Pharm final LILLEY
A mother of a 1-month-old infant calls the clinic and asks the nurse if the medication she is taking can be passed to her infant during breastfeeding. What is the nurse's best response to the mother's question? -"Drugs can cross from mother to infant in breast milk, it will depend on the specific drug you are taking." -"All medications pass to infants while breastfeeding." -"You should not take any medication while breastfeeding." -"I will leave the health care provider a message to return your call."
"Drugs can cross from mother to infant in breast milk, it will depend on the specific drug you are taking." The nurse is aware that medications can pass in breast milk, but each medication is different. Women who take medication while breastfeeding must be assessed on a case-by-case basis, including assessment of the medication the patient is taking.
A patient asks the nurse why a lower dose of IV pain medication is being given than the previous oral dose. What is the nurse's best response to the patient? -Drugs administered intravenously enter the portal system before systemic distribution." -"Medications given orally bypass the portal circulatory system." -"Medications given intravenously are not affected by the first-pass effect." -"A large percentage of an intravenously administered drug is metabolized into inactive metabolites in the liver."
"Medications given intravenously are not affected by the first-pass effect." When drugs with a high first-pass effect are administered orally, a large amount of drug may be metabolized before it reaches the systemic circulation. The same drug given IV will bypass the liver. This prevents the first-pass effect from taking place, and therefore more of the drug reaches the circulation. Parenteral doses of drugs with a high first-pass effect are much smaller than oral doses, yet they produce the same pharmacologic response.
A patient is prescribed epinephrine eyedrops for treatment of chronic open-angle glaucoma. The patient complains of burning with instillation of the drops. What statement is the nurse's best response? "It is a normal sensation because the eyedrops reduce inflammation." "This will occur if the drop is not placed in the correct area of the eye." "That should not occur. Contact your health care provider immediately." "This is a typical adverse effect and may lessen over time."
"This is a typical adverse effect and may lessen over time."
The nurse is preparing to administer an injection of morphine to a patient. Assessment notes a respiratory rate of 10 breaths/min. Which action will the nurse perform? - Administer a smaller dose and record the findings. - Notify the physician and delay drug administration. - Administer the prescribed dose and notify the physician .- Hold the drug, record the assessment, and recheck in 1 hour.
- Notify the physician and delay drug administration. Respiratory depression is a side effect of narcotic analgesia. Therefore since the patient's respiratory rate is below normal, the nurse should withhold the morphine and notify the physician.
When assessing for the most serious adverse reaction to a narcotic analgesic, what does the nurse monitor for in the patient? - Respiratory rate - Heart rate - Blood pressure - Mental status
- Respiratory rate The most serious side effect of narcotic analgesics is respiratory depression.
While admitting a patient for treatment of an acetaminophen overdose, the nurse prepares to administer which medication to prevent toxicity? - naloxone (Narcan) - acetylcysteine (Mucomyst) - methylprednisolone (Solu-Medrol) - vitamin K
- acetylcysteine (Mucomyst) Acetylcysteine is the antidote for acetaminophen overdose. It must be administered as a loading dose followed by subsequent doses every 4 hours for 17 more doses and started as soon as possible after the acetaminophen ingestion (ideally within 12 hours).
Which medication is used to treat a patient suffering from severe adverse effects of a narcotic analgesic? - naloxone (Narcan) - acetylcysteine (Mucomyst) - methylprednisolone (Solu-Medrol) - flumazenil (Romazicon)
- naloxone (Narcan) Naloxone is the narcotic antagonist that will reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.
A patient who is prescribed an anticoagulant requests an aspirin (acetylsalicylic acid) for headache relief. What is the nurse's best action? a. Inform the patient of potential drug interactions with anticoagulants. b. Explain that a common initial adverse effect is a headache for this drug. c. Explain that acetylsalicylic acid is contraindicated and administer ibuprofen .d. Administer 650 mg of acetylsalicylic acid and reassess pain in 30 minutes.
A
The nurse notes a patient's international normalized ratio (INR) value of 2.5. What is the meaning of this reported value? a. The patient's warfarin dose is within the therapeutic range .b. The patient needs the subcutaneous heparin dose increased .c. The patient is not receiving enough warfarin for a therapeutic effect. d. The patient is receiving too much heparin and is at risk for bleeding.
A
What information should the nurse chart when documenting medication administration? (Select all that apply.) A) The dosage of medication administered B) The time of administration C) The patient's age D) Information about an "incident report" in the patient's chart E) The route of administration
A) The dosage of medication administered B) The time of administration E) The route of administration
What things should the nurse check when reviewing a prescription with a patient? (Select all that apply.) A) The signature of the prescriber B) The age of the patient C) The patient's home address D) The patient's emergency contact
A) The signature of the prescriber E) The route of administration
The nurse recognizes that the patient understands the teaching about warfarin (Coumadin) when the patient verbalizes an increased risk of bleeding with concurrent use of which herbal product? (Select all that apply.) a. Garlic b. Ginkgo c. Dong quai d. Glucosamine e. St. John's wort
A,B,C,E
When teaching a patient who will be receiving antihistamines, the nurse will include which instructions? (SELECT ALL THAT APPLY.) A. "Drink extra fluids if possible. "B. "Take the medication on an empty stomach to maximize absorption of the drug. "C. "Avoid activities that require alertness until you know how adverse effects are tolerated. "D. "Antihistamines may cause restlessness and disturbed sleep. "E. "Take the medication with food to minimize gastrointestinal distress. "F. "Antihistamines are generally safe to take with over-the-counter medications."
