Pharmacology

A patient is receiving warfarin [Coumadin] for a chronic condition. Which patient statement requires immediate action by the nurse?

"I will increase dark green, leafy vegetables in my diet." Dark green, leafy vegetables are rich in vitamin K, which would antagonize the effects of warfarin. Rather than increase the intake of these vegetables, it is more important to maintain a consistent daily intake of vitamin K. The patient should monitor his or her incidence of bruising carefully. The medication will usually be ordered to be taken at the same time each day.

Which statement made by a patient about nitroglycerin indicates understanding?

"I will keep the nitroglycerin stored in the bottle it comes in." Nitroglycerin needs to be stored away from heat, humidity, and light, all of which can decrease its potency. Keeping it in the brown light-resistant bottle helps achieve this. It should be replaced every 3 to 6 months to maintain potency. Nitroglycerin is used every 5 minutes for pain relief or just prior to engaging in activity that is known to cause chest pain.

The nurse is teaching a patient who is being discharged with a prescription for metoprolol. Which patient statement indicates understanding of the teaching?

"I will not drive until I know how this medication affects me." Metoprolol can cause dizziness and blood pressure changes. Patients should not drive until they know how the body will respond to the medication.

Which statement indicates that the patient needs additional teaching on oral hypoglycemic agents?

"I will take the medication only when I need it." Oral hypoglycemic agents must be taken on a daily scheduled basis to maintain euglycemia and prevent long-term complications of diabetes. When alcohol is ingested with certain oral hypoglycemic drugs, the hypoglycemic effect can be intensified. The patient may experience fatigue and loss of appetite as side effects of the medication, and these should be reported to the healthcare provider. The patient needs to closely monitor blood sugar.

Which statement indicates to the nurse that the patient needs additional teaching on oral hypoglycemic agents? I will limit my alcohol consumption." "I will report symptoms of fatigue and loss of appetite." "I will take the medication only when I need it." "I will monitor my blood sugar daily."

"I will take the medication only when I need it." Oral hypoglycemic agents must be taken on a daily scheduled basis to maintain euglycemia and prevent long-term complications of diabetes. When alcohol is ingested with certain oral hypoglycemic drugs, the hypoglycemic effect can be intensified. The patient may experience fatigue and loss of appetite as side effects of the medication, and these should be reported to the health care provider. The patient needs to closely monitor blood sugar.

After the patient underwent renal transplantation, the nurse provides teaching about immunosuppressant drugs. Which information from the patient indicates a correct understanding of the teaching?

"I will take these drugs for the rest of my life."

A patient who is prescribed lisinopril asks the nurse, "Will this drug help the swelling in my legs?" Which nursing response is appropriate?

"Lisinopril may help the edema from progressing, as this drug suppresses aldosterone, which promotes sodium and water excretion."

A patient who is prescribed lisinopril asks the nurse, "Will this drug help the swelling in my legs?" Which nursing response is appropriate?

"Lisinopril may help the edema from progressing, as this drug suppresses aldosterone, which promotes sodium and water excretion." Lisinopril does suppress the release of aldosterone, which promotes sodium and water excretion. With an increase in sodium and water excretion, the edema should not progress, however, a diuretic may still be required in conjunction with the angiotensin-converting enzyme (ACE) inhibitor.

The nurse is teaching a patient about the transmission of malarial infections. Which statement made by the nurse is appropriate?

"Malaria is transmitted by an infected female mosquito."

A patient is newly diagnosed with hypertension and asks for a minoxidil prescription. The patient states, "It was the only medication that helped my dad's hypertension." Which nursing statement is appropriate?

"Minoxidil is only indicated for patients with severe hypertension who have not responded to previous treatment." Because of the serious side effects, minoxidil is only used in patients with severe hypertension who have not responded to previous treatment.

Which teaching would the nurse include for a patient who is being discharged home from an acute care setting on a calcium channel blocker?

"Record each angina attack in a journal." "Assess your heart rate before taking your medication." "Do not chew or crush the sustained-release medication." keep a daily record of your blood pressure

A patient taking sildenafil [Viagra] asks the nurse what action to take if an erection does not resolve following ejaculation. Which response should the nurse make?

"Seek emergency help if an erection lasts longer than 4 hours, because permanent damage can occur."

At a follow-up appointment, a patient who is taking hydralazine for hypertension reports feeling lightheaded and dizzy when standing up. What teaching will the nurse provide?

"Sit on the edge of the chair and stand up slowly."

A patient is prescribed zidovudine. The nurse understands that the drug may cause esophageal ulceration if not taken properly. What instruction will the nurse give to the patient to prevent this adverse effect? 1 "Lie down after taking the drug." 2 "Avoid taking the drug with milk." 3 "Avoid taking the drug with food." 4 "Sit upright when taking the drug."

"Sit upright when taking the drug."

A patient has a new prescription for propylthiouracil. Which instructions are important in relation to drug therapy? Select all that apply. "Stopping the drug suddenly is not recommended." "Antithyroid drugs are safe during pregnancy." "Take antithyroid drugs with meals." "This drug should not take amiodarone with the prescribed drug." "Report a slow heart rate of below 60 beats per minute." "Reporting a dry cough is important."

"Stopping the drug suddenly is not recommended." "Take antithyroid drugs with meals." "This drug should not take amiodarone with the prescribed drug." "Report a slow heart rate of below 60 beats per minute."

The nurse teaches the patient about his essential hypertension. What statement should be included in the teaching plan?

"The cause of your hypertension is unknown but treatable." The specific cause of essential (primary) hypertension is unknown. Surgical treatment may cure secondary hypertension but not idiopathic hypertension.

Which statement made by the patient prescribed subcutaneous alirocumab would alert the nurse that further patient teaching is needed?

"The drug should be injected into my buttocks." "I will remember to always inject the medication into my hip."

