomach.

The nurse is preparing to administer a drug and learns that it is an indirect-acting cholinergic agonist. The nurse understands that this drug a. acts on muscarinic receptors. b. acts on nicotinic receptors. c. inhibits cholinesterase. d. inhibits cholinergic receptors.

ANS: C Agents that inhibit cholinesterase, which is the enzyme that destroys acetylcholine, indirectly enhance the actions of acetylcholine.

A patient will take an anthelmintic medication and asks the nurse about side effects. The nurse will tell the patient that anthelmintic drugs a. can cause hepatic toxicity. b. cause orthostatic hypotension. c. commonly have gastrointestinal (GI) side effects. d. have many serious adverse reactions.

ANS: C Anthelmintic drugs have many GI side effects, including anorexia, nausea, vomiting, diarrhea, and cramps. Adverse reactions do not occur frequently.

The nurse is teaching a young adult patient who will begin receiving interferon. Which statement by the patient indicates understanding of the teaching? a. "I may have a low-grade fever while taking this medication." b. "I may have serious cardiovascular side effects because of this drug." c. "I should take antiemetics prior to each dose of this medication. d. "I may need to avoid people who are sick while I'm taking this drug."

ANS: C Antiemetics should be given prior to treatment to prevent nausea from occurring. Fevers are common and are usually high. Cardiovascular side effects tend to occur in older patients. Neutropenia is rare with interferon and does not predispose patients to infection.

A pregnant patient is HIV-positive. Which antiretroviral agent will the nurse expect the patient's provider to order? a. Abacavir/lamivudine/zidovudine (Trizivir) b. Efavirenz/emtricitabine/tenofovir (Atripla) c. Lamivudine/zidovudine (Combivir) d. Rilpivirine/emtricitabine/tenofovir (Complera)

ANS: C Antiretroviral therapy is strongly recommended for all pregnant HIV-infected patients. The preferred dual nucleoside reverse transcriptase inhibitor is Combivir.

The nurse is caring for a patient in the post-anesthesia recovery unit. The nurse notes that the patient received atropine sulfate 2 mg 30 minutes prior to anesthesia induction. The patient has received 1,000 mL of intravenous fluids and has 700 mL of urine in the urinary catheter bag. The patient reports having a dry mouth. The nurse notes a heart rate of 82 beats per minute. What action will the nurse perform? a. Administer a fluid bolus. b. Give the patient ice chips. c. Palpate the patient's bladder. d. Reassess the patient in 15 minutes.

ANS: C Atropine can cause urinary retention. The patient's urine output is less than the fluid intake, so the nurse should palpate the bladder to assess for distension. Dry mouth is an expected side effect and does not indicate dehydration.

A patient will be discharged on beta blockers. Which skill is essential for the nurse to teach the patient's family? a. How to prepare a low-sodium diet b. Assessments to detect fluid retention c. How to monitor heart rate and blood pressure d. Early signs of changing level of consciousness

ANS: C Because of the action and side effects of beta blockers, heart rate and blood pressure should be monitored frequently.

The nurse is caring for a patient who has recently begun taking atenolol (Tenormin) to treat hypertension. The patient reports dizziness, nausea, vomiting, and decreased libido since beginning the medication. What will the nurse do? a. Hold the next dose until the provider can be notified of these side effects. b. Reassure the patient that these symptoms are common and not worrisome. c. Recommend that the patient discuss these effects with the provider. d. Suggest that the patient request a different beta-adrenergic blocker.

ANS: C Beta-adrenergic blockers can cause these side effects, which are often dose-related. Patients experiencing these side effects should be encouraged to discuss them with their providers. Beta blockers should not be discontinued abruptly, or rebound symptoms may occur. Since symptoms may be dose-related, reassuring the patient is not correct. All beta blockers have similar side effects.

A patient who has parkinsonism has been taking carbidopa-levodopa and has shown improvement in symptoms but develops dystonic movements, nausea, and vomiting. Which medication will the nurse expect the provider to order for this patient to replace carbidopa-levodopa? a. Amantadine HCl (Symmetrel) b. Benztropine (Cogentin) c. Bromocriptine mesylate (Parlodel) d. Tacrine (Cognex)

ANS: C Bromocriptine is often used for patients who do not tolerate carbidopa-levodopa. Amantadine is useful for treating Parkinson's disease but does not have sustained effects. Benztropine is given to reduce muscle rigidity and some tremors. Tacrine is used to treat Alzheimer's disease.

The nurse is teaching a patient who will begin taking oral theophylline (Theo-Dur) when discharged home from the hospital. What information will the nurse include when teaching the patient about this drug? a. An extra dose should be taken when symptoms worsen. b. Anorexia and gastrointestinal upset are unexpected side effects. c. Avoid caffeine while taking this medication. d. Food will decrease the amount of drug absorbed.

ANS: C Caffeine and theophylline are both xanthine derivatives and should not be taken together because of the increased risk of toxicity and severe adverse effects. Theophylline has a narrow therapeutic range and must be dosed carefully; patients should never increase or decrease the dose without consulting their provider. Gastrointestinal symptoms are common side effects. Food slows absorption but does not prevent the full dose from being absorbed.

A provider has prescribed ipratropium bromide/albuterol sulfate (Combivent) for a patient who has chronic obstructive pulmonary disease (COPD). The nurse explains that this combination product is prescribed primarily for which reason? a. To be more convenient for patients who require both medications b. To improve compliance in patients who may forget to take both drugs c. To increase forced expiratory volume, an indicator of symptom improvement d. To minimize the side effects that would occur if the drugs are given separately

ANS: C Combivent is more effective and has a longer duration of action than if either agent is used alone, and the two agents combined increase the FEV1. While it is more convenient and may improve compliance, this is not the primary reason for using it. The combination does not alter drug side effects.

The nurse is caring for a patient who has recurrent muscle spasms. The provider has ordered metaxalone (Skelaxin) to treat the spasms. The nurse learns that the patient has a history of drug and alcohol abuse. The nurse will contact the provider to discuss switching this patient to which medication? a. Carisoprodol (Soma) b. Chlorzoxazone (Parafon forte DSC) c. Cyclobenzaprine (Flexeril) d. Methocarbamol (Robaxin)

ANS: C Cyclobenzaprine is a muscle relaxant that does not cause drug dependence. The other muscle relaxants can cause drug dependence.

Which cholinesterase inhibitor would be prescribed for a patient who has Alzheimer's disease? a. Ambenonium chloride (Myletase) b. Benztropine (Cogentin) c. Donepezil HCl (Aricept) d. Neostigmine methylsulfate (Prostigmin)

ANS: C Donepezil is used to treat Alzheimer's disease. Ambenonium and neostigmine are used to treat myasthenia gravis. Benztropine is used to treat Parkinson's disease.

A patient who has HIV infection will begin treatment with efavirenz. The nurse expects this agent to be given in the combination product Atripla in order to a. avoid development of psychiatric comorbidities. b. prevent dizziness, sedation, and nightmares. c. reduce viral resistance. d. prevent severe rash and hepatotoxicity.

ANS: C Efavirenz is optimally given as a component of Atripla. The primary reason for using combination products is to reduce viral resistance. Efavirenz should not be given to patients who have psychiatric histories. Efavirenz may cause dizziness, sedation, nightmares, rash, and hepatotoxicity, but this is not minimized with combination therapy.

The nurse is teaching a patient who will take oral cyclophosphamide (Cytoxan). Which statement by the patient indicates understanding of the teaching? a. "I should follow a diet high in organ meats and beans while taking this drug." b. "I should brush my teeth and gums vigorously twice daily." c. "I should report any low-grade temperature elevation immediately." d. "I should take the drug at bedtime to minimize side effects."

ANS: C Even a low-grade temperature should be reported because it can indicate significant infection in immunocompromised patients. Patients should eat a low-purine diet while taking this medication. Patients should brush teeth and gums with a soft bristle toothbrush. Patients should take the medication early in the day to avoid accumulation in the bladder.

The nurse is helping to develop a plan of care for a patient who has advanced Alzheimer's disease. The patient will be taking a new medication. Which is a realistic goal for this patient? a. Demonstrate improved cognitive function. b. Exhibit improved ability to provide self-care. c. Receive appropriate assistance for care needs. d. Show improved memory for recent events.

ANS: C For the most part, drugs to treat AD do not result in improvement of symptoms but help slow the progress. The most realistic care plan for a patient with advanced AD is that they will receive appropriate and safe care.

A patient is diagnosed with tinea capitis. The provider will order which systemic antifungal medication for this patient? a. Anidulafungin (Eraxis) b. Fluconazole (Diflucan) c. Griseofulvin (Fulvicin) d. Ketoconazole (Nizoral)

ANS: C Griseofulvin is used to treat tinea capitis. Anidulafungin is used to treat esophageal candidiasis, candidemia, and other Candida infections. Fluconazole is used to treat Candida infections and cryptococcal meningitis. Ketoconazole is used to treat Candida infections, histoplasmosis, blastomycosis, and other infections.

The nurse is caring for a patient who is receiving a third dose of high-dose cyclophosphamide (Cytoxan). The nurse notes hematuria. The nurse will notify the provider and will perform which action? a. Ask whether the patient takes allopurinol (Lopurin). b. Assess the patient's skin and fingernails for darkening. c. Question the patient about fluid intake. d. Reassure the patient that this is an expected side effect.

ANS: C Hemorrhagic cystitis is a common adverse effect of high-dose cyclophosphamide and can be mitigated by increasing fluid intake. Allopurinol is given to treat gout, which is characterized by uric acid crystalluria. Darkening of the fingernails and skin is a common adverse effect of cyclophosphamide but is unrelated to hemorrhagic cystitis.