A. "Drink extra fluids if possible." C. "Avoid activities that require alertness until you know how adverse effects are tolerated. "E. "Take the medication with food to minimize gastrointestinal distress."
When applying transdermal nitroglycerin patches, which instruction by the nurse is correct? A. "Rotate application sites with each dose." B. "Apply the patch to the same site each time." C. "Temporarily remove the patch if you go swimming." D. "Use only the chest area for application sites."
A. "Rotate application sites with each dose."
When the nurse is administering topical nitroglycerin ointment, which technique is correct? A. Remove the old ointment before new ointment is applied. B. Message the ointment gently into the skin, and then cover the area wit plastic wrap .C. Apply the ointment on the skin on the forearm. D. Apply the ointment only in the case of a mild angina episode.
A. Remove the old ointment before new ointment is applied.
The nurse is reviewing medications for the treatment of asthma. Which drugs are used for acute asthma attacks? (SELECT ALL THAT APPLY.) A. epinephrine B. fluticasone (Flovent) Rotadisk inhaler C. salmeterol (Serevent) inhaler D. montelukast (Singulair) E. aminophylline IV infusion F. albuterol (Proventil) nebulizer solution
A. epinephrine E. aminophylline IV infusion F. albuterol (Proventil) nebulizer solution
Which nursing diagnosis is appropriate for a patient who has started aminoglycoside therapy? A.Risk for injury (renal damage) B.Constipation C.Disturbed body image related to gynecomastia D.Imbalanced nutrition, less than body requirements, related to nausea
A.Risk for injury (renal damage)
The nurse is monitoring a patient who has been on antibiotic therapy for 2 weeks. Today the patient tells the nurse that he has had watery diarrhea since the day before and is having abdominal cramps. His oral temperature is 101 F (38.3 C). Based on these findings, which conclusion will the nurse draw? A.The patient needs to be tested for Clostridium difficile infection .B.The patient's original infection has not responded to the antibiotic therapy. C.The patient will need to take a different antibiotic. D.The patient is showing typical adverse effects of antibiotic therapy.
A.The patient needs to be tested for Clostridium difficile infection.
A patient is taking a combination of antiviral drugs as treatment for early stages of HIV infection. While discussing the drug therapy, the patient asks the nurse if the drugs will kill the virus. When answering, the nurse keeps in mind which fact about antiviral drugs? A.They may also kill healthy cells while killing viruses. B.They are given for palliative reasons only. C.They can be given in large enough doses to eradicate the virus without harming the body's health cells. D.They will be effective as long as the patient is not exposed to the virus again.
A.They may also kill healthy cells while killing viruses.
When a patient is on aminoglycoside therapy, the nurse will monitor the patient for which indicators of potential toxicity?A.Tinnitus and dizziness B.Fever C.White blood cell count of 8000 cells/mm3 D.Decreased blood urea nitrogen (BUN) levels
A.Tinnitus and dizziness
When teaching a patient about the proper application of timolol (Timoptic) eyedrops, the nurse will include which instruction? a. "Apply the drops into the conjunctival sac instead of directly onto the eye. "b. "Apply the drops directly to the eyeball (cornea) for the best effect." c. "Blot your eye with a tissue immediately after applying the drops." d. "Tilt your head forward before applying the eyedrops."
ANS: A All ophthalmic drugs should be administered in the conjunctival sac. Gently use a tissue to remove excess eye medication—do not blot the eye after giving the medication. Tilt the head back before giving the eyedrops.
A patient with elevated lipid levels has a new prescription for nicotinic acid (niacin). The nurse informs the patient that which adverse effects may occur with this medication? a. Pruritus, cutaneous flushing b. Tinnitus, urine with a burnt odor c. Myalgia, fatigue d. Blurred vision, headaches
ANS: A Possible adverse effects of nicotinic acid include pruritus, cutaneous flushing, and gastrointestinal distress. Tinnitus, urine with a burnt odor, and headaches are possible adverse effects of bile acid sequestrants. Headaches are also possible adverse effects of HMG-CoA reductase inhibitors, as are myalgia and fatigue.
A patient has had recent mechanical heart valve surgery and is receiving anticoagulant therapy. While monitoring the patient's laboratory work, the nurse interprets that the patient's international normalized ratio (INR) level of 3 indicates that :a.the patient is not receiving enough warfarin to have a therapeutic effect. b.the patient's warfarin dose is at therapeutic levels .c.the patient's intravenous heparin dose is dangerously high. d.the patient's intravenous heparin dose is at therapeutic levels.
