Pharmacology Final

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 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

A 66-year-old woman's most recent physical assessment and diagnostic workup reveal the presence of dyslipidemia. The woman is a candidate for monotherapy with a statin, and she will soon begin treatment with atorvastatin (Lipitor). The nurse should anticipate what order? A) "Lipitor 150 mg PO BID" B) "Lipitor 10 mg PO OD" C) "Lipitor 50 mg PO TID with meals" D) "Lipitor 75 mg PO BID"

B Lipitor is administered PO 10 to 80 mg daily in a single dose.

A patient is prescribed fenofibrate (TriCor). When providing patient teaching, which of the following accurately describes the action of fenofibrate? A) It binds to bile acids in the intestinal lumen. B) It increases oxidation of fatty acids in the liver. C) It inhibits an enzyme required for hepatic synthesis. D) It inhibits mobilization of free fatty acids from peripheral tissues

B Most effective for reducing serum triglyceride levels

A patient with ulcers has asked the nurse if it would be acceptable for him to take bismuth subsalicylate. Before recommending an OTC formulation of this drug, the nurse should assess the patient's A) immunization history. B) allergy status. C) cognition. D)normal bowel pattern

B People with allergy to aspirin or other salicylates should not take Pepto-Bismol (which is a subsalicylate) This drug can also cause serious bleeding if used alone in patients with ulcers because it is a salicylate (like aspirin)

A patient has a history of clot formation. She is scheduled for bowel resection due to colorectal cancer. What anticoagulant agent will be administered prophylactically? A) Acetylsalicylic acid (Aspirin) B) Heparin C) Warfarin (Coumadin) D) Streptokinase (Streptase)

B Prophylactically, low doses of heparin are given to prevent thrombus formation in patients having major abdominal surgery. Warfarin takes several days for therapeutic effects to occur; thus it is not used prophylactically to prevent thrombus in a patient with abdominal surgery. Streptokinase promotes thrombolysis and is not used to prevent thrombus.

Protein binding is an important aspect of pharmacokinetics. Protein binding ultimately has which of the following effects on drug action? A) Increases the drug's speed of action B) Decreases the drug's speed of action C) Increases the rate of excretion D) Averts adverse effects

B Protein binding allows part of a drug to be stored and released as needed. Drugs that are highly bound to plasma proteins or stored extensively in other tissues have a long duration of action

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, 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 experienced the formation of clots and has bruising. It is determined that there is a depletion of the patient's coagulation factors and widespread bleeding. Which of the following medications will be administered? A Aminocaproic acid (Amicar) B) Heparin C) Warfarin (Coumadin) D) Protamine sulfate

B The development of clots and widespread bleeding is indicative of disseminated intravascular coagulation. The patient should be administered heparin to slow the formation of clots. The goal of heparin therapy in DIC is to prevent blood coagulation long enough for clotting factors to replenish and control hemorrhage.

A patient is admitted with an acute asthma attack. He has been using inhaled corticosteroids two times daily. Based on this information in the patient's history, what should you anticipate will be required in his care? A) The patient will require an antibiotic to treat infection. B) The patient will require high doses of systemic drugs. C) The patient will need to be treated with an oral opioid. D) The patient will have diminished tidal volume after treatment.

B The patient who has taken inhaled steroids will require high doses of systemic drugs during acute attacks because aerosols are not effective.

A patient with a diagnosis of bipolar disorder has begun lithium therapy, and the nurse has explained the need for regular monitoring of the patient's serum drug levels. What is the primary rationale for the nurse's instruction? A) It is necessary to regularly test for blood-drug incompatibilities that may develop during treatment. B) It is necessary to ensure that the patient's drug levels are therapeutic but not toxic. C) It is needed to determine if additional medications will be needed to potentiate the effects of lithium. D) It is needed in order to confirm the patient's adherence to the drug regimen.

B.

10. A nurse who provides care on a postsurgical unit frequently administers Schedule II drugs to patients. Which of the following aspects of administering these drugs falls under the auspices of the Drug Enforcement Agency? A) Performing a thorough patient assessment prior to administration B) Recording each dose administration on an agency narcotic sheet C) Informing patients of the potential risks and benefits of Schedule II drugs prior to the first dose D) Assessing the patient shortly after administration to ensure therapeutic effect

B.

12. A hospital nurse is vigilant in ensuring the safe use of medications and consistently applies the rights of medication administration. Which of the following is one of the traditional rights of medication administration? A) Right to refuse B) Right route C) Right education D) Right evaluation

B.

A nurse is aware of the importance of adhering to the intended route of a medication. Which of the following drugs are formulated to be absorbed through the skin? A) Amoxicillin, tetracycline, and penicillin B) Clonidine, fentanyl, and nitroglycerin C) Digoxin, lidocaine, and propranolol D) Insulin, heparin, and morphine

B.

A patient is suffering from a cough associated with an upper respiratory infection. Which oral medication will likely produce the most therapeutic effect? A) A tablet B) An expectorant C) A topical spray D) A timed-release tablet

B.

A patient has questioned why she cannot stop taking her prescribed corticosteroid as soon as she achieves relief of her symptoms. The nurse should explain the rationale for the patient's regimen based on which of the following? A) The serum half-life of many corticosteroids can exceed 3 months. B) Corticosteroids are sequestered in hepatocytes and released over several weeks. C) The HPA axis does not normally resume full function for several months. D) Abrupt cessation of corticosteroid therapy can cause nephrotoxicity.

C

A patient is administering eye drops. What should the patient be taught in order to decrease systemic absorption of eye drops? A) Lie supine for 1 minute after instillation. B) Apply pressure for 2 minutes over the tear duct. C) Apply pressure for 5 minutes over the tear duct. D) Remain still for 10 minutes after instillation

C

A patient is admitted to the emergency department with severe heart failure. Milrinone (Primacor) is administered IV. For what adverse effect should the patient be assessed? A) Hypertension B) Bradycardia C) Atrial dysrhythmias D) Lethargy

C

A patient is beginning therapy with isosorbide dinitrate (Isordil). When will the nurse know that the patient has maximal tolerance? A) When nausea develops B) When halos are seen around lights C) When a headache develops D) When the heart rate increases to 100

C

A patient is being administered heparin IV and has been started on warfarin (Coumadin). The patient asks the nurse why she is taking both medications. What is the nurse's most accurate response? A) "After a certain period of time, you must start warfarin and heparin together." B) "You will need both warfarin and heparin for several days." C) "Warfarin takes 3 to 5 days to develop anticoagulant effects, and you still need heparin." D) "Warfarin cannot be given without heparin due to the amount of clotting you need."

C

A patient is diagnosed with B. fragilis, an anaerobic organism resistant to most drugs. What is the drug of choice to treat this microorganism? A) Cefaclor (Ceclor) B) Cefamandole nafate (Mandol) C) Cefoxitin (Mefoxin) D) Cefuroxime sodium (Zinacef)

C

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

A patient is instructed to take diphenhydramine (Benadryl) after an allergic reaction. Which of the following statements by the patient indicates successful teaching concerning the safe and effective use of diphenhydramine? A) "I will still be able to have my after-dinner drink with this medication." B) "I will eat a diet low in sodium while taking this medication." C) "I should not drive my car after taking this medication." D) "I can take this medication every 2 hours until I feel better."

C

A patient is scheduled for an ophthalmic examination. Which of the following medications will be administered? A) Pseudoephedrine hydrochloride B) Epoetin alfa (Epogen) C) Phenylephrine D) Pilocarpine (Pilocar)

C

A patient is scheduled to have her serum triglyceride level assessed. How long should the patient be without food or fluids prior to the serum triglyceride test? A) 6 hours B) 8 to 10 hours C) 12 hours D) 24 hours

C

A patient is scheduled to receive an immunization. In which of the following patients may the administration of a live vaccine be contraindicated? A) Patient with renal insufficiency B) Patient with hepatic failure C) Patient taking steroid therapy D) Patient over the age of 65 years

C

A patient is scheduled to undergo craniofacial surgery, a procedure that will necessitate the use of propofol. The operating use nurse should be aware that alternative medications will be absolutely necessary in order to produce what effect in the patient? A) Amnesia B) Euphoria C) Analgesia D) Hypnosis

C

A patient is started on levothyroxine (Synthroid) for treatment of hypothyroidism. During patient teaching, how frequently can the dosage be increased until symptoms are relieved? A) Every 3 to 5 days B) Weekly C) Every 2 weeks D) Monthly

C

A patient is taking warfarin (Coumadin) to prevent clot formation related to atrial fibrillation. How are the effects of the warfarin (Coumadin) monitored? A) RBC B) aPTT C) PT and INR D) Platelet count

C

A patient requires a high dose of his new antihypertensive medication because the new medication has a significant first-pass effect. This means that the drug A) must pass through the patient's bloodstream several times to generate a therapeutic effect. B) passes through the renal tubules and is excreted in large amounts. C) is extensively metabolized in the patient's liver. D) is ineffective following the first dose and increasingly effective with each subsequent dose.

C

A patient states that she takes acetaminophen (Tylenol) four to five times daily when she is at home. Which of the following laboratory tests is a relevant response to this practice? A) Cardiac enzymes B) Peak and trough C) Liver enzymes D) White blood cell count

C

A patient with a complex medical history states that his primary care provider has changed his proton pump inhibitor from omeprazole (Prilosec) to esomeprazole (Nexium). The patient is unsure of the rationale for this change in medication and has raised this question with the nurse. What rationale is most plausible? A) Nexium has fewer adverse effects. B) Nexium can be used long term. C) Nexium has fewer drug interactions. D) Nexium can be taken on an outpatient basis.

C

A patient with a history of angina has sustained a mild head injury in a motor vehicle accident. He has nitroglycerin tablets for chest pain and asks the nurse for one due to chest pain. What effect will the nitroglycerin have on the patient's current status? A) Nitroglycerin will raise the patient's blood pressure. B) Nitroglycerin will cause decreased cerebral edema. C) Nitroglycerin will increase intracranial pressure. D) Nitroglycerin will decrease blood glucose.

C

A patient with a long-standing history of asthma has failed to achieve adequate symptom control with first-line drugs. As a result, her care provider has prescribed theophylline. The nurse is aware of the narrow therapeutic range of this drug and has taught the patient to recognize the signs and symptoms of toxicity. These include which of the following? A) Polyuria and polyphagia B) Confusion and decreased level of consciousness C) Agitation and dysrhythmias D) Chest pain and shortness of breath

C

A patient with asthma has been prescribed ipratropium (Atrovent) 2 puffs QID. The nurse should recognize which of the following as the most likely goal of this treatment? A) Promoting short-term relief of acute asthma symptoms B) Relieving acute bronchoconstriction C) Promoting long-term management of asthma symptoms D) Promoting blood flow in the alveolar capillaries

C

A patient with hypertension has been prescribed a combination diuretic. What is the major purpose in administering a combination diuretic agent? A) It prevents sodium imbalance. B) It is less expensive than two medications. C) It prevents potassium imbalance. D) It prevents allergic reactions.

C

A patient with septicemia is administered cefotaxime sodium (Claforan), a second-generation cephalosporin. How is this medication excreted? A) It is excreted by the lungs. B) It is excreted by the liver. C) It is excreted by the kidneys. D) It is excreted through the GI tract.

C

A patient's chronic venous ulcer on the lower lateral surface of his leg requires incision and debridement (I & D). The nurse should anticipate that lidocaine will be administered by which of the following routes? A) Intravenous B) Topical C) Injection D) Nebulized

C

A public health nurse is responsible for the administration of numerous immunizations. Which of the following guidelines regarding anaphylaxis should the nurse adhere to? A) The patient should be observed for anaphylaxis for 1 minute after administration. B) The patient should be observed for anaphylaxis for 5 minutes after administration. C) The patient should be observed for anaphylaxis for 30 minutes after administration. D) The patient should be observed for anaphylaxis for 90 minutes after administration.

C

A teenager is being treated for acne vulgaris. Which oral antibiotics may be prescribed to treat acne? A) Neomycin and vancomycin B) Gentamicin and Rocephin C) Tetracycline and erythromycin D) Bacitracin and polymyxin B

C

An 88-year-old woman has developed syncope (fainting) since an antihypertensive agent was added to her medication regime. The development of syncope may be related to which of the following physiologic processes? A) Interaction of other medications B) Ingestion of herbal supplements C) Diminished excretion of the medication D) Increased metabolism of the medication

C

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

An adult patient with a diagnosis of asthma has been prescribed montelukast (Singulair). The nurse should teach the patient that this drug will help relieve symptoms by A) reducing the muscle tone in the alveoli and facilitating gas exchange. B) relaxing smooth muscle in the bronchi and bronchioles. C) preventing the bronchoconstriction and inflammation that is caused by leukotrienes. D) preventing mast cells from releasing histamine.

C

An older adult patient is recovering in hospital from an ischemic stroke and has a feeding tube in place due to dysphagia. The patient has developed an infected pressure ulcer, and ciprofloxacin suspension has been ordered as empiric therapy. How should the nurse follow up this order? A) The nurse should flush the patient's feeding tube with free water before and after administration of the ciprofloxacin suspension. B) The nurse should dilute the suspension thoroughly before administration. C) The nurse should liaise with the care provider to provide an alternative route of administration. D) The nurse should administer small, frequent doses of the drug to minimize GI upset.

C

During a teaching session on the care of the diabetic patient, a family member asks why her daughter has a different insulin than her best friend. The nurse should make which of the following statements to explain the differences in insulin? A) "Insulin is prescribed based on the insurer's criteria for reimbursement." B) "Insulin is prescribed based on the patient's age." C) "Insulins have different onsets and durations of action." D) "Insulin type is matched with the appropriate oral hypoglycemic agent."

C

Laboratory testing of an 80-year-old patient who is well-known to the clinic nurse indicates that his liver function has been gradually decreasing over the last several years. How will this age-related physiological change influence drug metabolism? A) The patient will metabolize drugs more quickly but derive less of a therapeutic benefit from them. B) The liver will sequester drug molecules in the hepatocytes, and they will be released at unpredictable times. C) Many of the patient's medications will remain in his body for a longer time. D) The patient's kidneys will be forced to metabolize a disproportionate quantity of medications.

