Pharm 2-2

The nurse is caring for a 27-year-old patient taking a cannabinoid during chemotherapy. Which consideration will the nurse take into account? a. Antihistamines may potentiate the effects. b. Monitor the patient for fluid volume excess. c. Previous use of marijuana requires increased dosage. d. Inform the patient to avoid the intake of potassium.

ANS: A Antihistamines, alcohol, analgesics, benzodiazepines, barbiturates, antidepressants, muscle relaxants, and sedative hypnotics increase toxic effects. Fluid volume excess is not an adverse effect of cannabinoids. Previous use does not necessarily require increased dosage. There are no dietary restrictions with the use of cannabinoids.

Which instruction will the nurse include in the discharge teaching of a patient taking psyllium? a. "Administer with a full glass of water." b. "Limit the intake of high-fiber foods." c. "Avoid mixing in juice." d. "Fat soluble vitamin deficiency is common."

ANS: A It is important that bulk-forming laxatives be dispersed in a full glass of water or juice before administration. High-fiber foods should not be limited. Psyllium may be mixed in juice for administration. Fat soluble vitamin deficiency is not a common adverse effect.

The nurse is caring for a patient receiving palliative care with opioid-induced constipation. Laxative therapy has been unsuccessful in treating this patient. Which PRN medication should the nurse provide to best alleviate this type of constipation? a. Methylnaltrexone b. Bisacodyl c. Mineral oil d. Docusate

ANS: A Methylnaltrexone is used for the treatment of opioid-induced constipation in patients with advanced illness who are receiving palliative care when their response to laxative therapy has not been adequate. Bisacodyl, mineral oil, and docusate are not the treatment of choice for this situation.

Which instruction by the nurse will assist in the patient's understanding of lactulose, an osmotic laxative? a. "This medication draws water into the intestine and stimulates defecation." b. "There is increased irritability directly on the intestinal wall." c. "There is lubrication of the intestinal wall that softens the stool." d. "There is an effect on the nerves to increase the peristalsis of the intestinal smooth muscle."

ANS: A Osmotic laxatives (e.g., magnesium hydroxide, magnesium sulfate, magnesium citrate, sodium phosphate, lactulose, polyethylene glycol) are hypertonic compounds that draw water into the intestine from surrounding tissues.

A patient who has had a myocardial infarction is advised to avoid straining with defecation. Which medication would be prescribed to this patient? a. Stool softeners b. Bulk-forming laxatives c. Stimulants d. Emollients

ANS: A Stool softeners are routinely used for the prevention of constipation or to prevent straining with defecation (e.g., in patients recovering from myocardial infarction or abdominal surgery). Bulk-forming laxatives and emollients can cause straining. Stimulants can cause cramping and straining.

The nurse administers hydralazine IV to control the blood pressure of a woman diagnosed with preeclampsia. If the nurse administered this medication at 0800, the next assessment of blood pressure should occur at: a. 0803. b. 0815. c. 0830. d. 1000.

ANS: A The vasodilator hydralazine is usually administered to control blood pressure. If IV has been given, monitor the maternal and fetal heart rates and the mother's blood pressure every 2 to 3 minutes after the initial dose and every 10 to 15 minutes thereafter.

Which drug is administered after delivery to reduce the risk of postpartum hemorrhage after the placenta has been delivered? a. Oxytocin (Pitocin) b. Magnesium sulfate c. Vitamin K d. Dopamine

ANS: A Uterine stimulants, primarily oxytocin, given in low dose infusions after delivery of the fetus and placenta, help stimulate firm uterine contractions to reduce the risk of postpartum hemorrhage from an atonic uterus. Magnesium sulfate is given to treat eclampsia and preeclampsia. Vitamin K is given to prevent hemorrhage. Dopamine is given to treat hypotension.

Why is drug therapy important for selected causes of nausea and vomiting? (Select all that apply.) a. Relieves the distress associated with nausea and vomiting b. Prevents aspiration of gastric contents into the lung c. Prevents dehydration d. Prevents electrolyte imbalances e. Increases intracranial pressure

ANS: A, B, C, D Promoting comfort is a goal of treating nausea and vomiting. Aspiration can lead to severe respiratory complications. Dehydration is a common consequence of vomiting and can cause disturbances in electrolyte balances. Electrolytes are salts that the body needs to function well and stay healthy. Drugs that control nausea and vomiting do not increase intracranial pressure.

