Pharm final
A postoperative patient reports pain in the left lower extremity. The nurse notes swelling in the lower leg, which feels warm to the touch. The nurse will anticipate giving which medication?
Enoxaparin (Lovenox)
The nurse is preparing to administer a first dose of ado-trastuzumab emtansine [Kadcycla] to a patient who has metastatic breast cancer. Which nursing action is correct?
Ensure that the patient has HER2-positive disease.
A patient who has urinary bladder cancer will begin receiving the chemotherapeutic agent valrubicin [Valstar]. What will the nurse do when administering this drug?
Ensure that the tubing used to administer the drug does not contain polyvinyl chloride.
A patient taking a glucocorticoid for arthritis reports feeling bloated. The nurse notes edema of the patient's hands and feet. Which action by the nurse is correct?
Ask the patient about sodium intake.
A patient who recently started therapy with an HMG-COA reductase inhibitor asks the nurse, "How long will it take until I see an effect on my LDL cholesterol?" The nurse gives which correct answer?
"A reduction usually is seen within 2 weeks."
A nurse is discussing adenosine with a nursing student. Which statement by the student indicates a need for further teaching?
"Adenosine can be used to prevent paroxysmal supraventricular tachycardia and Wolff-Parkinson-White syndrome."
A nurse is discussing the care of a patient with cancer with a nursing student. The patient is about to begin chemotherapy with a bifunctional alkylating agent. Which statement by the student indicates an understanding of this chemotherapeutic agent?
"Alkylating agents are toxic to tissues that have rapidly dividing cells."
A nurse is teaching a course in bioterrorism to a group of military nurses. Which statement by a military nurse indicates understanding of the teaching?
"Although smallpox has been eradicated, it remains a threat."
A nurse is teaching a group of nursing students about antidysrhythmic medications. Which statement by a student indicates understanding of the teaching?
"Antidysrhythmic drugs can cause new dysrhythmias or worsen existing ones."
A pregnant patient in her third trimester asks the nurse whether she can take aspirin for headaches. Which response by the nurse is correct?
"Aspirin may cause premature closure of the ductus arteriosus in your baby."
A woman who is breastfeeding is prescribed a low pharmacologic dose of a glucocorticoid and asks the nurse about potential effects on her infant. What will the nurse tell her about this medication?
"At this dose, the concentration in your breast milk is safe."
A patient with atrial fibrillation is taking verapamil [Calan]. The patient has read about the drug on the Internet and wants to know why a drug that affects the rate of ventricular contraction is used to treat an abnormal atrial contraction. What will the nurse tell the patient?
"Atrial dysrhythmias can have life-threatening effects on ventricular function."
A patient asks a nurse about ways to minimize side effects of chemotherapy. Which response is correct?
"Avoid contact with people who are ill."
A nurse provides teaching to a patient with angina who also has type 2 diabetes mellitus, asthma, and hypertension. Which statement by the patient indicates a need for further teaching?
"Beta blockers can help me control hypertension."
A patient with variant angina wants to know why a beta blocker cannot be used to treat the angina. Which response by the nurse is correct?
"Beta blockers do not help relax coronary artery spasm."
A nurse is teaching a group of nursing students about cyclooxygenase (COX) inhibitors. A student asks the nurse about characteristics of COX-1 inhibitors. Which statement by the nurse is true?
"COX-1 inhibitors protect against myocardial infarction and stroke."
A nurse is teaching a group of nursing students about cancer treatment. Which statement by a student indicates an understanding of the characteristics of cancer cells?
"Cancer cells are characterized by unrestrained growth and division."
A nurse is teaching a group of nursing students about how cytotoxic anticancer drugs affect normal cells. Which statement by a student indicates an understanding of this teaching?
"Cytotoxic drugs lack tissue specificity."
The nurse is teaching a group of nursing students about dofetilide [Tikosyn] to treat dysrhythmias. Which statement by a student indicates understanding of the teaching?
"Dofetilide is used for patients with severe symptoms of atrial dysrhythmias."
Which claim may be made by manufacturers of dietary supplements? (Select all that apply.)
"Energizes and rejuvenates" "Promotes pulmonary health" "Reduces stress"
A patient has been receiving heparin while in the hospital to treat deep vein thromboses and will be discharged home with a prescription for enoxaparin [Lovenox]. The nurse provides teaching for the nursing student who asks about the advantages of enoxaparin over heparin. Which statement by the student indicates a need for further teaching?
"Enoxaparin is more cost-effective than heparin."
A patient who has leukemia is receiving chemotherapy and develops severe anemia. The provider has ordered hospitalization and blood transfusions. The patient asks the nurse about using erythropoietin (epoetin alfa) instead. What will the nurse tell this patient?
"Erythropoietin (epoetin alfa) can make your leukemia worse."
A nursing student asks a nurse why patients with chronic renal failure (CRF) have low erythrocyte counts. Which response by the nurse is correct?
"Erythropoietin is no longer produced by cells in the kidneys."
A nurse discusses ginger root with a pregnant patient who asks about the risks and benefits of using ginger root to treat morning sickness during pregnancy. Which statement by the patient indicates a need for further teaching?
"Ginger root can decrease my risk of bleeding."
A patient who is a long-distance runner has been diagnosed with rheumatoid arthritis in both knees and will begin glucocorticoid therapy. When teaching the patient about the medication, the nurse will include what information?
"Glucocorticoids are used as adjunctive therapy during acute flare-ups."
A nurse is discussing glucocorticoids with a group of nursing students. Which statement by a student indicates understanding of the teaching?
"Glucocorticoids have both endocrine and nonendocrine uses."
A nurse is teaching a group of nursing students why glucocorticoids are preferred over nonsteroidal anti-inflammatory drugs in the treatment of inflammation. Which statement by a student indicates a need for further teaching?
"Glucocorticoids have fewer side effects than nonsteroidal anti-inflammatory drugs."
A nurse is providing discharge teaching instructions for a patient taking cholestyramine [Questran]. Which statement made by the patient demonstrates a need for further teaching?
"I can take cholestyramine with my hydrochlorothiazide."
A nurse provides teaching for a patient who will begin taking procainamide [Procanbid] for long-term suppression of a dysrhythmia. Which statement by the patient indicates a need for further teaching?
"I may have increased bruising, but this is a temporary side effect."
A nurse is providing teaching to a patient who is admitted to the hospital for initiation of treatment with amiodarone [Cordarone] for atrial fibrillation that has been refractory to other medications. Which statement by the patient indicates a need for further teaching?
"I may have itching, malaise, and jaundice, but these symptoms will subside."
A nurse is teaching a patient who is about to undergo direct-current (DC) cardioversion to treat atrial flutter. The patient has been taking verapamil and warfarin for 6 months. Which statement by the patient indicates understanding of the teaching?
"I may need long-term therapy with another cardiac medication after the procedure."
A nurse is providing medication teaching for a patient who will begin taking diclofenac [Voltaren] gel for osteoarthritis in both knees and elbows. Which statement by the patient indicates understanding of the teaching?