C

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

Resetting of a patient's fracture will take place under local anesthetic. These anesthetics reduce movement and sensation by decreasing the permeability of the nerve cell membrane to ions. What is the most important ion that participates in this process? A) Calcium B) Magnesium C) Sodium D) Potassium

C

The home care nurse sees a patient for the first time. The patient has crackles in the lower lobes of the lungs, an audible S3, and pitting edema in the feet and ankles. What condition is the patient most likely experiencing? A) Pneumonia B) Liver disease C) Heart failure D) Myocardial infarction

C

The physician orders tretinoin (Retin-A) for the treatment of acne. Which of the following instructions should be provided? A) "You will see positive results in 1 week" B) "Apply the medication two to three times a day." C) "Apply the topical medication one time per day." D) "Apply the medication for 1 hour and remove it."

C

When instructing a patient on the use of a nitroglycerin patch, what should the patient be taught regarding the advantage of the nitroglycerin patch? A) It is only administered one time per week. B) It is more effective than the tablets. C) It has a longer duration of action. D) It has a faster action than the tablets.

C

When providing dietary instruction on a low-sodium diet, which dietary choice is most appropriate for a patient with hypertension? A) Hot dog, baked beans, and coleslaw B) Grilled hamburger, french fries, and cola C) Grilled chicken, green salad, and apple D) Ham sandwich, potato chips, and cookie

C

You have received an order for a medication to be administered buccally. Where is the medication administered? A) Eye B) Vagina C) Cheek D) Nose

C

An adult patient has complained to the nurse that she has been experiencing a dry mouth and urinary retention after several nights of taking an OTC sleep aid. The nurse should suspect that this medication contains what antihistamine? A) Loratadine (Claritin) B) Promethazine (Phenergan) C) Diphenhydramine (Benadryl) D) Olopatadine (Patanol)

C 1st Generation Antihistamines are known to cause anticholinergic effects (dry mouth and urinary retention in this case)

A patient has been prescribed alendronate (Fosamax). Which of the following instructions should the patient be given regarding the administration of this medication? A) Take the medication with whole milk. B) Take the medication and lie down for 30 minutes. C) Take the medication on an empty stomach. D) Take the medication to increase bone resorption.

C fosamax is a medication for bone health

An elderly patient has taken ibuprofen (Motrin) 800 mg two times per day for the past 3 years. Which of the following laboratory tests is the priority assessment? A) Renin and aldosterone levels B) 24-hour urine for microalbumin C) Blood urea nitrogen and serum creatinine D) Complete blood count

C ibuprofen (motrin) is NEPHROTOXIC aspirin is NEPHROTOXIC acetaminophen (tylenol) is HEPATOTOXIC

An older adult patient has sought care for the treatment of hemorrhoids, and the care provider has prescribed topical lidocaine. The nurse should teach the patient that full pain relief will normally be achieved how long after application of lidocaine? A) 5 to 10 minutes B) 15 to 30 minutes C) 20 to 60 minutes D) 90 minutes to 2 hours

C topical lidocaine becomes numb after 20 to 60 minutes

The nurse is providing health education for the parents of a child whose otitis media has warranted treatment with Cortisporin Otic. The nurse should explain that this medication contains which of the following components? Select all that apply. A) An analgesic B) A topical anesthetic C) An antibiotic D) A steroid E) An immunomodulator

C, D cortisporin otic is an ear drop used for bacterial infections of the ear

5. Which of the following reference books provides information from the drug manufacturers' inserts? A) American Formulary Service B) Drug Facts and Comparisons C) Physicians' Desk Reference D) Lippincott's Nursing Drug Guide

C.

9. A nurse is aware that American drug laws have a long and complex history, with numerous jurisdictions being involved. What is the primary purpose of drug laws in the United States? A) To ensure maximum choice for consumers B) To expedite the workload of care providers C) To protect the safety of the public D) To enhance the efficient delivery of health care

C.

Trials of a new drug are scheduled to soon begin and the testing methodology will integrate the stipulations of the National Institutes of Health (NIH) Revitalization Act. According to this act, the manufacturer must A) independently fund the entire testing process. B) make the results of the testing process publicly available. C) include women and minorities in the testing process. D) exclude any potential for financial gain during the testing process.

C.

3. A nurse is responsible for maintaining an accurate count and record of the controlled substances on the nursing unit. This nursing action is regulated by which of the following laws or agencies? A) Food, Drug, and Cosmetic Act of 1938 B) Public Health Service C) Drug Enforcement Administration D) Shirley Amendment

C. The Drug Enforcement Administration enforces the Controlled Substances Act. Under this enforcement, nurses are responsible for storing controlled substances in locked containers, administering them only to the people for whom they are prescribed, recording each dose given, and maintaining an accurate inventory. The Food, Drug, and Cosmetic Act of 1938 revised and broadened FDA powers and responsibilities, giving the FDA control over drug safety. The Public Health Service is regulated by the state to maintain the health of individual citizens of the state. The Shirley Amendment of 1912 prohibited fraudulent claims of drug effectiveness.

4. Which organization is responsible for approving new drugs in the United States? A) American Medical Association B) American Pharmaceutical Association C) Food and Drug Administration D) United States Pharmacopeia

C. The Food and Drug Administration is responsible for approving new drugs in the United States. The American Medical Association represents the physicians of the United States. The American Pharmaceutical Association represents the pharmacists of the United States. The United States Pharmacopeia was adopted in 1906 and is issued every 5 years under the supervision of a national committee of pharmacists, scientists, and physicians.

A child's primary health care provider has prescribed Cortisporin Otic for a child who has otitis media in her right ear. What administration instructions should the nurse provide to the parents of the child? A) "Put one drop into her right ear each morning." B) "Place two drops in her right ear each morning and then again before bedtime." C) "Put one to two drops in her right ear whenever you notice discharge or she complains of pain." D) "Place three drops into her ear four times a day."

D

A college sophomore has sought care because of her worsening acne. Before beginning a medical regime that includes a retinoid, which of the following laboratory tests must be negative? A) Throat culture B) Skin culture C) Stool for occult blood D) Pregnancy test

D

A community health nurse is facilitating a health promotion session to a group of seniors. Which of the following is most important to instruct regarding hypertension? A) Hypertension will increase the risk of cancer. B) An increase in sodium is recommended with hypertension. C) Vigorous exercise will increase the risk of hypertension. D) Hypertension will increase the risk of heart disease.

D

A gerontological nurse is aware that older adults' abilities to excrete medications diminish with age. When appraising an older adult's ability to excrete medications, what laboratory or diagnostic finding should the nurse prioritize? A) Renal ultrasound B) Complete blood count (CBC) C) Serum bilirubin and albumin levels D) Blood urea nitrogen and creatinine levels

D

A hospital patient with a diagnosis of liver failure has been prescribed a low dose of spironolactone in order to treat ascites. The nurse who is providing this patient's care should prioritize assessments for the signs and symptoms of what health problem? A) Peritonitis B) Liver cancer C) Cirrhosis D) Hepatic encephalopathy

D

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

A nurse begins a patient interaction by systematically gathering information on the patient's care and eventually evaluating the outcomes of care. Which of the following represents this continuum of care? A) Assessment process B) Outcomes analysis C) Nursing interventions D) Nursing process

D

A nurse has provided an oral dose of morphine, an opioid agonist, to a woman in early labor. The nurse should be aware of what characteristic of agonists? A) Agonists alter the normal processes of distribution and metabolism. B) Agonists counteract the action of specific neurotransmitters. C) Agonists block the action of specific neurotransmitters. D) Agonists bind to receptors and cause a physiological effect.

D

A nurse is administering a mumps vaccine to an adolescent. Which of the following medications should be available when administering an immunization? A) Diphenhydramine (Benadryl) B) Hydroxyzine (Vistaril) C) Physostigmine D) Epinephrine

D

A patient has been administered an aminoglycoside. It is time for his next dose, and the nurse learns his creatinine level is elevated at 3.9 mg/dL. What action should the nurse take regarding this assessment? A) Administer the medication and report the creatinine level. B) Hold the dose until another creatinine level is assessed. C) Administer the medication with 100 mL of fluids. D) Hold the medication and assess the urine output.

D

A patient has been prescribed digoxin (Lanoxin) and furosemide (Lasix) for treatment of congestive heart failure. What is the patient at risk for developing with this combination of medications? A) Hyperkalemia B) Hyperglycemia C) Tachycardia D) Digoxin toxicity

D

A patient has been receiving morphine sulfate 5 mg IV every 4 hours for the past several days. She states that the pain is not being relieved as well as it was in the past. What is the reason for this development? A) She has developed a dependency on the morphine. B) She has metastatic cancer and is dying. C) She has greater pain with inactivity. D) She has developed tolerance to morphine

D

A patient has received a rubella immunization. The patient was unaware that she was pregnant. What risk is associated with the administration of the rubella immunization in this patient? A) Risk of development of the disease in the newborn B) Risk of low infant birth weight C) Risk of preterm labor D) Risk of birth defects

D

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

A patient is being treated for a urinary tract infection with trimethoprim-sulfamethoxazole (Bactrim). What assessment should the nurse make prior to the administration of the medication? A) Assessing for the presence of asthma B) Assessing for hypertension C) Assessing for diabetes mellitus D) Assessing for renal insufficiency

D

A patient is diagnosed with heart failure. She asks the nurse for further details about heart failure. Which of the following statements is most accurate? A) "Heart failure can be caused by atherosclerotic plaque due to high-fat diets." B) "Hypothyroidism will result in decreased heart rate and development of heart failure." C) "The administration of diuretics increases blood volume, causing symptoms to abate." D) "The use of digoxin will slow heart rate to make your heart more efficient."

D

A patient is diagnosed with hypertension, and the care team is establishing the best medication regimen to match the patient's decreased level of function. Which of the following medications can be administered by transdermal patch? A) Amlodipine (Norvasc) B) Candesartan (Atacand) C) Enalapril (Vasotec) D) Clonidine (Catapres)

D

A patient is experiencing nausea and visual disturbances when taking digoxin (Lanoxin). Which of the following medications will be administered? A) Acetylsalicylic acid (aspirin) B) Nesiritide (Natrecor) C) Felbamate (Felbatol) D) Digoxin immune fab (Digibind)

D

A patient is instructed on the administration of inhaled corticosteroid agents to treat asthma. How do inhaled corticosteroid agents assist in the treatment of asthma? A) Inhaled corticosteroid agents will depress the central nervous system. B) Inhaled corticosteroid agents will reduce respiratory rate. C) Inhaled corticosteroid agents will reduce bronchodilation. D) Inhaled corticosteroid agents will reduce airway inflammation.

D

A patient is near the end of life and has developed increased respiratory secretions and labored breathing. The physician is likely to order which of the following medications to decrease these symptoms? A) Meclizine (Antivert) B) Ampicillin C) Naloxone (Narcan) D) Morphine sulfate

D

A patient is prescribed a potassium-sparing diuretic. What electrolyte imbalance would the patient be prone to develop? A) Hypernatremia B) Hyponatremia C) Hypokalemia D) Hyperkalemia

D

A patient is prescribed an adrenergic bronchodilator for airway constriction. Which of the following conditions will require it to be administered cautiously? A) Liver failure B) Renal failure C) Respiratory constriction D) Seizure disorder

D

A patient is prescribed ranolazine (Ranexa) to treat chronic angina. Which of the following electrocardiogram changes will contraindicate the use of ranolazine? A) Normal ST segment B) Inverted P wave C) Shortened QRS D) QT prolongation

D

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

A patient is scheduled to receive one unit of packed red blood cells. The patient states that she has had an allergic reaction to a transfusion in the past. What class of medication will assist in preventing a reaction to the packed red blood cell transfusion? A) Antipyretics B) Antimicrobials C) Antianginals D) Antihistamines

D

A patient is taking spironolactone (Aldactone). When providing patient teaching about this medication, what foods should the patient be instructed to avoid? A) Fish B) Apples C) Crackers D) Bananas

D

A patient is taking warfarin (Coumadin) after open heart surgery. The patient tells the home care nurse she has pain in both knees that began this week. The nurse notes bruises on both knees. Based on the effects of her medications and the complaint of pain, what does the nurse suspect is the cause of the pain? A) Joint thrombosis B) Torn medial meniscus C) Degenerative joint disease caused by her medication D) Bleeding

D

A patient is using an albuterol (Proventil) inhaler, which is a bronchodilator. Which of the following patient teaching interventions is a priority for the patient who experiences shortness of breath related to constriction of airways? A) Administer insulin to decrease hand shaking. B) Administer ibuprofen (Advil) to decrease inflammation. C) Exercise should be limited to one time per week. D) Stop smoking due to the bronchoconstriction.

D

A patient undergoing chemotherapy for the treatment of lung cancer has developed stomatitis. Oral lidocaine viscous has consequently prescribed by the primary caregiver. To minimize the patient's chance of aspiration, the nurse should encourage the patient to A) take small bites of food and small sips of fluid after administration. B) adopt a minced and pureed diet for the duration of treatment. C) remain in a high Fowler's position for 90 minutes following the use of lidocaine viscous. D) avoid eating or drinking for 1 hour following the use of lidocaine viscous

D

A patient with a diagnosis of cardiovascular disease is taking atorvastatin calcium (Lipitor) to reduce serum cholesterol. What is the goal of therapy for LDL cholesterol for a patient taking atorvastatin calcium (Lipitor)? A) 100 to 115 mg/dL B) 75 to 85 mg/dL C) Less than 60 mg/dL D) Less than 100 mg/dL

D

A patient with angina is prescribed propranolol (Inderal). Following absorption of the drug, the nurse should expect to assess A) relief of fatigue. B) increased oxygen saturation levels. C) mild to moderate drowsiness. D) decreased heart rate.

