PHARM FINAL

Place the phases of the nursing process in the correct order, with 1 as the first phase and 5 as the last phase. (Select all that apply.) a. Planning b. Evaluation c. Assessment d. Implementation e. Nursing Diagnoses

(ADPIE)

2. The patient is asking the nurse about current U.S. laws and regulations of herbal products. According to the Dietary Supplement and Health Education Act of 1994, which statement is true? a. Medicinal herbs are viewed as dietary supplements. b. Herbal remedies are held to the same standards as drugs. c. Producers of herbal products must prove therapeutic efficacy. d. Herbal remedies are protected by patent laws.

ANS: A Current U.S. laws view herbal products as dietary supplements and do not hold them to the same efficacy standards as drugs. The other options do not correctly reflect current U.S. laws regarding herbal supplements. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

. The patient is experiencing chest pain and needs to take a sublingual form of nitroglycerin. Where does the nurse instruct the patient to place the tablet? a. Under the tongue b. On top of the tongue c. At the back of the throat d. In the space between the cheek and the gum

ANS: A Drugs administered via the sublingual route are placed under the tongue. Drugs administered via the buccal route are placed in the space between the cheek and the gum; oral drugs are swallowed. The other options are incorrect.

Which activity best reflects the implementation phase of the nursing process for the patient who is newly diagnosed with hypertension? a. Providing education on keeping a journal of blood pressure readings b. Setting goals and outcome criteria with the patient's input c. Recording a drug history regarding over-the-counter medications used at home d. Formulating nursing diagnoses regarding deficient knowledge related to the new treatment regimen

ANS: A Education is an intervention that occurs during the implementation phase. Setting goals and outcomes reflects the planning phase. Recording a drug history reflects the assessment phase. Formulating nursing diagnoses reflects analysis of data as part of planning.

1. The nurse is reviewing medication errors. Which situation is an example of a medication error? a. A patient refuses her morning medications. b. A patient receives a double dose of a medication because the nurse did not cut the pill in half. c. A patient develops hives after having started an IV antibiotic 24 hours earlier. d. A patient complains of severe pain still present 60 minutes after a pain medication was given.

ANS: B A medication error is defined as a preventable adverse drug event that involves inappropriate medication use by a patient or health care provider. The other options are not preventable. The patient's refusing to take medications and complaining of pain after a medication is given are patient behaviors, and the development of hives is a possible allergic reaction. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

3. During a nursing assessment, which question by the nurse allows for greater clarification and additional discussion with the patient? a. "Are you allergic to penicillin?" b. "What medications do you take?" c. "Have you had a reaction to this drug?" d. "Are you taking this medication with meals?"

ANS: B Asking "What medications do you take?" is an open-ended question that will encourage greater clarification and additional discussion with the patient. The other options are examples of closed ended questions, which prompt only a "yes" or "no" answer and provide limited information. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

4. When administering medication by IV bolus (push), the nurse will occlude the IV line by which method? a. Not pinching the IV tubing at all b. Pinching the tubing just above the injection port c. Pinching the tubing just below the injection port d. Pinching the tubing just above the drip chamber of the infusion set

ANS: B Before a medication is injected by IV push, the IV line is occluded by pinching the tubing just above the injection port. The other locations are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. An 83-year-old woman has been given a thiazide diuretic to treat mild heart failure. She and her daughter should be told to watch for which problems? a. Constipation and anorexia b. Fatigue, leg cramps, and dehydration c. Daytime sedation and lethargy d. Edema, nausea, and blurred vision Chapter 03: Lifespan Considerations 17

ANS: B Electrolyte imbalance, leg cramps, fatigue, and dehydration are common complications when thiazide diuretics are given to elderly patients. The other options do not describe complications that occur when these drugs are given to the elderly.

4. During a period of time when the computerized medication order system was down, the prescriber wrote admission orders, and the nurse is transcribing them. The nurse is having difficulty transcribing one order because of the prescriber's handwriting. Which is the best action for the nurse to take at this time? a. Ask a colleague what the order says. b. Contact the prescriber to clarify the order. c. Wait until the prescriber makes rounds again to clarify the order. d. Ask the patient what medications he takes at home.

ANS: B If a prescriber writes an order that is illegible, the nurse should contact the prescriber for clarification. Asking a colleague is not useful because the colleague did not write the order. Waiting for the prescriber to return is incorrect because it would delay implementation of the order. Asking the patient about medications is incorrect because this question will not clarify the current order written by the prescriber. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

The nurse is reviewing pharmacology terms for a group of newly graduated nurses. Which sentence defines a drug's half-life? a. The time it takes for the drug to cause half of its therapeutic response b. The time it takes for one half of the original amount of a drug to reach the target cells c. The time it takes for one half of the original amount of a drug to be removed from the body d. The time it takes for one half of the original amount of a drug to be absorbed into the circulation

ANS: C A drug's half-life is the time it takes for one half of the original amount of a drug to be removed from the body. It is a measure of the rate at which drugs are removed from the body. The other options are incorrect definitions of half-life.

8. The nurse is administering drugs to neonates and will consider which factor may contribute the most to drug toxicity? a. The lungs are immature. b. The kidneys are small. c. The liver is not fully developed. d. Excretion of the drug occurs quickly.

ANS: C A neonate's liver is not fully developed and cannot detoxify many drugs. The other options are incorrect. The lungs and kidneys do not play major roles in drug metabolism. Renal excretion is slow, not fast, because of organ immaturity, but this is not the factor that contributes the most to drug toxicity. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Planning MSC: NCLEX: Health Promotion and Maintenance

When given an intravenous medication, the patient says to the nurse, "I usually take pills. Why does this medication have to be given in the arm?" What is the nurse's best answer? a. "The medication will cause fewer adverse effects when given intravenously." b. "The intravenous medication will have delayed absorption into the body's tissues." c. "The action of the medication will begin sooner when given intravenously." d. "There is a lower chance of allergic reactions when drugs are given intravenously."

ANS: C An intravenous (IV) injection provides the fastest route of absorption. The IV route does not affect the number of adverse effects, nor does it cause delayed tissue absorption (it results in faster absorption). The IV route does not affect the number of allergic reactions

13. When giving a buccal medication to a patient, which action by the nurse is appropriate? a. Encouraging the patient to swallow, if necessary b. Administering water after the medication has been given c. Placing the medication between the upper or lower molar teeth and the cheek d. Placing the tablet under the patient's tongue and allowing it to dissolve completely

ANS: C Buccal medications are properly administered between the upper or lower molar teeth and the cheek. Caution the patient against swallowing, and do not administer with water. Medications given under the tongue are sublingually administered. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. The nurse is preparing to give an injection to a 4-year-old child. Which intervention is age appropriate for this child? a. Give the injection without any advanced preparation. b. Give the injection, and then explain the reason for the procedure afterward. c. Offer a brief, concrete explanation of the procedure at the patient's level and with the parent or caregiver present. d. Prepare the child in advance with details about the procedure without the parent or caregiver present.

ANS: C For a 4-year-old child, offering a brief, concrete explanation about a procedure just beforehand, with the parent or caregiver present, is appropriate. The other options are incorrect for any age group. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Psychosocial Integrity

5. When taking a telephone order for a medication, which action by the nurse is most appropriate? a. Verify the order with the charge nurse. b. Call back the prescriber to review the order. c. Repeat the order to the prescriber before hanging up the telephone. d. Ask the pharmacist to double-check the order.

ANS: C For telephone or verbal orders, repeat the order back to the prescriber before hanging up the telephone. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

6. The nurse needs to administer insulin subcutaneously to an obese patient. Which is the proper technique for this injection? a. Using the Z-track method b. Inserting the needle at a 5- to 15-degree angle until resistance is felt c. Pinching the skin at the injection site, and then inserting the needle to below the Chapter 09: Photo Atlas of Drug Administration 43 tissue fold at a 90-degree angle d. Spreading the skin tightly over the injection site, inserting the needle, and then releasing the skin

ANS: C The proper technique for a subcutaneous injection for an obese patient is to pinch the skin at the site and inject the needle to below the skin fold at a 90-degree angle. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

1. Which nursing diagnosis is appropriate for the patient who has just received a prescription for a new medication? a. Noncompliance related to new drug therapy b. Impaired memory related to new drug therapy c. Lack of knowledge regarding newly prescribed drug therapy d. Deficient knowledge related to newly prescribed drug therapy

ANS: D A patient who has a limited understanding of newly prescribed drug therapy may have the nursing diagnosis of deficient knowledge. Noncompliance is incorrect because that term implies that the patient does not follow a recommended regimen, which is not the case with a newly prescribed drug. Impaired memory is not appropriate in this situation. "Lack of knowledge" is not a nursing diagnosis. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Nursing Diagnosis MSC: NCLEX: Safe and Effective Care Environment: Management of Care

6. The nurse is assessing an elderly Hispanic woman who is being treated for hypertension. During the assessment, what is important for the nurse to remember about cultural aspects? a. The patient should be discouraged from using folk remedies and rituals. b. The nurse will expect the patient to value protective bracelets and "root workers" as healers. c. The nurse will remember that the balance among body, mind, and environment is important for this patient's health beliefs. d. The nurse's assessment needs to include gathering information regarding religious practices and beliefs regarding medication, treatment, and healing.

ANS: D All beliefs need to be considered clearly so as to prevent a conflict from arising between the goals of nursing and health care and the dictates of a patient's cultural background. Assessing religious practices and beliefs is part of a thorough cultural assessment. The other options are incorrect. The nurse should not ignore a patient's cultural practices. The concept of balance among body, mind, and environment and the valuing of protective bracelets and root workers reflect beliefs or practices that usually do not apply to the Hispanic cultural group. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Psychosocial Integrity

9. A 60-year-old patient is on several new medications and expresses worry that she will forget to take her pills. Which action by the nurse would be most helpful in this situation? a. Teaching effective coping strategies b. Asking the patient's prescriber to reduce the number of drugs prescribed c. Assuring the patient that she will not forget once she is accustomed to the routine d. Assisting the patient with obtaining and learning to use a calendar or pill container

ANS: D Calendars, pill containers, or diaries may be helpful to patients who may forget to take prescribed drugs as scheduled. The nurse must ensure that the patient knows how to use these reminder tools. Teaching coping strategies is a helpful suggestion but will not help with remembering to take medications. Asking the prescriber to reduce the number of drugs that are prescribed is not an appropriate action by the nurse. Assuring the patient that she will not forget is false reassurance by the nurse and inappropriate when education is needed. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

When administering a new medication to a patient, the nurse reads that it is highly protein bound. Assuming that the patient's albumin levels are normal, the nurse would expect which result, as compared to a medication that is not highly protein bound? a. Renal excretion will be faster. b. The drug will be metabolized quickly. c. The duration of action of the medication will be shorter. d. The duration of action of the medication will be longer.

ANS: D Chapter 02: Pharmacologic Principles 11 Drugs that are bound to plasma proteins are characterized by longer duration of action. Protein binding does not make renal excretion faster, does not speed up drug metabolism, and does not cause the duration of action to be shorter.

3. When given a scheduled morning medication, the patient states, "I haven't seen that pill before. Are you sure it's correct?" The nurse checks the medication administration record and verifies that it is listed. Which is the nurse's best response? a. "It's listed here on the medication sheet, so you should take it." b. "Go ahead and take it, and then I'll check with your doctor about it." c. "It wouldn't be listed here if it were not ordered for you!" d. "Let me check on the order first before you take it."

ANS: D Chapter 05: Medication Errors: Preventing and Responding 27 When giving medications, the nurse should always listen to and honor any concerns or doubts expressed by the patient. If the patient doubts an order, the nurse should check the written order and/or check with the prescriber. The other options illustrate that the nurse is not listening to the patient's concerns. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care

The patient is complaining of a headache and asks the nurse which over-the-counter medication form would work the fastest to help reduce the pain. Which medication form will the nurse suggest? a. A capsule b. A tablet c. An enteric-coated tablet d. A powder

ANS: D Of the types of oral medications listed, the powder form would be absorbed the fastest, thus having a faster onset. The tablet, the capsule, and, finally, the enteric-coated tablet would be absorbed next, in that order. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

The nurse is assessing a newly admitted 83-year-old patient and determines that the patient is experiencing polypharmacy. Which statement most accurately illustrates polypharmacy? a. The patient is experiencing multiple illnesses. b. The patient uses one medication for an illness several times per day. c. The patient uses over-the-counter drugs for an illness. d. The patient uses multiple medications simultaneously.

ANS: D Polypharmacy usually occurs when a patient has several illnesses and takes medications for each of them, possibly prescribed by different specialists who may be unaware of other treatments the patient is undergoing. The other options are incorrect. Polypharmacy addresses the medications taken, not just the illnesses. Polypharmacy means the patient is taking several different medications, not just one, and can include prescription drugs, over-the-counter medications, and herbal products. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. The nurse is monitoring a patient who is in the 26th week of pregnancy and has developed gestational diabetes and pneumonia. She is given medications that pose a possible fetal risk, but the potential benefits may warrant the use of the medications in her situation. The nurse recognizes that these medications are in which U.S. Food and Drug Administration pregnancy safety category? a. Category X b. Category B c. Category C d. Category D

ANS: D Pregnancy category D fits the description given. Category B indicates no risk to animal fetus; information for humans is not available. Category C indicates adverse effects reported in animal fetus; information for humans is not available. Category X consists of drugs that should not be used in pregnant women because of reports of fetal abnormalities and positive evidence of fetal risk in humans. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

The nurse recognizes that it is not uncommon for an elderly patient to experience a reduction in the stomach's ability to produce hydrochloric acid. This change may result in which effect? a. Delayed gastric emptying b. Increased gastric acidity c. Decreased intestinal absorption of medications d. Altered absorption of weakly acidic drugs

ANS: D Reduction in the stomach's ability to produce hydrochloric acid is an aging-related change that results in a decrease in gastric acidity and may alter the absorption of weakly acidic drugs. The other options are not results of reduced hydrochloric acid production. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Health Promotion and Maintenance

5. When the nurse teaches a skill such as self-injection of insulin to the patient, what is the best way to set up the teaching/learning session? a. Provide written pamphlets for instruction. b. Show a video, and allow the patient to practice as needed on his own. c. Verbally explain the procedure, and provide written handouts for reinforcement. d. After demonstrating the procedure, allow the patient to do several return demonstrations.

ANS: D Return demonstration allows the nurse to evaluate the patient's newly learned skills. The techniques in the other options are incorrect because those suggestions do not allow for evaluation of the patient's technique. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

11. The nurse is reviewing a list of scheduled drugs and notes that Schedule C-I drugs are not on the list. Which is a characteristic of Schedule C-I drugs? a. No refills are permitted. b. They may be obtained over-the-counter with a signature. c. They are available only by written prescription. d. They are used only with approved protocols.

ANS: D Schedule C-I drugs are used only with approved protocols. Schedule C-II drugs are available only by written prescription, and refills are not permitted. Being available over-the-counter with a signature may be true of Schedule C-V drugs in certain states.

19. When giving medications, the nurse will use Standard Precautions, which include what action? a. Bending the needle to prevent reuse b. Recapping needles to prevent needle sticks c. Discarding all syringes and needles in the trash can d. Discarding all syringes and needles in a puncture-resistant container

ANS: D Standard Precautions include wearing clean gloves when there is potential exposure to a patient's blood or other body fluids; never recapping needles; never bending needles or syringes; and discarding all disposable syringes and needles in the appropriate puncture-resistant container. DIF: COGNITIVE LEVEL: Remembering (Knowledge) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

3. The nurse is explaining the Human Genome Project to colleagues. Which of these is the main purpose of the Human Genome Project? a. The study of genetic diseases. b. The study of genetic traits in humans. c. The discovery new genetic diseases. d. To describe the entire genome of a human being.

