Pharm Midterm Review

What is the target organ when a beta1 agonist is administered? a) Heart b) Kidney c) Respiratory d) Liver

ANS: A A beta1 agonist increases the patient's heart rate and blood pressure and is used in heart failure. Beta1 agonists would not be used for kidney, respiratory, or liver failure.

The parents of a child with asthma ask the nurse why their child cannot use oral corticosteroids more often, because they are so effective. The nurse will offer which information that is true for children? a. Chronic steroid use can inhibit growth. b. Frequent use of this drug may lead to a decreased response. c. A hypersensitivity reaction to this drug may occur. d. Systemic steroids are more toxic in children.

ANS: A A specific age-related reaction to a drug is growth suppression caused by glucocorticoids. Children with asthma may need these from time to time for acute exacerbations, but chronic use is not recommended. None of the other three effects occurs in either adults or children.

A child with moderate hemophilia A who weighs 20 kg is admitted to the hospital after a knee injury with bleeding into the joint. The nurse will expect the provider to order which medication? A. Advate 400 units IV over 10 minutes B. Benefix 800 units slow IV push C. Desmopressin 6 mcg IV over 15 to 30 minutes D. Tranexamic acid [Cyklokapron] 200 mg IV

ANS: A Advate is a third-generation product for factor VIII replacement, which this child needs. Third- generation products are safer, because they are not exposed to BSA or HAS during production; therefore, this is the product of choice.

A nurse is giving aspirin to a patient during acute management of STEMI. The patient asks why a chewable tablet is given. Which response by the nurse is correct? A. "Aspirin is absorbed more quickly when it is chewed." B. "Chewing aspirin prevents it from being metabolized by the liver." C. "Chewing aspirin prevents stomach irritation." D. "More of the drug is absorbed when aspirin is chewed."

ANS: A Aspirin should be chewed to allow rapid absorption across the buccal mucosa. Chewing aspirin does not affect hepatic metabolism, stomach irritation, or the amount absorbed.

A nurse is teaching a group of nursing students about antidysrhythmic medications. Which statement by a student indicates understanding of the teaching? A. "Antidysrhythmic drugs can cause new dysrhythmias or worsen existing ones." B. "Adverse effects of these drugs are mainly noncardiac in nature." C. "For most antidysrhythmic drugs, there is evidence of reduced mortality." D. "Use of these drugs may be necessary even if the benefits are unknown."

ANS: A Because antidysrhythmic drugs have prodysrhythmic actions, they can exacerbate existing dysrhythmias or generate new ones.

A patient recently was diagnosed with bipolar disorder. The patient, who has a history of seasonal allergies, is an athlete who participates in track. The nurse is teaching the patient about lithium [Lithobid], which the prescriber has just ordered. Which statement by the patient indicates the need for further teaching? a. "I can continue to use ibuprofen as needed for muscle pain." b. "I should drink extra fluids before and during exercise." c. "I should not use antihistamines while taking lithium." d. "I should report muscle weakness and tremors to my provider."

ANS: A Because nonsteroidal anti-inflammatory drugs (NSAIDs) can increase lithium levels as much as 60%, they should not be used by patients taking lithium.

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? A. Administer the dose as ordered. B. Hold the dose and notify the provider. C. Request an order for a reduced dose. D. Suggest that the provider increase the dose.

ANS: A Because the risks of severe cardiovascular events and death are higher in patients whose hemoglobin levels exceed 11 gm/dL, the nurse should hold the dose and notify the provider of this level.

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: A. determining the cause of the anemia. B. giving intravenous iron dextran. C. giving oral carbonyl iron [Feosol]. D. teaching about dietary iron.

ANS: A Before therapy for iron deficiency anemia is started, the cause must be determined so that the appropriate treatment is given.

A postoperative patient complains of abdominal bloating and discomfort. The nurse caring for this patient will contact the provider to request which medication? a. Bethanechol b. Droperidol c. Promethazine d. Ondansetron

ANS: A Bethanechol is a muscarinic agonist that is used to treat abdominal distention and urinary retention. The other three agents are antiemetics and would not be useful in this situation.

A patient who has been taking clonidine [Catapres] for several weeks complains of drowsiness and constipation. What will the nurse do? a. Recommend that the patient take most of the daily dose at bedtime. b. Suggest asking the provider for a transdermal preparation of the drug. c. Suspect that the patient is overusing the medication. d. Tell the patient to stop taking the drug and call the provider.

ANS: A CNS depression is common with clonidine, but this effect lessens over time. Constipation is also a common side effect. Patients who take most of the daily amount at bedtime can minimize daytime sedation.

A patient complains to the nurse that the clonidine [Catapres] recently prescribed for hypertension is causing drowsiness. Which response by the nurse to this concern is appropriate? a. "Drowsiness is a common side effect initially, but it will lessen with time." b. "You may also experience orthostatic hypotension along with the drowsiness." c. "You may be at risk for addiction if you have central nervous system side effects." d. "You should discontinue the medication and contact your prescriber."

ANS: A CNS depression, evidenced in this patient by drowsiness, is common in about 35% of the population. These responses become less intense with continued drug use.

Supplemental oxygen has been shown to help reduce symptoms for which type of headache? a. Cluster b. Menstrual migraine c. Migraine d. Tension-type

ANS: A Cluster headaches can be treated with 100% oxygen inhalation. Oxygen therapy is not used to treat other types of headaches.

A patient is receiving oral iron for iron deficiency anemia. Which antibiotic drug, taken concurrently with iron, would most concern the nurse? A. Tetracycline B. Cephalosporin C. Metronidazole [Flagyl] D. Penicillin

ANS: A Coadministration of tetracycline and iron reduces absorption of both iron and tetracycline. Cephalosporin, metronidazole, and penicillin have no significant drug-to-drug interaction with iron.

A nurse is caring for a patient who is receiving a drug that causes constriction of arterioles. The nurse expects to observe which effect from this drug? A. Decreased stroke volume B. Increased stroke volume C. Decreased myocardial contractility D. Increased myocardial contractility

ANS: A Constriction of arterioles increases the load against which the heart must pump to eject blood.

A patient is hospitalized with head trauma after a motor vehicle accident. The nurse caring for the patient notes a marked increase in the output of pale, dilute urine. The nurse suspects which condition? A. Diabetes insipidus B. Diabetes mellitus C. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) D. Water intoxication

ANS: A Deficiency of antidiuretic hormone (ADH) produces hypothalamic diabetes insipidus, in which large volumes of dilute urine are produced. Head trauma can cause the hypothalamus to stop producing ADH.

A nurse teaches a nursing student about the differences between desmopressin (DDAVP) and vasopressin [Pitressin]. Which statement by the student indicates a need for further teaching? A. "Desmopressin has a shorter duration of action than vasopressin." B. "Desmopressin is easier to administer than vasopressin." C. "Vasopressin can be used in cardiac resuscitation." D. "Vasopressin can cause serious adverse cardiovascular effects."

ANS: A Desmopressin has a long duration of action, which is the reason it is preferred for the treatment of diabetes insipidus.

A patient newly diagnosed with cancer is admitted to the hospital, and the provider orders oxycodone [OxyContin] every 4 to 6 hours PRN pain. The patient requests pain medication whenever he or she reports pain as a 7 or 8 on a scale of 1 to 10 (10 being the worst pain), but he or she tells the nurse the medication is not working well. The nurse will contact the provider to discuss: a. a fixed dosing schedule for the oxycodone. b. intramuscular meperidine [Demerol]. c. intravenous morphine sulfate. d. transdermal fentanyl.

ANS: A Dosing should be done on a fixed schedule to prevent opioid levels from becoming subtherapeutic once patients begin to have more severe pain.

The nurse assesses a newly diagnosed patient for short-term complications of diabetes. What does this assessment include? A. Evaluation for hyperglycemia, hypoglycemia, and ketoacidosis B. Cranial nerve testing for peripheral neuropathy C. Pedal pulse palpation for arterial insufficiency D. Auscultation of the carotids for bruits associated with atherosclerosis

ANS: A High blood sugar, low blood sugar, and ketoacidosis are short-term complications of diabetes.

A patient has three separate blood pressure (BP) readings of 120/100, 138/92, and 126/96 mm Hg. Which category describes this patient's BP? A. Hypertension B. Isolated systolic hypertension C. Normal D. Prehypertension

ANS: A Hypertension is defined as systolic BP over 140 mm Hg or diastolic BP over 90 mm Hg.