A patient with type 1 diabetes has a new prescription for hydrocortisone. Which education should the nurse provide to this patient? "If you have a sudden increase in weight, try to limit your fluids for a couple of days." "Contact the health care provider if you are going to have surgery so your medications can be withheld." "If your baseline bone density test was normal, then you do not have to be concerned about osteoporosis related to hydrocortisone therapy." "The insulin drug dosage to manage your diabetes may need to be increased since hydrocortisone can raise your blood glucose levels."

"The insulin drug dosage to manage your diabetes may need to be increased since hydrocortisone can raise your blood glucose levels."

When teaching a patient with genital herpes about treatment with valacyclovir [Valtrex], the nurse should include which statement?

"The intensity of infection episodes is reduced when the medication is taken daily."

A 30-year-old female patient who is taking a beta blocker asks the nurse, "Can I take this drug if I am considering pregnancy?" Which nursing response is appropriate?

"There is potential risk to the fetus because metoprolol crosses the placental barrier." Beta blockers readily cross the placental barrier, which has known risks to the fetus.

What is the best information for the nurse to provide to a patient who is receiving spironolactone and furosemide therapy?

"This combination promotes urine output but decreases the risk of low potassium." Spironolactone [Aldactone] is a potassium-sparing diuretic; furosemide [Lasix] causes potassium loss. Giving these together minimizes electrolyte imbalance. It is not accurate to state that the drug combination prevents dehydration and loss of fluid volume or that it increases the osmolality of plasma and the glomerular filtration rate. Stating that giving two different diuretics is more effective than a large dose of one is not accurate.

The patient newly diagnosed with type 2 diabetes mellitus has been ordered insulin glargine (Lantus). What information is essential for the nurse to teach this patient? This medication should be mixed with the regular insulin each morning." "This medication is very short-acting. You must be sure you eat after injecting it." "This medication is very expensive, but you will be receiving it only a short time." "This medication has a duration of action of 24 hours."

"This medication has a duration of action of 24 hours." Insulin glargine (Lantus) has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas. This medication cannot be mixed with other insulins and is not a short-acting insulin. The patient may need to receive this medication for a long time.

What information will the nurse teach the patient who has been prescribed an alpha glucosidase inhibitor? This medication will stimulate pancreatic insulin release." "This medication will increase the sensitivity of insulin receptor sites." "This medication will delay the absorption of carbohydrates from the intestines." "This medication cannot be used in combination with other antidiabetic agents."

"This medication will delay the absorption of carbohydrates from the intestines." Alpha glucosidase is an enzyme necessary for the absorption of glucose from the GI tract. Inhibiting this enzyme inhibits glucose absorption, delaying rises in postprandial serum glucose levels.

The nurse is teaching a patient about body lice. Which information should the nurse include in the teaching session?

"Wash and dry clothing and bedding in hot water."

The nurse is providing education to a patient who is being discharged on valsartan. Which patient responses indicate that more education is required?

"Which of those is for my blood pressure?" "I have to take it with food or it won't work."The patient's statement requires further education, as ARBs can be taken with or without food. "I take it only when my blood pressure is over 180/80 mm Hg."The patient's statement requires further education, as ARBs should be taken as prescribed daily, not only when blood pressure reaches a certain number.

Which statement by a nursing student about insulin glargine [Lantus] indicates effective learning?

"You cannot mix this insulin in the same syringe with regular insulin." Insulin glargine [Lantus] is a long-acting insulin with a duration of action up to 24 hours. Hence, it can be given at bedtime to provide up to 24 hours of insulin coverage. It should not be mixed with any other insulin. It is given alone because of the low pH of the diluent.

The nurse should include which statement when teaching a patient about insulin glargine [Lantus]?

"You cannot mix this insulin with any other insulin in the same syringe." Insulin glargine [Lantus] is a long-acting insulin with a duration of action up to 24 hours. It should not be mixed with any other insulins. The insulin is not fast acting.

In the pediatric clinic, a child is receiving growth hormone (GH). The adolescent sibling asks about receiving the same medication. He would like to play basketball but is too short. How should the nurse respond? "We'll need to draw labs first to see if you need growth hormones." "That is a possibility, but you need to see the health care provider." "Growth hormones may not help your height and have side effects." "You have stopped growing and can't take growth hormone."

"You have stopped growing and can't take growth hormone."

Which information should the nurse include in the teaching plan for a patient who has been prescribed repaglinide [Prandin]?

"You will need to be sure you eat as soon as you take this medication." Repaglinide [Prandin] is short acting. The drug's very fast onset of action allows patients to take the drug with meals and skip a dose when they skip a meal. The effects of repaglinide [Prandin] are enhanced when taken with aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), which may result in increased hypoglycemia. Hypoglycemia is a side effect of this medication, and there are many other possible side effects of this medication.

The nurse is teaching a patient who has been prescribed repaglinide (Prandin). Which information will the nurse include in the teaching plan? You will need to be sure you eat as soon as you take this medication." "This medication is compatible with all of your cardiac medications." "This medication will not cause hypoglycemia." "This medication has no side effects."

"You will need to be sure you eat as soon as you take this medication." Repaglinide (Prandin) is short-acting. The drug's very fast onset of action allows patients to take the drug with meals and skip a dose when they skip a meal. Prandin interacts with beta-adrenergic blockers as well as other medications. Hypoglycemia is a side effect of this medication, and there are many other possible side effects of this medication.

Which instruction should be the priority for the nurse to teach a patient scheduled to start taking sirolimus [Rapamune]?

"You'll need to notify your doctor if you experience any sore throat or fever."

Permethrin

- Disrupts nerve traffic, causing paralysis - Active against mites, lice, fleas, and ticks - approved for 2 mon and older - Fails to eradicate head lice in 5% of people - then use malathion or benzyl alcohol - only 2% absorbed

praziquantel

- very active against FLUKES and TAPEWORMS (cestodes) - Drug of choice for tapeworms, schistosomiasis, and other fluke infestations - MOA: Low dose - spastic paralysis, high dose - disrupts integument of worms = open to attack by host

Which statements are true about antiseptics? Select all that apply.

