Exam 5 Review Questions
A patient with a history of heavy alcohol use needs a medication for pain. The recommended maximum daily dose of acetaminophen for this patient would be A.1000 mg. B.2000 mg. C.3000 mg. 4000 mg.
B. Rationale: Chronic heavy alcohol abusers may be at increased risk of liver toxicity from excessive acetaminophen use. For this reason, a maximum daily dose of 2000 mg is generally recommended for these persons.
Which statement regarding conscious sedation does the nurse identify as being accurate? A.The intravenous route of drug administration is commonly used in pediatric patients to provide conscious sedation. B.Mild amnesia is a common effect of midazolam. C.Patients receiving conscious sedation must be intubated with an endotracheal tube. D.Effects of propofol include relief of anxiety and pain.
B. Rationale: Midazolam allows the patient to relax and have markedly reduced or no anxiety, yet still maintain his or her open airway and response to verbal commands while producing mild amnesia. The oral route of drug administration for conscious sedation is preferred for pediatric patients; patients receiving conscious sedation are able to maintain their own airway. Propofol will relieve anxiety; however, pain medications must be used along with propofol therapy for situations that can cause a pain response.
A patient is taking ibuprofen 800 mg three times a day by mouth as treatment for osteoarthritis. While taking a health history, the nurse finds out that the patient has few beers on weekends. What concern would there be with the interaction of the alcohol and ibuprofen? A. Increased bleeding tendencies B. Increased chance for gastrointestinal bleeding C. Increased nephrotoxic effects D. Reduced antiinflammatory effects of the nonsteroidal antiinflammatory drug (NSAID)
B. Rationale: NSAIDs taken with alcohol may result in increased risk of gastrointestinal bleeding.
While taking a history of a 68-year-old female patient who is receiving estrogen therapy as part of palliative treatment for advanced breast cancer, which assessment finding would be of most concern to the nurse? A.The patient is on transdermal opioids for cancer pain. B.The patient smokes 1 pack of cigarettes a day. C.The patient drinks a glass of wine one evening a week. D.The patient has a history of osteoporosis.
B. Rationale: Smoking should be avoided during estrogen therapy because it adds to the risk for thrombosis.
A foreign particle is removed from the patient's eye. He tells the nurse that he previously forgot to mention that he takes eyedrops for glaucoma. He can't remember the name of the drug, but he knows the eyedrop bottle has a purple lid. The nurse identifies a purple lid as most likely containing which type of antiglaucoma drug? A.Direct-acting cholinergic B.Sympathomimetics C.Prostaglandin agonist D.Carbonic anhydrase inhibitor
B. Rationale: Sympathomimetics are usually in a bottle that has a purple lid. Direct-acting cholinergics are usually in a bottle that has a green lid. Prostaglandin agonists are usually in a bottle which has a teal or clear lid, and carbonic anhydrase inhibitors are usually in a bottle with an orange lid.
When administering eyedrops for glaucoma, the nurse understands the desired drug effect causes: A.increased intraocular pressure. B.decreased intraocular pressure. C.reduced cycloplegia. D.decreased inflammation.
B. Rationale: The desired effect of ophthalmic drops for glaucoma is decreased intraocular pressure.
While administering medications, the nurse finds a patient's eardrops in the medication refrigerator. If the nurse gives the eardrops immediately, what response might the patient have? A.No unusual response B.Immediate relief of ear discomfort C.A vestibular-type reaction D.Increased ear pain
C. Rationale: Administration of cold eardrops may cause a vestibular type of reaction, resulting in vomiting and dizziness.
A 2-year-old is seen in the pediatrician's office with a bacterial middle ear infection. Which medication does the nurse anticipate being prescribed for the child? A.amoxicillin B.Cortic C.carbamide peroxide (Debrox) D.Acetasol HC
A. Amoxicillin is the first-line drug for most children with bacterial otitis media. Cortic is composed of hydrocortisone (a steroid), pramoxine (a local anesthetic), chloroxylenol (an antiseptic antifungal), propylene glycol diacetate (an emulsifying drug), and benzalkonium chloride (an antiseptic preservative), and is used for fungal infections of the ear. Carbamide peroxide (Debrox) is a commonly used earwax emulsifier. Acetasol HC is used to treat fungal infections of the ear.