ANS: D The Human Genome Project was undertaken to describe in detail the entire genome of a human being. The other options do not describe the Human Genome Project. Chapter 08: Gene Therapy and Pharmacogenomics 39 DIF: COGNITIVE LEVEL: Remembering (Knowledge) TOP: NURSING PROCESS: General MSC: NCLEX: Physiological Integrity: Physiological Adaptation

A patient is to receive a penicillin intramuscular (IM) injection in the ventrogluteal site. The nurse will use which angle for the needle insertion?

a. 15 degrees b. 45 degrees c. 60 degrees d. 90 degrees ANS: D The proper angle for IM injections is 90 degrees. The other angles are incorrect.

The patient is to receive oral guaifenesin (Mucinex) twice a day. Today, the nurse was busy and gave the medication 2 hours after the scheduled dose was due. What type of problem does this represent? a. "Right time" b. "Right dose" c. "Right route" d. "Right medication"

ANS: A "Right time" is correct because the medication was given more than 30 minutes after the scheduled dose was due. "Dose" is incorrect because the dose is not related to the time the medication administration is scheduled. "Route" is incorrect because the route is not affected. "Medication" is incorrect because the medication ordered will not change.

10. A patient is undergoing major surgery and asks the nurse about a living will. He states, "I don't want anybody else making decisions for me. And I don't want to prolong my life." The patient is demonstrating which ethical term? a. Autonomy b. Beneficence c. Justice d. Veracity

ANS: A Autonomy includes self-determination, or the ability to act on one's own, including making one's own decisions about health care. Veracity is defined as the duty to tell the truth. Justice is the ethical principle of being fair or equal in one's actions. Beneficence is the ethical principle of doing or actively promoting good. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: General MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

The nurse has been monitoring the patient's progress on a new drug regimen since the first dose and documenting the patient's therapeutic response to the medication. Which phase of the nursing process do these actions illustrate? a. Nursing diagnosis b. Planning c. Implementation d. Evaluation

ANS: D Monitoring the patient's progress, including the patient's response to the medication, is part of the evaluation phase. Planning, implementation, and nursing diagnosis are not illustrated by this example.

7. The nurse is teaching a patient how to self-administer triptan injections for migraine headaches. Which statement by the patient indicates that he needs further teaching? a. "I will take this medication regularly to prevent a migraine headache from occurring." b. "I will take this medication when I feel a migraine headache starting." c. "This medication does not reduce the number of migraines I will have." d. "I will keep a journal to record the headaches I have and how the injections are working."

ANS: A Although they may be taken during aura symptoms by patients who have auras with their headaches, these drugs are not indicated for preventive migraine therapy. The medication is intended to relieve the migraine and not to prevent it or to reduce the number of attacks. The triptans do not reduce the number of migraines a person will have. Journal recordings of headaches and the patient's responses to the medication are helpful. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. When an adrenergic drug stimulates beta1-adrenergic receptors, the result is an increased force of contraction, which is known as what type of effect? a. Positive inotropic b. Anti-adrenergic c. Negative dromotropic d. Positive chronotropic

ANS: A An increased force of contraction is known as a positive inotropic effect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

1. A patient who has received some traumatic news is panicking and asks for some medication to help settle down. The nurse anticipates giving which drug that is most appropriate for this situation? a. Diazepam (Valium) b. Zolpidem (Ambien) c. Phenobarbital d. Cyclobenzaprine (Flexeril)

ANS: A Benzodiazepines such as diazepam are used as anxiolytics, or sedatives. Zolpidem is used as a hypnotic for sleep. Phenobarbital is not used as an anxiolytic but is used for seizure control. Cyclobenzaprine is a muscle relaxant and is not used to reduce anxiety. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

1. The nurse reads in the patient's medication history that the patient is taking buspirone (BuSpar). The nurse interprets that the patient may have which disorder? a. Anxiety disorder b. Depression c. Schizophrenia d. Bipolar disorder

ANS: A Buspirone is indicated for the treatment of anxiety disorders, not depression, schizophrenia, or bipolar disorder. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. A patient taking entacapone (Comtan) for the first time calls the clinic to report a dark discoloration of his urine. After listening to the patient, the nurse realizes that what is happening in this situation? a. This is a harmless effect of the drug. b. The patient has taken this drug along with red wine or cheese. Chapter 15: Antiparkinson Drugs 79 c. The patient is having an allergic reaction to the drug. d. The ordered dose is too high for this patient.

ANS: A COMT inhibitors, including entacapone, may darken a patient's urine and sweat. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

1. A patient is receiving instructions regarding the use of caffeine. The nurse shares that caffeine should be used with caution if which of these conditions is present? a. A history of peptic ulcers b. Migraine headaches c. Asthma d. A history of kidney stones

ANS: A Caffeine should be used with caution by patients who have histories of peptic ulcers or cardiac dysrhythmias or who have recently had myocardial infarctions. The other conditions are not contraindications to the use of caffeine. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient who has advanced cancer is receiving opioid medications around the clock to keep him comfortable as he nears the end of his life. Which term best describes this type of therapy? a. Palliative therapy b. Maintenance therapy c. Empiric therapy d. Supplemental therapy

ANS: A Chapter 02: Pharmacologic Principles 12 The goal of palliative therapy is to make the patient as comfortable as possible. It is typically used in the end stages of illnesses when all attempts at curative therapy have failed. Maintenance therapy is used for the treatment of chronic illnesses such as hypertension. Empiric therapy is based on clinical probabilities and involves drug administration when a certain pathologic condition has an uncertain but high likelihood of occurrence based on the patient's initial presenting symptoms. Supplemental (or replacement therapy) supplies the body with a substance needed to maintain normal function.

6. A 22-year-old patient has been taking lithium for 1 year, and the most recent lithium level is 0.9 mEq/L. Which statement about the laboratory result is correct? a. The lithium level is therapeutic. b. The lithium level is too low. c. The lithium level is too high. d. Lithium is not usually monitored with blood levels.

ANS: A Chapter 16: Psychotherapeutic Drugs 83 Desirable long-term maintenance lithium levels range between 0.6 and 1.2 mEq/L. The other responses are incorrect. DIF: COGNITIVE LEVEL: Analyzing (Analysis) TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

21. When administering nasal spray, which instruction by the nurse is appropriate? a. "You will need to blow your nose before I give this medication." b. "You will need to blow your nose after I give this medication." c. "When I give this medication, you will need to hold your breath." d. "You need to sit up for 5 minutes after you receive the nasal spray."

ANS: A Clear the nasal passages before receiving nasal spray. Blowing one's nose after receiving the medication will remove the medication from the nasal passages. The patient will receive the spray while inhaling through the open nostril and needs to remain in a supine position for 5 minutes afterward. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. The nurse notes in the patient's medication history that the patient is taking cyclobenzaprine (Flexeril). Based on this finding, the nurse interprets that the patient has which disorder? a. A musculoskeletal injury b. Insomnia Chapter 12: Central Nervous System Depressants and Muscle Relaxants 64 c. Epilepsy d. Agitation

ANS: A Cyclobenzaprine (Flexeril) is the muscle relaxant most commonly used to reduce spasms following musculoskeletal injuries. It is not appropriate for insomnia, epilepsy, or agitation. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. A patient is experiencing status epilepticus. The nurse prepares to give which drug of choice for the treatment of this condition? a. Diazepam (Valium) b. Midazolam (Versed) c. Valproic acid (Depakote) d. Carbamazepine (Tegretol)

ANS: A Diazepam (Valium) is considered by many to be the drug of choice for status epilepticus. Other drugs that are used are listed in Table 14-3 and do not include the drugs listed in the other options. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

The nurse is administering parenteral drugs. Which statement is true regarding parenteral drugs? a. Parenteral drugs bypass the first-pass effect. b. Absorption of parenteral drugs is affected by reduced blood flow to the stomach. c. Absorption of parenteral drugs is faster when the stomach is empty. d. Parenteral drugs exert their effects while circulating in the bloodstream.

ANS: A Drugs given by the parenteral route bypass the first-pass effect. Reduced blood flow to the stomach and the presence of food in the stomach apply to enteral drugs (taken orally), not to parenteral drugs. Parenteral drugs must be absorbed into cells and tissues from the circulation before they can exert their effects; they do not exert their effects while circulating in the bloodstream.

12. A patient is taking gabapentin (Neurontin), and the nurse notes that there is no history of seizures on his medical record. What is the best possible rationale for this medication order? a. The medication is used for the treatment of neuropathic pain. b. The medication is helpful for the treatment of multiple sclerosis. c. The medication is used to reduce the symptoms of Parkinson's disease. d. The medical record is missing the correct information about the patient's history of seizures.

ANS: A Gabapentin (Neurontin) is commonly used to treat neuropathic pain. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. Phenytoin (Dilantin) has a narrow therapeutic index. The nurse recognizes that this characteristic indicates which of these? a. The safe and the toxic plasma levels of the drug are very close to each other. Chapter 14: Antiepileptic Drugs 73 b. The phenytoin has a low chance of being effective. c. There is no difference between safe and toxic plasma levels. d. A very small dosage can result in the desired therapeutic effect.

ANS: A Having a "narrow therapeutic index" means that there is a small difference between safe and toxic drug levels. These drugs require monitoring of therapeutic plasma levels. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. The nurse is administering an IV push medication through an IV lock. After injecting the medication, which action will be taken next? a. Flushing the lock b. Regulating the IV flow c. Clamping the tubing for 10 minutes Chapter 09: Photo Atlas of Drug Administration 44 d. Holding the patient's arm up to improve blood flow

ANS: A IV locks are to be flushed before and after each use; either heparin or saline flush is used, depending on the individual institution's policy. The other actions are not appropriate. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. The nurse is trying to give a liquid medication to a -year-old child and notes that the medication has a strong taste. Which technique is the best way for the nurse to give the medication to this child? a. Give the medication with a spoonful of ice cream. b. Add the medication to the child's bottle. c. Tell the child you have candy for him. d. Add the medication to a cup of milk.

ANS: A Ice cream or another nonessential food disguises the taste of the medication. The other options are incorrect. If the child does not drink the entire contents of the bottle, medication is wasted and the full dose is not administered. Using the word candy with drugs may lead to the child thinking that drugs are actually candy. If the medication is mixed with a cup of milk, the child may not drink the entire cup of milk, and the distasteful drug may cause the child to refuse milk in the future. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 03: Lifespan Considerations 18

7. The U.S. Food and Drug Administration has issued a warning for users of antiepileptic drugs. Based on this report, the nurse will monitor for which potential problems with this class of drugs? a. Increased risk of suicidal thoughts and behaviors b. Signs of bone marrow depression c. Indications of drug addiction and dependency d. Increased risk of cardiovascular events, such as strokes

ANS: A In December 2008, the U.S. Food and Drug Administration (FDA) required black box warnings on all antiepileptic drugs regarding the risk of suicidal thoughts and behaviors. Patients being treated with antiepileptic drugs for any indication need to be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. When a patient is taking an adrenergic drug, the nurse expects to observe which effect? a. Increased heart rate b. Bronchial constriction c. Constricted pupils d. Increased intestinal peristalsis

ANS: A Increased heart rate is one of the effects of adrenergic drugs. Sympathetic nervous system stimulation also results in bronchodilation, dilated pupils, and decreased gastrointestinal mobility, depending upon which receptors are stimulated. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. While the nurse is assisting a patient in taking his medications, the medication cup falls to the floor, spilling the tablets. What is the nurse's best action at this time? Chapter 09: Photo Atlas of Drug Administration 45 a. Discarding the medications and repeating preparation b. Asking the patient if he will take the medications c. Waiting until the next dose time, and then giving the medications d. Retrieving the medications and administering them to avoid waste

ANS: A Medications that fall to the floor must be discarded, and the procedure must be repeated with new medications. The other actions are not appropriate. DIF: COGNITIVE LEVEL: Analyzing (Analysis) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

6. For accurate medication administration to pediatric patients, the nurse must take into account which criteria? a. Organ maturity b. Renal output c. Body temperature Chapter 03: Lifespan Considerations 16 d. Height

ANS: A To administer medications to pediatric patients accurately, one must take into account organ maturity, body surface area, age, and weight. The other options are incorrect; renal output and body temperature are not considerations, and height alone is not sufficient

5. A patient is recovering from a minor automobile accident that occurred 1 week ago. He is taking cyclobenzaprine (Flexeril) for muscular pain and goes to physical therapy three times a week. Which nursing diagnosis would be appropriate for him? a. Risk for injury related to decreased sensorium b. Risk for addiction related to psychologic dependency c. Decreased fluid volume related to potential adverse effects d. Disturbed sleep pattern related to the drug's interference with REM sleep

ANS: A Musculoskeletal relaxants have a depressant effect on the CNS; thus, the patient needs to be taught the importance of taking measures to minimize self-injury and falls related to decreased sensorium. "Risk for addiction" is not a NANDA nursing diagnosis. The other nursing diagnoses are not appropriate for this situation. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Nursing Diagnosis MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

6. A patient is taking flurazepam (Dalmane) three to four nights a week for sleeplessness. She is concerned that she cannot get to sleep without taking the medication. What nonpharmacologic measures should the nurse suggest to promote sleep for this patient? Chapter 12: Central Nervous System Depressants and Muscle Relaxants 63 a. Providing a quiet environment b. Exercising before bedtime to become tired c. Consuming heavy meals in the evening to promote sleepiness d. Drinking hot tea or coffee just before bedtime

ANS: A Nonpharmacologic approaches to induce sleep include providing a quiet environment, avoiding heavy exercise before bedtime, avoiding heavy meals late in the evening, and drinking warm decaffeinated drinks, such as warm milk, before bedtime. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

2. A member of an investigational drug study team is working with healthy volunteers whose participation will help to determine the optimal dosage range and pharmacokinetics of the drug. The team member is participating in what type of study? a. Phase I b. Phase II c. Phase III d. Phase IV

ANS: A Phase I studies involve small numbers of healthy volunteers to determine optimal dosage range and the pharmacokinetics of the drug. The other phases progressively involve volunteers who have the disease or ailment that the drug is designed to diagnose or treat. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. The nurse is conducting a smoking-cessation program. Which statement regarding drugs used in cigarette-smoking-cessation programs is true? a. Rapid chewing of the nicotine gum releases an immediate dose of nicotine. b. Quick relief from withdrawal symptoms is most easily achieved by using a transdermal patch. c. Compliance with treatment is higher with use of the gum rather than the transdermal patch. d. The nicotine gum can be used only up to six times per day.

