Pharm Exam 3 Chapter 53, 55, 56, 57, 58

A patient presents to the clinic with a temperature of 101.5°F; malaise, myalgia, arthralgia, and a purulent, productive cough. The patient states "The fever just started today but I have had this cough for many, many months." What would the nurse suspect the patient has? A) Acute pneumonia B) Bronchitis C) Chronic obstructive pulmonary disease (COPD) D) Bronchiectasis

D) Bronchiectasis Feedback: Bronchiectasis is a chronic disease that involves the bronchi and bronchioles. It is characterized by dilation of the bronchial tree and chronic infection and inflammation of the bronchial passages. With chronic inflammation, the bronchial epithelial cells are replaced by a fibrous scar tissue. The loss of the protective mucus and ciliary movement of the epithelial cell membranes, combined with the dilation of the bronchial tree, leads to chronic infections in the now unprotected lower areas of lung tissue. Patients with bronchiectasis often have an underlying medical condition that makes them more susceptible to infections (e.g., immune suppression, acquired immune deficiency syndrome, chronic inflammatory conditions). Patients present with the signs and symptoms of acute infection, including fever, malaise, myalgia, arthralgia, and a purulent, productive cough. Patients who have pneumonia and bronchitis may present with the above symptoms, but it is not a chronic disorder. COPD is a chronic disorder but the patient with this disorder has more symptoms related to shortness of breath.

While assessing a new patient on the unit, the nurse notes the following: productive cough, respiratory rate of 22, oxygen saturation of 90%, and increased secretions. The patient has a 20-year history of smoking 1.5 packs of cigarettes daily. What chronic condition might this patient have? A) Pneumonia B) Cystic fibrosis C) Pleural effusion D) Chronic obstructive pulmonary disease (COPD)

D) Chronic obstructive pulmonary disease (COPD) Feedback: Chronic obstructive pulmonary disease (COPD) is a permanent, chronic obstruction of airways, often related to cigarette smoking. It is caused by two related disorders, emphysema and chronic bronchitis, both of which result in airflow obstruction on expiration, as well as overinflation of the lungs and poor gas exchange. Emphysema is characterized by loss of the elastic tissue of the lungs, destruction of alveolar walls, and a resultant alveolar hyperinflation with a tendency to collapse with expiration. Chronic bronchitis is a permanent inflammation of the airways with mucus secretion, edema, and poor inflammatory defenses. Characteristics of both disorders often are present in the person with COPD. Pneumonia and pleural effusion are not chronic conditions. Cystic fibrosis is a genetic disease of excessive pulmonary tract secretions and GI tract involvement.

The nurse is caring for a patient who suffered a head injury and is now having difficulty breathing. The nurse knows that this patient may have injured what part of the central nervous system? A) Cerebral cortex B) Cerebellum C) Hypothalamus D) Medulla oblongata

D) Medulla oblongata Feedback: The act of breathing is controlled by the medulla, which depends on a functioning muscular system and a balance between the sympathetic and parasympathetic systems. The cerebral cortex, cerebellum, and hypothalamus are not involved with this process.

A patient returns to the unit after thoracic surgery with a water-sealed chest drainage system. What should the nurse instruct the patient and the family that this drainage system is used for? A) Maintaining positive chest wall pressure B) Monitoring pleural fluid C) Providing positive intrathoracic pressure D) Re-expanding the lung and restoring the negative pressure to the space between the pleura

D) Re-expanding the lung and restoring the negative pressure to the space between the pleura Feedback: In the case of a pneumothorax, treatment would involve insertion of a chest tube to restore the negative pressure to the space between the pleura. A water-sealed chest drainage system does not maintain positive chest wall pressure, monitor pleural fluid, or provide positive intrathoracic pressure.

The nursing instructor is teaching a class on respiratory disorders and asks the students "What condition is a result of the upper airways response to pollen, mold, or dust?" A) Cystic fibrosis B) Adult respiratory distress syndrome (ARDS) C) Atelectasis D) Seasonal rhinitis

D) Seasonal rhinitis Feedback: Seasonal rhinitis is an inflammation of the nasal cavity; it occurs when the upper airways respond to a specific antigen such as pollen, mold, or dust. Cystic fibrosis, atelectasis, and ARDS are not associated with an allergic response.

A woman has just given birth to a premature infant. The mother asks why the infant is having such a hard time breathing. The nurse explains that the infant's alveoli are unable to stay open. What is the infant lacking that is necessary for correct functioning of the alveoli? A) Adenosine triphosphate (ATP) B) Histamine C) Serotonin D) Surfactant

D) Surfactant Feedback: Surfactant is a lipoprotein that decreases the surface tension in the sac and prevents alveolar collapse. ATP, histamine, and serotonin are released from mast cells throughout the airway to ensure a quick and intense inflammatory reaction to any cell injury, which may lead to a respiratory infection.

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57

The pediatric nurse practitioner is caring for a child who is diagnosed with cystic fibrosis (CF). The parents ask what the treatment is for because CF is considered a terminal illness. What would be the nurse's best response? A) "Treatment is aimed at maintaining airway patency as much as possible." B) "Treatment is aimed at lowering high levels of carbon dioxide in the blood." C) "Treatment is aimed at raising oxygen levels to the extremities." D) "Treatment is aimed at maintaining the child until lung transplantation can occur."

A) "Treatment is aimed at maintaining airway patency as much as possible." Feedback: Treatment is aimed at keeping the secretions fluid and moving and maintaining airway patency as much as possible. Treatment for CF is not aimed at lowering hypercapnia or raising oxygen levels to the extremities. Treatment for CF is not aimed at maintaining the child until lung transplantation can occur.

The nurse is caring for a 6-year-old patient with cystic fibrosis. The parents ask how the cystic fibrosis started. The nurse explains that the key feature in the presentation of cystic fibrosis includes what? A) Airway obstruction B) Obstructed bowel C) Sweet-tasting sweat D) Clubbing of the extremities

A) Airway obstruction Feedback: CF results in the accumulation of copious amounts of very thick secretions in the lungs. Eventually, the secretions obstruct the airways, leading to destruction of the lung tissue. Parents will often comment that their child tastes salty, not sweet. Newborns with CF often present with meconium ileus but not a bowel obstruction. Clubbing of the extremities occurs after many years of inadequate oxygenation.

A nurse is caring for a 73-year-old woman who just arrived on the medical surgical floor following a radical mastectomy for breast cancer. The nurse will encourage the patient to cough and breathe deeply to help prevent what? A) Atelectasis B) Asthma C) Bronchiectasis D) Sinusitis

A) Atelectasis Feedback: Atelectasis most commonly occurs as a result of airway blockage, which prevents air from entering the alveoli, keeping the lung expanded. This occurs when a mucous plug, edema of the bronchioles, or a collection of pus or secretions occludes the airway and prevents the movement of air. Patients may experience atelectasis after surgery, when the effects of anesthesia, pain, and decreased coughing reflexes can lead to a decreased tidal volume and accumulation of secretions in the lower airways. Asthma, bronchiectasis, and sinusitis are not directly related to surgery but instead result from other conditions.

The nurse is caring for a patient who has just been admitted with atelectasis and anticipates which possible treatments for this patient? (Select all that apply.) A) Chest tube B) Surgical removal of the affected lung C) Oxygen delivery D) Assisted ventilation E) Antianxiety medication

A) Chest tube B) Surgical removal of the affected lung D) Assisted ventilation Feedback: Treatments for atelectasis include airway clearance (e.g., postural drainage and suctioning), oxygen delivery, and assisting ventilation. Patients with atelectasis may feel some anxiety if the patients oxygen level has lowered, but it is not a treatment for atelectasis. Removal of the portion of the lung that is affected is not an effective treatment.

A nursing instructor is discussing ways that the respiratory tract protects itself from bacteria and shares with the students that it is done in which ways? (Select all that apply.) A) Cough and sneeze reflex B) Surfactant in the alveoli C) Goblet cells D) Gas exchange in the alveoli E) Nasal cilia

A) Cough and sneeze reflex C) Goblet cells E) Nasal cilia Feedback: Nasal hairs, mucus-producing goblet cells, cilia, the superficial blood supply of the upper respiratory tract, and the cough and sneeze reflexes all work to keep foreign substances from entering the lower respiratory tract. Surfactant and gas exchange in the alveoli are involved in the oxygenation process but are not involved in protecting the respiratory tract.

The nurse is caring for a patient with pneumonia. The nurse would expect to see which symptoms? (Select all that apply.) A) Difficulty breathing B) Urinary retention C) Rash D) Fever E) Oxygen saturation of 88%

A) Difficulty breathing D) Fever E) Oxygen saturation of 88% Feedback: Symptoms of patients with pneumonia include fever, difficulty breathing, fatigue, noisy breath sounds, and poor oxygenation. Urinary retention and rash are not usual symptoms of pneumonia.

The anatomy and physiology teacher is discussing ventilation with the nursing students. What would the instructor say causes an increased respiratory rate? A) Increased stimulation of the respiratory center B) Decreased stimulation of the respiratory center C) Increased O2 D) Decreased pH

A) Increased stimulation of the respiratory center Feedback: Respiration, or the act of breathing to allow gas exchange, is controlled by the central nervous system. The inspiratory musclesdiaphragm, external intercostal muscles, and abdominal musclesare stimulated to contract by the respiratory center in the medulla. The medulla receives input from chemoreceptors (neuroreceptors sensitive to carbon dioxide and acid levels) to increase the rate and/or depth of respiration to maintain homeostasis in the body.

The nursing instructor is discussing the oxygenation process and explains unoxygenated blood is received from the right ventricle by the alveoli. The delivery of this blood is referred to as what? A) Perfusion B) Oxygenation C) Expiration D) Inhalation

A) Perfusion Feedback: The lung tissue receives its blood supply from the bronchial artery, which branches directly off the aorta. The alveoli receive unoxygenated blood from the right ventricle via the pulmonary artery. The delivery of this blood to the alveoli is referred to as pulmonary perfusion. Oxygenation is the process where unoxygenated blood receives oxygen in the lungs. Expiration is the act of exhaling to rid the body of excess carbon dioxide. Inhalation is the act of inhaling or taking in air to replace oxygen from the air.

A nurse is caring for a patient with chronic bronchiectasis. The nurse should assess the patient for what clinical manifestations? A) Purulent cough B) Angina C) Pigeon chest D) Pulmonary hypertension

A) Purulent cough Feedback: Patients present with the signs and symptoms of acute infection, including fever, malaise, myalgia, arthralgia, and a purulent, productive cough. A patient with bronchiectasis would not present with pulmonary hypertension, chest deformity, or chest pain related to lack of oxygen to the heart.

The nurse is aware that patients with bronchiectasis often have an underlying medical condition that increases the chance for infection. What are some of these medical conditions? (Select all that apply.) A) Rheumatoid arthritis B) AIDS C) Diabetes mellitus D) Hydrocephalus E) Organ transplant patient

A) Rheumatoid arthritis B) AIDS E) Organ transplant patient Feedback: Patients with bronchiectasis often have an underlying medical condition that makes them more susceptible to infections. These underlying medical conditions include immune suppression, which would include patients who have had organ transplants and are receiving antirejection medication. Other conditions include acquired immune deficiency syndrome (AIDS) and chronic inflammatory conditions, such as rheumatoid arthritis. Diabetes mellitus and hydrocephalus do not fit into these categories.

The nurse teaches the patient that a common adverse effect of loperamide (Imodium) is what? A) Fatigue B) Flatulence C) Disorientation D) Tremors

Ans: A Feedback: Adverse effects associated with antidiarrheal drugs, such as constipation, distention, abdominal discomfort, nausea, vomiting, dry mouth, and even toxic megacolon, are related to their effects on the gastrointestinal (GI) tract. Other adverse effects that have been reported include fatigue (option A), weakness, dizziness, and rash. options B, C, and D are not correct.

The nurse administers ranitidine (Zantac) cautiously to patients with evidence of what conditions? A) Renal disease B) Diabetes mellitus C) Pulmonary disease D) Migraine headaches

Ans: A Feedback: All histamine-2 antagonists are eliminated through the kidneys; dosages need to be reduced in patients with renal impairment. No caution is necessary with Zantac therapy in people with diabetes, pulmonary disease, or migraine headaches.

A man with irritable bowel syndrome reports ongoing diarrhea and asks for a prescription for alosetron (Lotronex), which was helpful for his coworker who recently started taking the drug. What is the nurses best response? A) This drug is only approved for use in women. B) This drug is used as a laxative. C) This drug is contraindicated with irritable bowel syndrome. D) This drug is no longer on the market for prescription use.

Ans: A Feedback: Alosetron (Lotronex) is approved for use in women with irritable bowel syndrome with diarrhea being the predominant complaint and should be discontinued immediately if the patient develops constipation or symptoms of ischemic colitis. Patients must read and sign a patientphysician agreement before it can be prescribed. Options B, C, and D are not correct.