Which assessment(s) will the nurse complete during routine pregnancy visits? (Select all that apply.) a. Blood pressure b. Hemoglobin c. Weight d. Fetal heart sounds e. Glucose tolerance test (GTT)

ANS: A, C, D Assessments during routine pregnancy visits include blood pressure, weight, and fetal heart sounds. Assessments during routine pregnancy visits do not include hemoglobin or GTT.

The nurse in a long-term care facility is preparing to pass medications to the residents. To which of the following residents should the nurse administer an antidiarrheal? (Select all that apply.) a. An 80-year-old woman with diarrhea of sudden onset that has lasted 3 days b. A 76-year-old man with infectious diarrhea c. A 92-year-old man with diarrhea secondary to inflammatory bowel disease d. A 70-year-old woman with a history of chronic diarrhea from GI surgery e. An 88-year-old man that has had two episodes of stress-induced diarrhea

ANS: A, C, D Diarrhea of sudden onset lasting more than 2 or 3 days can cause significant fluid and water loss; therefore, an antidiarrheal is indicated. Patients with inflammatory bowel disease develop diarrhea. Rapid treatment shortens the course of the incapacitating diarrhea and allows the patient to live a more normal lifestyle. Postoperative GI surgery patients develop diarrhea. These patients may require chronic antidiarrheal therapy to allow adequate absorption of fluids and electrolytes. Antidiarrheals should not be given to patients known to have infectious diarrhea. Two bouts of diarrhea would not indicate a need for an antidiarrheal.

For which reason will betamethasone IM be administered to the mother in premature labor? a. To stop uterine contractions b. To prevent precipitous labor c. To stimulate lung maturity in the fetus d. To stimulate prolactin to enhance breastfeeding

ANS: C Glucocorticoids may be administered IM to accelerate fetal lung maturation to minimize respiratory distress syndrome. Tocolytic drugs are given to stop uterine contractions. Prolactin production and release are triggered by pituitary hormone, estrogen, and progesterone.

A patient at 33 weeks' gestation is admitted to the obstetric unit in active labor with symptoms associated with pregnancy induced hypertension (PIH). Which action(s) will the nurse implement? (Select all that apply.) a. Vital signs hourly b. Administration of IV pitocin c. Administration of magnesium sulfate IV d. Fetal stress test e. Assessment of deep tendon reflexes

ANS: A, C, D, E Important nursing assessments and/or interventions include monitoring of vital signs and level of consciousness continuously, continuous fetal monitoring with stress tests and external or internal fetal monitoring, and deep tendon reflexes. IV magnesium sulfate is often prescribed for patients with PIH. Oxytocin increases uterine contractions and is contraindicated in preterm labor.

Which sign(s) and symptom(s) is/are consistent with dehydration? (Select all that apply.) a. Increased hemoglobin and hematocrit b. Decreased urine specific gravity c. Mental confusion and excessive thirst d. Periorbital edema and increased blood pressure e. Nonelastic skin turgor and delayed capillary filling

ANS: A, C, E Blood work of dehydrated patients will show falsely elevated hemoglobin and hematocrit levels as a result of decreased capillary fluid. Dehydrated patients may become confused as a result of electrolyte imbalances and often complain of thirst. Older patients may not complain of thirst as a result of perceptual changes. Dehydration is evident by nonelastic skin turgor and delayed capillary filling.

A patient going on vacation asks the nurse what she can give to her 3-year-old child who becomes car sick. Which response(s) would be accurate? (Select all that apply.) a. "Positioning techniques such as placing the child facing forward and blocking out scenery through the side windows can be helpful." b. "There is no such thing as car sickness." c. "If your child does vomit, give over-the-counter Benadryl." d. "I would check with the pharmacist regarding over-the-counter products available for young children."