The patient improved within the first three months of treatment with methotrexate. Six months later, the patient experienced worsening of symptoms. The prescriber will most likely order which monoclonial antibody for the treatment of rheumatoid arthritis? A.adalimumab (Humira) B.trastuzumab (Herceptin) C.rituximab (Rituxan) D.cetuximab (Erbitux)
A. Rationale: Adalimumab (Humira) is indicated for the treatment of severe, progressive RA for which other RA therapies have failed. Trastuzumab (Herceptin) is indicated for the treatment of breast cancer. Rituximab (Rituxan) is used for the treatment of non-Hodgkin's lymphoma, and cetuximab (Erbitux) is indicated for the treatment of metastatic colorectal cancer.
When teaching a patient about spinal headaches, which statement will the nurse include? A.Spinal headaches can be prevented with bed rest after the epidural procedure. B.Patients who have a spinal headache should have very limited fluid intake. C.A graft of skin from the patient's hand can be used to seal the leaking area causing the headache. D.High Fowler's positioning should be used for patients who have a spinal headache.
A. Rationale: Adequate hydration using IV fluids is often used to increase cerebral spinal fluid pressure. A "blood patch" is often used to help close up or seal the leak. A small amount of blood is taken from the patient and injected into the epidural space. The patient should be positioned flat to prevent spinal headache and if a patient has a spinal headache, relief is often obtained by lying flat.
Which statement about use of corticosteroids for ocular inflammation does the nurse identify as being true? A.They are used during the acute phase of the injury process to prevent fibrosis and scarring, which result in visual impairment. B.Corticosteroids produce a lesser immunosuppressant effect than the NSAIDs. C.They are used for the treatment of minor abrasions and wounds of the eye. D.Use of corticosteroids for ocular inflammation results in discoloration of the iris.
A. Rationale: Corticosteroids are used during the acute phase of the injury process to prevent fibrosis and scarring, which result in visual impairment. Corticosteroids produce a greater immunosuppressant effect than NSAIDs, and they are not used for the treatment of minor abrasions and wounds of the eye because of the greater risk for infection. They do not change the color of the iris.
A 40-year-old female patient is seen in the clinic. She has been newly diagnosed with rheumatoid arthritis. Which medication does the nurse anticipate being ordered for the patient? A.methotrexate B.adalimumab C.infliximab D.etanercept
A. Rationale: For the treatment of rheumatoid arthritis, the recommend therapy with nonbiologic DMARDs usually begins with methotrexate or leflunomide for most patients. Biologic DMARDs are generally reserved for those patients whose disease does not respond to methotrexate or leflunomide. The biologic DMARDs include etanercept, infliximab, adalimumab, abatacept, and rituximab.
When assessing a patient under general anesthesia, which change to organ systems does the nurse expect? A.Nystagmus B.Skeletal muscle constriction C.Hypertension Decreased intracranial pressure
A. Rationale: Nystagmus can occur as a result of the use of general anesthesia. Other findings include skeletal muscle relaxation, hypotension, and increased intracranial pressure.
Which antiglaucoma drug works by increasing the outflow of aqueous humor between the uvea and sclera as well as via the usual exit through the trabecular meshwork? A.Prostaglandins B.Osmotic diuretics C.Carbonic anhydrase inhibitors D.Ophthalmic beta blockers
A. Rationale: Prostaglandins reduce intraocular pressure by increasing the outflow of aqueous humor between the uvea and sclera as well as via the usual exit through the trabecular meshwork. Osmotic diuretics reduce ocular hypertension by causing the blood to become hypertonic in relation to both intraocular and spinal fluids. This creates an osmotic gradient that draws water from the aqueous and vitreous humors into the bloodstream, which causes a reduction in the volume of intraocular fluid; the result is a decrease in intraocular pressure. Carbonic anhydrase inhibitors work by inhibiting the enzyme carbonic anhydrase, which results in decreased intraocular pressure by reduction of aqueous humor formation. The ophthalmic beta blockers reduce both elevated and normal intraocular pressure. They reduce intraocular pressure by reducing aqueous humor formation. In addition, timolol may produce a minimal increase in aqueous outflow.