D

A patient with sepsis is being treated with gentamicin, and her medication regimen takes into account the phenomenon of postantibiotic effects. What are postantibiotic effects? A) The tendency for patients to exhibit symptoms mimicking hypersensitivity after drug administration B) The tendency for adverse effects of a drug to be masked during administration C) The ability of microorganisms to proliferate between doses of antibiotics D) The ability of an antibiotic to kill bacteria even when serum concentrations are low

D

A patient's medication administration record specifies that the patient is to receive 20 units of NPH insulin at 08:00. Before administering this medication, the nurse must do which of the following? A) Massage the chosen injection site. B) Assess the patient's understanding of diabetes. C) Assess the patient's urine for the presence of glucose. D) Have a colleague confirm the dosage.

D

A perioperative nurse is explaining the process of general anesthesia in anticipation of the adult patient's imminent bowel resection. When describing the phase of induction, the nurse should explain that this is usually achieved by what means? A) Intramuscular injection of anesthetics and benzodiazepines B) Intravenous administration of opioid analgesics C) Subcutaneous injection of a rapid-acting anesthetic D) Intravenous administration of anesthetics

D

A second-generation H1 receptor antagonist antihistamine formulated as a nasal spray for topical use is A) chlorpheniramine (Chlor-Trimeton). B) clemastine (Tavist). C) cyproheptadine (Periactin). D) azelastine (Astelin).

D

A young adult began acne treatment several weeks ago using a combination ointment and has presented for a follow-up appointment at the clinic. When assessing the patient for adverse effects of treatment, what question should the nurse prioritize? A) "Have you found that the ointment makes your skin a lighter color?" B) "Do you find that the ointment makes your pimples bleed more easily?" C) "Do your eyes burn when you apply the ointment to your face?" D) "Is the skin on your face uncomfortably dry since you began using the ointment?"

D

An 8-month-old infant is admitted to the pediatric floor of the community hospital with a new diagnosis of diabetes. The patient is to receive 1 unit of regular insulin subcutaneously. How will that 1 unit be administered? A) It is administered orally. B) It is administered as U-5. C) It is administered with a TB syringe. D) It is administered as U-10

D

An adult patient has a history of rheumatic fever. Which of the following medications should be administered as prophylaxis for rheumatic fever? A) Cyclacillin (Cyclapen) B) Amoxicillin (Augmentin) C) Dicloxacillin D) Penicillin G benzathine (Bicillin LA)

D

An older adult patient has a complex medical history that includes heart failure, type 1 diabetes, and diabetic nephropathy. The nurse has questioned a care provider's order for oral spironolactone because the patient's health problems would contribute to a high risk of A) metabolic acidosis. B) hypocalcemia. C) hemolytic anemia. D) hyperkalemia.

D

A patient has been taking digoxin (Lanoxin) for 5 years for the treatment of heart failure. In the last 3 months, she has noticed she is tired all the time, her heart rate is very slow, and she is always cold. The nurse assessing the patient notes her blood pressure at 88/50 and pulse rate is 44. The nurse instructs the patient not to take her digoxin. What condition may the patient be suffering from that would contraindicate the administration of digoxin? A) Hypothyroidism B) Myocardial infarction C) Cerebrovascular accident D) Intermittent claudication

A

A patient has undergone a thyroidectomy in which his parathyroid glands were also inadvertently removed. The patient's morning blood work reveals a serum calcium level of 3.1 mg/dL (normal 8.5 to 10.5 mg/dL). The nurse should consequently assess this patient's A) muscle tone. B) level of consciousness. C) respiratory rhythm. D) respiratory rate.

A

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

A patient is being assessed by the home care nurse on the appropriate use of her metered-dose inhalers. Which of the following will assist in proper administration of the inhaler? A) Use of a spacer B) Administration of a corticosteroid first C) Pushing fluids D) Exhaling immediately after administration

A

A patient is being treated for heart failure. Which of the following is most indicative of improved health status? A) Decreased pedal edema B) Increased skin turgor C) Heart rate of 52 D) Improved sensorium

A

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

A patient is diagnosed with erectile dysfunction. He asks what effect sildenafil (Viagra) has because he is taking nitroglycerin for chest pain. What is the best explanation for why nitrates are contraindicated with sildenafil (Viagra)? A) "Nitroglycerin and Viagra cause a severe decrease in blood pressure." B) "Nitroglycerin and Viagra can lead to prostate cancer." C) "Nitroglycerin decreases the effect of Viagra for erectile dysfunction." D) "Nitroglycerin and Viagra will diminish the effectiveness of chest pain relief."

A

A patient is experiencing chest pain and administers her nitroglycerin sublingually. When should the patient expect to notice relief of her chest pain? A) 1 to 3 minutes B) 5 to 10 minutes C) 15 to 20 minutes D) 30 to 60 minutes

A

A patient is in the intensive care unit to be digitalized. This patient is to be digitalized rapidly. What is the total dose range of digoxin (Lanoxin) for rapid digitalization? A) 0.75 to 1.5 mg B) 2.0 to 2.5 mg C) 3.75 to 4 mg D) 0.125 to 0.05 mg

A

A patient is prescribed a proton pump inhibitor to treat erosive gastritis. How soon will the patient's symptoms most likely be abolished? A) 1 to 2 weeks B) 4 weeks C) 1 month D) 6 weeks

A

A patient is receiving acetaminophen (Tylenol) for fever. The patient also has inflammation in the knees and elbows with pain. Why will acetaminophen (Tylenol) assist in reducing fever but not in decreasing the inflammatory process? A) Prostaglandin inhibition is limited to the central nervous system. B) Acetaminophen inhibits cyclooxygenase (COX-1 and COX-2) only. C) Acetaminophen has an antiplatelet effect to decrease edema. D) Prostaglandins decrease the gastric acid secretion.

A

A patient is predicted to benefit from dexamethasone eye drops. The presence of what eye disorder would contraindicate the use of this drug? A) Fungal infection B) Nearsightedness C) Cataracts D) Bacterial conjunctivitis

A Contraindications to dexamethasone include corneal or conjunctival viral disease caused by herpes simplex, vaccina, or varicella. other contraindications are mycobacterial and fungal infection of the eye as well as advanced glaucoma and hypersensitivity to corticosteroids.

An 85-year-old patient has an elevated serum creatinine level, indicating impaired kidney function. When the patient is administered a medication, this patient is at risk for which of the following medication-related effects? A) Toxicity B) Increased absorption C) Delayed gastric emptying D) Idiosyncratic effects

A.

An 80-year-old woman has sought care for a dermatological health problem that most often requires treatment with an oral corticosteroid. When considering whether to prescribe steroids to this patient, the care provider should prioritize which of the following questions? A) "Should this patient receive a medication that was likely tested on younger adults?" B) "Do the potential benefits of this medication outweigh the potential harm?" C) "Are there plausible herbal or complementary alternatives to this medication?" D) "Is there a younger adult who can oversee this patient's medication regimen?"

B

A health care worker has received her annual influenza vaccination and has remained at the clinic after administration so that the nurse may observe for adverse reactions. The worker complains of pain at the site of IM injection. The nurse should recommend which of the following? A) ASA B) Acetaminophen C) Meperidine (Demerol) D) Heat application

B

A hospital patient is complaining of nausea and vomiting that has failed to respond to first-line antiemetics. Which of the following medications may be administered for the treatment of nausea and vomiting? A) First-generation antihistamine agent: chlorpheniramine (Chlor-Trimeton) B) First-generation antihistamine agent: hydroxyzine (Vistaril) C) Second-generation antihistamine agent: loratadine (Claritin) D) Second-generation antihistamine agent: cetirizine (Zyrtec)

B

A hospital patient's medication administration record specifies concurrent doses of nebulized ipratropium and albuterol at 08:00 and 20:00. When administering these drugs, which of the following statements is true? A) The two drugs should be administered at least 30 minutes apart, with ipratropium administered first. B) The two drugs can be mixed in the nebulizer immediately before administration. C) The two drugs should be administered at least 30 minutes apart, with albuterol administered first. D) The nurse should contact the prescriber due to the increased risk of adverse effects when these drugs are administered concurrently.

B

A medical nurse is aware of the need to assess for potential ototoxicity in patients who are being treated with gentamicin. Which of the following patients is likely most susceptible to developing ototoxicity secondary to gentamicin? A) A man who received his first dose of IV gentamicin 12 hours ago B) A man who has required repeated courses of gentamicin over the past several months C) A woman who has a Pseudomonas infection but who has a hypersensitivity to penicillins D) A woman who is immunocompromised and who is being treated with gentamicin

B

A nurse has administered a scheduled dose of 50-mg atenolol PO for the treatment of angina. Following administration, the nurse should prioritize what assessment? A) Level of consciousness B) Blood pressure C) SaO2 D) Oral temperature

B

A nurse has informed the laboratory technician that a patient's gentamicin has finished infusing and the technician will soon draw a blood sample to determine the patient's serum drug concentration. Why is assessment of gentamicin levels necessary? A) To identify possible changes in the patient's serum osmolality B) To identify whether the drug is at a therapeutic level C) To identify whether the drug is causing hepatotoxicity D) To identify possible hemolysis following administration

B

A nurse has poured a hospital patient's scheduled dose of hydrochlorothiazide (HCTZ). The nurse should know that this drug reduces preload by which of the following means? A) Exerting a direct relaxant effect on the vascular smooth muscle B) Increasing renal excretion of sodium and water C) Increasing the contractility of myocardial fibers D) Stimulating the SA node to fire more frequently

B

A nurse is administering eye drops of two different drugs to a patient. How long should the nurse wait between the instillation of the first medication and the second medication? A) At least 1 minute B) At least 5 minutes C) At least 15 minutes D) At least 20 minutes

B

A nurse is aware that the dosing scheduling of a patient's new medication takes into account the serum half-life of the drug. What is the serum half-life of a medication? A) The time required for IV medications to penetrate the brain tissue B) The time needed for the serum level to fall by 50% C) The safest margin to prevent toxicity D) The dose adjustment that reduces the risk of adverse effects by one half

B

A nurse is instructing a patient on the administration of an opioid medication. What medication effect will most likely develop? A) Lower extremity paresthesia B) Drowsiness C) Occipital headache D) Polyuria

B

A nurse is preparing to simultaneously administer two drugs to a patient. The nurse knows that the drugs have been ordered to be given together because of their synergistic effect. This means that A) the adverse effects of one of the drugs are nullified by the other drug. B) the combined effects are greater than the effects of either one of the drugs alone. C) one of the drugs enhances metabolism, while the other drug enhances either distribution or absorption. D) both drugs are toxic in isolation but therapeutic when administered together.

B

A nurse is working with an adult patient who has recently been diagnosed with hypertension and begun combination therapy. Which of the patient's following statements would suggest a need for further health education? A) "I'm going to make up a schedule for checking my blood pressure on a regular basis." B) "I'll only need to take these drugs on days when my blood pressure is particularly high." C) "My wife and I are thinking of ways that we can cut down the amount of salt in our diet." D) "I've made plans with my best friend to start going for walks in the morning four times a week."

B

A nurse practitioner has discussed the possible risks and benefits of isotretinoin treatment with a patient who has acne vulgaris. The nurse should be aware that this medication achieves a reduction in the signs and symptoms of acne by what method? A) Stimulating phagocytosis in the epidermis and dermis B) Suppressing the production of sebum C) Enhancing humoral immunity D) Inhibiting the function of sudoriferous glands

B

A patient has an elevated total serum cholesterol of 260 mg/dL. Which of the following aspects of patient teaching of lifestyle changes is most important for the patient? A) Eat organic foods. B) Stop smoking. C) Increase rest periods. D) Drink whole milk.

B

A patient has been administered an opioid. For which of the following effects should the patient be assessed? A) Oliguria B) Decreased level of consciousness C) Edema D) Tachycardia

B

A patient has suffered a severe laceration to his thumb and index finger during a workplace accident, and local anesthetic is to be utilized to facilitate suturing. Which of the patient's following statements should prompt the nurse to provide further health education? A) "I have to admit I'm relieved that they'll be freezing my hand before they stitch it up." B) "I'm feeling pretty queasy about getting stitches, so I'm glad they'll be knocking me out." C) "They told me that it will take a few hours before I can feel my hand again." D) "If I understand correctly, I won't be able to move my hand normally for a while after getting the anesthesia."

B

A patient has sustained a burn from a gas grill. She has been prescribed a sulfonamide to prevent a burn infection. What route is preferred in the prevention of a burn infection? A) Intrathecal B) Topical C) Parenteral D) Oral

B

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

A patient is administered furosemide (Lasix) 20 mg PO every morning. What effect will a diet high in sodium have on the patient? A) Decreased blood pressure B) Decreased diuresis C) Hyperkalemia D) Hyperglycemia

B

A patient is admitted to the emergency department with a suspected overdose of acetaminophen (Tylenol). What adverse effect is most common in acute or chronic overdose of acetaminophen (Tylenol)? A) Nephrotoxicity B) Hepatotoxicity C) Pulmonary insufficiency D) Pancreatitis

B

A patient is admitted to the emergency department with chest pain that is unrelieved with sublingual organic nitrates. What medication will most likely be administered? A) Intravenous morphine sulfate B) Intravenous nitroglycerin C) Oral nonsteroidal anti-inflammatory agents D) Duragesic topical patch

B

A patient is admitted to the hospital with a diagnosis of heart failure. The patient is ordered to receive furosemide (Lasix) 40 mg IV. How soon after administration should the nurse expect to see evidence of diuretic effects? A) 1 minute B) 5 minutes C) 30 minutes D) 2 hours

B

A patient is being administered digoxin (Lanoxin) for treatment of heart failure. At what level should the serum potassium level be maintained? A) 1.5 to 2.0 mEq/L B) 3.5 to 5.0 mEq/L C) 6.0 to 8.0 mEq/L D) 8.5 to 10 mEq/L

B

A patient is being treated for hypothyroidism and has developed symptoms of adrenal insufficiency. What medication will be added to the patient's medication regimen? A) Anti-infective agent B) Corticosteroid agent C) Nonsteroidal anti-inflammatory agent D) Antiadrenergic agent

B

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

A patient is prescribed ciprofloxacin (Cipro). Which of the following nursing interventions will best prevent crystalluria? A) The nurse should limit oral fluids to 500 mL/day. B) The nurse should administer 2000 mL of oral fluids per day. C) The nurse should insert a urinary catheter. D) The nurse should administer phenazopyridine (Pyridium).