ANS: A, D Positioning techniques that help block out the rapid peripheral movement assist young children who suffer from motion sickness. Over-the-counter products are available to medicate a young child. A health care provider should recommend dosages and evaluate other medications being currently given. Motion sickness is very real, and dismissing a patient's complaints is unprofessional. Benadryl is not effective for treating nausea or vomiting.

The nurse is assessing a patient with constipation. Which situation(s) would cause constipation? (Select all that apply.) a. Diet low in fiber and/or residue b. Excessive fluid intake c. Diet low in cheese and yogurt d. Iron supplements e. Use of morphine

ANS: A, D, E Constipation can be caused by diets lacking in adequate residue and/or fiber and fluids or the use of constipating medicines (morphine, codeine, anticholinergic agents). Iron has a constipating effect. Fluid intake helps prevent constipation. Constipation can be caused by excessive intake of constipating foods such as cheese or yogurt.

Which test would the nurse anticipate to be done to determine if preterm labor is present in a patient whose symptoms are questionable? a. Sonogram b. Fetal fibronectin test c. Amniocentesis d. Doppler study

ANS: B A fetal fibronectin test may be ordered to assess the presence of preterm labor in patients whose presenting symptoms are questionable, so that early intervention (e.g., tocolytic therapy, corticosteroids, transport to a tertiary center) can be initiated when indicated. Sonograms determine the presence and viability of a fetus. Amniocentesis determines genetic problems in a fetus. Doppler determines circulation in the vascular system of the mother or the baby.

An older adult is admitted through the emergency department with complaints of nausea, abdominal tenderness, and continual stooling. On assessment, the nurse notes abdominal distention, smearing of stool on undergarments, and hypoactive bowel sounds LUQ and LLQ. The patient is unable to determine when the last bowel movement was. What is the nurse's priority assessment? a. Signs and symptoms of an infection b. An impaction c. A pattern of laxative abuse d. History of GI disease

ANS: B A nursing priority is to determine basic needs such as last bowel movement, constipation, and pain control. The symptoms presented do not indicate an infection as a priority. Frequent stooling indicated by the history and smearing on the undergarments are signs of an impaction, or an area of hardened stool. Laxative abuse or a history of GI disease may be contributing factors that the health care provider will review. Although the patient may have an infection or history of GI disease, checking for an impaction is a higher priority because it is done more quickly and is more likely to yield results. These symptoms are not characteristic of laxative abuse.

The nurse is assessing a patient with nausea and vomiting. Which additional autonomic symptoms that often accompany vomiting will the nurse observe? a. Bradycardia, diarrhea, and flushing b. Pallor, sweating, and tachycardia c. Urinary urgency, chills, and dizziness d. Fever, hyperventilation, and bradycardia

ANS: B Autonomic symptoms of pallor, sweating, and tachycardia cause additional discomfort associated with vomiting. Bradycardia, diarrhea, flushing, urinary urgency, chills, dizziness, fever, and hyperventilation are not autonomic symptoms associated with vomiting.

Which emergency drug must be available when caring for a patient receiving magnesium sulfate? a. Naloxone b. Calcium gluconate c. Dextrose d. Dopamine

ANS: B Calcium gluconate is the antidote for magnesium sulfate and should always be available when magnesium sulfate is administered. Naloxone is an antidote for opioid drugs. Dextrose is given to treat hypoglycemia. Dopamine is given to treat hypotension.

Which medication is used to treat a patient with atonic uterus? a. Estradiol b. Ergonovine c. Ergotamine d. Egophony

ANS: B Continued intravenous infusions of low dose oxytocin or intramuscular injections of ergonovine or methylergonovine may be used to stimulate firm uterine contractions to reduce the risk of postpartum hemorrhage from an atonic uterus. Estradiol is an estrogen and is not used to treat atonic uterus. Ergotamine is used to treat migraine headaches. Egophony is a change in lung sounds characteristic of plural effusion.