A pregnant woman who is in labor has a blood pressure of 189/110 mm Hg and exhibits muscle contractions followed by jerking of her arms and legs. The nurse will prepare to administer which medication to this patient? a. Carbamazepine (Tegretol) b. Diazepam (Valium) c. Magnesium sulfate d. Phenobarbital (Luminal)

ANS: C Magnesium sulfate is used to control seizures during eclampsia.

A child is diagnosed with pinworms. Which anthelmintic drug will the provider order for this child? a. Bithionol (Bitin) b. Diethylcarbamazine (Hetrazan) c. Mebendazole (Vermox) d. Praziquantel (Biltricide)

ANS: C Mebendazole is used to treat pinworms. The other drugs treat other types of parasites.

The patient who has nasal congestion asks the nurse to recommend a decongestant medication. The nurse performs a medication history and learns that the patient takes a beta blocker to treat hypertension. Which over-the-counter product will the nurse recommend? a. Diphenhydramine (Benadryl) b. Ephedrine HCl (Pretz-D) c. Phenylephrine nasal (NeoSynephrine Nasal) d. Loratadine (Claritin)

ANS: C NeoSynephrine Nasal is a topical decongestant and causes less systemic side effects than ephedrine, which should not be given with beta blockers. Diphenhydramine and loratadine are antihistamines, not decongestants.

Which muscle relaxant is used in surgery as a skeletal muscle relaxant? a. Baclofen (Lioresal) b. Chlorzoxazone (Parafon forte) c. Pancuronium bromide (Pavulon) d. Methocarbamol (Robaxin)

ANS: C Pancuronium bromide is used as a depolarizing muscle relaxant during anesthesia.

A nursing student asks the nurse to differentiate the pathology of Alzheimer's disease from that of Parkinson's disease. Which description is correct? a. Alzheimer's disease involves a possible excess of acetylcholine and neuritic plaques. b. Alzheimer's disease is caused by decreased amounts of dopamine and degeneration of cholinergic neurons. c. Parkinson's disease is characterized by an imbalance of dopamine and acetylcholine. d. Parkinson's disease involves increased dopamine production and decreased acetylcholine.

ANS: C Parkinson's disease (PD) is characterized by an imbalance of dopamine (DA) and acetylcholine (ACh) caused by an unexplained degeneration of the dopaminergic neurons allowing the excitatory response of acetylcholine to exceed the inhibitory response of dopamine. Alzheimer's disease (AD) may result from decreased ACh, degeneration of cholinergic neurons, and neuritic plaques. Dopamine does not appear to play a role in Alzheimer's disease.

The nurse is teaching a patient who will receive acyclovir for a herpes virus infection. What information will the nurse include when teaching this patient? a. Blood cell counts should be monitored closely. b. Dizziness and confusion are harmless side effects. c. Increase fluid intake while taking this medication. d. Side effects are rare with this medication.

ANS: C Patients taking acyclovir should increase fluid intake to maintain hydration. A complete blood count is not required. Dizziness and confusion should be reported to the provider. Antiviral medications have many side effects.

The nurse is caring for a patient who is HIV-positive and has been receiving antiretroviral therapy for several months. The nurse experiences a needlestick injury resulting in exposure to the patient's blood. The nurse asks the Occupational Health nurse if treatment is necessary. How will the Occupational Health nurse respond? a. "No treatment is necessary since the patient is receiving antiretroviral therapy." b. "We will treat you if the patient's VL is > 20 copies/mL." c. "You will require 4 weeks of antiretroviral therapy." d. "You will undergo HIV testing and will be treated if you are positive."

ANS: C Persons exposed to the blood of HIV-infected patients should receive 4 weeks of antiretroviral therapy.

A patient who has AIDS is at risk to contract aspergillosis. The nurse will anticipate that which antifungal medication will be ordered prophylactically for this patient? a. Metronidazole (Flagyl) b. Micafungin (Mycamine) c. Posaconazole (Noxafil) d. Voriconazole (Vfend)

ANS: C Posaconazole is given for prophylactic treatment of Aspergillus and Candida infections.

A patient is receiving bone marrow transplantation for cancer and receives filgrastim (Neupogen). The patient reports abdominal pain in the left upper quadrant. The nurse will perform which action? a. Administer acetaminophen 650 mg. b. Administer an antiemetic medication. c. Report a potentially life-threatening event. d. Request an order for cardiac enzyme levels.

ANS: C Splenic rupture can occur with this drug and is manifested by pain in the left upper quadrant. The nurse should report the abdominal pain to the provider so the patient can be evaluated for splenic rupture.

The nurse is teaching a family member about an elderly parent's new prescription for tacrine (Cognex) to treat Alzheimer's disease (AD). The family member asks what to expect from this drug. The nurse will respond that the patient will a. demonstrate improved ambulation. b. have reversal of all symptoms. c. have decreased deterioration of cognition. d. show improved communication ability.

ANS: C Tacrine can help to increase cognitive function for patients with mild to moderate AD. For the most part, drugs to treat AD do not result in improvement of symptoms but help slow the progress.

The nurse is teaching a nursing student about the minimal effective concentration (MEC) of antibiotics. Which statement by the nursing student indicates understanding of this concept? a. "A serum drug level greater than the MEC ensures that the drug is bacteriostatic." b. "A serum drug level greater than the MEC broadens the spectrum of the drug." c. "A serum drug level greater than the MEC helps eradicate bacterial infections." d. "A serum drug level greater than the MEC increases the therapeutic index."

ANS: C The MEC is the minimum amount of drug needed to halt the growth of a microorganism. A level greater than the MEC helps eradicate infections. Drugs at or above the MEC are usually bactericidal, not bacteriostatic. Raising the drug level does not usually broaden the spectrum or increase the therapeutic index of a drug.

The nurse is performing a medication history on a patient who reports long-term use of montelukast (Singulair) and an albuterol metered-dose inhaler (Proventil). The nurse will contact the provider to discuss an order for which laboratory tests? a. Cardiac enzymes and serum calcium b. Electrolytes and a complete blood count c. Liver function tests and serum glucose d. Urinalysis and serum magnesium

ANS: C The beta2 agonists can increase serum glucose levels and montelukast can elevate liver enzymes, so these should be monitored in patients taking these medications.

A nurse is teaching a patient how to use phenylephrine (Neo-Synephrine) nasal spray. To avoid systemic absorption, the nurse teaches the patient to perform which action? a. Apply pressure to the nose after spraying. b. Administer the spray while in the supine position. c. Insert the spray while sitting up. d. Exhale deeply while injecting the nasal spray.

ANS: C The patient should insert the spray while sitting up to avoid it being absorbed systemically.

The nurse caring for a patient who has tuberculosis and who is taking isoniazid, rifampin, and streptomycin reviews the medical record and notes the patient's sputum cultures reveal resistance to streptomycin. The nurse will anticipate that the provider will take which action? a. Add ethambutol (Myambutol). b. Change the streptomycin to clarithromycin. c. Change the streptomycin to kanamycin. d. Order renal function tests.

ANS: C The patient's current regimen is first-phase treatment. If resistance to streptomycin develops, the provider can change to kanamycin or to ciprofloxacin. Ethambutol is added if there is resistance to isoniazid. Clarithromycin is used during phase II. Renal function tests are not indicated.

The nurse is teaching a patient who is going on a cruise about the use of transdermal scopolamine . What information will the nurse include when teaching this patient? a. "Apply the patch as needed for nausea and vomiting." b. "Apply the patch to your upper arm." c. "Change the patch every 3 days." d. "Restrict fluids while using this patch."

ANS: C The transdermal scopolamine patch is designed to last for 72 hours. The patient should be taught to change it every 3 days. It works best when worn at all times and not just for symptomatic relief. The patch should be applied behind the ear. Patients should not restrict fluids.

A patient is receiving the erythropoietin-stimulating agent epoietin alfa (Procrit). Which assessment finding would cause the nurse to notify the patient's provider? a. Blood pressure of 90/65 mm Hg b. Headache and nausea c. Hemoglobin > 12 g/dL d. Infiltration of the IV

ANS: C There is an increased risk of death and serious cardiovascular events when the hemoglobin is greater than 12 g/dL. There is no need to notify the provider of the other findings.

A patient is admitted to the hospital after developing pneumonia. During the admission assessment, the patient reports having used a nasal decongestant spray for the past few weeks but thinks the nasal congestion is getting worse. The nurse will a. request an order for a systemic decongestant medication. b. request an order so the patient can continue to use the decongestant spray. c. tell the patient the congestion will clear up after stopping the spray. d. tell the patient to increase oral fluid intake.

ANS: C Use of nasal decongestants longer than 3 days can cause rebound congestion. This will clear up when the decongestant spray is discontinued for several days or weeks. A systemic decongestant is not indicated. Continuing the spray will increase the congestion. Increasing fluid intake is not recommended.

The nurse is performing a health history on a patient who is ordered to begin therapy with valproic acid (Depakote) to treat epilepsy. Which aspect of the patient's medical history will cause the nurse to be concerned? a. Chronic obstructive pulmonary disease b. Gastrointestinal disease c. Liver disease d. Renal disease

ANS: C Valproic acid can elevate liver enzymes. Patients with a history of liver disease should be monitored closely while taking this drug.

A patient who has tuberculosis asks the nurse why three drugs are used to treat this disease. The nurse will explain that multi-drug therapy is used to reduce the likelihood of a. disease relapse. b. drug hypersensitivity reactions. c. drug resistance. d. drug adverse effects.