"I should cover areas where the gel is applied to protect them from sunlight."
A nurse provides teaching to a patient who will begin taking oral cyclophosphamide to treat non-Hodgkin's lymphoma. Which statement by the patient indicates an understanding about how to minimize side effects while taking this drug?
"I should drink plenty of fluids while taking this drug."
A nurse is teaching a patient who has taken glucocorticoids for over a year about glucocorticoid withdrawal. Which statement by the patient indicates a need for further teaching?
"I should reduce the dose by half each day until I stop taking the drug."
Tadalafil [Cialis] was prescribed 4 weeks ago for a patient with erectile dysfunction. The patient also takes prazosin [Minipress] for hypertension. Which statement by the patient best demonstrates understanding of the use of tadalafil [Cialis]?
"I should take this medication no more than once a day."
A nurse is providing patient education about colesevelam [Welchol], a bile acid sequestrant. Which statement made by the patient demonstrates a need for further teaching?
"I will need to take supplements of fat-soluble vitamins."
A patient has been taking warfarin [Coumadin] for atrial fibrillation. The provider has ordered dabigatran etexilate [Pradaxa] to replace the warfarin. The nurse teaches the patient about the change in drug regimen. Which statement by the patient indicates understanding of the teaching?
"I will stop taking the warfarin and will start taking the dabigatran when my INR is less than 2."
While giving discharge instructions to a patient who will be taking cholestyramine [Questran], the nurse wants to assess the patient's understanding of the treatment. Which statement made by the patient best demonstrates a need for additional teaching?
"I will weigh myself weekly."
A nurse is providing teaching for a patient with stable angina who will begin taking nitroglycerin. Which statement by the patient indicates understanding of the teaching?
"If I take nitroglycerin before exertion, I can reduce the chance of an anginal attack."
A nurse is teaching a patient about the use of sildenafil [Viagra] for erectile dysfunction. Which statement by the patient indicates understanding of the teaching?
"If my erection lasts longer than 4 hours, I should contact my provider."
A healthy male patient who does not have erectile dysfunction asks about medications to improve sexual stamina. What will the nurse tell this patient?
"Medications for ED have no effect on erections in healthy men."
A patient with chronic myeloid leukemia (CML) begins treatment with imatinib [Gleevec]. Which statement by the patient indicates understanding of this medication?
"Resistance to this drug may develop over time."
A nurse tells a nursing student that the glucocorticoids given for rheumatoid arthritis are nearly identical to substances produced naturally by the body. The student remarks that the drug must be very safe. Which response by the nurse is correct?
"Side effects can occur and are dependent on the dose and duration of treatment."
A patient will begin taking atorvastatin [Lipitor] to treat elevated LDL levels. The patient asks the nurse what to do to minimize the risk of myositis associated with taking this drug. What will the nurse counsel this patient?
"Take vitamin D and coenzyme Q supplements."
A nurse is teaching a patient who has chronic renal failure who will begin receiving epoetin alfa [Epogen] about this drug therapy. Which statement by the patient indicates understanding of the teaching?
"Taking this drug will not eliminate my need for blood transfusions."
A nurse explains to a patient with cancer why it is difficult to achieve 100% cell kill to cure cancer with chemotherapy. Which statement by the patient indicates a need for further teaching?
"The immune system attacks chemotherapeutic agents and renders them impotent."
A nursing student who is preparing to care for a postoperative patient with deep vein thrombosis asks the nurse why the patient must take heparin rather than warfarin. Which response by the nurse is correct?
"The onset of warfarin is delayed."
A nurse responds when a patient asks why the smallpox vaccine is no longer given. Which statement by the patient indicates a need for further teaching?
"The smallpox vaccine is too expensive to give routinely."
A nurse is discussing vesicant chemotherapeutic agents with a nursing student. Which statement by the student indicates a need for further teaching about this type of drug?
"These drugs may be administered orally as well as intravenously."
A patient with cancer has a tumor composed mostly of G0 cells. When teaching this patient about the disease, the nurse will make which statement?
"This tumor will be managed primarily with surgery."
A nurse is teaching a nursing student who wants to know how aspirin and nonaspirin first-generation NSAIDs differ. Which statement by the student indicates a need for further teaching?
"Unlike aspirin, first-generation NSAIDs do not carry a risk of hypersensitivity reactions."
A nurse is discussing the difference between stable and variant angina with a group of nursing students. Which statement by a student indicates the need for further teaching?
"Variant angina is the result of increased oxygen demand by the heart."
A nurse is discussing heart failure with a group of nursing students. Which statement by a student reflects an understanding of how compensatory mechanisms can compound existing problems in patients with heart failure?
"When the heart rate increases to increase cardiac output, it can prevent adequate filling of the ventricles."
A patient has begun taking an HMG-COA reductase inhibitor. Which statement about this class of drugs made by the nurse during patient education would be inappropriate?
"You should come into the clinic for liver enzymes in 1 month."
A nurse is instructing a patient receiving a cholesterol-lowering agent. Which information should the nurse include in the patient education?
"You should continue your exercise program to increase your HDL serum levels."
A patient who takes nitroglycerine to treat stable angina reports having erectile dysfunction and states that he plans to ask his primary provider for a prescription for tadalafil [Cialis]. What will the nurse tell this patient?
"You should discuss another anti-angina medication with your provider."
A patient with a history of elevated triglycerides and LDL cholesterol begins taking nicotinic acid [Niacin]. The patient reports uncomfortable flushing of the face, neck, and ears when taking the drug. What will the nurse advise the patient?
"You should take 325 mg of aspirin a half hour before each dose of Niacin to prevent this effect."
A patient who has renal impairment will begin taking ranolazine [Ranexa] as an adjunct to nitroglycerine to treat angina. What will the nurse include when teaching this patient?
"You will need to monitor your blood pressure closely while taking this drug."
A patient who has gout will begin taking febuxostat [Uloric] and colchicine. What will the nurse include when teaching this patient about this drug regimen?
"You will stop taking the colchicine within 6 months after starting therapy."
A patient with gout who has increasingly frequent acute gouty attacks will begin receiving allopurinol [Zyloprim] and colchicine. The nurse will include which statement when teaching the patient about this drug regimen?
"You will take both drugs initially and then stop taking the colchicine."
A patient tells a nurse that she is thinking about getting pregnant and asks about nutritional supplements. What will the nurse recommend?
400 to 800 mg of folic acid per day
The prescriber orders 20 mg of hydrocortisone orally once each day. The nurse will make sure the drug is scheduled to be administered at what time?
8:00 am
A patient with asthma and depression develops stable angina. In addition to organic nitrites, which other medications will be used to treat this condition? (Select all that apply.)
ACE inhibitors Antiplatelet drugs Calcium channel blockers Cholesterol-lowering drugs
A patient is recovering from a myocardial infarction but does not have symptoms of heart failure. The nurse will expect to teach this patient about:
ACE inhibitors and beta blockers
A nurse is discussing the administration of an intravenous infusion of rituximab (Rituxan) with a nursing student. Which statement by the student indicates a need for further education about the care of a patient receiving this drug?
