Nonprescribed Medications

1. 1. Dong quai increases the risk of bleeding postoperatively, but the nurse would not need to assess for abnormal bleeding preoperatively. 2. The American Society of Anesthesiologists recommends that all herbal products be stopped at least 2-3 weeks before surgery to avoid potential complications of herbal use. The client should have been NPO since midnight; therefore, determining when the client last took the herb is the nurse's first intervention. 3. The client's allergies, not the medication the client is currently taking, should be documented on the front of the chart. 4. The nurse should first determine when she last took the herb before notifying the surgeon

1. The female client tells the perioperative nurse that she takes dong quai for menstrual cramps. Which intervention should the nurse implement first? 1. Assess the client for any abnormal bleeding. 2. Determine when the client took the last dose. 3. Document the finding on the front of the client's chart. 4. Notify the client's surgeon that the client takes this herb.

10. 1. Ephedra can interact with anesthetics; therefore, the nurse should take some action. 2. Ephedra can interact with anesthetics to cause dangerous elevations in blood pressure and heart rate that can lead to arrhythmias, stroke, myocardial infarction, and cardiac arrest. The nurse should notify the nurse anesthetist immediately to make sure he or she is aware that the client is taking this herb. 3. These diagnostic tests may be needed prior to the client receiving anesthesia, but the preoperative nurse must notify the anesthetist about the client taking ephedra. 4. It doesn't make a difference if the client has taken ephedra for 1 day, 1 week, or 1 year; the nurse must notify the nurse anesthetist because ephedra use should be a reason to cancel an elective surgical procedure.

10. The male client is scheduled for an elective surgical procedure. While in the preoperative waiting area he tells the nurse he is taking ephedra, which he says really helps his asthma. Which action should the preoperative nurse implement? 1. Document in the chart and take no further action. 2. Notify the client's nurse anesthetist immediately. 3. Request a stat electrocardiogram and chest x-ray. 4. Determine how long the client has been taking the ephedra

11. 1. Signs and symptoms of vitamin A overdose include nausea, vomiting, anorexia, dry skin and lips, headache, and loss of hair. The nurse should instruct the client to quit taking the vitamin A immediately. 2. Paresthesia is not a sign of vitamin A toxicity. It may be a sign of thiamine deficiency, along with neuralgia and progressive loss of feeling and reflexes. 3. Dermatitis, fatigue, and dementia are symptoms of advanced niacin deficiency. 4. Bleeding gums and gingivitis are signs of vitamin C deficiency.

11. The client is taking vitamin A. Which assessment data indicates to the nurse that the client is experiencing vitamin A toxicity? 1. Nausea, vomiting, and diarrhea. 2. Tingling and numbness of extremities. 3. Dermatitis, fatigue, and dementia. 4. Bleeding gums and gingivitis.

12. 1. This is appropriate information for the client who is taking vitamin A. Mineral oil inhibits the absorption of vitamin A. 2. The client should avoid drinking alcohol because it increases folic acid requirements. 3. This is appropriate information for the client who is taking vitamin A. Vitamin A may cause miosis, papilledema, and nystagmus. 4. Milk and milk products are a good source of vitamin D, not folic acid. MEDICATION MEMORY JOGGER: Alcohol consumption is always discouraged when taking any prescribed or over-the-counter medication because of adverse interactions. The nurse should encourage the client not to drink alcoholic beverages.

12. The client is prescribed folic acid, a vitamin. Which information should the nurse discuss with the client? 1. Do not use any laxatives that contain mineral oil. 2. Avoid drinking any type of alcoholic beverage. 3. See the ophthalmologist periodically. 4. Increase the intake of milk and milk products.

13. 1. Iron turns the stool a harmless black or dark green. This statement indicates the client does not understand the medication teaching. 2. The iron tablet should be taken between meals and with 8 ounces of water to promote absorption. The iron tablet should not be taken within 1 hour of ingesting antacid, milk, ice creams, or other milk products such as pudding. This statement indicates the client does not understand the medication teaching. 3. Sitting upright will prevent esophageal corrosion from reflux. This statement indicates the client understands the medication teaching. 4. The drug treatment for anemia is generally less than 6 months. This statement indicates the client does not understand the medication teaching.

13. The client diagnosed with anemia is taking an iron tablet, a mineral, daily. Which statement indicates the client understands the medication teaching? 1. "I will call my HCP if my stools become black or dark green." 2. "I must take my iron tablet with meals and one glass of milk." 3. "I will sit upright for 30 minutes after taking my iron tablet." 4. "I will have to take an iron tablet for the rest of my life."

14. 1. Sickle cell anemia is a genetically inherited disease, and there is no medication that can prevent a child from getting this disease. 2. This is the correct scientific rationale for administering vitamin K to newborn infants. 3. Increasing fluid intake, phototherapy, and exposure to sun will help the infant who is jaundiced. 4. There is no medication that will prophylactically help a newborn fight off an infection.

14. The mother of a newborn African American infant asks the nursery nurse, "Why did you give my baby a vitamin K injection?" Which statement is the nurse's best response? 1. "It will help protect your child from getting sickle cell anemia." 2. "Your baby's gut is sterile, and this will help the blood to clot." 3. "This will help prevent your baby from becoming jaundiced." 4. "Vitamin K will help your infant's ability to fight off infection."

15. 1. Intramuscular iron, not vitamin B12, must be administered Z-track to prevent staining of the skin. 2. Cyanocobalamin does not stain the teeth and therefore does not need to be administered through a straw. Liquid iron must be administered through a straw. 3. This is required when administering insulin or digoxin intravenous push, but it is not required when administering this medication. 4. Because conversion to normal red blood cell production—the purpose of giving vitamin B12—increases the need for potassium, hypokalemia is a possible side effect of this medication, especially during the first 48 hours medication is administered.