ANS: A Quick or acute relief from withdrawal symptoms is most easily achieved with the use of the gum because rapid chewing of the gum produces an immediate dose of nicotine. However, treatment compliance is higher with the use of the transdermal patch system. Nicotine gum can be used whenever the patient has a strong urge to smoke. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 17: Substance Use Disorder 91

7. When reviewing the various schedules of controlled drugs, the nurse knows that which description correctly describes Schedule II drugs? a. Drugs with high potential for abuse that have accepted medical use b. Drugs with high potential for abuse that do not have accepted medical use c. Medically accepted drugs that may cause moderate physical or psychologic dependence d. Medically accepted drugs with limited potential for causing physical or psychologic dependence

ANS: A Schedule II drugs are those with high potential for abuse but that have accepted medical use. Drugs that have high potential for abuse but do not have accepted medical use are Schedule I drugs. Medically accepted drugs that may cause moderate physical or psychologic dependence are Schedule III drugs. Medically accepted drugs with limited potential for causing physical or psychologic dependence are Schedule IV and V drugs. DIF: COGNITIVE LEVEL: Remembering (Knowledge) TOP: NURSING PROCESS: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. The nurse has given medication instructions to a patient receiving phenytoin (Dilantin). Which statement by the patient indicates that the patient has an adequate understanding of the instructions? a. "I will need to take extra care of my teeth and gums while on this medication." b. "I can go out for a beer while on this medication." c. "I can skip doses if the side effects bother me." d. "I will be able to stop taking this drug once the seizures stop."

ANS: A Scrupulous dental care is necessary to prevent gingival hypertrophy during therapy with phenytoin. Alcohol and other central nervous system depressants may cause severe sedation. Consistent dosing is important to maintain therapeutic drug levels. Therapy with AEDs usually must continue for life and must not be stopped once seizures stop. DIF: COGNITIVE LEVEL: Analyzing (Analysis) TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

7. The nurse will plan to use the Z-track method of intramuscular (IM) injections for which situation? a. The medication is known to be irritating to tissues. b. The patient is emaciated and has very little muscle mass. c. The medication must be absorbed quickly into the tissues. d. The patient is obese and has a deep fat layer below the muscle mass.

ANS: A The Z-track method is used for medications known to irritate tissues or for medications that are painful or cause stains to the tissues. It also prevents the deposit of medication into more sensitive subcutaneous tissues. The other options are not appropriate situations for the Z-track method. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

6. A patient with a new prescription for a diuretic has just reviewed with the nurse how to include more potassium in her diet. This reflects learning in which domain? a. Cognitive b. Affective c. Physical d. Psychomotor

ANS: A The cognitive domain refers to problem-solving abilities and may involve recall and knowledge of facts. The affective domain refers to values and beliefs. The term physical does not refer to one of the learning domains. The psychomotor domain involves behaviors such as learning how to perform a procedure. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

1. During the development of a new drug, which would be included in the study by the researcher to prevent any bias or unrealistic expectations of the new drug's usefulness? a. A placebo b. FDA approval c. Informed consent d. Safety information

ANS: A To prevent bias that may occur as a result of unrealistic expectations of an investigational new drug, a placebo is incorporated into the study. The other options are incorrect. FDA approval, if given, does not occur until after phase III. Informed consent is required in all drug studies. Safety information is not determined until the study is under way. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: General MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

The patient is receiving two different drugs. At current dosages and dosage forms, both drugs are absorbed into the circulation in identical amounts. Which term is used to identify this principle? a. Bioequivalent b. Synergistic c. Prodrugs d. Steady state

ANS: A Two drugs absorbed into the circulation in the same amount (in specific dosage forms) have the same bioavailability; thus, they are bioequivalent. A drug's steady state is the physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed from each dose. The term synergistic refers to two drugs, given together, with a resulting effect that is greater than the sum of the effects of each drug given alone. A prodrug is an inactive drug dosage form that is converted to an active metabolite by various biochemical reactions once it is inside the body

When giving medications, the nurse will follow the rights of medication administration. The rights include the right documentation, the right reason, the right response, and the patient's right to refuse. Which of these are additional rights? (Select all that apply.) a. Right drug b. Right route c. Right dose d. Right diagnosis e. Right time f. Right patient

ANS: A, B, C, E, F Additional rights of medication administration must always include the right drug, right dose, right time, right route, and right patient. The right diagnosis is incorrect.

2. The barbiturate phenobarbital is prescribed for a patient with epilepsy. While assessing the patient's current medications, the nurse recognizes that interactions may occur with which drugs? (Select all that apply.) a. Antihistamines b. Opioids c. Diuretics d. Anticoagulants e. Oral contraceptives f. Insulin

ANS: A, B, D, E The co-administration of barbiturates and alcohol, antihistamines, benzodiazepines, opioids, and tranquilizers may result in additive CNS depression. Co-administration of anticoagulants and barbiturates can result in decreased anticoagulation response and possible clot formation. Coadministration of barbiturates and oral contraceptives can result in accelerated metabolism of the contraceptive drug and possible unintended pregnancy. There are no interactions with diuretics and insulin. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

1. Which statements are true regarding pediatric patients and pharmacokinetics? (Select all that apply.) a. The levels of microsomal enzymes are decreased. b. Perfusion to the kidneys may be decreased and may result in reduced renal function. c. First-pass elimination is increased because of higher portal circulation. d. First-pass elimination is reduced because of the immaturity of the liver. e. Total body water content is much less than in adults. f. Gastric emptying is slowed because of slow or irregular peristalsis. g. Gastric emptying is more rapid because of increased peristaltic activity.

ANS: A, B, D, F In children, first-pass elimination by the liver is reduced because of the immaturity of the liver, and microsomal enzymes are decreased. In addition, gastric emptying is reduced because of slow or irregular peristalsis. Perfusion to the kidneys may be decreased, resulting in reduced renal function. The other options are incorrect. In addition, remember that total body water content is greater in children than in adults. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Health Promotion and Maintenance

MULTIPLE RESPONSE 1. When assessing the medication history of a patient with a new diagnosis of Parkinson's disease, which conditions are contraindications for the patient who will be taking carbidopa-levodopa? (Select all that apply.) a. Angle-closure glaucoma b. History of malignant melanoma c. Hypertension d. Benign prostatic hyperplasia Chapter 15: Antiparkinson Drugs 80 e. Concurrent use of monoamine oxidase inhibitors (MAOIs)

ANS: A, B, E Angle-closure glaucoma, a history of melanoma or other undiagnosed skin conditions, and concurrent use of MAOIs are contraindications to the use of carbidopa-levodopa. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Assessment

MULTIPLE RESPONSE 1. The nurse is preparing to administer dexmedetomidine (Precedex) to a patient. Which is an appropriate indication for dexmedetomidine? (Select all that apply.) a. Procedural sedation b. Surgeries of short duration c. Surgeries of long duration d. Postoperative anxiety e. Sedation of mechanically ventilated patients

ANS: A, B, E Dexmedetomidine (Precedex) is used for procedural sedation and for surgeries of short duration, and it is also used in the intensive care setting for sedation of mechanically ventilated patients. The other options are incorrect.

2. Which statements are true regarding the elderly and pharmacokinetics? (Select all that apply.) a. The levels of microsomal enzymes are decreased. b. Fat content is increased because of decreased lean body mass. c. Fat content is decreased because of increased lean body mass. d. The number of intact nephrons is increased. e. The number of intact nephrons is decreased. Chapter 03: Lifespan Considerations 19 f. Gastric pH is less acidic. g. Gastric pH is more acidic.

ANS: A, B, E, F In the elderly, levels of microsomal enzymes are decreased because the aging liver is less able to produce them; fat content is increased because of decreased lean body mass; the number of intact nephrons is decreased as the result of aging; and gastric pH is less acidic because of a gradual reduction of the production of hydrochloric acid. The other options are incorrect statements.

10. While a patient is receiving drug therapy for Parkinson's disease, the nurse monitors for dyskinesia, which is manifested by which finding? a. Rigid, tense muscles b. Difficulty in performing voluntary movements c. Limp extremities with weak muscle tone d. Confusion and altered mental status

ANS: B Dyskinesia is the difficulty in performing voluntary movements that is experienced by some patients with Parkinson's disease. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. The nurse is reviewing the criteria for over-the-counter drugs. Which criteria for over-the counter status in the United States are accurate? (Select all that apply.) a. The drug must be easy to use. b. The drug must have a low therapeutic index. c. The consumer must be able to monitor the drug's effectiveness. d. The drug must have a low potential for abuse. e. The drug must not have any interactions with other drugs.

ANS: A, C, D In the United States, criteria for over-the-counter status include the drug being easy to use, the drug having a low potential for abuse, and the consumer must be able to monitor the drug's effectiveness for the condition. The drug must have a high therapeutic index (not a low one), and the drug must have limited interactions with other drugs. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. The nurse is monitoring a patient who is experiencing severe ethanol withdrawal. Which are signs and symptoms of severe ethanol withdrawal? (Select all that apply.) a. Agitation b. Drowsiness c. Tremors d. Systolic blood pressure higher than 200 mm Hg e. Temperature over 100° F (37.7° C) f. Pulse rate 110 beats/min

ANS: A, C, D Signs and symptoms of severe ethanol withdrawal (delirium tremens) include systolic blood pressure higher than 200 mm Hg, diastolic blood pressure higher than 140 mm Hg, pulse rate higher than 140 beats/min, temperature above 101° F (38.3° C), tremors, insomnia, and agitation. See Box 17-6 for all signs and symptoms of ethanol withdrawal. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

1. Which are appropriate considerations when the nurse is assessing the learning needs of a patient? (Select all that apply.) a. Cultural background b. Family history c. Level of education d. Readiness to learn e. Health beliefs

ANS: A, C, D, E Family history is not a part of what the nurse considers when assessing learning needs. The other options are appropriate to consider when the nurse is assessing learning needs.

2. The nurse is performing an admission assessment. Which findings reflect components of a cultural assessment? (Select all that apply.) a. The patient uses aspirin as needed for pain. b. The patient has a history of hypertension. c. The patient uses herbal tea to relax in the evenings. d. The patient does not speak English. e. The patient is allergic to shellfish. f. The patient does not eat pork products for religious reasons.

ANS: A, C, D, F The past use of medicines, use of herbal treatments, languages spoken, and religious practices and beliefs are components of a cultural assessment. The other options reflect components of a general medication assessment or health history

1. The nurse is conducting a class for senior citizens about the use of over-the-counter (OTC) drugs. Which statements are true regarding the use of OTC drugs? (Select all that apply.) a. Use of OTC drugs may delay treatment of serious ailments. b. Drug interactions with OTC medications are rare. c. OTC drugs may relieve symptoms without addressing the cause of the problem. d. OTC drugs are indicated for long-term treatment of conditions. e. Patients may misunderstand product labels and use the drugs improperly.

ANS: A, C, E Chapter 07: Over-the-Counter Drugs and Herbal and Dietary Supplements 37 It is true that use of OTC drugs may delay treatment of serious ailments; OTC drugs may relieve symptoms without addressing the cause of the problem, and patients may misunderstand product labels and use the drugs improperly. These statements should be included when teaching patients about their use. In contrast, drug interactions with OTC medications are not rare and may indeed occur with prescription medications and other OTC drugs. Normally, OTC drugs are intended for short-term treatment of minor ailments. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE 1. A patient who has been taking a selective serotonin reuptake inhibitor (SSRI) is complaining of "feeling so badly" when he started taking an over-the-counter St. John's wort herbal product at home. The nurse suspects that he is experiencing serotonin syndrome. Which of these are symptoms of serotonin syndrome? (Select all that apply.) a. Agitation b. Drowsiness c. Tremors d. Bradycardia e. Sweating f. Constipation

ANS: A, C, E Common symptoms of serotonin syndrome include delirium, agitation, tachycardia, sweating, hyperreflexia, shivering, coarse tremors, and others. See Box 16-1 for a full list of symptoms. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE 1. The nurse is reviewing the use of central nervous system stimulants. Which of these are indications for this class of drugs? (Select all that apply.) a. Narcolepsy b. Depression c. Panic attacks d. Neonatal apnea e. Attention deficit hyperactivity disorder (ADHD) f. Appetite suppression

ANS: A, D, E, F Central nervous system stimulants can be used for narcolepsy, neonatal apnea, ADHD, and appetite suppression in the treatment of obesity. They are not used for depression and panic attacks. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 13: Central Nervous System Stimulants and Related Drugs 69

MULTIPLE RESPONSE 1. The nurse is presenting information to a class of students about adrenergic drugs. Which are the effects of drugs that stimulate the sympathetic nervous system? (Select all that apply.) a. Dilation of bronchioles b. Constriction of bronchioles c. Decreased heart rate d. Increased heart rate e. Dilated pupils f. Constricted pupils g. Glycogenolysis

ANS: A, D, E, G Stimulation of the sympathetic nervous system causes bronchodilation, increased heart rate, pupil dilation, and glycogenolysis as well as many other effects (see Table 18-1). The other responses are effects that occur as a result of the stimulation of the parasympathetic nervous system. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

14. A patient wants to take a ginseng dietary supplement. The nurse instructs the patient to look for which potential adverse effect? a. Drowsiness b. Palpitations and anxiety c. Dry mouth d. Constipation

ANS: B Elevated blood pressure, chest pain or palpitations, anxiety, insomnia, headache, nausea, vomiting, and diarrhea are potential adverse effects of ginseng. Drowsiness, difficulty with urination, and constipation are not potential adverse effects of ginseng. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

10. A patient has been taking an AED for several years as part of his treatment for partial seizures. His wife has called because he ran out of medication this morning and wonders if he can go without it for a week until she has a chance to go to the drugstore. What is the nurse's best response? a. "He is taking another antiepileptic drug, so he can go without the medication for a week." b. "Stopping this medication abruptly may cause withdrawal seizures. A refill is needed right away." c. "He can temporarily increase the dosage of his other antiseizure medications until you get the refill." d. "He can stop all medications because he has been treated for several years now."

ANS: B Abrupt discontinuation of antiepileptic drugs can lead to withdrawal seizures. The other options are incorrect. The nurse cannot change the dose or stop the medication without a prescriber's order. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. A 50-year-old man who has been taking phenobarbital for 1 week is found very lethargic and unable to walk after eating out for dinner. His wife states that he has no other prescriptions and that he did not take an overdose—the correct number of pills is in the bottle. The nurse suspects that which of these may have happened? a. He took a multivitamin. b. He drank a glass of wine. c. He took a dose of aspirin. Chapter 12: Central Nervous System Depressants and Muscle Relaxants 62 d. He developed an allergy to the drug.