Angioedema and hypersensitivity may occur, but they are usually self-limiting and mild."
A nursing student asks the nurse what differentiates antiestrogen drugs from aromatase inhibitors in the treatment of breast cancer. What is the correct response by the nurse?
Antiestrogen drugs increase the risk for endometrial cancer.
An adolescent is brought to the emergency department by a parent who reports that the patient took a whole bottle of extended-release acetaminophen tablets somewhere between 8 and 10 hours ago. The nurse will anticipate administering which of the following?
Acetylcysteine (Mucomyst)
A patient with stable exertional angina has been receiving a beta blocker. Before giving the drug, the nurse notes a resting heart rate of 55 beats per minute. Which is an appropriate nursing action?
Administer the drug as ordered, because this is a desired effect.
A patient with renal failure is undergoing chronic hemodialysis. The patient's hemoglobin is 10.6 gm/dL. The provider orders sodium-ferric gluconate complex (SFGC [Ferrlecit]). What will the nurse expect to do?
Administer the drug intravenously with erythropoietin.
Which medications are included in first-line therapy for heart failure? (Select all that apply.)
Agents that inhibit the renin-angiotensin-aldosterone system (RAAS) Beta blockers Diuretics
Which patients are eligible to receive erythropoiesis stimulating agents? (Select all that apply.)
All patients with nonmyeloid malignancies who require transfusions All patients with nonmyeloid malignancies whose chemotherapy is palliative All patients with nonmyeloid malignancies and chemotherapy-induced anemia
Which disorders may be treated with glucocorticoids? (Select all that apply.)
Allergic rhinitis Gout Ulcerative colitis
A patient will begin chemotherapy with cisplatin. Which medications will the nurse expect to administer to offset this agent's side effects?
Amifostine [Ethyol], diuretics, and antiemetics
A child is to begin long-term glucocorticoid therapy. The parents ask the nurse about the effects of this drug on the child's growth. Which response by the nurse is correct?
Ask your provider about every other day dosing."
A patient is admitted to the hospital with unstable angina and will undergo a percutaneous coronary intervention. Which drug regimen will the nurse expect to administer to prevent thrombosis in this patient?
Aspirin, heparin, abciximab [ReoPro]
A prescriber has ordered propranolol [Inderal] for a patient with recurrent ventricular tachycardia. The nurse preparing to administer this drug will be concerned about what in the patient's history?
Asthma
A patient who has erectile dysfunction asks about medications to treat this disorder, but tells the nurse he doesn't want to have to plan sexual activity several hours in advance. Which medication will the nurse expect the provider to order for this patient?
Avanafil [Stendra]
A patient with Stage C heart failure (HF) who has been taking an ACE inhibitor, a beta blocker, and a diuretic begins to have increased dyspnea, weight gain, and decreased urine output. The provider orders spironolactone [Aldactone]. The nurse will instruct the patient to:
Avoid potassium supplements
The potassium-sparing diuretic spironolactone [Aldactone] prolongs survival and improves heart failure symptoms by which mechanism?
Blocking aldosterone receptors
What are the indications for administration of a parenteral iron preparation? (Select all that apply.)
Blood loss of 750 mL/week Celiac disease Megaloblastic anemia
A prescriber has ordered filgrastim (granulocyte colony-stimulating factor) for a patient undergoing myelosuppressive chemotherapy. The nurse will prepare the patient for which potential side effect?
Bone pain
The nurse is caring for a patient in the oncology unit who was recently diagnosed with advanced renal carcinoma. The nurse prepares to administer aldesleukin [Proleukin] as part of the treatment regimen. What is the primary adverse effect of this drug?
Capillary leakage syndrome
A nursing student asks about the differences between cell-cycle phase-specific chemotherapeutic agents and those that are cell-cycle phase nonspecific. What will the nurse explain?
Cell-cycle phase-specific drugs do not harm "resting" cells.
What contributes to drug resistance to chemotherapeutic agents? (Select all that apply.)
Cellular production of P-glycoprotein Creation of selection pressure by drugs Reduced target molecule sensitivity
A patient is receiving intravenous vincristine [Oncovin]. The patient complains of pain at the IV insertion site. The nurse examines the site and notes an area of erythema and edema. What will the nurse do?
Change the IV site and notify the provider of the extravasation.
A patient has been taking digoxin [Lanoxin] 0.25 mg, and furosemide [Lasix] 40 mg, daily. Upon routine assessment by the nurse, the patient states, "I see yellow halos around the lights." The nurse should perform which action based on this assessment?
Check the patient for other symptoms of digitalis toxicity.
A patient will begin taking immunosuppressant drugs for rheumatoid arthritis. The nurse will caution this patient to avoid which dietary supplement?
Echinacea
A nurse prepares to administer a scheduled dose of digoxin. The nurse finds a new laboratory report showing a plasma digoxin level of 0.7 ng/mL. What action should the nurse take?
Check the patient's apical pulse, and if it is within a safe range, administer the digoxin.
A patient will be taking amiodarone [Cordarone]. Which baseline tests are necessary before this medication is started? (Select all that apply.)
Chest radiograph and pulmonary function tests Ophthalmologic examination Thyroid function tests
A patient taking high doses of a glucocorticoid develops weakness in the muscles of the upper arms and in the legs. What will the nurse do?
Contact the provider to ask about reducing the dose.
A patient who has arthritis has been taking ibuprofen [Motrin] and a glucocorticoid medication. The patient reports having tarry stools but denies gastric pain. Which action by the nurse is correct?
Contact the provider to discuss ordering an antiulcer medication.
A patient with angina who uses sublingual nitroglycerin tells the nurse that the episodes are increasing in frequency and usually occur when the patient walks the dog. The patient reports needing almost daily doses of the nitroglycerin and states that one tablet usually provides complete relief. What will the nurse do?
Contact the provider to suggest ordering a transdermal patch for this patient.
The nurse is providing smallpox vaccinations after determining that an individual who works for a local military laboratory was exposed. After administering the vaccine, how should the nurse instruct the individual to care for the site?
Cover the site with sterile gauze and tape the edges.
Which plasma lipoprotein level is most concerning when considering the risk of coronary atherosclerosis?
Elevated low-density lipoprotein
An 88-year-old patient with heart failure has progressed to Stage D and is hospitalized for the third time in a month. The nurse will expect to discuss which topic with the patient's family?
End-of-life care
A patient newly diagnosed with heart failure is admitted to the hospital. The nurse notes a pulse of 90 beats per minute. The nurse will observe this patient closely for:
Decreased urine output
A patient with advanced cancer of the prostate begins treatment with leuprolide [Lupron Depot] injections and will receive 7.5 mg IM once per month. After the first injection, the patient experiences an increase in cancer symptoms. What will the nurse tell the patient?
Desensitization to the drug over time will result in a decrease in these symptoms.