A nurse is assessing a patient who has heart failure. The patient complains of shortness of breath, and the nurse auscultates crackles in both lungs. The nurse understands that these symptoms are the result of: A. decreased force of ventricular contraction. B. increased force of ventricular contraction. C. decreased ventricular filling. D. increased ventricular filling.

ANS: A In the failing heart, Starling's law breaks down, and the force of contraction no longer increases in proportion to the amount of ventricular filling

A prescriber orders clonidine [Kapvay] ER tablets for a 12-year-old child. The nurse understands that this drug is being given to treat which condition? a. ADHD b. Hypertension c. Severe pain d. Tourette's syndrome

ANS: A Kapvay ER is used to treat ADHD and is given as a single dose at bedtime. This form of clonidine is not used for hypertension, severe pain, or treatment of Tourette's syndrome.

A nurse is teaching a group of nursing students about neuropharmacology. Which statement by a student about peripheral nervous system (PNS) drugs indicates a need for further teaching? a. "Drugs affecting axonal conduction have a variety of uses." b. "Drugs that alter synaptic transmission can be highly selective." c. "Many PNS drugs act by altering synaptic transmission." d. "These drugs work by influencing receptor activity."

ANS: A Local anesthetics are drugs that work by altering axonal conduction. Any drug affecting axonal conduction would be nonselective, because axonal conduction of impulses is essentially the same in all neurons.

A patient who has been taking alprazolam [Xanax] to treat generalized anxiety disorder (GAD) reports recently stopping the medication after symptoms have improved but reports having feelings of panic and paranoia. Which initial action by the nurse is correct? A. Ask the patient if the medication was stopped abruptly. B. Instruct the patient to resume taking the alprazolam. C. Notify the provider that the patient is experiencing a relapse. D. Suggest that the patient discuss taking buspirone [Buspar] with the provider.

ANS: A Long-term use of benzodiazepines can cause physical dependence, with symptoms of panic, paranoia, and delirium occurring with abrupt withdrawal.

A patient with bipolar disorder has been taking lithium [Lithobid] for several years. The patient has developed a goiter, and serum tests reveal hypothyroidism. What will the nurse expect the provider to order for this patient? a. Administration of levothyroxine b. Increasing the lithium dose c. Iodine supplements d. Referral to an endocrinologist

ANS: A Patients taking lithium may experience reduced incorporation of iodine into the thyroid hormone, resulting in goiter and hypothyroidism.

A patient with hypertension has a previous history of opioid dependence. Which medication would the nurse question? a. Clonidine [Catapres] b. Guanabenz [Wytensin] c. Methyldopa d. Reserpine [Serpasil]

ANS: A Patients who abuse cocaine, opioids, and other such drugs also frequently abuse clonidine, so this agent would not be the best choice for this patient. The other drugs do not share this abuse potential.

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? A."You will need to monitor your blood pressure closely while taking this drug." B. "You should take this drug 1 hour before or 2 hours after a meal." C. "You may experience rapid heart rate while taking this medication." D. "You do not need to worry about drug interactions with this medication."

ANS: A Ranolazine can elevate blood pressure in patients with renal impairment, so patients taking this drug will need to monitor blood pressure.

A patient with a new-onset seizure disorder receives a prescription for phenobarbital. The patient reports being concerned about the sedative side effects of this drug. Which response by the nurse is correct? A. "Phenobarbital doses for seizures are nonsedating." B. "This is a short-acting barbiturate, so sedation wears off quickly." C. "Tolerance to the sedative effects will develop in a few weeks." D. "You may actually experience paradoxical effects of euphoria."

ANS: A Rationale: Phenobarbital and mephobarbital are used for seizure disorders and suppress seizures at doses that are nonsedative.

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: A. reduce the ESA dose. B. discontinue the ESA. C. order a blood transfusion. D. order heparin.

ANS: A The patient's hemoglobin has risen just over 1 gm/dL in 2 weeks, so the dose of ESA should be reduced. The ESA should be discontinued when the hemoglobin is greater than 13 gm/dL.

A female patient with essential hypertension is being treated with hydralazine 25 mg twice daily. The nurse assesses the patient and notes a heart rate of 96 beats/min and a blood pressure of 110/72 mm Hg. The nurse will request an order to: A. administer a beta blocker. B. administer a drug that dilates veins. C. reduce the dose of hydralazine. D. give the patient a diuretic.

ANS: A This patient is showing signs of reflex tachycardia, so a beta blocker is indicated to slow the heart rate.

A patient arrives in the emergency department complaining of chest pain that has lasted longer than 1 hour and is unrelieved by nitroglycerin. The patient's electrocardiogram reveals elevation of the ST segment. Initial cardiac troponin levels are negative. The patient is receiving oxygen via nasal cannula. Which drug should be given immediately? A. Aspirin 325 mg chewable B. Beta blocker given IV C. Ibuprofen 400 mg orally D. Morphine intravenously

ANS: A This patient shows signs of acute ST-elevation myocardial infarction (STEMI). Because cardiac troponin levels usually are not detectable until 2 to 4 hours after the onset of symptoms, treatment should begin as symptoms evolve.

A nurse is caring for a child who has hemophilia. While reviewing this child's immunization records, the nurse notes that the child needs the tetanus and reduced diphtheria toxoids and acellular pertussis (Tdap) vaccine and the hepatitis A vaccine. The nurse should notify the provider and obtain an order to give: A. both vaccines intramuscularly. B. both vaccines subcutaneously. C. the hepatitis A vaccine only subcutaneously. D. the Tdap vaccine only intramuscularly.

ANS: A To minimize the risk of hepatitis, all patients with hemophilia should be fully vaccinated, and all newly diagnosed patients should receive both the hepatitis A and hepatitis B vaccines to minimize the risk of hepatitis from infusions

A nurse is caring for a patient who is receiving verapamil [Calan] for hypertension and digoxin [Lanoxin] for heart failure. The nurse will observe this patient for: A. AV blockade. B. gingival hyperplasia. C. migraine headaches. D. reflex tachycardia.

ANS: A Verapamil and digoxin both suppress impulse conduction through the AV node; when the two drugs are used concurrently, the risk of AV blockade is increased

A prescriber has ordered clonidine [Catapres] for a patient who has hypertension. The nurse teaches the patient about the side effects of this drug. Which statement by the patient indicates an understanding of the teaching? a. "I should chew sugar-free gum or drink water to reduce dry mouth." b. "I should not drive as long as I am taking this drug." c. "I should stand up slowly when taking this medication." d. "I should stop taking this drug if I feel anxious or depressed."

ANS: A Xerostomia is a common side effect of clonidine and is often uncomfortable enough that patients stop using the drug. Counseling patients to chew sugar-free gum and take frequent sips of liquid can help alleviate this discomfort.

During assessment of the patient, which finding would concern the nurse that the patient taking Atropine may be experiencing toxicity? a. Delirium b. Fatigue c. Tachypnea d. Fever

ANS: A tropine toxicity presents as delirium and hallucinations. Untreated, this could lead to coma, and death.

A patient who is an opioid addict has undergone detoxification with buprenorphine [Subutex] and has been given a prescription for buprenorphine with naloxone [Suboxone]. The patient asks the nurse why the drug was changed. Which response by the nurse is correct? A. "Suboxone has a lower risk of abuse." B. "Suboxone has a longer half-life." C. "Subutex causes more respiratory depression." D. "Subutex has more buprenorphine."

ANS: A The combination of buprenorphine and naloxone [Suboxone] discourages intravenous abuse, because with IV use, the naloxone precipitates withdrawal

A patient with hemophilia A is undergoing a tooth extraction at the dentist's office. As an adjunct to factor VIII, what additional medication should the nurse anticipate being ordered for this patient? A. Tranexamic acid [Cyklokapron] B. Acetaminophen [Tylenol] C. Desmopressin [Stimate] D. Vitamin K

ANS: A Antifibrinolytic drugs (eg, aminocaproic acid and tranexamic acid) can be used as adjuncts to factor VIII and factor IX in special situations, such as a tooth extraction.