ANS: B Alcohol has an additive effect when combined with barbiturates and causes central nervous system (CNS) depression. Multivitamins and aspirin do not interact with barbiturates, and this situation does not illustrate an allergic reaction. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. A patient is receiving gabapentin (Neurontin), an anticonvulsant, but has no history of seizures. The nurse expects that the patient is receiving this drug for which condition? a. Inflammation pain b. Pain associated with peripheral neuropathy c. Depression associated with chronic pain d. Prevention of seizures

ANS: B Anticonvulsants are often used as adjuvants for treatment of neuropathic pain to enhance analgesic efficacy. The other indications listed are not correct. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 10: Analgesic Drugs 54

5. A 10-year-old patient will be started on methylphenidate hydrochloride (Ritalin) therapy. The nurse will perform which essential baseline assessment before this drug is started? a. Eye examination b. Height and weight c. Liver function studies d. Hearing test

ANS: B Assessment of baseline height and weight is important before beginning Ritalin therapy because it may cause a temporary slowing of growth in prepubertal children. The other studies are not as essential at this time. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

1. A patient has been taking selegiline (Eldepryl), 20 mg/day for 1 month. Today, during his office visit, he tells the nurse that he forgot and had a beer with dinner last evening, and "felt awful." What did the patient most likely experience? a. Hypotension b. Hypertension c. Urinary discomfort d. Gastrointestinal upset

ANS: B At doses that exceed 10 mg/day, selegiline becomes a nonselective monoamine oxidase inhibitor (MAOI), contributing to the development of the cheese effect, so-called because it interacts with tyramine-containing foods (cheese, red wine, beer, and yogurt) and can cause severe hypertension. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

3. A patient is recovering from abdominal surgery, which he had this morning. He is groggy but complaining of severe pain around his incision. What is the most important assessment data to consider before the nurse administers a dose of morphine sulfate to the patient? a. His pulse rate b. His respiratory rate c. The appearance of the incision d. The date of his last bowel movement

ANS: B Chapter 10: Analgesic Drugs 51 One of the most serious adverse effects of opioids is respiratory depression. The nurse must assess the patient's respiratory rate before administering an opioid. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

9. While monitoring a depressed patient who has just started SSRI antidepressant therapy, the nurse will observe for which problem during the early time frame of this therapy? a. Hypertensive crisis b. Self-injury or suicidal tendencies c. Extrapyramidal symptoms d. Loss of appetite

ANS: B Chapter 16: Psychotherapeutic Drugs 84 In 2005, the U.S. Food and Drug Administration (FDA) issued special black-box warnings regarding the use of all classes of antidepressants in both adult and pediatric patient populations. Data from the FDA indicated a higher risk for suicide in patients receiving these medications. As a result, current recommendations for all patients receiving antidepressants include regular monitoring for signs of worsening depressive symptoms, especially when the medication is started or the dosage is changed. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

1. A patient was diagnosed with pancreatic cancer last month, and has complained of a dull ache in the abdomen for the past 4 months. This pain has been gradually increasing, and the pain relievers taken at home are no longer effective. What type of pain is the patient experiencing? a. Acute pain b. Chronic pain c. Somatic pain d. Neuropathic pain

ANS: B Chronic pain is associated with cancer and is characterized by slow onset, long duration, and dull, persistent aching. The patient's symptoms are not characteristics of acute pain, somatic pain, or neuropathic pain. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

1. A 38-year-old male patient stopped smoking 6 months ago. He tells the nurse that he still feels strong cigarette cravings and wonders if he is ever going to feel "normal" again. Which statement by the nurse is correct? a. "It's possible that these cravings will never stop." b. "These cravings may persist for several months." c. "The cravings tell us that you are still using nicotine." d. "The cravings show that you are about to experience nicotine withdrawal."

ANS: B Cigarette cravings may persist for months after nicotine withdrawal. The other statements are false. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

8. A hospitalized patient is experiencing a severe anaphylactic reaction to a dose of intravenous penicillin. Which drug will the nurse expect to use to treat this condition? a. Ephedra b. Epinephrine c. Phenylephrine d. Pseudoephedrine

ANS: B Epinephrine is the drug of choice for the treatment of anaphylaxis. The other drugs listed are incorrect choices. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. The nurse is reviewing herbal therapies. Which is a common use of the herb feverfew? a. Muscle aches b. Migraine headaches c. Leg cramps d. Incision pain after surgery

ANS: B Feverfew is commonly used for migraine headaches, menstrual problems, arthritis, and fever. Possible adverse effects include muscle stiffness and muscle and joint pain. DIF: COGNITIVE LEVEL: Remembering (Knowledge) TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. The nurse is presenting a substance-abuse lecture for teenage girls and is asked about "roofies." The nurse recognizes that this is the slang term for which substance? a. Cocaine b. Flunitrazepam c. Secobarbital d. Methamphetamine

ANS: B Flunitrazepam is a benzodiazepine that has recently gained popularity as a recreational drug and is commonly called roofies (the "date-rape" drug). The other drugs are not known as roofies. DIF: COGNITIVE LEVEL: Remembering (Knowledge) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

4. An adrenergic agonist is ordered for a patient in shock. The nurse will note that this drug has had its primary intended effect if which expected outcome occurs? Chapter 18: Adrenergic Drugs 94 a. Volume restoration b. Increased cardiac output c. Decreased urine output d. Reduced anxiety

ANS: B For a patient in shock, a primary benefit of an adrenergic agonist drug is to increase cardiac output. A drug in this category should not be used in place of volume restoration, nor does it provide volume restoration (IV fluids do this). Adrenergic agonists may enhance urine output if cardiac output and perfusion to the kidneys increase. These drugs do not reduce anxiety. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. A 57-year-old woman being treated for end-stage breast cancer has been using a transdermal opioid analgesic as part of the management of pain. Lately, she has been experiencing breakthrough pain. The nurse expects this type of pain to be managed by which of these interventions? a. Administering NSAIDs b. Administering an immediate-release opioid c. Changing the opioid route to the rectal route d. Making no changes to the current therapy

ANS: B If a patient is taking long-acting opioid analgesics, breakthrough pain must be treated with an immediate-release dosage form that is given between scheduled doses of the long-acting opioid. The other options are not appropriate actions. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 10: Analgesic Drugs 53

13. The nurse will be injecting a drug into the fatty tissue of the patient's abdomen. Which route does this describe? a. Intradermal b. Subcutaneous c. Intramuscular d. Transdermal

ANS: B Injections into the fatty subcutaneous tissue under the dermal layer of skin are referred to as subcutaneous injections. Injections under the more superficial skin layers immediately underneath the epidermal layer of skin and into the dermal layer are known as intradermal injections. Injections into the muscle beneath the subcutaneous fatty tissue are referred to as intramuscular injections. Transdermal drugs are applied to the skin via an adhesive patch.

6. The nurse is giving an intravenous dose of phenytoin (Dilantin). Which action is correct when administering this drug? a. Give the dose as a fast intravenous (IV) bolus. b. Mix the drug with normal saline, and give it as a slow IV push. c. Mix the drug with dextrose (D5W), and give it as a slow IV push. d. Mix the drug with any available solution as long as the administration rate is correct.

ANS: B Intravenous phenytoin is given only with normal saline solution to prevent precipitation formation caused by incompatibilities. The IV push dose must be given slowly (not exceeding 50 mg/min in adults), and the patient must be monitored for bradycardia and decreased blood pressure. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. A patient is being prepared for an oral endoscopy, and the nurse anesthetist reminds him that he will be awake during the procedure but probably will not remember it. What type of anesthetic technique is used in this situation? a. Local anesthesia b. Moderate sedation c. Topical anesthesia d. Spinal anesthesia Chapter 11: General and Local Anesthetics 59

ANS: B Moderate sedation effectively reduces patient anxiety, sensitivity to pain, and recall of the medical procedure, yet it preserves a patient's ability to maintain his or her own airway and respond to verbal commands. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

During a busy night shift, a new nurse administered an unfamiliar medication without checking it in a drug handbook. Later that day, the patient had a severe reaction because he has renal problems, which was a contraindication to that drug. The nurse may be liable for which of these? a. Medical negligence b. Nursing negligence c. Non maleficence d. Autonomy

ANS: B Negligence is the failure to act in a reasonable and prudent manner or failure of the nurse to give the care that a reasonably prudent (cautious) nurse would render or use under similar circumstances. In this case, nursing negligence applies to nurses, not medical negligence. Non maleficence is defined as the duty to do no harm; autonomy is defined as the right to make one's own decisions, or self-determination. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: General MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

8. The nurse is reviewing facts about pharmacology for a review course. The term legend drug refers to which item? a. Over-the-counter drugs b. Prescription drugs c. Orphan drugs d. Older drugs

ANS: B The term legend drug refers to prescription drugs, which were differentiated from over-the counter drugs by the 1951 Durham-Humphrey Amendment. Orphan drugs are drugs that are developed for rare diseases. The other options are not examples of legend drugs. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 04: Cultural, Legal, and Ethical Considerations 23

6. A patient has been treated for lung cancer for 3 years. Over the past few months, the patient has noticed that the opioid analgesic is not helping as much as it had previously and more medication is needed for the same pain relief. The nurse is aware that this patient is experiencing which of these? Chapter 10: Analgesic Drugs 52 a. Opioid addiction b. Opioid tolerance c. Opioid toxicity d. Opioid abstinence syndrome

ANS: B Opioid tolerance is a common physiologic result of long-term opioid use. Patients with opioid tolerance require larger doses of the opioid agent to maintain the same level of analgesia. This situation does not describe toxicity (overdose), addiction, or abstinence syndrome (withdrawal). DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A patient in a rehabilitation center is beginning to experience opioid withdrawal symptoms. The nurse expects to administer which drug as part of the treatment? a. Diazepam (Valium) b. Methadone c. Disulfiram (Antabuse) d. Bupropion (Zyban)

ANS: B Opioid withdrawal can be managed with either methadone or clonidine (Catapres). Diazepam and disulfiram are used for treatment of alcoholism, and bupropion is used to assist with smoking cessation. DIF: COGNITIVE LEVEL: Remembering (Knowledge) TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. The wife of a patient who has been diagnosed with depression calls the office and says, "It's been an entire week since he started that new medicine for his depression, and there's no change! What's wrong with him?" What is the nurse's best response? a. "The medication may not be effective for him. He may need to try another type." b. "It may take up to 6 weeks to notice any therapeutic effects. Let's wait a little longer to see how he does." c. "It sounds like the dose is not high enough. I'll check about increasing the dosage." d. "Some patients never recover from depression. He may not respond to this therapy."

ANS: B Patients and family members need to be told that antidepressant drugs commonly require several weeks before full therapeutic effects are noted. The other answers are incorrect. DIF: COGNITIVE LEVEL: Analyzing (Analysis) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. The nurse is developing a care plan for a patient who is taking an anticholinergic drug. Which nursing diagnosis would be appropriate for this patient? a. Diarrhea b. Urinary retention c. Risk for infection d. Disturbed sleep pattern

ANS: B Patients receiving anticholinergic drugs are at risk for urinary retention and constipation, not diarrhea. The other nursing diagnoses are not applicable to anticholinergic drugs. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Nursing Diagnosis MSC: NCLEX: Physiological Integrity: Physiological Adaptation

1. The nurse is reviewing the dosage schedule for several different antiepileptic drugs (AEDs). Which antiepileptic drug allows for once-a-day dosing? a. Levetiracetam (Keppra) b. Phenobarbital c. Valproic acid (Depakote) d. Gabapentin (Neurontin)

ANS: B Phenobarbital has the longest half-life of all standard AEDs, including those listed in the other options, so it allows for once-a-day dosing. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

18. A patient with asthma is to begin medication therapy using a metered-dose inhaler. What is an important reminder to include during teaching sessions with the patient? a. Repeat subsequent puffs, if ordered, after 5 minutes. b. Inhale slowly while pressing down to release the medication. c. Inhale quickly while pressing down to release the medication. d. Administer the inhaler while holding it 3 to 4 inches away from the mouth.

ANS: B Position the inhaler to an open mouth, with the inhaler 1 to 2 inches away from the mouth, or attach a spacer to the mouthpiece of the inhaler, or place the mouthpiece in the mouth. To administer, press down on the inhaler to release the medication while inhaling slowly. Wait 1 to 2 minutes between puffs if a second puff of the same medication has been ordered. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. Chlorpromazine (Thorazine) is prescribed for a patient, and the nurse provides instructions to the patient about the medication. The nurse includes which information? a. The patient needs to avoid caffeine while on this drug. Chapter 16: Psychotherapeutic Drugs 85 b. The patient needs to wear sunscreen while outside because of photosensitivity. c. Long-term therapy may result in nervousness and excitability. d. The medication may be taken with an antacid to reduce gastrointestinal upset.

ANS: B Sun exposure and tanning booths need to be avoided with conventional antipsychotics because of the adverse effect of photosensitivity. Instruct the patient to apply sunscreen liberally and to wear sun-protective clothing and hats. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. During the immediate postoperative period, the Post Anesthesia Care Unit nurse is assessing a patient who had hip surgery. The patient is experiencing tachycardia, tachypnea, and muscle rigidity, and his temperature is 103° F (39.4° C). The nurse will prepare for what immediate treatment? a. Naltrexone hydrochloride (Narcan) injection, an opioid reversal drug b. Dantrolene (Dantrium) injection, a skeletal muscle relaxant c. An anticholinesterase drug, such as neostigmine d. Cardiopulmonary resuscitation (CPR) and intubation

ANS: B Tachycardia, tachypnea, muscle rigidity, and raised temperature are symptoms of malignant hyperthermia, which is treated with cardiorespiratory supportive care as needed to stabilize heart and lung function as well as with immediate treatment with the skeletal muscle relaxant dantrolene. CPR is not immediately needed because the patient still has a pulse and respirations. Naltrexone and anticholinesterase drugs are not appropriate in this situation. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. The nurse is asking a patient about his family history as part of an assessment. Which component is included in an effective family history? a. Asking the patient about the current and past health status of the patient's children b. Covering at least three generations of family history c. Obtaining a family history of the patient's spouse d. Asking about the family history for the patient's siblings and parents only

ANS: B The family history is most effective if it covers at least three generations and includes the current and past health status of each family member. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Health Promotion and Maintenance

3. When a patient is receiving a second-generation antipsychotic drug, such as risperidone (Risperdal), the nurse will monitor for which therapeutic effect? a. Fewer panic attacks b. Decreased paranoia and delusions c. Decreased feeling of hopelessness d. Improved tardive dyskinesia

ANS: B The therapeutic effects of the antipsychotic drugs include improvement in mood and affect, and alleviation or decrease in psychotic symptoms (decrease in hallucinations, paranoia, delusions, garbled speech). Tardive dyskinesia is a potential adverse effect of these drugs. The other options are incorrect. Chapter 16: Psychotherapeutic Drugs 82 DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

7. A patient is being treated for ethanol alcohol abuse in a rehabilitation center. The nurse will include which information when teaching him about disulfiram (Antabuse) therapy? a. He should not smoke cigarettes while on this drug. b. He needs to know about the common over-the-counter substances that contain alcohol. c. This drug will cause the same effects as the alcohol did, without the euphoric effects. d. Mouthwashes and cough medicines that contain alcohol are safe because they are used in small amounts.

ANS: B The use of disulfiram (Antabuse) with alcohol-containing over-the-counter products will elicit severe adverse reactions. As little as 7 mL of alcohol may cause symptoms in a sensitive person. Cigarette smoking does not cause problems when taking disulfiram. Disulfiram does not have the same effects as alcohol. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. During an assessment, the patient tells the nurse that he eats large amounts of garlic for its cardiovascular benefits. Which drug or drug class, if taken, would have a potential interaction with the garlic? a. Acetaminophen (Tylenol) b. Insulin c. Antilipemic drugs d. Sedatives

ANS: B The use of garlic may interfere with hypoglycemic drugs. The other options are incorrect because acetaminophen, antilipemic drugs, and sedatives do not have interactions with garlic. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential Chapter 07: Over-the-Counter Drugs and Herbal and Dietary Supplements 36

7. A patient wants to take the herb gingko to help his memory. The nurse reviews his current medication list and would be concerned about potential interactions if he is taking a medication from which class of drugs? a. Digitalis b. Anticoagulants c. Sedatives d. Immunosuppressants

ANS: B The use of gingko increases the risk of bleeding with anticoagulants (warfarin, heparin) and antiplatelets (aspirin, clopidogrel). The other concerns do not occur with gingko supplements. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

2. Before beginning a patient's therapy with selective serotonin reuptake inhibitor (SSRI) antidepressants, the nurse will assess for concurrent use of which medications or medication class? a. Aspirin b. Anticoagulants c. Diuretics d. Nonsteroidal anti-inflammatory drugs

ANS: B Use of selective serotonin reuptake inhibitor (SSRI) antidepressants with warfarin results in an increased anticoagulant effect. SSRI antidepressants do not interact with the other drugs or drug classes listed. See Table 16-6 for important drug interactions with SSRIs. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

9. Nurses have the ethical responsibility to tell the truth to their patients. What is this principle known as? a. Justice b. Veracity c. Beneficence d. Autonomy

ANS: B Veracity is defined as the duty to tell the truth. Justice is the ethical principle of being fair or equal in one's actions. Beneficence is the ethical principle of doing or actively promoting good. Autonomy is self-determination, or the ability to make one's own decisions. DIF: COGNITIVE LEVEL: Remembering (Knowledge) TOP: NURSING PROCESS: General MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

2. A patient has been given a prescription for levodopa-carbidopa (Sinemet) for her newly diagnosed Parkinson's disease. She asks the nurse, "Why are there two drugs in this pill?" The nurse's best response reflects which fact? a. Carbidopa allows for larger doses of levodopa to be given. b. Carbidopa prevents the breakdown of levodopa in the periphery. c. There are concerns about drug-food interactions with levodopa therapy that do not exist with the combination therapy. d. Carbidopa is the biologic precursor of dopamine and can penetrate into the central nervous system.