A patient with bone cancer tells the nurse that he is in pain. The nurse knows that bone pain is classified as which type of pain? A.Somatic pain B.Referred pain C.Visceral pain D.Neuropathic pain
A. Rationale: Somatic pain, which includes bone pain, originates from the skeletal muscles, ligaments, and joints. Referred pain occurs when visceral nerve fibers synapse at a level in the spinal cord close to fibers that supply specific subcutaneous tissues in the body. Visceral pain originates from organs and smooth muscles. Neuropathic pain usually results from damage to peripheral or CNS nerve fibers or injury but may also be idiopathic.
A 48-year-old man asks the nurse practitioner for a prescription for sildenafil (Viagra). He is currently taking transdermal nitroglycerin, hydrochlorothiazide, and potassium supplements for cardiac problems, as well as a multivitamin with iron. Which medication would be a cause for concern if taken with the sildenafil? A. Transdermal nitroglycerin B. Hydrochlorothiazide C. Potassium D. Multivitamin with iron
A. Rationale: Taking drugs like sildenafil with nitrates may lead to dangerous hypotensive episodes.
A 60-year-old male with a history of benign prostatic hypertrophy and hypertension is seen in the Emergency Department because he was trimming his shrubs and got something in his right eye. He complains of a pain rating of 8 on a scale of 1 to 10 in the right eye. Which medication does the nurse anticipate administering via eyedrop to help control the patient's pain? A.tetracaine B.atropine C.morphine D.lidocaine
A. Rationale: Tetracaine is a local anesthetic of the ester type. It is applied as an eyedrop to numb the eye for various ophthalmic procedures. Tetracaine begins to work in about 25 seconds and lasts for about 15 to 20 minutes. Additional drops are applied as needed. It is currently available only in solution form.
The nurse anesthetist is planning to use balanced anesthesia during a surgical procedure. A characteristic of this type of anesthesia is the A.administration of minimal doses of multiple anesthetic drugs. B.administration of inhaled anesthetics. C.IV administration of anesthetics. administration of anesthetics to cause muscle relaxation.
A. Rationale: The use of a combination of drugs allows less of each drug to be used and a more balanced, controlled state of anesthesia to be achieved.
The patient improved within the first three months of treatment with methotrexate. Six months later, the patient experienced worsening of symptoms. The prescriber will most likely order which monoclonial antibody for the treatment of rheumatoid arthritis? A.adalimumab (Humira) B.trastuzumab (Herceptin) C.rituximab (Rituxan) D.cetuximab (Erbitux)
A. Rationale: Adalimumab (Humira) is indicated for the treatment of severe, progressive RA for which other RA therapies have failed. Trastuzumab (Herceptin) is indicated for the treatment of breast cancer. Rituximab (Rituxan) is used for the treatment of non-Hodgkin's lymphoma, and cetuximab (Erbitux) is indicated for the treatment of metastatic colorectal cancer.
A 40-year-old female patient is seen in the clinic. She has been newly diagnosed with rheumatoid arthritis. Which medication does the nurse anticipate being ordered for the patient? A.methotrexate B.adalimumab C.infliximab etanercept
A. Rationale: For the treatment of rheumatoid arthritis, the recommend therapy with nonbiologic DMARDs usually begins with methotrexate or leflunomide for most patients. Biologic DMARDs are generally reserved for those patients whose disease does not respond to methotrexate or leflunomide. The biologic DMARDs include etanercept, infliximab, adalimumab, abatacept, and rituximab.
After administering an ophthalmic anesthetic drug, which adverse effects does the nurse anticipate as possibly developing in the patient? (Select all that apply.) A.Stinging B.Burning C.Redness D.Lacrimation E.Blurred vision
All are correct Rationale: Adverse effects are rare with ophthalmic anesthetic drugs and are limited to local effects such as stinging, burning, redness, lacrimation, and blurred vision. Systemic toxicity is rare but can theoretically lead to central nervous system (CNS) stimulation and/or CNS or cardiovascular depression.