-"Antiseptics are agents used on living tissue." -"Antiseptics are often used as prophylactic agents." -"Antiseptics reduce the acquisition and transmission of infection."

Which statements are true about disinfectants? Select all that apply.

-"Disinfectants are agents applied to objects." -"Disinfectants are too harsh for application on living tissue." -"Disinfectants are used most frequently on surgical instruments." -"Disinfectants reduce the acquisition and transmission of infection."

A nurse instructs a patient with rheumatoid arthritis who was prescribed prednisone 20 mg PO daily. Which statements by the patient indicate that patient teaching was effective?

-"I will make sure to have a diet rich in vitamin D and calcium to reduce my risk for osteoporosis." -"I will make sure to take the prednisone with food to avoid an upset stomach." -"I may experience side effects and adverse effects such as insomnia, weight gain, and mood swings."

Which patients does a nurse determine cannot safely receive prednisone?

-A 33-year-old patient with active tuberculosis -A 78-year-old patient with cataracts

Why is it recommended to use alcohol-based hand rubs rather than soap and water for routine hand antisepsis? Select all that apply.

-Accessibility of alcohol-based hand rubs -Time savings of using alcohol-based rubs -Alcohol-based rubs lessen skin damage compared to soap and water -Greater efficacy of alcohol to reduce the number of bacteria on the skin

Which adverse effects will the nurse monitor for in a patient receiving chemotherapy? Select all that apply.

-Alopecia -Stomatitis -Neutropenia

Match the chemical class to the NSAID

-Aspirin: Salicylate -Diclofenac sodium: acetic acid derivative -Piroxicam: enolic acid derivative -Naproxen: propionic acid derivative

Which information would a nurse include when teaching a patient about the administration of colchicine for gout?

-Avoid grapefruit juice -Nausea/vomiting/diarrhea may occur -Report blood in urine or muscle pain to MD immediately -Best to take on empty stomach but can take with food if it upsets stomach

A patient on fluconazole should have which laboratory tests monitored frequently?

-BUN/creatinine -Liver enzymes -Serum potassium

A patient inquires about gonorrhea. What does the nurse correctly tell this patient about this infection? Select all that apply.

-Gonorrhea is transmitted almost exclusively by sexual contact. -The current treatment of choice for gonorrhea is oral cephalosporins. -Gonorrhea is often painful for men, and women are usually asymptomatic. -The treatment of gonorrhea has been affected greatly by antibiotic resistance.

Which statements accurately describe what occurs in the body of patients with gout?

-Gout may be caused by overproduction of uric acid, decreased uric acid excretion, or both -When crystals deposit, symptoms of inflammation may result -Hyperuricemia is too much uric acid in the blood, which can lead to formation of uric acid crystals -Uric acid is formed when the body converts purines to hypoxanthine, which then converts to xanthine and finally the end product of uric acid

Antimalarial drugs

-Include chloroquine and primaquine -Therapeutic objectives of antimalarial drugs are dependent on the life cycle of Plasmodium

Antiprotozoal drugs

-Includes nitazoxanide (for cryptosporidiosis) and metronidazole (for giardiasis and trichomoniasis)

Aspirin MOA

-Inhibits prostaglandin synthesis by inhibiting both COX-1 and COX-2 to decrease inflammation and pain. -Unlike all other NSAIDs, aspirin is an irreversible COX inhibitor, and its duration of action depends on the ability of target tissues to synthesize COX-1 and COX-2. -Effects may persist even after drug levels fall.

Which antigout drugs are associated with an increased risk for stroke and myocardial infarction?

-Lesinurad -Febuxostat

What makes iodine one of the most widely used germicidal agents? Select all that apply.

-Low cost of iodine solutions -Various iodine solutions are available for open and intact skin -Has the ability to kill all known bacteria, fungi, protozoa, viruses, and yeasts

Anthelmintic drugs

-Mebendazole is the drug of choice for pinworms, roundworms, and hookworms -Praziquantel is effective against tapeworms and roundworms

Glucocorticoids affect ___

-Metabolism of carbs, fats & proteins -Also exert anti inflammatory effects -Cortisol is the major glucocorticoid secreted by the adrenal cortex

Which dietary modifications should be shared with a patient who has gout and is receiving colchicine?

-Minimize or avoid caffeine & alcohol -Increase water intake

Glucocorticoid effects on inflammatory process

-Modulation of the inflammatory response by stabilizing the cell membranes of lysosomes (inflammatory cells) to reduce capillary permeability and leukocyte migration -Reduction of interleukin-1 release from white blood cells to decrease fever -Stimulation of erythroid cells that eventually become red blood cells -Promotion of protein metabolism, glycogen production, and fat redistribution from peripheral to central areas of the body

Which results are expected when arachidonic acid is metabolized through the prostaglandin pathway?

-Pain -Edema -Vascular permeability

Which factor(s) increase a person's risk of acquiring a helminthic infestation? Select all that apply.

-Poor water sanitation -cost of medication treatment

Which statements regarding the pharmacokinetics of glucocorticoids are accurate?

-Rate of absorption varies depending on the glucocorticoid and route of administration -Glucocorticoids undergo hepatic metabolism to produce inactive metabolites -Rapid absorption occurs when sodium phosphate and sodium succinate esters are given intramuscularly

Which statements regarding the pharmacokinetics of glucocorticoids are accurate?

-Rate of absorption varies depending on the glucocorticoid and route of administration. -Rapid absorption occurs when sodium phosphate and sodium succinate esters are given intramuscularly. -Glucocorticoids undergo hepatic metabolism to produce inactive metabolites.

Mineralocorticoids affect ___

-Regulation of fluids & electrolytes -Aldosterone is major mineralocorticoid and affects pH, sodium, potassium, and BP

Which patient does a nurse identify cannot safely receive therapy with naproxen?