ANS: B When given in combination with levodopa, carbidopa inhibits the breakdown of levodopa in the periphery and thus allows smaller doses of levodopa to be used. Lesser amounts of levodopa result in fewer unwanted adverse effects. Levodopa, not carbidopa, is the biologic precursor of dopamine and can penetrate into the CNS. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. When adding medications to a bag of intravenous (IV) fluid, the nurse will use which method to mix the solution? a. Shaking the bag or bottle vigorously b. Turning the bag or bottle gently from side to side c. Inverting the bag or bottle one time after injecting the medication d. Allowing the IV solution to stand for 10 minutes to enhance even distribution of medication

ANS: B When medications are added to IV fluid containers, the medication and the IV solution are mixed by holding the bag or bottle and turning it end-to-end, mixing it gently. Shaking vigorously is not appropriate; inverting the bag just once or simply allowing the bag to stand for 10 minutes may not be sufficient to mix the medication into the fluid. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. The nurse is monitoring a patient who has been taking carbamazepine (Tegretol) for 2 months. Which effects would indicate that autoinduction has started to occur? a. The drug levels for carbamazepine are higher than expected. b. The drug levels for carbamazepine are lower than expected. c. The patient is experiencing fewer seizures. d. The patient is experiencing toxic effects from the drug.

ANS: B With carbamazepine, autoinduction occurs and leads to lower than expected drug concentrations. Therefore, the dosage may have to be adjusted with time. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

1. The nurse can prevent medication errors by following which principles? (Select all that apply.) a. Assess for allergies after giving medications. b. Use two patient identifiers before giving medications. Chapter 05: Medication Errors: Preventing and Responding 28 c. Do not give a medication that another nurse has drawn up in a syringe. d. Minimize the use of verbal and telephone orders. e. Use trade names instead of generic names to avoid confusion.

ANS: B, C, D Measures that prevent medication errors include using two patient identifiers, giving only medications that you have drawn up or prepared, and minimizing the use of verbal and telephone orders. Assessment for allergies should be done before medications are given. Generic names should be used to avoid the many sound-alike trade names of medications.

2. A patient has a new prescription for phentermine (Ionamin) as part of the treatment for weight loss. Which information will the nurse include when teaching this patient about a stimulant such as phentermine? (Select all that apply.) a. Take this medication after meals. b. Take this medication in the morning. c. This drug is taken along with supervised exercise and suitable diet. d. Use mouth rinses, sugarless gum, or hard candies to minimize dry mouth. e. Avoid foods that contain caffeine, such as coffee, tea, and colas.

ANS: B, C, D, E This drug should be taken in the morning to avoid interference with sleep, and the patient should also be on a supervised exercise and dietary regime. Caffeine-containing products should be avoided because of possible additional stimulation. Dry mouth can be minimized by the use of mouth rinses, sugarless gum, or hard candy. The other option is incorrect. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

1. The nurse is reviewing the concept of drug polymorphism. Which factors contribute to drug polymorphism? (Select all that apply.) a. The number of drugs ordered by the physician b. Inherited factors c. The patient's diet and nutritional status d. Different dosage forms of the same drug e. The patient's health beliefs and practices f. The patient's drug history g. The various available forms of a drug

ANS: B, C, E Inherited factors, diet and nutritional status, and health beliefs and practices are some of the factors that contribute to drug polymorphism. The other options are not factors that contribute to drug polymorphism. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE 1. The nurse is reviewing antiepileptic drug (AED) therapy. Which statements about AED therapy are accurate? (Select all that apply.) a. AED therapy can be stopped when seizures are stopped. b. AED therapy is usually lifelong. c. Consistent dosing is the key to controlling seizures. d. A dose may be skipped if the patient is experiencing adverse effects. e. Do not abruptly discontinue AEDs because doing so may cause rebound seizure activity.

ANS: B, C, E Patients need to know that AED therapy is usually lifelong, and compliance (with consistent dosing) is important for effective seizure control. Abruptly stopping AED therapy may cause withdrawal (or rebound) seizure activity. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE 1. Vicodin (acetaminophen/hydrocodone) is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication? (Select all that apply.) a. Diarrhea b. Constipation c. Lightheadedness d. Nervousness Chapter 10: Analgesic Drugs 56 e. Urinary retention f. Itching

ANS: B, C, E, F Constipation (not diarrhea), lightheadedness (not nervousness), urinary retention, and itching are some of the common adverse effects that the patient may experience while taking Vicodin.

MULTIPLE RESPONSE 1. A nurse is providing teaching for a patient who will be taking varenicline (Chantix) as part of a smoking-cessation program. Which teaching points are appropriate for a patient taking this medication? (Select all that apply.) a. This drug is available as a chewing gum that can be taken to reduce cravings. b. Use caution when driving because drowsiness may be a problem. c. There have been very few adverse effects reported for this drug. d. Notify the prescriber immediately if feelings of sadness or thoughts of suicide occur. e. Avoid caffeine while on this drug.

ANS: B, D Patients taking varenicline have reported drowsiness, which has prompted the U.S. Food and Drug Administration (FDA) to recommend caution when driving and engaging in other potentially hazardous activities until the patient can determine how the drug affects his or her mental status. In addition, the FDA has warned about psychiatric symptoms including agitation, depression, and suicidality. Varenicline is an oral tablet, and common adverse effects include nausea, vomiting, headache, and insomnia. There are no cautions about taking caffeine while on this drug. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

MULTIPLE RESPONSE 1. The nurse is preparing to administer a barbiturate. Which conditions or disorders would be a contraindication to the use of these drugs? (Select all that apply.) a. Gout Chapter 12: Central Nervous System Depressants and Muscle Relaxants 65 b. Pregnancy c. Epilepsy d. Severe chronic obstructive pulmonary disease e. Severe liver disease f. Diabetes mellitus

ANS: B, D, E Contraindications to barbiturates include pregnancy, significant respiratory difficulties, and severe liver disease. The other disorders are not contraindications. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

1. The nurse is performing an assessment of a patient. Which assessment findings may indicate a higher risk for genetic disorders? (Select all that apply.) a. The patient's father was diagnosed with heart disease at 60 years of age. b. The patient's mother was diagnosed with breast cancer at 33 years of age. c. The patient's grandfather died of a cerebral vascular accident at 78 years of age. d. The patient's sister has a history of both renal and lung cancer. e. The patient has two uncles and a grandparent who have been diagnosed with

ANS: B, D, E The nurse should assess for factors that may indicate a risk for genetic disorders. A few examples of factors that may indicate a risk for genetic disorders are a higher incidence of a particular disease or disorder in the patient's family than in the general population; diagnosis of a disease in family members at an unusually young age; or diagnosis of a family member with an unusual form of cancer or with more than one type of cancer. The options regarding heart disease at 60 years of age and cerebral vascular accident at 78 years of age are not factors that indicate a higher risk for genetic disorders

MULTIPLE RESPONSE 1. The nurse is preparing to give an aqueous intramuscular (IM) injection to an average-sized adult. Which actions are appropriate? (Select all that apply.) a. Choose a 26- or 27-gauge, - to -inch needle. b. Choose a 22- to 27-gauge, 1- to -inch needle. c. Choose the dorsogluteal site, the preferred site for IM injections for adults. d. Insert the needle at a 45-degree angle. e. Insert the needle at a 90-degree angle. f. Before injecting the medication, withdraw the plunger to check for blood return.

ANS: B, E, F In general, aqueous medications can be given with a 22- to 27-gauge needle, and average needle lengths for adults range from 1 to inches. Insert the needle at a 90-degree angle. Checking for blood return is also part of the technique for IM injections to prevent inadvertent administration into the bloodstream. The ventrogluteal site is the preferred site for IM injections in adults. The dorsogluteal site is to be avoided because of proximity to nerves and blood vessels.

The medication order reads, "Give ondansetron (Zofran) 4 mg, 30 minutes before beginning chemotherapy to prevent nausea." The nurse notes that the route is missing from the order. What is the nurse's best action? Chapter 01: The Nursing Process and Drug Therapy 6 a. Give the medication intravenously because the patient might vomit. b. Give the medication orally because the tablets are available in 4-mg doses. c. Contact the prescriber to clarify the route of the medication ordered. d. Hold the medication until the prescriber returns to make rounds.

ANS: C A complete medication order includes the route of administration. If a medication order does not include the route, the nurse must ask the prescriber to clarify it. The intravenous and oral routes are not interchangeable. Holding the medication until the prescriber returns would mean that the patient would not receive a needed medication.

The nurse is reviewing the applications of gene therapy. Which drug is manufactured as a result of indirect gene therapy? a. Vitamin K b. Warfarin c. Human insulin d. Heparin

ANS: C A recombinant form of human insulin is one of the most widespread uses of indirect gene therapy. Other examples include hormones, vaccines, antitoxins, and monoclonal antibodies. The other options listed are not examples of drugs manufactured by indirect gene therapy. DIF: COGNITIVE LEVEL: Remembering (Knowledge) TOP: NURSING PROCESS: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. A patient is to receive acetylcysteine (Mucomyst) as part of the treatment for an acetaminophen (Tylenol) overdose. Which action by the nurse is appropriate when giving this medication? a. Giving the medication undiluted for full effect b. Avoiding the use of a straw when giving this medication c. Disguising the flavor with soda or flavored water d. Preparing to give this medication via a nebulizer

ANS: C Acetylcysteine has the flavor of rotten eggs and so is better tolerated if it is diluted and disguised by mixing with a drink such as cola or flavored water to help increase its palatability. The use of a straw helps to minimize contact with the mucous membranes of the mouth and is recommended. The nebulizer form of this medication is used for certain types of pneumonia, not for acetaminophen overdose. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

1. The nurse is aware that adrenergic drugs produce effects similar to which of these nervous systems? a. Central nervous system b. Somatic nervous system c. Sympathetic nervous system d. Parasympathetic nervous system

ANS: C Adrenergic drugs mimic the effects of the sympathetic nervous system. DIF: COGNITIVE LEVEL: Remembering (Knowledge) TOP: NURSING PROCESS: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

13. The nurse is reviewing the food choices of a patient who is taking a monoamine oxidase inhibitor ( MAOI). Which food choice would indicate the need for additional teaching? a. Orange juice b. Fried eggs over-easy c. Salami and Swiss cheese sandwich d. Biscuits and honey

ANS: C Aged cheeses, such a Swiss or cheddar cheese, and Salami contain tyramine. Patients who are taking MAOIs need to avoid tyramine-containing foods because of a severe hypertensive reaction that may occur. Orange juice, eggs, biscuits, and honey do not contain tyramine. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

6. A patient is on a low-dose dobutamine drip for heart failure. She had been feeling better but now has a sense of tightness in her chest, palpitations, and a bit of anxiety. Her heart rate is up to 110 per minute, and her blood pressure is 150/98 mm Hg (increased from previous readings of 86 per minute and 120/80 mm Hg). What is the nurse's immediate concern for this patient? a. She is experiencing normal adverse effects of dobutamine therapy. b. She may be experiencing an allergic reaction to the dobutamine. c. The medication may be causing a worsening of a pre-existing cardiac disorder. d. The dosage of the dobutamine needs to be increased to control the symptoms better.

ANS: C Because dobutamine is a vasoactive adrenergic, it works by increasing the cardiac output in heart failure patients by increasing myocardial contractility and stroke volume. However, adrenergic drugs may worsen a pre-existing cardiac disorder, such as causing a myocardial infarction in a patient with coronary artery disease. The other options are incorrect. DIF: COGNITIVE LEVEL: Analyzing (Analysis) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 18: Adrenergic Drugs 95

4. A patient has been taking temazepam (Restoril) for intermittent insomnia. She calls the nurse to say that when she takes it, she sleeps well, but the next day she feels "so tired." Which explanation by the nurse is correct? a. "Long-term use of this drug results in a sedative effect." b. "If you take the drug every night, this hangover effect will be reduced." c. "These drugs affect the sleep cycle, resulting in daytime sleepiness." d. "These drugs increase the activity of the central nervous system, making you tired the next day."

ANS: C Benzodiazepines suppress REM sleep to a degree (although not as much as barbiturates) and, thus, result in daytime sleepiness (a hangover effect). The other statements are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

9. The nurse recognizes that adrenergic drugs cause relaxation of the bronchi and bronchodilation by stimulating which type of receptors? a. Dopaminergic b. Beta1 adrenergic c. Beta2 adrenergic d. Alpha1 adrenergic

ANS: C Stimulation of beta2-adrenergic receptors results in bronchodilation. The other choices are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 18: Adrenergic Drugs 96

3. During discharge patient teaching, the nurse reviews prescriptions with a patient. Which statement is correct about refills for an analgesic that is classified as Schedule C-III? a. No prescription refills are permitted. b. Refills are allowed only by written prescription. c. The patient may have no more than five refills in a 6-month period. d. Written prescriptions expire in 12 months.

ANS: C Chapter 04: Cultural, Legal, and Ethical Considerations 21 Schedule C-III medications may be refilled no more than five times in a 6-month period. The patient should be informed of this regulation. No prescription refills are permitted for Schedule C-II drugs. Requiring refills by written prescription only applies to Schedule C-II drugs. Schedule C-III prescriptions (written or oral) expire in 6 months. DIF: COGNITIVE LEVEL: Remembering (Knowledge) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. When admitting a patient with a suspected diagnosis of chronic alcohol use, the nurse will keep in mind that chronic use of alcohol might result in which condition? a. Renal failure b. Cerebrovascular accident c. Korsakoff's psychosis d. Alzheimer's disease

ANS: C Chapter 17: Substance Use Disorder 90 A variety of serious neurologic and mental disorders, such as Korsakoff's psychosis and Wernicke's encephalopathy, as well as cirrhosis of the liver, may occur with chronic use of alcohol. Renal failure, cerebrovascular accident, and Alzheimer's disease are not associated directly with chronic use of alcohol. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

16. A patient is suffering from tendonitis of the knee. The nurse is reviewing the patient's medication administration record and recognizes that which adjuvant medication is most appropriate for this type of pain? a. Antidepressant b. Anticonvulsant c. Corticosteroid d. Local anesthesia

ANS: C Corticosteroids have an anti-inflammatory effect, which may help to reduce pain. The other medications do not have anti-inflammatory properties. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

15. The nurse is reviewing medications used for depression. Which of these statements is a reason that selective serotonin reuptake inhibitors (SSRIs) are more widely prescribed today than tricyclic antidepressants? a. SSRIs have fewer sexual side effects. Chapter 16: Psychotherapeutic Drugs 86 b. Unlike tricyclic antidepressants, SSRIs do not have drug-food interactions. c. Tricyclic antidepressants cause serious cardiac dysrhythmias if an overdose occurs. d. SSRIs cause a therapeutic response faster than tricyclic antidepressants.