15. The client diagnosed with pernicious anemia is prescribed cyanocobalamin (Cyanabin), vitamin B12. Which intervention should the nurse implement? 1. Administer the intramuscular injection via Z-track. 2. Instruct the client to sip medication through a straw. 3. Double-check the dose with another registered nurse. 4. Monitor the client's serum potassium level.

16. 1. Vitamins are usually over-the-counter medications. If the client does not have money for OTC medications, she would not have money for a prescription. 2. A balanced diet can provide all of the vitamins a client needs daily, but if the client was taking a daily vitamin, the nurse should not discourage her from taking the vitamins. 3. Vitamin supplements are not necessary if the person is healthy and receives proper nutrition on a regular basis. 4. Signs or symptoms of vitamin deficiencies will not occur if the client has not taken the vitamins in more than a week. Vitamin deficiencies may take months to occur, and if the client is eating a well-balanced diet, vitamin deficiencies will not occur.

16. The female client having her annual physical exam tells the clinic nurse, "I take vitamins daily but I have not had the money to buy any for the past week." Which response is most appropriate for the nurse? 1. "I will have the HCP give you a prescription for some vitamins." 2. "As long as you eat a balanced diet you do not need to take vitamins." 3. "Daily vitamins are necessary, so please get them as soon as possible." 4. "This should not hurt you because vitamin deficiencies do not occur for some time."

17. 1. Vitamin E is a primary antioxidant that prevents the formation of free radicals that damage cell membranes and cellular structure. 2. This is the role of vitamin A in the body. It is essential for general growth and development. 3. This statement includes medical jargon that the client probably would not understand. The nurse needs to explain information in layman's terms. 4. Vitamin K, not the antioxidant vitamin E, is required by the body to help the blood clot.

17. The client asks the clinic nurse, "Vitamin E is a primary antioxidant. What does that mean?" Which statement is the nurse's best response? 1. "Antioxidants minimize damage and keep your body's cells healthy." 2. "Vitamin E is essential for general growth and development." 3. "Antioxidants prevent the formation of free radicals in your muscles and skin." 4. "The antioxidants are vitamins that help the blood clot."

18. 1. Copper is needed for the formation of red blood cells and connective tissue. 2. Iron is vital for hemoglobin regeneration. More than 60% of the iron in the body is found in hemoglobin. 3. The use of zinc has greatly increased in the past few years; it is thought by some that zinc can alleviate the symptoms of the common cold. 4. Vitamin C aids in the absorption of iron and in the conversion of folic acid.

18. The health-care provider has recommended the client take 100 mg of zinc a day. Which statement best supports the scientific rationale for taking zinc daily? 1. Zinc is needed for the formation of connective tissue. 2. Zinc is vital for hemoglobin regeneration in the client's body. 3. Zinc is thought to help alleviate the common cold. 4. Zinc aids in the absorption of iron and in the conversion of folic acid.

19. 1. Vitamin A is a fat-soluble vitamin that is essential for the maintenance of epithelial tissues, skin, eyes, hair, and bone growth. 2. Vitamin D is a fat-soluble vitamin that has a major role in regulating calcium and phosphorus metabolism and is needed for calcium absorption from the intestines. 3. Vitamin E is a fat-soluble vitamin that has antioxidant properties that protect cellular components from being oxidized and red blood cells from hemolysis. 4. Vitamin C is a water-soluble vitamin that aids in the absorption of iron and conversion of folic acid. 5. Folic acid is a water-soluble vitamin that is essential for body growth; it is needed for DNA synthesis, and without folic acid there is a disruption in cellular division.

19. The nurse is discussing vitamins with a group of women at a community center. The nurse is discussing water-soluble vitamins and fat-soluble vitamins. Which vitamins are fat-soluble vitamins? Select all that apply. 1. Vitamin A. 2. Vitamin D. 3. Vitamin E. 4. Vitamin C. 5. Folic acid.

2. 1. Aloe vera juice is used externally for treatment of minor burns, insect bites, and sunburn. It is a safe herb to use externally and will not hurt the client. 2. Aloe taken internally is a powerful laxative, but the client is asking about burns, not about using aloe as a laxative. 3. This is a true statement about many herbal supplements, but topical aloe does not have any known complications that would prevent it from being used for minor burns. 4. This is a false statement. Aloe can be used externally for treating minor burns. Many lotions have aloe as an ingredient.

2. The client asks the nurse, "My grandmother puts aloe vera on her burns when she is cooking. Is that all right?" Which statement is the nurse's best response? 1. "Aloe vera juice is safe to use for minor burns but not for deep burns." 2. "Aloe is approved by the U.S. Food and Drug Administration as a laxative." 3. "Any type of herbal product or remedy has potential complications." 4. "Aloe should not be used on any type of burns. Flush the burn with cool water."

20. 1. Most authorities believe that vitamin C does not cure or prevent the common cold. Rather, it is believed that vitamin C has a placebo effect. This would not be appropriate information to share with the client. 2. Megadoses of vitamin C taken with aspirin or sulfonamides may cause crystalluria, crystal formation in the urine. 3. Megadoses of vitamins can cause toxicity and might result in a minimal desired effect. 4. The use of megavitamin therapy, massive doses of vitamins, is questionable at best. The nurse should not recommend this action.

20. The nurse is taking the male client's medication history. The client informs the nurse he takes megadoses of vitamin C daily, a daily aspirin, and an iron tablet. Which statement is the nurse's best response? 1. "I am glad you take megadoses of vitamin C because it prevents the common cold." 2. "Taking aspirin and megadoses of vitamin C may cause crystals in your urine." 3. "Megadoses of vitamins and a balanced diet will help prevent you from getting sick." 4. "You should take megavitamins—not just megadoses of vitamin C alone."