-Renal failure patients with or without dialysis -NSAIDs are hard on the kidneys

A patient has been diagnosed with human immunodeficiency virus (HIV) infection. The patient states, "I thought that only gay men could get that." The nurse would teach the patient that possible causes of this disease include what? Select all that apply.

-Sexual contact with an infected person -Sharing IV needles with an infected person -Receiving a blood infusion from an infected person

Ibuprofen MOA

-Similar to ASA but is reversible

Which statements accurately describe the actions glucocorticoids exert in the inflammatory process?

-Stimulation of erythroid cells -Reduction of interleukin-1 release from white blood cells -Promotion of protein metabolism, glycogen production, and fat redistribution -Stabilization of lysosomal cell membranes to reduce capillary permeability and leukocyte migration

Which statements regarding treatment modalities for cancer should the nurse identify as true? Select all that apply.

-Surgery is the most common treatment for solid cancers. -Drug therapy is the treatment of choice for disseminated cancers. -Drug therapy is effective as an adjunct therapy in treating a patient who has had irradiation.

Which side/adverse effects and/or laboratory results would a nurse monitor for while a patient is receiving fludrocortisone?

-Swelling in the extremities -Increased blood sugars -Hypertension -Decreased bone mineral density

What are the drawbacks of the use of soap and water for hand hygiene? Select all that apply.

-Takes considerable time -Adherence tends to be poor -Promotes skin irritation and dryness -Requires a sink and hand-washing supplies

COX 2

-The "bad" COX -Causes pain and inflammation

COX 1

-The "good" COX -involved in housekeeping activities such as gastric mucosal protection, platelet aggregation, and maintenance of renal function

Which statement(s) should the nurse include when teaching a patient about ectoparasites? Select all that apply.

-The main ectoparasites that infest humans are mites and lice. -Most ectoparasites that infest humans live on the skin and hair. -Some ectoparasites live on clothing and bedding and move to the host to feed.

A patient has been diagnosed with malaria. Which factors should the primary healthcare provider consider before prescribing medications for the patient? Select all that apply.

-The species of Plasmodium. -The clinical status of the patient.

Which parameters will a nurse ensure have been assessed before administering allopurinol to a patient newly prescribed the drug?

-Uric acid levels -Kidney function -CBC -Complete accurate list of meds

A university nurse is teaching her students how to decrease the risk of contracting the human immunodeficiency virus (HIV). What will she include in her teaching? Select all that apply.

-Using condoms -Sexual abstinence -Circumcision of males -Limiting sexual partners

Which parameters would be assessed in a patient who has been prescribed prednisone?

-Vital signs -Glucose levels -Potassium levels -Presence of preexisting edema -Skin color, turgor, and temperature

The nurse explains the importance of hand washing to a student nurse. When is it important to wash hands with an antimicrobial soap and water? Select all that apply.

-When hands are visibly dirty -When hands are contaminated with proteinaceous material -When hands have touched a questionably infectious surface -When hands are visibly soiled with blood or other body fluids

Inflammatory process (prostaglandin pathway)

-cyclooxygenase (COX) metabolizes arachidonic acid to prostaglandins that cause vasodilation and promote vasopermeability -bradykinin's and histamine's effects are enhanced, causing pain and edema

What are the properties of an ideal antiseptic? Select all that apply.

-safe -effective -selective

Which range is therapeutic for amiodarone?

0.8 to 2.8 mcg/mL Amiodarone's therapeutic range is 0.8 to 2.8 mcg/mL.

A nurse is preparing to administer adenosine through an established intravenous site with intravenous fluids infusing. Which intravenous fluids would the nurse accept as compatible with adenosine?

0.9% NaCl 0.9% NaCl (normal saline) is compatible with adenosine. D5W D5W is compatible with adenosine. Ringer's lactate Ringer's lactate is compatible with adenosine.

A nurse is preparing to administer adenosine through an established intravenous site with intravenous fluids infusing. Which intravenous fluids would the nurse accept as compatible with adenosine?

0.9% NaCl D5W Ringer's lactate

The nurse is administering an oral dose of clonidine at 0600. At which time would the nurse anticipate the onset of the medication?

0700 The nurse would anticipate onset of the medication at 0700 because onset of oral clonidine is 30 to 60 minutes after administration.

The nurse is administering oral hydralazine at 0800 to a patient for hypertension. At which time would the nurse anticipate the onset of the drug?

0830 The nurse would anticipate the onset of the drug at 0830 because the onset occurs 20 to 30 minutes following oral administration.

A nurse administered diltiazem intravenously at 0900. At which time will the nurse assess the patient for therapeutic effects of diltiazem?

0905

The nurse administers propranolol intravenously at 0900. At which time will the nurse start assessing for its therapeutic effects?

0905 The onset for propranolol administered intravenously occurs within 2 minutes. Therefore the nurse would assess its effects around 0905.

A nurse takes a rectal temperature, which stimulates the vagus nerve. When the nurse checks the pulse, what would the nurse expect to find? 1 The pulse is lowered. 2 The pulse is elevated. 3 The pulse is the same. 4 The pulse will wildly fluctuate.

1

Which assessment is most important for the nurse to obtain prior to administering digoxin to a patient with heart failure? 1 Pulse 2 Blood pressure 3 Respiratory rate 4 Weight in kilograms

1

the nurse assesses a patient's pulse before administering digoxin and notes a rate of 55 beats/min. What is the priority intervention by the nurse? 1 Withhold the dose. 2 Administer the drug. 3 Check potassium level before giving. 4 Reduce the dose to half the prescribed dose.

1

A patient who takes nitroglycerin to treat stable angina reports having erectile dysfunction and states that he plans to ask his primary provider for a prescription for tadalafil. What will the nurse tell this patient? A."You should discuss another anti-angina medication with your provider." B."You should avoid sexual activity since this increases oxygen demands on the heart." C."You may take these two drugs together safely as long as you take them as directed." D."You should not take tadalafil and nitroglycerine within 30 to 60 minutes of each other."