What drug does the nurse recognize as being classified as a chemical stimulant? A) Bisacodyl (Dulcolax) B) Polycarbophil (FiberCon) C) Magnesium hydroxide (Milk of Magnesia) D) Docusate (Colace)

Ans: A Feedback: Bisacodyl is a chemical stimulant. Polycarbophil and magnesium hydroxide are bulk laxatives. Docusate is a lubricant laxative.

The nurse, teaching a patient to be discharged with an order to use chemical stimulant laxatives PRN, instructs the patient that one of the most common adverse effects of this type of laxative is what? A) Abdominal cramping B) Rectal bleeding C) Confusion D) Iron deficiency anemia

Ans: A Feedback: Common adverse effects of laxatives are diarrhea, abdominal cramping, and nausea. Central nervous system (CNS) adverse effects such as dizziness, headache, and weakness can occur. Rectal bleeding, confusion, and iron deficiency anemia are not associated with appropriate use of laxatives but may occur when laxatives are abused.

The nurse questions an order for a proton pump inhibitor when the patient is known to take what other medication? A) Theophylline B) Penicillin C) Digoxin D) Heparin

Ans: A Feedback: Decreased levels of ketoconazole and theophylline have been reported when combined with these drugs, leading to loss of effectiveness. There are no drugdrug interactions with penicillin, digoxin, or heparin.

The patient had surgery 2 days ago and bowel motility has not returned. What drug might the nurse administer to stimulate the gastrointestinal (GI) tract? A) Dexpanthenol B) Docusate C) Psyllium (Metamucil) D) Senna

Ans: A Feedback: Dexpanthenol is indicated for the prevention of intestinal atony or loss of intestinal muscle tone in postoperative adults. Docusate, psyllium, and senna are laxatives that would not be indicated for the postoperative patient with no bowel activity.

The nurse collects a stool culture from a patient diagnosed with travelers diarrhea. What bacterium does the nurse expect the culture to grow? A) Escherichia coli B) Staphylococcus aureus C) Streptococcus type B D) Pseudomonas

Ans: A Feedback: Escherichia coli is the most common cause of travelers diarrhea. Staphylococcus, Streptococcus, and Pseudomonas would be highly unlikely to grow in the stool of a patient with travelers diarrhea.

A patient presents at the walk-in clinic complaining of stomach pain that is relieved by eating which the nurse suspects is caused by a peptic ulcer. How would the nurse explain the ulceration in the stomach to the patient? A) A mucosal lining protects the stomach from hydrochloric acid and a reduction in the mucosal lining or increase in acid production allows peptic ulcers to develop. B) After digesting food, the stomach secretes a neutralizing solution to make the pH of the stomach neutral and if this doesnt occur peptic ulcers can develop. C) Our body makes hydrochloric acid for the digestion of the food we eat and that can eat right through the stomach causing ulceration when you eat a diet high in spicy food. D) Acid is secreted by cells in the first part of the small intestine and when we eat the acid flows into the stomach so people who eat often have more exposure to acid.

Ans: A Feedback: Gastrin and the parasympathetic system stimulate histamine-2 receptors near the parietal cells, causing the cells to release hydrochloric acid into the lumen of the stomach. Other digestive enzymes are released appropriately, in response to proteins and carbohydrates, to begin digestion. Peptic ulcers can develop when there is a decrease in the protective mucosal layer or an increase in acid production. Research indicates that people who eat a spicy diet everyday are less prone to stomach ulceration; the stomach does not neutralize the hydrochloric acid but the highly alkaline duodenum neutralizes the pH when chyme arrives from the stomach. Acid does not flow from the small intestine to the stomach.

The nurse administers metoclopramide to the patient with what condition? A) Chronic diabetic gastroparesis B) Impaction C) Encopresis D) Patients requiring diagnostic procedures

Ans: A Feedback: Indications for metoclopramide include relief of acute and chronic diabetic gastroparesis, short-term treatment of gastroesophageal reflux disorder in adults who cannot tolerate standard therapy, prevention of postoperative or chemotherapy-induced nausea and vomiting, facilitation of small-bowel intubation, stimulation of gastric emptying, and promotion of intestinal transit of barium. It would not be used for treatment of impaction, encopresis, and in patients requiring diagnostic procedures.

The nurse administers lubiprostone (Amitiza) to the patient with irritable bowel syndrome and anticipates what therapeutic action from the drug? A) Secretion of chloride-rich intestinal fluid leading to increased motility B) Adding bulk to the fecal matter to ease the process of stooling C) Irritation of the inner lining of the bowel to increase bowel motility D) Stimulate the bowel by increasing innervation

Ans: A Feedback: Lubiprostone is a locally acting chloride channel activator that increases the secretion of a chloride-rich intestinal fluid without changing sodium or potassium levels. Increasing the intestinal fluid leads to increased motility. It does not add bulk, irritate the inner lining, or innervate the bowel.

The hospice nurse is caring for a patient diagnosed with bone cancer who is receiving large doses of opioid medications to relieve pain. The patient has used other laxatives in the past to treat opioid-induced constipation but nothing is working now. What drug would the nurse request the family doctor to order for this patient? A) Methylnaltrexone (Relistor) B) Castor oil C) Paregoric D) Mineral oil

Ans: A Feedback: Methylnaltrexone (Relistor) was approved in 2008 for the treatment of opioid-induced constipation in patients with advanced disease who are receiving palliative care and are no longer responsive to traditional laxatives. Castor oil, mineral oil, and paregoric would likely be ineffective in this patient.

The nurse is caring for a 27-year-old female patient who has just been prescribed misoprostol. What is a priority teaching point for this patient? A) You will need to use a barrier-type contraceptive B) Do not take NSAIDs with this drug C) Adverse effects include nausea and diarrhea D) It protects the lining of the stomach

Ans: A Feedback: Misoprostol is contraindicated during pregnancy because it is an abortifacient. Women of childbearing age who use misoprostol should be advised to use barrier-type contraceptives. All other options are correct but are not a priority for this patient.

The family brings a patient to the emergency department saying he has been hallucinating and falls so deeply asleep he stops breathing when not stimulated. The nurse learns the patient has been self-treating diarrhea and suspects the patient was taking what medication? A) Paregoric B) Bismuth subsalicylate C) Loperamide D) Colace

Ans: A Feedback: Opium derivatives, like paregoric, are associated with light-headedness, sedation, euphoria, hallucinations, and respiratory depression related to their effect on opioid receptors. Nonopioids such as bismuth subsalicylate and loperamide would not cause respiratory depression. Colace is a stool softener, not an antidiarrheal.

A patient presents to the walk-in clinic complaining of vomiting and burning in his or her mid-epigastria. The nurse suspects peptic ulcer disease and knows that to confirm peptic ulcer disease, the physician is likely to order a diagnostic test to detect the possible presence of what? A) Infection with Helicobacter pylori B) Decreased stomach acid secretion C) Gastric irritation caused by nonsteroidal anti-inflammatory drugs (NSAIDs) D) Overconsumption of spicy foods

Ans: A Feedback: Peptic ulcers may result from increased acid production, decrease in the protective mucous lining of the stomach, infection with Helicobacter pylori bacteria, or a combination of these. Peptic ulcers do not result from decreased acid secretion or overconsumption of spicy foods. While gastric irritation can be caused by NSAIDs gastric irritation can result from many different causes so this would not be specifically assessed for unless the patient was found to use NSAIDs frequently, which is not indicated by the question.

What is the most basic type of movement that occurs in the esophagus? A)Peristalsis B) Mass movement C) Churning D) Segmentation

Ans: A Feedback: Peristalsis is the basic movement of the esophagus. The large intestine uses mass movement, the stomach uses churning, and the small intestine uses segmentation.

A patient comes to the clinic complaining of acid indigestion and tells the nurse he is tired of buying over-the-counter (OTC) antacids and wants a prescription drug to cure the problem. What would the nurse specifically assess for? A) Alkalosis B) Hypocalcemia C) Hypercholesterolemia D) Rebound tenderness at McBurneys point

Ans: A Feedback: Prolonged or excessive use of OTC antacids can lead to the development of metabolic alkalosis. Many antacids contain calcium so that low calcium levels would be unlikely. Because metabolic alkalosis is a concern, metabolic acidosis is unlikely. High cholesterol levels are not associated with OTC antacid use. Rebound tenderness at McBurneys point is related to appendicitis and not antacid use.

The nurse admits a patient who reports having taken a proton pump inhibitor for more than a decade. What assessment question will the nurse ask this patient? A) Are you experiencing diarrhea? B) Do you experience much abdominal pain? C) Have you noticed any blood in your urine? D) When is the last time you checked your blood pressure?

Ans: A Feedback: Research indicates that patients taking proton pump inhibitors or histamine-2 antagonists demonstrate a significant increase in cases of Clostridium difficile infections leading to diarrhea so the nurse should assess this patient for diarrhea. There would be no indications to ask about abdominal pain, blood in the urine, or blood pressure.

The nurse expects to find that the major activities of the GI tract decrease in a patient experiencing what? A) A stress reaction B) A medication regimen including cholinergic drugs C) A local irritation of the small intestine D) Thoughts of food

Ans: A Feedback: Stimulation of the sympathetic nervous system will decrease all activity in the GI tract, and stress is a trigger for stimulating the sympathetic nervous system. Parasympathetic stimulation caused by cholinergic drugs, local irritation of the intestine, and the thought of food will all increase GI activity.

The nurse administers loperamide (Imodium) to decrease the number and liquidity of stool by what mechanism? A) Decreasing intestinal motility B) Absorbing toxins C) Binding with fecal material to increase bulk D) Blocking the chemoreceptor trigger zone (CTZ)

Ans: A Feedback: Systemic antidiarrheal agents slow the motility of the gastrointestinal (GI) tract through direct action on the lining of the GI tract to inhibit local reflexes (bismuth subsalicylate), through direct action on the muscles of the GI tract to slow activity (loperamide), or through action on central nervous system (CNS) centers that cause GI spasm and slowing (opium derivatives). Options B, C, and D are not correct.

The 59-year-old patient has peptic ulcer disease and is started on sucralfate (Carafate). What is an appropriate nursing diagnosis related to this medication? A) Risk for constipation related to GI effects B) Risk for injury: bleeding C) Imbalanced nutrition related to nausea D) Deficient fluid volume

Ans: A Feedback: The adverse effects associated with sucralfate are primarily related to its GI effects. Constipation is the most frequently seen adverse effect. Imbalanced nutrition, if seen, would be related to diarrhea or constipation and not nausea. Fluid volume deficit and bleeding are not common adverse effects of this drug.

The patient prescribed nizatidine (Axid) chooses to take the medication once a day at bedtime. What dosage will the nurse administer? A) 150 to 300 mg B) 100 to 125 mg C) 20 to 40 mg D) 5 to 7.5 mg

Ans: A Feedback: The dosage for nizatidine, when taken PO only at bedtime, is 150 to 300 mg. Options B, C, and D are not correct.

When the nurse administers a medication that stimulates the parasympathetic nervous system the drug will have what impact on the GI system? A) Decrease sphincter tone B) Decrease muscle tone C) Decrease contractions D) Decrease secretions

Ans: A Feedback: The effect of the parasympathetic nervous system is that of rest and digest. It stimulates the GI tract causing increased muscle tone, secretions and contractions, and decreased sphincter tone allowing for easy movement.

After providing teaching to a patient prescribed lansoprazole (Prevacid), the nurse evaluates the patient understands the action of this medication when the patient makes what statement? A) The medication inhibits acid secretions. B) The medication is an antibiotic. C) The medication is an analgesic. D) The medication will promote healing of my ulcer.

Ans: A Feedback: The gastric acid pump or proton pump inhibitors suppress gastric acid secretion by specifically inhibiting the hydrogenpotassium adenosine triphosphatase (H+,K+-ATPase) enzyme system on the secretory surface of the gastric parietal cells. The statement, The medication inhibits acid secretions, indicates that the patient understands that the medication inhibits acid secretion. This medication does not act as an antibiotic or analgesic, nor will it repair the ulcer.

What actions are required by the patient to protect the lungs when vomiting? A) Closing of the glottis B) Deep respirations C) Production of extra saliva in the mouth D) Reduction in acid production in the stomach

Ans: A Feedback: The glottis must close and seal off the trachea in order to prevent entry of stomach contents into the lungs. The patient normally takes a deep breath just before the glottis closes but should not breath during emesis. Production of extra saliva and reduction in stomach acid do not protect the lungs.

The nurse is caring for a patient who has developed severe constipation. What rationale does the nurse have for why the patient has also lost his or her appetite? A) Ileogastric reflex B) Intestinalintestinal reflex C) Peritoneointestinal reflex D) Renointestinal reflex

Ans: A Feedback: The introduction of chyme or stretch to the large intestine slows stomach activity, known as the ileogastric reflex which explains why patients who are constipated have no appetite. The intestinalintestinal reflex is triggered by irritation of a section of the small intestine causing cessation of activity above that section. Peritoneointestinal reflex results from irritation of the peritoneum while renointestinal reflex results from irritation or swelling of the renal capsule.