A patient with colorectal cancer is admitted to the hospital oncology unit to receive cetuximab [Erbitux]. The nurse notes that the prescriber has not ordered any other medications. The nurse will contact the prescriber to request an order for which medication in order to minimize cetuximab's side effects?
Diphenhydramine [Benadryl]
A patient is receiving fluorouracil [Adrucil] as a continuous intravenous dose to treat a solid tumor. The patient reports soreness and blisters in the mouth, loose stools, and tingling of the hands and feet. What will the nurse do?
Discontinue the medication and contact the provider to report these symptoms.
A patient who reports regular consumption of two or three alcoholic beverages per day asks about taking acetaminophen when needed for occasional recurrent pain. What will the nurse tell the patient?
Do not take more than 2 gm of acetaminophen a day."
Which are guidelines for selecting chemotherapeutic agents to use in combination therapy? (Select all that apply.)
Drugs used should have different mechanisms. Each drug should be effective. Toxicities should be minimally overlapping.
The nurse is caring for a patient who has been receiving vinorelbine [Navelbine] for about 5 days. Which assessment finding in this patient would cause the nurse to withhold the next dose and notify the prescriber?
Dyspnea and cough
A patient is being started on nicotinic acid [Niaspan] to reduce triglyceride levels. The nurse is providing patient education and should include teaching about which adverse effects? (Select all that apply.
Facial flushing Gastric upset Itching
A patient is about to undergo a procedure to harvest hematopoietic stem cells from the bone marrow. Which medication will the nurse anticipate giving before this procedure?
Filgrastim (Neupogen)
A nurse is teaching a patient who will undergo chemotherapy with fluorouracil [Adrucil] to treat a solid tumor. Which statement by the patient indicates understanding of this chemotherapeutic agent's actions?
Fluorouracil acts to deprive cancer cells of thymidylate needed to make DNA."
A patient with chronic hypertension is admitted to the hospital. During the admission assessment, the nurse notes a heart rate of 96 beats per minute, a blood pressure of 150/90 mm Hg, bibasilar crackles, 2+ pitting edema of the ankles, and distension of the jugular veins. The nurse will contact the provider to request an order for which medication?
Furosemide (Lasix)
A nurse is performing a preoperative drug history on a patient who is admitted to the hospital for surgery. To evaluate the risk of hemorrhage, the nurse will ask the patient about antiplatelet and anticoagulant medications as well as which dietary supplement?
Ginkgo biloba
A hospitalized patient complains of acute chest pain. The nurse administers a 0.3-mg sublingual nitroglycerin tablet, but the patient continues to complain of pain. Vital signs remain stable. What is the nurse's next step?
Give a second dose of nitroglycerin in 5 minutes.
A nurse is preparing to administer digoxin [Lanoxin] to a patient. The patient's heart rate is 62 beats per minute, and the blood pressure is 120/60 mm Hg. The last serum electrolyte value showed a potassium level of 5.2 mEq/L. What will the nurse do?
Give the dose of digoxin and notify the provider of the potassium level.
A patient who has been prescribed oral ferrous sulfate reports taking extra doses for the past few months. The patient's serum iron level is 560 mcg/dL. What will the nurse expect the provider to order for this patient?
Giving parenteral deferoxamine [Desferal]
A 12-year-old female patient is admitted to the hospital before sinus surgery. The nurse preparing to care for this patient notes that the admission hemoglobin is 10.2 gm/dL, and the hematocrit is 32%. The nurse will ask the child's parents which question about their daughter?
Has she begun menstruating?"
A nurse is obtaining a history from a patient who will receive tadalafil [Cialis] for erectile dysfunction. The patient reports that he expects to have sexual activity three or four times a week. What should the nurse tell the patient?
He should talk to his provider about daily dosing of tadalafil
A 45-year-old patient with a family history of breast cancer is considering using tamoxifen [Nolvadex] for cancer prevention. The nurse performs a health history and learns that the woman had a child when she was 35 years old, that she has not had a hysterectomy, and that she experienced DVT when she was pregnant. What will the nurse tell the patient?
Her history of DVT outweighs any possible benefits she may have with this drug.
A 43-year-old patient with a strong family history of breast cancer considers taking tamoxifen [Nolvadex] for cancer prevention. Which assessment finding is a possible contraindication?
History of deep vein thrombosis (DVT)
The nurse is preparing to administer a dose of epoetin alfa to a patient and notes that the patient has a hemoglobin level of 11.7 gm/dL. Which action by the nurse is correct?
Hold the dose and notify the provider
A nurse is providing teaching for an adult patient with arthritis who has been instructed to take ibuprofen [Motrin] for discomfort. Which statement by the patient indicates a need for further teaching?
I may experience tinnitus with higher doses of this medication."
A patient with vitamin B12 deficiency is admitted with symptoms of hypoxia, anemia, numbness of hands and feet, and oral stomatitis. The nurse expects the prescriber to order which of the following therapies?
IM cyanocobalamin and folic acid
A patient with volume overload begins taking a thiazide diuretic. The nurse will tell the patient to expect which outcome when taking this drug?
Improved exercise tolerance
A nurse is reviewing a patient's medications and realizes that gemfibrozil [Lopid] and warfarin [Coumadin] are to be administered concomitantly. Which effect will the nurse anticipate in this patient?
Increased anticoagulant effects
The nurse is obtaining a history from a patient who discloses daily use of St. John's wort in addition to prescription drugs. Which effect of this dietary supplement would most concern the nurse?
It accelerates the metabolism of some drugs.
A patient asks a nurse why he cannot use digoxin [Lanoxin] for his heart failure, because both of his parents used it for HF. The nurse will explain that digoxin is not the first-line therapy for which reason?
It does not correct the underlying pathology of heart failure.
The nurse educator is providing patient education about the Cardiac Arrhythmia Suppression Trial (CAST). The nurse correctly explains that the trial demonstrated what effect from the pharmacologic suppression of dysrhythmias?
It doubled the risk of a second MI.
A patient who is taking acetaminophen for pain wants to know why it does not cause gastrointestinal upset, as do other over-the-counter pain medications. The nurse will explain that this is most likely because of which property of acetaminophen?
It has minimal effects at peripheral sites.
A patient will begin taking dabigatran etexilate [Pradaxa] to prevent stroke. The nurse will include which statement when teaching this patient?
It is important not to crush, chew, or open capsules of dabigatran.
A nursing student is helping to care for a patient who takes verapamil for stable angina. The nurse asks the student to explain the purpose of verapamil in the treatment of this patient. Which statement by the student indicates a need for further teaching?
It relaxes coronary artery spasms."
A patient asks a nurse about who is eligible to receive anthrax vaccine [BioThrax]. The nurse will respond by saying that which groups of people would be candidates for this vaccine? (Select all that apply.)
Laboratory workers Military personnel Veterinarians
A patient with non-Hodgkin's lymphoma is about to begin chemotherapy with a massive dose of methotrexate [Rheumatrex]. The nurse will expect to administer which medication concurrently with this drug?
