Pharm Exam 2
An 80-year-old patient has been prescribed an anticholinergic agent for treatment of Parkinson-related symptoms. What patient education should be provided? A) "Avoid high environmental temperatures." B) "Anticholinergics increase mental alertness." C) "It is safe to take Sudafed for a cold." D) "You may experience urinary incontinence."
A) "Avoid high environmental temperatures." Anticholinergic drugs decrease sweating and may cause heat stroke. The patient should be instructed to avoid high environmental temperatures. Anticholinergic agents will decrease mental alertness. Sudafed will produce anticholinergic effects and should not be administered. Anticholinergic agents produce urinary retention, not incontinence.
An adult patient is preparing to begin corticosteroid treatment for rheumatoid arthritis. When teaching this patient about the appropriate use of corticosteroids, the nurse should include what teaching point? A) "You will likely gain some weight after you start taking this drug." B) "Try to eat as many organic and natural foods as possible while taking this drug." C) "You might have some slight bleeding in your stool after you start this drug." D) "Ensure that you vary the times that you take your drug in order to maximize effectiveness."
A) "You will likely gain some weight after you start taking this drug." An initial weight gain is likely to occur with steroid treatment and is usually attributed to increased appetite. Organic foods are not necessary, and a consistent schedule of administration is imperative. Bleeding is not expected.
The nurse is administering telithromycin (Ketek) to a child with Streptococcus pneumoniae infection. What nursing intervention is implemented when administering this medication? A) Administer the medication with or without food. B) Administer the medication with grapefruit juice. C) Increase the dose in the event of QT elongation. D) Administer the medication with lovastatin.
A) Administer the medication with or without food. When administering telithromycin, food does not affect the absorption of the medication. The administration of the medication with grapefruit juice may increase the plasma concentration and cause adverse effects. Telithromycin can cause an elongation of the QT interval; thus, the dose should not be increased. The administration of telithromycin and lovastatin can cause an increase in the QT interval.
A patient is diagnosed with an infection attributable to the gram-negative microorganism Pseudomonas. Which of the following anti-infective agents is most reliable in treating this microorganism? A) Aminoglycoside B) Antifungal C) Aminopenicillin D) GABA analog
A) Aminoglycoside Aminoglycosides are used to treat infections caused by gram-negative microorganisms, such as Pseudomonas. Antifungal and aminopenicillin agents are not used to treat Pseudomonas. A GABA analog is used to treat pain related to neuropathy.
Mr. Garcia has been taking antibiotics at home for the treatment of a respiratory infection for the past 6 days, and there is no evident improvement in his infection. Which of the following nursing assessments is most appropriate? A) Assess Mr. Garcia's adherence to his medication regimen. B) Assess Mr. Garcia's home hygiene. C) Assess Mr. Garcia's understanding of his illness. D) Assess Mr. Garcia's use of herbal or alternative remedies.
A) Assess Mr. Garcia's adherence to his medication regimen. Nonadherence to antibiotic therapy can result in a continuation or exacerbation of the infection. Poor hygiene is a risk factor for the development of infection but is less likely to perpetuate an existing infection that is being treated appropriately with antibiotics. Herbs may be contraindicated but are unlikely to negate the therapeutic effects of an antibiotic. The nurse should gauge the patient's understanding of his illness, but this does not have a bearing on his lack of improvement.
Prior to the administration of metoprolol, a beta-adrenergic blocking agent, which is most important for the nurse to assess? A) Blood pressure B) Lung sounds C) Mental status D) Urine output
A) Blood pressure Beta-adrenergic blocking agents cause vasodilation and decreased heart rate, resulting in lowering of the blood pressure. A premedication assessment is to take baseline heart rate and blood pressure. Fluid retention may occur as a serious adverse effect but is not the most important assessment prior to the administration of a beta-adrenergic blocking agent. Mental status and urine output are not the most important assessments prior to the administration of a beta-adrenergic blocking agent.
A 12-year-old boy was recently diagnosed with asthma, and his primary care provider has prescribed a corticosteroid to be administered by metered-dose inhaler. This drug achieves a therapeutic effect by which of the following means? A) By increasing the number of beta-adrenergic receptors B) By increasing the muscle tone in the smooth muscle of the trachea C) By increasing the permeability of the alveolar membrane D) By increasing the number of binding sites on erythrocytes
A) By increasing the number of beta-adrenergic receptors Corticosteroids increase the number of beta-adrenergic receptors and increase or restore responsiveness of beta receptors to beta-adrenergic bronchodilating drugs. They do not influence the permeability of alveoli, muscle tone, or the structure of red blood cells.
An elderly patient is treated for pneumonia with clindamycin (Cleocin). One week after the completion of the medication, she develops diarrhea. What is the most probable cause of the diarrhea? A) Change in normal flora B) Food-borne illness C) Crohn's disease D) Incontinence
A) Change in normal flora Much of the normal flora can cause disease under certain conditions, especially in the elderly, debilitated, or immunosuppressed people. The development of infectious diarrhea is related to the change in the normal flora of the bowel. Food-borne illness, Crohn's disease, and incontinence do not contribute to this particular development of diarrhea.
A 71-year-old woman with a history of chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) has begun tapering off of prednisone. The nurse should prioritize which of the following assessments during this phase of the woman's care? A) Daily weights B) Level of consciousness assessment C) Nonstress cardiac testing D) Positional blood pressure measurement
A) Daily weights When caring for a patient with COPD and a history of heart failure who takes a tapering dose of prednisone, it is necessary to instruct the patient to check his or her weight daily. The patient should also assess his or her extremities for edema. If the patient's weight increases, edema is evident, and shortness of breath develops, the patient should notify the primary health provider. This potential alteration in fluid balance is more likely than blood pressure changes, decreased LOC, or acute cardiac changes.