What does the liver produce that is important in the digestive process? A) Bile B) Glucagon C) Ammonia D) Bilirubin

Ans: A Feedback: The liver produces bile, which is stored in the gallbladder. The bile is very important in the digestion of fats and is deposited into the small intestine when the gallbladder is stimulated to contract by the presence of fats. Glucagon is a hormone secreted in response to the presence of food in the bowel. Ammonia is a byproduct of the breakdown of protein and bilirubin is metabolized by the liver and stored to produce more red blood cells.

The nurse collects a nursing history from a patient who says she keeps so busy she often ignores the need to defecate. The nurse explains the danger of this behavior is what? A) External sphincter will require more distention to stimulate reflex B) Incontinence of stool due to loss of sphincter control C) Diarrhea D) Malabsorption of nutrients from the colon

Ans: A Feedback: The receptors in the external sphincter adapt relatively quickly and will stretch and require more and more distention to stimulate the reflex if the reflex is ignored. This will not lead to bowel incontinence and is more likely to result in constipation from prolonged water absorption than diarrhea. Nutrients are not absorbed from the colon. 23.

What symptoms would the nurse find to be consistent with a diagnosis of a peptic ulcer? A) Pain a few hours after eating B) Pain described as sharp and stabbing C) Explosive diarrhea within 1 hour of eating D) Unable to stand comfortably due to abdominal pain

Ans: A Feedback: Ulcer patients present with a predictable description of gnawing, burning pain often occurring a few hours after meals. The pain is not described as sharp and stabbing. Diarrhea is not usually associated with peptic ulcer disease and patients do not find it difficult to stand upright.

What does the nurse anticipate will happen first when the chemoreceptor trigger zone (CTZ) is stimulated? A) Salivation increases B) Gastric acid production decreases C) Sweating increases D) Heart rate increases

Ans: A Feedback: When the CTZ is stimulated, salivation is stimulated first, which leads to a decrease in gastric acid production and then an increase in sweating and heart rate.

The nurse recognizes the potential for stimulation of the patients CTZ in what circumstances? (Select all that apply.) A) Stimulation of the back of the throat when examining the oral cavity B) Excessive stomach distention C) Increased intracranial pressure D) Stimulation of stretch receptors in the large bowel E) When the patient sits up abruptly

Ans: A, B, C Feedback: Tactile stimulation of the back of the throat, excessive stomach distention, increased intracranial pressure, stimulation of vestibular receptors in the inner ear, and stimulation of stretch receptors in the uterus and bladder are types of stimuli that can activate the CTZ. Stimulating stretch receptors in the large bowel and sitting up abruptly are not activators of the CTZ.

What would the nurse consider an indication for the use of antacids? (Select all that apply.) A) Gastric hyperacidity B) Gastritis C) Peptic esophagitis D) Hiatal hernia E) Duodenal ulcer

Ans: A, B, C, D Feedback: Antacids neutralize stomach acid by direct chemical reaction. They are recommended for the symptomatic relief of upset stomach associated with hyperacidity, as well as the hyperacidity associated with peptic ulcer, gastritis, peptic esophagitis, gastric hyperacidity, and hiatal hernia. Duodenal ulcer is not an indication for the use of an antacid.

What organs are considered accessory digestive organs because they add in the digestive process? (Select all that apply.) A) The liver B) The pancreas C) The spleen D) The gallbladder E) The appendix

Ans: A, B, D Feedback: The pancreas, liver, and gallbladder are accessory organs that support the functions of the GI system. The spleen is not involved in digestion and the appendix is a part of the bowel, not an accessory organ.

What nursing interventions are included in the plan of care for a patient receiving antacids to relieve GI discomfort? A) Administer this drug with other drugs or food. B) Administer the antacid 1 hour before or 2 hours after other oral medications. C) Limit fluid intake to decrease dilution of the medication in the stomach. D) Have the patient swallow the antacid whole and do not crush or chew the tablet.

Ans: B Feedback: A patient taking antacids should be advised to take the antacid 1 hour before or 2 hours after other oral medications. These tablets are often chewed to increase effectiveness. Limiting fluid intake can result in rebound fluid retention so that patients should be encouraged to maintain hydration. It is not necessary to take an antacid with other drugs, nor with food.

What drug does the nurse administer that inhibits intestinal peristalsis through direct effects on the longitudinal and circular muscles of the intestinal wall? A) Bismuth subsalicylate B) Loperamide C) Paregoric D) Magnesium citrate

Ans: B Feedback: Actions of loperamide include that it inhibits intestinal peristalsis through direct effects on the longitudinal and circular muscles of the intestinal wall, slowing motility and movement of water and electrolytes. Bismuth subsalicylate inhibits local reflexes. Paregoric works through action on CNS centers that cause GI spasm and slowing. Magnesium citrate is a laxative.

A patient taking a chemical stimulant laxative and medications for heart failure and osteoarthritis calls the clinic and reports to the nurse that she is not feeling right. What is the priority question the nurse should ask this patient? A) Effectiveness of laxatives B) Timing of medication administration C) The amount of fiber in her diet D) Amount of fluid ingested

Ans: B Feedback: Because laxatives increase the motility of the gastrointestinal (GI) tract and some laxatives interfere with the timing or process of absorption, it is not advisable to take laxatives with other prescribed medications. The administration of laxatives and other medications should be separated by at least 30 minutes, so the nurse should question when the patient is taking the laxatives and other medication. Other options may be questions the nurse would eventually ask, but the priority is timing of medication administration.

Which substance is required for digestion and absorption of fats and fat-soluble vitamins? A) Hydrochloric acid B) Bile C) Pancreatic enzymes D) Gastric juice

Ans: B Feedback: Bile is an alkaline secretion that is formed continuously in the liver, carried to the gallbladder by the bile ducts, and stored there. Bile salts are required for digestion and absorption of fats, including fat-soluble vitamins. Hydrochloric acid is produced in the stomach and begins the process of digestion. Pancreatic enzymes include chymotrypsin and trypsin that break down proteins, lipases to break down fat, and amylases to break down sugars. Gastric juice includes hydrochloric acid.

The nurse, providing patient teaching, explains that difenoxin and diphenoxylate are chemically related to what medication? A) Morphine B) Demerol C) Diphenhydramine D) Diflucan

Ans: B Feedback: Difenoxin and diphenoxylate are chemically related to meperidine and are used at doses that decrease gastrointestinal activity without having analgesic or respiratory effects.

What is the stimulus for the Duodenalcolic reflex? A) Cephalic stimulation B) Presence of food C) Over extension of stomach D) Swallowing

Ans: B Feedback: Duodenalcolic reflex is stimulated by the presence of food or stretching in the duodenum that stimulates colon activity and mass movement, again to empty the colon for the new chyme.

What histamine-2 antagonist might the nurse administer to a child? A) Cimetidine B) Famotidine C) Nizatidine D) Ranitidine

Ans: B Feedback: Famotidine is the only histamine2 antagonist approved for use in children if a histamine-2 antagonist is needed. Therefore, other options are not correct.

For treatment of a gastric ulcer, what would the recommended dosing schedule of famotidine (Pepcid) be? A) 10 mg b.i.d B) 20 mg b.i.d C) 60 mg at bedtime D) 40 mg q am

Ans: B Feedback: Famotidine should be administered 40 mg every day at bedtime or 20 mg b.i.d for treatment of a gastric ulcer. Options A, C, and D are not correct.

What is the priority nursing diagnosis for an 89-year-old patient with frequent liquid stools? A) Imbalanced nutrition: less than body requirements B) Deficient fluid volume C) Deficient knowledge related to medications D) Pain related to abdominal cramping

Ans: B Feedback: Fluid volume deficits may develop rapidly in older adults with diarrhea. Older adults are more likely to develop adverse effects associated with the use of these drugs, including sedation, confusion, dizziness, electrolyte disturbances, fluid imbalance, and cardiovascular effects. Although nutrition, pain, and knowledge deficit may be concerns for this patient, they are not the priority concern.

The patient will receive ranitidine (Zantac) 150 mg PO at bedtime. Prior to administration, the nurse will inform the patient that common adverse effects related to this medication include what? A) Tremors B) Headache C) Visual disturbances D) Anxiety

Ans: B Feedback: Headache, dizziness, somnolence, and mental confusion may occur with H2 antagonists. Visual disturbances, tremors, and anxiety are not normally associated with ranitidine.

A clinic patient with a history of heart failure requires a laxative for treatment of chronic constipation. What medication would be most appropriate for this patient? A) Senna (Senokot) B) Lactulose (Chronulac) C) Magnesium sulfate (Milk of Magnesia) D) Castor oil (Neoloid)

Ans: B Feedback: Lactulose is often the drug of choice when a patient with cardiovascular problems requires a laxative. It is salt free, an important consideration in patients with heart failure; it acts by exerting a gentle osmotic pull of fluid into the intestinal lumen. Senna, magnesium sulfate, and castor oil are more aggressive laxatives and might not be the best choice for a patient with cardiovascular problems.

The nurse develops a teaching plan for a 77-year-old patient who has been prescribed loperamide PRN. The nurses priority teaching point is what? A) May cause hallucinations or respiratory depression B) Take drug after each loose stool C) Drug remains in the bowel without being absorbed into the bloodstream D) Avoid pregnancy and breast-feeding while taking drug.

Ans: B Feedback: Loperamide is taken repeatedly after each loose stool. Teaching the patient when to take the drug is the priority teaching point. Paregoric, and not loperamide, can cause hallucinations and respiratory depression. The drug is absorbed systemically. It is unlikely a 77-year-old patient will get pregnant or breast-feed so this is not the highest priority.

What is the antidiarrheal of choice the nurse will administer to children older than 2 years of age with diarrhea? A) Bismuth salts (Pepto-Bismol) B) Loperamide (Imodium) C) Paregoric (generic) D) Difenoxin (Motofen)

Ans: B Feedback: Loperamide may be the antidiarrheal of choice in children older than 2 years of age if such a drug is needed. Special precautions need to be taken to monitor for electrolyte and fluid disturbances and supportive measures should be taken as needed. Serious fluid volume deficits may rapidly develop in children with diarrhea. Appropriate fluid replacement should include oral rehydration solutions. Although bismuth salts and paregoric may be given to children, they are not the drugs of choice. Difenoxin is not for use in children under 12 years of age.

A patient who is taking metoclopramide (Reglan) has come to the clinic for a follow-up visit. The nurse will be most concerned about a drug-drug interaction when learning the patient is taking what other medication? A) Albuterol (Proventil) B) Digoxin (Lanoxin) C) Furosemide (Lasix) D) Acetylsalicylic acid (ASA)

Ans: B Feedback: Metoclopramide has been associated with decreased absorption of digoxin from the gastrointestinal (GI) tract. The nurse should monitor patients taking this combination carefully. The other options do not pose a concern about drugdrug interactions.

The nurse is caring for a patient who does not produce adequate mucus in the stomach resulting in what problem? A) Diarrhea B) Ulceration C) Constipation D) Distention

Ans: B Feedback: Mucus functions to protect the lining of the digestive tract from digestive juices and protects the gastrointestinal mucosa from injury. Lack of mucous does not cause diarrhea, constipation, or distention.

What H2 antagonist would the nurse consider the drug of choice for a patient with advanced liver failure? A) Cimetidine B) Nizatidine C) Ranitidine D) Famotidine

Ans: B Feedback: Nizatidine differs from the other three drugs in that it is eliminated by the kidneys, with no first-pass metabolism in the liver. It is the drug of choice for patients with liver disease or dysfunction.

The nurse provides drug teaching to the patient who will begin taking polycarbophil (FiberCon). What is the nurses priority teaching point? A) Do not eat or drink anything for 2 hours after taking the medication. B) Drink lots of water when taking the drug. C) Take at night before bedtime. D) The drug can be taken up to six times per day.

Ans: B Feedback: Patients must take plenty of water with polycarbophil. If only a little water is consumed, the medication may absorb enough fluid in the esophagus to swell the food into a gelatin-like mass that can cause obstruction and other severe problems. The drug should be taken no more than four times a day and should not be taken at night.

The nurse will question an order for bismuth salts (Pepto-Bismol) in a patient with what condition? A) Rheumatoid arthritis B) Allergy to aspirin C) Hypertension D) Viral gastroenteritis

Ans: B Feedback: Pepto-Bismol has aspirin in it and should not be given to a patient with an allergy to aspirin. There is no contraindication for a patient with rheumatoid arthritis, hypertension, or viral gastroenteritis.

A nurse in a rehab facility recognizes the patient with damage to what area of the brain will affect the patients ability to swallow? A) Temporal lobe B) Medulla oblongata C) Cerebellum D) Pons

Ans: B Feedback: Swallowing is a voluntary act that is regulated by a swallowing center in the medulla oblongata of the central nervous system. Therefore, other options are incorrect.

The nurse teaches the patient to best maintain optimal GI function by including what in the daily routine? A) Exercise, adequate sleep, and avoiding caffeine B) Proper diet, fluid intake, and exercise C) Proper diet, avoiding alcohol, and cautious use of laxatives D) Avoiding prescription medications, increased fluid intake, and vigorous exercise

Ans: B Feedback: The best way to maintain gastrointestinal (GI) function is through proper diet including optimizing fiber intake, adequate fluid intake, and exercise, which will stimulate GI activity. Drugs should only be used when normal function cannot be maintained. Options A, C, and D are not correct.

