NCLEX-style Review Questions for Exam 3 Pharm

The healthcare provider prescribes lovastatin [Mevacor] for a patient discharged from the hospital post-myocardial infarction. Which instructions are most appropriate for the nurse to include in the patient's teaching plan? (Select all that apply.) a) "Do not start any new medications without first talking to your healthcare provider." b) "Before starting this medication a blood test will be done to check your total cholesterol level and to measure liver enzymes." c) "Take your medication in the morning, with a full glass of water for best results." d) "Take one 325-mg aspirin 30 minutes before your dose to lessen the problem of flushing and itching that can occur with this drug." e) "Lower the total fat and saturated fat in your diet by increasing your intake of fresh fruits and vegetables and whole grains."

a) "Do not start any new medications without first talking to your healthcare provider." b) "Before starting this medication a blood test will be done to check your total cholesterol level and to measure liver enzymes." e) "Lower the total fat and saturated fat in your diet by increasing your intake of fresh fruits and vegetables and whole grains." Lovastatin, simvastatin, and atorvastatin levels may be elevated when these drugs are combined with other drugs that inhibit CYP3A4. If these drugs are combined, caution is warranted. Before starting a statin, obtain a baseline lipid profile that includes total cholesterol and obtain baseline LFTs. The statins are taken once daily with food. It is recommended to take them with the evening meal because endogenous cholesterol synthesis increases during the night. The statins do not typically cause flushing and itching; that effect occurs with niacin. A diet low in total fat and saturated fat is recommended when antilipemic drugs are prescribed.

Which instruction should be included in the teaching for a patient for whom fluticasone propionate [Flovent] MDI has been ordered? a) "Gargle after using your inhaler." b) "Take the medication immediately at the onset of an attack." c) "Take your albuterol first, followed by the Flovent 5 minutes later." d) "Make sure you monitor your fingerstick blood glucose level each morning."

a) "Gargle after using your inhaler." Patients should be taught to gargle after using inhaled glucocorticoids, such as fluticasone propionate, to minimize dysphonia and oropharyngeal candidiasis. The medication is not used to abort an acute attack. Short-acting bronchodilators, such as albuterol, should be administered 5 minutes before inhaled glucocorticoids to enhance delivery to the bronchial tree. Oral glucocorticoids pose a risk of hyperglycemia.

A patient has been given instructions about levothyroxine [Synthroid]. Which statement by the patient indicates understanding of these instructions? a) "I'll take this medication in the morning so as not to interfere with sleep." b) "I'll plan to double my dose if I gain more than 1 pound per day." c) "It is best to take the medication with food so I don't have any nausea." d) "I'll be glad when I don't have to take this medication in a few months."

a) "I'll take this medication in the morning so as not to interfere with sleep." Levothyroxine is used to treat hypothyroidism by increasing the basal metabolism and thus wakefulness. It is administered as a once-daily dose and is a lifelong therapy. It is best taken on an empty stomach to enhance absorption.

Which statement is most appropriate for the nurse to include in the discharge teaching plan for a 30-year-old woman beginning a new prescription of clonidine [Catapres]? a) "If you stop taking this drug abruptly, your blood pressure might go up very high." b) "You will need to have your blood drawn regularly to check for anemia." c) "Take this medication first thing in the morning to reduce nighttime wakefulness." d) "This medication often is used to manage hypertension during pregnancy."

a) "If you stop taking this drug abruptly, your blood pressure might go up very high." Rebound hypertension is a potential adverse effect of clonidine. Patients should be warned against abrupt withdrawal. Clonidine is not associated with anemia. It can cause drowsiness and usually is taken at night. Clonidine is not recommended for pregnant patients.

A patient is receiving desmopressin [DDAVP] for the treatment of diabetes insipidus. Which instruction is the priority for a nurse to give the patient? a) "Reduce your water intake to prevent water intoxication." b) "Rotate the nostril you use daily to prevent irritation." c) "Weigh yourself several times each week." d) "You'll quickly see the results of a lower urine amount."

a) "Reduce your water intake to prevent water intoxication." Failure to reduce the fluid intake while using desmopressin results in water intoxication, leading to seizures and coma. DDAVP is administered intranasally; therefore, rotating the nostril used is important to prevent irritation. Monitoring weekly weights for volume status and understanding that a rapid treatment response occurs also are important; however, they are not as important as reducing the fluid intake to prevent water intoxication.

A patient with nonvalvular atrial fibrillation is to be discharged on dabigatran etexilate [Pradaxa]. Which statement should the nurse include in the discharge teaching? a) "The medication must be stored in the manufacturer-supplied bottle." b) "Once a new bottle is opened, the capsules maintain efficacy for 90 days." c) "If you have difficulty swallowing the capsule, you can open it and mix it with food." d) "You will need to learn how to give yourself a subcutaneous injection in your abdomen."

a) "The medication must be stored in the manufacturer-supplied bottle." Dabigatran is unstable, especially when exposed to moisture, and should be stored in the manufacturer-supplied bottle, which has a desiccant cap. Current labeling of the pill bottle indicates that once the bottle is opened, the pills should be used within 30 days. However, recent evidence indicates that they maintain efficacy for 60 days, provided they have been stored in the original container. Capsules should be swallowed intact, because chewing, crushing, or opening enhances absorption by 75% and increases the risk of bleeding. The medication is administered orally, not subcutaneously.

After administering acetylcysteine [Mucomyst] to a patient who overdosed on acetaminophen [Tylenol], a nurse should recognize which outcome as an indicator of the therapeutic effects of acetylcysteine? a) Absence of jaundice b) Clear breath sounds c) Increased bowel sounds d) Palpable pedal pulses

a) Absence of jaundice Acetylcysteine [Mucomyst] substitutes for depleted glutathione in the reaction that removes the toxic metabolite of acetaminophen [Tylenol] (which accumulates with acetaminophen poisoning) and thereby minimizes liver damage. Severe hepatic injury may occur with acetaminophen [Tylenol] poisoning, which is manifested by jaundiced sclera and skin. The assessment of bowel sounds, breath sounds, and pedal pulses is not used to determine the therapeutic effects of acetylcysteine [Mucomyst] for the treatment of acetaminophen overdose.

The nurse is administering epoetin alfa [Procrit] to a patient receiving chemotherapy. Which adverse effect is a potential risk with this drug? a) Accelerated tumor progression b) Hypotension c) Easy bruising d) Bone pain

a) Accelerated tumor progression Epoetin alfa has been shown to accelerate tumor progression and shorten life in some patients with cancer. This is more common when the hemoglobin level rises above 12 gm/dL. Other adverse effects associated with epoetin alfa include hypertension, cardiovascular events, and deep vein thrombosis when the drug is used preoperatively. Bone pain is associated with filgrastim.

What does the nurse identify as a possible adverse effect of long-term glucocorticoid therapy? (Select all that apply.) a) Adrenal insufficiency b) Osteoporosis c) Hypoglycemia d) Hyperkalemia e) Cataracts

a) Adrenal insufficiency b) Osteoporosis e) Cataracts Adverse effects of long-term glucocorticoid therapy include adrenal insufficiency, osteoporosis, hyperglycemia, hypokalemia, and cataracts.

A nurse provides discharge instructions for a patient who is taking acetaminophen [Tylenol] after surgery. The nurse should instruct the patient to avoid which product while taking acetaminophen? a) Alcoholic drinks b) Leafy green foods c) Bananas d) Dairy products

a) Alcoholic drinks Through several mechanisms, regular alcohol consumption while taking acetaminophen [Tylenol] increases the risk of liver injury when dosages are excessive. Therapeutic doses of acetaminophen [Tylenol] may be safe for patients who drink alcohol; however, the U.S. Food and Drug Administration (FDA) requires that acetaminophen [Tylenol] labels state an alcohol warning for patients who consume three or more drinks a day to consult their prescriber to determine whether acetaminophen [Tylenol] can be taken safely. It is not necessary to avoid leafy green foods, bananas, or dairy products when taking acetaminophen.

Which drug is the most effective for lowering LDL cholesterol? a) Atorvastatin [Lipitor] b) Cholestyramine [Questran] c) Gemfibrozil [Lopid] d) Ezetimibe [Zetia]

a) Atorvastatin [Lipitor] The statin drugs, such as atorvastatin, are the most effective drugs for lowering LDL cholesterol. They are better tolerated, have fewer adverse effects, and produce better clinical outcomes than any other agents available for lowering LDL.

When assessing a patient for adverse effects of cyclosporine [Sandimmune], it is most important for the nurse to review which laboratory findings? (Select all that apply.) a) Creatinine level b) Hemoglobin level c) Platelet count d) Bilirubin level Correct e) White blood cell (WBC) count

a) Creatinine level e) White blood cell (WBC) count Cyclosporine is an immunosuppressant medication used to prevent organ rejection. Adverse effects include significant neurotoxicity, renal toxicity, hepatotoxicity, and infection risk. The hemoglobin level and the platelet count are not adversely affected by cyclosporine.