A

The nurse administers candesartan [Atacand] to a patient. Which assessment finding should the nurse use as a clinical indicator of the therapeutic effectiveness of the medication? 1 Blood pressure reduction 2 Serum potassium retention 3 Peripheral perfusion reduction 4 Pulmonary congestion retention

1 All angiotensin receptor blockers (ARBs), such as candesartan [Atacand], are approved for hypertension. Reduction in blood pressure equals those seen with angiotensin-converting enzyme (ACE) inhibitors. ARBs will decrease pulmonary congestion. Because ARBs promote vasodilation, the nurse expects the patient's extremities to be warm and pink from increased perfusion. In contrast to ACE inhibitors, ARBs do not cause clinically significant hyperkalemia.

The nurse is caring for a patient who takes an angiotensin-converting enzyme (ACE) inhibitor. If the patient develops a persistent nonproductive cough, what should the nurse do? 1 Notify the provider of the new development. 2 Tell the patient that the cough will subside in a few days. 3 Assess the patient for other symptoms of upper respiratory infection. 4 Instruct the patient to take antitussive medication until the symptoms subside.

1 Angiotensin-converting enzyme (ACE) inhibitors prevent the breakdown of bradykinins, frequently causing a nonproductive cough. The patient should be switched to a different medication if the side effect cannot be tolerated. The cough will not subside in a few days. This is not a sign of infection but is a known side effect of ACE inhibitors. Medications will not make the cough subside.

The nurse is reviewing the chart for a patient who has been receiving an angiotensin-converting enzyme (ACE) inhibitor for 4 days. Which finding would cause the nurse to hold the ACE inhibitor until evaluated by the patient's primary care provider? 1 Reports sore throat 2 Has bronchial asthma 3 Diabetic with nephropathy 4 No history of renal artery stenosis

1 Sore throat is a sign of neutropenia in a patient receiving an angiotensin-converting enzyme (ACE) inhibitor. Neutropenia, with its associated risk of infection, is a rare but serious complication. Calcium channel blockers (CCB), verapamil, and hydrochlorothiazide can be used safely in patients with bronchial asthma, a condition that precludes the use of beta2-adrenergic antagonists. ACE inhibitors can benefit patients with diabetic nephropathy, slowing the progression of renal disease. ACE inhibitors can cause severe renal insufficiency in patients with bilateral renal artery stenosis or stenosis in the artery to a single remaining kidney; however, this patient has no history of this.

Which statement by a client would lead the nurse to believe that the client has understood the teaching regarding angina? A. Heavy meals and cigarette smoking can precipitate an angina attack. B.There is no correlation between my hypertension and angina C. As long as I take the medicine, I need to make no lifestyle changes D.I will remain inactive because it helps angina

A

The nurse has just administered the initial dose of enalapril [Vasotec] to a newly admitted patient with hypertension. What is the priority nursing intervention over the next several hours? 1 Check the heart rate. 2 Monitor blood pressure. 3 Auscultate lung sounds. 4 Draw a potassium level.

2 First-dose hypotension is a serious potential adverse effect of angiotensin-converting enzyme (ACE) inhibitors such as enalapril [Vasotec]. Monitoring the blood pressure is the priority nursing intervention. If hypotension develops, the nurse will place the patient in the supine position and possibly increase intravenous fluids. The other interventions may be appropriate for this patient; however, in the hours immediately after the first dose of an ACE inhibitor, monitoring of the blood pressure is most important.

The nurse is administering a prescribed dose of sodium nitroprusside to a patient at 2100 hours. At what time will the nurse anticipate the peak effect of the drug?

2102

The nurse is caring for a patient who takes spironolactone [Aldactone] and quinapril [Accupril] for treatment of heart failure. Which finding indicates a potential additive effect between these two drugs? 1 Heart rate of 58 beats/min 2 Glucose level of 180 mg/dL 3 Potassium level of 5.7 mEq/L 4 Elevated serum quinapril level

3

The nurse is using the New York Heart Association's (NYHA's) functional classification of heart failure. Which patients would receive a class III ranking? 1 Patients with symptoms at rest 2 Patients with slight limitation of physical activity 3 Patients with marked limitation of physical activity 4 Patients with no limitation of ordinary physical activity

3

The nurse who administers spironolactone to a patient with heart failure should recognize that it promotes improvement by what mechanism? 1 It is a strong diuretic. 2 It promotes fluid retention. 3 It blocks the action of aldosterone. 4 It promotes elimination of excess potassium.

3

Which time frame after administration of flecainide would the nurse expect the onset of action to occur?

3 Hours

Heparin and warfarin are started simultaneously in a patient who is diagnosed with a deep vein thrombosis. The nurse would anticipate that the heparin will most likely be discontinued at which time?

3 days after being on warfarin

The healthcare provider orders mannitol [Osmitrol] 72 gm infusion over 24 hours. The nurse should plan to set the infusion pump for how many grams per hour?

3 gm To infuse 72 grams over 24 hours, divide 72 by 24 for the total per hour. 72 divided by 24 equals 3 grams per hour.

In which time frame should patients expect full therapeutic response from levothyroxine? 24 hours 3 to 5 days 1 week 3 to 4 weeks

3-4 weeks

A nurse is teaching a patient about the distribution of blood. Which information indicates the patient has a correct understanding of the teaching? 1 The majority of blood is in the heart. 2 The majority of blood is in the lungs. 3 The majority of blood is in the capillaries. 4 The majority of blood is in the venous system.