ANS: B A normal INR (without warfarin) is 1.0. A therapeutic INR for patients who have had mechanical heart valve surgery ranges from 2.5 to 3.5, with a middle value of 3.
A patient is receiving heparin therapy as part of the treatment for a pulmonary embolism. The nurse monitors the results of which laboratory test to check the drug's effectiveness? a.Bleeding times b.Activated partial thromboplastin time (aPTT) c.Prothrombin time/international normalized ratio (PT/INR) d.Vitamin K levels
ANS: B Ongoing aPTT values are used to monitor heparin therapy. PT/INR is used to monitor warfarin therapy. The other two options are not used to monitor anticoagulant therapy.
A patient has been instructed to take one enteric-coated low-dose aspirin a day as part of therapy to prevent strokes. The nurse will provide which instruction when providing patient teaching about this medication? a.Aspirin needs to be taken on an empty stomach to ensure maximal absorption .b.Low-dose aspirin therapy rarely causes problems with bleeding. c.Take the medication with 6 to 8 ounces of water and with food. d.Coated tablets may be crushed if necessary for easier swallowing.
ANS: C Enteric-coated aspirin is best taken with 6 to 8 ounces of water and with food to help decrease gastrointestinal upset. Enteric-coated tablets should not be crushed. Risk for bleeding increases with aspirin therapy, even at low doses.
A patient has been prescribed warfarin (Coumadin) in addition to a heparin infusion. The patient asks the nurse why he has to be on two medications. The nurse's response is based on which rationale? a.The oral and injection forms work synergistically. b.The combination of heparin and an oral anticoagulant results in fewer adverse effects than heparin used alone. c.Oral anticoagulants are used to reach an adequate level of anticoagulation when heparin alone is unable to do so .d.Heparin is used to start anticoagulation so as to allow time for the blood levels of warfarin to reach adequate levels.
ANS: D This overlap therapy is required in patients who have been receiving heparin for anticoagulation and are to be switched to warfarin so that prevention of clotting is continuous. This overlapping is done purposefully to allow time for the blood levels of warfarin to rise, so that when the heparin is eventually discontinued, therapeutic anticoagulation levels of warfarin will have been achieved. Recommendations are to continue overlap therapy of the heparin and warfarin for at least 5 days; the heparin is stopped after day 5 when the international normalized ratio (INR) is above 2.
The nurse determines the patient has a good understanding of the discharge instructions regarding warfarin (Coumadin) with which patient statement? a. "I should keep taking ibuprofen for my arthritis." b. "I should use a soft toothbrush for dental hygiene." c. "I should decrease the dose if I start bruising easily." d. "I will double my dose if I forget to take it the day before."
B
The nurse is caring for a patient admitted with gastrointestinal bleeding who is anticoagulated with warfarin (Coumadin). Which medication should the nurse anticipate administering? a. Vitamin E b. Vitamin K (Phytonadione) c. Protamine (Protamine sulfate) d. Calcium gluconate
B
The nurse is giving discharge instructions to a patient prescribed warfarin (Coumadin) for atrial fibrillation. Which statement by the patient indicates a need for further instruction from the nurse? a. "I will take my medication in the early evening each day." b. "I will increase the dark green leafy vegetables in my diet." c. "I will contact my health care provider if I develop excessive bruising." d. "I will avoid activities that have a risk for injury such as contact sports."
B
The nurse would question the use of milrinone (Primacor) in a patient with which condition? a. Acute renal failure b. Aortic regurgitation c. Systolic heart failure d. Mitral valve prolapse
B
While observing a patient self-administer enoxaparin (Lovenox), the nurse identifies the need for further teaching when the patient performs which self-injection action? a. Does not aspirate before injecting the medication b. Massages the site after administration of the medication c. Administers the medication into subcutaneous (fatty) tissue d. Injects the medication greater than 2 inches away from the umbilicus
B
The nurse plans care for a male patient who is 80 years old. The nursing diagnosis is noncompliance with the medication regimen related to living alone, as evidenced by uncontrolled blood pressure. What should the nurse do next? A) Collaborate with the provider on a new medication regimen. B) Enlist the help of a home care nurse for pharmacotherapy. C) Assess the impact of home self-management of medications. D) Examine the results of nursing help with the medications.
B) Enlist the help of a home care nurse for pharmacotherapy.