ANS: C Without multi-drug therapy, patients easily develop resistance to antitubercular drugs. Using more than one antitubercular drug does not prevent relapse, hypersensitivity reactions, or adverse effects.

A patient will begin taking amoxicillin. The nurse should instruct the patient to avoid which foods? a. Green leafy vegetables b. Beef and other red meat c. Coffee, tea, and colas d. Acidic fruits and juices

ANS: D Acidic fruits and juices should be avoided while the client is being treated with amoxicillin because amoxicillin can be irritating to the stomach. Stomach irritation will be increased with the ingestion of citrus and acidic foods. Amoxicillin may also be less effective when taken with acidic fruit or juice.

A patient who has Raynaud's disease will begin taking an alpha-adrenergic blocker. The patient asks the nurse how the drug works to treat symptoms. The nurse explains that alpha-adrenergic blockers treat Raynaud's disease by causing a. decreased peripheral vascular resistance. b. orthostatic hypotension. c. reflex tachycardia. d. vasodilation.

ANS: D Alpha-adrenergic blockers can be used to treat peripheral vascular disease because they cause vasodilation.

A woman who has advanced breast cancer will begin receiving androgen therapy. The nurse will explain to the patient that androgen therapy is used to a. enhance her own estrogen production. b. give her a sense of well-being. c. minimize hot flashes. d. promote regression of her tumor.

ANS: D Androgen is used to treat breast cancer to promote regression of tumors. Other hormonal therapies are used in other circumstances to promote well-being.

The nurse is teaching a patient about the use of an anticholinergic medication. What information will the nurse include when teaching this patient about this medication? a. "Check your heart rate frequently to monitor for bradycardia." b. "Drink extra fluids while you are taking this medication." c. "Rise from a chair slowly to avoid dizziness when taking this drug." d. "Use gum or lozenges to decrease dry mouth caused by this drug."

ANS: D Anticholinergic medications cause dry mouth, so patients should be advised to use gum or lozenges to counter this side effect. Anticholinergics cause increased heart rate and increased blood pressure. Anticholinergics can cause urinary retention so patients should not increase fluid intake.

A patient is receiving bleomycin (Blenoxane) as part of a chemotherapeutic regimen to treat leukemia. During intravenous administration of this drug, what will the nurse observe the patient closely for? a. Hypotension and visual disturbances b. Pain and blistering at the IV site c. Pink to red urine d. Shortness of breath and wheezing

ANS: D Bleomycin can cause anaphylaxis, so patients should be monitored for respiratory distress. Pain and blistering at the IV site is common to antitumor antibiotics except for bleomycin. Urine color changes occur with doxorubicin. Vincristine causes hypotension and visual disturbances.

A patient asks the nurse about using dextromethorphan for cough. What information will the nurse include when teaching this patient about this drug? a. "It does not cause sedation except at high doses." b. "It may be used to treat cough for up to 2 weeks." c. "It is non-narcotic, and it is OK to consume alcohol while taking this drug." d. "It should not be taken by patients who have chronic obstructive pulmonary disease (COPD)."

ANS: D Dextromethorphan is contraindicated in patients with COPD. It may cause sedation at low doses. If a cough lasts longer than 1 week, patients should be instructed to contact their provider and not to continue to treat with over-the-counter antitussives. Alcohol can cause excess sedation when taken with dextromethorphan.

The nurse is teaching a patient who is receiving vincristine (Oncovin) about long-term management of the treatment regimen. Which information will the nurse provide in teaching the patient? a. "If you experience numbness of your hands, it will eventually resolve." b. "If your IV starts to hurt, you should pull the IV out immediately." c. "You should ask for antinausea medication at the first sign of nausea." d. "You should report difficulty buttoning your clothes to your provider."

ANS: D Difficulty buttoning clothing is a sign of peripheral neuropathy and should be reported. Numbness of hands may resolve after chemotherapy is stopped, but it may never resolve. If the IV infiltrates, the infusion should be stopped and the needle left in until attempts to aspirate residual vesicant are performed. Antinausea medication should be given prior to beginning the infusion.

The nurse is providing teaching to the parents of a 5-year-old child who will begin taking phenytoin (Dilantin). What information will the nurse include when teaching these parents about their child's medication? a. "Drug interactions are uncommon with phenytoin." b. "There are very few side effects associated with this drug." c. "The therapeutic range of phenytoin is between 15 and 30 mcg/mL." d. "Your child may need a higher dose than expected."

ANS: D Drug dosage for phenytoin is age-related and children, who have a rapid metabolism, may need higher doses than those used for newborns and adults. Phenytoin has many drug interactions and many side effects. The therapeutic range is 10-20 mcg/mL.

A patient will be discharged home with albuterol (Proventil) to use for asthma symptoms. What information will the nurse include when teaching this patient about this medication? a. Failure to respond to the medication indicates a need for a higher dose. b. Monitor for hypoglycemia symptoms when using this medication. c. Palpitations are common with this drug even at normal, therapeutic doses. d. Overuse of this medication can result in airway narrowing and bronchospasm.

ANS: D Excessive use of an aerosol drug can occasionally cause severe paradoxical airway resistance, so patients should be cautioned against overuse. Excessive use can also lead to tolerance and loss of drug effectiveness, but patients should not increase the dose because of the risk of bronchospasm and the increased incidence of adverse effects such as tremors and tachycardia. Hyperglycemia can occur. Palpitations are common with increased doses but not at therapeutic doses.

A patient will begin taking the antiepileptic drug ethosuximide (Zarontin) and asks the nurse whether to take the drug with or without food. The nurse will counsel the patient to take this medication a. at bedtime. b. 1 hour before meals. c. 2 hours after meals. d. with meals.

ANS: D Gastric irritation is common with ethosuximide, so patients should be counseled to take it with food. It is given twice daily.

A patient exhibits ptosis of both eyes, and the provider orders edrophonium (Tensilon). The nurse notes immediate improvement of the ptosis. The nurse understands that this patient most likely has which disorder? a. Cerebral palsy b. Multiple sclerosis c. Muscle spasms d. Myasthenia gravis

ANS: D Improvement of symptoms after administration of edrophonium is diagnostic for myasthenia gravis.

The nurse is caring for a patient who is receiving an intravenous antibiotic. The nurse notes that the provider has ordered serum drug peak and trough levels. The nurse understands that these tests are necessary for which type of drugs? a. Drugs with a broad spectrum b. Drugs with a narrow spectrum c. Drugs with a broad therapeutic index d. Drugs with a narrow therapeutic index

ANS: D Medications with a narrow therapeutic index have a limited range between the therapeutic dose and a toxic dose. It is important to monitor these medications closely by evaluating regular serum peak and trough levels.

The nurse is caring for a patient who is receiving intravenous mechlorethamine (Mustargen). The patient reports pain at the IV site, and the nurse assesses swelling and pallor at the site. What action will the nurse take? a. Administer an analgesic medication. b. Apply a warm compress to the site. c. Slow the infusion and notify the provider. d. Stop the infusion immediately.

ANS: D Methchlorethamine is a severe vesicant and can cause tissue necrosis if it infiltrates into the tissues. The nurse should stop the infusion.

An oncology home care nurse is preparing to administer a chemotherapeutic agent to a patient at the patient's home. What precautions will the nurse take while administering the IV chemotherapeutic agent? a. Clear a counter space for preparation of the solution. b. Don a surgical mask while administering the drug. c. Take surgical scrubs to wear during the infusion. d. Wear an impermeable, disposable gown when hanging the drug.

ANS: D Nurses should take precautions when handling cytotoxic drugs if inhalation, ingestion, or contact with skin and mucous membranes is possible. When hanging an IV solution, it is possible to splash solution onto the skin, so the nurse should wear a disposable, impermeable gown. If the nurse has to prepare a solution at home, a plastic-backed pad should be used as a surface. When there is a risk of aerosol exposure, a National Institute for Occupational Safety and Health-approved respirator is necessary. Surgical masks do not provide adequate respiratory protection. Surgical scrubs are permeable.

The nurse is caring for a 55-year-old patient who has been HIV-infected for 15 years. The nurse understands that this patient a. has an increased risk of transmitting the HIV infection. b. is less likely to develop AIDS than younger persons with HIV infection. c. is less likely to respond to antiretroviral agents. d. may have comorbid illnesses that can complicate HIV.

ANS: D Older HIV-infected patients may have age-related comorbid illness that can complicate management of HIV infection.

A patient who will begin antiretroviral therapy reports having trouble sticking with drug regimens in the past. Which action will the nurse take? a. Ask the patient's family members to administer the medications. b. Avoid discussing adverse effects to prevent focus on negative aspects of ART. c. Give a detailed list of medications and stress the need to adhere to the schedule. d. Offer written and verbal information about each drug's purpose.

ANS: D Patients often are more motivated to adhere to a drug regimen if they understand the purpose of the medications. Patients should be encouraged to take responsibility for their medications. Side effects need to be discussed so patients can plan ways to manage these before they occur.

A patient who takes an oral sulfonylurea medication will begin taking fluconazole (Diflucan). The nurse will expect to monitor which lab values in this patient? a. Blood urea nitrogen (BUN) and creatinine b. Electrolytes c. Fluconazole levels d. Glucose

ANS: D Patients taking sulfonylurea drugs may have altered serum glucose when taking antifungal medications.

The patient will begin taking penicillin G procaine (Wycillin).The nurse notes that the solution is milky in color. What action will the nurse take? a. Call the pharmacist and report the milky color. b. Add normal saline to dilute the medication. c. Call the physician and report the milky appearance. d. Administer the medication as ordered by the physician.

ANS: D Penicillin G procaine (Wycillin) has a milky appearance; therefore, the appearance should not concern the nurse.