Both IV ampicillin/sulbactam [Unasyn] and gentamicin are ordered for a patient. When administering these medications, the nurse will do what? a) Ensure that separate IV solutions are used. b) Use two different peripheral IV sites. c) Administer the gentamicin first. d) There are no necessary precautions.

a) Ensure that separate IV solutions are used. When penicillins are present in high concentrations, they interact chemically with aminoglycosides, causing inactivation of the aminoglycosides. Therefore, penicillins and aminoglycosides should not be mixed in the same IV solution. Rather, these drugs should be administered separately. Two different peripheral IV sites are not necessary. Administering the gentamicin first does not ensure separation of the two medications.

The nurse should review which baseline data before starting epoetin alfa [Epogen] therapy in a patient with chronic renal failure (CRF)? (Select all that apply.) a) Ferritin level b) Temperature trends c) Blood glucose level d) Blood pressure trends e) Hemoglobin and hematocrit

a) Ferritin level d) Blood pressure trends e) Hemoglobin and hematocrit Baseline data that should be collected and evaluated before initiation of epoetin alfa [Epogen] include blood pressure, blood chemistry (blood urea nitrogen [BUN], uric acid, creatinine, phosphorous, potassium), degree of transferrin saturation, ferritin concentration, and hemoglobin and hematocrit. The ferritin concentration should be at least 100 ng/mL for epoetin alfa therapy to be effective. In patients with CRF, epoetin alfa is associated with a rise in blood pressure. Knowledge of baseline blood pressures is essential to determine whether changes are occurring. Baseline hemoglobin/hematocrit levels serve as a measure of comparison for determining the effectiveness of therapy. It is not essential to know the temperature trends or blood glucose level before starting therapy.

Which medications should be used with caution in a hypertensive diabetic patient? (Select all that apply.) a) Furosemide [Lasix] b) Metoprolol [Lopressor] c) Diltiazem [Cardizem] d) Hydrochlorothiazide [HCTZ] e) Enalapril [Vasotec]

a) Furosemide [Lasix] b) Metoprolol [Lopressor] d) Hydrochlorothiazide [HCTZ] Hydrochlorothiazide and furosemide promote hyperglycemia, and metoprolol suppresses glycogenolysis and can mask signs of hypoglycemia. Therefore, these medications should be administered with caution to patients with diabetes. Diltiazem and enalapril do not cause either of these effects.

A nurse teaches a patient who takes daily low-dose aspirin for protection against myocardial infarction and stroke to avoid also taking which medication? a) Ibuprofen [Motrin] b) Zolpidem [Ambien] c) Loratadine [Claritin] d) Diphenhydramine [Benadryl]

a) Ibuprofen [Motrin] Ibuprofen [Motrin] can block the antiplatelet effects of aspirin; therefore, patients who take low-dose aspirin to protect against myocardial infarction and thrombosis should avoid taking ibuprofen [Motrin]. It is not necessary to avoid taking zolpidem [Ambien], loratadine [Claritin], or diphenhydramine [Benadryl] while taking aspirin.

What does the nurse identify as possible complications of glucocorticoid therapy? (Select all that apply.) a) Impaired carbohydrate and glucose tolerance b) Increased production of glucocorticoids from the adrenals c) Predisposition to gastrointestinal ulceration d) Decrease in serum sodium and glucose levels e) Increase in plaque development in coronary arteries

a) Impaired carbohydrate and glucose tolerance c) Predisposition to gastrointestinal ulceration Adverse effects of glucocorticoids occur in response to pharmacologic doses; they include suppression of adrenal glucocorticoids; glucose and carbohydrate intolerance, elevated blood glucose level; water and sodium retention; and increased gastric acid secretion. Plaque development in arteries is not affected.

The nurse is preparing to administer a dose of clonidine [Catapres]. Which is the best description of the action of this drug? a) It selectively activates alpha2 receptors in the central nervous system (CNS). b) It causes peripheral activation of alpha1 and alpha2 receptors. c) It depletes sympathetic neurons of norepinephrine. d) It directly blocks alpha and beta receptors in the periphery.

a) It selectively activates alpha2 receptors in the central nervous system (CNS). Clonidine is an alpha2-adrenergic agonist that causes selective activation of alpha2 receptors in the CNS. This in turn reduces sympathetic outflow to the blood vessels and the heart. Although the body's responses are similar to those from a peripheral adrenergic blocker, clonidine's action occurs in the CNS.

A nurse is preparing to give bethanechol [Urecholine]. What is an expected outcome of this drug? a) Nondistended bladder b) Increased heart rate and blood pressure c) Improved pulse oximetry reading d) Relief of cardiac rhythm problems

a) Nondistended bladder Bethanechol is a muscarinic agonist and therefore activates muscarinic receptors. This can lead to relaxation of the urinary sphincter muscles and increased voiding pressure. It also can cause bradycardia and hypotension, bronchoconstriction, and dysrhythmias in hyperthyroid patients.

A nurse administers which medication to inhibit an enzyme that makes gastric acid in a patient who has a duodenal ulcer? a) Omeprazole [Prilosec] b) Famotidine [Pepcid] c) Misoprostol [Cytotec] d) Ranitidine [Zantac]

a) Omeprazole [Prilosec] Omeprazole causes irreversible inhibition of the proton pump, the enzyme that generates gastric acid. It is a powerful suppressant of acid secretion. Famotidine and ranitidine block histamine2 receptors on parietal cells. Misoprostol protects against ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs) by stimulating the secretion of mucus and bicarbonate to maintain submucosal blood flow.

The nurse identifies which statements about penicillins as true? (Select all that apply.) a) Penicillins are the safest antibiotics available. b) The principal adverse effect of penicillins is allergic reaction. c) A patient who is allergic to penicillin always has a cross-allergy to cephalosporins. d) A patient who is allergic to penicillin is also allergic to vancomycin, erythromycin, and clindamycin. e) Penicillins are normally eliminated rapidly by the kidneys but can accumulate to harmful levels if renal function is severely impaired.

a) Penicillins are the safest antibiotics available. b) The principal adverse effect of penicillins is allergic reaction. e) Penicillins are normally eliminated rapidly by the kidneys but can accumulate to harmful levels if renal function is severely impaired. A patient who is allergic to penicillin has a 1% chance of also being allergic to cephalosporins. Patients who are allergic to penicillin are safely able to take vancomycin, erythromycin, and clindamycin. The other three statements are true.

Which are beneficial effects that can be derived from simvastatin [Zocor] and other drugs in this class? (Select all that apply.) a) Reduction of LDLs b) Elevation of HDLs c) Stabilization of the plaque in coronary arteries d) Reduction of risk of cardiovascular events e) Improvement of liver function

a) Reduction of LDLs b) Elevation of HDLs c) Stabilization of the plaque in coronary arteries d) Reduction of risk of cardiovascular events The statin drugs have many benefits, the most important being reduction of LDLs. They also promote an increase in HDLs, stabilization of atherosclerotic plaque, and reduced inflammation at the plaque site. Among other benefits, they also slow progression of coronary artery calcification. The statins reduce the overall risk of cardiovascular events. They can have serious adverse effects on the liver, but these are relatively rare.

A nurse should teach a patient to observe for which side effects when taking ampicillin? a) Skin rash and loose stools b) Reddened tongue and gums c) Digit numbness and tingling d) Bruising and petechiae

a) Skin rash and loose stools Ampicillin's most common side effects are rash and diarrhea; both reactions occur more frequently with ampicillin than with any other penicillin. Reddened tongue and gums, digit numbness and tingling, and bruising and petechiae are not associated side effects of ampicillin.

The nurse should question an order for glucocorticoids in the treatment of a patient with what? a) Systemic fungal infection b) Diabetes mellitus c) Myasthenia gravis d) Glaucoma

a) Systemic fungal infection Glucocorticoids are contraindicated in the treatment of a patient with a systemic fungal infection or in patients receiving live vaccines. Glucocorticoids should be used with caution in patients with diabetes mellitus, myasthenia gravis, and glaucoma.

Which manifestations should a nurse investigate first when monitoring a patient who is taking levothyroxine [Synthroid]? a) Tachycardia b) Tremors c) Insomnia d) Irritability

a) Tachycardia High doses of levothyroxine may cause thyrotoxicosis, a condition of profound excessive thyroid activity. Tachycardia is the priority assessment, because it can lead to severe cardiac dysfunction. Tremors, insomnia, and irritability are other symptoms of thyrotoxicosis and should be assessed after tachycardia.