Which effect will the nurse expect when a patient is taking psyllium while on digoxin? a. Decreased effectiveness of the laxative b. Increased laxative effect c. Increased absorption of the digoxin d. Decreased absorption of the digoxin

ANS: D Do not administer products containing psyllium (e.g., Metamucil) at the same time as salicylates, nitrofurantoin, or digoxin glycosides. The psyllium may inhibit absorption. Administer these medications at least 1 hour before or 2 hours after psyllium. Digoxin does not affect laxatives.

A friend reports using loperamide (Imodium) for continual diarrhea for a week since returning home from a vacation outside the country. Which is the nurse's best response? a. "There are some other over-the-counter products available for diarrhea, such as Kaopectate (bismuth subsalicylate)." b. "I'd stop taking the Imodium and go in to see a health care provider immediately. You may have an infection in your intestinal tract." c. "If you're not running a temperature, I wouldn't worry. That happens to many people when they travel." d. "As long as you can drink plenty of fluids, I'm sure the diarrhea will go away once you're back in a normal routine."

ANS: B Diarrhea may be a defense mechanism to rid the body of infecting organisms or irritants. Diarrhea is usually self-limiting and should not be suppressed with over-the-counter products. It is safest for people who are suffering from diarrhea after traveling outside the country to visit their health care provider, who can determine whether an infection is present.

Which drug will the health care provider prescribe to soften the cervix of a woman who is at 42 weeks of gestation? a. Methylergonovine (Methergine) b. Dinoprostone (Prepidil) c. Betamethasone (Celestone) d. Terbutaline (Brethine)

ANS: B Dinoprostone is a natural chemical in the body that causes uterine and gastrointestinal smooth muscle stimulation. It plays a role in cervical softening and dilation unrelated to uterine muscle stimulation. It is used to start and continue cervical ripening at term. Methergine is used to treat postpartum bleeding. Betamethasone is used to enhance fetal lung development. Terbutaline is used to treat premature labor.

Which drug would be most effective for an obstetric patient who is complaining of constipation as a result of her enlarging uterus and use of prenatal vitamins? a. Saline laxative b. Lubricant laxative c. Stimulant laxative d. Mineral oil

ANS: B Lubricant and bulk-forming laxatives may be used in the pregnant patient because little cramping accompanies their use. Saline laxatives are not safe for a pregnant woman because of the bowel distention and possible electrolyte imbalance they may cause. Stimulant laxatives are too harsh for a pregnant woman because they may cause cramping. Mineral oil is not a good laxative to use on a regular basis because it can cause malabsorption of vitamins.

The nurse is performing a premedication assessment. For which patient would laxative use be contraindicated? a. Patient with quadriplegia b. Patient with appendicitis c. Geriatric patient d. Patient with fractured femur

ANS: B Patients who have a history of an inflammation of the gastrointestinal (GI) tract, including gastritis, colitis, Crohn's disease, ulcerative colitis, and appendicitis, should not take laxatives and should be referred to a health care provider. Quadriplegic and geriatric patients as well as patients with fractures may generally take laxatives and stool softeners on a regular basis.

A woman is 32 weeks pregnant and has been examined by the health care provider on June 1. She is scheduling her next appointment. The most appropriate day for the nurse to schedule the appointment is: a. June 9. b. June 16. c. June 30. d. July 7.

ANS: B The pregnant woman who does not experience complications is usually examined monthly for the first 6 months, every 2 weeks in the seventh and eighth months, and weekly during the last month.

The recovery room nurse is preparing to assist with the care of several postoperative patients. Which patient would the nurse prioritize care for regarding the potential for postoperative nausea and vomiting (PONV)? a. A 5-year-old child undergoing a closed reduction procedure with regional anesthesia b. A 50-year-old woman undergoing a total hysterectomy with general anesthesia c. A 27-year-old man undergoing a middle ear manipulation with general anesthesia d. An 80-year-old man undergoing a total hip replacement with spinal anesthesia

ANS: B Women have a higher incidence of PONV, possibly because of hormonal differences. Patients who have had general anesthesia have a higher incidence of PONV than those who have had regional anesthesia. Children ages 11 to 14 years have the highest incidence of PONV based on age group. Spinal anesthesia is generally least emetogenic.