Which statement regarding use of monoclonal antibodies in the treatment of cancer does the nurse identify as being true? Monoclonal antibodies A.are not as effective as other chemotherapy drugs. B.have few adverse effects. C.may cause flulike effects but do not cause the typical adverse effects associated with chemotherapy. D.are only used in cases of last resort when other chemotherapy drugs have failed.
C. Rationale: Because these drugs only target cancer cells, they do not have the adverse effects that are typically associated with chemotherapy. However, they do cause acute symptoms that are similar to classic allergy or flulike symptoms. As a result, these symptoms are managed during therapy.
When administering eyedrops to a patient, the nurse places the drop A.directly onto the cornea. B.in the inner canthus. C.into the lower conjunctival sac. D.onto the sclera.
C. Rationale: Eyedrops should be placed into the lower conjunctival sac.
A patient's chemotherapy has ended at 1800 on a Tuesday afternoon. When is it appropriate to start therapy with filgrastim? A.1800 on Tuesday B.0600 on Wednesday C.1800 on Wednesday D.1 week later, 1800 the next Tuesday
C. Rationale: Filgrastim and sargramostim have significant drug interactions when given with myelosuppressive antineoplastic drugs. Typically filgrastim and sargramostim are not given within 24 hours of administration of myelosuppressive antineoplastics.
Gentle massage of the tragus area of the ear after administering eardrops results in A.decreased absorption of the medication. B.softening of the cerumen in the ear canal. C.increased coverage of the medication in the ear canal. D.reduced pain in the ear.
C. Rationale: Gentle massage of the tragus area of the ear after instillation of eardrops helps to increase the coverage or distribution of the medication in the ear canal.
A patient is to receive a neuromuscular blocking drug while on mechanical ventilation. While the patient is receiving this medication, the nurse should expect the patient to be: A.sedated. B.resisting the ventilator. C.awake but unable to move. D.pain free.
C. Rationale: Neuromuscular blocking drugs make the patient unable to move, but they do not cause sedation or relieve pain.
A patient in the intensive care unit will be receiving a neuromuscular blocking drug. Which piece of equipment is essential to have nearby when the nurse initiates this therapy? A.Defibrillator B.Sphygmomanometer C.Mechanical ventilator D.Oxygen source
C. Rationale: Neuromuscular drugs paralyze the respiratory muscles; it is essential to have sufficient ventilator support nearby in case the medication causes the patient to lose the ability to breathe. Oxygen alone is not sufficient.
Prior to administering methotrexate, it is most important for the nurse to assess the patient for A.allergy to eggs. B.congestive heart failure. C.latent tuberculosis. D.hypothyroidism.
C. Rationale: Prior to administering DMARDs, it is important for the nurse to assess the patient for contraindications to the use of DMARDs such as active bacterial infections, active herpes, active/latent tuberculosis, and acute or chronic hepatitis B or C.
A patient receiving tetrahydrozoline asks how the drug works. The best response by the nurse will include that the drug works by A.pulling fluid from the eye tissue to the blood stream. B.decreasing the amount of fluid produced by the eye. C.promoting vasoconstriction of blood vessels in and around the eye. D.causing the pupil to constrict.
C. Rationale: Tetrahydrozoline is an ocular decongestant. It works by promoting vasoconstriction of blood vessels in and around the eye. This reduces the edema associated with allergic and inflammatory processes. It is specifically indicated to control redness, burning, and other minor irritations.
A hospitalized patient has an order for ketorolac (Toradol). The nurse notes that the order is only for 5 days. What is the reason for this? A.The patient's pain should subside by that time. B.There are concerns about addiction to the drug. C.The drug can cause severe renal and gastrointestinal effects. D.The drug loses its effectiveness over time.
C. Rationale: The main adverse effects of ketorolac include renal impairment, edema, gastrointestinal pain, dyspepsia, and nausea. It is important to note that the drug can only be used for 5 days because of its potential adverse effects on the kidney and gastrointestinal tract.