A psychiatric nurse is teaching a patient about an antidepressant medication. The nurse tells the patient that therapeutic effects may not occur for several weeks. The nurse understands that this is likely the result of: a. changes in the brain as a result of prolonged drug exposure. b. direct actions of the drug on specific synaptic functions in the brain. c. slowed drug absorption across the blood-brain barrier. d. tolerance to exposure to the drug over time.

ANS: A It is thought that beneficial responses to central nervous system (CNS) drugs are delayed because they result from adaptive changes as the CNS modifies itself in response to prolonged drug exposure, and that the responses are not the result of the direct effects of the drugs on synaptic functions.

A nurse is discussing the use of benzodiazepines as sedative-hypnotic agents with a group of nursing students. A student asks about the actions of these drugs in the central nervous system. The nurse makes which correct statement? A. "Benzodiazepines affect the hippocampus and the cerebral cortex to cause anterograde amnesia." B. "Benzodiazepines depress neuronal functions by acting at a single site in the Brain." C. "Benzodiazepines induce muscle relaxation by acting on sites outside the central nervous system." D. "Benzodiazepines promote sleep through effects on the limbic system."

ANS: A Rationale: All beneficial and most adverse effects of benzodiazepines occur from depressant actions in the central nervous system (CNS); the various effects depend on the site of action.

The nurse is providing multiple medications to a patient whose spouse brings grapefruit juice every morning. The nurse will be concerned about which classes of drugs? (Select all that apply.) a. Calcium channel blockers b. Selective serotonin reuptake inhibitors c. Aminoglycosides d. Beta blockers e. Penicillins

ANS: A, B Calcium channel blockers and selective serotonin reuptake inhibitors have been shown to reach increased and/or toxic levels when taken with grapefruit juice. Grapefruit juice is not contraindicated with aminoglycosides, beta blockers, or penicillins.

A prescriber has ordered methyldopa for a female patient with hypertension. The nurse understands that which laboratory tests are important before beginning therapy with this drug? (Select all that apply.) a. Coombs' test b. Hemoglobin and hematocrit (H&H) c. Liver function tests d. Pregnancy test e. Urinalysis

ANS: A, B, C A positive Coombs' test result occurs in 10% to 20% of patients who take methyldopa chronically.

MULTIPLE RESPONSE The nurse understands that muscarinic antagonists are often referred by other names. Which names should the nurse recognize for this category of drug? a. Parasympatholytic drugs b. Anticholinergic drugs c. Antimuscarinic drugs d. Muscarinic blockers e. Cholinergic drugs

ANS: A, B, C, D The nurse should recognize that following as being synonymous with muscarinic antagonists: parasympatholytic, anticholinergic, antimuscarinic, and Muscarinic blockers.

Clonidine is approved for the treatment of which conditions? (Select all that apply.) a. ADHD b. Hypertension c. Opioid withdrawal d. Severe pain e. Smoking cessation

ANS: A, B, D Clonidine has three approved uses: treatment of ADHD, hypertension, and severe pain. It has investigational uses for management of opioid withdrawal and for smoking cessation.

A nurse is caring for a patient who is taking multiple medications. To help ensure that adverse drug reactions are prevented or minimized, the nurse will do which of the following? (Select all that apply.) a. Ask the patient about over-the-counter medications used. b. Contact the prescriber to request cytochrome P450 levels. c. Limit the patient's calcium intake. d. Obtain a thorough diet history. e. Request orders for PRN medications to treat any anticipated symptoms of drug interactions.

ANS: A, B, D Over-the-counter medications add to drug interactions, and a thorough history of all medications taken by the patient is essential to minimize adverse drug reactions. Cytochrome P450 levels yield important information about a patient's ability to metabolize drugs and can help predict whether drugs will reach toxic levels or be ineffective. A diet history allows providers to anticipate significant known food-drug interactions.

Which are effective ways to help prevent medication errors? (Select all that apply.) a. Developing nonpunitive approaches to track errors bFocusing on caregivers who make errors c. Helping patients to be active, informed members of the healthcare team d. Naming, blaming, and shaming those who make errors e. Using electronic medical order entry systems

ANS: A, C, E To help prevent medication errors, it is important to create an environment for tracking errors that is nonpunitive so that caregivers can learn from mistakes and work together to change systems appropriately. Helping patients be active, informed members of the healthcare team is a useful tool in this process

A patient is admitted to the coronary care unit from the emergency department after initial management of STEMI. A primary percutaneous coronary intervention has been performed. The nurse notes an initial heart rate of 56 beats/min and a blood pressure of 120/80 mm Hg. The patient has a history of stroke and a previous myocardial infarction. Which order will the nurse question? A. Aspirin B. Beta blocker C. Clopidogrel D. Heparin

ANS: B A beta blocker would be contraindicated in this patient, because it slows the heart, and this patient is already bradycardic

A nurse is educating the staff nurses about ketoacidosis. To evaluate the group's understanding, the nurse asks, "Which sign or symptom would not be consistent with ketoacidosis? " The group gives which correct answer? A. Blood glucose level of 600 mg/dL B. Blood glucose level of 60 mg/dL C. Acidosis D. Ketones in the urine

ANS: B A patient with diabetic ketoacidosis (DKA) has a high glucose level (at least 500 mg/dL or higher); therefore, a glucose level of 60 mg/dL would not be consistent with DKA.

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/min, 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? A. Observe the patient closely for signs of respiratory toxicity. B. Question the order for azithromycin [Zithromax]. C. Report the patient's increase in blood pressure to the provider. D. Request an order for a different calcium channel blocker.

ANS: B Agents that inhibit CYP3A4 can increase levels of ranolazine and also the risk of torsades de pointes.

A nurse is teaching a patient who will begin taking methimazole [Tapazole] for Graves' disease about the medication. Which statement by the patient indicates understanding of the teaching? A. "Because of the risk for liver toxicity, I will need frequent liver function tests." B. "I should report a sore throat or fever to my provider if either occurs." C. "I will need a complete blood count every few months." D. "It is safe to get pregnant while taking this medication."

ANS: B Agranulocytosis is rare but can occur with methimazole, so patients should report signs of infection, such as a sore throat or fever.

A patient collapses after running a marathon on a hot day and is brought to the emergency department to be treated for dehydration. The nurse will expect to provide which therapy? A. Intravenous hypertonic fluids given slowly over several hours B. Intravenous hypotonic fluids administered in stages C. Intravenous isotonic fluids given as a rapid bolus D. Oral electrolyte replacement fluids with potassium

ANS: B Because this patient is experiencing fluid volume loss as the result of excessive sweating, this is most likely hypertonic dehydration, in which loss of water exceeds loss of electrolytes.

A nurse is explaining activation of beta2 receptors to nursing students during a clinical rotation at the hospital. Which statement by a student demonstrates a need for further teaching? a. "Beta2 activation results in bronchodilation." b. "Beta2 activation results in contraction of uterine muscle." c. "Beta2 activation results in glycogenolysis." d. "Beta2 activation results in vasodilation of skeletal muscles."

ANS: B Beta2 activation would result in relaxation of uterine smooth muscle, not contraction; this statement indicates a need for further teaching.

Dopamine is administered to a patient who has been experiencing hypotensive episodes. Other than an increase in blood pressure, which indicator would the nurse use to evaluate successful response? a. Decrease in pulse b. Increase in urine output c. Weight gain d. Improved gastric motility

ANS: B Dopamine would cause an increase in urine output, because cardiac output is increased as a result of the increase in blood pressure.

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? A. "Drugs that treat ventricular dysrhythmias help to restore normal sinus rhythm." B. "Atrial dysrhythmias can have life-threatening effects on ventricular function." C. "Treating ventricular dysrhythmias helps prevent the likelihood of stroke." D. "When ventricular contraction slows, atrial contraction is also slowed."

ANS: B Dysrhythmic activity in the atria does not significantly reduce cardiac output but can be dangerous when dysrhythmic impulses cross the AV node, causing ventricular dysrhythmias, which can be life threatening.

A nursing student asks the nurse why epinephrine, and not other adrenergic agonists, is used to treat anaphylactic shock. What will the nurse tell the student? a. "Epinephrine is the only adrenergic agonist that may be given parenterally." b. "Epinephrine has the ability to activate multiple types of adrenergic receptors." c. "Other adrenergic agonists have more severe adverse effects and are not safe in the doses needed to treat anaphylaxis." d. "Other adrenergic agonists have little or no effects on beta2-adrenergic receptors."