When participating in the care of a patient who is being treated with antimicrobials, the nurse can promote the appropriate use of these medications in which of the following ways? A) Encouraging the use of narrow-spectrum, rather than broad-spectrum, antibiotics B) Promoting the use of prophylactic antibiotics for patients possessing risk factors for infection C) Initiating empiric therapy for all older adult patients admitted to a health care facility D) Promoting the use of herbal treatment for infection rather than antimicrobial drugs
A) Encouraging the use of narrow-spectrum, rather than broad-spectrum, antibiotics Guidelines to promote more appropriate use of antimicrobial drugs include using a narrow-spectrum antibacterial drug instead of a broad-spectrum drug, whenever possible, in order to decrease the risk of a superinfection. Herbal alternatives are frequently not available. Antibiotics should not normally be administered in the absence of a diagnosed infection.
A patient is experiencing anaphylaxis. Which of the following medications will most likely be administered? A) Epinephrine B) Norepinephrine C) Acetylcysteine (Mucomyst) D) Dantrolene sodium (Dantrium)
A) Epinephrine Epinephrine is the adrenergic drug of choice for relief of anaphylactic shock, the most serious allergic reaction, as well as in treatment of cardiac arrest. Norepinephrine is not administered. Acetylcysteine (Mucomyst) is used for acetaminophen overdose. Dantrolene sodium is used to treat malignant hyperthermia.
A patient who is being treated in the intensive care unit has been diagnosed with ventilator-associated pneumonia. Culture and sensitivity testing of the patient's sputum indicates that erythromycin is a treatment option. The nurse knows that this drug is likely contraindicated for what reason? A) Erythromycin inhibits normal liver function. B) Erythromycin is associated with gastrointestinal upset. C) Erythromycin is nephrotoxic. D) Erythromycin cannot be administered orally.
A) Erythromycin inhibits normal liver function. Erythromycin is seldom used in critical care settings, partly because broader spectrum bactericidal drugs are usually needed in critically ill patients and partly because it inhibits liver metabolism and slows elimination of several other drugs. Erythromycin is not nephrotoxic. The drug is administered orally, and GI upset does not contraindicate use.
A young woman is seen in the physician's office and wants to ensure that she is vaccinated against hepatitis. Vaccines are available for which of the following types of hepatitis? Select all that apply. A) Hepatitis A virus B) Hepatitis B virus C) Hepatitis C virus D) Hepatitis D virus E) Hepatitis G virus
A) Hepatitis A virus B) Hepatitis B virus Vaccines are available for hepatitis A and B.
A patient is administered acetylsalicylic acid (aspirin) for fever and headache. What is the action of acetylsalicylic acid (aspirin)? A) Inhibiting prostaglandin synthesis in the central and peripheral nervous system B) Providing selective action by inhibiting prostaglandin synthesis in the CNS C) Inhibiting the release of norepinephrine to increase blood pressure D) Suppressing the function of the hypothalamus to decrease inflammation
A) Inhibiting prostaglandin synthesis in the central and peripheral nervous system Aspirin inhibits prostaglandin synthesis in the central nervous system and the peripheral nervous system. Acetylsalicylic acid does not provide selective action by inhibiting prostaglandin synthesis in the CNS. Aspirin does not inhibit the release of norepinephrine to increase blood pressure. Aspirin does not suppress the function of the hypothalamus to decrease inflammation.
A patient is diagnosed with a gram-negative infection and is prescribed an aminoglycoside. What is the action of an aminoglycoside? A) It blocks protein synthesis of the cell wall. B) It blocks DNA replication. C) It destroys the integrity of the cell wall structure. D) It increases white blood cell viability.
A) It blocks protein synthesis of the cell wall. Aminoglycosides penetrate the cell walls of susceptible bacteria and bind irreversibly to 30S and 50S ribosomes, intracellular structures that synthesize proteins. Aminoglycosides do not block DNA replication, destroy cell wall structure, or increase white blood cells.
A patient is administered atropine to increase the heart rate. What is the action of atropine? A) It blocks the parasympathetic vagal stimulation. B) It exacerbates the parasympathetic vagal stimulation. C) It provides long-acting antihistamine blockage. D) It blocks cell wall synthesis of gram-negative bacilli.
A) It blocks the parasympathetic vagal stimulation. Moderate to large doses of atropine increase the heart rate by blocking parasympathetic vagal stimulation. The exacerbation of the parasympathetic vagal stimulation is opposite the effect of atropine. The blockage of histamine is seen with the antihistamine medications, not anticholinergic agents. Atropine does not block cell wall synthesis.
A patient is to be discharged on prednisone to be administered every other day at 9:00 AM. When implementing discharge teaching, what should the nurse explain as the rationale for giving the medication every other day? A) It reduces adverse effects. B) It prolongs therapeutic effects. C) It prevents steroid tolerance. D) It increases effectiveness.
A) It reduces adverse effects. Alternate-day therapy allows rest periods so that adverse effects are decreased. Alternative-day therapy will not prolong the therapeutic effects, prevent steroid tolerance, or increase effectiveness.
A home care nurse is visiting a patient, and the assessment will include blood pressure and heart rate. The patient's grandson has a large amount of pseudoephedrine (Sudafed) in the kitchen. For what might the nurse suspect the patient's grandson is using the pseudoephedrine? A) Methamphetamine production B) Treatment of bronchial asthma C) Treatment of sinusitis D) To increase appetite
A) Methamphetamine production Pseudoephedrine and ephedrine are ingredients used in making methamphetamine, a highly addictive and illegal drug of abuse. Pseudoephedrine is used in the treatment of bronchospasm but is not the drug of choice. Pseudoephedrine is used in the treatment of sinusitis, but, in large quantities, the nurse should suspect methamphetamine production. Pseudoephedrine will increase basal metabolic rate but is not the drug of choice to increase appetite.