During surgery, the anesthetist notes that the patient's heart rate is gradually increasing and becoming more irregular, the patient's blood pressure is becoming unstable, and the patient is starting to sweat profusely. What other assessment should the anesthetist note immediately? A.Pupillary reactions B.Respiratory effort C.Temperature D.Urinary output
C. Rationale: These are indications of malignant hyperthermia, which can progress rapidly.
A woman in labor is on an oxytocin infusion. The nurse notes that her contractions are close to 100 seconds apart and are lasting 1.25 seconds. The mother's blood pressure has increased to 130/98, and the fetal heart rate decreases during the contractions. The woman states, "Wow, this medicine is sure hurrying things along!" The nurse's next action(s) will be to: A.continue to monitor the labor, which is progressing nicely. B.offer comfort measures during the contractions. C.stop the infusion, administer oxygen, have her lie on her left side, and notify the physician immediately. D.take the patient to the delivery area because delivery is imminent.
C. Rationale: These are signs of hyperstimulation of the uterus from the oxytocin. Fetal compromise may occur if the infusion is not stopped.
The nurse is administering medications. One patient has an order for aspirin 325 mg by mouth daily and another patient has an order for aspirin 650 mg 4 to 6 times daily (maximum 4 g/day). The nurse understands that the indication for the 325 mg of aspirin once daily is A. pain management. B. fever reduction. C. treatment of osteoarthritis. D. thromboprevention.
D. Rationale: "Low-dose" aspirin, such as 81 or 325 mg once daily, is given for thromboprevention. Dosages for pain, fever, or arthritis are much higher usually.
When assessing a patient taking testosterone, which laboratory value is most important for the nurse to review? A. Hemoglobin A1C B. Triglycerides C. Potassium D. Lactate dehydrogenase (LDH)
D. Rationale: Assess the patient for liver disease because formation of blood-filled cavities may occur. This condition, also called peliosis, is associated with long-term therapy and may be life-threatening. Perform liver function studies (e.g., LDH, CPK, and bilirubin levels) as ordered to monitor for the possible adverse effect of abnormal liver function and jaundice.
A 60-year-old woman is taking a bisphosphonate. She calls the clinic and tells the nurse that her stomach has been bothering her and wants to know what she should do. The nurse will instruct her to: A.take this medication with milk. B.take this medication with breakfast. C.remain upright in a sitting position for at least 10 minutes after taking this medication. D.stop the medication and to come in for an evaluation.
D. Rationale: Bisphosphonates (e.g., alendronate) are to be taken exactly as prescribed; that is, the drug is taken at least 30 minutes before the first morning beverage, food, or other medication and with at least 6 to 8 oz of water. Emphasize the importance of remaining upright for at least 30 minutes after taking the medication to prevent esophageal and GI adverse effects. Esophageal irritation, dysphagia, severe heartburn, and retrosternal pain must be reported to the prescriber immediately to help prevent severe reactions.
The ophthamologist tells the patient that she is going to place a dye onto the patient's eye to help identify the location of the foreign object. Which drug does the nurse anticipate the ophthamologist will use? A.olopatadine (Patanol) B.cromolyn sodium (Crolom) C.tetrahydrozoline D.fluorescein (AK-Fluor)
D. Rationale: Fluorescein (AK-Fluor) is an ophthalmic diagnostic dye used to identify corneal defects and to locate foreign objects in the eye. Olopatadine (Patanol) is an ocular antihistamine used to treat symptoms of allergic conjunctivitis (hay fever). Cromolyn sodium (Crolom) is an antiallergic drug that inhibits the release of inflammation-producing mediators from sensitized inflammatory cells called mast cells. Tetrahydrozoline is an ocular decongestant. It works by promoting vasoconstriction of blood vessels in and around the eye.
Which drug does the nurse associate with the development of potentially life-threatening skin adverse effects of exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis? A. probenecid B. colchicine C. febuxostat (Uloric) D. allopurinol (Zyloprim)
D. Rationale: If the patient is taking allopurinol, assess the integrity of the skin due to potentially life-threatening skin adverse effects of exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis.