21. 1. Most adult clients self-medicate for minor problems, such as a headache or indigestion, and only seek medical attention if the symptoms are unrelieved. This is not the best response for the nurse to make. 2. Up to 90% of adult-onset asthma is caused by gastroesophageal reflux disease (GERD). The nurse should assess what other symptoms are occurring. 3. The medication is taken for up to 2 weeks per package instructions. Many clients have been prescribed Prilosec for many months to years. 4. The histamine2 blockers (Tagamet, Zantac, Pepcid) may or may not be more effective than Prilosec. It depends on the individual's response to the medication. Most clients report better symptom control with the proton-pump inhibitors.

21. The male client tells the clinic nurse that he has been taking the over-the-counter medication Prilosec for heartburn. Which statement is the nurse's best response? 1. "You should not take medications without notifying the HCP." 2. "Have you also had breathing difficulties, especially at night?" 3. "Be sure to limit taking the medication to less than 1 week."

22. 1. The arterial blood gases would give information about the immediate situation, not long-term problems. 2. Tylenol is toxic to the liver, and the liver function tests should be monitored in the hospital and in the HCP's office afterward to determine if there is permanent liver damage. 3. BUN and creatinine tests determine kidney functioning. Tylenol does not affect the kidneys. 4. Tylenol does not damage the bone marrow. It is not necessary to monitor the CBC.

22. The adolescent client has been admitted to the intensive care department for an overdose of acetaminophen (Tylenol). Which laboratory data should the nurse monitor for long-term complications from the attempt? 1. The arterial blood gases. 2. The liver function tests. 3. The BUN and creatinine. 4. The complete blood count.

23. 1. NSAIDs interfere with prostaglandin production in the stomach, resulting in the client being susceptible to ulcer formation. To prevent erosion of the stomach lining, the client should not take the medication on an empty stomach. 2. NSAIDs will not affect the PTT/PT/INR results. 3. If the NSAIDs are effective, there is no reason for the HCP to prescribe a narcotic. 4. The priority is to prevent complications from the medication; the client is taking the medication because fractures of the bones are painful.

23. The elderly female client has been diagnosed with compression fractures of the vertebrae and has been taking large doses of ibuprofen for pain. Which intervention should the nurse implement? 1. Teach the client not to take the medication on an empty stomach. 2. Have the HCP order PTT/PT and INR laboratory tests. 3. Ask the HCP to prescribe a narcotic medication for the client. 4. Determine why the client thinks she needs so much medication.

24. 1. The parent should be taught never to administer aspirin to a child because of the association of aspirin with Reye's syndrome. Tylenol or ibuprofen may be administered to a child for a fever. 2. Benadryl will make the child drowsy and will help nasal congestion, but it will not treat a fever. 3. Abreva is a topical medication for cold sores, not for fever. 4. Colace is a stool softener, not an antipyretic.

24. The parent of a 1-year-old child calls the clinic to ask about medications that can be administered to reduce fever. Which medication should the nurse discuss with the parent? 1. Acetylsalicylic acid (aspirin), an antipyretic. 2. Diphenhydramine (Benadryl), an antihistamine. 3. Docosanol (Abreva), an anti-infective. 4. Docusate sodium (Colace), a gastrointestinal agent.

25. 1. Tylenol Cold and Sinus contains ingredients that cause vasoconstriction. The client with hypertension should not take any medication that increases vasoconstriction. 2. Advil Cold and Sinus contains ingredients that cause vasoconstriction. The client with hypertension should not take any medication that increases vasoconstriction. 3. Nyquil contains ingredients that cause vasoconstriction. The client with hypertension should not take any medication that increases vasoconstriction. 4. Coricidin HBP has been formulated to control symptoms of the cold or flu without causing vasoconstriction. This is the only medication in this list that will not increase the client's blood pressure.

25. The female client diagnosed with essential hypertension tells the nurse that she has a cold and a runny nose. Which over-the-counter medication should the nurse tell the client to take? 1. Tylenol Cold and Sinus. 2. Advil Cold and Sinus. 3. Nyquil. 4. Coricidin HBP

26. 1. Tylenol is an analgesic. It is not formulated with ingredients that induce sleep. Tylenol PM contains diphenhydramine. This medication can be taken to aid in sleep. 2. Ibuprofen is an analgesic and antipyretic, not a sleeping medication. 3. Diphenhydramine is an antihistamine that has the side effect of causing drowsiness. This is the main ingredient in over-the-counter sleep aids. 4. Ambien is not an over-the-counter medication.

26. The client calls the clinic nurse to discuss problems concerning not being able to sleep at night. Which over-the-counter medications are taken to assist with sleep? 1. Acetaminophen (Tylenol), an analgesic. 2. Ibuprofen (Motrin), an NSAID. 3. Diphenhydramine (Benadryl), an antihistamine. 4. Zolpidem (Ambien), a sedative-hypnotic.

27. 1. Pseudoephedrine can cause insomnia, not drowsiness. It is the ability to rev people up that makes it an ingredient in "uppers." 2. Oral or topical contraceptive hormone products interact with antibiotics, not pseudoephedrine. 3. This is a class C medication. Its use during pregnancy is questionable, but it is not known to be teratogenic. 4. The federal government enacted a law limiting the purchase of products containing pseudoephedrine to adults and to no more than two products within a 24-hour time period. The client should be able to prove her age when purchasing the products at the pharmacy.