A patient who is taking isoniazid (INH) as part of a two-drug tuberculosis treatment regimen reports tingling of the fingers and toes. The nurse will recommend discussing which treatment with the provider? a. Adding pyrazinamide b. Changing to ethambutol c. Increasing oral fluid intake d. Taking pyridoxine (B6)

ANS: D Peripheral neuropathy is an adverse reaction to INH, so pyridoxine is usually given to prevent this. It is not necessary to change medications. Increasing fluids will not help with this.

Which person should be treated with prophylactic antitubercular medication? a. A child who attends the same school with a child who has tuberculosis b. A nurse who is working in a hospital c. An individual who is HIV-positive with a negative TB skin test d. A patient who has close contact with someone who has tuberculosis

ANS: D Personal contact with a person having a diagnosis of tuberculosis is required to indicate prophylactic treatment with antitubercular therapy. Attending the same school does not necessarily mean close contact occurs. Health care professionals do not need prophylactic treatment. HIV-positive individuals with negative TB skin tests do not need prophylaxis.

The nurse is preparing to administer bethanechol (Urecholine) to a patient who is experiencing urinary retention. The nurse notes that the patient has a blood pressure of 90/60 mm Hg and a heart rate of 98 beats per minute. The nurse will perform which action? a. Administer the drug and monitor urine output. b. Administer the medication and monitor vital signs frequently. c. Give the medication and notify the provider of the increased heart rate. d. Hold the medication and notify the provider of the decreased blood pressure.

ANS: D Side effects of this medication are a decrease in the pulse rate and vasodilation, which can exacerbate bradycardia and hypotension. The nurse should hold the drug and notify the provider.

The patient has been ordered to receive Sudafed to treat nasal congestion. The nurse performing an admission assessment learns that the patient has diabetes mellitus. What action is appropriate for the nurse to take? a. Administer the medication as ordered. b. Contact the provider to discuss a lower dose. c. Give the medication and monitor serum glucose closely. d. Hold the medication and contact the provider.

ANS: D Sympathetic drugs should not be taken by patients with diabetes. The medication should not be given.

The nurse is teaching a patient who has Parkinson's disease about the side effects of carbidopa-levodopa. Which statement by the patient indicates a need for further teaching? a. "I may experience urinary retention, dry mouth, and constipation." b. "I may feel dizzy at first, but this side effect will go away with time." c. "I should report nightmares and mental disturbances to my provider." d. "I should take the drug with food to increase absorption."

ANS: D Taking carbidopa-levodopa with food decreases absorption of the drug, although gastrointestinal distress may decrease when the medication is taken with food. Cholinergic side effects are common. Orthostatic hypotension occurs early and will resolve over time. Nightmares and mental disturbances should be reported.

A patient arrives in the emergency department after developing a rash, runny nose, and sneezing after eating strawberries. What action will the nurse expect to take first? a. Administer diphenhydramine. b. Administer epinephrine. c. Assess for urinary retention. d. Assess heart rate, respiratory rate, and lung sounds.

ANS: D The patient probably has a food allergy, since eating strawberries is the precipitating event. The nurse should assess cardiac and respiratory status to determine whether the patient is developing an anaphylactic reaction. Diphenhydramine will be given for mild allergic symptoms of rash, runny nose, and sneezing, but epinephrine must be given for anaphylaxis. Urinary retention is a side effect of diphenhydramine and will be assessed if diphenhydramine is given.

The nurse is preparing to give a dose of a cephalosporin medication to a patient who has been receiving the antibiotic for 2 weeks. The nurse notes ulcers on the patient's tongue and buccal mucosa. Which action will the nurse take? a. Hold the drug and notify the provider. b. Obtain an order to culture the oral lesions. c. Gather emergency equipment to prepare for anaphylaxis. d. Report a possible superinfection side effect of the cephalosporin.

ANS: D The patient's symptoms may indicate a superinfection and should be reported to the physician so it can be treated; however, the drug does not need to be held. It is not necessary to culture the lesions. The symptoms do not indicate impending anaphylaxis.

The nurse is preparing to administer an antibiotic to a patient who has been receiving the antibiotic for 2 days after a culture was obtained. The nurse notes increased erythema and swelling, and the patient has a persistent high fever of 39° C. What is the nurse's next action? a. Administer the antibiotic as ordered. b. Contact the provider to request another culture. c. Discuss the need to add a second antibiotic with the provider. d. Review the sensitivity results from the patient's culture.

ANS: D The sensitivity results from the patient's culture will reveal whether the organism is sensitive or resistant to a particular antibiotic. The patient is not responding to the antibiotic being given, so the antibiotic should be held and the provider notified. Another culture is not indicated. Antibiotics should be added only when indicated by the sensitivity.

The nurse provides teaching to a patient who will begin taking cyclobenzaprine (Flexeril) to treat muscle spasms. Which statement by the patient indicates a need for further teaching? a. "I may experience dizziness and drowsiness when I take this drug." b. "I should not consume alcohol while taking this medication." c. "I should take this medication with food to decrease stomach upset." d. "I will take this medication for three weeks and then stop taking it."

ANS: D This medication should not be stopped abruptly. Patients may experience dizziness and drowsiness. Alcohol will compound the central nervous system sedative effects. To decrease gastrointestinal upset, the nurse should counsel the patient to take it with food.

The nurse is performing a health history on a patient who has multiple sclerosis. The patient reports episodes of muscle spasticity and recurrence of muscle weakness and diplopia. The nurse will expect this patient to be taking which medication? a. Adrenocorticotropic hormone (ACTH) b. Cyclophosphamide (Cytoxan) c. Cyclobenzaprine (Flexeril) d. Interferon-B (IFN-B)

ANS: D This patient is showing signs of remission and exacerbation of MS symptoms. Interferon is used to treat this phase. ACTH is used for acute attacks. Cyclophosphamide is used for chronic, progressive symptoms. Cyclobenzaprine is a centrally acting muscle relaxant that is used for muscle spasms to decrease pain and increase range of motion.

The nurse is preparing to administer the first dose of an antibiotic to a patient admitted for a urinary tract infection. Which action is most important prior to administering the antibiotic? a. Administering a small test dose to determine whether hypersensitivity exists b. Having epinephrine available in the event of a severe hypersensitivity reaction c. Monitoring baseline vital signs, including temperature and blood pressure d. Obtaining a specimen for culture and sensitivity

ANS: D To obtain the most accurate culture, the specimen should be obtained before antibiotic therapy begins. It is important to obtain cultures when possible in order to correctly identify the organism and help determine which antibiotic will be most effective. Administering test doses to determine hypersensitivity is sometimes done when there is a strong suspicion of allergy when a particular antibiotic is needed. Epinephrine is kept close at hand when there is a strong suspicion of allergy.

A child is being treated for pinworms, and the parent asks the nurse how to prevent spreading this to other family members. What will the nurse tell the parent? a. "Give your child baths every day." b. "Obtain a daily stool specimen from your child." c. "Wash your child's clothing in hot water." d. "Your child should wash hands well after using the toilet."

ANS: D To prevent the spread of pinworms, good hand washing after toileting is recommended. Patients should take showers, not baths. It is not necessary to get regular stool specimens or to wash clothing in hot water.

The patient has been started on a treatment regimen that includes atenolol (Tenormin) and complains to the nurse of feeling weak. Which is the best response from the nurse? a. "I will hold your next dose of the medication." b. "You may need an increase in your next dose of the medication." c. "This is an adverse reaction to the medication. I will stop the drug." d. "This is a side effect of the medication. I will notify your physician."

ANS: D Weakness can be a side effect of atenolol. Beta blockers should not be stopped abruptly.

The charge nurse observes a nurse administer undiluted intravenous pyridostigmine bromide (Mestinon) at a rate of 0.8 mg/min. The charge nurse will stop the infusion and perform which action? a. Administer atropine sulfate to prevent cholinergic crisis. b. Monitor the patient closely for respiratory distress. c. Suggest that the nurse dilute the medication with colloidal fluids. d. Tell the nurse to slow the rate of infusion of the pyridostigmine.

ANS: D When given, IV pyridostigmine should be administered undiluted at a rate of 0.5 mg/min and should not be added to IV fluids. It is not necessary to administer atropine, since the patient is not symptomatic of cholinergic crisis.

A patient who uses an inhaled glucocorticoid medication reports having a sore tongue. The nurse notes white spots on the patient's tongue and oral mucous membranes. After notifying the provider, the nurse will remind the patient to perform which action? a. Avoid using a spacer with the inhaled glucocorticoid medication. b. Clean the inhaler with hot, soapy water after each use. c. Consume yogurt daily while using this medication. d. Rinse the mouth thoroughly with water after each use.

ANS: D When using inhaled glucocorticoid medications, Candida albicans oropharyngeal infections may be prevented by rinsing the mouth and throat with water after each dose. Patients should also use a spacer to reduce deposits of the drug in the oral cavity. The inhaler should be washed with warm water daily, but not after each use. There is no indication that yogurt is effective.

The nurse is preparing to administer the first dose of intravenous ceftriaxone (Rocephin) to a patient. When reviewing the patient's chart, the nurse notes that the patient previously experienced a rash when taking amoxicillin. What is the nurse's next action? a. Administer the drug and observe closely for hypersensitivity reactions. b. Ask the provider whether a cephalosporin from a different generation may be used. c. Contact the provider to report drug hypersensitivity. d. Notify the provider and suggest an oral cephalosporin.

ANS: A A small percentage of patients who are allergic to penicillin could also be allergic to a cephalosporin product. Patients should be monitored closely after receiving a cephalosporin if they are allergic to penicillin. There is no difference in hypersensitivity potential between different generations or method of delivery of cephalosporins.