The patient reports that she had to switch pharmacies to save money. She noticed that her "thyroid pill" looks different. The nurse anticipates that the healthcare provider will order what? a) Thyroid stimulating hormone (TSH) b) Electrocardiogram (ECG) c) Beta human chorionic gonadotropin (hCG) test d) Creatinine level

a) Thyroid stimulating hormone (TSH) If a switch is made (from one branded product to another, from a branded product to a generic product, or from one generic product to another), retest serum TSH in 6 weeks, and adjust the levothyroxine dosage as indicated.

The nurse is caring for a patient receiving atropine. Which is a therapeutic indication for giving this drug? a) Use as a preanesthesia medication b) Treatment of tachycardias c) Prevention of urinary retention d) Reduction of intraocular pressure in glaucoma

a) Use as a preanesthesia medication Atropine is a muscarinic antagonist and can help prevent dangerous bradycardia during surgery. It often is administered before the induction of anesthesia. Its side effects may include urinary retention, constipation, and tachycardia.

Using a stepwise approach to managing asthma, a nurse teaches a patient who is at step 1 to use albuterol MDI [Proventil] at which of these times? a) Whenever needed (PRN) as a quick-relief agent b) Twice daily combined with an inhaled glucocorticoid c) Only with a long-acting beta2 agonist (LABA) d) If nighttime awakenings occur more than 2 days a week

a) Whenever needed (PRN) as a quick-relief agent For patients at step 1 in the stepwise approach to managing asthma, albuterol is a short-acting beta2 agonist (SABA) used only PRN to relieve ongoing asthma attacks and prevent exercise-induced bronchospasm. For patients at step 1, no long-term control medications are taken. A patient is at a higher step than 1 in the stepwise approach if the patient requires a daily inhaled glucocorticoid or LABA or awakens at night more often than 2 days a week. For patients at steps 2 to 6, albuterol is considered a quick-relief medication taken PRN.

Antimuscarinic adverse effects include which of the following? (Select all that apply.) a) Xerostomia b) Blurred vision c) Diarrhea d) Decrease in intraocular pressure e) Anhidrosis

a) Xerostomia b) Blurred vision e) Anhidrosis Antimuscarinic side effects include xerostomia (dry mouth), blurred vision, constipation, and anhidrosis. Diarrhea and decrease in intraocular pressure are incorrect.

Which are advantages of a dry-powder inhaler (DPI) over a metered-dose inhaler (MDI)? (Select all that apply.) a) More of the drug is delivered to the lungs and less to the oropharynx. b) Use of a spacer is not necessary. c) Less propellant is needed to deliver the medication. d) Less hand-lung coordination is required. e) DPIs pose no environmental risk.

a, b, d, e DPIs deliver more drug to the lungs (20% of the total released, compared to 10% for MDIs). Spacers are not necessary with DPIs; they are recommended for use with MDIs to increase the delivery of drug to the lungs rather than the oropharyngeal mucosa. DPIs do not require the hand-lung coordination needed with MDIs. DPIs present no environmental hazard, because no propellant is required for delivery.

A patient with Parkinson's disease who takes levodopa/carbidopa [Sinemet] comes to the clinic for a semiannual physical examination. Which question is the most important for the nurse to ask? a) "Have you noticed any swelling in your feet?" b) "Are you having vivid dreams or hallucinations?" c) "Have you noticed any changes in your stool?" d) "Have you had your flu vaccine?"

b) "Are you having vivid dreams or hallucinations?" Patients taking levodopa/carbidopa [Sinemet] are at increased risk for the psychiatric side effects of levodopa, including visual hallucinations, vivid dreams, nightmares, and paranoid ideation. The other questions are not directly related to problems that are likely to occur with this drug.

Which statement does the nurse include when teaching a patient about antipsychotic drug therapy? (Select all that apply.) a) "Restrict the use of antipsychotic drugs to 3 months to prevent the development of addiction." b) "Dilute oral preparations in fruit juice to improve their palatability." c) "Store oral preparations in a dark area." d) "Do not make skin contact with these drugs; flush the affected area with water if a spill occurs." e) "Take an over-the-counter sleep aid if you have trouble falling asleep at night."

b) "Dilute oral preparations in fruit juice to improve their palatability." c) "Store oral preparations in a dark area." d) "Do not make skin contact with these drugs; flush the affected area with water if a spill occurs." Patients should be informed that antipsychotic drugs do not cause addiction and that they should be taken as prescribed. Patients should be instructed to avoid all drugs with anticholinergic properties, including antihistamines and certain over-the-counter sleep aids, to prevent drug interactions. All of the other statements are appropriate to include in teaching the patient about the use of antipsychotic medications.

Which statement by the patient taking fexofenadine would require further teaching? a) "This medication will help with my seasonal allergies." b) "I will take this medication in the morning with my juice and breakfast." c) "I know that I don't have to be as concerned about sleepiness with this medication as I used to be with other allergy medications." d) "I will take this medication as directed on the package, and as needed."

b) "I will take this medication in the morning with my juice and breakfast." Certain fruit juices (eg, apple juice, orange juice, grapefruit juice) can decrease intestinal absorption of fexofenadine, possibly reducing effectiveness. Advise patients to avoid fruit juice in the interval between 4 hours before dosing and 1 to 2 hours after dosing. The other statements are correct.

A patient asks a nurse, "Why should I switch to fexofenadine [Allegra] for my allergies when I've taken diphenhydramine [Benadryl] for so long?" Which response should the nurse make? a) "You'll have much less risk of cardiac problems." b) "There is not nearly as much drowsiness and sedation." c) "The biggest benefit is that the cost is so much lower." d) "The dosing is more convenient, because you take it once a week."

b) "There is not nearly as much drowsiness and sedation." Fexofenadine is a second-generation antihistamine that crosses the blood-brain barrier poorly, thus producing much less sedation than first-generation medications, such as diphenhydramine. Fexofenadine has no associated cardiac risks, and daily dosing is still required. Second-generation antihistamines are not less expensive, but pricing is lower now that they are available over the counter.

A nurse is teaching a patient about montelukast [Singulair]. Which statement by the patient would indicate that the nurse's teaching was effective? a) "I'll take a dose as soon as I feel short of breath and start to cough." b) "While taking this medicine, I may be able to reduce my steroid medication." c) "This is the priority medication for preventing exercise-induced asthma symptoms." d) "If I have nosebleeds or excessive bruising, I'll stop the medication immediately."

b) "While taking this medicine, I may be able to reduce my steroid medication." Montelukast is an antileukotriene agent. Combining montelukast with an inhaled glucocorticoid medication can improve asthma symptoms and thus may allow a reduction in the glucocorticoid dosage. The effects of montelukast develop slowly, so it cannot be used as a quick-relief agent. Short-acting beta2 agonists are preferred for exercise-induced asthma. Montelukast does not affect coagulation, so bleeding and bruising do not occur.

A nurse assesses a male patient who has developed gynecomastia while receiving treatment for peptic ulcers. Which medication from the patient's history should the nurse recognize as a contributing factor? a) Amoxicillin [Amoxil] b) Cimetidine [Tagamet] c) Metronidazole [Flagyl] d) Omeprazole [Prilosec]

b) Cimetidine [Tagamet] Cimetidine binds to androgen receptors, producing receptor blockade, which can cause enlarged breast tissue (gynecomastia), reduced libido, and impotence. All these effects reverse when dosing stops. Amoxicillin, metronidazole, and omeprazole are not associated with gynecomastia.

The nurse is caring for a group of patients who are all receiving anticholinergic drugs. In which patient is an anticholinergic drug contraindicated? a) A 60-year-old woman with an overactive bladder (OAB) b) A 72-year-old man with glaucoma c) A 45-year-old woman with peptic ulcer disease (PUD) d) A 26-year-old man being prepared for surgery today

b) A 72-year-old man with glaucoma Anticholinergic drugs tend to cause adverse effects of dry mouth, blurred vision, elevation of intraocular pressure, urinary retention, constipation, anhidrosis, tachycardia, and asthma. They are contraindicated in patients with glaucoma because of the potential danger of increased intraocular pressure. Anticholinergics are used to treat OAB and are used as preanesthetic agents. They are not contraindicated in PUD.

A nurse is caring for several patients. In which patient is it appropriate to use the drug chlorpromazine [Thorazine]? (Select all that apply.) a) An 85-year-old man with Alzheimer's disease b) A 78-year-old man with intractable hiccups c) A 76-year-old woman with severe dementia d) A 48-year-old woman with schizoaffective disorder e) A 30-year-old man with anxiety and depression

b) A 78-year-old man with intractable hiccups d) A 48-year-old woman with schizoaffective disorder The primary indications for chlorpromazine, a first-generation antipsychotic agent, are schizophrenia and other psychotic disorders. It may also be used for schizoaffective disorder, bipolar disorder, suppression of emesis, and relief of intractable hiccups. Antipsychotics are not used for dementia because of increased mortality. Chlorpromazine is not a primary treatment for Alzheimer's disease or depression.