Which treatment(s) would be considered safe for an infant? (Select all that apply.) a. Saline laxatives b. Bulk-forming laxatives c. Malt soup extract d. Stimulant laxatives

ANS: B, C Constipation in infants can be treated with a bulk-forming laxative and malt soup extract. Saline laxatives are not appropriate for infants because of the risk of electrolyte imbalances. Stimulant laxatives are not appropriate for infants.

Which is characterized by seizures? a. Pregnancy induced hypertension b. Preeclampsia c. Eclampsia d. Premature rupture of membranes

ANS: C Eclampsia (convulsions accompanying preeclampsia) is characterized by seizures. Pregnancy induced hypertension is characterized by sudden hypertension (an elevation of systolic pressure 30 mm Hg or more than prior readings, systolic blood pressure of 140 mm Hg or more, or diastolic pressure of 90 mm Hg or more). Preeclampsia is characterized by elevated blood pressure and proteinuria. Premature rupture of membranes is characterized by leakage of amniotic fluid from the vagina.

When caring for the neonate immediately following delivery, the priority nursing diagnosis will be: a. risk for bleeding. b. altered body temperature. c. ineffective airway clearance. d. risk for infection.

ANS: C Ensuring that the airway remains open is the priority because if the airway does not remain patent, oxygenation will be impaired. Risk for bleeding, altered body temperature, and risk for infection are relevant but not priorities at this time.

Which drug will the nurse administer to prevent neonatal conjunctivitis in the newborn? a. Silver nitrate b. Dexamethasone c. Erythromycin d. Vitamin K

ANS: C Erythromycin or tetracyclines are the drugs of choice because they prevent neonatal conjunctivitis from Neisseria gonorrhoeae and chlamydial ophthalmia neonatorum from Chlamydia trachomatis. Silver nitrate is an outdated treatment for neonatal ocular infections. Dexamethasone is given for lung development. Vitamin K is given for treatment of hemorrhage.

A 36-week primigravida patient has been admitted to the unit with a blood pressure of 200/120 mm Hg, severe headache, and edema. Which medication does the nurse anticipate that the health care provider will order? a. Nifedipine (Procardia) b. Furosemide (Lasix) c. Magnesium sulfate d. Terbutaline (Brethine)

ANS: C Magnesium sulfate depresses the central nervous system and blocks peripheral nerve transmission, which produces anticonvulsant effects and smooth muscle relaxation. In cases of preeclampsia or eclampsia, magnesium sulfate is used to control seizure activity. Hypertension, headache, and edema are signs of preeclampsia in a pregnant woman. Calcium channel blockers, such as nifedipine, are sometimes given as tocolytic agents. Furosemide is given for diuresis; it may be used in the treatment of hypertension, but not eclampsia. Terbutaline is given as a tocolytic agent.

What is the purpose for the nurse administering metoclopramide (Reglan) IV postoperatively? a. Prolong the effects of anesthesia b. Decrease the potential for thrombus formation c. Prevent postoperative nausea and vomiting d. Decrease postoperative pain

ANS: C Metoclopramide (Reglan) is an antiemetic and antagonist of dopamine and serotonin receptors. In addition to acting on receptor sites in the brain, metoclopramide increases sphincter tone in the gastrointestinal tract, which reduces nausea and vomiting. Metoclopramide does not affect anesthesia or the vascular system and does not have analgesic effects.

Why does the nurse monitor daily weights prior to the administration of antiemetic medications to chemotherapy patients? a. Antiemetics are calculated according to body surface area. b. Antiemetics are toxic, and the minimal dosage should be administered. c. Weight loss is a common adverse effect associated with chemotherapy, and dosages may need to be readjusted. d. Fluid overload is common, and antiemetic dosages are increased as treatment progresses.

ANS: C Patients receiving chemotherapy are prone to weight loss resulting from nausea and vomiting. As with any drug therapy, the safe dosage per weight parameters should be assessed daily to avoid potential overmedication when patients are losing significant weight. Antiemetics are not calculated according to body surface area. Antiemetics are not toxic in recommended dosages. Fluid overload is unrelated to antiemetic therapy.