The nurse is caring for a patient who has multiple sclerosis. The patient is experiencing an acute attack. Which drug does the nurse anticipate the provider will order? a. Adrenocorticotropic hormone (ACTH) b. Cyclophosphamide (Cytoxan) c. Glatiramer acetate (Copaxone) d. Interferon-B (IFN-B)

ANS: A ACTH is given to treat an acute attack of MS. Glatiramer acetate and interferon are used for remission-exacerbation states. Cyclophosphamide is given for chronic, progressive symptoms.

The nurse is providing teaching for the family of a patient who has been newly diagnosed with Alzheimer's disease (AD). Which statement by the family member indicates understanding of the teaching? a. "Alzheimer's disease is a chronic, progressive condition." b. "Alzheimer's disease affects memory but not personality." c. "The onset of Alzheimer's disease is usually between 65 and 75 years." d. "With proper treatment, symptoms of this disease can be arrested."

ANS: A AD is chronic and progressive, and there is no cure. It affects memory and personality. The onset is usually between 45 and 65 years. Symptoms cannot be arrested but may be slowed with treatment.

A patient is diagnosed with influenza and will begin taking a neuraminidase inhibitor. The nurse knows that this drug is effective when taken within how many hours of onset of flu symptoms? a. 12 hours b. 24 hours c. 48 hours d. 72 hours

ANS: C Neuraminidase inhibitors, such as zanamivir and oseltamivir, should be taken within 48 hours of onset of symptoms for best effect.

A patient is brought to the emergency department and reports having taken "a lot" of acetaminophen extra-strength tablets 16 hours prior. The nurse will expect the provider to order a. acetylcysteine (Mucomyst). b. dornase alfa (Pulmozyme). c. gastric lavage. d. renal enzyme tests.

ANS: A Acetylcysteine is used as an antidote for acetaminophen overdose if given within 12 to 24 hours of ingestion. Dornase alfa is used to treat cystic fibrosis. Gastric lavage is no longer used as treatment. Liver enzyme tests are indicated since acetaminophen is hepatotoxic.

The nurse is caring for a patient who has recurrent urinary tract infections. The patient's current infection is not responding to an antibiotic that has been used successfully several times in the past. The nurse understands that this is most likely due to a. acquired bacterial resistance. b. cross-resistance. c. inherent bacterial resistance. d. transferred resistance.

ANS: A Acquired resistance occurs when an organism has been exposed to the antibacterial drug. Cross-resistance occurs when an organism that is resistant to one drug is also resistant to another. Inherent resistance occurs without previous exposure to the drug. Transferred resistance occurs when the resistant genes of one organism are passed to another organism.

The nurse receives the following order for a patient who is diagnosed with herpes zoster virus: PO acyclovir (Zovirax) 400 mg TID for 7 to 10 days. The nurse will contact the provider to clarify which part of the order? a. Dose and frequency b. Frequency and duration c. Drug and dose d. Drug and duration

ANS: A Acyclovir is used for herpes zoster, but the dose should be 800 mg 5 times daily for 7 to 10 days. The nurse should clarify the dose and frequency. For herpes simplex, 400 mg 3 times daily is correct.

The nurse is caring for a patient recently diagnosed with mild emphysema and provides teaching about the disease and medications for treatment. Which statement by the patient indicates understanding of the medication regimen? a. "I should use albuterol when my symptoms worsen." b. "I will need to take oral prednisone on a daily basis." c. "My provider will prescribe prophylactic antibiotics." d. "My symptoms are reversible with proper medications."

ANS: A Albuterol is used to treat bronchospasm during symptom flares. Oral prednisone is given for acute flares but not generally on a daily basis until symptoms are chronic and severe because of the risk of adrenal suppression. Prophylactic antibiotics are not given regularly because of the risk of antibiotic resistance. Symptoms of emphysema are not reversible.

A patient is taking doxazosin mesylate (Cardura) 1 mg per day to treat hypertension. The nurse notes a blood pressure of 110/72 mm Hg and a heart rate of 92 beats per minute. The nurse will contact the provider to discuss which change to the drug regimen? a. Changing to a beta-adrenergic blocker b. Decreasing the drug dose c. Increasing the drug dose d. Adding a diuretic

ANS: A Alpha-adrenergic blockers can cause orthostatic hypotension and reflex tachycardia. Beta blockers do not cause reflex tachycardia. Decreasing or increasing the drug dose is not recommended. Diuretics are added if blood pressure is not well-controlled.

A nursing student asks why a direct-acting cholinergic agonist drug that is selective to muscarinic receptors is described as being non-specific. The nurse will explain that this is because a. muscarinic receptors are present in many different tissues. b. the action of cholinesterase alters the bioavailability at different sites. c. these drugs can also affect nicotinic receptors. d. they vary in their reversible and irreversible effects.

ANS: A Although drugs classified as direct-acting cholinergic agonists are primarily selective for muscarinic receptors, they are non-specific because muscarinic receptors are located in different sites, causing actions in various organs. They are not affected differently by cholinesterase activity and have negligible actions on nicotinic receptors.

The nurse is teaching a nursing student about the antifungal drug amphotericin B. Which statement by the student indicates a need for further teaching? a. "Amphotericin B may be given intravenously or by mouth." b. "Patients who take this drug should have potassium and magnesium levels assessed." c. "Patients with renal disease should not take amphotericin B." d. "This drug is used for severe systemic infections."

ANS: A Amphotericin B is not absorbed from the gastrointestinal tract, so is not given by mouth. It can cause nephrotoxicity and electrolyte imbalance. It is highly toxic and is reserved for severe, systemic infections.

A patient who has irritable bowel syndrome would most likely receive which type of drug to treat this condition? a. An anticholinergic b. A cholinergic esterase inhibitor c. A muscarinic agent d. A nicotinic agent

ANS: A Anticholinergic drugs are used to treat peptic ulcers and intestinal spasticity because of their actions to decrease gastric secretions and gastrointestinal spasms.

A patient who has epilepsy will begin an anticonvulsant medication. The patient asks the nurse how long the medication will be necessary. How will the nurse respond? a. "The medication is usually taken for a lifetime." b. "The medication will be given until you are seizure-free." c. "You will need to take the medication for 3 to 5 years." d. "You will take the medication as needed for seizure activity."

ANS: A Anticonvulsants are given to prevent seizures and are usually taken throughout the patient's lifetime. Stopping the medication will lead to recurrence of seizures in most patients. Some patients may attempt to stop taking the medications after 3 to 5 years of no seizure activity. Anticonvulsants are not given as needed.

A patient who has narrow-angle glaucoma asks the nurse to recommend a medication to alleviate cold symptoms such as nasal congestion and runny nose. The nurse will suggest the patient talk to the provider about which medication? a. Azelastine (Astelin) b. Cetirizine (Zyrtec) c. Chlorpheniramine maleate (Chlor-Trimeton) d. Diphenhydramine (Benadryl)

ANS: A Antihistamines have anticholinergic effects, which are contraindicated in patients with narrow-angle glaucoma. Cetirizine and azelastin are second-generation antihistamines, with fewer anticholinergic side effects, but azelastine is a nasal spray and is less likely to have systemic side effects.

A patient is receiving high doses of a cephalosporin. Which laboratory values will this patient's nurse monitor closely? a. Blood urea nitrogen (BUN), serum creatinine, and liver function tests b. Complete blood count and electrolytes c. Serum calcium and magnesium d. Serum glucose and lipids

ANS: A Cefazolin will produce an increase in the patient's BUN, creatinine, AST, ALT, ALP, LDH, and bilirubin.

A patient who takes phenytoin reports regular alcohol consumption. The nurse might expect a serum phenytoin level in this patient to be in which range? a. 5 to 10 mcg/mL b. 10 to 20 mcg/mL c. 20 to 30 mcg/mL d. 30 to 50 mcg/mL

ANS: A Chronic ingestion of alcohol increases hydantoin metabolism, which would decrease serum drug levels. The therapeutic range is 10 to 20 mcg/mL, so a level lower than this may be expected in patients who consume alcohol regularly.

A patient who has cancer will begin treatment with a colony-stimulating factor. The patient verbalizes understanding of this drug's action with which statement? a. "This drug allows higher doses of chemotherapy." b. "This drug has antitumor activity." c. "This drug has cytotoxic effects." d. "This drug has antiviral effects."

ANS: A Colony-stimulating factors permit the delivery of higher doses of drugs because they counter myelosuppression. They do not have antitumor activity, cytotoxic effects, or antiviral effects.

A patient who is using inhaled cromolyn sodium (Intal) daily calls the clinic to report experiencing cough and a bad taste. The nurse will instruct the patient to perform which action? a. Drink water before and after using the inhaler. b. Schedule an appointment to discuss these effects with the provider. c. Stop taking the medication immediately. d. Use the inhaler only as needed for acute bronchospasms.

ANS: A Cough and a bad taste are the most common side effects associated with cromolyn sodium, and these effects can be decreased by drinking water before and after using the drug. The effects are not serious and do not warrant discussion with the provider. Stopping the medication abruptly can cause a rebound bronchospasm. This medication is not useful in acute bronchospasm.

A patient is preparing to travel to a country with prevalent malaria. To prevent contracting the disease, the provider has ordered chloroquine HCl (Aralen). The nurse will instruct the patient to take this drug according to which schedule? a. 500 mg weekly beginning 2 weeks prior to travel and continuing for 6 to 8 weeks after travel b. 1000 mg weekly beginning 2 weeks prior to travel and continuing for 6 to 8 weeks after travel c. 500 mg once followed by 500 mg per dose in 6 hours, 24 hours, and 48 hours d. 1000 mg once followed by 500 mg per dose in 6 hours, 24 hours, and 48 hours

ANS: A For malaria prophylaxis, chloroquine is given 500 mg/dose weekly for 2 weeks prior to travel and then weekly until 6 to 8 weeks after exposure. The dosing schedule of 1000 mg once, followed by 500 mg in 6, 24, and 48 hours is used to treat acute malaria.