A patient is receiving glucocorticoids for the treatment of rheumatoid arthritis. The patient complains of having a headache. Which ordered medication should the nurse administer? a) Aspirin [Bayer] b) Acetaminophen [Tylenol] c) Ibuprofen [Advil] d) Naproxen sodium [Aleve]

b) Acetaminophen [Tylenol] The risk of gastrointestinal irritation and ulceration for a patient taking glucocorticoids is increased by concurrent use of other medications, such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs).

A patient develops supraventricular tachycardia (SVT) and is hypotensive. Which medication should the nurse anticipate will be administered? a) Lidocaine [Xylocaine] b) Adenosine [Adenocard] c) Amiodarone [Cordarone] d) Phenytoin [Dilantin]

b) Adenosine [Adenocard] The drug of choice for terminating SVT is adenosine. Lidocaine is used for ventricular dysrhythmias; amiodarone is used for atrial and ventricular dysrhythmias; and phenytoin is used for digoxin-induced dysrhythmias.

A patient is receiving isosorbide dinitrate [Isordil] 20 mg 3 times per day for management of newly diagnosed stable angina. Which assessment finding would require an immediate nursing intervention? a) A change in blood pressure from 122/70 to 108/66 mm Hg b) An increase in the resting heart rate to 110 beats per minute from baseline rates of 68 to 72 beats per minute c) A headache the patient rates as a 5 on a pain scale of 0 to 10 d) Report of increased frequency of urination

b) An increase in the resting heart rate to 110 beats per minute from baseline rates of 68 to 72 beats per minute Because nitrates lower blood pressure, isosorbide dinitrate can activate the baroreceptor reflex, causing sympathetic stimulation of the heart; this negates the benefits of treatment with nitrates, because it increases the cardiac oxygen demand. For these reasons, addressing the tachycardia becomes the nurse's immediate priority. A decrease in blood pressure would be expected, and there is no indication the patient is experiencing side effects of decreased cardiac output. Headache is an adverse effect and should be treated (eg, with acetaminophen), but it does not require immediate intervention. Increased frequency of urination may be related to the presence of a urinary tract infection and requires follow-up, but it is not the immediate concern.

Before administering intravenous (IV) penicillin, the nurse should do what? a) Flush the IV site with normal saline. b) Assess the patient for allergies. c) Review the patient's intake and output record. d) Determine the latest creatinine clearance result.

b) Assess the patient for allergies. The principal adverse effect of penicillins is allergic reaction. Penicillins are contraindicated in patients with a history of severe allergic reactions to penicillins, cephalosporins, or carbapenems. IV patency is important, as is monitoring renal function, because impairment can cause penicillins to reach toxic levels; however, these are not as important as determining allergy status.

Which classes of medications are prescribed as initial therapy for hypertension after a myocardial infarction (MI)? a) Diuretic and beta blocker b) Beta blocker and ACE inhibitor c) ACE inhibitor and calcium channel blocker d) Diuretic and calcium channel blocker

b) Beta blocker and ACE inhibitor Beta blockers and ACE inhibitors, as well as aldosterone antagonists, are the drug classes recommended for initial therapy of hypertension after an MI. Diuretics and calcium channel blockers are not part of initial therapy for hypertension after an MI.

Which are the main types of drugs used to prevent or relieve anginal pain? (Select all that apply.) a) Platelet inhibitors b) Beta blockers c) Nitrates d) Calcium channel blockers e) Statins

b) Beta blockers c) Nitrates d) Calcium channel blockers The three main types of antianginal drugs are organic nitrates, beta blockers, and calcium channel blockers. Platelet inhibitors and statins (unless contraindicated) are incorporated into the treatment plan to reduce the risk of myocardial infarction.

The nurse identifies which symptom as a result of activation of histamine1 (H1) by allergic reaction? a) Hypertension b) Bronchoconstriction c) Sweating d) Pupillary dilation

b) Bronchoconstriction Activation of H1 receptors in an allergic reaction causes bronchoconstriction. Vasodilation of small blood vessels and increased capillary permeability cause loss of fluid, which, if extensive, results in severe hypotension. Histamine has no effect on pupil reaction, nor does it cause sweating.

Which statement should the nurse include in the teaching plan for a patient being started on levodopa/carbidopa [Sinemet] for newly diagnosed Parkinson's disease? a) Take the medication on a full stomach. b) Change positions slowly. c) The drug may cause the urine to be very dilute. d) Carbidopa has many adverse effects.

b) Change positions slowly. Postural hypotension is common early in treatment, so the patient should be instructed to change positions slowly. Administration with meals should be avoided, if possible, because food delays the absorption of the levodopa component. If the patient is experiencing side effects of nausea and vomiting, administration with food may need to be considered. The levodopa component in Sinemet may darken the color of the urine. Carbidopa has no adverse effects of its own.

The nurse is reviewing the prescriber's orders and notes that omeprazole [Prilosec] has been ordered for a patient admitted with acute coronary syndrome (ACS). The nurse should be concerned if this medication is combined with which medication noted on the patient's record? a) Aspirin 81 mg daily b) Clopidogrel [Plavix] 75 mg daily c) Heparin 5000 units subQ every 12 hours d) Metoprolol 50 mg every 8 hours

b) Clopidogrel [Plavix] 75 mg daily For patients who lack risk factors for GI bleeding, combined use of clopidogrel with a PPI, such as omeprazole, may reduce the effects of clopidogrel without offering any real benefits and thus should be avoided. This is due to inhibition of CYP2C19, which converts the drug to its active form. Nothing in the question indicates that the patient is at risk for GI bleeding. The other options are not cause for concern.

The nurse is caring for a patient with MS who is receiving interferon beta-1a [Rebif] by subcutaneous injection. Which laboratory tests should be performed regularly in this patient to monitor for a potential adverse effect? (Select all that apply.) a) Blood urea nitrogen b) Complete blood count c) Hemoglobin A1c d) Alkaline phosphatase e) Immunoglobulin G levels

b) Complete blood count d) Alkaline phosphatase When monitoring a patient receiving interferon, the nurse should watch for potential adverse reactions of hepatotoxicity (alkaline phosphatase) and myelosuppression (complete blood counts). The blood urea nitrogen value is an indicator of renal function, which is not affected by interferon beta-1a. The hemoglobin A1c test is a weighted average of the glucose level over the past several months. Glucose levels are not affected by interferon beta-1a. Immunoglobulin G levels might be assessed when making the diagnosis, but they are not used to monitor for adverse effects of interferon.

A patient with Parkinson's disease is prescribed pramipexole [Mirapex] along with his levodopa/carbidopa [Sinemet]. Which symptom is most likely a manifestation of an adverse effect of these drugs when given together? a) Diarrhea b) Dyskinesia c) Wheezing d) Headache

b) Dyskinesia When pramipexole is combined with the levodopa component in Sinemet, patients are most likely to experience symptoms of dyskinesias, such as dyskinesia (head bobbing) and orthostatic hypotension. The other effects are not common responses to these drugs.

A patient develops hypotension, laryngeal edema, and bronchospasm after eating peanuts. Which medication should the nurse prepare to administer? a) Promethazine [Phenergan] b) Epinephrine c) Diphenhydramine [Benadryl] d) Hydroxyzine [Vistaril]

b) Epinephrine The patient is showing signs of anaphylaxis caused by a peanut allergy. Histamine1 activation plays a minor role in anaphylaxis; other substances are the principal mediators. Therefore, the drug of choice for anaphylaxis is epinephrine. The antihistamines promethazine, diphenhydramine, and hydroxyzine are effective only for symptoms of mild allergy; they may be used as adjuncts in the treatment of anaphylaxis, but they will have only limited benefit.

Which finding in a patient taking levothyroxine [Synthroid] and warfarin [Coumadin] would require follow-up by a nurse? a) Cardiac dysrhythmias b) Excessive bruising c) Weight loss of 5 kg d) Shortness of breath

b) Excessive bruising Levothyroxine intensifies the effect of warfarin, an anticoagulant that increases the patient's risk for bleeding. The warfarin dose may need to be reduced. Bruising, weight loss, and shortness of breath are not effects associated with interactions of levothyroxine and warfarin.

A patient is prescribed hydralazine [Apresoline] for the treatment of essential hypertension. Which expected adverse effects should the nurse discuss with the patient? (Select all that apply.) a) Nausea b) Fatigue c) Dizziness d) Headache e) Joint pain

b) Fatigue c) Dizziness d) Headache Some of the common adverse effects of hydralazine include fatigue, dizziness, and headache. Nausea is associated with minoxidil. Joint pain is not a common adverse effect of hydralazine.