A patient with a diagnosis of breast cancer is administered a corticosteroid in addition to chemotherapy agents. What effect will the corticosteroids have on this patient's course of recovery? A) The corticosteroid will decrease signs and symptoms of cancer. B) The corticosteroid will alter the action of the chemotherapy agent. C) The corticosteroid will decrease metastasis to distant sites. D) The corticosteroid will decrease hepatic effects of the chemotherapy.
A) The corticosteroid will decrease signs and symptoms of cancer. The administration of corticosteroid agents in cancer will assist in decreasing symptoms associated with cancer. The administration of the corticosteroid will not alter the action of the chemotherapy agent. The corticosteroid will not affect metastasis. The corticosteroid will not decrease hepatic effects.
A patient has been prescribed an oral penicillin for an infection caused by gram-negative bacilli. When conducting health education for this patient, the nurse should emphasize which of the following? A) The need to take the medication on an empty stomach B) The fact that a mild rash frequently follows the first few doses C) The need to increase fluid intake for the duration of treatment D) The fact that the drug should be discontinued once symptoms subside
A) The need to take the medication on an empty stomach Most penicillins should be best taken on an empty stomach. Increased fluid intake is not normally necessary. A rash is an unexpected finding that should be reported promptly. The patient should take the full course of antibiotics.
A nurse has returned to a patient's hospital room for a follow-up assessment during the intravenous infusion of vancomycin. What assessment finding would signal the nurse to the possibility that the patient's infusion is running too quickly? A) The patient is flushed and has a visible skin rash. B) The patient's apical heart rate is irregular. C) The patient is difficult to rouse and has dilated pupils. D) The patient complains of pain at the intravenous access site.
A) The patient is flushed and has a visible skin rash. It is very important to give IV infusions slowly, over 1 to 2 hours, to avoid an adverse reaction characterized by hypotension, flushing, and skin rash. This reaction, sometimes called red man syndrome, is attributed to histamine release.
A patient with a history of type 1 diabetes after myocardial infarction has been placed on a beta-adrenergic blocking agent. Which statement by the patient indicates a need for further teaching? A) "This medication should not be discontinued suddenly." B) "This medication lowers my blood pressure by helping me get rid of fluid." C) "I may not have my usual symptoms of a hypoglycemic reaction while on this drug." D) "This medication may take a few weeks to work."
B) "This medication lowers my blood pressure by helping me get rid of fluid." Beta-adrenergic blocking agents decrease the heart rate and dilate blood vessels to lower blood pressure. Sudden discontinuation of beta-adrenergic blocking agents may result in an exacerbation of angina symptoms. Beta-adrenergic blocking agents may mask symptoms of hypoglycemia. Beta-adrenergic blocking agents may take several days to weeks to show optimal improvement.
A child has symptoms of influenza, including a fever. Which of the following medications should not be administered to the child because of the risk of Reye's syndrome? A) Acetaminophen (Tylenol) B) Acetylsalicylic acid (aspirin) C) Ibuprofen (Motrin) D) Ascorbic Acid (vitamin C)
B) Acetylsalicylic acid (aspirin) In children and adolescents, aspirin is contraindicated in the presence of viral infections, such as influenza or chickenpox, because of its association with Reye's syndrome. Acetaminophen (Tylenol) and ibuprofen (Motrin) are safe to administer for fever reduction and pain relief in children and adolescents. Ascorbic acid (vitamin C) is safe to administer to children but is not used to reduce fever or pain.
Which nerve endings liberate norepinephrine? A) Cholinergic B) Adrenergic C) Anticholinergic D) Muscarinic
B) Adrenergic Nerve endings that secrete norepinephrine are called adrenergic fibers. These nerve endings liberate acetylcholine. Anticholinergic describes the action of certain medications that inhibit the transmission of parasympathetic nerve impulses and thereby reduce spasms of smooth muscle (e.g., as in the bladder). Muscarinic receptors are those membrane bound acetylcholine receptors that are more sensitive to muscarine than to nicotine.
Which category of medications is used for peripheral vascular diseases characterized by excessive vasoconstriction, such as Raynaud's disease? A) Adrenergic agents B) Alpha-adrenergic blocking agents C) Beta-adrenergic blocking agents D) Cholinergic agents
B) Alpha-adrenergic blocking agents Alpha-adrenergic blocking agents interfere with the stimulation of alpha-1 and alpha-2 receptors. Because the primary action of alpha receptor stimulation is vasoconstriction, alpha-adrenergic blocking agents are indicated for patients with diseases associated with vasoconstriction. Adrenergic drugs cause vasoconstriction. Beta-adrenergic blocking agents are used to treat hypertension and dysrhythmias. Cholinergic drugs are used to treat ocular diseases such as glaucoma, respiratory tract disease, and urinary system diseases.
A patient is taking ibuprofen (Motrin) for knee pain. The patient is admitted to the hospital with abdominal pain. Which of the following assessments should the nurse prioritize? A) Assessment for diarrhea B) Assessment for occult blood in the patient's stool C) Assessment of the patient's urine for hematuria D) Assessment for hemoptysis
B) Assessment for occult blood in the patient's stool Nonsteroidal anti-inflammatory agents that block COX-1 and COX-2 place the patient at risk for gastrointestinal bleed. Patients who have symptoms of abdominal pain and are taking NSAIDs should be assessed for signs and symptoms of gastrointestinal bleed. Assessing the patient for diarrhea is not related to ibuprofen (Motrin) administration. Assessing the patient for hematuria or hemoptysis is not a priority.
A patient develops itching and burning of the vaginal vault while taking an anti-infective to treat strep throat. What fungal agent has most likely caused the burning and itching? A) Cryptococcus neoformans B) Candida albicans C) Aspergillus D) Dermatophytes
B) Candida albicans Growth of Candida organisms is normally restrained by intact immune mechanisms and bacterial competition of nutrients. When these restraining forces are altered (antibacterial drug therapy), fungal overgrowth and opportunistic infection can occur. Cryptococcus neoformans organisms evade normal immune defense of phagocytosis. Aspergillus organisms produce protease. Dermatophytes grow on cool body surfaces.