ANS: C Death from overdose of tricyclic antidepressants usually results from either seizures or dysrhythmias. SSRIs are associated with significantly fewer and less severe systemic adverse effects, especially anticholinergic and cardiovascular adverse effects. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. The nurse is reviewing a list of verbal medication orders. Which is the proper notation of the dose of the drug ordered? a. Digoxin .125 mg b. Digoxin .1250 mg c. Digoxin 0.125 mg d. Digoxin 0.1250 mg

ANS: C Digoxin 0.125 mg illustrates the correct notation with a leading zero before the decimal point. Omitting the leading zero may cause the order to be misread, resulting in a large drug overdose. Digoxin .125 mg and digoxin .1250 mg do not have the leading zero before the decimal point. Digoxin 0.1250 mg has a trailing zero, which also is incorrect. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

Drug transfer to the fetus is more likely during the last trimester of pregnancy for which reason? a. Decreased fetal surface area b. Increased placental surface area c. Enhanced blood flow to the fetus d. Increased amount of protein-bound drug in maternal circulation

ANS: C Drug transfer to the fetus is more likely during the last trimester as a result of enhanced blood flow to the fetus. The other options are incorrect. Increased fetal surface area, not decreased, is a factor that affects drug transfer to the fetus. The placenta's surface area does not increase during this time. Drug transfer is increased because of an increased amount of free drug, not protein bound drug, in the mother's circulation. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: General MSC: NCLEX: Health Promotion and Maintenance

2. The nurse is discussing gene therapy in a continuing education class. Which is the best definition of eugenics? a. The use of gene therapy to prevent disease b. The development of new drugs based on gene therapy c. Intentional selection, before birth, of genotypes that are considered more desirable than others d. The determination of genetic factors that influence a person's response to medications

ANS: C Eugenics is the intentional selection of genotypes, before birth, that are considered more desirable than others, and it is a major ethical issue concerning gene therapy. The other options do not describe eugenics. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: General MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

4. A patient has been taking haloperidol (Haldol) for 3 months for a psychotic disorder, and the nurse is concerned about the development of extrapyramidal symptoms. The nurse will monitor the patient closely for which effects? a. Increased paranoia b. Drowsiness and dizziness c. Tremors and muscle twitching d. Dry mouth and constipation

ANS: C Extrapyramidal symptoms are manifested by tremors and muscle twitching, and the incidence of such symptoms is high during haloperidol therapy. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. A patient will be discharged with a 1-week supply of an opioid analgesic for pain management after abdominal surgery. The nurse will include which information in the teaching plan? a. How to prevent dehydration due to diarrhea b. The importance of taking the drug only when the pain becomes severe c. How to prevent constipation d. The importance of taking the drug on an empty stomach

ANS: C Gastrointestinal (GI) adverse effects, such as nausea, vomiting, and constipation, are the most common adverse effects associated with opioid analgesics. Physical dependence usually occurs in patients undergoing long-term treatment. Diarrhea is not an effect of opioid analgesics. Taking the dose with food may help minimize GI upset. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

7. A 38-year-old man has come into the urgent care center with severe hip pain after falling from a ladder at work. He says he has taken several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol). The nurse is aware that the most serious toxic effect of acute acetaminophen overdose is which condition? a. Tachycardia b. Central nervous system depression c. Hepatic necrosis d. Nephropathy

ANS: C Hepatic necrosis is the most serious acute toxic effect of an acute overdose of acetaminophen. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

4. A patient has a 9-year history of a seizure disorder that has been managed well with oral phenytoin (Dilantin) therapy. He is to be NPO (consume nothing by mouth) for surgery in the morning. What will the nurse do about his morning dose of phenytoin? a. Give the same dose intravenously. b. Give the morning dose with a small sip of water. c. Contact the prescriber for another dosage form of the medication. d. Notify the operating room that the medication has been withheld.

ANS: C If there are any questions about the medication order or the medication prescribed, contact the prescriber immediately for clarification and for an order of the appropriate dose form of the medication. Do not change the route without the prescriber's order. There is an increased risk of seizure activity if one or more doses of the AED are missed. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

17. A 2-year-old child is to receive eardrops. The nurse is teaching the parent about giving the eardrops. Which statement reflects the proper technique for administering eardrops to this child? a. Administer the drops without pulling on the ear lobe. b. Straighten the ear canal by pulling the lobe upward and back. c. Straighten the ear canal by pulling the pinna down and back. d. Straighten the ear canal by pulling the pinna upward and outward.

ANS: C In an infant or a child younger than 3 years of age, the ear canal is straightened by pulling the pinna down and back. In adults, the pinna is pulled up and outward. Pulling the lobe and administering eardrops without pulling on the ear lobe are not appropriate actions. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Implementation Chapter 09: Photo Atlas of Drug Administration 47 MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

14. The nurse is assessing a patient for contraindications to drug therapy with acetaminophen (Tylenol). Which patient should not receive acetaminophen? a. A patient with a fever of 101° F (38.3° C) b. A patient who is complaining of a mild headache c. A patient with a history of liver disease d. A patient with a history of peptic ulcer disease

ANS: C Liver disease is a contraindication to the use of acetaminophen. Fever and mild headache are both possible indications for the medication. Having a history of peptic ulcer disease is not a contraindication. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 10: Analgesic Drugs 55

4. A 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually awakening, he requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is very lethargic and his respirations are shallow, with a rate of 7 per minute. The nurse prepares for which priority action at this time? a. Assessment of the patient's pain level b. Immediate intubation and artificial ventilation c. Administration of naloxone (Narcan) d. Close observation of signs of opioid tolerance

ANS: C Naloxone, an opioid-reversal agent, is used to reverse the effects of acute opioid overdose and is the drug of choice for reversal of opioid-induced respiratory depression. This situation is describing an opioid overdose, not opioid tolerance. Intubation and artificial ventilation are not appropriate because the patient is still breathing at 7 breaths/min. It would be inappropriate to assess the patient's level of pain. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. When evaluating a patient who is taking orlistat (Xenical), which is an intended therapeutic effect? a. Increased wakefulness b. Increased appetite c. Decreased weight d. Decreased hyperactivity

ANS: C Orlistat (Xenical) is a nonstimulant drug that is used as part of a weight loss program. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. Ramelteon (Rozerem) is prescribed for a patient with insomnia. The nurse checks the patient's medical history, knowing that this medication is contraindicated in which disorder? a. Coronary artery disease b. Renal insufficiency c. Liver disease d. Anemia

ANS: C Ramelteon is contraindicated in cases of severe liver dysfunction. The other conditions are not contraindications. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. The nurse is aware that confusion, forgetfulness, and increased risk for falls are common responses in an elderly patient who is taking which type of drug? a. Laxatives b. Anticoagulants c. Sedatives d. Antidepressants

ANS: C Sedatives and hypnotics often cause confusion, daytime sedation, ataxia, lethargy, forgetfulness, and increased risk for falls in the elderly. Laxatives, anticoagulants, and antidepressants may cause adverse effects in the elderly, but not the ones specified in the question. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

5. For which cultural group must the health care provider respect the value placed on preserving harmony with nature and the belief that disease is a result of ill spirits? a. Hispanics b. Asian Americans c. Native Americans d. African Americans

ANS: C Some Native Americans believe in preserving harmony with nature and that disease is a result of ill spirits. The groups listed in the other options do not typically reflect these practices. DIF: COGNITIVE LEVEL: Remembering (Knowledge) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Psychosocial Integrity

The nurse is performing an assessment of a newly admitted patient. Which is an example of subjective data? a. Blood pressure 158/96 mm Hg b. Weight 255 pounds c. The patient reports that he uses the herbal product ginkgo. d. The patient's laboratory work includes a complete blood count and urinalysis.

ANS: C Subjective data include information shared through the spoken word by any reliable source, such as the patient. Objective data may be defined as any information gathered through the senses or that which is seen, heard, felt, or smelled. A patient's blood pressure, weight, and laboratory tests are all examples of objective data.

20. A patient says he prefers to chew rather than swallow his pills. One of the pills has the abbreviation SR behind the name of the medication. The nurse needs to remember which correct instruction regarding how to give this medication? a. Break the tablet into halves or quarters. b. Dissolve the tablet in a small amount of water before giving it. c. Do not crush or break the tablet before administration. d. Crush the tablet as needed to ease administration.

ANS: C Sustained-release (SR) and enteric-coated tablets or capsules are forms of medications that must not be crushed before administration so as to protect the gastrointestinal lining or the medication itself. Do not break, dissolve, or crush these tablets before administering. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation Chapter 09: Photo Atlas of Drug Administration 48 MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

5. A 29-year-old male patient is admitted to the intensive care unit with the following symptoms: restlessness, hyperactive reflexes, talkativeness, confusion and periods of panic and euphoria, tachycardia, and fever. The nurse suspects that he may be experiencing the effects of taking which substance? a. Opioids b. Alcohol c. Stimulants d. Depressants

ANS: C The adverse effects listed may occur with use of stimulants and are commonly an extension of their therapeutic effects. Opioids, alcohol, and depressants do not have these effects. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. After administering an intradermal (ID) injection for a skin test, the nurse notices a small bleb at the injection site. The best action for the nurse to take at this time is to: a. apply heat. b. massage the area. c. do nothing. d. report the bleb to the physician.

ANS: C The formation of a small bleb is expected after an ID injection for skin testing. The other actions are not appropriate. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A 22-year-old nursing student has been taking NoDoz (caffeine) tablets for the past few weeks to "make it through" the end of the semester and exam week. She is in the university clinic today because she is "exhausted." What nursing diagnosis may be appropriate for her? a. Noncompliance b. Impaired physical mobility c. Disturbed sleep pattern d. Imbalanced nutrition: less than body requirements

ANS: C The main ingredient in NoDoz, caffeine, is a central nervous system stimulant that can be used to increase mental alertness. Restlessness, anxiety, and insomnia are common adverse effects. Thus, disturbed sleep pattern is the most appropriate nursing diagnosis of those listed. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Nursing Diagnosis MSC: NCLEX: Physiological Integrity: Physiological Adaptation

12. The nurse is assessing a patient who has been admitted to the emergency department for a possible opioid overdose. Which assessment finding is characteristic of an opioid drug overdose? a. Dilated pupils b. Restlessness c. Respiration rate of 6 breaths/min d. Heart rate of 55 beats/min

ANS: C The most serious adverse effect of opioid use is CNS depression, which may lead to respiratory depression. Pinpoint pupils, not dilated pupils, are seen. Restlessness and a heart rate of 55 beats/min are not indications of an opioid overdose. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

When the nurse considers the timing of a drug dose, which factor is appropriate to consider when deciding when to give a drug? a. The patient's ability to swallow b. The patient's height c. The patient's last meal d. The patient's allergies

ANS: C The nurse must consider specific pharmacokinetic/pharmacodynamic drug properties that may be affected by the timing of the last meal. The patient's ability to swallow, height, and allergies are not factors to consider regarding the timing of the drug's administration.

7. During an admission assessment, the nurse discovers that the patient does not speak English. Which is considered the ideal resource for translation? a. A family member of the patient b. A close family friend of the patient c. A translator who does not know the patient d. Prewritten note cards with both English and the patient's language

ANS: C The nurse should communicate with the patient in the patient's native language if at all possible. If the nurse is not able to speak the patient's native language, a translator should be made available so as to prevent communication problems, minimize errors, and help boost the patient's level of trust and understanding of the nurse. In practice, this translator may be another nurse or health care professional, a nonprofessional member of the health care team, or a layperson, family member, adult friend, or religious leader or associate. However, it is best to avoid family members as translators, if possible, because of issues with bias, misinterpretation, and potential confidentiality issues. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

6. A patient calls the clinic to ask about taking cranberry dietary supplement capsules because a friend recommended them. The nurse will discuss which possible concern when a patient is taking cranberry supplements? a. It may increase the risk for bleeding if the patient is taking anticoagulants. b. It may increase the risk of toxicity of some psychotherapeutic drugs. c. It may reduce elimination of drugs that are excreted by the kidneys. d. Cranberry may increase the intensity and duration of effects of caffeine.

ANS: C The use of cranberry decreases the elimination of many drugs that are renally excreted. The other concerns do not occur with cranberry supplements. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

11. When treating patients with medications for Parkinson's disease, the nurse knows that the wearing-off phenomenon occurs for which reason? a. There are rapid swings in the patient's response to levodopa. b. The patient cannot tolerate the medications at times. c. The medications begin to lose effectiveness against Parkinson's disease. d. The patient's liver is no longer able to metabolize the drug. MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

ANS: C The wearing-off phenomenon occurs when antiparkinson medications begin to lose their effectiveness, despite maximal dosing, as the disease progresses. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. The nurse is developing a care plan for a patient who will be self-administering insulin injections. Which statement reflects a measurable outcome? a. The patient will know about self-administration of insulin injections. b. The patient will understand the principles of self-administration of insulin injections. c. The patient will demonstrate the proper technique of self-administering insulin injections. d. The patient will comprehend the proper technique of self-administering insulin injections.

ANS: C The word demonstrate is a measurable verb, and measurable terms should be used when developing goals and outcome criteria statements. The other options are incorrect because the terms know, understand, and comprehend are not measurable terms. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care

7. A patient is brought to the emergency department for treatment of a suspected overdose. The patient was found with an empty prescription bottle of a barbiturate by his bedside. He is lethargic and barely breathing. The nurse would expect which immediate intervention? a. Starting an intravenous infusion of diluted bicarbonate solution b. Administering medications to increase blood pressure c. Implementing measures to maintain the airway and support respirations d. Administrating naloxone (Narcan) as an antagonist

ANS: C There are no antagonists/antidotes for barbiturates. Treatment supports respirations and maintains the airway. The other interventions are not appropriate. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. The nurse is assessing the medication history of a patient with a new diagnosis of Parkinson's disease. Which condition is a contraindication for the patient, who will be taking tolcapone (Tasmar)? a. Glaucoma Chapter 15: Antiparkinson Drugs 78 b. Seizure disorder c. Liver failure d. Benign prostatic hyperplasia

ANS: C Tolcapone is contraindicated in patients who have shown a hypersensitivity reaction to it, and it should be used with caution in patients with pre-existing liver disease. The other conditions listed are not contraindications. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

5. The nurse is administering a stat dose of epinephrine. Epinephrine is appropriate for which situation? a. Severe hypertension b. Angina c. Cardiac arrest d. Tachycardia

ANS: C Treatment of cardiac arrest is an indication for the use of epinephrine. The other options are not indications for epinephrine. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. A patient has been admitted to the emergency department with a suspected overdose of a tricyclic antidepressant. The nurse will prepare for what immediate concern? a. Hypertension b. Renal failure c. Cardiac dysrhythmias d. Gastrointestinal bleeding

ANS: C Tricyclic antidepressant overdoses are notoriously lethal. The primary organ systems affected are the central nervous system and the cardiovascular system, and death usually results from either seizures or dysrhythmias. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. The patient wants to take the herb valerian to help him rest at night. The nurse would be concerned about potential interactions if he is taking a medication from which class of drugs? a. Digitalis b. Anticoagulants c. Sedatives Chapter 07: Over-the-Counter Drugs and Herbal and Dietary Supplements 35 d. Immunosuppressants

ANS: C Valerian may cause increased central nervous system depression if used with sedatives. Digitalis, anticoagulants, and immunosuppressants do not have interactions with valerian. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

2. Which statements are true regarding the selective serotonin reuptake inhibitors (SSRIs)? (Select all that apply.) a. Avoid foods and beverages that contain tyramine. b. Monitor the patient for extrapyramidal symptoms. c. Therapeutic effects may not be seen for about 4 to 6 weeks after the medication is started. d. If the patient has been on an MAOI, a 2- to 5-week or longer time span is required before beginning an SSRI medication. e. These drugs have anticholinergic effects, including constipation, urinary retention, dry mouth, and blurred vision. f. Cogentin is often also prescribed to reduce the adverse effects that may occur.