The nurse assesses a patient who takes ibuprofen [Advil] on a regular basis. Which finding does the nurse know is an adverse effect of ibuprofen [Advil] therapy? a) Hives b) Hematemesis c) Dysmenorrhea d) Jaundice

b) Hematemesis Ibuprofen is a member of the nonaspirin first-generation nonsteroidal anti-inflammatory drugs (NSAIDs). Through inhibition of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), ibuprofen poses a risk for gastric ulceration and bleeding, which may lead to hematemesis. Ibuprofen is used to reduce inflammation, fever, and pain and therefore is effective in reducing dysmenorrhea (painful menstrual cramping). It is not known to cause hives or jaundice, which are signs of impaired liver function.

A nurse is caring for a patient with decreased triiodothyronine (T3) and thyroxine (T4) and elevated thyroid-stimulating hormone (TSH) levels. The nurse knows the patient is likely suffering from what? a) Thyrotoxicosis b) Hypothyroidism c) Hyperthyroidism d) Graves' disease

b) Hypothyroidism The anterior pituitary increases production of TSH when thyroid hormone levels of T3 and T4, are reduced, reflecting primary hypothyroidism. Patients may experience fatigue caused by a lowered basal metabolic rate. Thyrotoxicosis, hyperthyroidism, and Graves' disease are medical conditions indicative of excessive thyroid activity.

A patient with a history of numbness, weakness, and blurred vision recently was diagnosed with multiple sclerosis (MS). What does the nurse understand to be the underlying pathophysiology for these symptoms? a) An imbalance of dopamine and acetylcholine in the central nervous system b) Inflammation and myelin destruction in the central nervous system c) An inability of serotonin to bind to its receptors in the chemoreceptor trigger zone d) High-frequency discharge of neurons from a specific focus area of the brain

b) Inflammation and myelin destruction in the central nervous system The underlying pathophysiology of MS is related to myelin destruction and slowing of axonal conduction related to inflammation within the central nervous system. The demyelination leads to the characteristic neurologic symptoms associated with MS.

A patient who takes cyclosporine [Sandimmune] also is receiving ketoconazole [Nizoral]. The nurse should expect which therapeutic outcome from the combined medications? a) Improved glomerular filtration rate b) Inhibition of cyclosporine metabolism c) Decreased risk of lymphoma occurrence d) Decreased risk of bacterial and viral infections

b) Inhibition of cyclosporine metabolism Ketoconazole raises cyclosporine levels and can increase the risk of toxicity. However, some physicians administer ketoconazole with cyclosporine, because this greatly reduces the cost of cyclosporine treatment; the dosage of cyclosporine may be reduced by up to 88%. An improved glomerular filtration rate, decreased risk of lymphoma occurrence, and decreased risk of bacterial and viral infections are not effects of cyclosporine.

Which statements about levothyroxine [Synthroid] are correct? (Select all that apply.) a) Levothyroxine should be taken with food. b) Levothyroxine can be given by IV but is usually taken orally. c) Levothyroxine brands should not be changed if possible. d) Levothyroxine should be taken at night to avoid adverse effects. e) Levothyroxine can affect the metabolism of other medications.

b) Levothyroxine can be given by IV but is usually taken orally. c) Levothyroxine brands should not be changed if possible. e) Levothyroxine can affect the metabolism of other medications. Levothyroxine is almost always administered by mouth. Oral doses should be taken once daily on an empty stomach (to enhance absorption). Dosing is usually done in the morning, at least 30 to 60 minutes before breakfast. Maintain patients on the same brand-name levothyroxine product. Intravenous administration is used for myxedema coma and for patients who cannot take levothyroxine orally. Levothyroxine affects the metabolism of other medications, including warfarin.

The nurse is working with the multidisciplinary healthcare team to optimize the care of a patient with schizophrenia. Which concepts will guide the nursing care of this patient? (Select all that apply.) a) The second-generation antipsychotics generally are more effective than the first-generation agents. b) Most antipsychotic agents increase the risk of mortality in elderly patients with dementia. c) Antipsychotic depot preparations carry a greater risk of neuroleptic malignant syndrome. d) The lipid levels of patients receiving second-generation antipsychotics should be monitored. e) Schizophrenia is characterized by disordered thinking and loss of touch with reality.

b) Most antipsychotic agents increase the risk of mortality in elderly patients with dementia. d) The lipid levels of patients receiving second-generation antipsychotics should be monitored. e) Schizophrenia is characterized by disordered thinking and loss of touch with reality. The first- and second-generation antipsychotics are considered equally effective, even though the second-generation agents are more widely used today. Most antipsychotics should be avoided in elderly patients with dementia because of increased mortality. Antipsychotic depot preparations are effective for the long-term control of schizophrenia and do not have an increased risk of side effects. Second-generation antipsychotics may cause weight gain, diabetes, and dyslipidemia. Schizophrenia is characterized by disordered thinking and loss of touch with reality.

When performing a skin test for penicillin allergy, the nurse will do what? (Select all that apply.) a) Inject a tiny amount of the allergen subcutaneously. b) Observe for a local allergic response. c) Have epinephrine readily available. d) Have respiratory support readily available. e) Administer diphenhydramine [Benadryl] as the first-line agent should anaphylaxis occur.

b) Observe for a local allergic response. c) Have epinephrine readily available. d) Have respiratory support readily available. For a penicillin allergy skin test, a small amount of allergen is injected intradermally. The nurse observes for a local allergic reaction and has epinephrine and respiratory support readily available. Epinephrine is administered as the first-line agent should anaphylaxis occur.

To achieve therapeutic effectiveness, a nurse teaches a patient with chronic asthma to use an inhaled glucocorticoid medication according to which schedule? a) Only in an emergency b) On a continuing, daily basis c) To abort an asthma attack d) 2 weeks on, 2 weeks off

b) On a continuing, daily basis Glucocorticoid medications are the first-line therapy for asthma to reduce symptoms of inflammation. They should be taken for prophylaxis on a daily basis. Therapeutic effects develop slowly, so these drugs cannot be taken to abort an asthma attack or in an emergency. They are most effective when administered on a fixed schedule, not PRN.

The nurse identifies which most common serious adverse effect of TCA therapy? a) Excitation b) Orthostatic hypotension c) Skin rash d) Sexual dysfunction

b) Orthostatic hypotension Orthostatic hypotension is the most common adverse effect of tricyclic antidepressant therapy.

Which label most aptly describes the drug atropine [Sal-Tropine]? a) Cholinergic b) Parasympatholytic c) Muscarinic agonist d) Parasympathomimetic

b) Parasympatholytic Atropine is a muscarinic antagonist agent. Other terms for this agent are parasympatholytic, antimuscarinic, muscarinic blocker, and anticholinergic.

A patient has received a toxic dose of an antihistamine. It is most important for the nurse to assess the patient for what? a) Tinnitus b) Seizure activity c) Lethargy d) Visual disturbances

b) Seizure activity Toxicity associated with antihistamines can produce CNS stimulation, and seizures may result. Tinnitus, lethargy, and visual disturbances are not associated with increased doses of antihistamines.

The nurse has just administered the first dose of haloperidol [Haldol] to a patient with schizophrenia. Which finding, if present, is the most important for the nurse to report to the healthcare provider before administering the next dose of medication? a) Dry mouth b) Temperature of 101°F c) BP of 104/72 mm Hg d) Drowsiness

b) Temperature of 101°F Sudden high fever is a symptom of neuroleptic malignant syndrome, a rare but serious complication of high-potency, first-generation antipsychotics, such as haloperidol. The other findings are potential side effects of the drug but would not necessarily need to be reported to the healthcare provider

Which statement made by a patient indicates a need for further teaching by the nurse about reducing injection site reactions from interferon beta? a) "I need to rotate my injection sites, so I'll need to keep a record of them." b) "I will apply hydrocortisone ointment to the injection site if it is itchy." c) "Applying a warm compress before giving the injection will reduce the risk of pain at the site." d) "I can take over-the-counter Benadryl if the injection site itches and is red."

c) "Applying a warm compress before giving the injection will reduce the risk of pain at the site." Brief application of ice rather than warm compress application is indicated prior to injection. Warm compresses may be helpful following the injection. Injections sites should be rotated to decrease discomfort. Itching and erythema can be reduced by topical application of hydrocortisone or oral diphenhydramine.

A patient currently taking sirolimus [Rapamune] tells the nurse that she is starting a very low-fat diet. Which statement by the nurse is the most appropriate? a) "Low-fat diets don't work. You should try a low-carb diet." b) "It is fine to be on a low-fat diet with your medication, as long as you take it with food." c) "If you change the fat content in your regular diet you should check with your prescriber." d) "Diet will not affect your medication, so you can do whatever diet you would like."

c) "If you change the fat content in your regular diet you should check with your prescriber." High-fat foods can increase sirolimus absorption by about 35%. To minimize variability, patients should take all doses consistently (ie, all with food having similar percentage of fat or all without food). The patient should maintain a consistent diet or speak with the prescriber about possible changes in medication doses.