What reflex causes an increase in small intestine activity when the stomach is stimulated by stretching, the presence of food, or cephalic stimulation? A) Duodenalcolic B) Gastroenteric C) Gastrocolic D) Ileogastric

Ans: B Feedback: The gastroenteric reflex is stimulation of the stomach, which causes an increase in activity in the small intestine. The duodenalcolic reflex stimulates colon activity and mass movement. The gastrocolic reflex is stimulation in the stomach, which increases activity in the colon. The ileogastric reflex is the introduction of chyme or stretch to the large intestine and slow stomach activity.

The nurse admits a woman to the clinic for an annual exam. The patient denies any health issues but reports frequent constipation despite increasing fiber and water intake in her diet. What assessment questions will the nurse ask? A) How many calories do you eat per day? B) Do you often wear Spanx or other tight constraining clothing? C) Do you often ignore the need to urinate and allow your bladder to fill? D) Have you been taking narcotics every day?

Ans: B Feedback: The nurse would assess the women to determine if tight constraining clothing such as Spanx are worn because taut stretching of skin and muscles over the abdomen irritates the nerve plexus and causes a slowing or cessation of GI activity to prevent further irritation. Calories per day would not contribute to constipation. It is unlikely the urge to void could be ignored long enough to cause constipation. Asking about the use of narcotics would only be appropriate if there are other manifestations that indicate the likelihood of this problem as constipation can be caused by many other things.

What is the purpose of the peritoneum A) Help propel the GI contents down the tract B) Help keep the GI tract in place and prevent friction with movement C)Decrease the muscle tone to slow the GI tract from moving too fast D) Serve as a supportive layer and helps the tube maintain its shape

Ans: B Feedback: The peritoneum lines the abdominal wall and viscera and helps keep the GI tract in place and prevents a buildup of friction with movement. The muscularis mucosa layer helps propel the GI contents downward. The nerve plexus helps to slow the GI tract when digestion is not a priority or stimulates it for digestion. The adventitia serves as a supportive layer and helps the tube maintain its shape.

The patient who experiences nausea produces less stomach acid. The nurse recognizes this as having what effect? A) Increases the feeling of nausea B) Protects the lining of the upper GI tract C) Stimulates the parasympathetic nervous system D) Directs fluid to mucus production in the small bowel

Ans: B Feedback: There is a large increase in the production of mucus in the upper GI tract, which is accompanied by a decrease in gastric acid production. This action protects the lining of the GI tract from potential damage by the acidic stomach contents when vomiting occurs. It does not increase the feeling of nausea, stimulate the parasympathetic nervous system, nor does it direct fluid to mucus production.

The nurse, caring for a patient with cystic fibrosis, administers pancreatic enzymes on what schedule? A) 1 hour after meals and snacks B) With meals and snacks C) 2 hours before meals and snacks D) In the morning and before bed

Ans: B Feedback: To be sure the pancreatic enzymes are in place when food enters the small bowel the enzymes are administered with every meal and snack. Administering them before or after meals would render them ineffective. 35.

The nurse is caring for a patient who has had impacted stools twice in the past month. What is an appropriate laxative for this patient? A) Milk of Magnesia B) Agoral Plain C) Colace D) Dulcolax

Ans: B Feedback: Mineral oil (Agoral Plain) is not absorbed and forms a slippery coat on the contents of the intestinal tract. When the intestinal bolus is coated with mineral oil, less water is drawn out of the bolus and the bolus is less likely to become hard or impacted. Other options shown do not have this same effect of reducing the risk of another impaction as well as helping to eliminate stool.

The nurse is caring for a patient admitted with a suspected malabsorption disorder as the result of pancreatic damage. What digestive enzymes does the pancreas secrete? (Select all that apply.) A) Pepsin B) Lipase C) Amylase D) Trypsin E) Ptyalin

Ans: B, C, D Feedback: Digestive enzymes secreted by the pancreas include trypsin, which aids in digesting protein; amylase, which aids in digesting starch; and lipase, which aids in digesting fats. Pepsin is secreted by the stomach and ptyalin is secreted in the saliva.

The nurse would assess patients with what condition to determine whether there is a need for a saliva substitute? (Select all that apply.) A) Cystic fibrosis B) Stroke C) Cancer receiving chemotherapy or radiation therapy D) Myocardial infarction E) Chronic dry mouth

Ans: B, C, E Feedback: A saliva substitute helps in conditions that result in dry mouthstroke, radiation therapy, chemotherapy, and other illnesses. Patients with myocardial infarction do not require this drug. Patients with cystic fibrosis receive pancreatic enzymes rather than saliva substitute.

A patient has been prescribed esomeprazole (Nexium). What statement by the patient does the nurse evaluate as indicating that he or she has a good understanding of his newly prescribed drug? A) I should open the capsules and crush the drug into applesauce. B) It is important that I take the drug after each meal. C) I need to swallow the drug whole and not chew the capsules. D) I should always take the drug with an antacid.

Ans: C Feedback: Esomeprazole must be swallowed whole, not cut, crushed, or chewed, which would interfere with its effectiveness. The drug should not be taken with an antacid, which could interfere with absorption. The drug is taken once a day, not with each meal.

The nurse is preparing a patient for discharge with a prescription for sucralfate (Carafate) and teaches the patient to take the medication when? A) With meals B) With an antacid before breakfast C) 1 hour before or 2 hours after meals and at bedtime D) After each meal

Ans: C Feedback: Administer drug on an empty stomach, 1 hour before or 2 hours after meals and at bedtime, to ensure therapeutic effectiveness of the drug. Administer antacids, if ordered, between doses of sucralfate and not within 30 minutes of taking the drug. Options A, B, and D are not correct.

The nurse assesses the postoperative patient who had abdominal surgery and finds a complete absence of bowel sounds caused by what reflex? A) Gastrocolic reflex B) Renointestinal reflex C) Intestinalintestinal reflex D) Somatointestinal reflex

Ans: C Feedback: After the intestinal irritation that occurs with handling the bowel during abdominal surgery, the risk of paralytic ileus is high because of the intestinalintestinal reflex. The gastrocolic reflex increases GI movement when food is in the stomach. The renointestinal reflex slows GI activity in response to renal capsule swelling. The somatointestinal reflex slows GI activity in response to tight stretching of skin across the abdominal wall.

When comparing the histamine-2 antagonists to each other the nurse recognizes that cimetidine (Tagamet) is more likely to cause which adverse effect? A) Dizziness B) Headache C) Gynecomastia D) Somnolence

Ans: C Feedback: Cimetidine was the first drug in this class to be developed. It has been associated with antiandrogenic effects, including gynecomastia and galactorrhea. Dizziness, headache, and somnolence are associated with all histamine-2 antagonists.

The home health nurse is caring for a 72-year-old man in his home. He complains about almost daily diarrhea. The nurse assesses for what common cause of diarrhea in older adults? A) Diabetes B) Hypertensive medications C) Laxative overuse D) Glaucoma

Ans: C Feedback: Diarrhea in older adults may result from laxative overuse so the nurse should assess what over-the-counter (OTC) products the patient is using. Diabetes, hypertension medications, and glaucoma are not common causes of diarrhea in patients.

A patient complains of frequent acid indigestion. The nurse instructs the patient to increase intake of what to reduce stimulation of acid production? A) Protein B) Calcium C) Fiber D) Alcohol

Ans: C Feedback: Fiber does not promote acid production so it would be a safe food for patients to eat to avoid stimulating more acid in the stomach. Acid production in the stomach is stimulated by gastrin which increases in the presence of protein, calcium, caffeine, or alcohol in the stomach.

The nurse is caring for a patient who is having difficulty swallowing tablets. What action will the nurse implement to help the patient swallow their medication? A) Turn the patients head to one side B) Place a warm cloth on the back of the patients neck C) Have the patient suck on a Popsicle D) Give the patient a copious amount of water to drink with the tablet

Ans: C Feedback: Have the patient suck on a Popsicle, which will block external nerve impulses and allow the basic reflex to respond. The patients head should be straight to allow the muscle pairs to work together. A cold cloth can be placed on the back of the neck or the sternum to stimulate the reflex, but a warm cloth is not indicated. Textured food, not liquids, can also help with swallowing a tablet.

A patient with a duodenal ulcer is receiving sucralfate for short-term treatment. What will the nurse advise the patient to avoid? A) Milk of Magnesia B) Tums C) Aluminum salts D) Proton pump inhibitors

Ans: C Feedback: If aluminum salts (AlternaGEL) are taken concurrently with sucralfate, a risk of high aluminum levels and related aluminum toxicity exists. The combination of sucralfate and aluminum salts should be avoided or used with extreme caution. Adverse reactions with sucralfate are not associated with Milk of magnesia, Tums, or proton pump inhibitors.

When would it be appropriate for the nurse to administer castor oil as a laxative? A) To ease the passage of stool in the patient who recently had a baby B) To remove ingested poisons from the lower gastrointestinal (GI) tract C) To evacuate the bowel for diagnostic procedures D) To treat chronic constipation

Ans: C Feedback: Indications include evacuating the bowel for diagnostic procedures and for short-term treatment of constipation. Castor oil is not indicated to remove ingested poisons nor to ease the passage of stool after having a baby. This drug should only be used on a short-term basis and is not for the treatment of chronic constipation because repeated use will cause GI tract exhaustion.

The home health nurse is caring for a patient with encopresis who was started on mineral oil therapy. The nurse teaches the patient and family that a common adverse effect is what? A) Nausea B) Vomiting C) Leakage D) Vitamin C deficiency

Ans: C Feedback: Leakage and staining may be a problem when mineral oil is used and the stool cannot be retained by the external sphincter. Mineral oil does not cause nausea, vomiting, or vitamin C deficiency.

The nurse is providing education for a patient with peptic ulcer disease resulting from chronic nonsteroidal anti-inflammatory drug (NSAID) use who will begin a prescription of misoprostol (Cytotec). The nurse evaluates that the patient understands the actions of this drug when he or she says it does what? A) Reduces the stomachs volume of hydrochloric acid B) Increases the speed of gastric emptying C) Protects the stomachs lining D) Increases lower esophageal sphincter pressure

Ans: C Feedback: Misoprostol is a synthetic prostaglandin that, like physiologic prostaglandin, protects the gastric mucosa. NSAIDs decrease prostaglandin production and predispose the patient to peptic ulceration. Misoprostol does not reduce gastric acidity (option A), improve emptying of the stomach (option B), or increase lower esophageal sphincter pressure (option D).

While bathing the noncommunicative patient, the nurse notices the patient is swallowing repeatedly. What should the nurse do in response? A) Offer the patient a drink B) Put the patient in a supine position C) Ready the emesis basin D) Continue the bath

Ans: C Feedback: Nauseated patients who start swallowing repeatedly or complain about secretions in their throat are in the process of preparing for vomiting. The nurse should reach for the emesis basin. Offering water will increase vomiting. Placing the patient in a supine position risks the danger of aspiration of stomach contents into the lungs. Continuing the bath does not prepare the nurse if the patient begins to vomit.

The nurse develops a discharge teaching plan for a patient who was prescribed pancreatic enzyme replacement and includes what important teaching point? A) Take the enzymes on an empty stomach. B) Crush the capsules and take with food. C) Avoid spilling the powder on the skin because it may be irritating. D) Pancreatin and pancrelipase are interchangeable.

Ans: C Feedback: Patients receiving pancreatic enzymes should be taught to avoid spilling the powder on the skin because it can be very irritating. The enzymes should be taken with food and are often in a powder form. Pancreatin and pancrelipase are not interchangeable.

A patient receiving loperamide (Imodium) should be alerted by the nurse to what possible adverse effect? A) Anxiety B) Bradycardia C) Fatigue D) Urinary retention

Ans: C Feedback: Patients should be aware that they should not drive or operate machinery while taking loperamide (Imodium) because it can cause fatigue. Anxiety, bradycardia, and urinary retention are not commonly associated with loperamide.

The nurse is caring for a patient with cystic fibrosis who has recently not been taking her pancreatic enzymes recently. What is the primary assessment finding the nurse will see as a result of this noncompliance? A) Constipation B) Diarrhea C) Malnutrition D) Abdominal pain

Ans: C Feedback: Patients with cystic fibrosis take pancreatic enzymes to promote digestion and absorption of nutrients so failure to take the drug would result in malnutrition and weight loss. Constipation, diarrhea, and abdominal pain would not be in the primary assessment finding.

What classification of drugs does the nurse administer to treat peptic ulcers by suppressing the secretion of hydrochloric acid into the lumen of the stomach? A) Antipeptic agents B) Histamine-2 antagonists C) Proton pump inhibitors D) Prostaglandins

Ans: C Feedback: Proton pump inhibitors suppress the secretion of hydrochloric acid into the lumen of the stomach. Antipeptic agents coat any injured area in the stomach to prevent further injury. H2 antagonists block the release of hydrochloric acid in response to gastrin. Prostaglandins inhibit secretion of gastrin and increase secretion of the mucous lining of the stomach.