27. The HCP has instructed the 21-year-old female client diagnosed with allergies to take the over-the-counter medication pseudoephedrine (Sudafed). Which specific information should the nurse tell the client? 1. An expected side effect is drowsiness, so plan for rest periods. 2. Plan to use a second method of birth control while taking this medication. 3. The medication will cause a developing fetus to become deformed. 4. Take a driver's license to the pharmacy when purchasing this medication.

28. 1. This is an assessment question to determine the extent of the client's problem. This is the first question. 2. The nurse should assess the problem before making this statement. 3. This is a true statement, especially for clients diagnosed with chronic illness, but it is not the first statement. 4. Eating yogurt daily will prevent most yeast infections when the client is taking prescribed antibiotics, but assessing the extent of the problem should be the nurse's first response. MEDICATION MEMORY JOGGER: Whenever the question asks for a "first" intervention, even when discussing medications, assessing is usually the correct answer.

28. The female client tells the clinic nurse that she has frequent vaginal yeast infections and uses an over-the-counter preparation to cure the infections. Which statement is the nurse's first response? 1. "How often do you use the over-the-counter yeast medications?" 2. "You should tell the HCP about the frequent infections." 3. "You should take lactic acidophilus when you take antibiotics." 4. "Have you tried eating yogurt daily to prevent the infections?"

29. 1. Ortho Tri-Cyclen is not an over-the-counter medication. 2. There are several types of over-the-counter birth control methods. 3. The client should be encouraged to use two forms of over-the-counter products to prevent pregnancy. The condom that is used should be compatible with the spermicidal product. Additionally, condoms provide some protection from acquiring a sexually transmitted disease. 4. The client is not asking for the nurse's opinion on sexual behavior. The nurse should provide the information requested.

29. The teenaged client asks the nurse about over-the-counter birth control methods. Which intervention or medication should the nurse discuss with the client? 1. The oral contraceptive medication Ortho Tri-Cyclen. 2. There are no over-the-counter products that will prevent pregnancy. 3. Tell her that spermicidal foams used with condoms are the most effective. 4. Discuss the problems of sexual activity at a young age.

3. 1. Users of St. John's wort do not need to avoid tyramine-rich foods. These types of foods should be avoided in clients taking MAO inhibitors for depression. 2. This would be appropriate when applying capsicum or cayenne pepper lotion. St. John's wort is a pill or can be taken in tea form. 3. St. John's wort can cause photosensitization dermatitis; therefore, the client should use sunscreen when outside. 4. Many herbal supplements are hepatotoxic, but St. John's wort is not one that causes liver damage.

3. The client tells the clinic nurse that she is taking St. John's wort for her depression. Which information should the nurse discuss with the client? 1. Discuss the need to avoid tyramine-rich foods. 2. Instruct the client to avoid touching the eyes after taking the medication. 3. Tell the client to apply sunscreen freely when outdoors. 4. Explain that this medication often causes liver damage.

30. 1. This is true, but this is not the most important information to provide the client. 2. Nutrition is an important consideration for clients diagnosed with cancer and undergoing treatment. Many of the antineoplastic medications can cause stomatitis, and a combination of huge amounts of vitamin C and chemotherapy could result in a serious complication for the client. 3. There are many alternative treatments that should be encouraged for use by clients with different diseases; this is not one of them. 4. This is true, but it is not the most important information for the nurse to teach the client.

30. The male client diagnosed with cancer tells the oncology clinic nurse that an employee of a health food store suggested that he take 50,000 mg of vitamin C every day to treat the cancer. Which information is most important for the nurse to discuss with the client? 1. Excessive amounts of water-soluble vitamins are excreted by the body. 2. Too much acid could result in the client developing mouth ulcers. 3. This is an alternative treatment to taking chemotherapy or radiation. 4. The individual at the store wanted to sell the vitamins to the client.

31. 1. This would indicate that vitamin A therapy is effective. 2. This would indicate zinc therapy is effective. 3. The potassium level would not indicate that iron therapy was effective. 4. The effectiveness of iron therapy can be determined by a normal hemoglobin level and by the client denying fatigue or shortness of breath. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

31. The client diagnosed with anemia is taking an iron tablet. Which assessment data indicates the medication is effective? 1. The client denies night blindness. 2. The client has not had a cold this winter. 3. The client's potassium level is 4.5 mEq/L. 4. The client's hemoglobin is 12.

32. 1. These symptoms and the client's age suggest that she is having "hot flashes" associated with menopause. There are over-the-counter preparations and hormone replacement that help the symptoms of menopause. 2. There are some natural estrogen enhancers such as soy (for example, in the form of soy milk, some vitamins containing soy) that many women believe help the symptoms of menopause. This is the best response. 3. In some instances the HCP will prescribe HRT for a woman experiencing menopause, but this is rarely done now because current research indicates that, although HRT protects against osteoporosis and treats the symptoms of menopause, it also increases the risk of heart attack, stroke, and breast cancer. 4. The client is asking for information, not expressing a need to discuss feelings.

32. The 50-year-old female client tells the nurse that she has been having frequent episodes of suddenly feeling hot and flushed and asks the nurse if there is any medication that can help her symptoms. Which statement is the nurse's best response? 1. "There is really nothing except time that helps these symptoms." 2. "I would suggest taking a vitamin that has soy in it to help the problem." 3. "The HCP can prescribe hormone replacement therapy for you." 4. "Are you concerned about having symptoms of menopause?"

33. 1. Vitamin C is a water-soluble vitamin that aids in the absorption of iron and conversion of folic acid. 2. Vitamin D is a fat-soluble vitamin that has a major role in regulating calcium and phosphorus metabolism and is needed for calcium absorption from the intestines. 3. Folic acid is a water-soluble vitamin that is essential for body growth. It is needed for DNA synthesis. Without folic acid, there is a disruption in cellular division. 4. Vitamin B12 is a water-soluble vitamin that, like folic acid, is essential for DNA synthesis. It aids in the conversion of folic acid to its active form. 5. Vitamin K is a fat-soluble vitamin that is needed for synthesis of prothrombin and clotting factors VII, IX, and X.