ANS: B Epinephrine is used to treat anaphylactic shock because of its ability to activate multiple adrenergic receptor types.

A nurse is teaching a patient who has chronic renal failure and will begin receiving epoetin alfa [Epogen] about this drug therapy. Which statement by the patient indicates understanding of the teaching? A. "If I have to start dialysis, I will have to stop taking this drug." B. "Taking this drug will not eliminate my need for blood transfusions." C. "Taking this medication will prevent the need for dialysis in the future." D. "When I take this, my serum ferritin levels will increase."

ANS: B Epoetin alfa virtually reduces, but does not eliminate, the need for blood transfusions in patients with CRF.

An 8-year-old child with advanced cancer has an order for oxycodone [OxyContin] PO, PRN for moderate to severe pain. The nurse notes that the child is constantly playing computer games and repeatedly denies having pain. What will the nurse do? a. Administer the oxycodone at regular intervals around the clock. b. Contact the provider to discuss using patient-controlled analgesia (PCA). c. Reassure the child's parent that the child will ask for pain medication as needed. d. Tell the child to notify the nurse when pain is present.

ANS: B For a number of reasons, even children who can verbalize pain correctly often under-report it. The child may fear that reporting pain may lead to painful procedures or may worry caregivers, or the child may be unaware that pain can be alleviated. Children involved in activities such as computer games may actually be using the activity to distract themselves from the pain, so such an activity is not an indication that the child is comfortable.

A nurse is caring for a patient who will begin taking hydralazine to treat hypertension. Which statement by the patient indicates understanding of the nurse's teaching about this drug? A. "I will need to ask for assistance when getting up out of a chair." B. "I will also take a beta blocker medication with this drug to prevent rapid heart rate." C. "I may develop joint pain, but this side effect will decrease over time." D. "This drug may cause excessive hair growth on my face, arms, and back."

ANS: B Hydralazine can cause severe reflex tachycardia; a beta blocker is usually given to counter this effect.

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/min, 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? A. Administer the ESA and request an order for a blood transfusion. B. Withhold the ESA and request an order for an antihypertensive medication. C. Request an order to increase the dose of ESA to raise the hemoglobin more quickly. D. Suggest initiating dialysis while giving the ESA.

ANS: B In patients with CRF, treatment with epoetin alfa is often associated with an increase in blood pressure, so patients with hypertension should be treated before beginning treatment with epoetin alfa.

A patient in whom drug therapy has failed several times in the past is readmitted to a hospital to begin therapy for schizophrenia. What will the nurse do to help improve adherence? a. Encourage the patient to take responsibility for medication management. b. Teach the patient about drug side effects and how to manage them. c. Tell the patient that an abstinence syndrome will occur if the drug is stopped. d. Tell the patient that the drug may be taken as needed to control symptoms.

ANS: B One way to promote adherence to a medication regimen is to teach patients about drug side effects and how to minimize undesired responses.

A nurse is giving an enteral medication. The patient asks why this method is preferable for this drug. How will the nurse reply? a) "This route allows more rapid absorption of the drug." b) "This route is safer, less expensive, and more convenient." c) "This route is the best way to control serum drug levels." d) "This route prevents inactivation of the drug by digestive enzymes."

ANS: B Parenteral routes include the intravenous, intramuscular, and subcutaneous routes. Enteral routes include oral administration, including pills and liquid suspensions. Enteral routes are safer, cheaper, and easier to use. Parenteral routes are used when rapid absorption, precise control of plasma drug levels, and prevention of digestive inactivation are important.

The nurse is providing patient education about glucocorticoid therapy to a patient preparing to be discharged home. Which statement made by the patient best demonstrates understanding of glucocorticoid therapy? A. "I will take the entire dose early with breakfast." B. "I may take two-thirds of the dose in the morning and one-third in the afternoon." C. "I will divide the dose in half and take half in the morning and half in the evening." D. "I will take a dose with each meal."

ANS: B Patients should be instructed to follow the prescribed dosing schedule. Some prescribers recommend dividing the daily dose by taking two-thirds in the morning and one-third in the evening.

A nurse is obtaining a health history from an older adult patient in an outpatient clinic. The patient reports chronic difficulty falling asleep and staying asleep. The nurse knows that the best treatment for this patient will be: A. alternative medications. B. improved sleep hygiene. C. short-term barbiturates. D. triazolam [Halcion].

ANS: B Rationale: Research has shown that cognitive behavioral therapy is superior to drug therapy for short-term and long-term management of chronic insomnia in older adults.

A nurse is reviewing the phenomenon of reflex tachycardia with a group of nursing students. Which statement by a student indicates understanding of this phenomenon? A. "Baroreceptors in the aortic arch stimulate the heart to beat faster." B. "Reflex tachycardia can negate the desired effects of vasodilators." C. "Reflex tachycardia is more likely to occur when beta blockers are given." D. "Venous dilation must occur for reflex tachycardia to occur."

ANS: B Reflex tachycardia, which is a compensatory mechanism in response to decreased blood pressure, can negate the desired effect of a vasodilator by eventually increasing blood pressure.

A patient who has recurrent migraine headaches is prescribed sumatriptan [Imitrex]. Which aspect of this patient's history is of concern when taking this drug? a. Asthma b. Coronary artery disease c. Diabetes d. Renal disease

ANS: B Serotonin receptor agonists can cause vasoconstriction and coronary vasospasm and should not be given to patients with coronary artery disease, current symptoms of angina, or uncontrolled hypertension.

A patient who has cancer asks the nurse about using acupuncture to manage cancer pain. What will the nurse tell this patient? a. "Acupuncture is not an effective treatment for cancer pain and should not be used." b. "Studies to date do not clearly indicate effectiveness of acupuncture for alleviating cancer pain." c. "Transcutaneous electrical nerve stimulation (TENS) has been shown to be more effective than acupuncture." d. "There is good evidence to suggest that acupuncture is an effective adjunct treatment for cancer pain."

ANS: B Studies regarding acupuncture for treatment for cancer pain have been few and not well designed, so there is insufficient evidence to support its use.

A nursing student caring for a patient with cancer tells the nurse that the patient seems to be exaggerating when reporting the degree of pain. Which statement by the nurse is an appropriate response to this concern? a. "Evaluation of the patient's vital signs can help you tell if this patient is exaggerating." b. "It is important to give pain medication as ordered for the degree of pain the patient reports." c. "We may need to evaluate the patient for the development of metastasis or infection." d. "You should monitor this patient's behavior and facial expressions for a more accurate assessment."

ANS: B The patient's description of his or her pain is the cornerstone of assessment. Pain is a personal experience, and caregivers must act on what the patient says, even if they suspect the patient is exaggerating or not telling the truth

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/min 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: A. an angiotensin-converting enzyme (ACE) inhibitor. B. intravenous nitroglycerin and a beta blocker. C. ranolazine (Ranexa) and quinidine. D. supplemental oxygen and intravenous morphine.

ANS: B This patient has unstable angina, and the next step, when pain is unrelieved by sublingual nitroglycerin, is to give intravenous nitroglycerin and a beta blocker.

A patient received atropine intravenously before surgery. The recovery room nurse notes that the patient is delirious upon awakening and has a heart rate of 96 beats/min, a respiratory rate of 22 breaths per minute, and a blood pressure of 110/78 mm Hg. The nurse notifies the anesthesiologist, who will order: a. activated charcoal to minimize intestinal absorption of the antimuscarinic agent. b. an acetylcholinesterase inhibitor to compete with the antimuscarinic agent at receptors. c. an antipsychotic medication to treat the patient's central nervous system symptoms. d. ipratropium bromide [Atrovent] to counter the respiratory effects of the antimuscarinic agent.

ANS: B This patient is showing signs of antimuscarinic toxicity caused by the atropine given during surgery. The most effective antidote is physostigmine, which inhibits acetylcholinesterase, allowing acetylcholine to build up at cholinergic junctions and compete with the antimuscarinic agent for receptor binding.