In which step of the nursing process does the nurse determine the outcome of medication administration? A) Implementation B) Evaluation C) Assessment D) Planning
B) Evaluation
A patient is in the intensive care unit and receiving an infusion of milrinone (Primacor) for severe heart failure. The prescriber has written an order for an intravenous dose of furosemide (Lasix). How will the nurse give this drug? A. Infuse the drug into the same intravenous line as the milrinone. B. Administer the furosemide in a seperate intravenous line. C. Stop the milrinone, flush the line, and then administer the furosemide. D. Notify the prescriber that the furosemide cannot be given at this time
B. Administer the furosemide in a seperate intravenous line.
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. Antihypertensives B. Anticoagulants C. Anti fungals D. Antacids
B. Anticoagulants
The nurse is discussing management of symptoms of an upper respiratory tract infection. Which classes of medications are often used in treating the symptoms of upper respiratory tract infections? (SELECT ALL THAT APPLY.) A. Antibiotics B. Antitussives C. Nasal decongestants D. Antihistamines E. Expectorants
B. Antitussives C. Nasal decongestants D. Antihistamines E. Expectorants
The nurse is reviewing discharge teaching for a patient who will be taking digoxin (Lanoxin) therapy. The nurse will teach the patient to avoid which foods when taking the digoxin? A. Dairy products B. Bran muffins C. Leafy green vegetables D. Grapefruit juice
B. Bran muffins
The nurse is reviewing drug therapy for hypertension. According to the JNC 7 guidelines, antihypertensive drug therapy for a newly diagnosed stage 1 hypertensive African-American patient would most likely include which drug or drug classes? A. Vasodilators alone B. Calcium channel blockers with thiazide diuretics C. Beta blockers with thiazide diuretics D. ACE inhibitors alone
B. Calcium channel blockers with thiazide diuretics
Which nursing diagnosis is appropriate for a patient receiving antidysrhythmics? A. Deficient fluid volume B. Deficient knowledge C. Urinary retention D. Risk for infection
B. Deficient knowledge
A patient has been diagnosed with angina and will be given a prescription for sublingual nitroglycerin tablets. When teaching the patient how to use sublingual nitroglycerin, the nurse will include which instruction? A. If the tablet does not dissolve quickly, chew the tablet for maximal effect. B. If the chest pain is not relieved after one tablet, call 911 immediately. C. Take up to five doses at 15-minute intervals for angina attack. D. Wait 1 minute between doses of sublingual tablets, up to three doses
B. If the chest pain is not relieved after one tablet, call 911 immediately.
A patient is in the emergency department with a new onset of rapid-rate atrial fibrillation, and the nurse is preparing a continuous infusion. Which drug is most appropriate for this dysrhythmia? A. adenosine (Adenocard) B. diltiazem (Cardizem) C. atenolol (Tenormin) D. lidocaine
B. diltiazem (Cardizem)
A patient who is HIV-positive has been receiving medication therapy that includes zidovudine (Retrovir). However, the prescriber has decided to stop the zidovudine because of its dose-limiting adverse effect. Which of these conditions is the dose-limiting adverse effect of zidovudine therapy?A.Hepatotoxicity B.Bone marrow suppression C.Renal toxicity D.Retinitis
B.Bone marrow suppression
The nurse is administering intravenous acyclovir (Zovirax) to a patient with a viral infection. Which administration technique is correct? A.Restrict oral fluids during intravenous acyclovir therapy. B.Infuse intravenous acyclovir slowly, over at least 1 hour. C.Infuse intravenous acyclovir by rapid bolus. D.Refrigerate intravenous acyclovir
B.Infuse intravenous acyclovir slowly, over at least 1 hour.
A patient who has been taking isoniazid (INH) has a new prescription for pyridoxine. She is wondering why she needs this medication. The nurse explains that pyridoxine is often given concurrently with the isonizid to prevent which condition? A.Hair loss B.Peripheral neuropathy C.Heart failure D.Renal failure
B.Peripheral neuropathy
The nurse is educating a patient with a new diagnosis of open-angle glaucoma on the adverse effects of the indirect-acting miotic eyedrops prescribed. What will the nurse include in the teaching as possible adverse effects? (Select all that apply.) Select all that apply. Blurred vision Decreased nighttime vision Farsightedness Paralysis of eyelids Stinging on instillation
Blurred vision Decreased nighttime vision Stinging on instillation
A patient has been advised to add a nasal spray (an adrenergic decongestant) to treat a cold. The nurse will include which instruction? A. "You won't see effects for at least 1 week. "B. "Avoid use of this spray if a fever develops. "C. "Limit use of this spray to 3 to 5 days." D. "Continue the spray until nasal stuffiness has resolved."
C. "Limit use of this spray to 3 to 5 days."
The nurse is reviewing the use of antitussive durgs. Antitussive drugs would be most appropriate for which patient? A. A patient who has had a productive cough for 2 weeks B. A patient who has a tracheostomy and thick mucus secretions C. A patient who has developed bronchitis 2 days after abdominal surgery D. A patient who has pneumonia with a productive cough
C. A patient who has developed bronchitis 2 days after abdominal surgery
A patient is in an urgent-care center with an acute asthma attack. The nurse expects that which medication will be used for initial treatement? A. An anticholinergic such as ipratropium (Atrovent) B. A long-acting beta2 agonist such as salmeterol (Serevent) C. A short-acting beta2 agonist such as albuterol (Proventil) D. A corticosteroid such as fluticasone (Flovent)
C. A short-acting beta2 agonist such as albuterol (Proventil)
A patient has been placed on a milrinone (Primacor) infusion as part of the therapy for end-stage heart failure. What adverse effect of this drug will the nurse watch for when assessing this patient during the infusion? A. Hyperkalemia B. Nausea and vomiting C. Cardiac dysrhythmias D. Hypertension
C. Cardiac dysrhythmias
Which factor is most involved in the elderly as a reason for polypharmacy?Select one: A. Decreased gastric acid levels. B. Reduced cardiovascular functioning. C. Greater incidence of chronic illness. D. Reduced OTC availability.