33. The nurse is discussing vitamins with a group of women at a community center. The nurse is discussing water-soluble vitamins and fat-soluble vitamins. Which vitamins are water-soluble vitamins? Select all that apply. 1. Vitamin C. 2. Vitamin D. 3. Folic acid. 4. Vitamin B12. 5. Vitamin K.

34. 1. Chasteberry exerts effects similar to those of progesterone. When used during menopause and postmenopause, it may help reverse vaginal changes and diminished libido. 2. The client is postmenopausal; therefore, the client does not have regular menstrual cycles. 3. The client would have a decrease in hot flashes and mood swings if the herb was helping decrease menopausal discomforts. 4. This would indicate the herb was helping a client with premenstrual syndrome.

34. The 60-year-old client who is postmenopausal tells the nurse she is taking the herb chasteberry. Which data indicates the herb is effective? 1. The client reports decreased pain with sexual intercourse. 2. The client reports less bleeding and a more regular menstrual cycle. 3. The client reports an increase in hot flashes and mood swings. 4. The client reports less bloating and breast fullness.

35. 1. Melatonin decreases alertness and decreases the body temperature, both of which make sleep more inviting. Therefore, this is a false statement. 2. Melatonin should not be taken by clients who are pregnant because there is a lack of studies that indicate its safety. Large doses of melatonin have been shown to inhibit ovulation, so women trying to conceive should reconsider taking melatonin. This is the most appropriate response for the nurse. 3. Melatonin does show efficacy for helping the client sleep, but because the client is 27 years old, the nurse's best response is to discuss pregnancy. 4. Over-the-counter medications, herbs, and natural hormones have been proved to help clients sleep. Therefore, a prescription medication is not absolutely necessary. MEDICATION MEMORY JOGGER: The test taker should question administering any medication to a client who is pregnant or may become pregnant. Many medications cross the placental barrier and could affect the fetus.

35. The 27-year-old female client tells the nurse she is taking melatonin, a natural hormone, to help her sleep better at night. Which response is most appropriate by the nurse? 1. "Melatonin has not shown any efficacy in helping people sleep." 2. "Is there any chance you may be pregnant or trying to get pregnant?" 3. "This natural hormone may help you to sleep better at night." 4. "You should really take a prescription medication to help you sleep."

36. 1. Licorice does not increase gastric acid production. 2. Frequent use of pure licorice root can contribute to sodium and water retention, hypertension, and other ill effects; therefore, this is not the nurse's best response. 3. The client is not asking what the best thing is for a stomach ulcer. The nurse's best response is to answer the client's question. 4. Licorice, a weak-tasting herb, contains substances that protect the lining of the stomach. It has been shown in several studies to help heal ulcers. It protects the stomach by increasing mucus production and blood flow through the membranes.

36. The client tells the nurse, "My grandmother gives me licorice tea to help my stomach ulcers. Is this bad for me?" Which response is most appropriate for the nurse? 1. "Yes, it is bad for you because it increases gastric acid production." 2. "Pure licorice root is the best type to take to help heal your ulcer." 3. "The best thing for a stomach ulcer is an antacid such as Maalox." 4. "No, it is not bad. It is one of the most effective herbs for stomach protection."

37. 1. Dandelion, an herb, is used as a digestive aid, laxative, diuretic, and liver and gallbladder protectant, and it prevents iron-deficiency anemia. It is not used to heal minor burns. 2. Peppermint helps soothe the stomach; it has a direct spasmolytic action on the smooth muscles of the digestive tract. 3. Cascara is FDA approved as a laxative. It stimulates peristalsis. 4. Witch hazel is FDA approved as an astringent, not as an antidepressant.

37. The nurse is teaching a class on herbal therapy to a community group. Which information should the nurse share with the group members? 1. Dandelion is an herb that can be used externally to help heal minor burns. 2. Peppermint is an herb that exerts a protective effect on the liver. 3. The herb cascara can be used as a laxative if the client is constipated. 4. Witch hazel is an herb that is used as a long-term antidepressant.

38. 1. St. John's wort is used for its antidepressant effects. 2. Ginkgo biloba has been shown to improve mental functioning and stabilize Alzheimer's disease. 3. Psyllium is FDA approved as a laxative. 4. The herb sarsaparilla is best used as a flavoring agent in soft drinks.

38. The wife of a client with Alzheimer's disease is requesting information about any herbal therapy that may help with her husband's memory. Which herb should the nurse discuss with the client? 1. St. John's wort. 2. Ginkgo biloba. 3. Psyllium. 4. Sarsaparilla.

39. 1. Garlic appears to provide some protection against atherosclerosis and stroke and may reduce blood cholesterol and blood pressure. 2. The herb gotu kola has the ability to promote wound healing. 3. This is a judgmental response, and the nurse should not be judgmental toward alternate therapy. Herbal treatment has shown efficacy. 4. Eucalyptus has shown some efficacy in treating respiratory disorders.

39. The client tells the nurse, "I take garlic every day because my parents did, but I am not sure what it does. Could you tell me?" Which response is most appropriate for the nurse to make? 1. "Garlic helps prevent atherosclerosis and helps reduce your cholesterol level." 2. "This herb has some anti-inflammatory effects and promotes wound healing." 3. "You take garlic every day just because your parents took this herb every day." 4. "Garlic is used to help prevent respiratory problems if people smoke cigarettes."