Leucovorin
The nurse is preparing to administer medication to a patient receiving cyclophosphamide [Cytoxan]. To protect against the side effect of hemorrhagic cystitis, the nurse would expect to administer which drug?
Mesna (Mesnex)
A patient on an oncology unit has been receiving ifosfamide [Ifex] for a few days. Before administering the next dose, the nurse reviews the patient's laboratory test results. Which finding would cause the nurse to hold the dose?
Microscopic hematuria
A woman who has arthritis is breast-feeding her infant and asks the nurse if it is safe to take NSAIDs while nursing. What will the nurse tell this patient?
NSAIDs are safe to take while breast-feeding.
The nurse on an oncology unit prepares to administer the fourth cycle of docetaxel [Taxotere] to a patient with breast cancer. Which clinical finding would cause the nurse to withhold the dose and call the prescriber?
Neutrophil count below 1500/mm3
A patient who will begin taking colchicine for gout reports taking nonsteroidal anti-inflammatory drugs, simvastatin, amoxicillin, and digoxin. What will the nurse do?
Notify the provider about the potential risk of muscle injury when simvastatin is taken with colchicine.
A patient with diabetes develops ventricular tachycardia and is in the hospital for evaluation of this condition. The nurse reviews the history and learns that the patient takes mexiletine [Mexitil] for pain caused by peripheral neuropathy. What should the nurse do?
Notify the provider to request that another drug be used for peripheral neuropathy pain.
A patient with lung cancer receives filgrastim [Neupogen] after chemotherapy to reduce neutropenia. The patient reports a moderate degree of bone pain. What will the nurse do?
Obtain an order to administer acetaminophen.
A patient who has erectile dysfunction asks a nurse whether sildenafil [Viagra] would be a good medication for him to take. Which aspect of this patient's history would be of most concern?
Occasional use of nitroglycerin
The nurse is caring for a patient who begins to complain of shortness of breath. The nurse assesses the patient and notes 3+ pitting edema bilaterally in the lower extremities. Which medication taken by the patient causes the most concern?
Oprelvekin (Interleukin 11)
Which are contraindications for taking sildenafil [Viagra]? (Select all that apply.)
Patients who are taking nitroglycerin for angina pectoris Patients with nonarteritic ischemic optic neuropathy (NAION) in one eye Patients with BPH who are taking alpha1-adrenergic antagonists
A patient is taking digoxin [Lanoxin] and develops a dysrhythmia. The nurse reports this finding to the prescriber, who will most likely order what? (Select all that apply.)
Phenytoin [Dilantin Serum electrolytes
A prescriber is considering prescribing the amiodarone derivative dronedarone [Multaq] for a patient with atrial flutter. The nurse should be concerned about which of the following?
QT interval of 520 msec
A patient with angina who is taking ranolazine [Ranexa] has developed a respiratory infection and a dysrhythmia. The provider has ordered azithromycin [Zithromax] for the infection and amlodipine for the dysrhythmia. A nursing student caring for this patient tells the nurse that the patient's heart rate is 70 beats per minute, and the blood pressure is 128/80 mm Hg. The nurse asks the student to discuss the plan for this patient's care. Which action is correct?
Question the order for azithromycin [Zithromax].
A nurse is preparing to administer a second infusion of trastuzumab [Herceptin] to a patient who has breast cancer. The patient tells the nurse that she experienced chills, fever, pain, and nausea after her first infusion. What will the nurse do?
Reassure the patient that these symptoms will diminish with each infusion.
A nurse is caring for a patient in the intensive care unit who is receiving intravenous lidocaine. The patient is drowsy and confused and reports numbness of the fingers and toes. Which standing order will the nurse initiate at this time?
Reduce the rate of infusion.
Which is a possible benefit of taking fish-oil supplements?
Reduced risk of dysrhythmia in patients after myocardial infarction
A patient reported to have been exposed to mustard gas is brought to the emergency department. The patient's skin is red and swollen with small blisters, and the patient's eyes are red and tearing. The patient has a runny nose and a dry, barking cough. What should the nurse's initial action be?
Remove the patient's clothing and clean the skin with soap and water.
A patient admitted to the emergency department with abdominal pain tells the nurse he has been taking kava. Which action is the nurse's priority at this time?
Review liver function studies.
An Asian patient will begin taking rosuvastatin [Crestor] to treat hypercholesterolemia. What will the nurse include when teaching this patient about this medication?
Serum drug levels must be monitored more frequently than with other patients.
A patient who has been taking a glucocorticoid for several months arrives in the clinic. The nurse notes that the patient's cheeks appear full and that a prominent hump of fat is present on the upper back. The nurse will ask the provider to order which test(s)?
Serum electrolytes
A patient with chronic gout has an acute gouty episode and is admitted to the hospital. The patient has been taking nonsteroidal anti-inflammatory drugs for several months. The prescriber plans to begin therapy with probenecid. What will the nurse do?
Suggest delaying the probenecid therapy until the acute episode has subsided.
A patient is about to receive prednisone for tendonitis. The nurse reviewing the chart would be concerned about which of the following in the patient's medical history?
Systemic fungal infection
Lovastatin [Mevacor] is prescribed for a patient for the first time. The nurse should provide the patient with which instruction?
Take lovastatin with your evening meal."
A patient is receiving oral iron for iron deficiency anemia. Which antibiotic drug, taken concurrently with iron, would most concern the nurse?
Tetracycline
A patient will begin taking hydroxychloroquine [Plaquenil] for rheumatoid arthritis. The patient is currently taking high-dose NSAIDs and methotrexate. What will the nurse teach the patient?
That an eye exam is necessary at the beginning of therapy with this drug
A child who has juvenile idiopathic arthritis and who has been taking methotrexate [Rheumatrex] will begin a course of abatacept [Orencia]. What will the nurse include when teaching the child's family about this drug?
That signs of infection may warrant immediate discontinuation of abatacept
A postmenopausal woman will begin taking atorvastatin [Lipitor] to treat hypercholesterolemia. The woman reports a history of osteopenia with a family risk of osteoporosis. What will the nurse include when teaching this patient?
The need to discuss taking a bisphosphonate medication with her provider
A nurse is reviewing the medications of a patient with diabetes before discharge. The nurse realizes that the patient will be going home on colesevelam, a bile acid sequestrant, and insulin. What patient education should the nurse provide in the discharge teaching for this patient?
The patient needs to monitor the blood sugar carefully, because colesevelam can cause hypoglycemia.
A patient tells the nurse that she takes aspirin for menstrual cramps, but she does not feel that it works well. What will the nurse suggest?
The patient should use a first-generation nonsteroidal anti-inflammatory medication instead.
These patients are receiving chemotherapy. Which patient should the nurse see first?
The patient with a fever of 100.3°F
A patient taking gemfibrozil [Lopid] and rosuvastatin [Crestor] concurrently begins to complain of muscle aches, fatigue, and weakness. What should the nurse monitor?
The patient's creatinine kinase levels
The nurse wants to evaluate a nursing student's understanding of chemotherapy. The nurse asks, "Which factor would be a major obstacle to successful chemotherapy?" What is the student's best response?