A patient with a history of hypertension is admitted for a procedure. If the patient's arterial pressure decreases, which clinical manifestation would the nurse expect to see? A. Decreased heart rate B. Increased heart rate C. Decreased blood pressure D. Syncope

ANS: B When arterial pressure decreases, the vasoconstrictor center causes constriction of nearly all arterioles, leading to an increase in peripheral resistance, constriction of veins, increasing venous return, and subsequent acceleration of the heart rate

A nurse is teaching a nursing student about the two classes of adrenergic agonist drugs. Which statement by the nursing student indicates an understanding of the teaching? a. "Catecholamines may be given orally." b. "Catecholamines often require continuous infusion to be effective." c. "Noncatecholamines do not cross the blood-brain barrier." d. "Noncatecholamines undergo rapid degradation by monoamine oxidase."

ANS: B Catecholamines undergo rapid degradation by monoamine oxidase (MAO) and catechol-O- methyltransferase (COMT). Consequently, they have a brief duration of action, and continuous infusion often is required to maintain the drug's effects. Catecholamines cannot be used orally. Catecholamines do not cross the blood-brain barrier; noncatecholamines do. Noncatecholamines are not degraded by MAO.

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? a. "Statins reduce the risk of morbidity from influenza." b. "You should come into the clinic for liver enzymes in 1 month." c. "Statins reduce the risk of coronary events in people with normal LDL levels." d. "You should maintain a healthy lifestyle and avoid high-fat foods."

ANS: B Baseline liver enzyme tests should be done before a patient starts taking an HMG-COA reductase inhibitor. They should be measured again in 6 to 12 months unless the patient has poor liver function, in which case the tests are indicated every 3 months.

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. "It will take 6 months to see a change." B. "A reduction usually is seen within 2 weeks." C. "Blood levels normalize immediately after the drug is started." D. "Cholesterol will not be affected, but triglycerides will fall within the first week."

ANS: B Reductions in LDL cholesterol are significant within 2 weeks and maximal within 4 to 6 weeks. It does not take 6 months to see a change.

Which nonpharmacologic therapies are effective in reducing cancer pain? (Select all that apply.) a. Acupuncture b. Cold c. Exercise d. Heat e. Transcutaneous electrical nerve stimulation (TENS)

ANS: B, C, D Cold, heat, and exercise have been shown to reduce pain. Acupuncture and TENS have not been demonstrated to be effective, although in theory they should work.

Which actions occur in 90% of fatal medication errors? (Select all that apply.) a. Confusing drugs with similar packaging b. Giving a drug intravenously instead of intramuscularly c. Giving Nasarel instead of Nizoral d. Using an infusion device that malfunctions e. Writing a prescription illegibly

ANS: B, C, E Ninety percent of fatal medication errors fall into three categories: human factors, communication mistakes, and name confusion. Giving a drug IV (intravenously) instead of IM (intramuscularly) is an example of a human factor; writing a prescription so that it is illegible is an example of a communication mistake; and giving a drug with a name that sounds like the name of another drug is an example of name confusion.

A patient on the unit complains of cluster headaches. A new graduate nurse is asked to differentiate between a migraine headache and cluster headaches. The graduate nurse is correct to state that manifestations and/or risk factors for a patient with cluster headaches include what? (Select all that apply.) a. Female gender b. Male gender c. Complaints of nausea and vomiting d. Short duration (15 minutes to 2 hours) e. Auras before the onset of headache pain f. Throbbing, sometimes piercing pain

ANS: B, D, F Cluster headaches are more common in males, are short in duration, and present as throbbing and piercing pain.

A patient with bipolar disorder is admitted to the hospital. The patient has been taking lithium [Lithobid] for several years and has not been evaluated by a provider for over a year. Besides obtaining a lithium level, the nurse caring for this patient will anticipate orders for which laboratory tests? (Select all that apply.) a. Calcium level b. Complete blood count with differential c. Liver function tests d. Renal function tests e. Serum potassium f. Thyroid function tests

ANS: B, D, F Patients taking lithium can develop a mild, reversible leukocytosis, so annual CBC evaluation with differential is recommended.

A young adult postoperative patient is receiving morphine 2 to 4 mg IV every 2 hours PRN pain. The last dose was 3 mg given 2 hours ago. The patient is asleep, and the nurse notes a heart rate of 86 beats/min and a respiratory rate of 8 breaths per minute. Which PRN medication will the nurse give this patient? a. Diphenhydramine [Benadryl] to counter morphine side effects b. Morphine 4 mg for increased pain, as indicated by tachycardia c. Naloxone [Narcan] to block the effects of the morphine d. Nothing at this time, because the patient is resting comfortably

ANS: C A respiratory rate of 8 breaths per minute indicates respiratory depression, which is a significant adverse effect indicating morphine toxicity. Naloxone blocks the actions of morphine at cell receptor sites and is given to quickly reverse the effects. This patient does not have signs of an allergic response, which would include shortness of breath, a rapid respiratory rate, and wheezing. The tachycardia might be a sign of worsening pain, but the toxic effects must be treated first. Patients who are sleeping are not always pain free.

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? A. Apply a nitroglycerin transdermal patch. B. Continue dosing at 10-minute intervals. C. Give a second dose of nitroglycerin in 5 minutes. D. Request an order for intravenous nitroglycerin.

ANS: C An initial dose of sublingual nitroglycerin is taken, and if the chest pain persists, as in this case, the patient should take another dose in 5 minutes

Which statement is correct regarding the effect of Atropine on the heart? a. Decreases heart rate b. Causes heart block c. Increases heart rate d. Induces cardiac arrest

ANS: C Atropine works by causes the heart rate to increase.

A patient is taking a beta1-adrenergic drug to improve the stroke volume of the heart. The nurse caring for this patient knows that this drug acts by increasing: A. cardiac afterload. B. cardiac preload. C. myocardial contractility. D. venous return.

ANS: C Beta1-adrenergic agents help increase the heart's stroke volume by increasing myocardial contractility

A patient receives topical atropine to facilitate an eye examination. The nurse will tell the patient to remain in a darkened room or to wear sunglasses for several hours until the effects of the medication wear off. This teaching is based on the nurse's knowledge that muscarinic antagonists cause: a. elevation of intraocular pressure. b. miosis and ciliary muscle contraction. c. paralysis of the iris sphincter. d. relaxation of ciliary muscles.

ANS: C By blocking muscarinic receptors in the eye, atropine causes paralysis of the iris sphincter, which prevents constriction of the pupil; consequently, the eye cannot adapt to bright light. This also causes an elevation in intraocular pressure, which increases the risk of glaucoma.

A patient with cancer who has been receiving an opioid analgesic reports having pain at a new location even though the previous pain is well controlled. The nurse will contact the provider to discuss: a. breakthrough pain. b. drug-seeking behavior. c. infection or metastasis. d. tolerance to drug therapy.

ANS: C Caregivers should be alert for new pain; this usually results from a new cause, such as metastasis, infection, or fracture, and should be investigated.

A nursing student asks a nurse why patients with chronic renal failure (CRF) have low erythrocyte counts. Which response by the nurse is correct? A. "Damage to the renal tubules increases serum blood loss." B. "Dialysis accelerates the breakdown of red blood cells." C. "Erythropoietin is no longer produced by cells in the kidneys." D. "Patients with CRF are deficient in iron, folic acid, and vitamin B12."

ANS: C Erythropoietin is normally produced by peritubular cells in the proximal tubules of the kidneys, but it is not produced in patients with CRF. Erythropoietin stimulates red blood cell (RBC) production; therefore, when it is absent, RBC production is compromised.

A nurse is discussing alcohol abuse with a group of nursing students. One student asks whether alcohol consumption has any beneficial effects. The nurse replies that, in moderate amounts, alcohol: A. helps people to sleep well. B. improves sexual responsiveness. C. may protect against dementia. D. prevents hypothermia.

ANS: C In moderate amounts, alcohol helps preserve cognitive function in the older adult and may protect against dementia.

A patient is admitted to the intensive care unit for treatment of shock. The prescriber orders isoproterenol [Isuprel]. The nurse expects this drug to increase tissue perfusion in this patient by activating: a. alpha1 receptors to cause vasoconstriction. b. alpha1 receptors to increase blood pressure. c. beta1 receptors to cause a positive inotropic effect. d. beta2 receptors to cause bronchodilation.

ANS: C Isoproterenol is used for shock because of its actions on beta1 receptors in the heart. It has a positive inotropic effect, which improves cardiac output and thus increases tissue perfusion. Isoproterenol does not affect alpha1 receptors. Although it activates beta2 receptors to cause bronchodilation, this is not indicated for the treatment of shock.