The nurse will include which statements when teaching a patient about the use of acetaminophen [Tylenol]? (Select all that apply.) a) "Acetaminophen is a useful drug for the treatment of inflammation, such as a rheumatoid arthritis." b) "The most common side effect of treatment with the drug is kidney failure." c) "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." d) "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." e) "Use of this drug can prevent heart attack and stroke."

c) "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." d) "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." Acetaminophen [Tylenol] is used to treat fever and pain. It is not an anti-inflammatory drug. The most serious side effect of acetaminophen therapy is liver failure; therefore, the healthcare provider should be notified if indications of jaundice are seen, such as yellowing of the skin or sclera. Acetaminophen therapy has no antiplatelet activity; therefore, it is not used to prevent heart attack or stroke. Routine use of acetaminophen may blunt the immune response to vaccines; therefore, it should be avoided as routine treatment for vaccine-associated fever and pain.

A patient newly diagnosed with MS asks the nurse how a person gets this disease. Which response by the nurse is most accurate and appropriate? a) "Multiple sclerosis is a congenital condition that typically manifests itself in late adulthood." b) "Multiple sclerosis is a disease believed to be caused by exposure to drugs during a mother's pregnancy." c) "This is an autoimmune disease that occurs in people with certain genetic traits when they are exposed to some environmental trigger factor." d) "This disease is most often caused by an increase of rapidly dividing cells in the central nervous system."

c) "This is an autoimmune disease that occurs in people with certain genetic traits when they are exposed to some environmental trigger factor." Although the exact cause is unknown, MS is believed to have a genetic link. Susceptible individuals have an autoimmune response when exposed to environmental or microbial factors. It is more common among first-degree relatives of individuals who have the disease and is more prevalent among Caucasians. It also is more common in cooler climates, with increased incidence moving away from the equator. MS may also be associated with the Epstein-Barr virus, human herpesvirus 6, and Chlamydia pneumonia.

A patient with Parkinson's disease who has been positively responding to drug treatment with levodopa/carbidopa [Sinemet] suddenly develops a relapse of symptoms. Which explanation by the nurse is appropriate? a) "You have apparently developed resistance to your current medication and will have to change to another drug." b) "This is an atypical response. Unfortunately, there are no other options of drug therapy to treat your disease." c) "This is called the 'on-off' phenomenon. Your healthcare provider can change your medication regimen to help diminish this effect." d) "You should try to keep taking your medication at the current dose. These effects will go away with time."

c) "This is called the 'on-off' phenomenon. Your healthcare provider can change your medication regimen to help diminish this effect." Patients who have been taking levodopa/carbidopa for a period of time may experience episodes of symptom return. Adding other medications to the drug regimen can help minimize this phenomenon.

A patient with asthma is scheduled to start taking a glucocorticoid medication with a metered-dose inhaler (MDI). The nurse should give the patient which instruction about correct use of the inhaler? a) "After you inhale the medication once, repeat until you obtain symptomatic relief." b) "Wait no longer than 30 seconds after the first puff before taking the second one." c) "Use a spacer with the inhaler and rinse your mouth after each dose administration." d) "Breathe in through the nose and hold for 2 seconds just before activating the inhaler."

c) "Use a spacer with the inhaler and rinse your mouth after each dose administration." Spacers are available for use with MDIs to prevent the patient from swallowing the dose and to allow for maximum delivery of medication to the lungs. Rinsing the mouth after administration is important for inhaled glucocorticoids to prevent candidiasis. Glucocorticoid inhalers are used for long-term prophylaxis of asthma, not for symptomatic relief. When two puffs are needed, an interval of at least 1 minute should separate the first puff from the second. Inhaling through the mouth just before activating the MDI is the proper technique.

A patient is taking oral theophylline for maintenance therapy of stable asthma. A nurse instructs the patient to avoid using which substance to prevent a complication? a) Echinacea b) Cimetidine [Tagamet] c) Sunscreen products d) Caffeine

d) Caffeine Theophylline is a methylxanthine that provides benefits through bronchodilation. It is used to reduce the frequency and severity of asthma attacks, especially those occurring at night. Caffeine also is a methylxanthine, and its pharmacologic actions may intensify the adverse effects of theophylline on the central nervous system (CNS) and heart. Sources of caffeine should be avoided. It is not necessary to avoid taking cimetidine or echinacea or using sunscreen products while taking theophylline.

Which instruction should be the priority for the nurse to teach a patient scheduled to start taking sirolimus [Rapamune]? a) "A lipid-lowering medication can be given to lower cholesterol levels." b) "There might be some joint pain, diarrhea, and rash with this medicine." c) "You'll need to notify your doctor if you experience any sore throat or fever." d) "Take this medication with food, but you'll need to avoid taking it with grapefruit juice."

c) "You'll need to notify your doctor if you experience any sore throat or fever." Sirolimus is an immunosuppressant approved only for preventing renal transplant rejection. It raises the risk of infection, and patients need to take precautions to avoid sources of contagion. Side effects include rash, joint pain, diarrhea, and increased levels of cholesterol, and taking sirolimus with grapefruit juice inhibits the drug's metabolism; these are lower levels of priority than the infection risk.

A nurse should use which approach when administering activated charcoal to a patient who has ingested a toxic agent? a) Give the antidote immediately before the charcoal. b) Have the patient take the dose with 30 mL of an acidifying liquid. c) Administer the dose within 30 minutes of ingestion of the poison. d) Mix the dose with 250 mL of tap water and give as an enema.

c) Administer the dose within 30 minutes of ingestion of the poison. Activated charcoal adsorbs medications and other chemicals, thereby preventing absorption into the blood and additional toxicity. When administered within 30 minutes after poison ingestion, charcoal can adsorb about 90% of the dose. Charcoal also can adsorb antidotes and neutralize their benefits; therefore, antidotes are not given before, with, or shortly after the charcoal. Taking the dose with an acidifying liquid and giving the dose as an enema are not therapeutic actions for the administration of charcoal.

Which statements about the care of a patient with aspirin poisoning does the nurse identify as true? (Select all that apply.) a) Warming blankets are routinely used to raise the patient's temperature. b) Diuretics and fluid restrictions are needed to correct the fluid overload commonly seen with aspirin poisoning. c) Bicarbonate infusions are used to reverse acidosis and promote renal excretion of salicylates. d) Activated charcoal is contraindicated in the treatment of aspirin poisoning. e) Hemodialysis or peritoneal dialysis can accelerate salicylate removal.

c) Bicarbonate infusions are used to reverse acidosis and promote renal excretion of salicylates. e) Hemodialysis or peritoneal dialysis can accelerate salicylate removal. Aspirin poisoning is an acute medical emergency that requires hospitalization. Treatment is largely supportive and consists of external cooling (eg, sponging with tepid water), infusion of fluids (to correct dehydration and electrolyte loss), infusion of bicarbonate (to reverse acidosis and promote renal excretion of salicylates), and mechanical ventilation (if respiration is severely depressed). Absorption of aspirin can be reduced by gastric lavage and by giving activated charcoal. If necessary, hemodialysis or peritoneal dialysis can accelerate salicylate removal.

Which assessment should a nurse monitor more frequently in a patient who takes both an alpha blocker for BPH and metoprolol [Lopressor]? a) Blood glucose level b) Hemoglobin level c) Blood pressure d) Urine output

c) Blood pressure Caution must be exercised in combining an alpha blocker (terazosin [Hytrin], doxazosin [Cardura], Tamsulosin [Flomax], alfuzosin [Uroxatral]) with an antihypertensive medication such as metoprolol, because severe hypotension could result. Blood glucose, hemoglobin, and urine output are not affected by combining an alpha blocker and a hypertensive medication.

Which assessment finding is most important for the nurse to obtain before administering hydralazine [Apresoline]? a) Peripheral pulses b) Homans' sign c) Blood pressure d) Capillary refill

c) Blood pressure Hydralazine is a vasodilator that causes arteriolar dilation, decreased resistance, and decreased blood pressure. Monitoring of the blood pressure and heart rate is the highest assessment priority.

The nurse is assessing a patient in a clinic who has been taking clonidine [Catapres] for hypertension. Which clinical findings are most indicative of an adverse effect of this drug? a) Cough and wheezing b) Epigastric pain and diarrhea c) Drowsiness and dry mouth d) Positive Coombs' test result and anemia

c) Drowsiness and dry mouth Drowsiness and dry mouth are common adverse effects (35% to 40%) associated with clonidine. The other effects are not commonly associated with clonidine.