4

A patient has reduced cardiac output. Which compensatory response would the nurse expect to occur in this patient? 1 Shrinkage of cardiac muscle 2 Excretion of water and blood volume 3 Suppression of the sympathetic nervous system (SNS) 4 Activation of the renin-angiotensin-aldosterone system (RAAS)

4

A patient is prescribed digoxin to treat heart failure. Which biochemical parameter should be assessed by the nurse to ensure safe drug administration? 1 Liver enzyme concentration 2 Blood glucose concentration 3 Serum calcium concentration 4 Serum potassium concentration

4

A patient of African American heritage with heart failure is unable to tolerate angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). Which medication is an appropriate alternative for this patient? 1 Eplerenone [Inspra] 2 Triamterene [Dyrenium] 3 Hydrochlorothiazide [Microzide] 4 Isosorbide dinitrate and hydralazine [BiDil]

4

A patient with heart failure and hypertension is being treated with a positive inotrope and an angiotensin-converting enzyme (ACE) inhibitor. Despite pharmacotherapy, the patient develops pulmonary edema. The patient is adherent to pharmacologic and nonpharmacologic management of the disease processes. Which action should the nurse take if the patient refuses to take additional medication? 1 Instruct the patient to reduce dietary sodium. 2 Ask the patient to perform a 24-hour dietary recall. 3 Suggest to the patient to drink diuretic beverages such as tea. 4 Collaborate with the healthcare provider to find a combination ACE inhibitor/diuretic.

4

A patient's arterial pressure drops upon standing. How should the nurse report this finding to the oncoming shift? 1 The patient has water retention. 2 The patient has reflex tachycardia. 3 The patient has steady-state control. 4 The patient has orthostatic hypotension.

4

A patient's preload is decreased. How should the nurse interpret this information? 1 The stroke volume has increased. 2 The more the ventricles will stretch. 3 The muscarinic receptors are activated. 4 The end-diastolic volume has decreased.

4

A patient's serum digoxin level is noted to be 0.5 ng/mL. Which action by the nurse is appropriate? 1 Notify the provider. 2 Administer an antidote. 3 Hold the ordered dose of digoxin. 4 Administer the ordered dose of digoxin.

4

A provider orders digoxin to be given intramuscularly to a patient with heart failure. Which action should the nurse take? 1 Dilute the drug in normal saline before injecting. 2 Administer the medication using the Z-track method. 3 Inject the medication quickly to ensure rapid digitalization. 4 Contact the provider and question the route of administration.

4

The nurse is caring for a patient with heart failure. Which drug classification should the nurse recognize as the cornerstone of therapy? 1 Cardiac glycosides 2 Sympathomimetics 3 Direct renin inhibitors 4 Angiotensin-converting enzyme inhibitors

4

The nurse is evaluating the effectiveness of treatment for heart failure in a patient. Which finding indicates a therapeutic effect? 1 Presence of ankle edema 2 Paroxysmal nocturnal dyspnea 3 Absence of nausea and vomiting 4 No neck vein distention with head of bed elevation

4

The nurse is preparing to administer a daily dose of digoxin [Lanoxin]. What is the priority nursing intervention? 1 Check blood pressure. 2 Palpate the pedal pulses. 3 Assess for Homans' sign. 4 Analyze heart rate and rhythm

4

The nurse is preparing to administer a daily dose of digoxin [Lanoxin]. What is the priority nursing intervention? 1 Check blood pressure. 2 Palpate the pedal pulses. 3 Assess for Homans' sign. 4 Analyze heart rate and rhythm.

4

The nurse is teaching a group of nursing students about beta blockers. Which statement indicates a correct understanding? 1 "Beta blockers increase myocardial contractility." 2 "Beta blockers increase the patient's urine output." 3 "Beta blockers increase dilation of the peripheral vessels." 4 "Beta blockers decrease sympathetic stimulation of the heart."

4

The nurse should notify the healthcare provider immediately about which patient? 1 A patient who takes digoxin [Lanoxin] 0.125 mg orally daily with a serum digoxin level of 0.8 ng/mL 2 A patient who takes digoxin [Lanoxin] 0.25 mg orally daily with a serum potassium level of 4.0 mEq/L 3 A patient who takes oral lisinopril [Zestril] 5 mg daily and digoxin [Lanoxin] 0.125 mg daily with a serum digoxin level of 0.5 ng/mL 4 A patient who takes oral spironolactone [Aldactone] 25 mg daily and enalapril [Vasotec] 5 mg daily with a serum potassium level of 5.5 mEq/L

4

The nurse would most likely administer the combination product isosorbide dinitrate/hydralazine [BiDil] to patients of which ethnic heritage? 1 Asian 2 Mexican 3 Native American 4 African American

4

Which situation will cause the natriuretic peptides to protect the cardiovascular system? 1 Patient has blood loss. 2 Patient has dehydration. 3 Patient has decreased preload. 4 Patient has sodium and water retention.

4

Which comment by a patient indicates correct understanding about the use of enalapril? 1 "If I feel tired, I should double the dose." 2 "I cannot go out in the sun while on this therapy." 3 "I should stop the drug if I have ringing in my ears." 4 "If I develop a chronic cough, I need to notify my provider."

4 A patient on therapy with an angiotensin-converting enzyme (ACE) inhibitor such as enalapril should report a nonproductive chronic cough, as this is a potential side effect. There is no treatment other than to change the medication therapy. The patient should not double the dose of an antihypertensive. Ringing in the ears in not a concern for ACE inhibitors and the patient need not avoid the sun.

The nurse is preparing discharge teaching for four patients. Which patient should be advised by the nurse that over-the-counter cold and allergy preparations contain phenylephrine and should be avoided? A)A 47-year-old woman with hypertensionB)A 52-year-old man with adult onset diabetes C)A 17-year-old girl with symptoms of an upper respiratory infection D)A 62-year-old man with gout

A Feedback: Phenylephrine, a potent vasoconstrictor and alpha1-agonist with little or no effect on the heart or bronchi, is used in many combination cold and allergy products. Patients with hypertension should avoid these drugs because serious increases in blood pressure could occur. Use of this drug in patients with diabetes and gout are not contraindicated. An upper respiratory infection may be an indication for the drug.