The toxicity of anticancer drugs to normal tissues."
A 50-year-old female patient asks a nurse about taking aspirin to prevent heart disease. The patient does not have a history of myocardial infarction. Her cholesterol and blood pressure are normal, and she does not smoke. What will the nurse tell the patient?
There is most likely no protective benefit for patients her age.
The nurse is caring for a patient who is receiving an infusion of botulinum antitoxin after consuming botulinum toxin in contaminated food. The patient has developed double vision, slurred speech, and upper body muscle weakness. The patient's spouse asks the nurse what the antitoxin will do. Which response is correct?
This infusion will help prevent further nerve damage."
A patient will begin receiving vincristine [Oncovin] to treat Hodgkin's lymphoma. Which side effect(s) will the nurse tell the patient to report immediately?
Tingling of the extremities
A patient with rheumatoid arthritis is taking leflunomide [Arava] and an oral contraceptive. She tells the nurse she would like to get pregnant. What will the nurse tell her?
To ask her provider about an 11-day course of cholestyramine
A patient will begin taking drugs for hyperlipidemia. The patient asks about using flaxseed supplements to increase fiber. What will the nurse tell this patient?
To take the flaxseed 1 hour before taking the drug
A patient is in the intensive care unit after a myocardial infarction. The nurse notes that the QT interval on this patient's electrocardiogram has been elongating. The nurse is concerned that which cardiac dysrhythmia may occur?
Torsades de pointes
A patient has heart failure and is taking an ACE inhibitor. The patient has developed fibrotic changes in the heart and vessels. The nurse expects the provider to order which medication to counter this development?
aldosterone antagonist
A premenopausal woman has ER-positive breast cancer, and her prescriber has ordered tamoxifen [Nolvadex]. She asks the nurse if anastrozole [Arimidex] would work better for her. What will the nurse tell her?
Until she is postmenopausal, anastrozole will not be effective.
A patient has had three gouty flare-ups in the past year. Which drug class will the nurse expect the provider to order for this patient?
Urate-lowering drugs
A patient is admitted to the hospital. The patient's initial laboratory results reveal megaloblastic anemia. The patient complains of tingling of the hands and appears confused. The nurse suspects what in this patient?
Vitamin B12 deficiency
A patient was given a 30-day supply of Feosol and has been taking the drug for 4 weeks for iron deficiency anemia. The patient's initial hemoglobin was 8.9 gm/dL. The nurse notes that the hemoglobin has risen to 9.7 gm/dL. What will the nurse ask the patient about?
Whether the prescription needs to be refilled
A patient with CRF who will begin receiving an erythropoiesis stimulating agent (ESA) is admitted to the hospital. The nurse notes that the patient's heart rate is 82 beats per minute, and the blood pressure is 140/100 mm Hg. A complete blood count reveals a hemoglobin of 8 gm/dL and a hematocrit of 29%. What will the nurse do?
Withhold the ESA and request an order for an antihypertensive medication.
A patient with chronic gout is admitted to the hospital for treatment for an infection. The patient is receiving allopurinol and ampicillin. The nurse is preparing to administer medications and notes that the patient has a temperature of 101°F and a rash. What will the nurse do?
Withhold the allopurinol and notify the prescriber of the drug reaction.
A patient who takes aspirin for rheumatoid arthritis is admitted to the hospital complaining of headache and ringing in the ears. The plasma salicylate level is 300 mcg/mL, and the urine pH is 6.0. What will the nurse do?
Withhold the aspirin until the patient's symptoms have subsided.
A patient is taking digoxin [Lanoxin] and quinidine to treat sustained ventricular tachycardia. Before giving medications, the nurse reviews the patient's electrocardiogram (ECG) and notes a QRS complex that has widened by 50% from the baseline ECG. What will the nurse do?
Withhold the quinidine and contact the provider to report the ECG finding.
A male patient is being treated for benign prostatic hyperplasia (BPH) by another provider but cannot remember which drug he is taking. He comes to the clinic seeking treatment for erectile dysfunction and receives a prescription for sildenafil [Viagra]. What will the nurse teach this patient?
You should not take sildenafil if you are taking silodosin [Rapaflo]."
A patient who takes warfarin [Coumadin] is brought to the emergency department after accidentally taking too much warfarin. The patient's heart rate is 78 beats per minute and the blood pressure is 120/80 mm Hg. A dipstick urinalysis is normal. The patient does not have any obvious hematoma or petechiae and does not complain of pain. The nurse will anticipate an order for:
a PT and an INR.
A patient who has recently immigrated to the United States from an impoverished country appears malnourished. The patient's folic acid levels are low, and the vitamin B12 levels are normal. The nurse expects this patient's treatment to include:
a diet high in folic acid.
A patient is admitted for treatment of gout that has been refractory to treatment with allopurinol and probenecid. The patient is taking colchicine, and the prescriber orders pegloticase [Krystexxa]. Before administering this drug, the nurse will expect to:
administer an antihistamine and a glucocorticoid.
A patient with atrial fibrillation is receiving warfarin [Coumadin]. The nurse notes that the patient's INR is 2.7. Before giving the next dose of warfarin, the nurse will notify the provider and:
administer the dose as ordered.
A nurse is caring for a patient who has been taking low-dose aspirin for several days. The nurse notes that the patient has copious amounts of watery nasal secretions and an urticarial rash. The nurse will contact the provider to discuss:
administering epinephrine.
A patient with a history of benign prostatic hyperplasia is admitted to the unit. The patient is taking multiple medications, including terazosin [Hytrin]. During the evening rounds, the patient begins to complain of dizziness and nasal congestion. Upon assessment, the patient is somnolent and has a blood pressure of 101/42 mm Hg. The nurse is correct to suspect:
adverse effects
The patient with which of the following is most at risk for folic acid deficiency?
alcoholism
A nursing student asks a nurse why chemotherapeutic agents are given intermittently instead of continuously. The nurse will tell the student that intermittent dosing:
allows normal cells to recover and repopulate.
A patient asks a nurse how to know whether dietary supplements are safe. The nurse will tell this patient that:
any standards addressing safety merely regulate labeling and manufacturing processes.
A patient who has a brain tumor will receive a nitrosourea agent. A nursing student asks why this type of drug is used for this type of cancer. The nurse will tell the student that nitrosoureas are useful because they:
are lipophilic
A patient with heart failure who has been given digoxin [Lanoxin] daily for a week complains of nausea. Before giving the next dose, the nurse will:
assess the heart rate (HR) and give the dose if the HR Is greater than 60 beats per minute.
A patient with cancer who is receiving chemotherapy develops a fever. The patient's chest radiograph is normal. The patient's neutrophil count is 750/mm3. The nurse expects the provider to:
begin empiric therapy with intravenous antibiotics.
Which two classes of antidysrhythmic drugs have nearly identical cardiac effects?
beta blockers and calcium channel blockers
The nurse has just received an order for tenecteplase [TNKase] for a patient experiencing an acute myocardial infarction. The nurse should administer this drug:
by bolus injection.