. A patient has been receiving bethanechol (Urecholine) for 1 week. One hour after the dose is administered, he develops sweating, flushing, abdominal cramps, and nausea. What is the rationale for the development of these symptoms? A) Myasthenic crisis B) Cholinergic overdose C) Anaphylactic reaction D) Pulmonary edema
B) Cholinergic overdose A patient who suffers cholinergic overdose will experience sweating, flushing, abdominal cramps, and nausea. An accurate diagnosis may be determined from timing in relation to medication. Signs and symptoms having an onset within approximately 1 hour after a dose of anticholinesterase drug are likely to be caused by cholinergic crisis. Signs and symptoms beginning 3 hours or more after a drug dose are more likely to be caused by myasthenic crisis. These symptoms are not the result of anaphylaxis or pulmonary edema.
A man with a neurogenic bladder secondary to a spinal tumor has been taking bethanechol. The patient has illuminated his call light, and the nurse has found him anxious, diaphoretic, and visibly flushed. Following a safety assessment, what action should the nurse take? A) Prepare to administer an IV dose of epinephrine to mitigate the effects of acetylcholine. B) Contact the physician as the patient may be experiencing a cholinergic crisis. C) Insert a Foley catheter as the patient may have excessive urine in his bladder. D) Assess the volume of the patient's bladder contents using a bladder ultrasound.
B) Contact the physician as the patient may be experiencing a cholinergic crisis. The presence of sweating and skin flushing in a patient taking bethanechol is suggestive of a cholinergic crisis. This is a medical emergency that warrants prompt intervention by the care team. This problem is not treated with epinephrine. Assessing the patient's bladder or inserting a Foley catheter is not sufficient.
A patient is to be started on an antibiotic. Which of the following is most important to take into consideration before beginning the antibiotic regimen? A) Duration of symptoms B) Culture and sensitivity C) The patient's hydration status D) The patient's age and weight
B) Culture and sensitivity Culture identifies the causative organism, and susceptibility tests determine which drugs are likely to be effective against the organism. The duration of symptoms and the patient's hydration status, age, and weight are important, but not imperative, in determining the antibiotic of choice.
A patient is administered a third-generation cephalosporin. Which of the following microorganisms are cephalosporins most effective in treating? A) Gram-positive B) Gram-negative C) Fungi D) Virus
B) Gram-negative Cephalosporins are broad-spectrum agents with activity against both gram-positive and gram-negative bacteria. Compared with penicillins, they are, in general, less active against gram-positive organisms but more active against gram-negative ones. Cephalosporins are not effective against fungi or viruses.
A patient is diagnosed with salicylate overdose. Which of the following medications will be administered for the treatment of salicylate overdose? A) Intravenous meperidine (Demerol) B) Intravenous sodium bicarbonate C) Intravenous furosemide (Lasix) D) Inhaled acetylcysteine (Mucomyst)
B) Intravenous sodium bicarbonate Intravenous sodium bicarbonate produces alkaline urine in which salicylates are more rapidly excreted in patients with salicylism.
A patient is scheduled for a hemithyroidectomy. She has been prescribed an anticholinergic agent prior to surgery. Why is it important to administer the anticholinergic agent in the preoperative phase? A) It will prevent tachycardia. B) It will decrease respiratory secretions. C) It will decrease gastric motility. D) It relaxes the detrusor muscle.
B) It will decrease respiratory secretions. In preoperative patients, the nurse assesses for diminished secretions, particularly when an anticholinergic is administered for head and neck surgery. The administration of an anticholinergic agent will not prevent tachycardia. Anticholinergic agents do decrease gastric motility, but this rationale is not a reason for administration in the preoperative phase. The anticholinergic agents cause relaxation of the detrusor muscle, but this rationale is not the reason for administration of the medication in the preoperative phase.
A patient is allergic to acetylsalicylic acid (aspirin). Which of the following medications is contraindicated due to cross-hypersensitivity reactions? A) Acetaminophen (Tylenol) B) Naproxen sodium (Naprosyn) C) Morphine sulfate (MS Contin) D) Naloxone (Narcan)
B) Naproxen sodium (Naprosyn) In people who have demonstrated hypersensitivity to aspirin, all nonaspirin NSAIDs are contraindicated because cross-hypersensitivity reactions may occur with any drugs that inhibit prostaglandin synthesis. Acetaminophen (Tylenol) does not have cross-sensitivity with acetylsalicylic acid (aspirin) because it is not an NSAID. Morphine sulfate (MS Contin) does not have a cross-sensitivity to aspirin because it is an opioid, not an NSAID. Naloxone (Narcan) is an opioid antagonist and does not have cross-sensitivity with aspirin.
A patient enters the emergency room with complaints of visual changes, drowsiness, and tinnitus. The patient is confused and hyperventilating. These symptoms may be attributable to which of the following? A) Acute acetaminophen toxicity B) Salicylism C) Ibuprofen overdose D) Caffeine overdose
B) Salicylism Salicylism, toxicity due to salicylates that may be associated with chronic use, is characterized by dizziness, tinnitus, difficulty hearing, and mental confusion. Ibuprofen overdose will cause gastric mucosal damage. Caffeine overdose will produce tachycardia.
A patient has presented to the emergency department after suffering a severe laceration to his hand in a workplace accident. During the subsequent process of acute inflammation, what physiological event took place first? A) The patient's B cells produced antibodies. B) The patient's blood vessels constricted. C) Neutrophils migrated to the injury site. D) Opsonization occurred.