C. Greater incidence of chronic illness.
The prescriber has changed the patient's medication regimen to include the leukotriene receptor antagonist montelukast (Singulair) to treat asthma. The nurse will emphasize which point about this medication? A. The patient needs to keep it close by at all times to treat acute asthma attacks. B. The proper technique for inhalation must be followed. C. It needs to be taken every day on a continuous schedule, even if symptoms improve. D. When the asthma symptoms improve, the dosage schedule can be tapered and eventually discontinued.
C. It needs to be taken every day on a continuous schedule, even if symptoms improve.
The nurse is monitoring drug levels for a patient who is receiving theophylline. The most recent theophylline level was 13 mcg/mL, and the nurse evaluates this level to be A. at a toxic level. B. above the therapeutic level .C. at a therapeutic level. D. below the therapeutic level.
C. at a therapeutic level.
Loratadine (Claritin) has an advantage over traditional antihistamines such diphenhydramine (Benadryle) in that loratadine has A. less gastrointestinal upset. B. less risk of cardiac arrhythmias. C. less sedative effect. D. increased bronchodilating effects.
C. less sedative effect.
The nurse is providing teaching to a patient taking an oral tetracycline antibiotic. Which statement by the nurse is correct?A."Milk and cheese products result in increased levels of tetracycline. "B."Take the medication until you are feeling better. "C."Avoid direct sunlight and tanning beds while on this medication. "D."Antacids taken with the medication help to reduce gastrointestinal distress."
C."Avoid direct sunlight and tanning beds while on this medication."
During drug therapy with a tetracycline antibiotic, a patient complains of some nausea and decreased appetite. Which statement is the nurse's best advice to the patient? A."Take it with cheese and crackers or yogart. "B."Take an antacid with each dose as needed. "C."Drink a full glass of water with each dose. "D."Take each dose with a glass of milk."
C."Drink a full glass of water with each dose."
The nurse will assess the patient for which potential contraindication to antitubercular therapy? A.Anemia B.Heart failure C.Hepatic impairment D.Glaucoma
C.Hepatic impairment
When monitoring patients on antitubercular drug therapy, the nurse knows that which drug may cause a decrease in visual acuity? A.rifampin (Rifadin) B.streptomycin C.ethambutol (Myambutol) D.isoniazid (INH)
C.ethambutol (Myambutol)
During drug therapy for pneumonia, a female patient develops a vaginal superinfection. The nurse explains that this infection is caused by A.an allergic reaction to the antibiotics. B.resistance of the pneumonia-causing bacteria to the drugs. C.large doses of antibiotics that kill normal flora. D.the infection spreading from her lungs to the new site of infection.
C.large doses of antibiotics that kill normal flora.
The nurse is reviewing the medication history of a patient who will be taking a sulfonamide antibiotic. During sulfonamide therapy, a significant drug interaction may occur with which of these drugs or drug classes? (Select all that apply.) A.Opioids B.Antihistamines C.phenytoin (Dilantin) D.Oral contraceptives E.Sulfonylureas F.warfarin (Coumadin)
C.phenytoin (Dilantin) D.Oral contraceptives E.Sulfonylureas F.warfarin (Coumadin)
A patient is prescribed oral anticoagulant therapy while still receiving IV heparin infusion. The patient is concerned about risk for bleeding. What is the nurse's best response? a. "Bleeding is a common adverse effect of taking warfarin. If bleeding occurs, your health care provider will prescribe an injection of medication to stop the bleeding." b. "Because you are now getting out of bed and walking around, you have a higher risk of blood clot formation and therefore need to be on both medications." c. "Because of your mechanical valve replacement, it is especially important for you to be fully anticoagulated, and the heparin and warfarin together are more effective than one alone." d. "It usually takes 4 to 5 days to achieve a full therapeutic effect for warfarin, so the heparin infusion is continued to help prevent blood clots until the warfarin reaches its therapeutic effect."
D
Before emergency surgery, the nurse would anticipate administering which medication to a patient receiving heparin? a. Vitamin K (Phytonadione) b. Vitamin E c. Phenytoin (Dilantin) d. Protamine (Protamine sulfate)
D
A patient has prescriptions for two inhalers. One inhaler is a bronchodilator, and the other is a corticosteroid. Which instruction regarding these inhalers will the nurse give to the patient A. "Take these two drugs at least 2 hours apart. "B. "Take the corticosteroid inhaler first. "C. "It does not matter which inhaler you use first." D. "Take the bronchodilator inhaler first.