A 60-year-old female patient is about to begin long-term therapy with a glucocorticoid. Which of the following will be important for minimizing the risk of osteoporosis?
calcium and vitamin D supplements
A patient will begin taking tamoxifen [Nolvadex] to treat breast cancer. The nurse performs a medication history and learns that the patient is taking sertraline [Zoloft] for depression. The nurse will tell the patient to contact her provider to ask about:
changing from sertraline to escitalopram [Lexapro].
A patient who is taking clopidogrel [Plavix] calls the nurse to report black, tarry stools and coffee-ground emesis. The nurse will tell the patient to:
continue taking the clopidogrel until talking to the provider.
A patient who has undergone surgical removal of a solid tumor has just begun chemotherapy. The patient experiences severe nausea and vomiting as well as alopecia. The nurse will expect the provider to:
continue the chemotherapeutic agent at the same dose.
A nurse is reviewing a patient's most recent blood count and notes that the patient has a hemoglobin of 9.6 gm/dL and a hematocrit of 33%. The nurse will notify the provider and will expect initial treatment to include:
determining the cause of the anemia.
A patient has been receiving intravenous ketorolac 30 mg every 6 hours for postoperative pain for 4 days. The patient will begin taking oral ketorolac 10 mg every 4 to 6 hours to prepare for discharge in 1 or 2 days. The patient asks the nurse whether this drug will be prescribed for management of pain after discharge. The nurse will respond by telling the patient that the provider will prescribe a(n):
different nonsteroidal anti-inflammatory drug for home management of pain.
A nurse caring for a patient receiving heparin therapy notes that the patient has a heart rate of 98 beats per minute and a blood pressure of 110/72 mm Hg. The patient's fingertips are purplish in color. A stat CBC shows a platelet count of less than 100,000 mm3. The nurse will:
discontinue the heparin and notify the provider.
A patient is taking a thiazide diuretic for hypertension and quinidine to treat a dysrhythmia. The prescriber orders digoxin 0.125 mg to improve this patient's cardiac output. The nurse should contact the provider to request:
discontinuing the quinidine.
A male patient tells the nurse he awakens once or twice each night to void and has difficulty starting his stream of urine. He describes these symptoms as "annoying." The patient's provider examines him and notes that the prostate is moderately enlarged. The patient is sexually active and tells the nurse that he does not want to take any medication that will interfere with sexual function. The nurse anticipates the provider will order:
doxazosin [Cardura
A patient with advanced prostate cancer will begin treatment with leuprolide [Lupron]. The provider has ordered flutamide to be given as adjunct therapy. The patient asks the nurse why both drugs are necessary. The nurse will tell the patient that:
flutamide suppresses initial tumor flare caused by leuprolide.
A patient is admitted to the emergency department with chest pain. An electrocardiogram shows changes consistent with an evolving myocardial infarction. The patient's cardiac enzymes are pending. The nurse caring for this patient will expect to:
give alteplase [Activase] within 2 hours.
A patient with chronic renal failure who is on dialysis receives an ESA. The nurse caring for this patient during dialysis notes that the patient's hemoglobin is 10.9 gm/dL, up from the 10.2 gm/dL recorded 2 weeks ago. The patient's blood pressure is 120/80 mm Hg. The nurse will contact the provider to suggest:
giving heparin.
A patient is beginning therapy with oral methotrexate [Rheumatrex] for rheumatoid arthritis. The nurse will teach this patient about the importance of:
having routine renal and hepatic function tests.
A patient is taking a calcium channel blocker (CCB) for stable angina. The patient's spouse asks how calcium channel blockers relieve pain. The nurse will explain that CCBs:
help relax peripheral arterioles to reduce afterload.
A nursing student asks a nurse what the NMBER system that rates dietary supplements means. The nurse responds that the NMBER system:
helps consumers evaluate the safety and efficacy of products.
A patient who is hospitalized for an acute gout attack has received several doses of hourly oral colchicine but still reports moderate to severe pain. As the nurse prepares to administer the next dose, the patient begins vomiting. What will the nurse do?
hold medication and notify prescriber
A patient is taking enalapril [Vasotec]. The nurse understands that patients taking this type of drug for heart failure need to be monitored carefully for:
hyperkalemia
A nurse is attending a conference about terrorism and emergency response. During a discussion of radiation emergencies, the use of potassium iodide is reviewed. When should potassium iodide be administered to be most effective after exposure to radiation?
immediately after exposure
A patient who has taken warfarin [Coumadin] for a year begins taking carbamazepine. The nurse will anticipate an order to:
increase dose of warfarin
A nursing student asks a nurse how beta blockers increase the oxygen supply to the heart in the treatment of anginal pain. The nurse tells the student that beta blockers:
increase the time the heart is in diastole
A nursing student asks a nurse how digoxin causes dysrhythmias. The nurse correctly states that digoxin:
increases automaticity in the Purkinje fibers.
A clinic patient who has been taking a glucocorticoid for arthritis for several months remarks to the nurse, "It's a good thing my symptoms are better, because my mother has been quite ill, and I have to take care of her." The patient's blood pressure is 100/60 mm Hg. The nurse will report this to the provider and ask about:
increasing the patient's dose.
A patient is admitted to the hospital with fever, cough, malaise, and weakness. Forty-eight hours later, the symptoms have become progressively worse, and they progress to severe respiratory distress, septicemia, and hemorrhagic meningitis. The nurse recognizes these signs and symptoms as:
inhalation anthrax
A patient with new-onset exertional angina has taken three nitroglycerin sublingual tablets at 5-minute intervals, but the pain has intensified. The nurse notes that the patient has a heart rate of 76 beats per minute and a blood pressure of 120/82 mm Hg. The electrocardiogram is normal. The patient's lips and nail beds are pink, and there is no respiratory distress. The nurse will anticipate providing:
intravenous nitroglycerin and a beta blocker.
A patient will begin taking etanercept [Enbrel] for severe rheumatoid arthritis. The patient has been taking methotrexate [Rheumatrex]. The patient asks if the etanercept is stronger than the methotrexate. The nurse will tell the patient that etanercept ____ methotrexate.
is better at delaying progression of joint damage than
A patient with heart failure who takes a thiazide diuretic and digoxin [Lanoxin] is admitted for shortness of breath. The patient's heart rate is 66 beats per minute, and the blood pressure is 130/88 mm Hg. The serum potassium level is 3.8 mEq/L, and the digoxin level is 0.8 ng/mL. The nurse admitting this patient understands that the patient:
is experiencing worsening of the disease.
A prescriber orders verapamil [Covera-HS] for a patient who is taking digoxin [Lanoxin] and warfarin. The nurse will expect the prescriber to ____ the dose of ____.
lower; digoxin
The nurse is taking a medication history on a newly admitted patient. The patient reports taking folic acid and vitamin B12. The nurse notifies the provider because of the concern that folic acid can:
mask the signs of vitamin B12 deficiency.