B) The patient's blood vessels constricted. The process of acute inflammation occurs in three stages. The first stage is the vascular stage; notable changes occur in the small blood vessels at the site of the cellular and tissue injury. At the time of the injury, vasoconstriction results, followed by vasodilation of the capillaries and venules to increase capillary blood flow, increasing temperature and redness at the site. Opsonization, neutrophil migration, and antibody production take place in later stages of inflammation.
A 43-year-old man has tested positive for systemic candidiasis, and the care team has decided on IV fluconazole as a first-line treatment. When administering this medication, the nurse should A) administer the drug with lactated Ringer's. B) infuse the drug no faster than 200 mg/h. C) avoid administering the drug through a peripheral IV. D) administer prophylactic heparin prior to the fluconazole.
B) infuse the drug no faster than 200 mg/h. Continuous infusion of fluconazole occurs at a maximum rate of 200 mg/h. The drug is not administered with lactated Ringer's or heparin. A peripheral IV may be used.
A patient began antiretroviral therapy several weeks ago for the treatment of HIV, and he has now presented to the clinic for a scheduled follow-up appointment. He states to the nurse, "I've been pretty good about taking all my pills on time, though it was a bit hit and miss over the holiday weekend." How should the nurse best respond to this patient's statement? A) "Remember that if you miss a dose, you need to take a double dose at the next scheduled time." B) "It's acceptable to miss an occasional dose as long as your symptoms don't get worse, but it's not really recommended." C) "Remember that your antiretroviral drugs will only be effective if you take them very consistently." D) "If you're not consistent with taking your medications, you're likely to develop more side effects."
C) "Remember that your antiretroviral drugs will only be effective if you take them very consistently." Effective treatment of HIV infection requires close adherence to drug therapy regimens involving several drugs and daily doses. Missing as few as one or two doses can decrease blood levels of antiretroviral drugs and result in increased HIV replication and development of drug-resistant viral strains.
A patient is being treated with amphotericin B. Which of the following statements indicates that the patient has understood the patient teaching? A) "The medication may cause diabetes." B) "The medication will cause liver necrosis." C) "The medication may cause kidney damage." D) "The medication will cause pancreatitis."
C) "The medication may cause kidney damage." The main concern with the administration of amphotericin B is the risk of nephrotoxicity. Thus, the statement that the medication may cause kidney damage is the most appropriate. The medication will not cause diabetes, liver necrosis, or pancreatitis.
A patient with Parkinson's disease asks the nurse why anticholinergics are used in the treatment. Which response by the nurse is most accurate? A) "These drugs help you urinate." B) "These drugs will decrease your eye pressure." C) "These drugs inhibit the action of acetylcholine." D) "These drugs will assist in lowering your heart rate."
C) "These drugs inhibit the action of acetylcholine." Anticholinergic agents inhibit the action of acetylcholine in the parasympathetic nervous system. These drugs occupy receptor sites at the parasympathetic nerve endings, preventing the action of acetylcholine. Inhibition of acetylcholine facilitates stimulation of the dopaminergic receptors, which relieves the symptoms associated with Parkinson's disease. Anticholinergic agents cause urinary retention, increase intraocular pressure, and increase the heart rate.
A patient has a tumor of the spinal cord and is administered a corticosteroid. What statement by the patient demonstrates an accurate understanding of this treatment? A) "This drug will cause my tumor to be more susceptible to treatment." B) "This drug will decrease my chance of infection and meningitis." C) "This drug won't cure my cancer, but it may help me feel much better." D) "This drug will stop my cancer cells from growing further."
C) "This drug won't cure my cancer, but it may help me feel much better." Patients tend to feel better when taking corticosteroids, although the basic disease process may be unchanged. The corticosteroid will not allow the tumor to be more susceptible to treatment. The corticosteroid will not prevent meningitis.
A patient is suffering from bursitis in the right elbow. Which of the following orally administered medications is most likely to diminish inflammation and assist in relieving pain? A) Acetaminophen (Tylenol) B) Morphine sulfate C) Acetylsalicylic acid (aspirin) D) Codeine
C) Acetylsalicylic acid (aspirin) Aspirin is widely used to prevent and treat mild to moderate pain and inflammation associated with musculoskeletal disorders. Aspirin is administered orally. Acetaminophen (Tylenol) will only relieve pain and not affect inflammation. Morphine sulfate will relieve pain but not affect inflammation. Codeine will relieve pain but not affect inflammation.
The autonomic nervous system can be subdivided into which types of adrenergic receptors? A) Nicotinic and muscarinic B) Afferent and efferent C) Alpha and beta D) Agonists and antagonists
C) Alpha and beta The autonomic nervous system can be subdivided into alpha- and beta-adrenergic receptors. Nicotine and muscarine are specific agonists of one type of cholinergic receptor. Afferent and efferent are sensory and motor nerves. An agonist is a molecule that activates a receptor by reproducing the effect of the neurotransmitter. An antagonist acts against and blocks a function.
A 12-year-old boy was bitten by a dog, and inflammation took place at the site of the injury. During the process of opsonization, what physiological event occurred? A) The boy's blood vessels dilated, allowing rapid peripheral blood flow. B) Viscosity of the boy's blood decreased, facilitating the migration of neutrophils. C) Antigens were coated, marking them for phagocytosis. D) T cells were released from the boy's thymus gland.
C) Antigens were coated, marking them for phagocytosis. The third stage of inflammation involves opsonization, which facilitates phagocytosis. During opsonization, a substance coats the foreign antigens, producing inflammation. This inflammation makes the antigens more susceptible to the macrophages and leukocytes, thus increasing phagocytic activity. Opsonization is not characterized by T-cell activity or changes in blood flow and viscosity.