B

A patient is prescribed losartan (Cozaar). The medication alone is not effective in controlling blood pressure. What medication will best increase the effectiveness of blood pressure control in this patient? A) Atorvastatin calcium (Lipitor) B) Hydrochlorothiazide (HCTZ) C) Hydralazine hydrochloride D) Digoxin (Lanoxin)

B

A patient is receiving furosemide (Lasix) and a potassium supplement. When monitoring daily laboratory values, what should the potassium level be for this patient? A) 1.5 to 3.0 mEq/L B) 3.5 to 5.0 mEq/L C) 5.0 to 7.5 mEq/L D) 6.0 to 6.5 mEq/L

B

A patient is scheduled for a vaginal hysterectomy. Which of the following medications is the drug of choice for surgical prophylaxis? A) Cefadroxil (Duricef) B) Cefazolin sodium (Ancef) C) Cephalexin (Keflex) D) Cephradine (Velosef)

B

A patient is scheduled to begin a drug regimen for the treatment of hyperthyroidism. Prior to administering propylthiouracil (PTU), the nurse has reviewed the relevant black box warning and should teach the patient about the need for what form of follow-up? A) Serial complete blood counts B) Routine liver function testing C) Daily nonfasting blood glucose testing D) Chest radiographs every 3 months

B

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

A patient older than 65 years is more likely to experience drug reaction than a much younger patient. Which of the following factors accounts for this variation? A) Drugs more readily crossing the blood-brain barrier in older people B) Age-related physiologic changes C) Increased drug-metabolizing enzymes in older people D) Diminished immune response

B

A patient who has been prescribed digoxin (Lanoxin) is also taking furosemide (Lasix) 20 mg daily. Which of the following electrolyte imbalances will precipitate the development of digoxin toxicity? A) Hyperkalemia B) Hypokalemia C) Hypermagnesemia D) Hyponatremia

B

A patient who suffered a laceration while doing woodwork in his garage will have his wound treated under local anesthesia achieved using lidocaine and epinephrine. The nurse who will assist with the procedure should recognize that epinephrine performs what function in this situation? A) Promoting vasodilation B) Prolonging the effects of lidocaine C) Preventing adverse effects of lidocaine D) Blocking the afferent nerve pathways

B

A patient who suffers from cancer pain is receiving morphine every 2 hours. For which of the following should the family be taught to assess while the patient is on morphine? A) Diarrhea B) Respiratory depression C) Lung sounds D) Urinary incontinence

B

A patient with a history of heart failure is being treated with digoxin (Lanoxin). The nurse knows that this medication increases the force of contractions of the heart. What effect improves the contractility of the heart? A) Positive chronotropic effect B) Positive inotropic effect C) Negative inotropic effect D) Negative dromotropic effect

B

A patient with a long-standing history of seasonal allergies has sought care during the spring and been advised to take a second-generation antihistamine. Which of the patient's following statements suggests a need for the nurse to perform health education? A) "I know these can be a bit expensive, but hopefully it will be worth it for me." B) "I'm really hoping that these pills will cure my allergies before summer starts." C) "I'll check with my doctor to make sure that the diet supplements I'm taking are okay to take at the same time as these pills." D) "It's handy that I don't necessarily have to take these pills at bedtime."

B

A patient with coronary artery disease is prescribed nitroglycerin ointment. When teaching the patient to safely administer this medication, the nurse should convey which of the following instructions? A) "The backs of your hands and the tops of your feet are ideal sites for applying the ointment." B) "Make sure you squeeze the ointment on to a paper measuring scale before applying it." C) "Massage the ointment into your skin for 10 to 15 seconds after applying it." D) "Don't apply the ointment unless you're experiencing chest pain at the time."

B

A patient with heart failure is admitted to the emergency department. The physician orders digoxin (Lanoxin) intravenously. What is the onset of action when digoxin (Lanoxin) is administered intravenously? A) 5 minutes B) 10 minutes C) 45 minutes D) 1 hour

B

A patient's low ionized calcium levels have necessitated an infusion of an IV calcium preparation. During the administration of this medication, the nurse should prioritize what assessment? A) Oxygen saturation levels B) Cardiac monitoring C) Assessment of cognition D) Assessment for visual changes

B

A surgical patient has highly elevated AST and ALT levels. Standard orders specify that she is to receive morphine sulfate 10 mg postoperatively. What action should the nurse take prior to administering the medication? A) Draw up half of the medication for administration. B) Notify the physician for a reduced dosage. C) Assess the patient's respiratory status. D) Assess the patient's pain tolerance.

B

A woman is started on propylthiouracil (PTU). What is the primary mode of action for propylthiouracil? A) Destroys part of the thyroid gland B) Inhibits production of thyroid hormone C) Suppresses the anterior pituitary hormones D) Stimulates the thyroid cells

B

An adult patient has questioned whether fexofenadine (Allegra) would be preferable to the first-generation H1 receptor antagonists that he has long taken in the treatment of his environmental allergies. When describing the benefits of second-generation drugs such as Allegra, the nurse should cite what advantage? A) Lower cost B) Decreased sedation C) Absence of adverse effects D) Once-weekly dosing

B

An obese patient who has an elevated triglyceride level and reduced high-density lipoprotein cholesterol is seen by her primary care physician. What do these data suggest in this patient? A) The development of arthritic syndrome B) The development of metabolic syndrome C) The development of Reye's syndrome D) The development of Tay-Sachs disease

B

Extreme caution would be necessary with the use of gentamicin in which of the following patients? A) A patient who is morbidly obese and who has primary hypertension B) A patient who has chronic renal failure secondary to diabetes mellitus C) A patient who has bipolar disorder and who is on long-term lithium therapy D) A patient who has an atrioventricular block

B

Fewer adverse effects are associated with monoclonal antibody therapy than those of cytotoxic drugs. However, some of the potential adverse effects of monoclonal antibodies can be life threatening, including which of the following? A) Heart failure and bleeding problems B) Changes in cognition and personality changes C) Ischemic heart disease D) Bronchoconstriction and pulmonary edema

B

Prior to her elective hip replacement surgery, the nurse is explaining the basic characteristics of general anesthesia to the patient. The nurse should perform this education in the understanding that general anesthesia is best understood as A) a nonreversible, temporary state of unresponsiveness. B) a state of reversible unconsciousness. C) stage N2 non-rapid eye movement sleep. D) stage N3 non-rapid eye movement sleep.

B

The college health nurse is providing health education for freshmen. Which of the following pieces of information about immunizations is applicable to individuals of this age group? A) The oral polio should be updated. B) The yearly administration of flu vaccine is recommended. C) The tetanus toxoid must be within 2 years. D) The administration of hepatitis A vaccine is mandatory.

B

The nurse has measured a patient's capillary blood glucose and is preparing to administer NPH insulin. Which of the following actions should the nurse perform? A) Administer intramuscularly. B) Rotate the liquid. C) Vigorously shake the vial. D) Administer intradermally.

B

The nurse is preparing to administer gentamicin (Garamycin) to a patient when he mentions that he has recently been experiencing diminished hearing. What action should the nurse take based on this statement? A) Administer the dosage and notify the physician of the alteration in hearing. B) Hold the dosage and notify the physician of the alteration in hearing. C) Administer the dosage and report the alteration in hearing to the audiologist. D) Hold the dosage and document the finding in the nurses' notes.

B

Unasyn is being administered to a patient with an infection caused by Staphylococcus aureus. What type of anti-infective is Unasyn? A) Extended-spectrum antipseudomonal penicillin B) Penicillin-beta-lactamase inhibitor combination C) Cephalosporin D) Aminopenicillin

B

An older adult's most recent blood work reveals that his serum albumin level is 21 g/L (low). This will most influence what aspect of pharmacokinetics? A) Absorption B) Distribution C) Metabolism D) Excretion

B Many medications require serum albumin to bind, transport, and distribute the medication to the target organ. In the event that the amount of serum albumin is insufficient, the amount of free drug rises and the effect of the drug is more intense.

A nurse is preparing to administer an intramuscular injection of an older adult's seasonal influenza vaccination. What size needle should the nurse use to administer the injection? A) 16 gauge B) 20 gauge C) 24 gauge D) 28 gauge

B 20 or 22 G- IM 25 G- Sub Q

A patient is prescribed trandolapril (Mavik). What adverse effect should the patient be instructed on that can occur with angiotensin-converting enzyme (ACE) inhibitors? A) Sedation B) Persistent cough C) Tachycardia D) Rash

B A persistent cough can develop with the use of ACE inhibitors: Captopril (Capoten)

A patient asks the nurse what dose of acetylsalicylic acid (Aspirin) is needed each day for antiplatelet effects to prevent heart attacks. What dose is most appropriate to reduce platelet aggregation? A) 10 mg B) 30 mg C) 625 mg D) 1000 mg

B A single dose of 300 to 600 mg or multiple doses of 30 mg inhibit cyclooxygenase in circulating platelets almost completely

A patient has edema of the lower extremities with crackles in the lung bases. What diuretic is the nurse most likely to administer? A) Hydrochlorothiazide B) Furosemide C) Spironolactone D) Mannitol

B Acute pulmonary edema is an indication for the use of lasix

A home care nurse observes that a client's supply of Synthroid has run out in less than half the time that it should have. What assessment findings would be most consistent with overuse of Synthroid? A) Constipation and abdominal distention B) Hyperactivity and insomnia C) Bradycardia and hypotension D) Joint pain and decreased mobility

B Adverse effects of synthroid include signs and symptoms of hyperthyroidism Most adverse reactions of synthroid stem from excessive doses which make the heart work very hard and fast in attempting to meet the tissue demands for oxygenated blood and nutrients

A 72-year-old woman with a 60-pack-year history of cigarette smoking has developed chronic obstructive pulmonary disease (COPD) and has consequently been prescribed albuterol, a beta2-adrenergic agonist. When administering this medication, the nurse should be aware that A) the drug carries a higher potential for hepatotoxicity in this patient than in a younger patient. B) the drug may be less effective than in a younger patient due to decreased beta-receptor function. C) the patient will need to take a beta-adrenergic blocker concurrently to mitigate the likelihood of adverse effects. D) the patient will need to have serial complete blood counts (CBCs) drawn following the initiation of therapy.

B Beta-adrenergic agonists are less effective in older adults as a result of the decreased function of the beta-receptor system.

A patient is being treated with cyclophosphamide (Cytoxan). Which of the following laboratory values should the nurse follow most closely? A) D-dimer B) Complete blood count C) C-reactive protein level D) Arterial blood gases

B Cytoxan is an immunosuppressive drug and chemotherapy. The CBC should be monitored closely because of the risk of bone marrow depression.

A patient is admitted to the intensive care unit with an electrolyte imbalance. Which of the following imbalances will contraindicate the administration of digoxin (Lanoxin)? A) Hyperkalemia B) Hypokalemia C) Hypermagnesemia D) Hypocalcemia

B Digoxin is contraindicated in patients with hypokalemia

A patient has been suffering from repeated sinus infections and is diagnosed with allergic rhinitis. The patient is prescribed a first-generation H1 receptor antagonist. What is one of the effects of this medication? A) It depletes norepinephrine and serotonin. B) It decreases capillary permeability. C) It catalyzes the enzymatic oxidation of uric acid. D) It raises the seizure threshold by impairing vitamin D.

B Diphenhydramine (Benadryl) decreases capillary permeability

A patient has a genitourinary infection and is being treated with a fluoroquinolone. What is the advantage of a fluoroquinolone over an aminoglycoside? A) The fluoroquinolone does not have adverse effects. B) The fluoroquinolone can be given orally. C) The fluoroquinolone has a nearly immediate peak. D) The fluoroquinolone has a broader spectrum.

B Fluoroquinolones: Ciprofloxacin (Cipro) are often given orally

The nurse is assessing a patient who was recently administered procaine for local anesthesia. Which of the following assessment findings would suggest the possibility of adverse effects? A) Increased temperature B) Increased heart rate C) Decreased blood pressure D) Lethargy

B Following administration of procaine, the nurse assesses the CNS for excitability and the cardiovascular status for tachycardia and hypertension, leading to cardiovascular collapse

A 50-year-old man has undergone a bunionectomy and has been admitted to the postsurgical unit. What aspect of the man's medical history would contraindicate the use of heparin for DVT prophylaxis? A) The man is morbidly obese. B) The man has a diagnosis of ulcerative colitis. C) The man had a myocardial infarction 18 months ago. D) The man has a diagnosis of type 2 diabetes mellitus.

B GI ulcerations contraindicate the use of heparin

A nursing student is scheduled to receive the hepatitis B series. What type of immunity will this immunization provide? A) Active immunity B) Passive immunity C) Innate immunity D) Natural immunity

B Hepatitis B series is passive immunity. Passive Immunity is when antibodies are formed by another person or animal and then transferred to the host.

An infant is being administered an immunization. Which of the following provides an accurate description of an immunization? A) It should be administered to a pregnant woman prior to the infant's birth. B) It is the administration of an antigen for an antibody response. C) It produces many adverse reactions, particularly autism, in the infant. D) It protects the infant from exposure to infectious antibodies.

B Immunization involves administration of an antigen to induce antibody formation

An oncology nurse is reviewing the medication administration record of a patient being treated for advanced prostate cancer. In addition to two chemotherapeutic agents, the nurse reads that the patient has been ordered a cytoprotective agent. The goal of this agent is to A) buffer the cytotoxins that result from the metabolism of chemotherapeutic agents. B) protect the patient from pathophysiological effects of his malignancy. C) potentiate the beneficial effects of chemotherapy. D) reduce the incidence or severity of adverse drug effects.

D

It is important for the nurse to stay informed of the most current recommendations for immunizations. Which of the following sources is most accurate regarding immunization guidelines? A) American Academy of Pediatrics B) American Academy of Family Physicians C) American Academy of Infectious Disease Physicians D) Centers for Disease Control and Prevention

D

Spinal anesthesia will be used to perform a patient's scheduled bunionectomy. What should the nurse teach the patient about the administration of this form of anesthesia? A) It will cause a significant, but temporary, decrease in level of consciousness. B) It will be injected at the level of C7 to T2. C) It will be injected between T8 and T9. D) It will be injected into the cerebrospinal fluid.