A patient who has occasional migraine headaches tells a nurse that the abortive medication works well, but she would like to do more to prevent the occurrence of these headaches. The nurse will suggest that the patient: a. ask the provider about an adjunct medication, such as prochlorperazine. b. discuss the use of prophylactic medications with the provider. c. keep a headache diary to help determine possible triggers. d. take the abortive medication regularly instead of PRN.

ANS: C Keeping a headache diary to try to identify triggers to migraines can be helpful when a patient is trying to prevent them, and is the first step in managing headaches.

A nurse is teaching nursing students about the pharmacology of methyldopa. Which statement by a student indicates the need for further teaching? a. "Methyldopa results in alpha2 agonist activation, but it is not itself an alpha2 agonist." b. "Methyldopa is not effective until it is converted to an active compound." c. "Methyldopa reduces blood pressure by reducing cardiac output." d. "Methyldopa's principal mechanism is vasodilation, not cardiosuppression."

ANS: C Methyldopa does not reduce the heart rate or cardiac output, so its hypotensive actions are not the result of cardiac depression. The drug is not, in itself, an alpha2 agonist. When taken up into brainstem neurons, it is converted into methylnorepinephrine, which is an alpha2 agonist; it is not effective until converted to this active compound

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? A. "I should not participate in aerobic exercise while taking this drug." B. "I should take aspirin daily to reduce my need for nitroglycerin." C. "If I take nitroglycerin before exertion, I can reduce the chance of an anginal attack." D. "I take nitroglycerin to increase the amount of oxygen to my heart."

ANS: C Nitroglycerin can be taken before stressful events or exertion to reduce the chance of an attack of angina.

A patient who has a long-term addiction to opioids takes an overdose of barbiturates. The nurse preparing to care for this patient will anticipate: A. a severe abstinence syndrome when the effects of the barbiturates are reversed. B. minimal respiratory depression, because the patient has developed a tolerance to opioids C. observing pinpoint pupils, respiratory depression, and possibly coma in this patient. D. using naloxone [Narcan] to reverse the effects of the barbiturates, because cross- tolerance is likely.

ANS: C Patients tolerant to opioids do not have cross-tolerance to barbiturates, so this patient will show signs of overdose such as pinpoint pupils, respiratory depression, and coma.

A patient who has chronic adrenal insufficiency is admitted to the hospital for an open cholecystectomy. The nurse obtaining the admission history learns that the patient takes hydrocortisone 25 mg PO daily in the morning. The patient's surgery is scheduled for the next morning. The nurse will expect an order to: A. administer the usual morning dose of hydrocortisone 25 mg PO. B. administer hydrocortisone 50 mg PO in the morning. C. administer hydrocortisone 50 mg IV before surgery. D. withhold the morning dose of hydrocortisone and give it after surgery.

ANS: C Patients who take steroids need extra steroid before situations that cause stress, such as surgery. Failure to administer the increased dose can prove fatal.

A patient is brought to the emergency department by friends, who say that they were at a party where alcohol and a mix of barbiturates and benzodiazepines were all available. They tell the nurse that the patient was among the first to arrive at the party, which started several hours ago. The patient is nonresponsive and has pinpoint pupils and respirations of 6 breaths per minute. After oxygen has been administered, the nurse should prepare the patient for which intervention? A. A central nervous system stimulant and IV fluids B. Activated charcoal and flumazenil [Romazicon] C. Maintaining adequate oxygenation to the brain D. Naloxone [Narcan] and a cathartic

ANS: C Rationale: Because time has elapsed, enough medication is present in the system to warrant treatment for systemic effects.

A patient in the emergency department is given intravenous diazepam [Valium] for seizures. When the seizures stop, the nurse notes that the patient is lethargic and confused and has a respiratory rate of 10 breaths per minute. The nurse will expect to administer which of the following? A. Flumazenil [Romazicon] B. Gastric lavage C. Respiratory support D. Toxicology testing

ANS: C Rationale: When benzodiazepines are administered IV, severe effects, including profound hypotension, respiratory arrest, and cardiac arrest, can occur.

A nurse is preparing to assist a nursing student to administer intravenous verapamil to a patient who also receives a beta blocker. The nurse asks the nursing student to discuss the plan of care for this patient. Which statement by the student indicates a need for further teaching? A. "I will check to see when the last dose of the beta blocker was given." B. "I will monitor vital signs closely to assess for hypotension." C. "I will monitor the heart rate frequently to assess for reflex tachycardia." D. "I will prepare to administer intravenous norepinephrine if necessary."

ANS: C Reflex tachycardia is not an expected effect; the greater risks are cardiosuppression and bradycardia.

A nursing student asks a nurse why a patient in hypertensive crisis is receiving both intravenous sodium nitroprusside [Nitropress] and oral hydralazine. The nurse will explain that this is done to prevent: A. cyanide poisoning. B. fluid retention. C. rebound hypertension. D. reflex tachycardia.

ANS: C Sodium nitroprusside acts rapidly and is given only intravenously. Rebound hypertension occurs immediately when the IV is stopped, so an oral antihypertensive should be given simultaneously.

A patient arrives in the emergency department complaining of dizziness, lightheadedness, and a pulsating headache. Further assessment reveals a blood pressure of 82/60 mm Hg and palpitations. The patient's friends tell the nurse that they were experimenting with "poppers." The nurse will expect to administer which medication? A. Diazepam [Valium] B. Haloperidol [Haldol] C. Methylene blue and supplemental oxygen D. Naloxone [Narcan]

ANS: C These findings are consistent with volatile nitrate overdose, as evidenced by the venous dilation.

A patient has had blood pressures of 150/95 and 148/90 mm Hg on two separate office visits. The patient reports a blood pressure of 145/92 mm Hg taken in an ambulatory setting. The patient's diagnostic tests are all normal. The nurse will expect this patient's provider to order: A. a beta blocker. B. a loop diuretic and spironolactone. C. a thiazide diuretic. D. counseling on lifestyle changes.

ANS: C This patient has primary, or essential, hypertension as evidenced by systolic pressure greater than 140 and diastolic pressure greater than 90, along with normal tests ruling out another primary cause.

A postoperative patient is reporting pain as a 7 on a scale from 1 to 10, with 10 being the worst pain. The nurse caring for the patient assesses vital signs of HR, 76; RR, 16; and BP, 110/70. The patient has vomited twice. Which postoperative medications will the nurse expect to administer? a. Atropine and morphine b. Bethanechol and ibuprofen c. Morphine and ondansetron [Zofran] d. Promethazine and clonidine [Catapres]

ANS: C This patient is experiencing postoperative symptoms of moderate to severe pain and nausea and vomiting.

A nurse obtaining an admission history on an adult patient notes that the patient has a heart rate of 62 beats/min, a blood pressure of 105/62 mm Hg, and a temperature of 96.2°F. The patient appears pale and complains of always feeling cold and tired. The nurse will contact the provider to discuss tests for which condition? A. Cretinism B. Graves' disease C. Hypothyroidism D. Plummer's disease

ANS: C This patient is showing signs of hypothyroidism: a low heart rate, low temperature, pale skin, and feeling cold and tired.

A nurse is administering a vasodilator that dilates resistance vessels. The nurse understands that this drug will have which effect on the patient? A. Decreased cardiac preload B. Decreased cardiac output C. Increased tissue perfusion D. Increased ventricular contraction

ANS: C Vasodilators that dilate resistance vessels, or arterioles, cause a decrease in afterload, which allows cardiac output and tissue perfusion to increase.

A patient is taking a drug that has known toxic side effects. What will the nurse do? a. Discontinue the drug at the first signs of toxicity. b. Ensure that complete blood counts are ordered periodically. c. Monitor the function of all organs potentially affected by the drug. d. Teach the patient how to treat the symptoms if they develop.

ANS: C When a drug is administered that has known toxic side effects, the nurse is responsible for monitoring all organ systems potentially affected by the drug

The nurse administers naloxone [Narcan] to a patient who has received a toxic dose of morphine sulfate. The nurse understands that the naloxone is effective because of which action? a. Countering the effects of morphine sulfate by agonist actions b. Increasing the excretion of morphine sulfate by altering serum pH c. Preventing activation of opioid receptors through antagonist actions d. Regulating the sensitivity of opioid receptors by neurochemical alterations

ANS: C Naloxone acts by blocking the action of opioids at opioid receptors. An opioid agonist would increase the effects of morphine. Naloxone does not affect serum pH or excretion of opioids. Naloxone does not alter the sensitivity of opioid receptors.