A female patient has been treated for strep throat with ampicillin by mouth. She visits the occupational health nurse and states she has vaginal itching. What organism is the cause of the vaginal itching? A) Klebsiella B) Enterobacter C) Candida albicans D) Proteus
C) Candida albicans The yeast Candida albicans is a normal resident of the vagina and the intestinal tract. An antibacterial drug may destroy the normal bacterial flora without affecting the fungal organism. Klebsiella, Enterobacter, and Proteus will not contribute to the development of a yeast infection.
A nurse is instructing a patient on the antibiotic regimen for the treatment of pneumonia. Which of the following is most important to teach the patient? A) Take the medication with orange juice. B) Supplement the medication with multivitamins. C) Complete the entire prescription of medication. D) Administer the medication with dairy products.
C) Complete the entire prescription of medication. Interruption or inadequate antimicrobial treatment of infections may also contribute to the emergences of antibiotic-resistant organisms. The administration of an antibiotic with orange juice is not recommended in all instances. The medication does not need to be supplemented with vitamins. Antibiotics need not be administered with dairy products.
Oral ampicillin has been ordered for a female patient whose urinary tract infection will be treated in a home setting. When teaching this patient about her antibiotic, the nurse should instruct the patient to do which of the following? A) Take the first dose together with diphenhydramine to reduce the chance of an allergic reaction. B) Take the drug immediately before a meal, unless the meal will contain large amounts of fat. C) Drink a full glass of water when taking a dose of the drug. D) Taper off the drug rather than abruptly stopping it.
C) Drink a full glass of water when taking a dose of the drug. Patients taking penicillins should take oral doses with a full glass of water. The drugs should otherwise be taken on an empty stomach. Tapering is unnecessary, and it is not advised to take the drug with diphenhydramine in an effort to reduce the allergy risk.
Which condition would alert the nurse of the need to use beta-adrenergic blockers cautiously? A) Hypertension B) Raynaud's phenomenon C) Emphysema D) Cardiac dysrhythmias
C) Emphysema Beta-adrenergic blockers can produce severe bronchoconstriction. Selective beta-1 antagonists are used to treat hypertension. Alpha-adrenergic blocking agents are used to treat patients with Raynaud's disease. Beta-adrenergic blocking agents are indicated for patients with cardiac arrhythmias.
A patient has sought care from her primary care provider after feeling "under the weather" for several days. The care provider suspects that the patient is suffering from a viral illness. What signs and symptoms typically accompany viral infections? Select all that apply. A) Increased white cell count B) Idiopathic bleeding C) Malaise D) Fever E) Headache
C) Malaise D) Fever E) Headache Symptoms usually associated with acute viral infections include fever, headache, cough, malaise, muscle pain, nausea and vomiting, diarrhea, insomnia, and photophobia. White blood cell counts usually remain normal, and bleeding is uncharacteristic.
The physician orders benztropine mesylate (Cogentin). What disease process would contraindicate the administration of this anticholinergic medication? A) Diabetes mellitus B) Myocardial infarction C) Narrow-angle glaucoma D) Hyperparathyroidism
C) Narrow-angle glaucoma Narrow-angle glaucoma will result in increased intraocular pressure, and the patient should not receive the anticholinergic agent. Patients who suffer from diabetes mellitus, myocardial infarction, or hyperparathyroidism can normally be administered anticholinergic agents.
A patient is in the admission department prior to outpatient surgery, and she states that she is exceptionally nervous. Which of the following actions increases this patient's stress-related release of cortisol? A) Negative feedback mechanism B) Stimulation of the hypothalamus C) Release of epinephrine and norepinephrine D) Atrophy of the adrenal cortex
C) Release of epinephrine and norepinephrine The stress response activates the sympathetic nervous system to produce more epinephrine and norepinephrine and the adrenal cortex to produce as much as 10 times the normal amount of cortisol. The negative feedback mechanism does not accelerate the stress response. Cortisol production is not based on the stimulation of the hypothalamus. The stress response will not cause atrophy of the adrenal cortex.
When administering the azoles in the home setting, the home health nurse should prioritize educational interventions that address what nursing diagnosis? A) Risk for injury related to antifungal therapy B) Risk for acute confusion related to antifungal therapy C) Risk for infection related to antifungal therapy D) Risk for falls related to antifungal therapy
C) Risk for infection related to antifungal therapy When administering the azoles in the home setting, it is important that the home care nurse instruct the patient and family on the management of the environment with the implementation of good hand hygiene, household cleanliness, removal of potted plants and fresh flowers, and the use of air conditioning and air filtration systems. The nurse should also tell the patient and family about measures to prevent the reinfection and spread of the fungal infection. Falls, confusion, and injury are less likely consequences of using the azoles in the home setting.
A patient with osteoarthritis has been prescribed meloxicam (Mobic). Which of the following instructions should the patient be given? A) Take the medication with orange juice. B) Crush enteric-coated tablets to aid swallowing. C) Take the medication with food. D) Take the medication at bedtime.
C) Take the medication with food. Meloxicam should be taken with food. Enteric-coated tablets are never crushed, and it is not always necessary to take this medication at bedtime. Orange juice is not of particular benefit.
An adult patient has been taking oral prednisone for the treatment of an acute dermatological condition. When teaching this patient about this course of treatment, what teaching point should the nurse emphasize? A) The need to supplement prednisone with high doses of vitamin D B) The need to avoid drinking grapefruit juice for the duration of treatment C) The importance of gradually reducing rather than abruptly stopping the drug D) The importance of matching each day's dose to the severity of symptoms
C) The importance of gradually reducing rather than abruptly stopping the drug Gradually tapering the dose is necessary for any systemic corticosteroid. It is not imperative to avoid grapefruit juice or take vitamin D supplements. Daily doses are not normally adjusted on the basis of short-term symptoms.
Why are beta blockers used cautiously in patients with respiratory conditions? A) They mask the signs and symptoms of acute hypoglycemia. B) They cause extensive vasodilation and cardiac overload. C) They may produce severe bronchoconstriction. D) They increase hypertensive episodes.