D

The nurse has administered a scheduled dose of phenylephrine to a patient. The nurse would recognize that a therapeutic effect has been achieved by which of the following assessment findings? A) The cornea can be manipulated without causing the patient to blink. B) The patient acknowledges an improvement in visual acuity. C) The patient's pupils neither dilate nor constrict in response to light. D) The inner aspect of the patient's eye can be visualized.

D

When a patient has an increased serum level of ionized calcium, which hormone will be released? A) Insulin B) Estrogen C) PTH D) Calcitonin

D

When acetylsalicylic acid (aspirin) is administered in low doses, it blocks the synthesis of thromboxane A2. What physiological effect results from this action? A) Inflammation is relieved. B) Core body temperature is reduced. C) Pain is relieved. D) Platelet aggregation is inhibited.

D

When instructing the parents of a child who has received immunization in the vastus lateralis, which reaction is most common in the days after the administration? A) Nausea, vomiting, and diarrhea B) Rash and edema C) Weakness and difficulty walking D) Tenderness and redness at the site

D

A patient has been prescribed omeprazole by her primary care provider. When questioned by the nurse about her perceived effectiveness of the drug, the patient states, "I think it's working quite well, and I've gotten in the routine of taking it every morning before breakfast." How should the nurse respond? A) "That's good, but remember that you shouldn't take it on days when you're not having any symptoms." B) "I'm glad it's working for you, but you'll probably find it works even better if you take it after eating." C) "That's great. If you find later that it's not working as well, you might want to try taking it at bedtime." D) "I'm glad to hear that. It sounds like you're taking it exactly like it should be taken."

D (PPI) Omeprazole (Prilosec) should be taken before meals.

A patient is being administered enalapril maleate (Vasotec). Which of the following diuretics can be combined with ACE inhibitors to increase effectiveness in decreasing blood pressure? A) Loop diuretics B) Osmotic diuretics C) Potassium-sparing diuretics D) Thiazide diuretics

D ACE inhibitors may be used alone or in combination with other antihypertensive medications such as thiazide diuretics

A patient started taking ramipril earlier in the week for the treatment of hypertension. At her latest clinic visit, she has stated that she now has a "nagging, dry cough." How should the nurse best follow up the patient's statement? A) Inform the patient that the drug should be immediately discontinued. B) Inform the patient that this is an adverse effect of the medication that may lead to pneumonitis. C) Explain why it will be necessary to obtain a sputum sample. D) Explain that drugs like ramipril often cause a cough.

D ACE inhibitors often cause a persistent cough

A patient is being administered phenylephrine in an outpatient clinic. Which of the following conditions requires that phenylephrine be administered cautiously? A) Cataracts B) Hypothyroidism C) Diabetes mellitus D) Hypertension

D Adrenergic mydriatics should be used cautiously in patients with hypertension, cardiac dysrhythmias, arteriosclerotic heart disease, and hyperthyroidism.

Antihistamines are used to treat nasal congestion. Which of the following patients should not be administered an antihistamine? A) A male patient with Parkinson's disease B) A female patient with asthma C) A male patient with diabetes mellitus D) A male patient with prostatic hypertrophy

D Antihistamines are contraindicated in patients with prostatic hypertrophy

A patient previously experienced an anaphylactic reaction to penicillin G. Which of the following medications should not be administered to this patient due to the potential for cross-sensitivity? A) Lactulose (Chronulac) B) Ketoconazole (Nizoral) C) Kanamycin (Kantrex) D) Cefadroxil (Duricef)

D Cefadroxil (Duricef) is a cephalosporin. Administration of cephalosporins or carbapenems should be avoided if possible in people with life-threatening allergic reactions to penicillin.

A teenager has acne that requires treatment. The physician does not want to use retinoids because of the adverse effects. Which of the following medication regimens will likely be most effective? A) Topical azelaic acid B) Topical benzoyl peroxide C) Topical clindamycin D) Topical clindamycin with benzoyl peroxide

D Combination products of topical clindamycin or erythromycin and benzoyl peroxide are more effective than antibiotics alone

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 Corticosteroids have strong antiemetic effects

A patient has been taking an ACE inhibitor and a beta-blocker for the treatment of hypertension but has been consistently obtaining blood pressure readings in the vicinity of 145/90 mm Hg. As a result, the patient's primary care provider has prescribed furosemide (Lasix). What order would be most consistent with this patient's health needs? A) Lasix 125 mg PO OD B) Lasix 40 mg IV TID C) Lasix 20 mg IV OD D) Lasix 40 mg PO BID

D For hypertension, Lasix is commonly given as 40 mg PO twice daily and gradually increased if necessary

An older adult patient whose medical history includes angina is gardening outside his home when he experiences a sudden onset of chest pain. This patient would most likely administer a dose of nitroglycerin by what route? A) Subcutaneous injection B) Oral sustained-release tablet C) Nebulized inhalation D) Transmucosal spray

D For relief of sudden-onset angina, fast-acting preparations of nitroglycerin include SL, chewable tablets and transmucosal spray

A 22-year-old male patient has been living with Crohn's disease for several years and is experiencing an exacerbation of symptoms. The nurse should anticipate the use of what corticosteroid? A) Oral fludrocortisone (Florinef) B) Topical hydrocortisone C) Oral dexamethasone (Decadron) D) Oral prednisone

D In moderate Crohn's disease, oral prednisone, 40 mg daily, is usually given until symptoms subside.

The nurse is providing care for a teenager with otitis media. When assessing the patient for potentially adverse effects of Cortisporin Otic, what question should the nurse ask? A) "Have you developed a fever since you started to use the ear drops?" B) "Have you been getting any headaches since you started taking the drops?" C) "Has there been any blood that you've noticed in your outer ear?" D) "Have you noticed any loss of hearing since you started taking the drops?"

D It is necessary to assess the patient taking Cortisporin Otic for signs of hearing loss due to ototoxicity.

A nurse is teaching an 81-year-old man about the risk for potential adverse effects before he begins a course of antibiotics for an upper respiratory infection. What characteristic of older adults predisposes them to adverse drug reaction? A) Increased excretion time due to increased bowel motility B) Impaired distribution due to polypharmacy C) A decrease in overall body surface area D) A decrease in the number of receptors needed for distribution

D Older adults are prone to adverse drug reactions because of a decrease in the number of receptors needed for drug distribution

A patient is in diabetic ketoacidosis. The patient blood glucose level is over 600 mg/dL. The physician has ordered the patient to receive an initial dose of 25 units of insulin intravenously. What type of insulin will most likely be administered? A) NPH insulin B) Lente insulin C) Ultralente insulin D) Regular insulin

D Regular insulin has a rapid onset and can be given IV

An infant is seen in the clinic for her first immunizations. When providing patient teaching to the parent, which of the following is no longer recommended for administration? A) Rubella and mumps vaccine B) Polio vaccine C) Diphtheria, pertussis, and tetanus vaccine D) Smallpox vaccine

D Smallpox has been largely eradicated and is no longer recommended to be administered to children

A patient is administered an oral contraceptive. Which of the following is the process that occurs between the time the drug enters the body and the time that it enters the bloodstream? A) Absorption B) Distribution C) Metabolism D) Excretion

A.

A patient is diagnosed with hypertension and is being treated with captopril (Capoten). Which of the following patients should be administered captopril as the first-line treatment? A) A patient with diabetes mellitus B) A patient with asthma C) A patient with glaucoma D) A patient with angina pectoris

A Captopril (Capoten) is the first-line agent for treating hypertension in diabetic patients, particularly those with type 1 diabetes

1. An infant's current weight indicates that the maximum safe dose of Tylenol is 30 mg by mouth. The physician orders 65 mg to be given, and the nurse administers Tylenol 65 mg. Who is legally responsible in the event that the infant has a toxic reaction to the medication? A) The nurse B) The pharmacist C) The physician D) The pharmacy technician

A

A 1-year-old child will receive her scheduled MMR vaccination shortly. The nurse should teach the child's parents that she may develop what possible adverse effect related to the administration of this medication? A) Cough and fever B) Pallor and listlessness C) Serum sickness D) Nausea and vomiting

A

A child is prescribed an inhaled corticosteroid agent to decrease respiratory inflammation. The child's parent administers high doses of the drug after 2 days of administration. What is the patient at risk for? A) Adrenal insufficiency B) Tachycardia C) Edema D) Hypoglycemia

A adrenal insufficiency is most likely to occur with systemic or high doses of inhaled corticosteroids. Beclomethasone (Beconase AQ).

A 17-year-old woman is prescribed isotretinoin (Accutane) for severe acne vulgaris. Which of the following is the most important intervention related to the administration of this medication? A) Effective contraception must accompany this medication. B) Administer the medication on an empty stomach to decrease discomfort. C) The tablets should be crushed if they are too large to swallow. D) Administer a vitamin A supplement daily to enhance effectiveness.

A

A patient has been ordered a fentanyl patch known as Duragesic for chronic pain. What patient teaching should be provided to the patient and family? A) Remove the patch every 3 days. B) Apply it to the chest only. C) Apply it for breakthrough pain. D) Remove it daily and clean skin.

A

A patient has been prescribed ciprofloxacin after being diagnosed with a sinus infection. Which of the following should the patient avoid taking concurrently with ciprofloxacin? A) Antacids B) Calcium channel blockers C) Beta-adrenergic blockers D) Diuretics

A

A patient in cardiovascular collapse requires pharmacological interventions involving a rapid drug action and response. What route of administration is most likely appropriate? A) Intravenous B) Oral C) Rectal D) Topical

A.

An unlicensed care provider administered Benadryl to an elderly resident who has been suffering from seasonal pollen allergies. Which of the following assessment findings should prompt the nurse at the facility to suspect that the resident is experiencing anticholinergic effects of this drug? A) Blurry vision B) Tinnitus C) Wheezing on expiration D) Urticaria

A 1st generation antihistamines are associated with anticholinergic effects: dry mouth, urinary retention, constipation & blurred vision

A 69-year-old female responded well to inpatient treatment with a third-generation cephalosporin. After being largely symptom free for 48 hours, the woman has developed a fever of 38.6°C and an elevated white cell count. What phenomenon may account for this patient's current clinical presentation? A) The patient may be infected with microorganisms that were resistant to the cephalosporin. B) The patient may be experiencing a delayed (type IV) hypersensitivity reaction to the cephalosporin. C) The patient may be developing glomerulonephritis secondary to the nephrotoxic cephalosporin. D) The cephalosporin may have initially caused leukopenia and made the patient susceptible to secondary infection.

A

A 70-year-old woman is assessed in the clinic for signs and symptoms of chronic bronchitis related to pneumococci. Which of the following is a sulfonamide that will most likely be prescribed? A) Trimethoprim-sulfamethoxazole (Bactrim) B) Tetracycline (Sumycin) C) Doxycycline (Vibramycin) D) Demeclocycline (Declomycin)

A

A 79-year-old woman has been diagnosed with osteoporosis, and the nurse is reviewing the risks and benefits of Fosamax, which her care provider has prescribed. The patient should be instructed to seek prompt medical attention if she develops which of the following? A) Esophageal bleeding B) Fever C) Sudden fatigue D) Musculoskeletal pain

A

A child is prescribed therapy with glucocorticoids. The child is placed on alternate-day therapy. What is the advantage of alternate-day therapy in this child? A) The child will have less chance of infection. B) It will protect the child from hyperglycemia. C) The child will have less chance of hypertension. D) Adherence will be increased

A

A hospital patient has been prescribed ciprofloxacin IV for the treatment of cellulitis. After initiating the infusion of the patient's first scheduled dose, the patient develops a pronounced rash to her chest and arms. How should the nurse respond to this event? A) Discontinue the infusion and inform the care provider promptly B) Slow down the rate so that the infusion takes place over 2 hours C) Administer oral diphenhydramine to the patient during the infusion D) Administer a STAT dose of acetylcysteine

A

A middle-aged patient is proud of the fact that she is proactive with her health maintenance and tells the nurse that she has been taking 2400 International Units of vitamin D daily, stating, "More is better when it comes to vitamins." The nurse should provide health teaching to the patient because her current vitamin D intake creates a risk for A) hypercalcemia. B) hyperphosphatemia. C) hypocalcemia. D) tetany.

A

A nurse has called an elderly patient's surgeon to question the order for meperidine hydrochloride (Demerol) for pain control. The nurse's action is prompted by the possibility of what adverse effect associated with the use of Demerol in older adults? A) Confusion B) Blood dyscrasias C) Gastrointestinal bleeding D) Hepatotoxicity

A

A nurse has established intravenous access in a patient whose infection necessitates treatment with IV cefazolin. What potential adverse reaction is most likely during this patient's course of treat? A) Gastrointestinal upset B) Dry skin and pruritus C) Drowsiness D) Orthostatic hypotension

A

A nurse is conducting a medication reconciliation of a woman who is newly admitted to a long-term care facility. When appraising the woman's medication regimen in light of the Beers Criteria, the nurse will look for A) drugs that are known to cause adverse effects in older adults. B) drugs for which generic equivalents are available at lower cost. C) drugs that have been found to be ineffective in older adults. D) drugs that are known to exacerbate the aging process.

A

A nurse is reviewing a new patient's admission blood work, which indicates that the patient's glomerular filtration rate is 51 mL/min/1.73 m2 (low). What implication does this have for the patient's subsequent pharmacotherapy? A) The patient may need lower-than-normal doses of some medications. B) The patient may require a fluid challenge prior to medication administration. C) The patient may need IV administration of a hypotonic solution to aid medication excretion. D) The patient may need to receive medications by topical and subcutaneous routes rather than parenteral.