A patient with schizophrenia receives a dose of risperidone [Risperdal Consta] IM. The nurse teaching this patient about this medication will make which statement? a. "You will experience therapeutic levels of this drug in 1 to 2 weeks." b. "You will need injections of this drug every 6 weeks." c. "You will need to take an oral antipsychotic drug for 3 weeks." d. "You probably will not have extrapyramidal symptoms with this drug."

ANS: C Risperidone given intramuscularly is a depot preparation used for long-term therapy. Significant release of the drug does not occur until 2 to 3 weeks after injection; therefore, patients must take an oral antipsychotic medication until drug levels are raised.

A patient with bipolar disorder who wants to minimize the need for drug therapy asks the nurse what else can be done to treat the disorder. The nurse will recommend which measures? (Select all that apply.) a. Electroconvulsive therapy b. Moderate use of alcohol to reduce stress c. Psychotherapy d. Regular sleep and exercise e. Using a chart to monitor mood changes

ANS: C, D, E BPD should be treated with a combination of drugs and adjunctive psychotherapy, because drug therapy alone is not optimal. Other measures, such as regular sleep and exercise and recognizing early symptoms of mood change, help minimize extreme mood swings

Before administering a medication, what does the nurse need to know to evaluate how individual patient variability might affect the patient's response to the medication? (Select all that apply.) a. Chemical stability of the medication b. Ease of administration c. Family medical history d. Patient's age e. Patient's diagnosis

ANS: C, D, E The family medical history can indicate genetic factors that may affect a patient's response to a medication. Patients of different ages can respond differently to medications. The patient's illness can affect how drugs are metabolized. The chemical stability of the medication and the ease of administration are properties of drugs.

A patient is brought to the emergency department after a motor vehicle accident. The patient's speech is slurred. The nurse notes the smell of alcohol on the patient's breath and observes hand tremors. The patient's blood alcohol level is 0.4%. The nurse will expect to: A. find that the patient has lost consciousness within a short time. B. administer naltrexone [ReVia] and prepare for gastric lavage. C. give carbamazepine to reduce the risk of seizures. D. provide mechanical ventilation and oxygen.

ANS: D A blood alcohol level that exceeds 0.4% poses a substantial risk of respiratory depression.

A patient has a free T4 level of 0.6 ng/dL and a free T3 of 220 pg/dL. The patient asks the nurse what these laboratory values mean. How will the nurse respond? A. "These laboratory values indicate that you may have Graves' disease." B. "These results suggest you may have hyperthyroidism." C. "We will need to obtain a total T4 and a total T3 to tell for sure." D. "We will need to obtain a TSH level to better evaluate your diagnosis."

ANS: D A free T4 level of less than 0.9 ng/dL and a free T3 of less than 230 pg/dL are consistent with hypothyroidism, but measurement of the thyroid-stimulating hormone (TSH) level is necessary to distinguish primary hypothyroidism from secondary hypothyroidism.

A patient with hemophilia B is admitted to the hospital for surgery. The patient's history reveals long-term use of factor replacement as prophylaxis for bleeding episodes. The nurse anticipates that the provider will order which medication to prevent excessive perioperative bleeding? A. Desmopressin B. Factor VIII C. Ibuprofen D. Tranexamic acid

ANS: D Antifibrinolytic drugs, such as tranexamic acid, which prevent the breakdown of fibrin, are used as adjuncts to replacement factor in special cases in which bleeding is likely.

A nurse is preparing a patient who will stop taking lorazepam [Ativan] for anxiety and begin taking buspirone [Buspar]. Which statement by the patient indicates a need for further teaching? A. "I can drink alcohol when taking Buspar, but not grapefruit juice." B. "I may need to use a sedative medication if I experience insomnia." C. "I may not feel the effects of Buspar for a few weeks." D. "I should stop taking the Ativan when I start taking the Buspar."

ANS: D Ativan should not be withdrawn quickly; it must be tapered to prevent withdrawal symptoms. Moreover, Buspar does not have immediate effects.

Which statement by the nurse indicates an understanding as to why atropine is given in the preoperative environment? a. "Atropine induces sleep". b. "Atropine works as a pain reliever". c. "Atropine impairs memory" d. "Atropine decreases secretions".

ANS: D Atropine decreases secretions from the salivary glands, which decreases the risk of aspiration during surgery.

A nursing student asks the nurse why the provider has ordered a combination product containing an opioid analgesic and an NSAID for a patient who has cancer. Which response by the nurse is correct? a. "There are decreased effects of NSAIDs on the GI tract when a combination product is used." b. "There are fewer adverse effects from both drugs when used in a combination product." c. "There is a decreased likelihood of opioid dependence when it is given in combination with an NSAID." d. "There is increased pain relief with the combination than when either product is used alone."

ANS: D Because the two types of drugs work by different mechanisms, use of a combination product yields greater pain relief than either agent alone.

A child with severe hemophilia A receives factor VIII. The nurse expects this drug to be given: A. on demand when bleeding occurs. B. on demand when plasma factor VIII activity is less than 1% above normal. C. prophylactically once weekly to maintain normal factor VIII activity. D. prophylactically 3 times weekly to maintain factor VIII activity above 1% of normal.

ANS: D Children with severe hemophilia are primary candidates for prophylactic therapy with factor VIII, and this is given every other day or 3 times weekly with a goal of maintaining factor VIII activity above 1% of normal.

A nurse provides teaching to a patient who will begin taking a drug with a known risk of hepatotoxicity. Which statement by the patient indicates a need for further teaching? a. "I should avoid taking acetaminophen while taking this drug." b. "I will need periodic evaluation of aspartate aminotransferase and alanine aminotransferase levels." c. "If I experience nausea, vomiting, or abdominal pain, I should call my provider." d. "Routine testing and early detection of problems will prevent liver failure."

ANS: D Drug-induced liver injury can progress from undetectable to advanced between routine tests; therefore, routine testing does not always prevent liver failure.

Which statement about food and drug interactions is true? a. Foods alter drug absorption and metabolism but not drug action. b. Medications are best absorbed on an empty stomach. c. Patient discomfort is the food and drug interaction of most concern. d. Some foods can inhibit CYP isoenzymes and alter drug metabolism.

ANS: D Grapefruit juice inhibits CYP3A4, which lowers the metabolism of some drugs, leading to toxic effects of drugs affected by these isoenzymes. Foods can alter all pharmacokinetic and pharmacodynamic processes. Not all medications are absorbed better on an empty stomach; some require certain foods to enhance absorption. Patient comfort is a concern, but it is not as important as more severe and possibly life-threatening food and drug interactions.

A prescriber has ordered methyldopa for a patient with hypertension. The nurse teaches the patient about drug actions, adverse effects, and the ongoing blood tests necessary with this drug. The nurse is correct to tell the patient what? a. "If you have a positive Coombs' test result, you will need to discontinue the medication, because this means you have hemolytic anemia." b. "Methyldopa can be used for its analgesic effects and for its hypertensive effects." c. "Xerostomia and orthostatic hypotension are serious side effects and indications for withdrawing the medication." d. "You will need to contact the provider and stop taking the medication if your eyes look yellow."

ANS: D Hepatotoxicity is a serious adverse effect of methyldopa and is an indication for withdrawal of the drug to prevent fatal hepatic necrosis.

A patient in the emergency department has severe chest pain. The nurse administers morphine intravenously. The patient asks the nurse why morphine is given. Which response by the nurse is correct? A. "Morphine helps by reducing anxiety and relieving pain." B. "Morphine helps by reducing pain and dissolving clots." C. "Morphine helps by relieving pain and lowering blood pressure." D. "Morphine helps by relieving pain and reducing the cardiac oxygen demand."

ANS: D IV morphine is the treatment of choice for STEMI-associated pain. Besides relieving pain, it promotes vasodilation and reduces cardiac preload, which lowers the cardiac oxygen demand

Which statement is accurate about the long-term complications of diabetes? A. Long-term complications are almost always the result of hypoglycemia and ketoacidosis. B. The complication rates for patients with optimally controlled type 2 diabetes are the same as for those whose disease is not optimally controlled. C. Optimal control of type 1 diabetes produces excessive episodes of life-threatening hypoglycemia. D. Optimal control of both types of diabetes reduces the risk of eye, kidney, and nerve damage.