ANS: C, D Chapter 16: Psychotherapeutic Drugs 87 During SSRI medication, therapeutic effects may not be seen for 4 to 6 weeks. To prevent the potentially fatal pharmacodynamic interactions that can occur between the SSRIs and the MAOIs, a 2- to 5-week washout period is recommended between uses of these two classes of medications. The other options apply to other classes of psychotherapeutic drugs, not SSRIs. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Which drugs would be affected by the first-pass effect? (Select all that apply.) a. Morphine given by IV push injection b. Sublingual nitroglycerin tablets c. Diphenhydramine (Benadryl) elixir d. Levothyroxine (Synthroid) tablets e. Transdermal nicotine patches f. Esomeprazole (Nexium) capsules g. Penicillin given by IV piggyback infusion

ANS: C, D, F Orally administered drugs (elixirs, tablets, capsules) undergo the first-pass effect because they are metabolized in the liver after being absorbed into the portal circulation from the small intestine. IV medications (IV push and IV piggyback) enter the bloodstream directly and do not go directly to the liver. Sublingual tablets and transdermal patches also enter the bloodstream without going directly to the liver, thus avoiding the first-pass effect.

The nurse is assigned to a patient who is newly diagnosed with type 1 diabetes mellitus. Which statement best illustrates an outcome criterion for this patient? a. The patient will follow instructions. b. The patient will not experience complications. c. The patient will adhere to the new insulin treatment regimen. d. The patient will demonstrate correct blood glucose testing technique.

ANS: D "Demonstrating correct blood glucose testing technique" is a specific and measurable outcome criterion. "Following instructions" and "not experiencing complications" are not specific criteria. "Adhering to new regimen" would be difficult to measure.

When monitoring the patient receiving an intravenous infusion to reduce blood pressure, the nurse notes that the patient's blood pressure is extremely low, and the patient is lethargic and difficult to awaken. This would be classified as which type of adverse drug reaction? a. Adverse effect b. Allergic reaction c. Idiosyncratic reaction d. Pharmacologic reaction

ANS: D A pharmacologic reaction is an extension of a drug's normal effects in the body. In this case, the antihypertensive drug lowered the patient's blood pressure levels too much. The other options do not describe a pharmacologic reaction. An adverse effect is a predictable, well-known adverse drug reaction that results in minor or no changes in patient management. An allergic reaction (also known as a hypersensitivity reaction) involves the patient's immune system. An idiosyncratic reaction is unexpected and is defined as a genetically determined abnormal response to normal dosages of a drug.

2. While monitoring a patient who had surgery under general anesthesia 2 hours ago, the nurse notes a sudden elevation in body temperature. This finding may be an indication of which problem? a. Tachyphylaxis b. Postoperative infection c. Malignant hypertension d. Malignant hyperthermia

ANS: D A sudden elevation in body temperature during the postoperative period may indicate the occurrence of malignant hyperthermia, a life-threatening emergency. The elevated temperature does not reflect the other problems listed. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

15. A patient arrives at the urgent care center complaining of leg pain after a fall when rock climbing. The x-rays show no broken bones, but he has a large bruise on his thigh. The patient says he drives a truck and does not want to take anything strong because he needs to stay awake. Which statement by the nurse is most appropriate? a. "It would be best for you not to take anything if you are planning to drive your truck." b. "We will discuss with your doctor about taking an opioid because that would work best for your pain." c. "You can take acetaminophen, also known as Tylenol, for pain, but no more than 1000 mg per day." d. "You can take acetaminophen, also known as Tylenol, for pain, but no more than 3000 mg per day."

ANS: D Acetaminophen is indicated for mild-to-moderate pain and does not cause drowsiness, as an opioid would. Currently, the maximum daily amount of acetaminophen is 3000 mg/day. The 1000-mg amount per day is too low. Telling the patient not to take any pain medications is incorrect. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

An elderly patient with a new diagnosis of hypertension will be receiving a new prescription for an antihypertensive drug. The nurse expects which type of dosing to occur with this drug therapy? a. Drug therapy will be based on the patient's weight. b. Drug therapy will be based on the patient's age. c. The patient will receive the maximum dose that is expected to reduce the blood pressure. d. The patient will receive the lowest possible dose at first, and then the dose will be increased as needed.

ANS: D As a general rule, dosing for elderly patients should follow the admonition, "Start low, and go slow," which means to start with the lowest possible dose (often less than an average adult dose) and increase the dose slowly, if needed, based on patient response. The other responses are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A patient has been taking phenobarbital for 2 weeks as part of his therapy for epilepsy. He tells the nurse that he feels tense and that "the least little thing" bothers him now. Which is the correct explanation for this problem? a. These are adverse effects that usually subside after a few weeks. b. The drug must be stopped immediately because of possible adverse effects. c. This drug causes the rapid eye movement (REM) sleep period to increase, resulting in nightmares and restlessness. d. This drug causes deprivation of REM sleep and may cause the inability to deal with normal stress.

ANS: D Barbiturates such as phenobarbital deprive people of REM sleep, which can result in agitation and the inability to deal with normal stress. A rebound phenomenon occurs when the drug is stopped (not during therapy), and the proportion of REM sleep increases, sometimes resulting in nightmares. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

8. A patient has a new order for a catechol ortho-methyltransferase (COMT) inhibitor as part of treatment for Parkinson's disease. The nurse recognizes that which of these is an advantage of this drug class? a. It has a shorter duration of action. b. It causes less gastrointestinal distress. c. It has a slower onset than traditional Parkinson's disease drugs. d. It is associated with fewer wearing-off effects.

ANS: D COMT inhibitors are associated with fewer wearing-off effects and have prolonged therapeutic benefits. They have a quicker onset, and they prolong the duration of action of levodopa. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. A 6-year-old boy has been started on an extended-release form of methylphenidate hydrochloride (Ritalin) for the treatment of attention deficit hyperactivity disorder (ADHD). During a followup visit, his mother tells the nurse that she has been giving the medication at bedtime so that it will be "in his system" when he goes to school the next morning. What is the nurse's appropriate evaluation of the mother's actions? a. She is giving him the medication dosage appropriately. b. The medication should not be taken until he is at school. c. The medication should be taken with meals for optimal absorption. d. The medication should be given 4 to 6 hours before bedtime to diminish insomnia.

ANS: D Central nervous system stimulants should be taken 4 to 6 hours before bedtime to decrease insomnia. Generally speaking, once-a-day dosing is used with extended-release or long-acting preparations. These formulations eliminate the need to take this medication at school. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

8. The nurse is teaching a 16-year-old patient who has a new diagnosis of type 1 diabetes about blood glucose monitoring and the importance of regulating glucose intake. When developing a teaching plan for this teenager, which of Erikson's stages of development should the nurse consider? a. Trust versus mistrust b. Intimacy versus isolation c. Industry versus inferiority d. Identity versus role confusion

ANS: D Chapter 06: Patient Education and Drug Therapy 32 According to Erikson, the adolescent (12 to 18 years of age) is in the identity versus role confusion stage of development. Trust versus mistrust reflects the infancy stage; intimacy versus isolation reflects the young adulthood stage; and industry versus inferiority reflects the school age stage of development. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Psychosocial Integrity

3. When assessing patients in the preoperative area, the nurse knows that which patient is at a higher risk for an altered response to anesthesia? a. The 21-year-old patient who has never had surgery before b. The 35-year-old patient who stopped smoking 8 years ago c. The 40-year-old patient who is to have a kidney stone removed d. The 82-year-old patient who is to have gallbladder removal

ANS: D Chapter 11: General and Local Anesthetics 58 The elderly patient is more affected by anesthesia than the young or middle-aged adult patient because of the effects of aging on the hepatic, cardiac, respiratory, and renal systems. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

3. When teaching a patient about taking a newly prescribed antiepileptic drug (AED) at home, the nurse will include which instruction? a. "Driving is allowed after 2 weeks of therapy." b. "If seizures recur, take a double dose of the medication." c. "Antacids can be taken with the AED to reduce gastrointestinal adverse effects." d. "Regular, consistent dosing is important for successful treatment."

ANS: D Chapter 14: Antiepileptic Drugs 71 Consistent dosing, taken regularly at the same time of day, at the recommended dose, and with meals to reduce the common gastrointestinal adverse effects, is the key to successful management of seizures when taking AEDs. Noncompliance is the factor most likely to lead to treatment failure. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

3. A patient has been taking naltrexone (ReVia) as part of the treatment for addiction to heroin. The nurse expects that the naltrexone will have which therapeutic effect for this patient? a. Naltrexone prevents the cravings for opioid drugs. b. Naltrexone works as a safer substitute for the heroin until the patient completes withdrawal. c. The patient will experience flushing, sweating, and severe nausea if he takes heroin while on naltrexone. d. If opioid drugs are used while taking naltrexone, euphoria is not produced; thus, the opioid's desired effects are lost.

ANS: D Chapter 17: Substance Use Disorder 89 Naltrexone works to eliminate the euphoria that occurs with opioid drug use; therefore, the reinforcing effect of the drug is lost. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. Carbidopa-levodopa (Sinemet) is prescribed for a patient with Parkinson's disease. The nurse informs the patient that which common adverse effects can occur with this medication? a. Drowsiness, headache, weight loss b. Dizziness, insomnia, nausea c. Peripheral edema, fatigue, syncope d. Heart palpitations, hypotension, urinary retention

ANS: D Common adverse reactions associated with carbidopa-levodopa include palpitations, hypotension, urinary retention, dyskinesia, and depression. The other effects may occur with other antiparkinson drugs. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. The nurse is setting up a teaching session with an 85-year-old patient who will be going home on anticoagulant therapy. Which educational strategy would reflect consideration of the age-related changes that may exist with this patient? a. Show a video about anticoagulation therapy. b. Present all the information in one session just before discharge. c. Give the patient pamphlets about the medications to read at home. d. Develop large-print handouts that reflect the verbal information presented.

ANS: D Developing large-print handouts addresses altered perception in two ways. First, by using visual aids to reinforce verbal instructions, one addresses the possibility of decreased ability to hear high-frequency sounds. By developing the handouts in large print, one addresses the possibility of decreased visual acuity. Showing a video does not allow discussion of the information; furthermore, the text and print may be small and difficult to read and understand. Presenting all the information in one session before discharge also does not allow for discussion, and the patient may not be able to hear or see the information sufficiently. Because of the possibility of decreased short-term memory and slowed cognitive function, giving pamphlets to read may not be appropriate. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Health Promotion and Maintenance

10. The nurse is preparing to administer dopamine. Which is the correct technique for administering dopamine? a. Orally b. Intravenous (IV) push injection c. Intermittent IV infusions (IV piggyback) d. Continuous IV infusion with an infusion pump

ANS: D Dopamine is available only as an IV injectable drug and is given by continuous infusion, using an infusion pump. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. When a patient is taking an anticholinergic such as benztropine (Cogentin) as part of the treatment for Parkinson's disease, the nurse should include which information in the teaching plan? a. Minimize the amount of fluid taken while on this drug. b. Discontinue the medication if adverse effects occur. c. Take the medication on an empty stomach to enhance absorption. Chapter 15: Antiparkinson Drugs 77 d. Use artificial saliva, sugarless gum, or hard candy to counteract dry mouth.

ANS: D Dry mouth can be managed with artificial saliva through drops or gum, frequent mouth care, forced fluids, and sucking on sugar-free hard candy. Anticholinergics should be taken with or after meals to minimize GI upset and must not be discontinued suddenly. The patient must drink at least 3000 mL/day unless contraindicated. Drinking water is important, even if the patient is not thirsty or in need of hydration, to prevent and manage the adverse effect of constipation. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

When administering drugs, the nurse remembers that the duration of action of a drug is defined as which of these? a. The time it takes for a drug to elicit a therapeutic response b. The amount of time needed to remove a drug from circulation c. The time it takes for a drug to achieve its maximum therapeutic response d. The time period at which a drug's concentration is sufficient to cause a therapeutic response

ANS: D Duration of action is the time during which drug concentration is sufficient to elicit a therapeutic response. The other options do not define duration of action. A drug's onset of action is the time it takes for the drug to elicit a therapeutic response. A drug's peak effect is the time it takes for the drug to reach its maximum therapeutic response. Elimination is the length of time it takes to remove a drug from circulation.

10. A patient has experienced insomnia for months, and the physician has prescribed a medication to help with this problem. The nurse expects which drug to be used for long-term treatment of insomnia? a. Secobarbital (Seconal), a barbiturate b. Diazepam (Valium), a benzodiazepine c. Midazolam (Versed), a benzodiazepine d. Eszopiclone (Lunesta), a nonbenzodiazepine sleep aid

ANS: D Eszopiclone (Lunesta) is one of the newest prescription hypnotics to be approved for long-term use in treatment of insomnia. Barbiturates and benzodiazepines are not appropriate for long-term treatment of insomnia; midazolam is used for procedural (moderate) sedation. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. A patient has been taking the monoamine oxidase inhibitor (MAOI) phenelzine (Nardil) for 6 months. The patient wants to go to a party and asks the nurse, "Will just one beer be a problem?" Which advice from the nurse is correct? a. "You can drink beer as long as you have a designated driver." b. "Now that you've had the last dose of that medication, there will be no further dietary restrictions." c. "If you begin to experience a throbbing headache, rapid pulse, or nausea, you'll need to stop drinking." d. "You need to avoid all foods that contain tyramine, including beer, while taking this medication."

ANS: D Foods containing tyramine, such as beer and aged cheeses, should be avoided while a patient is taking an MAOI. Drinking beer while taking an MAOI may precipitate a dangerous hypertensive crisis. The other options are incorrect. DIF: COGNITIVE LEVEL: Analyzing (Analysis) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

14. The nurse is giving medications through a percutaneous endoscopic gastrostomy (PEG) tube. Which technique is correct? a. Administering the medications using a 3-mL medication syringe b. Applying firm pressure on the syringe's piston to infuse the medication c. Flushing the tubing with 30 mL of saline after the medication has been given d. Using the barrel of the syringe, allowing the medication to flow via gravity into the tube

ANS: D For PEG tubes (and nasogastric tubes), medications are poured into the barrel of the syringe with the piston removed, and the medication is allowed to flow via gravity into the tube. Fluid must never be forced into the tube. The tubing is to be flushed with 30 mL of tap water (not saline) to ensure that the medication is cleared from the tube after the medication has been given. A 3-mL syringe is too small for this procedure. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

1. The nurse is writing a nursing diagnosis for a plan of care for a patient who has been newly diagnosed with type 2 diabetes. Which statement reflects the correct format for a nursing diagnosis? a. Anxiety b. Anxiety related to new drug therapy c. Anxiety related to anxious feelings about drug therapy, as evidenced by statements such as "I'm upset about having to test my blood sugars." d. Anxiety related to new drug therapy, as evidenced by statements such as "I'm upset about having to test my blood sugars."