4. 1. Ephedra is an herbal stimulant that causes the cardiovascular system to potentially increase the blood pressure and heart rate. It has been implicated in many deaths and serious adverse effects, such as heart attacks and strokes. It may be removed from the U.S. market because of safety concerns. The nurse should assess the client's blood pressure and pulse. 2. Ketones in the urine may be secondary to weight loss, which may occur when using ephedra, but that information is not included in the stem of the question. 3. Ephedra does not cause hyperpyrexia, an extremely elevated temperature. 4. This is an herbal stimulant, but there are no contraindications concerning caffeinated products.

4. The client admitted to the medical floor for pneumonia tells the nurse that he is taking the herb ephedra. Which intervention should the nurse implement? 1. Assess the client's blood pressure and pulse. 2. Check the client's urine for ketones. 3. Monitor the client for hyperpyrexia. 4. Avoid giving the client products with caffeine.

40. 1. Antioxidants protect the body from damage caused by harmful molecules called free radicals; this damage is a factor in the development of atherosclerosis. Vitamin C captures the free radical and neutralizes it before it causes damage. 2. Vitamin D is not an antioxidant. It is a fat-soluble vitamin that has a major role in regulating calcium and phosphorus metabolism and is needed for calcium absorption from the intestines. 3. Vitamin E is a chain-breaking antioxidant. Whenever vitamin E is sitting on a cell membrane, it breaks the chain reaction before the free radicals cause damage. 4. Selenium is an antioxidant that has shown efficacy in decreasing the risk for lung cancer, prostate cancer, and colorectal cancer. 5. Copper is a mineral, but it is not an antioxidant. Copper is needed for the formation of red blood cells and connective tissue.

40. The nurse is discussing the importance of antioxidants in the body. Which vitamins and minerals help neutralize the free radical assault and keep the client's body cells healthy? Select all that apply. 1. Vitamin C. 2. Vitamin D. 3. Vitamin E. 4. Selenium. 5. Copper.

41. 1. Cyanocobalamin is contraindicated in clients with severe pulmonary disease and is used cautiously in clients with heart disease. Clients with these conditions may develop pulmonary edema and heart failure. The nurse should question administering this medication. 2. Prenatal vitamins with iron are part of a pregnant woman's routine medications. Ferrous sulfate is pregnancy category A, which means it has been proved safe for the fetus. The nurse would not question administering this medication. 3. The normal INR is 2-3; therefore, the nurse would not question administering this medication because it is the antidote for overdose of Coumadin. 4. Hypocalcemia occurs when a serum calcium level falls below 4.5 mEq/L; therefore, the nurse would not question administering this medication to the client whose serum calcium level is low.

41. The nurse is preparing to administer the following medications. Which medication should the nurse question administering? 1. Cyanocobalamin (Cyanabin), vitamin B12, to a client diagnosed with end-stage chronic obstructive pulmonary disease. 2. Ferrous sulfate (Ferralyn), an iron supplement, to a client who is 22 weeks pregnant and is 2 days' postoperative appendectomy. 3. AquaMEPHYTON (vitamin K) to a client who has an International Normalized Ratio of 4.0. 4. Calcium citrate (Citracal), a mineral, to a client who has a serum calcium level of 4.0 mEq/L.

42. 1. Pulmocare is a supplement recommended for clients diagnosed with chronic lung disease because the supplement does not have as much carbon dioxide as a by-product of its metabolism as do other supplements; however, the stem did not state the client had lung disease. 2. Glucerna is the supplement recommended for clients who have diabetes because this supplement has a slower release of carbohydrates and provides more controllable blood glucose, but the stem did not state that the client has diabetes. 3. Because of the added fiber, Boost would be the supplement recommended for clients diagnosed with cancer who have significant pain and are taking narcotic pain medications, but this client is newly diagnosed and pain was not mentioned in the stem of the question. 4. Newly diagnosed clients should try homemade supplements to support their diets. Supplements are expensive (ranging from $1.75 to more than $2.00 per can), and if the client develops an aversion to the taste, then it is unlikely that anyone else in the family will want to drink the supplement. The nurse should suggest the client try to make milkshakes and use canned soups to supplement the diet first.

42. The nurse is discussing nutritional supplements with a client recently diagnosed with cancer. Which supplement should the nurse recommend for the client at this time? 1. Pulmocare, a supplement formulated for clients with lung diseases. 2. Glucerna, a supplement formulated for clients with diabetes mellitus. 3. Boost, a supplement formulated with added fiber. 4. None. The client should try milkshakes and other foods first.

43. 1. Many medications that are available only by prescription in the United States are available over the counter in other countries. Antibiotics, narcotics, and steroids are some of the medications that can be purchased over the counter in Mexico. The nurse should investigate to determine if the Tylenol purchased in Mexico was Tylenol #2, #3, or #4. All of these medications have codeine in them. 2. The Food and Drug Administration is responsible for the safety of medications in the United States, but the agency does not require the manufacturers of Tylenol to halve the dose of each pill. 3. Pain is what the client says it is and pain relief is what the client says it is. This is not an appropriate question. 4. This is a therapeutic response; the nurse should assess the situation and provide factual information.

43. The male client tells the clinic nurse that he purchased over-the-counter Tylenol in Mexico for back pain that worked very well and now he has purchased Tylenol at the local drug store, but now the medication does not work. Which statement is the nurse's best response? 1. "Do you still have the container of the Tylenol you purchased in Mexico?" 2. "The Food and Drug Administration makes the company halve the dose in the United States." 3. "What makes you think there is a difference in the two bottles of medication?" 4. "You are still having back pain. Would you like to talk about the pain?"