Which symptom is the patient with a lactase deficiency most likely to exhibit? a. Constipation b. Excessive salivation c. Diarrhea d. Vomiting

ANS: C Patients with deficiencies of digestive enzymes such as lactase or amylase have difficulty digesting certain foods. Diarrhea usually develops because of irritation from undigested food. Constipation, excessive salivation, and vomiting do not result from enzyme deficiencies.

A patient is receiving morphine for pain control. What will the nurse emphasize about preventing constipation? a. Adequate hydration consists of four full glasses of water every day. b. Laxatives should be given on a daily basis. c. Stool softeners are taken on a regular basis during opioid use. d. Enemas should be given on a weekly basis.

ANS: C When codeine or morphine is used regularly for pain control in cancer patients, it is imperative that the individual know that stool softeners should be initiated and continued as long as constipating medicines are being taken. Although adequate hydration is important in the prevention of constipation, individual needs vary, and hydration alone cannot prevent constipation related to opioid use. Laxatives are too harsh to be given regularly unless specifically ordered by the health care provider. Enemas are not a preventive measure but an intervention intended to produce a more positive outcome.

A patient is beginning the second round of high-dose cisplatin. Severe, chemotherapy-induced nausea and vomiting (CINV) occurred following the first treatment, requiring 72 hours of continuous IV hydration. In addition to her chemotherapy regimen, which medication would be best to administer? a. Prochlorperazine (Compazine) suppository daily, on the day of treatment and the next 3 days b. Anticholinergic agents, such as diphenhydramine or meclizine c. Parenteral ondansetron 1 hour before chemotherapy, with oral ondansetron to continue for the next 4 days d. Parenteral ondansetron during chemotherapy, with prochlorperazine suppositories daily for 1 week

ANS: C With the patient's first treatment history and the emetogenic chemotherapy agent, cisplatin, ondansetron has shown to be the most effective for prevention of severe nausea and vomiting. Prochlorperazine and anticholinergic agents are not used for the treatment of CINV. The ondansetron should be administered 1 hour before the chemotherapy and continued for the next several days to prevent vomiting and dehydration associated with chemotherapy administration.

What is the role of the chemoreceptor trigger zone (CTZ) in vomiting? (Select all that apply.) a. Initiates or induces vomiting b. Coordinates the vomiting reflex c. Activates the vomit center (VC) to induce vomiting d. Samples blood and spinal fluid for potentially toxic substances

ANS: C, D The CTZ stimulates the VC to induce vomiting as well as samples blood and spinal fluid for potentially toxic substances. The CTZ does not initiate vomiting or coordinate the vomiting reflex.

What will the nurse include when teaching a postpartum patient about expected adverse effects of Rho(D) immune globulin? (Select all that apply.) a. Nausea b. Constipation c. Fever d. Insomnia e. Aches f. Diarrhea g. Anorexia

ANS: C, E Fever as well as generalized aches and pains are common adverse effects of treatment with this drug. Nausea, constipation, insomnia, diarrhea, and anorexia are not adverse effects of Rho(D) immune globulin.

A prepared childbirth nurse educator is discussing potential discomforts during pregnancy with a group of women. When relaying information about nausea and vomiting, the nurse will include which statement(s)? (Select all that apply.) a. The majority of pregnant women experience nausea and vomiting. b. Severe, persistent vomiting during pregnancy is known as anticipatory vomiting. c. Vomiting during pregnancy is more common among primigravidas. d. Prior fetal loss puts a woman at higher risk. e. Nausea and vomiting during pregnancy can occur at any time of the day.

ANS: C, E Vomiting during pregnancy is more common among primigravidas. Nausea and vomiting during pregnancy can occur at any time of the day. The percentage of women reporting vomiting during the first 16 weeks of gestation is relatively constant at about 40%, decreasing to 20% from 17 to 20 weeks. Only 9% of women report vomiting after 20 weeks of pregnancy. Severe, persistent vomiting during pregnancy is known as hyperemesis gravidarum. Contrary to commonly held beliefs, vomiting is not more common in women who have experienced prior fetal losses.