ANS: D Formulation of nursing diagnoses is usually a three-step process. "Anxiety" is missing the "related to" and "as evidenced by" portions of defining characteristics. "Anxiety related to new drug therapy" is missing the "as evidenced by" portion of defining characteristics. The statement beginning "Anxiety related to anxious feelings" is incorrect because the "related to" section is simply a restatement of the problem "anxiety," not a separate factor related to the response.

MULTIPLE CHOICE 1. During a fishing trip, a patient pierced his finger with a large fishhook. He is now in the emergency department to have it removed. The nurse anticipates that which type of anesthesia will be used for this procedure? a. No anesthesia b. Topical benzocaine spray on the area c. Topical prilocaine (EMLA) cream around the site d. Infiltration of the puncture wound with lidocaine

ANS: D Infiltration anesthesia is commonly used for minor surgical procedures. It involves injecting the local anesthetic solution intradermally, subcutaneously, or submucosally across the path of nerves supplying the area to be anesthetized. The local anesthetic may be administered in a circular pattern around the operative field. The other types are not appropriate for this injury. This is a painful procedure; therefore, the option of "no anesthesia" is incorrect. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A patient has been selected as a potential recipient of an experimental drug for heart failure. The nurse knows that when informed consent has been obtained, it indicates which of these? a. The patient has been informed of the possible benefits of the new therapy. b. The patient will be informed of the details of the study as the research continues. c. The patient will receive the actual drug during the experiment. d. The patient has had the study's purpose, procedures, and the risks involved explained to him.

ANS: D Informed consent involves the careful explanation of the purpose of the study, the procedures to be used, and the risks involved. The other options do not describe informed consent. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

11. During a routine appointment, a patient with a history of seizures is found to have a phenytoin (Dilantin) level of 23 mcg/mL. What concern will the nurse have, if any? a. The patient is at risk for seizures because the drug level is not at a therapeutic level. b. The patient's seizures should be under control because this is a therapeutic drug level. c. The patient's seizures should be under control if she is also taking a second antiepileptic drug. d. The drug level is at a toxic level, and the dosage needs to be reduced.

ANS: D Therapeutic drug levels for phenytoin are usually 10 to 20 mcg/mL (see Table 14-6). The other options are incorrect. DIF: COGNITIVE LEVEL: Analyzing (Analysis) Chapter 14: Antiepileptic Drugs 74 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

4. A patient has just been told that she has the genetic markers for a severe type of breast cancer. After the patient meets with the physician, the patient's daughter asks the nurse, "What did the doctor tell my mother? She seems upset." What is the nurse's best response? a. "I'm sorry, but I'm not allowed to discuss that." b. "The physician will discuss this with you." c. "It seems that your mother has the genetic markers for a type of breast cancer." d. "This is information that your mother will need to discuss with you."

ANS: D Maintaining privacy and confidentiality is of utmost importance during genetic testing and counseling. The patient (not the nurse or the physician) is the one who decides whether to include or exclude any family members from the discussion and from knowledge of the results of genetic testing. Telling the patient's daughter that you are "not allowed" to discuss the matter would cause more anxiety. Telling the daughter about the genetic markers would be a violation of the patient's privacy. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

13. The drug nalbuphine (Nubain) is an agonist-antagonist (partial agonist). The nurse understands that which is a characteristic of partial agonists? a. They have anti-inflammatory effects. b. They are given to reverse the effects of opiates. c. They have a higher potency than agonists. d. They have a lower dependency potential than agonists.

ANS: D Partial agonists such as nalbuphine are similar to the opioid agonists in terms of their therapeutic indications; however, they have a lower risk of misuse and addiction. They do not have antiinflammatory effects, nor are they given to reverse the effects of opiates. They do not have a higher potency than agonists. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. When administering a neuromuscular blocking drug, the nurse needs to remember which principle? a. It is used instead of general anesthesia during surgery. b. Only skeletal muscles are paralyzed; respiratory muscles remain functional. c. It causes sedation and pain relief while allowing for lower doses of anesthetics. d. Artificial mechanical ventilation is required because of paralyzed respiratory muscles.

ANS: D Patients receiving neuromuscular blocking drugs require artificial mechanical ventilation because of the resultant paralysis of the respiratory muscles. In addition, they do not cause sedation or pain relief. They are used along with, not instead of, general anesthesia during surgery. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. A patient tells the nurse that he likes to drink kava herbal tea to help him relax. Which statement by the patient indicates that additional teaching about this herbal product is needed? a. "I will not drink wine with the kava tea." b. "If I notice my skin turning yellow, I will stop taking the tea." c. "I will not take sleeping pills if I have this tea in the evening." d. "I will be able to drive my car after drinking this tea."

ANS: D Patients should not drive after drinking this tea because it may cause sedation. Kava tea may cause skin discoloration (with long-term use). In addition, it must not be taken with alcohol, barbiturates, and psychoactive drugs. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

7. A patient with the diagnosis of schizophrenia is hospitalized and is taking a phenothiazine drug. Which statement by this patient indicates that he is experiencing a common adverse effect of phenothiazines? a. "I can't sleep at night." b. "I feel hungry all the time." c. "Look at how red my hands are." d. "My mouth has been so dry lately."

ANS: D Phenothiazines produce anticholinergic-like adverse effects of dry mouth, urinary hesitancy, and constipation. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

15. The nurse is about to give a rectal suppository to a patient. Which technique would facilitate the administration and absorption of the rectal suppository? Chapter 09: Photo Atlas of Drug Administration 46 a. Having the patient lie on his or her right side, unless contraindicated b. Having the patient hold his or her breath during insertion of the medication c. Lubricating the suppository with a small amount of petroleum-based lubricant before insertion d. Encouraging the patient to lie on his or her left side for 15 to 20 minutes after insertion

ANS: D Position the patient on his or her left side for rectal suppository insertion. The suppository is then lubricated with a small amount of water-soluble lubricant, not petroleum-based substances. The patient is told to take a deep breath and exhale through the mouth during insertion. Then the patient needs to remain lying on the left side for 15 to 20 minutes to allow absorption of the drug. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A patient who started taking orlistat (Xenical) 1 month ago calls the clinic to report some "embarrassing" adverse effects. She tells the nurse that she has had episodes of "not being able to control my bowel movements." Which statement is true about this situation? a. These are expected adverse effects that will eventually diminish. b. The patient will need to stop this drug immediately if these adverse effects are occurring. c. The patient will need to increase her fat intake to prevent these adverse effects. d. The patient will need to restrict fat intake to less than 30% to help reduce these adverse effects.

ANS: D Restricting dietary intake of fat to less than 30% of total calories can help reduce some of the GI adverse effects, which include oily spotting, flatulence, and fecal incontinence. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

7. A 14-year-old patient has been treated for asthma for almost 4 months. Two weeks ago, she was given salmeterol as part of her medication regimen. However, her mother has called the clinic to report that it does not seem to work when her daughter is having an asthma attack. Which response by the nurse is appropriate? a. "It takes time for a therapeutic response to develop." b. "She is too young for this particular medication; it will be changed." c. "She needs to take up to two puffs every 4 hours to ensure adequate blood levels." d. "This medication is indicated for prevention of bronchospasms, not for relief of acute symptoms."

ANS: D Salmeterol is indicated for the prevention of bronchospasms, not treatment of acute symptoms. The dosage is usually two puffs twice daily, 12 hours apart, for maintenance effects in patients older than 12 years of age. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. The nurse is measuring 4 mL of a liquid cough elixir for a child. Which method is most appropriate? a. Using a teaspoon to measure and administer b. Holding the medication cup at eye level and filling it to the desired level c. Withdrawing the elixir from the container using a syringe without a needle attached d. Withdrawing the elixir from the container using a calibrated oral syringe

ANS: D Small doses of liquid medications must be withdrawn using a calibrated oral syringe. A hypodermic syringe or a syringe with a needle or syringe cap must not be used. If hypodermic syringes are used, the drug may be inadvertently given parenterally, or the syringe cap or needle, if not removed from the syringe, may become dislodged and accidentally aspirated by the patient when the syringe plunger is pressed. The other methods are not accurate for small volumes. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. An 18-year-old basketball player fell and twisted his ankle during a game. The nurse will expect to administer which type of analgesic? a. Synthetic opioid, such as meperidine (Demerol) b. Opium alkaloid, such as morphine sulfate c. Opioid antagonist, such as naloxone HCL (Narcan) d. Nonopioid analgesic, such as indomethacin (Indocin)

ANS: D Somatic pain, which originates from skeletal muscles, ligaments, and joints, usually responds to nonopioid analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs). The other options are not the best choices for somatic pain. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

1. A 25-year-old woman is visiting the prenatal clinic and shares with the nurse her desire to go "natural" with her pregnancy. She shows the nurse a list of herbal remedies that she wants to buy so that she can "avoid taking any drugs." Which statement by the nurse is correct? a. "Most herbal remedies are not harmful and are safe for use during pregnancy." b. "Please read each label carefully before use to check for cautionary warnings." c. "Keep in mind that products from different manufacturers are required to contain consistent amounts of the herbal products." d. "It's important to remember that herbal remedies do not have proven safety ratings for pregnant women."

ANS: D The fact that a drug is an herbal or a dietary supplement does not mean that it can be safely administered to children, infants, or pregnant or lactating women. Many herbal products have not been tested for safety during pregnancy. Simply reading the labels may not provide enough information for use during pregnancy. Last, manufacturers of herbal products are not required to guarantee the reliability of the contents. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Health Promotion and Maintenance

8. A patient has been taking the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft) for about 6 months. At a recent visit, she tells the nurse that she has been interested in herbal therapies and wants to start taking St. John's wort. Which response by the nurse is appropriate? a. "That should be no problem." b. "Good idea! Hopefully you'll be able to stop taking the Zoloft." c. "Be sure to stop taking the herb if you notice a change in side effects." d. "Taking St. John's wort with Zoloft may cause severe interactions and is not recommended."

ANS: D The herbal product St. John's wort must not be used with SSRIs. Potential interactions include confusion, agitation, muscle spasms, twitching, and tremors. The other responses by the nurse are inappropriate. DIF: COGNITIVE LEVEL: Analyzing (Analysis) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

The nurse is administering medications to the patient who is in renal failure resulting from end stage renal disease. The nurse is aware that patients with kidney failure would most likely have problems with which pharmacokinetic phase? a. Absorption b. Distribution c. Metabolism d. Excretion

ANS: D The kidneys are the organs that are most responsible for drug excretion. Renal function does not affect the absorption and distribution of a drug. Renal function may affect metabolism of drugs to a small extent.

4. A patient is undergoing abdominal surgery and has been anesthetized for 3 hours. Which nursing diagnosis would be appropriate for this patient? a. Anxiety related to the use of an anesthetic b. Risk for injury related to increased sensorium from general anesthesia c. Decreased cardiac output related to systemic effects of local anesthesia d. Impaired gas exchange related to central nervous system depression produced by general anesthesia

ANS: D The nursing diagnosis of impaired gas exchange is appropriately worded for this patient. Anxiety would not be appropriate while the patient is in surgery. Sensorium would be decreased during surgery, not increased. Cardiac output is affected by general anesthesia, not local anesthesia. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Nursing Diagnosis MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. The patient has been taking an over-the-counter (OTC) acid-reducing drug because he has had "stomach problems" for several months. He tells the nurse that the medicine helps as long as he takes it, but once he stops it, the symptoms return. Which statement by the nurse is the best advice for this patient? a. "The over-the-counter drug has helped you, so you should continue to take it." b. "The over-the-counter dosage may not be strong enough. You should be taking prescription-strength for best effects." c. "For best results, you need to watch what you eat in addition to taking this drug." d. "Using this drug may relieve your symptoms, but it does not address the cause. You should be seen by your health care provider."

ANS: D The use of OTC drugs may postpone effective management of chronic disease states and may delay treatment of serious or life-threatening disorders because these drugs may relieve symptoms without necessarily addressing the cause of the disorder. The other options do not address the need to investigate the cause of the symptoms and are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care

5. The nurse has an order to administer an intramuscular (IM) immunization to a 2-month-old child. Which site is considered the best choice for this injection? a. Deltoid b. Dorsogluteal c. Ventrogluteal d. Vastus lateralis

ANS: D The vastus lateralis is the preferred site of injection of drugs such as immunizations for infants. The other sites are not appropriate for infants. The ventrogluteal site is the preferred site for adults and children. The deltoid site is used only for the administration of immunizations to toddlers, older children, and adults (not infants) and only for small volumes of medication. The dorsogluteal site is no longer recommended because of the possibility of nerve injury. DIF: COGNITIVE LEVEL: Understanding (Comprehension) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A patient has been treated with antiparkinson medications for 3 months. What therapeutic responses should the nurse look for when assessing this patient? a. Decreased appetite b. Gradual development of cogwheel rigidity c. Newly developed dyskinesias d. Improved ability to perform activities of daily living

ANS: D Therapeutic responses to antiparkinson agents include an improved sense of well-being, improved mental status, increased appetite, increased ability to perform activities of daily living and to concentrate and think clearly, and less intense parkinsonian manifestations. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

Before administering any medication, what is the nurse's priority action regarding patient safety? a. Verifying orders with another nurse b. Documenting the medications given c. Counting medications in the medication cart drawers d. Checking the patient's identification using two identifiers

ANS: D Verifying the patient's identity, using two identifiers, before administering any medication is essential for the patient's safety and reflects checking one of the "Nine Rights" of medication administration. Documentation is done after the medications are given.

16. A patient is receiving eyedrops that contain a beta-blocker medication. The nurse will use what method to reduce systemic effects after administering the eyedrops? a. Wiping off excess liquid immediately after instilling the drops b. Having the patient close the eye tightly after the drops are instilled c. Having the patient try to keep the eye open for 30 seconds after the drops are instilled d. Applying gentle pressure to the patient's nasolacrimal duct for 30 to 60 seconds after instilling the drops

ANS: D When administering ophthalmic drugs that may cause systemic effects, one's finger should be protected by a clean tissue or glove and gentle pressure applied to the patient's nasolacrimal duct for 30 to 60 seconds. The other actions are not appropriate. DIF: COGNITIVE LEVEL: Applying (Application) TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

When reviewing the mechanism of action of a specific drug, the nurse reads that the drug works by selective enzyme interaction. Which of these processes describes selective enzyme interaction? a. The drug alters cell membrane permeability. b. The drug's effectiveness within the cell walls of the target tissue is enhanced. c. The drug is attracted to a receptor on the cell wall, preventing an enzyme from binding to that receptor. d. The drug binds to an enzyme molecule and inhibits or enhances the enzyme's action with the normal target cell.

ANS: D With selective enzyme interaction, the drug attracts the enzymes to bind with the drug instead of allowing the enzymes to bind with their normal target cells. As a result, the target cells are protected from the action of the enzymes. This results in a drug effect. The actions described in the other options do not occur with selective enzyme interactions

3. When discussing dosage calculation for pediatric patients with a clinical pharmacist, the nurse notes that which type of dosage calculation is used most commonly in pediatric calculations? a. West nomogram b. Clark rule c. Height-to-weight ratio d. Milligram per kilogram of body weight formula

ANS: D The milligram per kilogram formula, based on body weight, is the most common method of calculating doses for pediatric patients. The other options are available methods but are not the most commonly used. Height-to-weight ratio is not used.