A patient who is taking simvastatin [Zocor] develops an infection and the provider orders azithromycin [Zithromax] to treat the infection. The nurse should be concerned if the patient complains of:
muscle pain
A postoperative patient will begin anticoagulant therapy with rivaroxaban [Xarelto] after knee replacement surgery. The nurse performs a history and learns that the patient is taking erythromycin. The patient's creatinine clearance is 50 mL/min. The nurse will:
notify the provider to discuss changing the patient's antibiotic.
A patient who is taking warfarin [Coumadin] has just vomited blood. The nurse notifies the provider, who orders lab work revealing a PT of 42 seconds and an INR of 3.5. The nurse will expect to administer:
phytonadione (vitamin K1) 1 mg IV over 1 hour.
A patient in her twenties has frequent urinary tract infections, and her prescriber suggests drinking cranberry juice. She asks the nurse how drinking this can help. The nurse will tell her that cranberry juice:
prevents bacteria from adhering to the urinary tract wall.
A patient asks a nurse how nitroglycerin works to relieve anginal pain. The nurse correctly states, "Nitroglycerin:
promotes vasodilation, which reduces preload and oxygen demand."
A patient is receiving heparin postoperatively to prevent deep vein thrombosis. The nurse notes that the patient has a blood pressure of 90/50 mm Hg and a heart rate of 98 beats per minute. The patient's most recent aPTT is greater than 90 seconds. The patient reports lumbar pain. The nurse will request an order for:
protamine sulfate.
A group of people has been exposed to ricin by inhalation of ricin mist. When preparing to receive these victims in the emergency department, nurses will prepare to:
provide respiratory support
A patient who takes warfarin for atrial fibrillation undergoes hip replacement surgery. On the second postoperative day, the nurse assesses the patient and notes an oxygen saturation of 83%, pleuritic chest pain, shortness of breath, and hemoptysis. The nurse will contact the provider to report possible ____ and request an order for ____.
pulmonary embolism; heparin
A patient with a hemoglobin of 7.2 gm/dL begins therapy with an ESA. Two weeks later the patient's hemoglobin is 8.3 gm/dL. The nurse anticipates that the provider will:
reduce the ESA dose.
A patient will receive intrathecal liposomal cytarabine [DepoCyt] to treat acute myelogenous leukemia. The provider has ordered the concurrent administration of dexamethasone. The nurse understands that this is given to:
reduce the severity of chemical arachnoiditis.
A nursing student asks a nurse how cancer cells become resistant to methotrexate [Rheumatrex]. The nurse is correct to respond by saying that cancer cells acquire resistance to methotrexate by:
reduced uptake of methotrexate into cells.
A patient is being treated with warfarin [Coumadin] to prevent thrombus. The patient develops hyperuricemia, and the provider orders allopurinol [Zyloprim]. The nurse will contact the provider to discuss ____ the ____ dose.
reducing; warfarin
Terrorists have detonated a "dirty bomb" in a shopping center. Nurses are called to the site to assist with triage of victims. Besides treating injuries incurred from the blast itself, the priorities for treatment for most of the victims will include:
removing clothing and bathing victims.
A nurse is caring for a patient after hip replacement surgery. The patient has been receiving iron replacement therapy for 2 days. The nurse notes that the patient's stools appear black. The patient is pale and complains of feeling tired. The patient's heart rate is 98 beats per minute, respirations are 20 breaths per minute, and the blood pressure is 100/50 mm Hg. The nurse will contact the provider to:
request a hemoglobin and hematocrit (H&H).
A patient with heart failure who has been taking an ACE inhibitor, a thiazide diuretic, and a beta blocker for several months comes to the clinic for evaluation. As part of the ongoing assessment of this patient, the nurse will expect the provider to evaluate:
serum electrolyte levels
A member of a community disaster response team received the smallpox vaccine 3 weeks ago and sees a nurse for a follow-up appointment. The nurse examines the area and should expect to see a:
small area of scarification.
A 68-year-old male patient receives a prescription for 25-mg tablets of sildenafil [Viagra] for erectile dysfunction. When he asks the nurse how to take the medication, the nurse will tell him to:
start with one tablet about 1 hour before anticipated sexual activity.
A patient who has been diagnosed with rheumatoid arthritis (RA) for 1 month and has generalized symptoms is taking high-dose nonsteroidal anti-inflammatory drugs (NSAIDs) and an oral glucocorticoid. The provider has ordered methotrexate [Rheumatrex]. The patient asks the nurse why methotrexate is necessary since pain and swelling have been well controlled with the other medications. The nurse will tell the patient that:
starting methotrexate early can help delay joint degeneration.
A patient who takes daily doses of aspirin is scheduled for surgery next week. The nurse should advise the patient to:
stop using aspirin immediately.
A patient is diagnosed with moderate vitamin B12 deficiency. The nurse reviews the laboratory work and notes that the plasma B12 is low; also, a Schilling test reveals B12 malabsorption. The provider orders oral cyanocobalamin 500 mcg per day. The nurse will contact the provider to:
suggest an increased dose.
The nurse would be correct to state that the purpose of angiogenesis inhibitors is to:
suppress the formation of new blood vessels in tumors.
A patient is receiving chemotherapy. Seven days after a dose, the patient's neutrophil count is 1000 cells/mm3. The nurse will tell this patient:
that the provider will probably repeat the lab work in 3 to 5 days.
A hospitalized patient with cancer is receiving chemotherapy and reports oral pain. Inspection of this patient's oral mucosa reveals erythema and inflammation without denudation or ulceration. The nurse understands that:
the patient can use a mouthwash with a topical anesthetic to control pain.
A patient has just been diagnosed with cancer and will begin chemotherapy. The patient asks the nurse about the possibility of nausea and vomiting. The nurse will tell the patient that:
the provider will order drugs to help prevent nausea and vomiting before each dose.
A patient about to begin therapy with etanercept has a positive tuberculin skin test. A chest radiograph is negative. The nurse will expect this patient to:
undergo tuberculosis treatment prior to beginning etanercept treatment.
The nurse is teaching a class on dysrhythmias and associated therapy. The nurse asks the class, "Which cardiac dysrhythmia would result in the lowest cardiac output, and what treatment would be effective?" The class best demonstrates understanding by responding that ____ results in the lowest cardiac output, and treatment includes ____.
ventricular fibrillation; defibrillation
A patient who has begun using transdermal nitroglycerin for angina reports occasional periods of tachycardia. The nurse will expect the prescriber to order:
verapamil as an adjunct to nitroglycerin therapy.
An older male patient with an increased risk of MI is taking furosemide [Lasix] and low-dose aspirin. The patient is admitted to the hospital, and the nurse notes an initial blood pressure of 140/80 mm Hg. The patient has had a 10-pound weight gain since a previous admission 3 months earlier. The patient has voided only a small amount of concentrated urine. The serum creatinine and blood urea nitrogen (BUN) levels are elevated. The nurse will contact the provider to discuss:
withdrawing the aspirin.