The nurse is assessing a patient taking lactulose to treat chronic constipation. Which adverse effect should the nurse immediately report to the health care provider? a. Nausea b. Abdominal spasms c. Flatulence d. Abdominal tenderness

ANS: D Abdominal tenderness is considered a serious adverse effect and can indicate acute abdomen. Nausea, abdominal spasms, and flatulence are common adverse effects.

A patient is a gravida 1, Rh-negative woman at a 28 weeks' gestation. The father of her child is Rh positive. The mother is asking the nurse about the effect on her unborn child of RhoGAM that has been ordered. What is the nurse's best reply? a. "Your child will do well after birth once transfusions are administered." b. "If the baby is Rh negative at birth, he or she will need RhoGAM also." c. "RhoGAM kills antibodies you make, so your child will be protected." d. "Your baby may be Rh positive and cause you to make antibodies. These won't affect this baby, but could affect future children if RhoGAM isn't given."

ANS: D An Rh-negative mother and an Rh-positive father have the potential for an Rh-positive baby. At birth or during any time that the uterus ruptures, fetal blood circulation can mix with maternal circulation, causing the mother to produce antibodies (active immunity) against Rh-positive blood. This would cause Rh hemolytic disease in children of future pregnancies. Rho(D) immune globulin suppresses the stimulation of active immunity by Rh-positive foreign red blood cells that enter maternal circulation at the time of delivery, at the termination of pregnancy, or during a transfusion of inadequately typed blood. Transfusions may cause further problems. Immune globulin is given to the mother. The drug does not kill antibodies; it suppresses production.

A patient expresses concerns about motion sickness. Which medication is most effective in preventing motion sickness? a. Serotonin antagonists b. Phenothiazines c. Corticosteroids d. Anticholinergics

ANS: D Anticholinergic agents are used to treat motion sickness by counterbalancing the excessive amounts of acetylcholine present. Serotonin antagonists are used in the treatment of emesis associated with cancer chemotherapy, radiation therapy, and postoperative nausea and vomiting. Phenothiazines are used in the treatment of mild to moderate nausea and vomiting associated with anesthesia and surgery, radiation therapy, and cancer chemotherapy. Corticosteroids are used in the treatment of nausea and vomiting related to pregnancy, postsurgical state, chemotherapy, radiation, and bowel obstruction.

What condition is occurring when a patient experiences nausea immediately on entering the clinic to receive another course of chemotherapy? a. Psychogenic b. Chemotherapy induced c. Hyperemesis gravidarum d. Anticipatory nausea and vomiting

ANS: D Anticipatory nausea and vomiting is a conditioned response triggered by the sight or smell of the clinic or hospital or by the knowledge that treatment is imminent. Delayed reaction from a previous treatment would have occurred in a shorter interval after the other treatment. Delayed emesis occurs 24 to 120 hours after the administration of chemotherapy. Although smells can trigger nausea, this is not likely the cause of this patient's sickness. Hyperemesis gravidarum is excessive vomiting and nausea associated with pregnancy.

What is an advantage of using benzodiazepines as an adjunctive treatment for nausea and vomiting associated with chemotherapy? a. The long half-life will prolong the effectiveness of other drugs. b. They increase a sense of euphoria. c. The patient will not develop tolerance to the medications as quickly. d. The antianxiety effect helps, in addition to reducing the frequency of nausea and vomiting.

ANS: D Benzodiazepines (e.g., diazepam, lorazepam, midazolam) are effective in reducing not only the frequency of nausea and vomiting but also the anxiety often associated with chemotherapy. Benzodiazepines do not affect the effectiveness of other drugs. Although distraction can be an effective intervention, using benzodiazepines is not a method to achieve this goal. Tolerance to benzodiazepines can develop quickly; they do not affect the development of tolerance to other drugs.

Which is the laxative of choice for an older patient who is in the end stage of Alzheimer's disease and requires a daily laxative? a. Emollient b. Stimulant c. Fecal softener d. Bulk forming

ANS: D Bulk-forming laxatives are considered the safest laxative for routine use because they cause water to be retained within the stool, which increases bulk, and stimulates peristalsis. Emollient laxatives reduce muscle tone and decrease peristalsis over time. Stimulant laxatives can cause cramping and should not be used on a regular basis. Fecal softeners are not laxatives

The nurse is administering medications to various patients during morning medication pass. The patient at the lowest risk of having an adverse reaction is the patient receiving a. ondansetron. b. scopolamine. c. promethazine. d. dexamethasone.