A patient will begin using an albuterol metered-dose inhaler to treat asthma symptoms. The patient asks the nurse about the difference between using an oral form of albuterol and the inhaled form. The nurse will explain that the inhaled form of albuterol a. has a more immediate onset than the oral form. b. may cause more side effects than the oral preparation. c. requires an increased dose in order to have therapeutic effects. d. will not lead to tolerance with increased doses.

ANS: A Inhaled medications have more immediate effects than oral preparations. As long as they are used correctly, systemic side effects are less common. Less drug is needed for therapeutic effects, since the drug is delivered directly to target tissues. Increased doses will lead to drug tolerance.

The nurse is preparing to administer phenytoin to an 80-year-old patient and notes the following order: IVP phenytoin 50 mg. The nurse will perform which action? a. Administer the undiluted drug through a Y-tube over two minutes. b. Contact the provider to question the route and the dose. c. Dilute the drug in dextrose solution and infuse over 15 to 20 minutes. d. Request an order to administer the drug intramuscularly.

ANS: A Intravenous phenytoin should be administered undiluted through a 3-way stopcock or Y-tubing. In older patients it should be infused at a rate of 25 mcg/min. The dose and the route are appropriate. Phenytoin will precipitate in dextrose solution. Intramuscular injection is very irritating to tissues and is not used.

The nurse is teaching a patient how to use phenylephrine HCl (Neo-Synephrine) nasal spray to treat congestion from a viral upper respiratory infection. What instruction will the nurse give the patient? a. Stop using the medication after 3 days. b. Spray the medication into the nose while lying supine. c. Use frequently since systemic side effects do not occur. d. Use the medication with any other over-the-counter medications.

ANS: A Nurses should explain to patients that continuous use of nasal sprays containing adrenergic agonists may result in rebound nasal congestion; these sprays should not be used more than 3 days. To avoid systemic absorption, spray should be administered while the patient is in an upright position. The medication may cause systemic side effects and should not be routinely used with other OTC cold medications.

Prior to administration of interferon alpha, the nurse will administer which medications? a. Acetaminophen and diphenhydramine b. Heparin and meperidine c. Lorazepam and furosemide d. Narcotic analgesics and loratadine

ANS: A Patients receiving these drugs should be premedicated with acetaminophen to reduce chills and fever and with diphenhydramine to reduce nausea.

The nurse is preparing to give sargramostim to a patient who has acute myelogenous leukemia (AML). The nurse assesses a heart rate of 78 beats per minute and a blood pressure of 120/70 mm Hg. The patient reports shortness of breath and has a cough and bilateral crackles. What will the nurse do next? a. Contact the provider; discuss giving a lower dose. b. Contact the pharmacist; request a bronchodilator. c. Contact the pharmacist; request an order for furosemide. d. Contact the provider; suggest administration of antibiotics.

ANS: A Patients receiving this drug can experience sequestration of granulocytes in the pulmonary circulation and may experience dyspnea. The sargramostim infusion should be reduced in half if this occurs. Bronchospasm, pulmonary edema, and infection are not common side effects.

The nurse is providing teaching to a patient who will begin taking a cephalosporin to treat an infection. Which statement by the patient indicates a need for further teaching? a. "I may stop taking the medication if my symptoms clear up." b. "I should eat yogurt while taking this medication." c. "I should stop taking the drug and call my provider if I develop a rash." d. "I will not consume alcohol while taking this medication."

ANS: A Patients should take all of an antibiotic regimen even after symptoms clear to ensure complete treatment of the infection. Patients are often advised to eat yogurt or drink buttermilk to prevent superinfection. A rash is a sign of hypersensitivity, and patients should be counseled to stop taking the drug and notify the provider if this occurs. Alcohol consumption may cause adverse effects and should be avoided by patients while they are taking cephalosporins.

The nurse is teaching a patient who will begin taking bethanechol (Urecholine). Which statement by the patient indicates a need for further teaching? a. "Excessive sweating is a normal reaction to this medication." b. "Excess salivation is a serious side effect." c. "I should get out of bed slowly while taking this drug." d. "I will not take the drug if my heart rate is less than 60 beats per minute."

ANS: A Patients taking bethanechol should be instructed to report increased salivation and diaphoresis since they can be early signs of overdosing. They should also be taught to rise slowly to avoid orthostatic hypotension and to hold the drug if their heart rate is low.

The nurse is teaching a patient about rifampin. Which statement by the patient indicates understanding of the teaching? a. "I should not wear soft contact lenses while taking rifampin." b. "I will need regular eye examinations while taking this drug." c. "I will report orange urine to my provider immediately." d. "I understand that renal toxicity is a common adverse effect."

ANS: A Patients taking rifampin should be warned that urine, feces, saliva, sputum, sweat, and tears may turn a harmless red-orange color. Patients should not wear soft contact lenses to avoid permanent staining. Regular eye exams are necessary for patients who receive isoniazid and ethambutol. Orange urine is a harmless side effect and does not need to be reported. Renal toxicity is not common with rifampin.

A young adult female who is taking metronidazole (Flagyl) to treat trichomoniasis calls the nurse to report severe headache, flushing, palpitations, cramping, and nausea. What will the nurse do next? a. Ask about alcohol consumption. b. Reassure her that these are harmless side effects. c. Tell her that this signals a worsening of her infection. d. Tell her to go to the emergency department immediately.

ANS: A Patients who are taking metronidazole can experience a disulfiram-like reaction when they drink alcohol. These are not harmless adverse effects or a sign of worsening of her infection.

The nurse is preparing to assist with blood collection on a newly admitted patient who has been taking phenytoin for several years. The provider has ordered a complete blood count and liver function tests. Which other blood test will the nurse discuss with the provider? a. Blood glucose b. Coagulation studies c. Renal function tests d. Serum electrolytes

ANS: A Patients who have taken hydantoins for long periods might have an elevated blood sugar. The nurse should discuss this test with the provider.

A patient will begin using ipratropium bromide (Atrovent), albuterol (Proventil), and an inhaled glucocorticoid medication (steroid) to treat chronic bronchitis. When teaching this patient about disease and medication management, the nurse will instruct the patient to administer these medications in which order? a. Albuterol, ipratropium bromide, steroid b. Albuterol, steroid, ipratropium bromide c. Ipratropium bromide, albuterol, steroid d. Steroid, ipratropium bromide, albuterol

ANS: A Patients who use a beta agonist should be taught to use it 5 minutes before administering ipratropium bromide, and ipratropium bromide should be given 5 minutes prior to an inhaled glucocorticoid. This helps the bronchioles to dilate so the subsequent medication can be deposited in the bronchioles for improved effect.

The nurse is caring for a patient who is receiving vincristine (Oncovin), a plant alkaloid chemotherapeutic agent, to treat non-Hodgkin's lymphoma. The nurse observes that the patient has difficulty walking. What action will the nurse take? a. Ask about numbness or tingling in the fingers and toes. b. Assess heart rate and blood pressure to evaluate for orthostatic hypotension. c. Assess the temperature to evaluate for infection. d. Request an order for a complete blood count and electrolytes.

ANS: A Peripheral neuropathy can occur with this drug and is manifested by difficulty walking and numbness and tingling in the fingers and toes. Orthostatic hypotension is not a side effect. Infection is always a concern, and regular evaluation of complete blood count and electrolytes is performed but not related to signs of peripheral neuropathy.

A patient who is HIV-infected takes 800 mg of indinavir (Crixivan), a protease inhibitor medication. The provider has ordered adding ritonavir (Norvir) to the regimen. The nurse will teach the patient that the addition of ritonavir a. allows decreasing the dosing from 3 times daily to twice daily. b. can lead to increased cholesterol and triglycerides. c. may worsen insulin resistance. d. will require increased dietary restrictions.

ANS: A Ritonavir boosting is a mainstay of protease inhibitor therapy and can reduce dosing frequency and pill burden as well as overcome viral resistance. It does not increase the likelihood of elevated cholesterol and triglycerides or insulin resistance and does not lead to increased dietary restrictions.

A patient who has parkinsonism will begin taking selegiline HCl (Eldepryl) to treat symptoms. What information will the nurse include when teaching this patient about this drug? a. "Avoid consuming foods that are high in tyramine." b. "This drug will prevent the need to take levodopa." c. "You may have red wine with dinner on occasion." d. "You will not have serious drug interactions with this drug."

ANS: A Selegiline (Eldepryl) inhibits monoamine oxidase-B, and it has similar adverse reactions to other monoamine oxidase inhibitors. Patients should be cautioned against consuming foods containing tyramine because of the risk of hypertensive crisis. Red wine is high in tyramine. Use of this drug may delay, but will not prevent, the need for levodopa. Severe adverse drug interactions may occur between this drug and tricyclic antidepressants.

The nurse is caring for a patient who is hospitalized for an asthma exacerbation. The patient reports taking diphenhydramine at home at night to help with symptoms of allergic rhinitis and cough. The nurse will contact the patient's provider to request an order for which medication? a. Benzonatate (Tessalon Perles) b. Cetirizine (Zyrtec) c. Dextromethorphan hydrobromide (Benylin DM) d. Diphenhydramine (Benadryl)

ANS: B Cetirizine is an antihistamine, which is indicated for this patient's symptoms. Diphenhydramine is also an antihistamine but, because of its anticholinergic side effects, is contraindicated in patients with asthma. Benzonatate and dextromethorphan are anti-tussives and not antihistamines.