ANS: D In both types of diabetes, optimal control of the disease slows the development of microvascular complications

Which statement is accurate about the long-term complications of diabetes? A. Long-term complications are almost always the result of hypoglycemia and ketoacidosis. B. The complication rates for patients with optimally controlled type 2 diabetes are the same as for those whose disease is not optimally controlled. C. Optimal control of type 1 diabetes produces excessive episodes of life-threatening hypoglycemia. D. Optimal control of both types of diabetes reduces the risk of eye, kidney, and nerve damage.

ANS: D In both types of diabetes, optimal control of the disease slows the development of microvascular complications.

A patient asks a nurse how nitroglycerin works to relieve anginal pain. The nurse correctly states, "Nitroglycerin: A. dilates coronary arteries to increase blood flow to the heart." B. increases the oxygen supply to the cardiac muscle." C. increases ventricular filling to improve cardiac output." D. promotes vasodilation, which reduces preload and oxygen demand."

ANS: D Nitroglycerin dilates the veins, which reduces venous return to the heart, which in turn decreases ventricular filling. The resulting decrease in preload reduces the oxygen requirements of the heart.

A patient who has been taking 25 mg of hydrocortisone each morning for several months reports feeling fatigued late in the day each day. What will the nurse tell the patient to discuss with the provider? A. Adding a mineralocorticoid to the drug regimen B. Assessing serum electrolytes to check for toxicity C. Increasing the dose to 50 mg daily D. Splitting the daily dose into a morning and an afternoon dose

ANS: D Patients generally take hydrocortisone once daily in the morning to mimic the body's natural cortisol release cycle. However, some patients develop fatigue late in the day. These patients may split the daily dose, taking two-thirds in the morning and one-third in the afternoon or early evening.

A patient diagnosed with STEMI is about to undergo a primary percutaneous coronary intervention (PCI). Which combination of pharmacotherapeutic agents will be given to augment this procedure? A. Beta blocker and nitroglycerin B. Abciximab and a fibrinolytic drug C. Angiotensin-converting enzyme (ACE) inhibitor and aspirin D. Heparin, aspirin, and clopidogrel

ANS: D Patients undergoing a primary PCI should receive heparin intravenously combined with aspirin and either clopidogrel or prasugrel

A patient who has been newly diagnosed with adrenal hormone deficiency will begin taking hydrocortisone. The nurse provides teaching for this patient. Which statement by the patient indicates understanding of the teaching? A. "I may take all of my daily dose in the morning or divide it in half and take it twice daily." B. "I will need to take this medication until my symptoms completely clear, and then I may stop." C. "Side effects are common with hydrocortisone, even with therapeutic doses." D. "When I am sick, I should take 3 times the normal dose for 3 days in a row."

ANS: D Patients who take hydrocortisone as replacement need to be taught to increase their daily dose during times of stress, because the drug causes adrenal suppression, and the adrenals will not be able to release cortisone as usual during stress

A nurse is preparing to care for a patient who is receiving digoxin. When screening for potential adverse effects from this drug, the nurse will review which of this patient's laboratory results? a. Albumin b. Blood urea nitrogen (BUN) and creatinine c. Hepatic enzymes d. Serum electrolytes

ANS: D Patients with low serum potassium are at risk for fatal cardiac dysrhythmias when taking digoxin, and it is essential to know this level before this medication is administered.

The nurse is teaching a patient how a medication works to treat an illness. To do this, the nurse will rely on knowledge of which topic? a. Clinical pharmacology b. Drug efficacy c. Pharmacokinetics d. Pharmacotherapeutics

ANS: D Pharmacotherapeutics is the study of the use of drugs to diagnose, treat, and prevent conditions. Clinical pharmacology is concerned with all aspects of drug-human interactions. Drug efficacy measures the extent to which a given drug causes an intended effect. Pharmacokinetics is the study of the impact of the body on a drug.

A patient who is experiencing alcohol withdrawal is given a benzodiazepine. The nurse understands that this drug is effective because: A. the alcohol does not interact with the benzodiazepine. B. the benzodiazepine potentiates alcohol withdrawal symptoms. C. the benzodiazepine relieves muscle spasms and spasticity. D. the patient has a cross-dependence to the benzodiazepine.

ANS: D Rationale: Benzodiazepines are given to ease withdrawal from alcohol because of cross-dependence with these drugs and alcohol, enabling the benzodiazepine to suppress withdrawal symptoms.

A nurse caring for a 5-year-old child notes that the child has discoloration of several teeth. When taking a medication history, the nurse will ask about which group of medications? a. Glucocorticoids b. Salicylates c. Sulfonamides d. Tetracyclines

ANS: D Tetracyclines cause discoloration in developing teeth in children. Glucocorticoids are associated with growth suppression. Salicylates are associated with Reye's syndrome. Sulfonamides are associated with kernicterus in newborns.

A patient with epistaxis and a history of hemophilia A is admitted to the unit and is scheduled for replacement therapy. The nurse should prepare to administer which medication? A. Tranexamic acid [Cyklokapron] B. Aminocaproic acid [Amicar] C. Desmopressin [Stimate] D. Factor VIII

ANS: D The cornerstone of treatment for hemophilia A is replacement therapy with factor VIII. Tranexamic acid and aminocaproic acid are antifibrinolytic agents that act primarily by preventing the formation of plasmin from its precursor.

An agitated, extremely anxious patient is brought to the emergency department. The prescriber orders a benzodiazepine. The nurse understands that benzodiazepines are used in this clinical situation based on which principle? A. Benzodiazepines have a very short half-life. B. Physical dependence is not a risk when taking benzodiazepines. C. Benzodiazepines are known to cure generalized anxiety. D. Benzodiazepines have a rapid onset of action.

ANS: D The patient is clearly in a state of extreme, uncontrolled anxiety. Benzodiazepines are the drugs of choice for acute episodes of anxiety because of their rapid onset of action.

What is the primary reason for opioid abuse? A. Ease of access B. Initial "rush" similar to orgasm C. Peer pressure D. Prolonged sense of euphoria

ANS: D The primary reason for opioid abuse is the prolonged sense of euphoria that occurs after the initial rush.

A patient in the postanesthesia recovery unit received ketamine [Ketalar] for right open reduction internal fixation surgery. What drug would be beneficial as a premedication to help minimize adverse reactions? a. Methohexital [Brevital] b. Sevoflurane [Ultane] c. Atropine [Sal-Tropine] d. Diazepam [Valium]

ANS: D To minimize the effects of ketamine, the patient should be premedicated with diazepam or midazolam to reduce the risk of an adverse reaction.

A patient newly diagnosed with cancer reports having pain at a level of 7 to 8 on a scale of 10. Which type of pain management will be used initially to treat pain in this patient? a. Acetaminophen [Tylenol] b. Ibuprofen [Motrin] c. Nonpharmacologic measures d. Opioid analgesics

ANS: D Traditionally, patients have been given opioid analgesics only after a trial with nonopioids has failed.

A prescriber orders transdermal clonidine [Catapres TTS] for a patient with hypertension. What will the nurse teach this patient? a. That medication given by transdermal patch has fewer systemic side effects b. That localized skin reactions are uncommon c. To apply the patch to intact skin on the forearm or leg d. To change the patch every week

ANS: D Transdermal patches are to be changed every 7 days

A nurse is teaching a group of nursing students how the CNS adapts to psychotherapeutic medications. Which statement by a nursing student indicates a need for further teaching? a. "Adaptation can lead to tolerance of these drugs with prolonged use." b. "Adaptation helps explain how physical dependence occurs." c. "Adaptation often must occur before therapeutic effects develop." d. "Adaptation results in an increased sensitivity to side effects over time."

ANS: D With adaptation of the central nervous system to prolonged exposure to CNS drugs, many adverse effects diminish and therapeutic effects remain.

A nurse is performing an admission assessment on a patient. The patient reports taking alprazolam [Xanax] for "nerves." The nurse knows that this patient is most likely being treated for which condition? A. Generalized anxiety disorder B. Obsessive-compulsive disorder (OCD) C. Panic disorder D. Post-traumatic stress disorder (PTSD)

ANS:A Benzodiazepines are the first-choice drugs for anxiety, and alprazolam and lorazepam are prescribed most often.