The steps of the swallowing reflex are 1. Soft palate elevates. 2. Respirations cease. 3. Larynx rises and the glottis closes. 4. Pharyngeal constrictor muscles contract. In what order do these actions occur in order to allow a person to swallow? A) 2, 4, 1, 3 B) 4, 3, 2, 1 C) 1, 2, 3, 4 D) 3, 1, 4, 2

Ans: C Feedback: Receptors send impulses to the medulla, which stimulates a series of nerves that cause the following actions, which are the soft palate elevates and seals off the nasal cavity, respirations cease in order to protect the lungs, the larynx rises and the glottis closes to seal off the airway, and the pharyngeal constrictor muscles contract and force the food bolus into the top of the esophagus, where pairs of muscles contract in turn to move the bolus down the esophagus into the stomach.

What priority teaching point does the nurse include when instructing patients about the use of antacids? A) Reduce calorie intake to reduce acid production. B) Take before each meal and before bed. C) Be aware of risk of acid rebound with long-term use. D) Consider liquid diet if diarrhea occurs.

Ans: C Feedback: Repeated use of antacids can result in rebound acid production because more gastrin is produced when pH of acid level decreases. Patients should be taught that long-term use of antacids requires follow-up care. Calorie and fluid intake does not need to be reduced because it is important to maintain nutrition, especially if diarrhea occurs. Antacids are taken at least 1 hour before or 2 hours after any other drug or meal.

What should the nurse tell the patient who will begin taking rifaximin (Xifaxan) for travelers diarrhea? A) Do not start taking the drug until the diarrhea has persisted for at least 24 hours. B) Taking the antibiotic will allow you to enjoy the local water and food without concern. C) Do not take the drug if you have bloody diarrhea. D) Start the drug 3 days before leaving for your trip and continue until you return.

Ans: C Feedback: Rifaximin should not be taken if a patient has bloody diarrhea or diarrhea that persists for more than 48 hours. It is started after the signs and symptoms of the disease develop and is taken for 3 days. The traveler should still avoid exposure to foreign bacteria by not drinking tap water and by avoiding fruits and vegetables washed in tap water. Options A, B, and D are not correct.

What is a unique characteristic of the gastrointestinal (GI) system? A) It contains multiple organs that work together. B) It is lined with epithelial tissue. C) It is the only system open to the external environment. D) The GI tract is sterile and contains no bacteria.

Ans: C Feedback: The GI system is the only system that is open to the external environment. The definition of a system is multiple organs working together to perform a function or functions. Many systems are lined with epithelial tissue. The GI tract is not sterile and does contain bacteria.

The nurse is caring for a child diagnosed with cystic fibrosis whose body does not produce pancreatic enzymes appropriately which results in what? A) Secretion of insulin B) Maintenance of serum glucose levels C) Digestion of carbohydrates D) Regulation of glucose metabolism

Ans: C Feedback: The absence of the pancreatic enzymes results in inadequate digestion and absorption of carbohydrates, fats, and proteins. The pancreas also secretes insulin and glucagon, hormones that regulate glucose metabolism and regulate blood sugar levels but this is not related to enzymes but rather to hormone secretion.

The patient learns there are healthy bacteria in the bowel that aids in digestion and asks the nurse why bacterium doesnt get into the bloodstream. The nurse described what barrier to answer the patients question? A) The mononuclear phagocyte system B) The portal system C) The omenta D) The vomiting reflex

Ans: C Feedback: The greater and lesser omenta hang from the stomach over the lower GI tract and are full of lymph nodes, lymphocytes, monocytes, and other components of the mononuclear phagocyte system. This barrier provides rapid protection for the rest of the body if any of the bacteria or other foreign agents in the GI tract should be absorbed into the body. Other options do not serve as barriers.

What occurs when the emetic zone is stimulated? A) Regurgitation B) Nothing due to overriding by mature centers C) Projectile vomiting D) Gagging

Ans: C Feedback: The more primitive center is called the emetic zone. When stimulated, it initiates projectile vomiting. This type of intense reaction is seen in young children and whenever increased pressure in the brain or brain damage allows the more primitive center to override the more mature chemoreceptor trigger zone (CTZ). Regurgitation is vomiting. In adults the CTZ does not always override the emetic zone (patient with a severe head injury), and gagging is an adult precursor to vomiting.

The nurse is caring for a patient requiring digestive enzyme replacement therapy and establishes what appropriate nursing diagnosis for this patient? A) Acute pain B) Risk for constipation C) Risk for imbalanced nutrition D) Bowel incontinence

Ans: C Feedback: The nurse would be concerned about the patients nutritional status because lack of digestive enzymes results in malnutrition. Replacement digestive enzymes help the patient improve digestion and absorption of essential nutrients. Effectiveness of the therapy is determined by the patients ability to maintain balanced nutrition. The other three options are not applicable to the use of replacement digestive enzymes.

The nurse, caring for a patient about to undergo gastric bypass surgery, explains that the majority of nutrients are absorbed where? A) Sigmoid colon B) Stomach C) Small intestine D) Ascending colon

Ans: C Feedback: The stomach empties into the small intestine where absorption of nutrients occurs. Therefore, very little absorption occurs in the stomach, mostly limited to alcohol and water. The colon allows for water to be absorbed from the feces but does not absorb nutrients.

The clinic nurse is caring for a 78-year-old male patient who is taking a proton pump inhibitor. What condition is this patient at increased risk for developing? A) Sickle cell anemia B) Megaloblastic anemia C) Pernicious anemia D) Iron deficiency anemia

Ans: C Feedback: The use of proton pump inhibitors and H2 blockers in older adults has been associated with decreased absorption of vitamin B12 and the development of pernicious anemia. The use of proton pump inhibitors does not increase the risk of sickle cell, megaloblastic, or iron deficiency anemias.

When would it be appropriate for the nurse to administer a cathartic laxative to the patient? (Select all that apply.) A) Partial small-bowel obstruction B) Appendicitis C) After having a baby D) After a myocardial infarction (MI) E) After anthelmintic therapy

Ans: C, D, E Feedback: Laxative, or cathartic, drugs are indicated for the short-term relief of constipation; to prevent straining when it is clinically undesirable (such as after surgery, myocardial infarction, or obstetric delivery); to evacuate the bowel for diagnostic procedures; to remove ingested poisons from the lower gastrointestinal (GI) tract; and as an adjunct in anthelmintic therapy when it is desirable to flush helminths from the GI tract. They are not indicated when a patient has an appendicitis or a partial small-bowel obstruction.

An adult patient is prescribed cimetidine (Tagamet). A nurse will instruct the patient that an appropriate dosage and frequency of cimetidine is what? A) 20 mg PO b.i.d B) 150 mg PO b.i.d C) 300 mg PO at bedtime D) 800 mg PO at bedtime

Ans: D Feedback: An appropriate dosage and frequency for cimetidine is 800 mg PO at bedtime. Also, 300 mg can be taken q.i.d at meals and at bedtime. Ranitidine is taken 150 mg daily or b.i.d. Famotidine is taken 20 mg PO b.i.d. Nizatidine can be taken 150 to 300 mg PO at bedtime.

What drug combination will the nurse normally administer most often to treat a gastric ulcer? A) Antibiotics and histamine-2 antagonists B) H2 antagonists, antibiotics, and bicarbonate salts C) Bicarbonate salts, antibiotics, and ZES D) Antibiotics and proton pump inhibitors

Ans: D Feedback: Currently, the most commonly used therapy for gastric ulcers is a combination of antibiotics and proton pump inhibitors that suppress or eradicate Helicobacter pylori. H2 receptor antagonists are used to treat duodenal ulcers. Bicarbonate salts are not used. ZES is the abbreviation for ZollingerEllison syndrome and not a drug.

A new mother required an episiotomy during the birth of her baby. Two days after delivery, the patient is in need of a laxative. What will be the most effective drug for the nurse to administer? A) Bisacodyl (Dulcolax) B) Castor oil (Neolid) C) Magnesium sulfate (epsom salts) D) Docusate (Colace)

Ans: D Feedback: Docusate is a stool softener that will make expulsion of stool easier in a traumatized body area following an episiotomy. Care must be taken to choose a mild laxative that will not enter breast milk and not affect the newborn if the mother is nursing. Docusate is the drug of choice from this list because it is mild and will produce a soft stool and decrease the need to strain. The other options would not be appropriate because they do not soften the stool and are harsher laxatives that can enter breast milk.

When caring for a patient diagnosed with a peptic ulcer, the nurse administers omeprazole (Prilosec) along with what antibiotic to eradicate Helicobacter pylori? A) Gentamicin B) Ketoconazole C) Tetracycline D) Amoxicillin

Ans: D Feedback: Gastric acid pump or proton pump inhibitors are recommended for the short-term treatment of active duodenal ulcers, gastroesophageal reflux disease, erosive esophagitis, and benign active gastric ulcer; for the long-term treatment of pathologic hypersecretory conditions; as maintenance therapy for healing of erosive esophagitis and ulcers; and in combination with amoxicillin and clarithromycin for the treatment of H. pylori infection. The other options are not antibiotics used to eradicate H. pylori.

What action does the histamine-2 antagonist administered by the nurse have on the human body that will help to prevent peptic ulcer disease? A) Destroys Helicobacter pylori B) Coats and protects the stomach lining C) Increases the pH of the secreted hydrochloric acid D) Reduces the amount of hydrochloric acid secreted

Ans: D Feedback: Histamine-2 antagonists are administered to reduce the amount of hydrochloric acid secreted in the stomach, which helps to prevent peptic ulcer disease. H2 antagonists do not act as an antibiotic to kill bacteria (i.e., H. pylori) coat and protect the stomach lining like sucralfate (Carafate), or increase the pH of the secreted hydrochloric acid.

The nurse is caring for a young child who fell and hit his or her head and is brought to the emergency room with projectile vomiting. How does the nurse interpret this behavior? A) The child is in intense pain B) The child probably ate too much for dinner C) The child likely has a full bladder D) The child has increased intracranial pressure

Ans: D Feedback: Increased intracranial pressure applies direct pressure to the CTZ resulting in projectile vomiting. This child requires a thorough neurological assessment. Intense pain would be indicated by crying. A full bladder or eating too much for dinner would not cause projectile vomiting in a healthy child.

What antidiarrheal would the nurse administer to reduce the volume of discharge from the patients ileostomy? A) Diphenoxylate (Lomotil) B) Octreotide (Sandostatin) C) Psyllium (Metamucil) D) Loperamide (Imodium)

Ans: D Feedback: Loperamide (Imodium), bismuth subsalicylate (Pepto-Bismol), and opium derivatives (paregoric) are indicated for the reduction of volume of discharge from ileostomies. The other options would not serve this purpose.

For what action would the nurse administer magnesium citrate? A) Block absorption of fats B) Directly stimulate the nerve plexus in the intestinal wall C) Form a slippery coat on the contents of intestine D) Increase motility, increase fluid, and enlarge bulk of fecal matter

Ans: D Feedback: Magnesium citrate is a rapid-acting, aggressive laxative that causes fecal matter to increase in bulk. It increases the motility of the gastrointestinal (GI) tract by increasing the fluid in the intestinal contents, which enlarges bulk, stimulates local stretch receptors, and activates local activity. It does not block absorption of fats, stimulate the nerve plexus, or form a slippery coat.

The nurse administers psyllium hydrophilic mucilloid (Metamucil) expecting it to have what action? A) Slows peristalsis B) Promotes reabsorption of water into bowel C) Has antibacterial properties D) Adds bulk to the stool

Ans: D Feedback: Metamucil is a natural substance that forms a gelatin-like bulk of the intestinal contents. This agent stimulates local activity. It is considered milder and less irritating than many other bulk stimulants. Patients must use caution and take it with plenty of water because Metamucil absorbs large amounts of water and produces stools of gelatin-like consistency. It does not slow peristalsis, promote water reabsorption, or have antibacterial properties.

The nurse teaches the patient who was prescribed a chemical stimulant laxative that this medication may have either a slow, steady effect or may cause severe cramping and rapid evacuation of the contents of the large intestine. What drug is the nurse teaching this patient about? A) Bismuth salts B) Bisacodyl C) Castor oil D) Cascara

Ans: D Feedback: Specifically related to chemical stimulants, cascara, although a reliable agent, may have a either slow, steady action or may cause severe cramping and rapid evacuation of the contents of the large intestine. Bisacodyl and castor oil do not have potential adverse effect. Bismuth salts are an antidiarrheal.

Which of these patients would the nurse expect to be the best candidate for misoprostol (Cytotec)? A) A 12-year-old with obsessive-compulsive disorder B) A 22-year-old pregnant patient C) A 46-year-old trial lawyer with hypertension D) An 83-year-old man with rheumatoid arthritis

Ans: D Feedback: The 83-year-old man with rheumatoid arthritis is most likely to be taking nonsteroidal anti-inflammatory drugs (NSAIDs). Misoprostol is indicated for prevention of NSAID induced ulcers in adults at high risk for development of gastric ulcers. The other three patients would not be candidates for this drug.