A patient is admitted with salicylate toxicity. When assessing the patient, the nurse anticipates which manifestation associated with salicylate toxicity? A.Bradycardia B.Hypoventilation C.Constipation D.Hyperglycemia
D. Rationale: Manifestations of salicylate toxicity include increased heart rate, tinnitus, hearing loss, dimness of vision, headache, dizziness, mental confusion, lassitude, drowsiness, nausea, vomiting, diarrhea, sweating, thirst, hyperventilation, and hypoglycemia or hyperglycemia.
The patient is scheduled for discharge. Which information does the nurse include when teaching the patient about methotrexate therapy? A.You can expect to develop mouth sores that will improve with time when taking this medication. B.Administer the methotrexate injection daily in the early morning. C.Mix the methotrexate with sterile saline prior to administration. D.Administer the methotrexate subcutaneously into the thigh, abdomen, or upper arm, rotating injection sites.
D. Rationale: Methotrexate should be administered subcutaneously into the thigh, abdomen, or upper arm, rotating injection sites. Methotrexate should not be administered with other solutions and without use of a filter. Methotrexate is taken weekly. The development of stomatitis should be reported to the prescriber immediately.
A woman has not taken her oral contraceptive since Monday. It is now Wednesday morning. What should she do now to prevent pregnancy? A.Take the two missing doses as soon as possible. B.Continue the drug as if no doses were missed. C.Start over with a new monthly pack of oral contraceptives. D.Resume the drug but also use a second form of birth control.
D. Rationale: Missed doses will reduce the effectiveness of the oral contraceptive, so another form of pregnancy prevention will be needed.
An 82-year-old woman is taking ibuprofen (Motrin) 3200 mg divided three times daily as treatment for arthritis. She has had no other health problems. What is the most important assessment for the nurse to monitor while the patient is on this therapy? A.Blood sugar B.Liver function studies C.Assessment of hearing D.Renal function studies
D. Rationale: NSAIDs disrupt the prostaglandins, which stimulate vasodilation and increase renal blood flow. This disruption may precipitate chronic or acute renal failure in some patients, and elderly patients are at greater risk for this adverse drug reaction
A patient who has metastasized bone cancer has been on transdermal fentanyl patches for pain management for 3 months. He has been hospitalized for tests and has told the nurse that his pain is becoming "unbearable." The nurse is reluctant to give him the ordered pain medication because the nurse does not want the patient to get addicted to the medication. The nurse's actions reflect A.appropriate concern for the patient's best welfare. B.appropriate caution for a patient who is already on a long-term opioid. C.an uncaring attitude toward the patient. D.a failure to manage the patient's pain properly.
D. Rationale: Patients with severe pain, including metastatic pain or bone pain, may need higher and higher doses of analgesics. The nurse is responsible for ensuring that the patient experiences adequate pain relief.
A patient tells the nurse that he takes saw palmetto because he thinks his prostate gland is enlarged. The patient informs the nurse of the medications he takes on a regular basis. Which medication will be of most concern to the nurse? A. Calcium with vitamin D B. acetaminophen (Tylenol) C. St. John's wort ibuprofen (Motrin)
D. Rationale: The nurse should be most concerned about concurrent use of saw palmetto with the NSAID ibuprofen (Motrin) because of the potential for drug interactions.
A patient is recovering from an appendectomy. She also has asthma and allergies to shellfish and iodine. To manage her postoperative pain, the physician has prescribed patient-controlled analgesia (PCA) with hydromorphone (Dilaudid). Which vital sign is of greatest concern? A.Pulse B.Blood pressure C.Temperature D.Respirations
D. Rationale: This patient has a history of asthma and allergies, and she will be receiving a drug that can depress respirations.
When teaching an adult patient about eardrops, which statement will the nurse include? A."Hold your ear down and back to instill the drops." B."If you feel dizzy after instilling the ear drops, stand up and walk around the room." C."Warm the ear drops up for 30 seconds in the microwave before using them." D."Lie on the opposite side of that of your affected ear for about 5 minutes after instilling the drug."
D. Rationale: The adult ear should be held up and back to instill eardrops. Warn the patient that dizziness may occur after application of the medication, requiring the patient to remain supine or sitting during instillation and for a few minutes thereafter. Advise the patient not to heat the medication; for example, a microwave oven must not be used for warming—because eardrops that are overheated may lose potency.