44. 1. The ointment and suppositories should be used after the area is cleaned and patted dry. 2. The medication will not harm the fetus. 3. The labeling directions for Preparation H state four times a day as part of the safe administration guidelines. The phenylephrine shrinks the size of the hemorrhoids and provides relief from the pain and burning, and the cocoa butter provides some emollient relief for expelling feces. 4. Tucks will provide relief from burning and itching but will not shrink the hemorrhoids. Tucks may initially sting when applied to the area.

44. The client who is pregnant tells the clinic nurse that she has been using Preparation H (phenylephrine and cocoa butter), an over-the-counter medication, for hemorrhoids. Which information should the nurse teach the client? 1. Apply the ointment after a bath but before drying the area. 2. Do not use the medication because of possible harm to the fetus. 3. Suppositories may be used up to four times a day for symptom relief. 4. Tucks (witch hazel) work better than Preparation H for hemorrhoids.

45. 1. Head and Shoulders is a dandruff shampoo. It is not effective in controlling psoriasis. 2. T-Gel is a shampoo formulated with coal tar and is recommended for clients with mild psoriasis. 3. Scalpicin has hydrocortisone and is marketed for mild psoriasis symptoms. 4. Ketoconazole is an antifungal medication that has some efficacy for psoriasis. 5. Psoriasis is a painful skin problem accompanied by intense itching. A mild shampoo without some other ingredient will not be effective for this client. MEDICATION MEMORY JOGGER: Nurses are frequently asked to provide information about over-the-counter medications and preparations. The test taker could eliminate option 5 in the previous question because of the diagnosis of psoriasis.

45. The client is diagnosed with mild psoriasis of the scalp. Which shampoo should the nurse recommend to the client? Select all that apply. 1. Head and Shoulders shampoo. 2. T-Gel, a tar shampoo. 3. Scalpicin, an anti-itch shampoo. 4. Nizoral (ketoconazole), a psoriasis shampoo. 5. A mild shampoo such as Suave.

6. 1. This is a guideline for prudent use of herbs. 2. According to guidelines for prudent use of herbs, babies and young children should not be given any types of herbs. 3. Herbs exposed to sunlight and heat may lose potency. 4. This is a guideline for prudent use of herbs. 5. This is a guideline that both consumers and health-care providers must be aware of when using herbal therapy.

6. The nurse is presenting a lecture on herbs to a group in the community. Which guidelines should the nurse discuss with the group? Select all that apply. 1. Do not take herbs if you are pregnant or attempting to get pregnant. 2. Administer smaller amounts of herbs to babies and young children. 3. Store the herbal remedy in a cool, dry, dark place. 4. Advise against belief in unsubstantiated claims of "miracle cures." 5. Think of herbs as medicines—more is not necessarily better

46. 1. The over-the-counter antispasmodic is masking some of the client's symptoms. The nurse should recognize the symptoms of a urinary tract infection. The client should see the HCP and have a urine culture performed. 2. The client should increase her amount of fluids when there is a suspicion of a urinary tract infection. 3. The client has symptoms of a urinary tract infection and should see the HCP for a urine culture and prescription for antibiotics. 4. Cranberry juice is helpful in preventing urinary tract infections (UTIs), but this client already has the symptoms of a UTI

46. The female client tells the clinic nurse that she has been having urinary frequency, lower abdominal cramping, and burning on urination. The client has been using an over-the-counter urinary antispasmodic but reports that the burning has not gone away. Which intervention should the nurse implement? 1. Tell the client to continue taking the antispasmodic. 2. Encourage the client to decrease her amount of fluid intake. 3. Make an appointment for the client to see the HCP. 4. Have the client start drinking cranberry juice daily.

47. 1. Lantus is not available over the counter. A prescription is required. 2. Humulin R, N, L, and U are all available over the counter, but they are usually kept behind the counter with the pharmacist. These insulins can be purchased without a prescription. In some states syringes may be purchased without a prescription. A prescription is only required if the client has insurance that will pay part of the cost. 3. Glucose tablets are recommended for clients to carry with them in case of a hypoglycemic reaction and may be purchased without a prescription. 4. Glucose-monitoring devices and strips may be purchased without a prescription. However, if the client has insurance that will pay for the equipment, a prescription is required. 5. Humulin R, N, and L are all available over the counter. They are kept behind the counter with the pharmacist but can be purchased without a prescription. In some states syringes may be purchased without a prescription. A prescription is only required if the client has insurance that will pay part of the cost.

47. Which medications and supplies can be purchased over the counter to treat diabetes mellitus? Select all that apply. 1. Glargine (Lantus), a steady-state insulin. 2. Humulin R (regular), a fast-acting insulin. 3. Glucose tablets. 4. Glucose-monitoring strips. Glucose does not need to be underlined. 5. Humulin N, an intermediate-acting insulin.

48. 1. Nix is applied once, and the clean hair is combed to get rid of the nits. 2. Nix and RID are over-the-counter medications that treat lice. 3. The child is not allowed to return to school until the nurse determines there are no more lice or nits. 4. This is the correct procedure for treating lice.

48. The school nurse assesses lice and nits (lice eggs) in the hair of a child attending the elementary school. Which instruction should the nurse include when talking with the parent? 1. Apply Nix (permethrin) topically to the scalp twice a day for 1 week. 2. Ask the HCP for a prescription for a shampoo to treat the lice. 3. It is fine to allow the child to continue attending class while being treated. 4. Shampoo the hair with RID (pyrethrin with piperonyl butoxide) and comb the nits out.