Water is absorbed in which portion of the intestine? A) Duodenum B) Jejunum C) Ileum D) Colon

Ans: D Feedback: The colon absorbs water and sodium. The duodenum, ileum, and jejunum are parts of the small intestine where nutrients are absorbed.

What process is used by the large intestine to evacuate waste products from the body? A) Rectal stimulation B) Basic electrical rhythm C) Segmentation D) Mass movement

Ans: D Feedback: The large intestine uses a process of mass movement with an occasional peristaltic wave. When the beginning segment of the large intestine is stimulated, it contracts and sends a massive peristaltic movement throughout the entire large intestine. The end result of the mass movement is usually excretion of waste products. Segmentation occurs in the small intestine. The nerve plexus maintains a basic electrical rhythm (BER), much like the pacemaker rhythm in the heart. Rectal stimulation is not normally required for a bowel movement.

What is a layer of the nerve plexus? A) Mesenteric B) Mucosal C) Sympathetic D) Myenteric

Ans: D Feedback: The nerve plexus has two layers of nerves, one submucosal layer and one myenteric layer. The other options are not part of the nerve plexus.

Nutrients absorbed from the small intestine travel directly to the liver via what system? A) Mesenteric system B) Splenic system C) Arterial system D) Portal system

Ans: D Feedback: The portal system drains the entire lower GI tract, where absorption occurs, and delivers what is absorbed into the venous system directly to the liver. The other options are distractors for this question.

The nurse would question an order for misoprostol if the patient was diagnosed with what condition? A) Diabetes B) Hypertension C) Arthritis D) Pregnancy

Ans: D Feedback: This drug is contraindicated during pregnancy because it is an abortifacient. The other options are not correct.

17. The patient is a 34-year-old man who recently started taking theophylline. The nurse knows that medication teaching has been successful when he agrees to what activity? A) Avoiding caffeine B) Eating foods high in potassium C) Limiting fluid intake to 1,000 mL a day D) Taking the medicine on an empty stomach

Ans: A Feedback: Both theophylline and caffeine are xanthenes. Theophylline increases cardiac output and heart rate. Caffeine also stimulates heart rate. This can have an additive effect. Eating foods high in potassium, limiting fluid intake, or taking the medicine on an empty stomach are not indications that the patient has understood the nurse's teaching.

26. A patient is prescribed salmeterol with dosage on a 4 to 6 hour schedule for treatment of exercise-induced asthma. What is the recommended dosing schedule of asthma experts regarding this drug? A) 30 minutes before exercise to prevent dyspnea during exercise B) Every 15 minutes during exercise to prevent dyspnea C) As needed to treat or prevent dyspnea during exercise D) Every 1 to 2 hours to treat or prevent dyspnea during exercise

Ans: A Feedback: Salmeterol (Serevent) adult and pediatric (12-year-old and older): two puffs every 12 hours; or two puffs 30 to 60 minutes before exercise. Therefore, options B, C, and D are incorrect.

9. A patient with chronic bronchial asthma is prescribed montelukast (Singulair). What will the nurse instruct the patient to avoid taking? A) Aspirin B) Penicillin C) Sertraline (Zoloft) D) Nifedipine (Procardia)

Ans: A Feedback: The nurse would instruct the patient to avoid aspirin, which might cause an increased montelukast level and toxicity. The other options do not cause drug-drug interactions with montelukast.

28. Why are inhaled steroids used to treat asthma and chronic obstructive pulmonary disease (COPD)? A) They act locally to decrease release of inflammatory mediators. B) They act locally to improve mobilization of edema. C) They act locally to increase histamine release. D) They act locally to decrease histamine release.

Ans: A Feedback: When administered into the lungs by inhalation, steroids decrease the effectiveness of the inflammatory cells. This has two effects, which are decreased swelling associated with inflammation and promotion of beta-adrenergic receptor activity, which may promote smooth muscle relaxation and inhibit bronchoconstriction. Options B, C, and D are incorrect.

34. A patient with asthma is going to begin taking an inhaled steroid. The nurse teaching the patient that what adverse effects may occur when using this drug? (Select all that apply.) A) Headache B) Rebound congestion C) Sepsis D) Epistaxis E) Depression

Ans: A, B, D Feedback: Adverse effects associated with the use of inhaled steroids include irritability, not depression, headache, rebound congestion, local infection, not sepsis and epistaxis.

33. The nurse has just admitted a patient with asthma and the emergency department doctor has ordered the patient to begin taking zafirlukast (Accolate). The nurse would hold the medication and contact the physician if the patient reported taking which medication at home? (Select all that apply.) A) Propranolol B) Warfarin C) Acetaminophen D) Ampicillin E) Terfenadine

Ans: A, B, E Feedback: Use zafirlukast with caution if propranolol, theophylline, terfenadine, or warfarin is taken at the same time because increased toxicity can occur. Toxicity may also occur if these drugs are combined with calcium channel blockers, cyclosporine, or aspirin. No reported change of toxicity occurs when the patient is currently taking acetaminophen or ampicillin.

32. The nursing instructor is talking to a group of nursing students about the treatment regimen for children with asthma. The students indicate they understand the information when they identify which class of drugs that comprise this regimen? (Select all that apply.) A) Long-acting inhaled steroids B) Xanthines C) Leukotriene-receptor antagonists D) Topical steroid nasal decongestants E) Beta-agonists

Ans: A, C, E Feedback: Antiasthmatics are frequently used in children. The leukotriene-receptor antagonists have been found to be especially effective for long-term prophylaxis in children. Acute episodes are best treated with a beta-agonist and then a long-acting inhaled steroid or a mast cell stabilizer. Xanthines (e.g., theophylline) have been used in children, but because of their many adverse effects and the better control afforded by newer agents, its use is reserved for patients who do not respond to other therapies. Topical steroid nasal decongestants may be used for symptom relief for nasal congestion but are not a regular part of asthma therapy in children.

18. The nurse caring for a 38-year-old patient started on albuterol (Proventil) should advise the patient that he or she may experience what adverse effect? A) Polydipsia B) Tachycardia C) Hypotension D) Diarrhea

Ans: B Feedback: Adrenergic agents stimulate beta1-adrenergic receptors in the heart as well as beta2-adrenergic receptors in the lungs. Adrenergic agents do not cause polydipsia, hypotension, or diarrhea.

8. A 76-year-old man with asthma is being treated with an anticholinergic. What will the nurse be careful to assess for? A) Cardiac arrhythmias B) Prostatic hypertrophy C) Thyroid conditions D) Parkinsonism

Ans: B Feedback: Anticholinergics can produce urinary hesitancy and urinary retention, conditions that would aggravate the signs and symptoms of prostatic hypertrophy. Older patients given anti-cholinergics should be encouraged to empty the bladder before taking the drug. These drugs are used to treat parkinsonism. Thyroid conditions and cardiac arrhythmias are not cautions or contraindications to the use of these drugs.

29. The nurse is caring for a patient with chronic obstructive pulmonary disease. The plan of care will focus on what patient problem? A) Pain B) Obstructed airway C) Activity intolerance D) Adverse effects of medication therapy

Ans: B Feedback: Asthma, emphysema, chronic obstructive pulmonary disease (COPD), and respiratory distress syndrome (RDS) are pulmonary obstructive diseases. All but RDS involve obstruction of the major airways. RDS obstructs the alveoli. Pain, activity intolerance, and adverse effects of medication therapy are conditions identified to detect, manage, and minimize the unexpected outcomes the nurse should be especially aware of the potential for an obstructed airway in these patients.

19. The nursing instructor is discussing bronchodilators with a group of nursing students. The students understand the instruction when they identify what drug is most effective in treating acute bronchospasm? A) Ipratropium bromide (Atrovent) B) Epinephrine (Adrenalin) C) Cromolyn (Intal) D) Ephedrine

Ans: B Feedback: Epinephrine may be injected subcutaneously in an acute attack of bronchoconstriction, with therapeutic effects in 5 minutes that last 4 hours. It is considered the drug of choice for the treatment of acute bronchospasm. Ipratropium bromide has an onset of action of 15 minutes when inhaled with a duration of 3 to 4 hours. Cromolyn is not for use during acute times of bronchospasm but is used to help prevent bronchospasm. Ephedrine can be used in acute bronchospasm but epinephrine remains the drug of choice.

24. Epinephrine, formerly the drug of choice for acute attacks of bronchoconstriction, has been replaced by what? A) Short-acting bronchodilators are the drug of choice in this situation. B) Nothing has replaced epinephrine as drug of choice in this situation. C) Self-administered metered-dose inhalers (MDIs) D) Long-acting beta2-adrenergic agonists (LABAs)

Ans: B Feedback: Epinephrine, the prototype drug, is the drug of choice in adults and children for the treatment of acute bronchospasm, including that caused by anaphylaxis; it is also available for inhalation therapy. Because epinephrine is associated with systemic sympathomimetic effects, it is not the drug of choice for patients with cardiac conditions. Options A, C, and D are not correct.

14. What action by the patient would indicate that the patient understands how to use an inhaler? A) The patient inhales as soon as the inhaler enters his or her mouth. B) The patient holds his or her breath for several seconds after releasing the medication. C) The patient administers three doses of medication within a 1-minute time frame. D) The patient exhales as soon as he or she compresses the inhaler.

Ans: B Feedback: Holding the breath prevents exhalation of medication still remaining in the mouth. The patient should inhale when the canister is compressed, not as soon as the inhaler enters his or her mouth. The patient should only administer one dose of medication at a time and the patient should wait to exhale until after the breath has been held as long as possible.

21. The nurse has provided health teaching for a 15-year-old boy newly diagnosed with asthma. What statement, made by the patient, indicates that he has a good understanding of the teaching the nurse has done regarding inhalers? A) "I should hold my breath when administering a puff." B) "The aerosol canister should be shaken well before using." C) "I need to take three short quick breaths when I administer the inhaler." D) "A second aerosol medication cannot be administered until 30 minutes after the first aerosol medication."

Ans: B Feedback: Inhalers should be shaken well, immediately before each use. It would not be appropriate to teach the patient to hold his breath when administering a puff, to take three short quick puffs when administering the inhaler, or that a second aerosol medication should not be administered until 30 minutes after the first dose of aerosol medication.

11. The nurse has admitted a patient (who takes ipratropium) to the respiratory unit with an acute exacerbation of chronic obstructive pulmonary disease (COPD). While writing a plan of care for this patient, what would be the most appropriate nursing diagnosis to use? A) Deficient knowledge regarding alternative therapy B) Imbalanced nutrition: Less than body requirements C) Acute pain related to renal effects of the drug D) Disturbed thought processes related to central nervous system (CNS) effects

Ans: B Feedback: Nursing diagnoses related to drug therapy might include acute pain related to CNS, gastrointestinal (GI), or respiratory effects of the drug; imbalanced nutrition: Less than body requirements, related to dry mouth and GI upset; and deficient knowledge regarding drug therapy. Options A, C, and D are not correct.

25. A patient has an acute asthma attack. A bronchodilator is used to bring the exacerbation under control. What drug would be used to prevent acute bronchoconstriction? A) Salbutamol (Ventolin) B) Salmeterol (Serevent) C) Fenoterol (Berotec) D) Terbutaline (Bricanyl)

Ans: B Feedback: Salmeterol (Serevent) and formoterol (Foradil) and are long-acting beta2-adrenergic agonists used only for prophylaxis of acute bronchoconstriction. Options A, C, and D are all short-acting beta2-adrenergic agonists and not used for prophylaxis.

30. The clinic nurse is caring for a patient who has just been diagnosed with chronic obstructive pulmonary disease (COPD). The patient asks the nurse what COPD means. What would be the nurse's best response? A) "It is an umbrella term for diseases like acute bronchitis." B) "It means that the lungs have been damaged in such a way that there airflow is limited in and out of the lungs." C) "It means your lungs can't expand and contract like they are supposed to, which makes it hard for you to breathe." D) "It is a term that covers so many lung diseases I can't list them all."

Ans: B Feedback: The obstruction of asthma, emphysema, and COPD can be related to inflammation that results in narrowing of the interior of the airway and to muscular constriction that results in narrowing of the conducting tube. With chronic inflammation, muscular and cilial action is lost, and complications related to the loss of these protective processes can occur, such as infections, pneumonia, and movement of inhaled substances deep into the respiratory system. In severe COPD, air is trapped in the lower respiratory tract, the alveoli degenerate and fuse together, and the exchange of gases is greatly impaired. Options A, C, and D are not incorrect, but option B is the best response.

3. A patient is in the clinic to have blood drawn to assess his or her theophylline level. The patient is taking theophylline (Theo-Dur) and appears to being doing well on the drug. He or she reports no problems. What serum level will the nurse expect the patient to have? A) Between 0.5 to 5 mcg/mL B) Between 10 to 20 mcg/mL C) Between 25 to 35 mcg/mL D) Between 40 to 50 mcg/mL

Ans: B Feedback: Therapeutic theophylline levels should be between 10 and 20 mcg/mL. A level between 0.5 and 5 mcg/mL would be low and would not produce a therapeutic effect. Levels between 25 and 50 mcg/mL would be too high and could cause serious adverse effects.