A patient reports weakness of the extremities and diplopia. The nurse knows that these symptoms are characteristic of which condition? a. Cerebral palsy (CP) b. Multiple sclerosis (MS) c. Myasthenia gravis (MG) d. Parkinson's disease (PD)

ANS: B Diplopia and weakness of the extremities are two symptoms of MS. CP is characterized by muscle spasticity. MG involves generalized weakness, especially of facial muscles and respiratory muscles. PD manifests as tremors and difficulty moving and walking.

A patient is taking entacapone (Comtan) along with carbidopa-levodopa to treat parkinsonism. The nurse notes that the patient's urine is orange in color. The nurse will a. notify the provider of possible drug toxicity. b. reassure the patent that this is a harmless side effect. c. request an order for liver function tests. d. request an order for a urinalysis.

ANS: B Entacapone can cause the urine to be dark yellow to orange. It does not indicate drug toxicity, liver effects, or changes in renal function.

A patient who is HIV-positive begins therapy with the fixed-dose combination nucleoside reverse transcriptase inhibitor (NRTI) Combivir (lamivudine/zidovudine) twice daily. The patient is in the clinic for follow-up 1 week after initiation of therapy and reports having nausea. The patient's creatinine clearance is 40 mL/minute. Based on these findings, the nurse will perform which action? a. Instruct the patient to take the medication 60 minutes prior to meals. b. Notify the provider to discuss single-dose NRTI products. c. Request an order for once-daily dosing of this medication. d. Suggest that the patient increase fluid intake.

ANS: B Patients should have dosage adjustments of NRTIs if creatinine clearance is less than 50 mL/min. The patient will need single-dose medications so that adjustments can be made. Taking the medication prior to meals improves absorption of didanosine but does not alter the side effect of nausea for Combivir, which should subside in the next week or so. This combination product is not given once daily. Increasing fluid intake will not affect this patient's symptoms.

The nurse is caring for an 80-year-old patient who has Alzheimer's disease who will begin taking rivastigmine (Exelon). What will the nurse include in the plan of care for this patient? a. Administer the drug once daily. b. Assist the patient to stand and walk. c. Give the drug with food to increase absorption. d. Use nonsteroidal anti-inflammatory drugs (NSAIDs) instead of acetaminophen for pain.

ANS: B Patients taking rivastigmine for Alzheimer's disease are at risk for falls and loss of balance. Caregivers should assist with standing and walking. The drug is taken twice daily, and it should be taken on an empty stomach. NSAIDs increase gastrointestinal side effects.

A patient who has chronic liver disease reports contact with a person who has tuberculosis (TB). The nurse will counsel this patient to contact the provider to discuss a. a chest x-ray. b. a TB skin test. c. liver function tests (LFTs). d. prophylactic antitubercular drugs.

ANS: B Patients who have exposure to TB should have a TB skin test. A chest x-ray is performed if the skin test is positive. LFTs do not need to be done simply because of TB exposure. This patient is not a candidate for antitubercular drug prophylaxis.

The nurse is preparing to administer benztropine (Cogentin) to a patient who has Parkinson's disease. When performing an assessment, which aspect of the patient's history would cause the nurse to hold the medication and notify the provider? a. Asthma b. Glaucoma c. Irritable bowel syndrome d. Motion sickness

ANS: B Patients who have glaucoma should not take anticholinergic medications.

The nurse is preparing to administer a first dose of benztropine (Cogentin) to a patient diagnosed with parkinsonism. The nurse would notify the patient's provider if the patient had a history of which condition? a. Asthma b. Glaucoma c. Hypertension d. Irritable bowel disease

ANS: B Patients with a history of glaucoma should not take anticholinergic medications. Anticholinergics are not contraindicated in patients who have asthma, hypertension, or irritable bowel disease.

A patient receiving interferon experiences confusion, somnolence, and aphasia. The nurse will perform which action? a. Discontinue the medication immediately. b. Inform the family that these symptoms may persist for years. c. Reassure the patient that these side effects are reversible. d. Request an order for lorazepam.

ANS: C Neurologic side effects, such as confusion, somnolence, and aphasia, are reversible after the drug is stopped. It is not necessary to stop the medication unless the symptoms progress and become severe. Lorazepam is not indicated.

The nurse is caring for a patient who will begin taking theophylline at home. During the assessment, the nurse learns that the patient smokes. The nurse reports this to the provider and will expect the provider to a. decrease the dose of theophylline. b. increase the dose of theophylline. c. keep the theophylline dose as ordered. d. discontinue the theophylline.

ANS: B Tobacco smoking increases the metabolism of theophylline, so the dose should be increased. Decreasing the dose will lead to subtherapeutic effects.

Which topical antifungal medication is used to treat vaginal candidiasis? a. Haloprogin (Halotex) b. Miconazole (Monistat) c. Oxiconazole (Oxistat) d. Terbenafine HCl (Lamisil)

ANS: B Topical miconazole is used to treat vaginal candidiasis.

The nurse assumes care of a patient who has myasthenia gravis and notes that a dose of neostigmine (Prostigmin) due 1 hour prior was not given. The nurse will anticipate the patient to exhibit which symptoms? a. Excessive salivation b. Muscle spasms c. Muscle weakness d. Respiratory paralysis

ANS: C Neostigmine must be given on time to prevent myasthenic crisis, which is characterized by generalized, severe muscle weakness. The other symptoms are characteristic of cholinergic crisis, caused by too much medication.

A patient is taking chloroquine (Aralen) to treat acute malaria. Which statement by the patient indicates understanding of this medication? a. "I should abstain from alcohol while taking this medication." b. "I should report urine output less than 1000 mL/day." c. "I should report visual changes immediately." d. "I should take this drug on an empty stomach."

ANS: C Patients taking chloroquine (Aralen) have a risk of visual injury related to side effects of blurred vision and should report visual changes to the provider. There is no restriction on alcohol. Patient should report urine output of less than 600 mL/day, and patients should take the drug with food.

The nurse is teaching a patient who will be discharged home from the hospital to take amoxicillin (Amoxil) twice daily for 10 days. Which statement by the nurse is correct? a. "Discontinue the antibiotic when your temperature returns to normal and your symptoms have improved." b. "If diarrhea occurs, stop taking the drug immediately and contact your provider." c. "Stop taking the drug and notify your provider if you develop a rash while taking this drug." d. "You may save any unused antibiotic to use if your symptoms recur."

ANS: C Patients who develop signs of allergy, such as rash, should notify their provider before continuing medication therapy. Patients should be counseled to continue taking their antibiotics until completion of the prescribed regimen even when they feel well. Diarrhea is an adverse effect but does not warrant cessation of the drug. Before deciding to stop taking a medication due to a side effect, encourage the patient to contact the provider first. Patients should discard any unused antibiotic.

The nurse is preparing to administer amoxicillin (Amoxil) to a patient and learns that the patient previously experienced a rash when taking penicillin. Which action will the nurse take? a. Administer the amoxicillin and have epinephrine available. b. Ask the provider to order an antihistamine. c. Contact the provider to discuss using a different antibiotic. d. Request an order for a beta-lactamase resistant drug.

ANS: C Patients who have previously experienced manifestations of allergy to a penicillin should not use penicillins again unless necessary. The nurse should contact the provider to discuss using another antibiotic from a different class. Epinephrine and antihistamines are useful when patients are experiencing allergic reactions, depending on severity.

A patient calls the clinic in November to report a temperature of 103° F, headache, a nonproductive cough, and muscle aches. The patient reports feeling well earlier that day. The nurse will schedule the patient to see the provider and will expect the provider to order which medication? a. Amantadine HCl (Symmetrel) b. Influenza vaccine c. Rimantadine HCl (Flumadine) d. An over-the-counter drug for symptomatic treatment

ANS: C Rimantadine is used for treatment of influenza. Amantadine is used primarily for prophylaxis, and this patient already has symptoms. The influenza vaccine may be given later to protect against other strains. Over-the-counter medications may be used as adjunct treatment.

The nurse is caring for a patient who has myasthenia gravis (MG) and takes pyridostigmine bromide (Mestinon) 60 mg every 4 hours. The patient's last dose was 45 minutes prior. The nurse notes severe muscle weakness, excess salivation, fasciculations of facial muscles, and pupil constriction. The nurse will perform which action? a. Assess the patient for signs of ptosis. b. Notify the provider to discuss an order for intravenous immune globulin (IVIG). c. Obtain an order for atropine sulfate. d. Request an order for an extra dose of pyridostigmine.

ANS: C Severe muscle weakness, excess salivation, fasciculations of facial muscles, and pupil constriction are the major signs of cholinergic crisis, caused by excess pyridostigmine. The antidote is atropine, so the nurse should obtain an order to give this. Ptosis is sign of myasthenic crisis. IVIG is given to treat symptoms of MG and not used for cholinergic crisis. Giving extra pyridostigmine would increase the symptoms.

The nurse is caring for a patient who is receiving trihexyphenidyl (Artane) to treat parkinsonism. The patient reports having a dry mouth, and the nurse notes a urine output of 300 mL in the past 8 hours. Which action will the nurse perform? a. Encourage increased oral fluids. b. Obtain an order for intravenous fluids. c. Report the urine output to the provider. d. Request an order for renal function tests.

ANS: C Urinary retention can occur with anticholinergic medications. Dry mouth is a harmless side effect. The nurse should report the lower than expected urine output to the provider. Increasing fluid intake will not increase urine output in the patient with urinary retention. Renal function tests are not indicated since this is a neuromuscular problem of the bladder caused by the medication.