ANS: D Dexamethasone is a corticosteroid. A particular advantage of the steroids, apart from their efficacy, is their relative lack of adverse effects. Ondansetron, scopolamine, and promethazine have more associated side effects than dexamethasone.

Which herb has been used in many cultures to provide relief of nausea associated with pregnancy? a. Mint b. Hyssop c. Echinacea d. Ginger

ANS: D Ginger is an herb used in many cultures to treat pregnancy-induced nausea and vomiting. Mint is often used to treat mild dyspepsia. Hyssop is used as an expectorant and anticatarrhal. Echinacea is used to boost the immune system.

The nurse would expect to administer which drug when treating hyperemesis gravidarum? a. THC (Marinol) b. Haloperidol (Haldol) c. Dexamethasone (Prednisone) d. Metoclopramide (Reglan)

ANS: D Metoclopramide is the drug of choice when treating hyperemesis gravidarum because no teratogenic effects have been reported with the use of this drug. THC is used in the treatment of nausea and vomiting associated with cancer and cancer treatment. Haloperidol is used in the treatment of nausea associated with chemotherapy. Prednisone is used in the treatment of nausea associated with pregnancy, postsurgical state, chemotherapy, radiation, and bowel obstruction.

When the nurse assesses bowel habits in a patient, which is the best example of normal bowel elimination? a. Daily bowel movements b. Multiple soft stools daily c. Daily liquid stools d. Regular bowel elimination pattern of soft stool

ANS: D Normal bowel habits are stools that are soft and occur on a regular schedule of elimination for that particular patient. Although this may be routine for some people, it is not normal for everyone. Liquid stools are not considered normal.

What is the mechanism of action of a stimulant laxative? a. Draws water into the bowel to facilitate the passage of feces b. Lubricates the intestinal wall and softens stool c. Increases bulk and stimulates peristalsis d. Irritates the intestine directly, promoting peristalsis and evacuation

ANS: D Stimulant laxatives act directly on the intestine, causing an irritation that promotes peristalsis and evacuation. Saline laxatives draw water into the bowel to facilitate the passage of feces. Lubricant laxatives lubricate the intestinal wall and soften the stool, allowing a smooth passage of fecal contents. Bulk-producing laxatives must be administered with a full glass of water. The laxative causes water to be retained within the stool. This increases bulk, which stimulates peristalsis.

Which drug is administered when a patient is experiencing premature labor? a. Magnesium sulfate b. Oxytocin (Pitocin) c. Levonorgestrel (Mirena) d. Terbutaline (Brethine)

ANS: D Terbutaline is a beta adrenergic receptor stimulant, which acts primarily on the beta2 receptors. Stimulation of beta1 receptors produces uterine relaxation and relaxation of the bronchial and vascular smooth muscle. In higher doses, terbutaline will stimulate the beta1 receptors, which raises heart rate. Magnesium sulfate is given to treat eclampsia. Oxytocin is given to produce uterine contractions. Levonorgestrel is a progestin given for contraception

A 26-year-old patient with preeclampsia is receiving IV magnesium sulfate. The 1400 assessment includes blood pressure, 100/70 mm Hg; respiration, 10; fetal heart tone, 100/min; urine output, 20 mL/hr; and absent patellar reflex. Which is the priority nursing action? a. Decrease IV magnesium sulfate to half the dose and reassess the patient and fetus in 15 minutes. b. Stop the IV magnesium sulfate and contact the health care provider. c. Place the patient on her left side and administer oxygen. d. Stop the IV magnesium sulfate and administer calcium gluconate 5 mEq IV over 3 minutes.

ANS: D The patient is exhibiting signs of magnesium sulfate toxicity, including respiratory depression. The infusion should be stopped at once. The antidote, calcium gluconate, should be administered.