C) They may produce severe bronchoconstriction Nonselective beta blockers, such as Inderal, and larger doses of selective beta antagonists will readily affect the beta-2 receptors of the bronchi, causing bronchoconstriction. Therefore, beta blockers must be used with extreme caution in patients with respiratory conditions such as bronchitis, emphysema, asthma, or allergic rhinitis. Beta blockers affect blood glucose by inducing the hypoglycemic effects of insulin. Vasodilation relieves cardiac overload. Beta blockers induce hypotensive effects.
A patient who is being administered metronidazole (Flagyl) to treat Clostridium difficile will also be administered which medication orally to assist in restructuring the flora of the intestinal tract? A) Spectinomycin (Trobicin) B) Rifaximin (Xifaxan) C) Vancomycin (Vancocin) D) Quinupristin-dalfopristin
C) Vancomycin (Vancocin) Oral vancomycin is used to treat pseudomembranous colitis caused by C. difficile. Spectinomycin (Trobicin), rifaximin (Xifaxan), and quinupristin-dalfopristin are not administered to treat pseudomembranous colitis caused by C. difficile.
What is the primary response to alpha-1 receptor stimulation? A) Bronchodilation B) Tachycardia C) Vasoconstriction D) Uterine relaxation
C) Vasoconstriction Stimulation of the alpha-1 receptors causes vasoconstriction of all blood vessels throughout the body. Alpha-1 receptor stimulation causes bronchoconstriction. Alpha-1 receptor stimulation does not cause tachycardia. Beta-2 receptor stimulation produces relaxation of smooth muscle tissue, such as the uterus.
A hospital nurse is aware that nosocomial infections pose a significant threat to many patients' health status. In order to reduce the spread of nosocomial infections, the nurse should prioritize which of the following actions? A) Increased use of empiric antibiotic therapy B) Use of disinfectants when providing patient hygiene C) Vigilant and thorough hand hygiene D) Patient education on the causes of infection
C) Vigilant and thorough hand hygiene Good hand hygiene is probably the most effective method of preventing infections. This supersedes the importance of education regarding the causes of infection or the use of disinfectants. Antibiotic therapy should only be used on patients who clearly need this treatment.
An adult patient with an autoimmune disorder regularly takes oral corticosteroids. The nurse knows that corticosteroids can be used in the successful treatment of inflammation but that they also create a risk for A) bleeding. B) leukocytosis. C) infection. D) electrolyte imbalances.
C) infection. Corticosteroids impair phagocytosis by preventing phagocytic cells from leaving the bloodstream. They decrease the amount of lymphocytes, fibroblasts, and collagen needed for tissue repair. This causes a reduction in inflammation but a commensurate increase in the patient's risk for infection.
A long-term care resident is taking an anticholinergic agent. The nurse observes the resident to be disoriented and hallucinating. The priority nursing action is to A) report development of alterations to the charge nurse. B) assess blood glucose. C) provide for resident's safety. D) medicate with antianxiety medication.
C) provide for resident's safety. Serious psychological side effects of anticholinergic agents include confusion, depression, nightmares, and hallucinations. The priority nursing action at onset of confusion and hallucinations is safety. Once the resident is safe, development of alterations may be reported. Blood glucose may be monitored once safety is established. If appropriate medications are ordered by the physician, they can be provided once the resident is calm and safe.
An emergency department nurse enters a patient's room with an order to administer epinephrine subcutaneously to treat his asthma attack. The patient's wife asks the nurse why it could not be given by mouth. Which of the following is the best response by the nurse? A) "The medication he is to receive is only given by an injection in the arm." B) "The medication is administered this way because it works faster than by mouth." C) "The medication is given many ways, but this is the way it was ordered." D) "The medication will not absorb in the GI tract if given by mouth."
D) "The medication will not absorb in the GI tract if given by mouth." Epinephrine is not given orally because enzymes in the GI tract and liver destroy it. The medication can be given through inhalation, intravenously, and subcutaneously. The medication will work more quickly in a parenteral form but is not given orally. Stating to the patient that this method is the way the physician ordered it to be given will belittle the patient and not provide adequate patient teaching.
Before the initiation of anticholinergic medications, it is important for the nurse to screen patients for which condition? A) Hypertension B) Infectious diseases C) Diabetes D) Closed-angle glaucoma
D) Closed-angle glaucoma The inhibition of cholinergic activity (anticholinergic effects) causes pupil dilation, which increases intraocular pressure in patients with glaucoma. In patients with closed-angle glaucoma, anticholinergic medications can precipitate an acute attack. Anticholinergic agents may produce increased heart rate but not hypertension. Anticholinergic agents do not affect infections or diabetes.
A patient who is receiving chemotherapy is administered a corticosteroid agent. What is the mostly likely intended effect of this drug administration? A) Increased pulmonary function B) Decreased diarrhea C) Decreased infection susceptibility D) Decreased nausea
D) Decreased nausea Corticosteroids have strong antiemetic effects; the mechanism is unknown. Corticosteroids diminish pulmonary inflammation, but this reaction is not related to chemotherapy administration. The administration of corticosteroids will decrease gastric inflammation but will not decrease diarrhea. The administration of corticosteroids will diminish the patient's ability to fight infection.
A nurse is preparing a patient's scheduled dose of oral vancomycin. This patient's current illness was most likely manifested by what sign or symptom? A) Vomiting B) Inflamed, swollen skin C) Shortness of breath D) Diarrhea
D) Diarrhea Oral vancomycin is useful only to treat staphylococcal enterocolitis and pseudomembranous colitis caused by C. difficile. These illnesses are always characterized by diarrhea, not vomiting, skin inflammation, or shortness of breath.