D. "Take the bronchodilator inhaler first."
After receiving a nebulizer treatment with a beta agonist, the patient complains of feeling slightly nervous and wonders if her asthma is getting worse. What is the nurse's best response? A. "We will hold the treatment for 24 hours. "B. "The next scheduled nebulizer treatment will be skipped." C. "I will notify the physician about this adverse effect. "D. "This is an expected adverse effect. Let me take your pulse."
D. "This is an expected adverse effect. Let me take your pulse.
A patient arrives in the emergency department with severe chest pain. The patient reports that the pain has been occurring off and on for a week now. Which assessment finding would indicate the need for cautious use of nitrates and nitrites? A. History of renal disease B. Apical pulse rate of 110 beats/min C. History of a myocardial infarction 2 years ago D. Blood pressure of 88/62 mm Hg
D. Blood pressure of 88/62 mm Hg
During a routine checkup, a patient states that she is unable to take the prescribed antihistamine because of one of its most common adverse effects. The nurse suspects that which adverse effect has been bothering this patient? A. Constipation B. Decreased libido C. Abdominal cramps D. Drowsiness
D. Drowsiness
The nurse monitors the fulfillment of goals, and may revise them, during which phase of the nursing process? A. Assessment B. Planning C. Implementation D. Evaluation
D. Evaluation
A patient is taking guaifenesin (Humibid) as part of treatment for a sinus infection. Which instruction will the nurse include during patient teaching? A. Avoid driving a car or operating heavy machinery because of the sedating effects. B. Report symptoms that last longer then 2 days. C. Report clear-colored sputum to the prescriber. D. Force fluids to help loosen and liquify secretions.
D. Force fluids to help loosen and liquify secretions
The nurse is providing instructions about the Advair inhaler (fluticasone propionate and salmeterol). Which statement about this inhaler is accurate? A. It is indicated for the treatment of acute bronchospasms .B. Patients need to avoid drinking water for 1 hour after taking this drug. C. It needs to be used with a spacer for best results. D. It is used for prevention of bronchospasms.
D. It is used for prevention of bronchospasms.
An 82-year-old woman is unable to take the influenza vaccine due to allergies, but she has been exposed to the virus through a family reunion. She does not yet have symptoms of the flu. Which option would be best for her? A.She should receive the flu vaccine as soon as possible. B.She should receive zanamivir (Relenza) in the inhalation form. C.She should begin oral oseltamivir (Tamiflu) therapy when symptoms begin. D.She should begin oral oseltamivir (Tamiflu) therapy as soon as possible
D. She should begin oral oseltamivir (Tamiflu)Rationale: Oseltamivir (Tamiflu) is the only one indicated for prophylaxis of influenza infection. Both oseltamivir and zanamivir can be used to treat active influenza illness. Treatment with oseltamivir and zanamivir ideally should begin within 2 days of symptom onset.
Which feature of a pediatric patient would the nurse recognize as most affecting the distribution of a fat soluble drug?Select one: A. The slower gastric emptying .B. The lower serum protein levels .C. The gastric acid level .D. The total body water (TBW).
D. The total body water (TBW).
The nurse receives lab values for a patient with a theophylline level of 14 mcg/mL. How does the nurse interpret this theophylline level?A. SubtherapeuticB. ToxicC. Life-threateningD. Therapeutic
D. Therapeutic
A patient with a tracheostomy has difficulty removing excessive, thick mucus from the respiratory tract. The nurse expects that which drug will be ordered to aid in the removal of mucus? A. benzonatate (Tessalon Perles) B. dextromethorphan (Robitussin DM) C. diphenhydramine (Benadryl )D. guaifenesin (Humibid)
D. guaifenesin (Humibid)
A gardener needs a decongestant because of seasonal allergy problems and asks the nurse whether he should take an oral form or a nasal spray. The nurse's answer considers that one benefit of orally administered decongestants is A. shorter duration. B. a more potent effect. C. immediate onset. D. lack of rebound congestion.
D. lack of rebound congestion.
A patient is receiving aminoglycoside therapy and will be receiving a beta-lactam antibiotic as well. The patient asks why two antibiotics have been ordered. What is the nurse's best response? A."One antibiotic is not strong enough to fight the infection." B."We have not yet isolated the bacteria, so the two antibiotics are given to cover a wide range of microorganisms. "C."We can give a reduced amount of each one if we give them together." D."The combined effect to both antibiotics is greater than each of them alone."
D."The combined effect to both antibiotics is greater than each of them alone."