When administering prednisone to a patient, the nurse will do what? a) Administer the prednisone in the evening to coincide with the natural secretion pattern of the adrenal cortex. b) Instruct the patient to stop taking the prednisone immediately if diarrhea develops. c) Ensure that meals are at bedside so that administration with food reduces gastric irritation. d) Avoid intravenous delivery to prevent adverse effects.

c) Ensure that meals are at bedside so that administration with food reduces gastric irritation. Glucocorticoids given in larger pharmacologic doses for nonendocrine causes produce many adverse effects, including gastric irritation and ulcers. They should be given with food. Doses should be administered before 9:00 AM to maximize endocrine function. Prednisone should not be stopped abruptly; the patient should contact the healthcare provider before discontinuing the medication. The drug may be administered by many routes, including the parenteral route.

Which nursing diagnosis should be the priority for a patient who is receiving desmopressin [DDAVP]? a) Activity intolerance b) Alteration in comfort c) Fluid volume imbalance d) Deficient knowledge

c) Fluid volume imbalance Desmopressin is a form of antidiuretic hormone that increases sodium and water retention, leading to an alteration in fluid volume. Monitoring of urine volumes and body weights is essential to prevent complications. Alteration in comfort, deficient knowledge of the condition, and activity intolerance are important nursing problems; however, they are not priorities according to the Maslow hierarchy of needs.

An 80-year-old patient with a history of renal insufficiency recently was started on cimetidine. Which assessment finding indicates that the patient may be experiencing an adverse effect of the medication? a) +3 pitting edema b) Pain with urination c) New onset of disorientation to time and place d) Heart rate changes from a baseline of 70 to 80 beats per minute (bpm) to 110 to 120 bpm

c) New onset of disorientation to time and place Effects on the central nervous system are most likely to occur in elderly patients who have renal or hepatic impairment. Patients may experience confusion, hallucinations, lethargy, restlessness, and seizures. The remaining options are not adverse effects of cimetidine.

The nurse is screening a patient before administering a live virus vaccine. The patient is currently taking a glucocorticoid medication. Which action should the nurse take? a) Continue screening and give the vaccine if appropriate. b) Note the contraindication but give the vaccine anyway. c) Note the contraindication and clarify the order with the healthcare provider. d) Hold the vaccine and notify the department of health.

c) Note the contraindication and clarify the order with the healthcare provider. The nurse should note the contraindication and clarify the order with the provider. Because of their immunosuppressant actions, glucocorticoids can decrease antibody responses to vaccines. Accordingly, immunization should not be attempted while glucocorticoids are in use. Furthermore, if a live virus vaccine is employed, there is an increased risk of developing viral disease. There is no need to contact the health department.

A patient is scheduled to start taking aspirin for the treatment of rheumatoid arthritis. The nurse anticipates that which medication most likely will be prescribed? a) Docusate sodium [Colace] b) Ascorbic acid (vitamin C) c) Pantoprazole [Protonix] d) Furosemide [Lasix]

c) Pantoprazole [Protonix] Aspirin inhibits COX-2 and thus suppresses inflammation and reduces moderate pain and fever. It also suppresses COX-1, which increases the risk for gastric ulceration and bleeding. This risk can be reduced through administration of a proton pump inhibitor, such as pantoprazole [Protonix]. It is not necessary for a patient to take vitamin C or docusate sodium while taking aspirin. Although aspirin may cause sodium and water retention in patients who have pre-existing renal dysfunction, it is not necessary for all patients to take furosemide [Lasix] with aspirin.

A nurse should recognize that a patient who takes an angiotensin-converting enzyme (ACE) inhibitor while also taking high-dose aspirin is at risk of developing what complication? a) Congestive heart failure b) Liver toxicity c) Renal failure d) Hemorrhage

c) Renal failure High-dose aspirin therapy should be avoided in patients taking ACE inhibitors. In susceptible patients, these medications can impair renal function when they are combined with aspirin. Liver toxicity, congestive heart failure, and hemorrhage are not effects of ACE inhibitor and aspirin interactions.

Which outcome should a nurse establish as a priority for a patient taking an oral glucocorticoid for long-term treatment of asthma? a) Increases the daily intake of vitamin D and calcium b) Records daily peak expiratory flow rates c) Supplements additional doses at times of stress d) Uses alternate-day therapy to reduce adverse effects

c) Supplements additional doses at times of stress Adrenal suppression can be profound with oral glucocorticoid use. It is a priority that patients take supplemental oral or intravenous doses at times of stress; failure to do so can be fatal. Alternate-day dosing, using a peak flowmeter, and minimizing bone loss with vitamin D and calcium intake are important; however, they are not as important as supplemental doses of glucocorticoid at times of stress.

A transplant recipient is receiving cyclosporine [Sandimmune]. Which response should a nurse expect if the medication is having the desired effect? a) Increased antibody response b) Increased natural killer (NK) cellular activity c) Suppression of T lymphocytes d) Suppression of hepatic metabolism of steroids

c) Suppression of T lymphocytes Immunosuppressants inhibit T-lymphocyte synthesis through inhibition of calcineurin, thus reducing the immune response to organ transplants. Increased antibody response, increased NK cellular activity, and suppression of hepatic metabolism of steroids are not actions of cyclosporine.

What is the goal of pharmacologic therapy in the treatment of Parkinson's disease? a) To increase the amount of acetylcholine at the presynaptic neurons b) To reduce the amount of dopamine available in the substantia nigra c) To balance cholinergic and dopaminergic activity in the brain d) To block dopamine receptors in presynaptic and postsynaptic neurons

c) To balance cholinergic and dopaminergic activity in the brain Parkinson's disease results from a decrease in dopaminergic (inhibitory) activity, leaving an imbalance with too much cholinergic (excitatory) activity. With an increase in dopamine, the neurotransmitter activity becomes more balanced, and symptoms are controlled.

The nurse is monitoring a patient with depression in the early phase of treatment with amitriptyline [Elavil]. Which question is most important for the nurse to ask the patient? a) "Have you noticed dry mouth or blurred vision?" b) "Have you had any changes in your urine function?" c) "When was your last bowel movement?" d) "Have you had any changes in your mood or anxiety level?"

d) "Have you had any changes in your mood or anxiety level?" In the early phase of treatment for depression, suicide risk may increase. Patients should be monitored closely for worsening mood, unusual changes in behavior, and suicide risk. The other questions would be useful in assessing the patient for adverse effects of amitriptyline [Elavil], but assessing suicide risk is the most important intervention.

The nurse is teaching a patient about the side effects associated with doxazosin [Cardura]. Which statement by the patient indicates an understanding of the nurse's instructions? a) "I may experience an increase in hair growth as a side effect." b) "I'll notify the healthcare provider if I develop a persistent cough." c) "I'll make sure I include extra sources of potassium in my diet, such as bananas and baked potatoes." d) "When getting out of bed in the morning, I will sit on the side of the bed for several minutes before standing."

d) "When getting out of bed in the morning, I will sit on the side of the bed for several minutes before standing." The most disturbing side effect of alpha blockers, such as doxazosin, is orthostatic hypotension, because it can affect the patient's safety. Patients should change positions slowly and carefully. Excessive hair growth is a side effect of minoxidil. Persistent cough is an adverse effect of ACE inhibitors. Hypokalemia is a side effect of thiazide and loop diuretics, so additional sources of potassium should be incorporated into the diet.

A nurse instructs the parent of a child with influenza that which medication or medications may be used safely to reduce fever? (Select all that apply.) a) Ibuprofen [Advil] b) Naproxen [Aleve] c) Aspirin [Bayer] d) Acetaminophen [Tylenol] e) Indomethacin [Indocin]

d) Acetaminophen [Tylenol] The use of NSAIDs, which include ibuprofen [Advil], naproxen [Aleve], indomethacin [Indocin], and especially aspirin [Bayer], by children with influenza or chickenpox may precipitate Reye's syndrome. This is a potentially fatal multisystem organ disease. Acetaminophen [Tylenol] may be used safely to reduce fever in children with influenza.

Thirty minutes after receiving an intramuscular (IM) injection of penicillin G [Pfizerpen], a patient reports itching and redness at the injection site. Which action should the nurse take first? a) Elevate the lower legs. b) Place an ice pack on the site. c) Make sure the patient stays calm. d) Administer subcutaneous epinephrine.

d) Administer subcutaneous epinephrine. Itching and redness at the IM injection site indicate an allergy to penicillin. The primary treatment is epinephrine (subcutaneous, IM, or IV) plus respiratory support. Elevation, ice packs, and calming the patient are done once epinephrine has been administered.