A

A nurse is reviewing a newly admitted patient's medication administration record and notes that the patient takes a loop diuretic as well as a thiazide diuretic. The nurse understands what primary rationale for the concurrent use of these two drugs? A) Increased diuretic effect B) Reduced risk of potassium imbalances C) Decreased blood pressure without a risk of bradycardia D) Increased adherence to treatment

A

A nurse who provides care in an ophthalmology clinic has an order to instill atropine eye drops to a patient prior to the patient's clinical examination. What health education should the nurse provide prior to this intervention? A) "These drops might sting a little bit, and they will make you temporarily sensitive to light." B) "These eye drops will make it more difficult to close your eyes, but this will pass in a few hours." C) "These drops will make your pupil temporarily constrict so that your eye can be examined more closely." D) "These drops will make your eyes very bloodshot and sensitive, but this is only temporary."

A

A patient began taking acetylsalicylic acid (aspirin) several years ago to prevent platelet aggregation following a myocardial infarction. Which dose of aspirin is most likely appropriate for this patient? A) 80 mg B) 180 mg C) 325 mg D) 650 mg

A

A patient has been administered lidocaine in anticipation of a bronchoscopy and lung biopsy. What change in status would the nurse recognize as a potential hypersensitivity to lidocaine? A) Audible wheeze B) Pleural pain C) Audible S3 D) Hemoptysis

A

A patient has been brought to the emergency department by ambulance, and his friend states that he has overdosed on methadone, a long-acting opioid. The care team is preparing to administer the appropriate antidote, naloxone, which has a shorter half-life than methadone. What are the implications of this aspect of pharmacokinetics? A) Repeated doses of naloxone will likely be necessary. B) A different antidote will be required after the serum level of naloxone decreases. C) An increased dose of naloxone will be required. D) The antidote is unlikely to have a therapeutic effect on the patient's symptoms.

A

A patient has been given MS Contin. You enter the room and the patient is unresponsive. His respirations are 6 breaths per minute. What medication will be ordered for the patient? A) Naloxone (Narcan) B) Capsaicin (Zostrix) C) Butorphanol (Stadol) D) Nalbuphine (Nubain)

A

A patient is receiving low molecular weight heparin to prevent thromboembolic complications. The nursing student asks the nursing instructor the reason why this treatment is given instead of heparin. What is the instructor's best explanation of the rationale for LMWH over heparin? A) "LMWH is associated with less thrombocytopenia than standard heparin." B) "LMWH is associated with stronger anticoagulant effects than standard heparin." C) "LMWH is given to patients who have a history of blood dyscrasia." D) "LMWH is more effective than standard heparin for patients with hypertension."

A

A patient is started on sulfamethoxazole-trimethoprim (Bactrim) for a urinary infection. What would contraindicate the use of Bactrim with this patient? A) Liver failure B) Rheumatoid arthritis C) Bone marrow depression D) Congestive heart failure

A

A patient is switched from furosemide (Lasix) to spironolactone (Aldactone). The patient asks the nurse why she has been switched to a new medicine. What is the nurse's best response? A) "You will lose less potassium with spironolactone than with furosemide." B) "You will have greater potassium losses with spironolactone than with furosemide." C) "You will have greater water losses with spironolactone than with furosemide." D) "You will have greater sodium losses with spironolactone than with furosemide."

A

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

A patient is undergoing a cytotoxic chemotherapy regimen for the treatment of stage III lung cancer. What effect will this regimen likely have on the patient's hemostatic function? A) The patient's platelet count will decline. B) The patient will be at increased risk of deep vein thrombosis. C) The patient will require prophylactic heparin. D) The patient will likely experience thrombocytosis.

A

A patient who has a diagnosis of peptic ulcer disease has begun taking sucralfate (Carafate). The nurse should caution the patient against the concurrent use of A) antacids. B) NSAIDs. C) acetaminophen. D) probiotics.

A

A patient who has been diagnosed with type 2 diabetes mellitus is being instructed on her medication regimen, diet, and exercise. She is having difficulty grasping information about when exactly she should administer insulin. Which of the following nursing diagnoses is most appropriate for this patient? A) Deficient knowledge: drug therapy regimen B) Noncompliance: overuse C) Risk for injury related to adverse effects D) Acute confusion related to insulin regimen

A

A patient who is 6 feet tall and weighs 280 pounds will require which of the following doses? A) Higher dose than a patient who weighs 180 pounds B) Lower dose than a patient who weighs 180 pounds C) Same dose as a patient who weighs 180 pounds D) A parenteral rather than oral dose

A

A patient who is recovering in hospital from a bilateral mastectomy has developed minor bleeding at one of her incision sites. During the process of clot formation, plasminogen will become part of a clot by which of the following means? A) By binding with fibrin B) By binding with platelets C) By activating plasmin D) By activating factor VII

A

A patient who regularly takes metformin has developed a severe infection. How will the infection change his diabetic regimen? A) Metformin is contraindicated in the presence of an infection. B) Metformin will be given more frequently to decrease blood sugar. C) Metformin will result in better regulation of blood sugar. D) Metformin will allow the patient to decrease the absorption of glucose.

A

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

A patient with a long-standing diagnosis of asthma is prescribed a beta-blocker for the treatment of angina. The nurse should consequently prioritize assessment for what health problem? A) Bronchospasm B) Hyperglycemia C) Pleural effusion D) Pneumonia

A

A patient with a recent diagnosis of asthma is anxious because she experienced an asthma attack and was unable to relieve the symptoms despite taking several puffs of her prescribed salmeterol (Serevent). How should the nurse respond to the patient's concerns? A) "Remember that your Serevent isn't effective when you take it at the time of an asthma attack." B) "It's important to take your Serevent as soon as you feel the first sensation of an asthma attack." C) "Unfortunately, Serevent can take up to 15 minutes to relieve your difficulty breathing." D) "It's best to take repeated doses of Serevent, every 5 minutes, until your symptoms subside."

A

A patient with diabetes mellitus is prescribed captopril (Capoten) to treat hypertension. What electrolyte imbalance might the patient be prone to develop? A) Hyperkalemia B) Hypokalemia C) Hypernatremia D) Hypermagnesemia

A

A patient with hand trauma following a gunshot wound currently has bier block anesthesia with lidocaine. What assessment finding should signal the nurse to the possibility that the patient has local anesthetic systemic toxicity (LAST)? A) The patient has become intensely anxious and agitated. B) The patient has complained of nausea and had an episode of blood-tinged emesis. C) The patient's heart rate has become bradycardic and irregular. D) The patient states that he still has sensation in his hand.

A

A patient's medication administration record include daily timolol maleate eye drops. The nurse should identify what goal of therapy when planning this patient's care? A) Decrease intraocular pressure. B) Constrict pupils. C) Promote lacrimation. D) Improve visual acuity.

A

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 prototipe is gentamycin (Garamycin), most effective in treating gram NEGATIVE microorganisms

A primiparous woman tells the nurse that she and her partner are highly reluctant to have their infant vaccinated, stating, "We've read that vaccines can potentially cause a lot of harm, so we're not sure we want to take that risk." How should the nurse respond to this family's concerns? A) "Vaccinations are not without some risks, but these are far exceeded by the potential benefits." B) "The potential risks of vaccinations have been investigated and determined to be nonexistent." C) "Unfortunately, state laws mandate that your child receive the full schedule of vaccines." D) "Vaccines indeed cause several serious adverse effects, but these are usually treated at the site where your child receives the vaccination."

A

An African American patient is being treated for a new diagnosis of hypertension. What antihypertensive agent is the most likely drug of choice for this patient? A) Diuretic B) Vasodilator C) Calcium channel blocker D) Beta-adrenergic blocker

A

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

An adult patient with a diagnosis of hypertension has had oral Lasix added to his medication regimen by his primary care provider. The nurse is planning a brief health education session with the patient in light of this change in his treatment plan. What goal should the nurse specify when planning this teaching session? A) The patient will identify strategies for limiting his sodium intake. B) The patient will describe the rationale for increasing his fluid intake. C) The patient will be able to demonstrate correct technique for blood glucose monitoring. D) The patient will accurately describe the basic structure and functions of the kidneys.

A

An elderly man who resides in a care facility has been prescribed antihypertensives for the first time following many years of generally good health. When administering the first dose of the prescribed medications, the nurse should recognize what nursing diagnosis? A) Risk for falls related to antihypertensive medications B) Risk for infection related to antihypertensive medications C) Risk for acute confusion related to antihypertensive medications D) Risk for impaired oxygenation related to antihypertensive medications

A

An elderly patient has begun taking bisoprolol (Zebeta) 10 mg PO once daily for the treatment of angina. The nurse should administer this drug in the knowledge that it achieves a therapeutic effect in what way? A) Decreasing heart rate B) Increasing the force of myocardial contractions C) Prolonging the QT interval D) Shortening the time required for repolarization

A

An elderly patient with a history of heart failure has presented to the emergency department in respiratory distress. Assessment reveals the presence of pulmonary edema, and an infusion of IV furosemide (Lasix) has been ordered. For the duration of treatment, the nurse should prioritize assessments related to what nursing diagnosis? A) Risk for deficient fluid volume related to diuretic administration B) Risk for decreased cardiac output related to adverse effects of furosemide C) Ineffective health maintenance related to pulmonary edema D) Functional urinary incontinence related to diuretic administration

A

An oncology nurse is preparing to administer cytotoxic chemotherapy medications. Which of the following measures best protects the nurse from harm related to the chemotherapy? A) Wearing protective equipment B) Performing thorough hand hygiene C) Mixing medication in a 1000-mL bag D) Administering medication intramuscularly whenever possible

A

In which of the following patients should the nurse question the physician's order for IV morphine? A) An 88-year-old female with failure to thrive B) A 45-year-old female, 1-day postoperative mastectomy C) An 8-year-old male with a fractured femur D) A 17-year-old female, 1-day postoperative appendectomy

A

Laboratory testing reveals that a patient is in a severely hyperthyroid state and propylthiouracil (PTU) has been prescribed. When providing health education related to this drug, what should the nurse teach the patient? A) "You'll need to take these pills every 8 hours." B) "I'm going to show you how to perform your daily injection." C) "At first, you'll come to the outpatient clinic for your IV infusion once per day." D) "It's best to inject PTU into your abdomen rather than your arm."

A

Spinal anesthesia using procaine has been ordered for a patient prior to revision of the patient's ankle hardware. This drug achieves anesthesia by A) preventing the influx of sodium into nerve cells. B) increasing the action of anticholinesterase in nerve synapses. C) antagonizing nociceptors. D) agonizing opioid receptors in the CNS.

A

The daughter of an 80-year-old woman states that her mother has been taking alendronate (Fosamax) for several years for the treatment of osteoporosis. The daughter tells the nurse that her mother never had any complaints of nausea after taking this medication until recently. How should the nurse respond to the daughter's statement? A) "It could be that your mother's stomach empties more slowly than it used to, which is a normal result of aging." B) "As your mother gets older, the medication travels down her esophagus more slowly than it used to. This can cause nausea." C) "Because your mother processes drugs more slowly than when she was younger, there is more time during which they can cause nausea." D) "As your mother ages, she has more of the receptors that trigger nausea. This is a normal change that accompanies the aging process."

A

The nurse is repeatedly unsuccessful in starting an IV on a patient who requires antibiotic therapy. The physician then orders the patient to receive an oral antibiotic. What is the major disadvantage of the oral route over the parenteral route? A) Slower rate of action B) Greater adverse effects C) Increased risk of tolerance D) Dose must be larger.

A

Which of the following assessments should be made before administering a new medication? A) Determine the patient's past medication history. B) Evaluate the patient's health beliefs. C) Instruct the patient on the effect of the medication. D) Teach the patient about the desired outcomes of drug therapy.

A

Which of the following is the antidote for acetaminophen (Tylenol) poisoning? A) Acetylcysteine (Mucomyst) B) Allopurinol (Zyloprim) C) Diclofenac sodium (Voltaren) D) Ketorolac (Toradol)

A

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 Corticosteroids increase the number of beta-adrenergic receptors and increase or restore responsiveness of beta receptors to beta-adrenergic bronchodilating drugs

An elderly patient is given diphenhydramine (Benadryl) for allergic response to mold. The nurse should consequently assess the patient for A) anticholinergic effects. B) dysrhythmias. C) increased muscle tone. D) respiratory depression.

A Diphenhydramine (Benadryl) is the prototype of first-generation antihistamines and causes a high incidence of drowsiness and anticholinergic effects

Which single drug class is known to be most effective in reducing the major types of dyslipidemia? A) Statins B) Bile acid sequestrants C) Fibrates D) Niacin

A For single-drug therapy, a statin is preferred for the treatment of dyslipidemia.

A patient is receiving gentamicin (Garamycin) to treat meningitis. The physician has ordered a peak serum level be drawn in association with the 07:00 dose, which will finish infusing at 07:30. When should the peak serum level be drawn? A) 08:00 B) 09:00 C) 10:00 D) 12:00

A Gentamycin (Garamycin) peak is 30-60 minutes after drug administration

A patient is seen in the primary care provider's office with complaints of polydipsia and polyuria without polyphagia. He has very edematous ankles, and his blood pressure is elevated. From which disorder of the adrenal cortex is the patient suffering? A) Hyperaldosteronism B) Adrenocortical hyperfunction C) Androgen-producing tumors D) Adrenal hyperplasia

A Hyperaldosteronism is characterized by hypokalemia, hypernatremia, hypertension, thirst, and polyuria.

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 Most penicillins should be taken on an empty stomach.

A male patient is taking atorvastatin calcium (Lipitor) to reduce serum cholesterol. Which of the following aspects of patient teaching is most important? A) Call his physician if he develops muscle pain. B) It is unacceptable to eat dietary fats. C) Decrease the dose if lethargy occurs. D) Eat two eggs per day to increase protein stores.