A woman is seen in the clinic for vaginal itching and discharge. Which of the following medications can be administered in a single dose to treat her discomfort and vaginal discharge? A) Caspofungin (Cancidas) B) Terbinafine (Lamisil) C) Ketoconazole (Nizoral) D) Fluconazole (Diflucan)
D) Fluconazole (Diflucan) Fluconazole (Diflucan) is used for vaginal candidiasis in a single oral dose of 150 mg. Caspofungin is not used for vaginal candidiasis, but for invasive aspergillosis. Terbinafine is used for interdigital tinea pedis. Ketoconazole is used for patients with organ transplants.
A patient is receiving hydrocortisone 40 mg PO daily for treatment of severe autoimmune inflammation. Which of the following nursing interventions is most important to implement? A) Increase dietary sodium. B) Limit dietary protein. C) Assess BUN and creatinine regularly. D) Implement infection control measures.
D) Implement infection control measures. Corticosteroids create a risk for infection due to immune suppression; infection control measures are a priority. When taking hydrocortisone daily, the patient should limit dietary sodium due to fluid retention. The patient should maintain a diet high in protein. The patient should not alter fluid intake unless the patient shows signs of fluid volume overload. Renal function may or may not be an assessment priority.
A patient is administered aztreonam (Azactam). What is the major advantage of this monobactam over the aminoglycosides in treating P. aeruginosa? A) It is a lower-cost medication. B) It is administered orally. C) It causes less GI distress. D) It has lower risk for hearing loss.
D) It has lower risk for hearing loss. Aztreonam is effective against gram-negative bacteria similar to aminoglycosides, but the drug does not cause kidney damage or hearing loss. Aztreonam is not a lower-cost medication. Aztreonam is not administered orally. Aztreonam does not cause less GI upset.
A patient is administered penicillin V orally for a strep throat. What is the mechanism of action of this medication? A) It inhibits protein synthesis. B) It lowers the pH of cellular contents. C) It causes mutations. D) It inhibits cell wall synthesis.
D) It inhibits cell wall synthesis. Beta-lactam antibacterial drugs inhibit synthesis of bacterial cell walls by binding to proteins in bacterial cell membranes. Penicillin V does not inhibit protein synthesis, cause mutations, or lower the pH of a bacterium's cellular contents.
Epinephrine is being considered in the treatment of an adult hospital patient. In anticipation, the nurse has reviewed the patient's current medication regimen. The presence of a drug from which of the following drug categories would contraindicate the safe use of epinephrine? A) Potassium-wasting diuretics B) Sulfonamide antibiotics C) Selective serotonin reuptake inhibitors (SSRIs) D) Monoamine oxidase (MAO) inhibitors
D) Monoamine oxidase (MAO) inhibitors It is essential not to give MAO inhibitors with adrenergic drugs because the combination may cause death. Use of adrenergics with diuretics, SSRIs, or sulfa antibiotics is not necessarily contraindicated.
A group of nursing students are learning about the factors that underlie recent increases in the incidence and prevalence of antibiotic-resistant microorganisms. What factor is known to contribute to antibiotic resistance? A) Increased survival rates from acute infections B) Increased population density C) Use of antibiotics that are ineffective against the infectious microorganism D) Overuse of antibiotics
D) Overuse of antibiotics Antibiotic overuse can contribute to antibiotic resistance. Resistance is not typically attributable to increased age of patients, increased population density, or the use of ineffective antibiotics.
A male patient has been on chronic corticosteroid therapy for several years and has been scheduled for a colonoscopy. How should the patient's corticosteroid therapy be altered to accommodate this impending stressful event? A) The patient should stop taking the corticosteroid 7 days prior to the procedure. B) The patient should continue taking the regular dose of his corticosteroid. C) The patient should temporarily change to IV administration of his corticosteroid. D) The patient should temporarily take a higher dose of his corticosteroid.
D) The patient should temporarily take a higher dose of his corticosteroid. For people receiving chronic corticosteroid therapy, dosage must be increased during periods of stress or illness. Some common sources of stress for most people include surgery and anesthesia, infections, anxiety, and extremes of temperature.
An older adult patient is to receive atenolol, a beta-adrenergic blocking agent. Prior to administration of the drug, the nurse assesses an apical pulse rate of 58 and notes ankle edema. Which action will the nurse take first? A) Determine the therapeutic blood level. B) Encourage the patient to decrease water intake. C) Elevate the patient's legs. D) Withhold the medication.
D) Withhold the medication. These signs and symptoms are indicative of serious adverse effects, and the medication should be held or discontinued until the patient is evaluated by a health care provider. Determining the therapeutic blood level, encouraging the patient to decrease water intake, and elevating the patient's legs are not the first actions that should be taken.
A patient hospitalized in an acute care setting reports to the nurse that since starting on an adrenergic medication, he has been feeling "dizzy and weak." The most appropriate action for the nurse is to A) immediately notify the physician. B) teach the patient to move slowly from standing to sitting. C) discontinue the adrenergic blocker. D) monitor the blood pressure in both the supine and standing positions.
D) monitor the blood pressure in both the supine and standing positions. Although infrequent and generally mild, adrenergic agents may cause some degree of orthostatic hypotension manifested by dizziness and weakness, particularly when therapy is initiated. This is anticipated and does not require the physician to be immediately notified.
The nurse is caring for a patient taking a cholinergic agent. When auscultating lung sounds, the nurse notes inspiratory and expiratory wheezing bilaterally. The best action for the nurse to take would be to A) provide the next dose of the cholinergic agent immediately. B) assess heart rate and blood pressure. C) reposition the patient. D) withhold the next dose and notify the physician.
D) withhold the next dose and notify the physician. Serious respiratory adverse effects of cholinergic agents include bronchospasm and wheezing. If these symptoms present, the next dose of the cholinergic agent should be withheld until the patient is evaluated by a health care provider.