A patient who has Parkinson's disease is being treated with the anticholinergic medication benztropine (Cogentin). The nurse will tell the patient that this drug will have which effect? a. Helping the patient to walk faster b. Improving mental function c. Minimizing symptoms of bradykinesia d. Reducing some of the tremors

ANS: D Benztropine is given to reduce rigidity and some of the tremors. It does not enhance walking or reduce bradykinesia or improve mental function.

A woman who is pregnant is taking an anticonvulsant medication to treat a seizure disorder. The nurse will ensure that the patient takes which dietary supplement toward the end of her pregnancy? a. Folate (folic acid) b. Iron c. Vitamin C d. Vitamin K

ANS: D Anticonvulsants act as inhibitors of vitamin K and can contribute to hemorrhage in infants shortly after birth. Women taking these drugs should receive vitamin K within the last week to 10 days of their pregnancies.

The nurse is preparing to administer the anticholinergic medication benztropine (Cogentin) to a patient who has Parkinson's disease. The nurse understands that this drug is used primarily for which purpose? a. To decrease drooling and excessive salivation b. To improve mobility and muscle strength c. To prevent urinary retention d. To suppress tremors and muscle rigidity

ANS: D Antiparkinson-anticholinergic drugs are used mainly to reduce tremors and muscle rigidity.

The nurse is preparing to administer interleukin-2 to a patient who has cancer. The patient reports shortness of breath. The nurse assesses clear breath sounds, a respiratory rate of 22 breaths per minute, a heart rate of 80 beats per minute, an oxygen saturation of 93% on room air, and a blood pressure of 92/68 mm Hg. The nurse will perform which action? a. Administer the dose as ordered. b. Administer oxygen while giving the dose. c. Discuss permanently discontinuing this treatment with the provider. d. Hold the dose and notify the provider.

ANS: D Because of pulmonary symptoms associated with interleukin-2, the drug should be held if the patient has an oxygen saturation <94% on room air. It may be given when the patient's oxygen saturation improves. The drug does not need to be permanently discontinued.

The nurse is caring for a patient who is receiving intravenous dopamine (Intropin). The nurse notes erythema and swelling at the IV insertion site. What is the nurse's initial action? a. Apply warm soaks to the area. b. Monitor the patient closely for hypertension. c. Obtain an order for an electrocardiogram. d. Notify the provider of a need for phentolamine mesylate (Regitine).

ANS: D Extravasation of dopamine causes tissue necrosis; if extravasation occurs, the antidote phentolamine mesylate should be infiltrated into the area.

A patient who has recently begun antiretroviral therapy with a combination drug develops immune reconstitution inflammatory syndrome (IRIS) with mild symptoms. What does the nurse expect that the provider will order? a. Administration of a high dose of corticosteroids b. Changing the regimen to a single antiretroviral drug c. Temporarily discontinuing the antiretroviral therapy d. Treating an underlying opportunistic infection

ANS: D IRIS is related to specific opportunistic infections that must be treated. Anti-inflammatory medications, such as corticosteroids, may be used if indicated after the underlying infection is treated. Changing or discontinuing the antiretroviral therapy regimen is not indicated.

A patient experiences severe muscle weakness, and the provider orders edrophonium bromide (Tensilon). The patient begins to show improved muscle strength within a few minutes after administration of this drug. The nurse anticipates the provider will order which drug? a. Atropine sulfate b. Edrophonium bromide (Tensilon) c. Intravenous immune globulin (IVIG) d. Pyridostigmine HCl (Mestinon)

ANS: D In this case, edrophonium is used to diagnose myasthenia gravis. Since symptoms improved with the AChE inhibitor, the patient will benefit from a longer-acting AChE inhibitor such as pyridostigmine. Atropine is given for AChE inhibitor overdose. Edrophonium is very short-acting, so it will not be used for treatment. IVIG is used when other AChE inhibitors fail.

The nurse provides teaching for patient who will begin taking montelukast sodium (Singulair). The patient reports sensitivity to aspirin. Which statement by the patient indicates a need for further teaching? a. "I will need to have periodic laboratory tests while taking this medication." b. "I will not take ibuprofen for pain or fever while taking this drug." c. "I will take one tablet daily at bedtime." d. "I will use this as needed for acute symptoms."

ANS: D Montelukast and other leukotriene receptor antagonists are not used to treat acute symptoms. Because they can affect liver enzymes, periodic liver function tests should be performed. Patients taking this drug should not use ibuprofen or aspirin for pain or fever if they have an aspirin sensitivity. Patients will achieve maximum effectiveness if the drug is taken in the evening.

The nurse is performing an admission assessment on a patient who has been taking carisoprodol (Soma) for 3 weeks to treat muscle spasms. The patient reports that the muscle spasms have resolved. The nurse will contact the provider to discuss a. changing to cyclobenzaprine (Flexeril). b. continuing the carisoprodol for 1 more week. c. discontinuing the carisoprodol now. d. ordering a taper of the carisoprodol.

ANS: D Muscle relaxants can cause drug dependence and should not be withdrawn abruptly. The nurse should discuss a drug taper.

The nurse is preparing to care for a patient who has myasthenia gravis. The nurse will be alert to symptoms affecting which body system in this patient? a. Cardiovascular system and postural muscles b. Central nervous system (CNS), memory, and cognition c. Gastrointestinal system (GI) and lower extremity muscles d. Respiratory system and facial muscles

ANS: D Myasthenia gravis causes fatigue and muscular weakness of the respiratory system, facial muscles, and extremities. It does not directly affect the cardiovascular system, CNS, or GI systems.

A 40-year-old woman is diagnosed with myasthenia gravis, and her provider recommends removal of her thymus gland. She asks the nurse why this would be helpful. The nurse will explain that removal of the thymus gland may a. increase binding of acetylcholine (ACh) molecules to ACh receptors. b. increase the amount of ACh available at neuromuscular junction sites. c. reduce the number of acetylcholine receptor sites. d. reduce the autoimmune destruction of ACh receptor sites.

ANS: D Myasthenia gravis is an autoimmune disorder involving an antibody response against a subunit of the ACh receptor site. Since the thymus is involved in systemic immunity, it is thought that removing the thymus can inhibit this process. It does not increase binding of ACh molecules to receptors or increase the amount of ACh or reduce the number of ACh receptor sites.

The nurse is preparing to administer isoproterenol (Isuprel) to a patient who is experiencing an acute bronchospasm. The nurse understands that, because isoproterenol is a nonselective beta-adrenergic agonist, the patient will experience which effects? a. Alpha- and beta-adrenergic agonist effects b. Anticholinergic effects c. A shorter duration of therapeutic effects d. Cardiac and pulmonary effects

ANS: D Non-selective beta-adrenergic agonists affect both beta1 and beta2 receptors, causing both tachycardia and bronchodilation. Alpha receptors are not affected.

A patient who has oral candidiasis will begin using nystatin suspension to treat the infection. What information will the nurse include when teaching this patient? a. "Coat the buccal mucosa with the drug and then rinse your mouth." b. "Gargle with the nystatin and then spit it out without swallowing." c. "Mix the suspension with 4 ounces of water and then drink it." d. "Swish the liquid in your mouth and then swallow after a few minutes."

ANS: D Patients should be taught to swish the suspension in the mouth to coat the tongue and buccal mucosa and then swallow the medication. It should not be spit out, diluted with water, or swallowed with water.

The nurse is teaching a patient who is receiving chloroquine (Aralen) for malaria prophylaxis. Which statement by the patient indicates a need for further teaching? a. "I may experience hair discoloration while taking this drug." b. "I should not take this drug with lemon juice." c. "I should use sunscreen while taking this drug." d. "If I have gastrointestinal upset, I should take an antacid."

ANS: D Patients should not take these drugs with antacids.

The nurse provides teaching for a patient who will begin taking phenytoin. Which statement by the patient indicates understanding of the teaching? a. "If I develop a rash, I should take diphenhydramine to control the itching." b. "If I experience bleeding gums, I should stop taking the medication immediately." c. "I may develop diabetes while I am taking this medication." d. "I should not be alarmed if my urine turns reddish-brown."

ANS: D Phenytoin will cause reddish-brown colored urine. Patients should be counseled to report a rash to the provider because it could be a serious adverse reaction. Bleeding gums are common, but patients should never stop taking anticonvulsants abruptly, or they may develop seizures. Changes in blood glucose may occur but do not necessarily result in diabetes.

A patient who has Parkinson's disease will begin treatment with benztropine (Cogentin). Which symptom of Parkinson's disease would be a contraindication for this drug? a. Drooling b. Muscle rigidity c. Muscle weakness d. Tardive dyskinesia

ANS: D Tardive dyskinesia is a contraindication for this drug.

A nursing student asks the nurse why patients who have parkinsonism receive a combination of carbidopa and levodopa. The nurse will explain that the combination product a. allows larger doses of levodopa to be given without causing increased adverse reactions. b. causes more levodopa to be converted to dopamine before crossing the blood-brain barrier. c. eliminates almost all drug side effects of both levodopa and carbidopa. d. reduces peripheral side effects by inhibiting decarboxylase in the peripheral nervous system.

ANS: D Without carbidopa, about 99% of levodopa is converted to dopamine before crossing the blood-brain barrier, causing peripheral adverse effects. When carbidopa is added, the enzyme decarboxylase is inhibited, allowing levodopa to cross into the brain before being converted to the active metabolite dopamine. The result is less levodopa required to achieve the desired effect. The drug still has many side effects, but the peripheral effects are lessened.