The nurse is discussing adverse effects of antitubercular drugs with a patient who has active tuberculosis. Which potential adverse effect of antitubercular drug therapy should the patient report to the prescriber? A.Gastrointestinal upset B.Reddish-orange urine and stool C.Headache and nervousness D.Numbness and tingling of extremities
D.Numbness and tingling of extremities
A patient is receiving isoniazid (INH) for the treatment of tuberculosis. Which vitamin does the nurse anticipate administering with the INH to prevent isoniazid-precipitated peripheral neuropathies? A.Vitamin C B.Vitamin B12 C.Vitamin D D.Vitamin B6
D.Vitamin B6Rationale: Pyridoxine (vitamin B6) may be indicated to prevent isoniazid-precipitated peripheral neuropathies and numbness, tingling, or burning of the extremities.
The nurse will question the use of a floroquinolone antibiotic in a patient already prescribed which medication?A.omeprazole B.metoprolol C.furosemide D.amiodarone
D.amiodarone
When calculating pediatric dosages, the nurse understands which method is most accurate for dosing calculations? Dosage calculation by body surface area because it takes into account the difference in size for children and neonates Medication dosing calculated according to body weight because it is based on maturational growth and development Calculated doses based on body weight need to be increased by 10% because of immature renal and hepatic function Use of drug reference recommendations based on mg/kg of body weight.
Dosage calculation by body surface area because it takes into account the difference in size for children and neonates The body surface area takes into account not only the child's weight but also the relationship with height and is therefore both the most accurate and most preferred method. Immature renal and hepatic function would necessitate a decrease in dose, not an increase.
A nurse working with older adult patients is concerned about the number of medications prescribed for each patient. Which older adult assessment should be of highest priority related to polypharmacy? Schedule of medications Drug interactions Cost of medications Nonadherence to drug regimen
Drug interactions The highest priority for older adult patients with multiple medications (polypharmacy) is the assessment for drug interactions. The more medications an older adult patient takes, the higher the risk for drug interactions.
Parasympathomimetic ophthalmic drugs such as pilocarpine reduce intraocular pressure in the treatment of glaucoma by what mechanism of action? Decrease in drainage of aqueous humor Miosis Cause the pupils to get larger Mydriasis
Miosis
A drug given by which route is altered by the first-pass effect? SubQ Oral IV Sublingual
Oral
What is the study of physiochemical properties of drugs and how they influence the body called? Pharmacokinetics Pharmacodynamics Pharmacology Pharmacotherapeutics
Pharmacodynamics In simple terms, pharmacodynamics is the study of what drugs do to the body.
Which statement best describes pharmacokinetics? -Converts medication into its active chemical substance -What the body does to the drug after it is administered -Physiologic interaction between a drug and body cells -Adverse effects and toxic reactions to medications
Pharmacodynamics In simple terms, pharmacodynamics is the study of what drugs do to the body.
What is the best description of the consumer safety precautions for herbal supplements? a. Reliable data on product efficacy is scarce .b. Medicinal herbs are under strict U.S. Food and Drug Administration (FDA) control. c. Herbs in tamper-resistant containers are safe. d. The package labeling clearly states product safety.
Reliable data on product efficacy is scarce. Some herbal preparations are effective; many are not. A few can cause harmful or lethal effects. Herbal products are exempt from meaningful regulation. Dietary supplements do not need FDA approval before they are marketed and they require no efficacy for standards.
The nurse is providing education to a patient with a diagnosis of bilateral conjunctivitis (pink eye) who is prescribed sulfacetamide. What information in the patient history is important and would be reported immediately to the health care provider? The patient does not like eyedrops The patient is allergic to sulfa drugs. The patient wears colored soft contact lenses. The patient has never had pink eye before.
The patient is allergic to sulfa drugs
Sympathomimetic mydriatics have the potential to react with other drugs if sufficient topical absorption occurs. When given concurrently, drugs in what class may interact with the sympathomimetic mydriatics? Calcium channel blockers Oral contraceptives Thyroid hormones Nonsteroidal antiinflammatory drugs
Thyroid hormones
A 47-year-old patient with diabetes is being discharged to home and must take insulin injections twice a day. The nurse keeps in mind which concepts when considering patient teaching? a. Teaching needs to begin at the time of diagnosis or admission and is individualized to the patient's reading level. b. The nurse can assume that because the patient is in his forties he will be able to read any written or printed documents provided. c. The majority of teaching can be done with pamphlets that the patient can share with family members. d. A thorough and comprehensive teaching plan designed for an eleventh-grade reading level needs to be developed.
a. Teaching needs to begin at the time of diagnosis or admission and is individualized to the patient's reading level.