A Notify physician if unexplained muscle pain or tenderness occurs. Muscle pain is the most common side effect (could lead to or be indicative of rhabdomyolysis)

A patient has begun taking antiasthmatic drugs. The patient should avoid excessive intake of what beverage? A) Coffee B) Grapefruit C) Green tea D) Acai juice

A Patients taking antiasthmatics should generally avoid large doses of caffeine containing drinks like coffee

Which herbal and dietary supplement has shown proven success in lowering LDL and total cholesterol in research studies? A) Soy B) Ginkgo biloba C) Green tea D) Garlic

A Soy has been researched to extensively lower cholesterol

An adult male patient with a diagnosis of osteomyelitis will soon begin treatment with gentamicin. Which of the following schedules is most likely to maximize efficacy and minimize nephrotoxicity? A) Gentamicin 500 mg IV OD at 1200 B) Gentamicin 250 mg PO BID at 07:30 and 19:30 C) Gentamicin 500 mg PO TID at 08:00, 12:00, and 17:00 D) Gentamicin 125 mg IV QID at 06:00, 1200, 18:00, and 24:00

A The ODA method uses higher doses (e.g., 4 to 7 mg/kg) to produce high initial drug concentrations, with no repeat dosing until the serum concentration is quite low (typically 24 hours later). The rationale for this dosing approach is a potential increase in efficacy with a reduced incidence of nephrotoxicity. Gentamicin is not administered orally

A patient is being treated with corticosteroids for chronic adrenocortical insufficiency. When should the patient be instructed to take the medication? A) Between 06:00 and 09:00 B) 12:00 C) Between 13:00 and 14:00 D) 21:00

A The entire daily dose should be taking in the morning between 06:00 and 09:00

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 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.

A patient has a decreased calcium level. Which of the following will participate in raising the patient's calcium level? A) Vitamin D B) Vitamin C C) Ferrous sulfate D) Vitamin B12

A Vitamin D is a fat-soluble vitamin that plays an important role in calcium and bone metabolism

A patient who has been treated with warfarin (Coumadin) after cardiac surgery is found to have an INR of 9.0. Which medication will be administered to assist in the development of clotting factors? A) Vitamin K B) Vitamin E C) Protamine sulfate D) Acetylsalicylic acid (Aspirin)

A Vitamin K is the antidote for coumadin (Warfarin) normal INR range is 2.0-3.0 (above 3 means the blood is "too thin") so an INR of 9 means that the patients blood was thinned too much by coumadin so they have to give the antidote of coumadin (vitamin K) so that the blood can "thicken"

An older adult patient has been receiving treatment for heart failure and has been experiencing frequent episodes of peripheral edema. As a result, her care provider has added furosemide (Lasix) to her medication regimen. What assessment should the nurse perform on a daily basis for the duration of treatment? A) Body weights B) Arterial blood gases C) Magnesium level D) Pupillary response

A When a patient is being treated with furosemide, the nurse weighs the patient daily and reports any increase in weight of greater than 2 pounds in 24 hours to the health care provider Sodium and potassium levels must be assessed with lasix as well

An older adult patient has been using levothyroxine (Synthroid) for several years on an outpatient basis. The patient has recently sought care, with complaints that are consistent with hypothyroidism. To which of the patient's following statements may the nurse attribute the decreased effect of Synthroid? A) "I've been using a lot of antacids lately because of my indigestion." B) "My daughter and I have started the Atkin's diet to try to lose some weight." C) "Overall, I'd say that I'm under a lot of stress lately." D) "I've stopped taking aspirin for my arthritis and started using Tylenol."

A antacids may decrease the effect of levothyroxine (Synthroid)

A patient will begin taking atorvastatin (Lipitor), and the nurse is conducting relevant health education. The nurse should emphasize the need to report any new onset of A) muscle pain. B) dry mouth. C) pruritus (itching). D) increased thirst.

A atorvastatin (Lipitor) can cause muscle pain- must report immediately

An outpatient has been prescribed hydrocodone for back pain related to a compression fracture. Which of the following interventions should the patient be taught regarding the medication administration? A) Consume a diet high in fiber. B) Decrease activity due to pain. C) Elevate the lower extremities. D) Take aspirin with the medication.

A hydrocodone is an opioid that can slow the motility of the GI tract and cause constipation. telling the patient to increase fiber intake can help to decrease the constipation

A 77-year-old patient was diagnosed with heart failure 3 years ago, and he had achieved reasonable symptom control with digoxin. In the last several months, his cardiac function has decreased significantly and his cardiologist has prescribed nesiritide during his current admission. What aspect of this patient's health status would potentially contraindicate the administration of nesiritide? A) Blood pressure of 88/50 mm Hg B) Jaundice C) Presence of +2 peripheral edema D) Irregular apical heart rate

A should not be administered if the systolic BP is <90

. A patient tells the nurse, "I took my sleeping pill yesterday evening, but it didn't seem to work for me like it usually does." The nurse should consider which of the following variables that can affect drug absorption? Select all that apply. A) GI function B) Blood flow to the site of administration C) The presence of other drugs D) Route of administration E) The presence of receptor agonists

A, B, C, D

A nurse at a long-term care facility is surprised to learn that a new resident's medication administration record runs four pages in length. The nurse knows that polypharmacy carries which of the following risks for older adults? Select all that apply. A) Increased risk of complications B) Decreased continuity of care C) Decreased cognition D) Decreased medication adherence E) Decreased costs of care

A, C Polypharmacy and the consequent interactions of medications can lead to greater complications and diminished mental status.

A 62-year-old man is surprised to learn that his recurrent indigestion has been attributed to a new diagnosis of peptic ulcer disease. The patient states, "I've never been a really anxious type of person, so I never thought I'd develop ulcers." The nurse has responded with health education addressing the etiology of peptic ulcer disease. What causative factors should the nurse cite? Select all that apply. A) Physiologic or psychological stress B) Diabetes mellitus C) Cigarette smoking D) Infections E) Nonsteroidal anti-inflammatory drugs

A, C, D, E

6. A nursing student in a pharmacology class should be encouraged to study the medications according to which categorization? A) Prototype B) Controlled substance C) Drug use D) Generic names

A.

A 55-year-old man has been diagnosed with coronary artery disease and begun antiplatelet therapy. The man has asked the nurse why he is not taking a "blood thinner like warfarin." What is the most likely rationale for the clinician's use of an antiplatelet agent rather than an anticoagulant? A) Antiplatelet agents do not require the man to undergo frequent blood work; anticoagulants require constant blood work to ensure safety. B) Antiplatelet agents are more effective against arterial thrombosis; anticoagulants are more effective against venous thrombosis. C) Antiplatelet agents are most effective in large vessels; anticoagulants are most effective in the small vessels of the peripheral circulation. D) Antiplatelet agents have fewer adverse effects than anticoagulants.

B

A 69-year-old man has been prescribed a nitrate and a calcium channel blocker for the treatment of unstable angina. When performing health education to promote adherence to his medication regimen, the nurse should emphasize which of the following? A) The fact that the patient will likely need medications until he no longer experiences the signs of angina B) The fact that the patient should take his medications as ordered even if he feels well in the short term C) The fact that inconsistent medication use will likely cause the onset of hypertension D) The fact that he should gauge his day's dose based on how he feels that morning

B

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

A clinical nurse educator on a nephrology and dialysis unit is reviewing renal physiology with a nursing student who is completing a preceptorship on the unit. The student should be aware that a majority of reabsorption takes place in what anatomical location? A) Ureters B) Proximal tubule C) Efferent arteriole D) Afferent arteriole

B

A gerontological nurse has encouraged a group of caregivers who work with older adults to avoid administering first-generation H1 receptor antagonists to these patients. The nurse's cautionary message is an acknowledgment of what possible nursing diagnosis? A) Risk for infection related to adverse effects of antihistamines B) Risk for falls related to sedation C) Risk for deficient fluid volume related to diuresis D) Risk for impaired skin integrity related to urticaria

B

An 80-year-old woman has experienced recent declines in bone density and has consequently been deemed a candidate for treatment with alendronate (Fosamax). During health education, what teaching point should the nurse emphasize? A) "Your Fosamax will be most effective if you couple it with an increase in your consumption of dairy products." B) "It's important that you not lie down for half an hour after taking your Fosamax." C) "Make sure to let your care provider know promptly if you experience bone pain." D) "You'll have less stomach upset if you take your Fosamax with some bland food."

B The person must remain upright (with head elevated 90 degrees if in bed, sitting upright in a chair, or standing) for at least 30 minutes after administration of Fosamax. It is always necessary to take the drug with a full glass of water, not juice or coffee, at least 30 minutes before breakfast and before taking other drugs.

A patient is administered a sulfonamide for a urinary tract infection. Which of the following nursing interventions is most appropriate to increase the alkalinity of the patient's urine? A) Provide at least 2000 mL of water daily. B) Administer sodium bicarbonate. C) Recommend a tub bath every evening. D) Provide orange juice daily.

B The urine can be alkalinized by giving sodium bicarbonate

A patient has edema of the lower extremities and abdomen. What is the reason for administering a stronger diuretic than a thiazide diuretic to this patient? A) A thiazide diuretic will reabsorb potassium in the distal tubule. B) A thiazide diuretic will be ineffective for immediate diuresis. C) A thiazide diuretic will provide peak effects in 2 hours. D) A thiazide diuretic will be excreted in more than 72 hours.

B Thiazide diuretics are ineffective when immediate diuresis is required. they act to reabsorb SODIUM in the distal convoluted tubule. reaches its peak in 4 to 6 hours.

An elderly patient with dyslipidemia has had fenofibrate (TriCor) added to her existing medication regimen. In addition to having her lipid profile drawn on a regular basis, the nurse should educate the patient about the need for what ongoing laboratory testing during therapy? A) Complete blood count (CBC) B) Liver panel C) INR and aPTT D) Reticulocyte count

B TriCor has a risk for hepatotoxicity

A patient's sudden increase in IOP has necessitated the oral administration of glycerin (Osmoglyn). When assessing the patient for adverse effects related to this intervention, the nurse should prioritize which of the following? A) Assessment for signs and symptoms of acid-base imbalances B) Assessment for signs and symptoms of fluid volume deficit C) Monitoring of serum potassium and sodium levels D) Monitoring of aPTT and INR

B adverse effects of glycerin relate to decreased fluid volume

A 69-year-old woman has been taking metformin for the treatment of type 2 diabetes for several years. Which of the following changes in the woman's laboratory values may demonstrate a need to discontinue the medication? A) A decrease in hemoglobin and hematocrit B) A decrease in glomerular filtration rate C) A decrease in potassium accompanied by an increase in sodium D) An increase in white blood cells

B discontinue metformin if renal impairment occurs

A patient has been admitted in acute hypercalcemia and has been determined to have a serum calcium level of 12.9 mg/dL. The emergency department nurse's priority intervention is A) administration of IV calcitonin. B) administration of IV normal saline. C) oxygen supplementation. D) subcutaneous administration of exogenous parathyroid hormone (PTH).

B emergency treatment of hypercalcemia- the priority is to rehydrate start with IV 0.9% NaCl solution at initial rate of 200-300 mL/hr adjust to maintain urine output of 100-150 mL/hr

A patient is confused about her care provider's advice and has stated to the nurse, "I wasn't sure whether he recommended Tylenol or whether he recommended acetaminophen." The nurse should include which of the following information in an explanation of generic and trade names? A) Prescribers should refer solely to generic names in their recommendations and written prescriptions. B) A generic name is independent of any particular drug manufacturer. C) Generic names change frequently, but trade names are more consistent. D) Prescribers should refer solely to trade names in their recommendations and written prescriptions.

B generic name: chemical or official name, they do not change trade name: determined by the manufacturer, the "brand name"

A teenage male patient is administered isotretinoin (Accutane) for severe acne. When teaching the teen and his parents about the medication, which of the following assessments should be routinely made? A) Assess blood pressure. B) Assess blood lipid levels. C) Assess for euphoria. D) Assess for increased weight.

B the administration of isotretinoin is linked with increased blood lipid levels (hyperlipidemia). the blood lipid levels should be periodically assessed

Oral atenolol has been ordered for a resident of a long-term care facility who has a diagnosis of angina. Which of the following assessment findings would prompt the nurse to withhold a scheduled dose of the drug? Select all that apply. A) Heart rate of 68 beats per minute B) Blood pressure of 88/49 mm Hg C) Heart rate of 58 beats per minute D) Blood pressure of 141/92 mm Hg E) Oxygen saturation of 90% on room air

B, C Dont administer atenolol for HR <60 BPM, or systolic BP <90

When teaching new parents about the benefits of adhering to the recommended vaccination schedule, the nurse should cite protection against which of the following diseases? Select all that apply. A) HIV B) Measles C) Varicella D) Poliomyelitis E) Hepatitis B

B, C, D, E

A patient is being treated in the hospital for a femoral fracture and is scheduled to receive his daily dose of metoprolol (Lopressor) that he has been taking for the treatment of hypertension for several years. Prior to administering this drug, the nurse should assess and document which of the following? Select all that apply. A) Oxygen saturation level B) Heart rate C) Potassium level D) Blood pressure E) Capillary refill

B, D

A male patient has been diagnosed with moderately increased LDL, and his primary care provider wishes to begin him on a statin. What is a potential disadvantage of statins that the care provider should consider? Select all that apply. A) Statins are nephrotoxic. B) Statins are expensive. C) Statins are contraindicated in patients with a history of myocardial infarction. D) Statins require regularly scheduled blood work. E) Statins have an immunosuppressive effect.

B, D Because liver enzymes may be elevated during atorvastatin use, patients need liver function tests and repeat lipid profiling on a regular basis.

2. The administration of anabolic steroids is regulated by which of the following laws? A) The Food, Drug, and Cosmetic Act of 1938 B) The Comprehensive Drug Abuse Prevention and Control Act C) The Harrison Narcotic Act D) The Shirley Amendment

B. The Comprehensive Drug Abuse Prevention and Control Act regulates the manufacture and distribution of narcotics, stimulants, depressants, hallucinogens, and anabolic steroids. The Food, Drug, and Cosmetic Act of 1938 revised and broadened FDA powers and responsibilities, giving the FDA control over drug safety. The Harrison Narcotic Act restricted the importation, manufacture, sale, and use of opium, cocaine, marijuana, and other drugs that the act defined as narcotics. The Shirley Amendment of 1912 prohibited fraudulent claims of drug effectiveness.

A 32-year-old female patient is being treated with a cytotoxic antineoplastic agent. Which of the following is the most important instruction related to the potential for teratogenicity? A) The medication will be completely eliminated 24 hours after the administration. B) The patient should protect herself from infections and take Bactrim. C) The patient should not become pregnant for several months. D) The patient will not get pregnant due to the elimination of ova.