A nurse assesses a patient receiving haloperidol [Haldol]. The nurse notices that the patient is shifting in the chair, rocking back and forth, and tapping both feet constantly. What is the most accurate term to document these findings? a) Dystonia b) Tardive dyskinesia c) Parkinsonism d) Akathisia

d) Akathisia Haloperidol is a traditional antipsychotic medication with the adverse effects of extrapyramidal symptoms. Akathisia, or motor restlessness, is an extrapyramidal symptom. Dystonia manifests as severe spasm of the muscles of the tongue, face, neck, or back and may include upward deviation of the eyes, severe cramping, and impaired respiration. Tardive dyskinesia presents with involuntary twisting, writhing, wormlike movements of the tongue and face, lip smacking, and tongue flicking. Parkinsonism appears with bradykinesia, masklike facies, drooling, tremor, rigidity, shuffling gait, and stooped posture.

A nurse prepares to administer a new prescription for bethanechol [Urecholine]. Which information in the patient's history should prompt the nurse to consult with the prescriber before giving the drug? a) Constipation b) Hypertension c) Psoriasis d) Asthma

d) Asthma Muscarinic agonists induce bronchospasm, which would cause problems for a patient with a history of asthma.

Which symptom is the most indicative of muscarinic poisoning? a) Constipation b) Heart rate of 140 beats per minute c) Blood pressure of 180/110 mm Hg d) Blurred vision

d) Blurred vision Muscarinic poisoning can result from overdose of muscarinic agonists or cholinesterase inhibitors or from ingestion of certain mushrooms. The symptoms include profuse salivation, lacrimation, visual disturbances, bronchospasm, diarrhea, bradycardia, and hypotension.

A nurse instructs a patient to discontinue the scheduled use of high-dose aspirin before undergoing which procedures? (Select all that apply.) a) Routine dental cleaning b) Removal of a skin mole c) Cataract surgery d) Cholecystectomy e) Hysterectomy

d) Cholecystectomy e) Hysterectomy Aspirin promotes bleeding by causing irreversible suppression of platelet aggregation. High-dose aspirin should be discontinued 1 week before elective surgery (cholecystectomy, hysterectomy). There is no need to stop aspirin before procedures with a low risk of bleeding, such as dental cleaning or dermatologic or cataract surgery.

A patient who abuses cocaine, opioids, and other drugs frequently abuses which drug? a) Guanfacine b) Reserpine c) Methyldopa d) Clonidine

d) Clonidine Patients who abuse cocaine, opioids, and other drugs frequently abuse clonidine as well.

A patient is taking a first-generation H1 blocker for the treatment of allergic rhinitis. It is most important for the nurse to assess for which adverse effect? a) Skin flushing b) Wheezing c) Insomnia d) Dry mouth

d) Dry mouth First-generation H1 blockers produce adverse effects that include atropine-like properties (ie, drying of mucous membranes) and gastrointestinal effects (eg, nausea). Sedation is a pronounced side effect. H1 blockade results in the inhibition of dilator action of histamine in the periphery, which reduces flushing. Wheezing is not an adverse effect.

The nurse is caring for a patient with anemia related to chronic renal failure. Which agent might be used to treat the anemia? a) Filgrastim [Neupogen] b) Sargramostim [Leukine] c) Oprelvekin [Neumega] d) Epoetin alfa [Procrit]

d) Epoetin alfa [Procrit] Epoetin alfa is used to increase red blood cell counts in patients with anemia from several causes, including chronic renal failure. Filgrastim is used to elevate neutrophil counts in cancer patients and for the treatment of severe chronic neutropenia. Sargramostim is used to accelerate recovery from bone marrow transplantation. Oprelvekin is given to stimulate platelet production during chemotherapy.

A patient is admitted to the emergency department with acute severe exacerbation of asthma. Which drug should the nurse anticipate will be included in the treatment plan? a) Oral theophylline [Elixophyllin] b) Subcutaneous omalizumab [Xolair] c) Inhaled mometasone furoate [Asmanex] d) High-dose albuterol [Proventil] via nebulizer treatment

d) High-dose albuterol [Proventil] via nebulizer treatment Nebulized high-dose SABAs, such as albuterol, are administered to relieve airflow obstruction. Oral theophylline is used for maintenance therapy of chronic stable asthma, not for treatment of exacerbation. Omalizumab is a second-line agent indicated for allergy-related asthma and only when preferred options have failed. Inhaled glucocorticoids, such as mometasone furoate, are not used to abort an acute attack. During an exacerbation they are administered systemically.

The nurse is developing a plan to minimize the risk of adrenal insufficiency for a patient who is receiving long-term glucocorticoid therapy. Which outcome should be included? a) Increases daily intake of sodium for vascular expansion b) Tapers blood pressure medications to avoid hypotension c) Obtains periodic ultrasound scans of adrenal glands d) Increases or supplements dosage of glucocorticoid at times of stress

d) Increases or supplements dosage of glucocorticoid at times of stress Exogenous steroids inhibit the synthesis and release of endogenous steroids by the adrenals, and recovery is variable, taking from days to a year. Failure to increase or supplement doses at times of stress may be life-threatening. Increasing sodium intake and tapering blood pressure medications could cause harm. Adrenal gland ultrasound scans are not a valid way to minimize adrenal insufficiency.

A patient takes glucocorticoids and digoxin [Lanoxin]. It is most important for the nurse to monitor which electrolyte? a) Calcium b) Magnesium c) Sodium d) Potassium

d) Potassium Because of the mineralocorticoid activity of sodium and water retention and potassium loss, glucocorticoids can increase the risk of toxicity from digoxin. They also can exacerbate hypokalemia caused by thiazide and loop diuretics. Calcium, magnesium, and sodium do not require more frequent monitoring as a result of digoxin and glucocorticoid use.

Antimuscarinic poisoning can result from overdose of antihistamines, phenothiazines, and tricyclic antidepressants. Differential diagnosis is important, because antimuscarinic poisoning resembles which other condition? a) Epilepsy b) Diabetic coma c) Meningitis d) Psychosis

d) Psychosis Antimuscarinic poisoning often resembles psychosis and psychotic episodes. It is important to differentiate, because antipsychotic drugs have antimuscarinic properties and could intensify the symptoms of poisoning.

Which laboratory result may be a consequence of therapy with a thiazide diuretic? a) Serum glucose level of 58 mg/dL b) Serum potassium level of 5.3 mEq/L c) Serum sodium level of 135 mEq/L d) Serum uric acid level of 10.4 mg/dL

d) Serum uric acid level of 10.4 mg/dL Hyperuricemia is a side effect of thiazide diuretics. Normal uric acid levels typically range from 3.6 to 8.5 mg/dL. Hyperglycemia, not hypoglycemia, and hypokalemia, not hyperkalemia, are side effects of thiazides. A serum sodium of 135 mEq/L is a normal value.

A patient with a chronic illness is on daily glucocorticoids. He is brought to the hospital following a severe motor vehicle accident. He is wearing a medical alert bracelet stating his home medications. Noting that the patient takes glucocorticoids daily, the nurse knows which of the following to be true? a) The patient will need lower doses of glucocorticoids following the trauma. b) The patient will have to stop all glucocorticoids immediately. c) The patient will need the same dose of glucocorticoids he used at home. d) The patient will need higher doses of glucocorticoids following a trauma.

d) The patient will need higher doses of glucocorticoids following a trauma. During times of stress, the adrenal glands normally secrete large amounts of glucocorticoids. If the stress is sufficiently severe (eg, trauma, surgery), these glucocorticoids are essential for supporting life. Accordingly, because of adrenal suppression, it is imperative that patients receiving long-term glucocorticoid therapy be given increased doses at times of stress.

The nurse is caring for a patient receiving hydralazine [Apresoline]. The healthcare provider prescribes propranolol [Inderal]. The nurse knows that a drug such as propranolol often is combined with hydralazine for what purpose? a) To reduce the risk of headache b) To improve hypotensive effects c) To prevent heart failure d) To protect against reflex tachycardia

d) To protect against reflex tachycardia Hydralazine is a vasodilator that lowers blood pressure, but it also can trigger reflex tachycardia. Beta blockers, such as propranolol, are added to the regimen to normalize the heart rate.

A patient who has diabetes insipidus is receiving desmopressin [DDAVP]. Which laboratory test should a nurse obtain to evaluate the effectiveness of the medication? a) Urine ketones b) Blood urea nitrogen (BUN) c) Creatinine d) Urine specific gravity

d) Urine specific gravity Diabetes insipidus is characterized by a decrease in the urine specific gravity because of the excretion of large volumes of dilute urine. Desmopressin acts to prevent fluid loss through the renal tubules and increases the urine specific gravity. Urine ketones are present in type 1 diabetes mellitus. The BUN and creatinine are indicators of renal function but not of the effectiveness of treatment of hypothalamic diabetes insipidus.