49. 1. The most common local anesthetic used in dental procedures is a "-caine" medication, Novocaine. Therefore, a client allergic to Novocaine could be allergic to benzocaine. 2. The most common local anesthetic used in dental procedures is a "-caine" medication, lidocaine. Therefore, a client allergic to Novocaine could be allergic to lidocaine. 3. The most common local anesthetic used in dental procedures is a "-caine" medication, dibucaine. Therefore, a client allergic to Novocaine could be allergic to dibucaine. 4. Mineral oil is not a "-caine"; therefore, the nurse would not caution the client using this medication. 5. Monistat vaginal cream is not a "-caine"; therefore, the nurse would not caution the client using this medication. MEDICATION MEMORY JOGGER: If the test taker was not familiar with the local anesthetic Novocaine, the test taker could possibly still get this question correct by reading the ending of the generic names in the first three options.

49. Which over-the-counter medication would the nurse caution the use of for a client who is allergic to the numbing medication used in dental offices? Select all that apply. 1. Benzocaine (Lanacane), a topical preparation for sunburns. 2. Benzalkonium and lidocaine (Bactine), an antiseptic/pain reliever. 3. Dibucaine (Nupercainal) for the pain, itching, and burning of hemorrhoids. 4. Mineral oil, a lubricant laxative used as a preparation for a radiologic exam. 5. Miconazole (Monistat) Vaginal Cream for a client with a yeast infection.

5. 1. There is no reason to quit taking the medication because of the odor. 2. There have been no reports of habituation or addiction with valerian root. 3. The "dirty socks" odor is related to the dried plant. Valerian root is known as the "herbal Valium," and it has no hangover effect. 4. The pungent odor and drowsiness are expected with this medication, and there is no reason to discuss this with the HCP.

5. The client taking valerian root, an herbal product, to decrease anxiety tells the nurse the medication has a pungent odor that smells like "dirty socks" and it makes her drowsy. Which action should the nurse take? 1. Tell the client to quit taking the medication immediately. 2. Warn the client that valerian root has addictive potential. 3. Explain the odor is related to the dried plant and is normal. 4. Determine if the client has discussed this with the HCP.

50. 1. There is evidence that CoQ10 in combination with fish oil (omega-3 fatty acid) or flax seed oil will reduce damage to blood vessels and may delay degeneration of the macula. 2. CoQ10 is a fat-soluble antioxidant found in almost every cell in the body. Flax seed oil (or omega-3 fatty acid) is taken in conjunction with CoQ10 to help the body utilize the CoQ10. Antioxidants are supportive of arterial health by decreasing fat deposits in the vessels. 3. CoQ10 is not an omega-3 fatty acid. 4. There is no cure for macular degeneration. An injection has recently been approved by the Food and Drug Administration for use by some clients with macular degeneration. The medication is injected into the eye on a monthly basis.

50. The client diagnosed with macular degeneration asks the nurse why the HCP would prescribe over-the-counter supplements of CoQ10 and flax seed oil. Which statement best describes the scientific rationale for the nurse's response? 1. This is an unproven folk remedy that the HCP thinks might work. 2. This is an antioxidant that will support arterial functioning. 3. This is an omega-3 fatty acid that decreases the risk of heart attack. 4. This combination of medications has been shown to cure eye problems.

7. 1. The nurse should not be judgmental when clients request information about herbal therapy. 2. Garlic is one of the best-studied herbs. It has been shown to decrease the aggregation of platelets, thus producing an anticoagulant effect that is useful in treating atherosclerosis. 3. Horehound has been used as an herbal remedy for the treatment of respiratory disorders, including asthma, bronchitis, whooping cough, and tuberculosis, but not atherosclerosis. 4. This is a true statement, but aspirin is a medical treatment and is not considered an herb.

7. The client with atherosclerosis tells the nurse, "I would really like to take herbs instead of medications for my atherosclerosis." Which statement is the nurse's best response? 1. "You should not take any herbs to treat your atherosclerosis." 2. "Garlic has been shown to decrease the 'stickiness' of platelets." 3. "Horehound has sometimes been used to decrease atherosclerosis." 4. "Taking a baby aspirin daily helps to decrease atherosclerosis."

8. 1. Lactobacillus acidophilus, not Echinacea purpurea, is used to restore or to maintain the normal flora of the intestine during antibiotic therapy. 2. Ginger is one of the best-studied herbs and is used for treating nausea caused by motion sickness, pregnancy morning sickness, and postoperative procedures. 3. Goldenseal is an herb that when used topically is purported to be of value in treating bacterial and fungal skin infections and oral conditions such as gingivitis and thrush. 4. Some substances in Echinacea appear to have antiviral activity. Thus, the herb is sometimes taken to treat or prevent the common cold, a use for which it has received official approval in Germany. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

8. The client is taking Echinacea purpurea. Which statement by the client would indicate to the nurse that the herb has been effective? 1. "It has prevented me from getting diarrhea since I have been taking antibiotics." 2. "Since I started taking echinacea I do not get nauseated in the morning anymore." 3. "The fungal infection on my feet is getting better since I started taking echinacea." 4. "This medication is the reason I have not had a cold the entire winter."

9. 1. Clients taking cardiac glycosides should avoid hawthorn because it has the ability to decrease cardiac output. The client with congestive heart failure would be taking cardiac glycosides. 2. Hawthorn has been purported to lower blood pressure after 4 weeks or longer of therapy; therefore, the nurse would not question the client with hypertension taking this medication. 3. Hawthorn is not recommended for a client diagnosed with Alzheimer's disease. Ginkgo biloba is the herb that is recommended for clients with Alzheimer's disease. 4. Hawthorn is not recommended for a client diagnosed with diabetes mellitus. Stevia, an herb indigenous to Paraguay, may be helpful to people with diabetes because it is used as a sweetener.

9. With which client would the nurse discuss taking hawthorn, an herb? 1. The client diagnosed with congestive heart failure. 2. The client diagnosed with hypertension. 3. The client diagnosed with Alzheimer's disease. 4. The client diagnosed with diabetes mellitus.