C

A 72-year-old woman has been diagnosed with osteoporosis and has begun taking alendronate (Fosamax). The nurse should be aware that this drug can increase the woman's bone density by which of the following means? A) Decreasing renal excretion of calcium B) Increasing the binding of vitamin D to calcium ions C) Suppressing the function of osteoclasts D) Enhancing the function of osteoblasts

C

A 74-year-old male patient is being treated in the hospital for a stroke and is undergoing an extended stay on a rehabilitation unit. The patient's wife has been participating actively in his care and performs much of his feeding and hygiene. This evening, the patient's wife has brought in a number of healthy snacks to keep at his bedside. Knowing that the patient's medication regimen includes simvastatin, the nurse would remove which of the following items? A) Purple grapes B) Cranberry cocktail C) Grapefruit juice D) Trail mix (salted nuts and seeds)

C

A hospital patient with peripheral edema has been prescribed furosemide (Lasix). How should the nurse best determine the extent of the patient's desired fluid loss? A) Assess the patient's skin turgor on a daily basis. B) Test the osmolarity of the patient's urine regularly. C) Weigh the patient daily. D) Auscultate the patient's chest each morning.

C

A nurse has noted that an older adult patient on an acute care for elders (ACE) unit has an exceptionally lengthy medication administration record. The nurse has alerted the pharmacist because one of the patient's long-standing medications appears on the Beers list. What medication is the nurse likely addressing? A) Low-dose enteric-coated ASA B) Metoprolol (Lopressor) C) Digoxin (Lanoxin) D) Vitamin D

C

A nurse is demonstrating the correct technique for instilling antibiotic ear drops into a child's ear canal. The nurse should teach the child's caregivers to do which of the following? A) Have the child lie supine during instillation of the ear drops. B) Have the child lie still for 30 to 45 minutes after instilling the ear drops. C) Place a cotton ball in the ear canal after instilling the ear drops. D) Rinse the child's ear canal with normal saline prior to instilling the ear drops.

C

A nurse is preparing to administer a patient's scheduled beta-adrenergic blocker. The nurse is aware that the patient is receiving this drug for the treatment of hypertension. The nurse has addressed which of the following rights of safe medication administration? A) Right indication B) Right diagnosis C) Right reason D) Right history

C

A nurse is providing health education about the way the normal intraocular pressure (IOP) is maintained. The nurse should explain that normal IOP results from which of the following? A) Consistent production and resorption of tears B) Consistent feedback from baroreceptors located throughout the retina C) A balance between production and drainage of aqueous humor D) Two-way interaction between the medulla oblongata and the eye

C

A patient asks the nurse why she has to take two diuretics when her friend only takes one with a combination medication. The patient takes hydrochlorothiazide 75 mg every day with a potassium-sparing diuretic. What is the nurse's best response? A) "Maybe you should speak with your doctor about the combination." B) "I do not know why your doctor prefers that you take two medications." C) "It could be that you need a larger dose than is available in the combination medications." D) "The combination medications are not as effective as two medications."

C

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

A patient is diagnosed with an adrenal tumor. With which of the following abnormalities of the adrenal gland will the patient most likely be diagnosed? A) Primary adrenocortical insufficiency B) Secondary adrenocortical insufficiency C) Adrenocortical hyperfunction D) Hyperaldosteronism

C Adrenocortical hyperfunction (Cushing's disease) may be a result of a primary adrenal tumor. Primary adrenocortical insufficiency is associated with destruction of the adrenal cortex by disorders such as tuberculosis, cancer, or hemorrhage. Secondary adrenocortical insufficiency is produced by inadequate secretion of corticotropin. Hyperaldosteronism is a rare disorder caused by adenoma or hyperplasia of the adrenal cortex cells that produce aldosterone

A patient has been prescribed a once-daily aminoglycoside. What is the advantage of this method of administration? A) It is associated with less hepatotoxicity. B) It is significantly more cost-effective. C) It reduces the risk of nephrotoxicity. D) It increases adherence to treatment.

C Aminoglycoside: Gentamycin (Garamycin) can be nephrotoxic and ototoxic

An older adult resident of a long-term care facility has been prescribed calcium citrate to address her decreasing bone density. The nurse should review the resident's medication administration record knowing that what medication may decrease the effects of calcium? A) Hydrochlorothiazide B) Ibuprofen C) Prednisone D) Diltiazem (Cardizem)

C Corticosteroids like Prednisone decrease the effect of calcium. calcitonin, and phosphates also decrease the effect of calcium. thiazide diuretics increase the effects of calcium

A 50-year-old male is admitted to the emergency room with a head injury after a motorcycle crash. He is unconscious with one eye dilated and one constricted. He has a widened pulse pressure. What corticosteroid will most likely be administered parenterally? A) Cortisone B) Prednisone C) Dexamethasone (Decadron) D) Fluticasone (Flonase)

C Dexamethasone is considered the corticosteroid of cerebral edema. It is thought to penetrate the blood-brain barrier more readily and achieve higher concentrations in cerebrospinal fluid. Cortisone is the drug of choice for adrenal insufficiency. Prednisone is the glucocorticoid of choice in nonendocrine disorders in which anti-inflammatory, antiallergic, antistress, and immunosuppressive effects are desired.

A hospital patient with a diagnosis of type 1 diabetes is ordered Humulin R on a sliding scale. Based on the patient's blood glucose reading, the nurse administered 8 units of insulin at 07:45. The nurse recognizes the need to follow up this intervention and will reassess the patient's blood glucose level when the insulin reaches peak efficacy. The nurse should consequently check the patient's blood glucose level at what time? A) 08:15 B) Between 08:45 and 09:45 C) Between 09:45 and 10:45 D) Between 11:15 and 11:45

C Humilin R peaks 2 to 3 hours after administration

A patient is scheduled for a thyroidectomy to treat thyroid cancer. What is the medication of choice administered preoperatively? A) Sodium iodide 131I (Iodotope) B) Methimazole (Tapazole) C) Propylthiouracil (PTU) D) Propranolol (Inderal)

C PTU is administered pre-operatively for thyroidectomy PTU inhibits production of the thyroid hormone

A hospital patient is to receive 4 units of regular insulin prior to lunch. The nurse knows that the lunch trays are usually distributed at approximately 12:15. The nurse should plan to administer the patient's insulin at what time? A) 12:15 B) 12:10 C) 11:45 D) 11:15

C Regular insulin should be injected 30 to 45 minutes before meals

A nurse who provides care at a long-term care facility is preparing to administer a resident's scheduled dose of levothyroxine (Synthroid). What assessment should the nurse perform prior to administration? A) Level of consciousness and orientation B) Oxygen saturation level C) Heart rate D) Respiratory rate

C Regular monitoring of blood pressure and pulse is essential in older adults receiving Synthroid. As a general rule, levothyroxine should not be given if the resting heart rate is more than 100 beats per minute.

A gerontological nurse is aware that increased aldosterone is a major factor in the pathophysiology of heart failure. Which of the following medications reduces aldosterone-induced retention of sodium and water? A) Hydrochlorothiazide B) Enalapril maleate C) Spironolactone D) Losartan potassium

C Spironolactone is an aldosterone antagonist that reduces aldosterone induced retention of sodium and water

A patient with hypothyroidism is started on levothyroxine (Synthroid). What should the patient be taught regarding medication administration in the home setting? A) Take medication with milk or food. B) Do not exercise with the medication. C) Take the medication on an empty stomach. D) Levothyroxine has a short half-life.

C Take levothyroxine (Synthroid) on an EMPTY STOMACH

A patient has an elevated BUN and creatinine. The patient has been prescribed digoxin (Lanoxin) for heart failure. What aspect of care is the priority regarding this patient? A) The patient should be taught to increase sodium in her diet. B) The dose should be increased when her heart rate is below 60. C) The dose should be decreased in this patient. D) The dosage should be 1.0 mg PO daily.

C The dose must be reduced in the presence of renal failure because most of the digoxin is excreted unchanged by the kidneys, leading to drug accumulation and toxicity

A patient states that he is seeing halos around lights. The patient takes digoxin (Lanoxin) by mouth every day. The physician orders the patient to have serum digoxin level drawn. At what digoxin level would the care team first suspect that the patient is experiencing toxicity? A) 0.5 ng/mL B) 1.5 ng/mL C) 3.0 ng/mL D) 6.0 ng/mL

C The therapeutic range for Digoxin is 0.8-2.0 ng/mL

The physician has ordered the patient hydrochlorothiazide. What assessment should the nurse make before administering the first dose of hydrochlorothiazide? A) Pulse rate B) Hemoglobin level C) Sulfonamide allergy D) Neutrophil level

C Thiazide diuretics must be used cautiously in patients who have an allergy to sulfonamides- cross sensitivity

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 aspirin (salicylate) is a blood thinner and antipyretic, analgesic, anti-inflammatory** (acts in the CNS and PNS) NSAIDS- ibuprofen: antipyretic, analgesic, anti-inflammatory acetaminophen (Tylenol): analgesic and anti-pyretic ONLY (acts in CNS only)

A 15-year-old boy has begun acne treatment using a combination ointment of clindamycin and benzoyl peroxide. The nurse should teach the boy to expect maximum results in how long? A) 5 to 7 days B) 1 to 2 weeks C) 3 to 5 weeks D) 8 to 12 weeks

D

A 71-year-old man with a history of osteoarthritis is scheduled for hip replacement surgery, and the surgeon has ordered a first-generation cephalosporin to be administered before and after surgery as prophylaxis. Which of the following drugs is a first-generation cephalosporin? A) Cefotetan (Cefotan) B) Cefoxitin (Mefoxin) C) Ceftriaxone (Rocephin) D) Cefazolin (Ancef)

D

A 90-year-old patient's most recent blood work includes the following data: alanine aminotransferase (ALT) 1.99 μkat/L (high) and aspartate aminotransferase (AST) 3.1 μkat/L (high). What implication do these data have for the patient's pharmacokinetics? A) Distribution of drugs may be erratic. B) Absorption of drugs may be incomplete. C) Excretion of drugs may be delayed. D) Metabolism of drugs may be impaired.

D

After obtaining several elevated blood pressure readings from the automated sphygmomanometer in his local drugstore, a 51-year-old man sought care from his primary care provider. The patient has been diagnosed with hypertension following several elevated blood pressure readings. The nurse at the clinic should recognize which of the following drug regimens as being most likely? A) Monotherapy with a loop diuretic B) Monotherapy with an ACE inhibitor C) A beta-blocker combined with a calcium channel blocker D) A thiazide diuretic combined with a beta-blocker

D The JNC 7 guidelines suggest thiazide diuretics be used as first-line therapy, either alone (monotherapy) or with a beta-blocker, ACE inhibitor, ARB, or calcium channel blocker

A patient is receiving IV heparin every 6 hours. An activated partial thromboplastin time (aPTT) is drawn 1 hour before the 08:00 dose. The PTT is 92 seconds. What is the most appropriate action by the nurse? A) Give the next two doses at the same time. B) Give the dose and chart the patient response. C) Check the patient's vital signs and give the dose. D) Hold the dose and call the aPTT result to the physician's attention.

D The normal control value is 25 to 35 seconds; therefore, therapeutic values are 45 to 70 seconds, approximately. A result of 92 seconds is a risk for bleeding, and the dose should be held until approval to administer is provided by the physician

A patient is being discharged from the hospital with warfarin (Coumadin) to be taken at home. Which of the following foods should the patient be instructed to avoid in his diet? A) Eggs B) Dairy products C) Apples D) Spinach

D Vitamin K is the antidote for warfarin (Coumadin) and spinach has lots of vitamin K so it will decrease effectiveness of the warfarin

A patient with colorectal cancer is being treated with oxaliplatin (Eloxatin). Which of the following potential adverse effects should the nurse explain to the patient? A) Dysuria B) Diarrhea C) Insomnia D) Cold-induced neuropathy

D oxaliplatin (Eloxatin) is a chemotherapy drug

A patient who is receiving warfarin (Coumadin) has blood in his urinary catheter drainage bag. What medication will likely be ordered by the physician? A) Aminocaproic acid (Amicar) B) Platelets C) Protamine sulfate D) Vitamin K

D warfarin (Coumadin) antidote is vitamin K

7. A patient with a long-standing dermatological health problem has been advised to use a drug with a local effect. The nurse should recognize what characteristic of this drug? A) It affects only the organ system in which it is metabolized. B) The drug requires application at multiple sites. C) It is effective only as long as it is in contact with skin. D) The drug acts primarily at the site where it is applied.

D.

A patient has a gastrostomy tube, and the pharmacy has delivered an extended-release tablet. What is the most appropriate action taken by the nurse? A) Administer the medication orally. B) Administer the medication through the tube. C) Crush the medication and administer half of it at a time. D) Call the pharmacy to obtain an immediate-release form.

D.

A patient's current medication administration record includes a drug that the nurse recognizes as an Institute for Safe Medication Practices (ISMP) high-alert medication. This designation signals the nurse to what characteristic of the drug? A) It can only be administered by a physician or advanced practice nurse. B) Administration must be cosigned by a second registered nurse or practical/vocational nurse. C) It is currently undergoing Phase IV testing and is pending full FDA approval. D) Administration errors carry a heightened risk of causing significant patient harm

D.

Which of the following sites of drug absorption is considered to have an exceptionally large surface area for drug absorption? A) Rectum B) Fundus of the stomach C) Esophagus D) Lungs

D.

1. The administration of diphenhydramine (Benadryl), which is an over-the-counter medication, is regulated by which government agency? A) Public Health Service B) Federal Trade Commission C) Occupational Safety and Health Administration D) Food and Drug Administration

D. The Food and Drug Administration approves drugs for over-the-counter availability, including the transfer of drugs from prescription to OTC status, and may require clinical trials to determine the safety and effectiveness of OTC use. The Public Health Service is regulated by the state to maintain the health of individual citizens of the state. The Federal Trade Commission regulates imports and exports throughout the nation. The Occupational Safety and Health Administration regulates safety within the workplace.