31. The nurse is caring for a child who has been newly diagnosed with asthma. What environmental modifications should the nurse encourage the parents to make to help their child avoid future attacks? (Select all that apply.) A) Make sure the child begins herbal therapy as soon as possible. B) Avoid crowded areas as much as possible. C) Keep the child away from any known allergens. D) Encourage the child to use a broom to sweep the bedroom every day. E) Keep the child away from areas that are filled with cigarette smoke.

Ans: B, C, E Feedback: Parents need to be encouraged to take measures to prevent acute attacks, including avoidance of known allergens, smoke-filled rooms, and crowded or dusty areas. OTC drugs and herbal remedies should be avoided if possible. The child should not be sweeping the bedroom because this will produce a lot of dust.

35. The nursing instructor is discussing the use of sympathomimetics in patients who have acute bronchospasm. The instructor shares with the students that this classification of drugs is contraindicated or only used with great caution in patients with what disorders? (Select all that apply.) A) Hypothyroidism B) Cardiac disease C) Kidney disease D) Diabetes mellitus E) Peripheral vascular disease

Ans: B, D, E Feedback: Before administering a sympathomimetic the nurse should assess for possible contraindications or cautions that include any known allergies to any drug in this class, cigarette use, cardiac disease, vascular disease, arrhythmias, diabetes, and hyperthyroidism. Sympathomimetics have no known adverse effects in hypothyroidism or kidney disease.

10. A patient presents at the emergency department in acute respiratory distress. A quick assessment by the triage nurse indicates that the patient experienced difficulty breathing immediately after taking Combivent for the first time. The nurse suspects that the patient may be allergic to what? A) Aspirin B) Penicillin C) Peanuts D) Ragweed pollen

Ans: C Feedback: Combivent is a combination drug of ipratropium and albuterol. The propellant used to make ipratropium has a cross-sensitivity to the antigen that causes peanut allergies. Aspirin, penicillin, and ragweed pollen are not associated with this drug.

2. A 6-year-old child weighing 52 pounds has had a loading dose of aminophylline (Truphylline). The nurse is ready to administer the regular prescribed dose of 4 mg/kg every 4 hours for three doses. How many milligram will the patient receive in 12 hours? A) 44 mg B) 94 mg C) 284 mg D) 344 mg

Ans: C Feedback: First, using the formula: 2.2 pounds and 52 pounds: times kg, determine the child's weight in kg (52/2.2 = 23.64). Next, using the formula of amount of drug prescribed times weight in kg, determine the amount the child will receive in one dose (4 times 23.64 = 94.56). To determine the mg in a 12-hour period multiply 94.56 times 3 = 283.68. Round to 284 mg. Options A, B, and D are not correct.

7. A patient who has chronic bronchial asthma has had a mast cell stabilizer prescribed. What drug would the physician prescribe? A) Ipratropium or budesonide B) Isoetharine or montelukast C) Nedocromil or cromolyn D) Aminophylline or caffeine

Ans: C Feedback: Nedocromil and cromolyn are mast cell stabilizers used in the treatment of asthma. Aminophylline and caffeine are xanthines. Ipratropium is an anti-cholinergic drug and budesonide is a corticosteroid. Isoetharine is a sympathomimetic drug and montelukast is a leukotriene receptor antagonist.

22. The nurse is writing a plan of care for a patient newly admitted to the floor with an asthma attack that occurred while exercising. What would be the most appropriate intervention for this patient? A) Assist patients with moderate to severe asthma in obtaining a home nebulizer unit B) Try to prevent or reduce panic, which may initiate bronchospasm C) Teach patient to use an inhaler before exercising D) Monitor peak flow rates, especially in children

Ans: C Feedback: Teach patient who use one of these drugs for exercise-induced asthma to use it 30 to 60 minutes before exercising to ensure peak therapeutic effects when they are needed. The most important intervention would be to use a bronchodilator as prophylaxis for a patient with exercise-induced asthma. It would not be monitoring peak flow rates, trying to prevent or reduce panic, or assisting patient in obtaining a home nebulizer unit.

5. An inhaled sympathomimetic drug has been ordered for a teenage athlete who has exercise-induced asthma. What should the patient be instructed to do? A) Use the inhaler every day at the same time each day. B) Use the inhaler as soon as the symptoms start. C) Use the inhaler 30 to 60 minutes before exercising to ensure peak therapeutic levels when needed. D) Use the inhaler 2 to 3 hours before exercising to ensure peak effectiveness.

Ans: C Feedback: Teaching a patient about using an inhaled sympathomimetic for management of exercise-induced asthma should include instructions to use the inhaler 30 to 60 minutes before exercising to ensure therapeutic levels when needed. The inhaler would not be used daily and waiting until symptoms occur will be too late for prevention. Options B and D are not correct.

12. A patient, diagnosed with asthma, has been prescribed tiotropium (Spiriva). What should the nurse teach the patient about this drug? (Select all that apply.) A) It makes you fatigued. B) You need to stay out of direct sunlight. C) It is an anticholinergic. D) You only need to take it once a day. E) It has a rapid onset of action and a long duration.

Ans: C, D, E Feedback: Tiotropium is the first drug approved for once-daily maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD). Patients who cannot tolerate the sympathetic effects of the sympathomimetics might respond to the anticholinergic drugs ipratropium (Atrovent) or tiotropium. Tiotropium has a rapid onset of action and a long duration, with a half-life of 5 to 6 days. Tiotropium is not associated with fatigue or photosensitivity.

16. The nurse is caring for a patient who is taking an adrenergic bronchodilator. In what disease process should adrenergic bronchodilators be used cautiously? A) Liver failure B) Renal failure C) Respiratory failure D) Heart failure

Ans: D Feedback: Adrenergic drugs cause cardiac stimulation. Patients with liver failure, renal failure, or respiratory failure do not need to use adrenergic bronchodilators cautiously.

27. The pharmacology instructor is explaining the difference between bronchodilators and anti-inflammatory drugs. How does an anti-inflammatory drug reduce bronchoconstriction? A) Increases ability to metabolize medication B) Decreases formation of mucus secretions C) Increases reactivity to medication D) By decreasing airway hyperreactivity to various stimuli

Ans: D Feedback: Bronchodilators, or antiasthmatics, are medications used to facilitate respirations by dilating the airways. They are helpful in symptomatic relief or prevention of bronchial asthma and for bronchospasm associated with chronic obstructive pulmonary disease (COPD). Reducing inflammation prevents and reduces bronchoconstriction by decreasing airway hyperreactivity to various stimuli that decreases mucosal edema and formation of mucus secretions that narrow airways. Anti-inflammatory drugs do not increase the ability to metabolize medication or increases reactivity to medication.

15. A patient, newly diagnosed with chronic obstructive pulmonary disease (COPD), calls the clinic and asks the nurse to explain what the newly prescribed medications are for. What would be the most appropriate response by the nurse? A) "The medications that have been ordered for you are what the physician thinks will help you the most." B) "The medications that have been ordered for you are to help you breathe easier." C) "The medications that have been ordered for you are designed to work together to help you feel better." D) "The medications that have been ordered for you are to help relieve the inflammation and promote dilation of the bronchi."

Ans: D Feedback: Drug treatment of asthma and COPD aims to relieve inflammation and promote bronchial dilation. The other options do not give the patient information about the use of these new medications.

4. A patient presents to the emergency department (ED) having an acute asthma attack. An ED physician has ordered a sympathomimetic (epinephrine). The nurse expects what as the therapeutic effect of this drug? A) Decrease the inflammatory response in the airways B) Reduce the surface tension within the alveoli allowing for gas exchange C) Inhibit the release of histamine and slow-reacting substance of anaphylaxis (SRSA) to prevent the allergic asthmatic response D) Cause dilation of the bronchi with increased rate and depth of respiration

Ans: D Feedback: Epinephrine will cause the bronchi to dilate and also cause the rate and depth of respiration to increase. Inhaled steroids decrease the inflammatory response and lung surfactants reduce the surface tension within the alveoli. Mast cell stabilizers inhibit the release of histamine and SRSA to prevent the allergic response. Options A, B, and C are not correct.

6. A premature newborn is being treated for respiratory distress syndrome. The nurse teaches the parents about what adverse effect that can occur with the use of lung surfactants? A) Kidney dysfunction B) Cardiac arrhythmias C) High fever D) Collapsed lung

Ans: D Feedback: Lung surfactants used therapeutically can cause many adverse effects including pneumothorax (collapsed lung), hypotension, pulmonary leak, hyperbilirubinemia, and sepsis. Other adverse effects may occur in the infant related to the degree of immaturity of the child's system and may not be related to the drug therapy. Options A, B, and C are not correct.

13. The nurse is providing health teaching to a newly diagnosed asthmatic patient. The patient has been prescribed theophylline. What is contraindicated with the use of this drug? A) Using insulin B) Taking anti-inflammatory drugs C) Exercising D) Smoking cigarettes

Ans: D Feedback: Nicotine increases the metabolism of xanthines in the liver so that xanthine dosage must be increased in patients who continue to smoke while using xanthines. In addition, extreme caution must be used if the patient decides to decrease or discontinue smoking because severe xanthine toxicity can occur. Bronchoconstriction is not caused by using insulin and anti-inflammatory drugs do not cause bronchoconstriction. Exercise with a physician's supervision is encouraged in individuals with asthma.

1. A 70-year-old man is being treated for chronic obstructive pulmonary disease (COPD) with theophylline (Theo-Dur). What will be a priority assessment by the nurse? A) Ingestion of fatty foods B) Weight C) Activity level D) Use of nicotine

Ans: D Feedback: Nutritional status, weight, and activity level would be important for a nurse to know about a COPD patient. However, it would be most important for the nurse to know whether the patient smokes or uses tobacco in other ways or smoking cessation methods that involve nicotine. Nicotine increases the metabolism of theophyllines; the dosage may need to be increased to produce a therapeutic effect.

20. A patient with chronic obstructive pulmonary disease (COPD) presents at the emergency department in acute respiratory distress. The patient's family tells the nurse that the patient's problems began right after the patient took his or her first dose of ipratropium (Atrovent). What would the nurse suspect is the problem? A) An allergy to milk B) Overexertion by the patient C) Patient not taking the medications correctly D) An allergy to soy products

Ans: D Feedback: The use of ipratropium or tiotropium is contraindicated in the presence of known allergy to the drug or to soy products or peanuts (the vehicle used to make ipratropium an aerosol contains a protein associated with peanut allergies) to prevent hypersensitivity reactions. An allergy to milk is not associated with sensitivity to ipratropium. Overexertion would not cause the patient to develop respiratory distress after using ipratropium for the first time. Misuse of the inhaler would not cause respiratory distress.

23. A patient tells the nurse that a friend has recommended the use of caffeine to treat the patient's asthma. The nurse counsels the patient to begin treatment immediately with the prescribed medication for what reason? A) Caffeine can aggravate the drugs used to treat asthma. B) Most natural products are less toxic or more potent than traditional asthma medications. C) Natural products decrease the adverse effects associated with adrenergic bronchodilators. D) Delays in appropriate treatment can have serious, even fatal, consequences.

Ans: D Feedback: The xanthines, including caffeine and theophylline, come from a variety of naturally occurring sources. These drugs were formerly the main treatment choices for asthma and bronchospasm. However, because they have a relatively narrow margin of safety, and they interact with many other drugs, they are no longer considered the first-choice bronchodilators. Delays in appropriate treatment can have serious, even fatal, consequences. Natural products do not decrease the adverse effects associated with adrenergic bronchodilators. Natural products have not been proven to be less toxic or more potent than prescribed asthma medications. Caffeine does not aggravate drugs used to treat asthma, but it can have an additive effect.

The nurse in the clinic is caring for a patient who has seasonal rhinitis and the patient wants to know what causes this to occur. What is the nurse's best response? A) "You are experiencing symptoms because bacteria have entered the nose and caused an infection." B) "Your upper airways are experiencing an inflammatory response to an inhaled antigen that is causing you to have sneezing and watery eyes." C) "Your sympathetic nervous system is responding to an acute amount of stress in your life causing you to have nasal congestion." D) "Your runny nose and sneezing have occurred because a portion of your lung has collapsed."

B) "Your upper airways are experiencing an inflammatory response to an inhaled antigen that is causing you to have sneezing and watery eyes." Feedback: Seasonal rhinitis usually occurs when the upper airways become inflamed because of the bodys response to an inhaled antigen. The lungs do not collapse and the sympathetic systems response to stress usually opens the airways and does not cause inflammation. Bacteria entering the nose do not cause inflammation of the rest of the upper airways.