1 (Lidocaine vials should contain clear solution labeled as cardiac or not for cardiac use. The plain solution is used for cardiac conditions. Parenteral solutions of these drugs are usually stable only for 24 hours. Epinephrine is a potent vasoconstrictor that should never be used parenterally.)

A 100 mg IV bolus of lidocaine is prescribed for client experiencing ventricular dysrhythmias. Which available lidocaine medication should the nurse use to prepare this bolus? 1 Lidocaine vial of clear solution 2 Lidocaine 1% vial of light yellow solution 3 Lidocaine with epinephrine vial of clear solution 4 Lidocaine pre-mixed in 50 mL normal saline prepared within past 48 hours

For which patients does the nurse recognize a contraindication for vasodilators?

A 36-year-old patient with a blood pressure of 88/40 mm Hg A 50-year-old patient with a history of heart failure A 29-year-old male patient with head trauma after a motor vehicle accident

For which patients does the nurse recognize a contraindication for vasodilators?

A 36-year-old patient with a blood pressure of 88/40 mm Hg -Vasodilators are contraindicated with hypotension. A 50-year-old patient with a history of heart failure A 29-year-old male patient with head trauma after a motor vehicle accident

Which patients would a nurse identify as being able to safely receive niacin?

A 49-year-old patient with hypertension A 51-year-old patient with chronic obstructive pulmonary disease

C Prednisone (Deltasone) as glucocorticoids can cause gastrointestinal distress and should be administered with food. The normal circadian secretion by the adrenal cortex occurs in the early morning to wake a person up, not early evening. These medications should be tapered slowly to prevent adrenal crisis; they can be administered intravenously as well.

A nursing student is asked to administer prednisone (Deltasone) to a patient. Which statement by the nursing student reflects effective planning? A. "The medication is administered early in the evening to coincide with the natural secretion of the adrenal cortex." B. "The medication is administered on a strict, unchanging schedule to prevent adverse effects." C. "The medication should be administered with food to diminish the risk of gastric irritation." D. "The medication should not be administered intravenously secondary to the risk of hypotension."

3

A parent of a child with head lice asks the nurse when the child may return to school after treatment with permethrin 1% [Nix]. Which response should the nurse make? 1 "When the hair has been cut off 2 inches so that the ova can't hatch." 2 "Two treatments usually are needed within 48 hours, so after that." 3 "After the one-time application and the nits have been removed with a comb." 4 "When family members who have had close contact have been treated."

A

A patient asks the nurse to explain the action of glucocorticoids. Which statement is the nurse's best response? A. "Glucocorticoids influence carbohydrate, lipid, and protein metabolism." B. "Glucocorticoids are produced in decreased amounts during times of stress." C. "Glucocorticoids decrease serum sodium and glucose levels." D. "Glucocorticoids stimulate defense mechanisms to produce immunity."

A Patients who have adrenal suppression may have impaired response to stress because of alterations in epinephrine release. Acetylcholine and dopamine concentrations are not altered by adrenal suppression. Therefore, the patient would not have memory loss, hallucinations, or impaired thinking.

A patient has been prescribed corticosteroids for adrenal suppression. Which behavior process would be observed in the patient because of this? A. Impaired stress response B. Memory loss C. Hallucinations D. Impaired thinking

B (Lidocaine is a sodium channel-blocking drug used specifically to treat ventricular arrhythmias.)

A patient has been prescribed lidocaine (Xylocaine). What does the nurse understand as the reason for this medication order? Bradycardia Ventricular arrhythmias Atrial arrhythmias Heart block

4 (Amphotericin B is toxic to cells of the kidneys. To evaluate renal injury, the plasma creatinine level should be monitored every 3 or 4 days, as well as intake and output. It is not necessary to monitor the serum protein or glucose levels or the serum pH in patients taking amphotericin B.)

A patient is receiving amphotericin B. It is most important for the nurse to monitor which laboratory result? 1 Serum pH 2 Protein level 3 Glucose level 4 Creatinine level

4 (Renal injury from amphotericin B may cause severe hypokalemia. Serum potassium levels should be monitored more frequently and potassium supplements given to correct low plasma levels. Furosemide, insulin, and vitamin K do not prevent any adverse effects of amphotericin B.)

A patient is receiving amphotericin B. The nurse identifies which medication as useful in preventing adverse effects of amphotericin B? 1 Furosemide [Lasix] 2 Insulin 3 Vitamin K 4 Potassium

3

A patient is scheduled to receive intravenous amphotericin B. Which medication should a nurse administer as pretreatment before the infusion? 1 10 units of regular insulin intravenously 2 20 mg famotidine [Pepcid] in 50 mL of 5% dextrose Incorrect 3 50 mg of diphenhydramine [Benadryl] and 650 mg of acetaminophen 4 1 g of calcium gluconate in 100 mL of normal saline

A patient presents at the free clinic complaining of nervousness, worrying about everything, and feeling very tense. What diagnose would the nurse suspect? A)Neurosis B)Psychosis C)Anxiety D)Depression

A patient presents at the free clinic complaining of nervousness, worrying about everything, and feeling very tense. What diagnose would the nurse suspect? A)Neurosis B)Psychosis C)Anxiety D)Depression Ans:C

About which patient should the nurse notify the healthcare provider immediately?

A patient who takes oral spironolactone [Aldactone] 25 mg daily and enalapril [Vasotec] 5 mg daily with a serum potassium level of 5.5 mEq/L

Digoxin is prescribed to a patient who has been taking verapamil for hypertension. Which dosing change would the nurse anticipate seeing in the prescription?

A reduction in digoxin dose by 50%

Digoxin is prescribed to a patient who has been taking verapamil for hypertension. Which dosing change would the nurse anticipate seeing in the prescription?

A reduction in digoxin dose by 50% Verapamil decreases digoxin clearance, thereby increasing the effects of digoxin. The dose of digoxin should be decreased by 50%.