A patient has a new prescription for an antiglaucoma eyedrop. The next day, she calls the clinic and states, "The package insert says this medication might make my blue eyes turn brown! Is this true?" The nurse realizes that the patient has a prescription for which eye medication? a.Latanoprost (Xalatan), a prostaglandin agonist b.Dorzolamide (Trusopt), an ocular carbonic anhydrase inhibitor c.Betaxolol (Betoptic), a direct-acting beta blocker d.Pilocarpine (Pilocar), a direct-acting cholinergic
a.Latanoprost (Xalatan), a prostaglandin agonist
When the nurse is teaching a patient about taking an antidysrhythmic drug, which statements by the nurse are correct? (Select all that apply.) a. "Take the medication with an antacid if stomach upset occurs. "b. "Do not chew sustained-release capsules." c. "If weight gains of 5 pounds within 1 week occurs, notify your physician at the next office visit." d. "If you experience severe adverse effects, stop the drug and notify your physician."e. "You may take the medication with food if stomach upset occurs."
b, e
A nurse administering niacin would implement which action to help to reduce adverse effects? a. Give the medication with grapefruit juice .b. Administer a small dose of aspirin or an NSAID 30 minutes before the niacin dose. c. Administer the medication on an empty stomach. d. Have the patient increase dietary fiber intake.
b. Administer a small dose of aspirin or an NSAID 30 minutes before the niacin dose
When taking a patient's drug history, the nurse asks about use of over-the-counter drugs. The patient responds by saying, "Oh, I frequently take aspirin for my headaches, but I didn't mention it because aspirin is nonprescription." What is the nurse's best response? a. "That's true; over-the-counter drugs are generally not harmful. "b. "Aspirin is one of the safest drugs out there. "c. "Although aspirin is over-the-counter, it's still important to know why you take it, how much you take, and how often. "d. " We need you to be honest about the drugs you are taking. Are there any others that you haven't told us about?"
c "Although aspirin is over-the-counter, it's still important to know why you take it, how much you take, and how often."
The nurse understands adenosine (Adenocard) is used to treat which condition? a. Atrial fibrillation b. Second-degree atrioventricular block c. Paroxysmal supraventricular tachycardia (PSVT) d. Atrial flutter
c Paroxysmal supraventricular tachycardia (PSVT)
Which point will the nurse emphasize to a patient who is taking an antilipemic medication in the "statin" class? a. The drug needs to be taken on an empty stomach before meals. b. A low-fat diet is not necessary while taking these medications. c. It is important to report muscle pain immediately. d. Improved cholesterol levels will be evident within 2 weeks.
c. It is important to report muscle pain immediately
The nurse is responsible for preoperative teaching for a patient who is mildly anxious about receiving pain medications postoperatively. The nurse recognizes that this level of anxiety may a. impede learning because anxiety is always a barrier to learning. b. lead to major emotional unsteadiness .c. result in learning by increasing the patient's motivation to learn. d. reorganize the patient's thoughts and lead to inadequate potential for learning.
c. result in learning by increasing the patient's motivation to learn.
The nurse would recognize which of these as the five rights of medication administration? a. Right patient, right teaching, right form of drug, right transcription, right response b. Right room, right time, right storage, right chart, right signature c. Right drug, right time, right patient, right dose, right route d. Right drawer, right documentation, right dosage calculation, right drug preparation, right pharmacy
c. right drug, right time, right patient, right dose, right route
A patient has an infected stage II pressure ulcer that contains some necrotic tissue and some normal, healing granulation tissue. The patient is taking warfarin (Coumadin). Which product would be most appropriate for wound care?
collagenase (Santyl) Collagenase (Santyl) is good for patients taking anticoagulants or in whom surgery is contraindicated. Collagenase (Santyl) selectively removes necrotic tissue, does not harm normal tissue, and is approved for use with infected wounds. Dakin's solution can aid in debridement; however, it is partly toxic and irritating to healing tissue. Hydrogen peroxide can also be harmful to normal cells. Sterile water does not aid in debridement
The nurse is reviewing the protocol for administration of IV adenosine (Adenocard). What is the MOST important nursing intervention to remember when giving this medication? a. Monitor the infusion site for hematoma .b. Assess for burning sensation at the IV site. c. Flush the IV catheter with normal saline. d. Administer it as a fast IV push.
d Administer it as a fast IV push.
When educating patients about the safe use of herbal products, the nurse remembers to include which concept? a. Herbal and over-the-counter products are approved by the FDA and under strict regulation. b. Herbal products are tested for safety by the FDA and the U.S. Pharmacopeia .c. No adverse effects are associated with these products because they are natural and may be purchased without a prescription. d. Take the product with caution because labels may not contain reliable information.
d Take the product with caution because labels may not contain reliable information.
The nurse is assessing a patient who has been diagnosed with MRSA on the right arm. The nurse anticipates use of which medication to treat the MRSA?
mupirocin (Bactroban) Mupirocin (Bactroban) is an antibacterial product available only by prescription. It is used on the skin for treatment of staphylococcal and streptococcal impetigo. It is used topically and intranasally to treat nasal colonization with MRSA. The drug is applied topically three times daily and intranasally twice daily to treat MRSA colonization. Adverse reactions are usually limited to local burning, itching, or minor pain.
While obtaining a medication history from a patient, the nurse notes that the patient is currently prescribed naltrexone. The nurse would question the patient about a previous history of which substance abuse? Cannabis Amphetamine Barbiturate Opioid
opiod