A nurse in the postanesthesia care unit is caring for a 77-year-old male patient after hip replacement surgery. While assessing the patient, the nurse notes crackles, dyspnea, cough, and changes in movement of the chest wall. The nurse would suspect the patient has developed what? A) Pneumonia B) Atelectasis C) Bronchitis D) Emphysema

B) Atelectasis Feedback: Patients may present with crackles, dyspnea, fever, cough, hypoxia, and changes in chest wall movement. Treatment may involve clearing the airways, delivering oxygen, and assisting ventilation. In the case of pneumothorax, treatment would also involve insertion of a chest tube to restore the negative pressure to the space between the pleura. These signs and symptoms are not the presentation of pneumonia, bronchitis, or emphysema.

The nursing instructor is discussing cystic fibrosis (CF) with his clinical group. What would the instructor cite as the hallmark pathology of CF? A) Alveolar mucous plugging, infection, and eventual bronchiectasis B) Bronchial mucous plugging, inflammation, and tissue damage C) Atelectasis, infection, and eventual chronic obstructive pulmonary disease (COPD) D) Bronchial mucous plugging, infection, and eventual chronic obstructive pulmonary disease (COPD)

B) Bronchial mucous plugging, inflammation, and tissue damage Feedback: CF results in the accumulation of copious amounts of very thick secretions in the lungs. Eventually, the secretions obstruct the airways, leading to destruction of the lung tissue. Mucous plugs occur in CF, but it is at the bronchial level, not the alveolar level. COPD is not an eventual outcome in this disease.

The nurse is developing the teaching portion of a care plan for a patient with asthma. What would be an important component for the nurse to emphasize? A) Smoking a half a pack of cigarettes weekly is allowable. B) Chronic inhalation of nonallergic inhaled irritants can trigger an attack. C) Minor respiratory infections are not treated. D) Activities of daily living (ADLs) should be completed in the waking hours.

B) Chronic inhalation of nonallergic inhaled irritants can trigger an attack. Feedback: Asthma is characterized by reversible bronchospasm, inflammation, and hyperactive airways. The hyperactivity is triggered by allergens or nonallergic inhaled irritants or by factors such as exercise and emotions. The trigger causes an immediate release of histamine, which results in bronchospasm in about 10 minutes. The later response (i.e., 3 to 5 hours) is cytokine-mediated inflammation, mucus production, and edema contributing to obstruction. Patients with asthma should not smoke at all and even minor respiratory infections should be treated to prevent an exacerbation of asthma and ADLs should be completed whenever the patient feels able.

A nurse is discussing ways the body protects itself against infection. What are the microscopic, hair-like projections of the cell membrane found in the nasal cavity, which transport foreign substances toward the throat where it can be swallowed and kept away from the respiratory system? A) Goblet cells B) Cilia C) Alveolar sacs D) Sinuses

B) Cilia Feedback: Cilia are found in the epithelial cells of the lining of the nasal cavity and are constantly in motion directing mucus and trapped substances down toward the throat. Goblet cells are found in the epithelial lining and produce mucus, which traps foreign substances. Alveolar sacs are located in the lower respiratory tract and are considered the functional units of the lung. Sinuses are air-filled passages through the skull, which open into the nasal cavity.

The nurse is admitting a patient with an obstructive respiratory disorder. The nurse knows this includes which disorders? (Select all that apply.) A) Atelectasis B) Cystic fibrosis C) Asthma D) Pneumonia E) Bronchiectasis

B) Cystic fibrosis C) Asthma Feedback: Obstructive disorders of the lower respiratory tract include asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis, and respiratory distress syndrome (RDS). Atelectasis is a collapse of once-expanded alveoli. Pneumonia is an infection of the lower respiratory tract. Bronchiectasis is a disorder of chronic infection and inflammation of the bronchial passages.

While discussing gas exchange, the instructor would tell the students that oxygen and carbon dioxide enter and leave the body by what method? A) Osmosis B) Diffusion C) Passive transport D) Active transport

B) Diffusion Feedback: The alveolar sac holds the gas, allowing needed oxygen to diffuse across the respiratory membrane into the the capillary, whereas carbon dioxide, which is more abundant in the capillary blood, diffuses across the membrane and enters the alveolar sac to be expired.

A patient is admitted with an asthma attack caused by an allergic reaction to a medication. The nurse is aware that this severe allergic response is triggered by the immediate release of what? A) Antihistamine B) Histamine C) Epinephrine D) Surfactant

B) Histamine Feedback: Asthma is characterized by reversible bronchospasm, inflammation, and hyperactive airways. The hyperactivity is triggered by allergens or nonallergic inhaled irritants or by factors such as exercise and emotions. The trigger causes an immediate release of histamine, which results in bronchospasm in about 10 minutes. An antihistamine is used to treat allergic responses because it counteracts the effects of histamine. Surfactant is a lubricating substance that is necessary to keep the alveoli open. Epinephrine is a medication used to treat acute allergic responses.

A nurse is caring for an 80-year-old patient with pneumonia. The most appropriate nursing diagnosis for this patient would be what? A) Dysfunctional ventilatory weaning response B) Impaired gas exchange C) Ineffective health maintenance D) Risk for delayed development

B) Impaired gas exchange Feedback: Pneumonia causes swelling, engorgement, and exudation of protective sera in the lower respiratory tract. The respiratory membrane is affected, resulting in decreased gas exchange. There is no indication that the patient has been on a ventilator so a diagnosis that concerns weaning is not appropriate. There is also no indication that this patient has pneumonia because of ineffective health maintenance and because the patient is 80 years old, a diagnosis of risk for delayed development is also inappropriate.

A patient is complaining of an inability to breathe nasally because of severe rhinitis. The nurse is aware that the nose plays what important role in breathing that is disrupted when the nasal passages are blocked? A) It decreases the number of pathogens inhaled. B) Inspired air is warmed and humidified. C) Carbon dioxide will not be inhaled. D) It simulates surfactant release from the alveoli.

B) Inspired air is warmed and humidified. Feedback: Air usually moves into the body through the nose and into the nasal cavity. The nasal hairs catch and filter foreign substances that may be present in the inhaled air. The air is warmed and humidified as it passes by blood vessels close to the surface of the epithelial lining in the nasal cavity. The epithelial lining contains goblet cells that produce mucus. This mucus traps dust, microorganisms, pollen, and any other foreign substances. The epithelial cells of the lining also contain ciliamicroscopic, hair-like projections of the cell membranewhich are constantly moving and directing the mucus and any trapped substances down toward the throat (Figure 53.2). The action of the goblet cells and cilia is commonly called the mucociliary escalator. It does not affect carbon dioxide or pathogen inhalation and does not stimulate surfactant release.

A 39-year-old teacher with bronchitis has been up all night with intense coughing spasms and asks the nurse "How is all this coughing related to my bronchitis?" The nurse tells the patient that a cough is initiated by what? A) Irritation to receptors in the nasal cavity B) Irritation to receptors in the bronchi C) Irritation to receptors in the pharynx D) Irritation to receptors in the sinus cavities

B) Irritation to receptors in the bronchi Feedback: Irritation to bronchial receptors will initiate a cough, which causes air to be pushed through the bronchial tree. Irritation to receptors in the nasal cavity, pharynx, and sinuses are more likely to initiate the sneeze reflex.

A student asks the pharmacy instructor where air exchange takes place in the human body. What would be the instructor's best response? A) "Air exchange in the human body takes place in the trachea." B) "Air exchange in the human body takes place in the bronchioles." C) "Air exchange in the human body takes place in the alveoli." D) "Air exchange in the human body takes place in the nares."

C) "Air exchange in the human body takes place in the alveoli." Feedback: Gas exchange occurs across the respiratory membrane in the alveolar sac. It does not occur in the bronchioles, the trachea, or the nares.

A patient arrives in the emergency room with an attack of acute bronchiectasis. The nurse knows that the principal pathologic finding in the diagnosis of bronchiectasis includes what? A) Increase in the red blood cell concentration in the blood B) Leakage of fluid into the alveolar interstitial spaces C) Chronic, irreversible dilation of the bronchi and bronchioles D) Obstruction of the pulmonary vasculature by a clot

C) Chronic, irreversible dilation of the bronchi and bronchioles Feedback: Bronchiectasis is a chronic disease that involves the bronchi and bronchioles. It is characterized by dilation of the bronchial tree, chronic infection, and inflammation of the bronchial passages. It is not caused by increased red blood cell concentration in the blood, leakage of fluid into the alveolar interstitial spaces, or the obstruction of the pulmonary vasculature by a clot.

A nurse is discussing cystic fibrosis (CF) with a couple who have just given birth to an infant with this disorder. The nurse explains that the respiratory component of this disease is caused by what? A) Bronchospasm B) Infection C) Excessive respiratory tract secretions D) Chemical irritation of the respiratory tract

C) Excessive respiratory tract secretions Feedback: CF is a hereditary disease involving the exocrine glands of the respiratory, gastrointestinal, and reproductive tracts. CF results in the accumulation of copious amounts of very thick secretions in the lungs. CF is not caused by bronchospasm or chemical irritation. Patients with cystic fibrosis develop many lung infections but that is secondary to the disease, not the underlying disease process itself.

The nursing instructor is discussing acute respiratory distress syndrome (ARDS) with her clinical group. What signs and symptoms would the instructor present to the students as characteristic of ARDS? A) Anoxia B) Hypocapnia C) Hypoxia D) Hypercapnia

C) Hypoxia Feedback: Acute respiratory distress syndrome (ARDS) is characterized by progressive loss of lung compliance and increasing hypoxia. Anoxia is a lack of oxygen to the body. ARDS will cause decreased oxygen (hypoxia). ARDS does not cause hypocapnia or hypercapnia, which is too little or too much carbon dioxide, respectively.

The nurse is teaching a class about common upper respiratory infections to parents of preschoolers. The parents correctly respond that which are examples of upper respiratory infections? (Select all that apply.) A) Bronchitis B) Asthma C) Pharyngitis D) Sinusitis E) Laryngitis

C) Pharyngitis D) Sinusitis E) Laryngitis Feedback: Upper respiratory infections include pharyngitis, sinusitis, and laryngitis. Asthma and bronchitis are examples of lower respiratory disorders.

A nurse is caring for a 45-year-old patient with acute respiratory distress syndrome (ARDS). The nurse is aware that this disease is characterized by what? A) Accumulation of copious amounts of very thick secretions in the lungs B) Loss of elastic tissue of the lungs and destruction of alveolar walls C) Progressive loss of lung compliance and increasing hypoxia D) Reversible bronchospasm, inflammation, and hyperactive airways

C) Progressive loss of lung compliance and increasing hypoxia Feedback: ARDS is characterized by progressive loss of lung compliance and increasing hypoxia and occurs as a result of a severe insult to the body. Accumulation of copious amounts of thick secretions in the lungs is associated with cystic fibrosis. Chronic obstructive pulmonary disease (COPD) is characterized by loss of the elastic tissue of the lung, destruction of alveolar walls, and hyperinflation with tendency to collapse with expiration. Reversible bronchospasm, inflammation, and hyperactive airways are characteristics of asthma.

The nursing instructor is discussing the need for lubrication of the alveoli for effective gas exchange and is produced by type II cells of the alveoli. The students know that what substance is produced by type II cells of the alveoli? A) Erythrocytes B) Lymphatic fluid C) Surfactant D) Pleural fluid

C) Surfactant Feedback: Type II cells produce surfactant. Erythrocytes are made in the bone marrow. Lymphatic fluid is produced by lymph glands; pleural fluid is secreted by cells in the pleural cavity.

A patient asks the nurse what causes a cold. The nurse would tell the patient that the common cold is most often caused by which type of microorganism? A) Gram-positive bacteria B) Gram-negative bacteria C) Virus D) Fungus

C) Virus Feedback: Various viruses cause the common cold. These viruses invade the tissues of the upper respiratory tract, initiating the release of histamine and prostaglandins and causing an inflammatory response. Bacteria and fungi can cause a respiratory infection but the disorder commonly known as a cold is caused by a virus.

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Chapter 56

The nurse admits to the clinic a 7-month-old infant whose mother reports that the baby has not had a bowel movement in 6 days. What drug would be appropriate to treat this patient? A) Cascara (generic) B) Magnesium hydroxide (Milk of Magnesia) C) Polyethylene glycol-electrolyte solution (GoLYTELY) D) Glycerin (Sani-Supp)

D Feedback: Glycerin suppositories are the best choice for infants and young children when constipation is a problem. The other choices are not recommended for infants or children.

The clinic nurse is caring for a patient who has just been diagnosed with chronic obstructive pulmonary disease (COPD). The patient asks the nurse what they could have done to minimize the risk of contracting this disease. What would be the nurse's best answer? A) "The most important risk factor for COPD is inadequate nutrition." B) "The most important risk factor for COPD is regular exercise." C) "The most important risk factor for COPD is exposure to dust and pollen." D) "The most important risk factor for COPD is cigarette smoking."

D) "The most important risk factor for COPD is cigarette smoking." Feedback: COPD is a permanent, chronic obstruction of airways, often related to cigarette smoking. Inadequate nutrition, regular exercise, and exposure to dust and pollen are not risk factors for COPD.

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chapter 55

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chapter 58