The nurse is caring for a patient with heart failure. Which drugs would the nurse typically administer for routine first-line therapy? Select all that apply. A Diuretics B Beta blockers C Cardiac glycosides D Sympathomimetics E Angiotensin-converting enzyme (ACE) inhibitors

A, B, E

permethrin, 1, 5

AKA Nix, Elimite Highly toxic to adult mites and lice, not as much to ova (causes paralysis of insect) __% formulation for lice __% formulation for scabies Fails to eradicate head lice 5% of the time AE: exacerbation of itching, erythema, edema, burning stinging numbness

The nurse is preparing to administer a loading dose of digoxin to a patient in atrial fibrillation with a heart rate of 130 beats/minute. Which statement describes the rationale for the loading dose?

Achieve therapeutic effect of digoxin more quickly.

A nurse is caring for a patient who has been diagnosed with genital herpes. Which medication is the drug of choice for this patient? 1 Ribavirin 2 Acyclovir 3 Zidovudine 4 Amantadine

Acyclovir

Which agent is used to treat most infections caused by herpes simplex viruses and varicella-zoster virus? 1 Acyclovir 2 Zanamivir 3 Ganciclovir 4 Amantadine

Acyclovir

A patient has been diagnosed with genital herpes. What drug will be used to treat and manage this infection? 1 Ribavirin 2 Acyclovir 3 Zidovudine 4 Amantadine

Acyclovir - Acyclovir is indicated for the treatment of genital herpes.

Which action related to drug administration will a nurse expect to take for a patient with unstable ventricular tachycardia?

Administer initial intravenous dose of amiodarone over 10 minutes. For ventricular tachycardia, amiodarone intravenous bolus is to be administered over 10 minutes at 15 mg/min.

Which is the nurse's best action when finding a patient with type 1 diabetes mellitus unresponsive, cold, and clammy?

Administer intravenous glucose. This patient is showing signs of hypoglycemia. In the hospital setting or when the patient is unconscious, intravenous glucose is an obvious option to treat hypoglycemia.

Routine medications were prescribed to resume for a patient who returned from major knee surgery 1 hour ago. The nurse is preparing to administer these medications, including clopidogrel. Which action would the nurse take?

Administer the clopidogrel.

A nurse is preparing to administer enoxaparin, a heparin derivative. Which action by the nurse demonstrates the correct technique for administering the medication?

Administer the drug at least 2 inches from the umbilicus. Enoxaparin is a heparin derivative that is administered deep SQ. The nurse should administer the medication at least 2 inches from the umbilicus.

A nurse is preparing to administer clopidogrel to a patient who has previously complained of dyspepsia 2 hours after taking the drug. Which action would the nurse take?

Administer the drug with a small amount of food. Clopidogrel is rapidly absorbed with or without food. Common side effects include gastrointestinal (GI) distress. The nurse would administer the drug with food to decrease GI distress.

A patient is started on clopidogrel and reports hematuria to the nurse before receiving the morning dose. The nurse has placed a call to the health care provider and is waiting for a response. Which action would the nurse take next?

Administer the medication. When signs of complications such as bleeding occur, the patient should continue taking clopidogrel until the health care provider instructs the patient to stop taking the medication.

The nurse is teaching a patient prescribed captopril [Capoten] for the treatment of hypertension. Which instructions should the nurse include? Select all that apply. A Expect a persistent dry cough. B Take the medication with food. C Expect a sore throat and fever. D Avoid potassium salt substitutes. E Report difficulty in breathing immediately.

A D E Salt substitutes contain potassium and may increase the risk of hyperkalemia with angiotensin-converting enzyme (ACE) inhibitors. A persistent, dry, nonproductive cough may develop. Angioedema includes edema of the tongue, glottis, and pharynx that may cause difficulty breathing, which requires immediate medical attention. Captopril [Capoten] must be taken at least one hour before meals. A sore throat and fever are not expected adverse effects. ACE inhibitors can lower white cell count and decrease the body's ability to fight an infection. Early signs of infection include fever and sore throat.

Sodium Nitroprusside Hypertensive Crisis/Urgency

Adult: IV infusion 0.25 to 10 mcg/kg/min; max 10 mcg/kg/min for 10 min. Monitor blood pressure continuously during administration. Administer via infusion pump only. Solution must be protected from light even during administration. Do not exceed maximum dose due to the risk for thiocyanate toxicity.

4 (The main effects of the antidysrhythmics involve the heart, circulation, and central nervous system (CNS). Specific antidotes are not available, and the management of an overdose involves maintaining adequate circulation and respiration using general support measures (such as CPR) and providing any required symptomatic treatment. Early chest compressions and defibrillation, as indicated, are recommended ASAP by the American Heart Association 2010 guidelines.)

A client has received three times the ordered dose of propafenone (Rythmol) in error. The charge nurse is called into the room and observes that the client is unresponsive with no pulse. What is the nurse's priority action? 1 Administer the reversal agent STAT. 2 Start an IV line with a large bore catheter. 3 Place the client on cardiac monitoring. 4 Begin cardiopulmonary resuscitation efforts.

Hydralazine hypertension

Adult: Initially, PO 10 mg four times a day with gradual increase. Usual maintenance dose is 25 to 100 mg twice a day.

Minoxidil Severe Hypertension

Adult: PO 5 mg/day in 1 to 2 divided doses; max 100 mg/day; usual range 10 to 40 mg/day divided in 1 to 2 doses.Geriatric: PO 2.5 mg/day, may be increased gradually.

2 (When beta blockers are used with an antidysrhythmic, any shortness of breath, weight gain, changes in baseline blood glucose levels, or excess fatigue must be reported to the prescriber immediately. The client is complaining of excess fatigue in this case, because exercise is an activity he "usually' completes without complaint, as inferred from the client's statement.)

A client taking atenolol and amiodarone by mouth complains of not being able to complete his usual exercise routine. The client attributes this complaint to the medication, because the atenolol is a new medication. What is the nurse's best response? 1 "You should not be exercising at all while taking this medication." 2 "You should report your fatigue to your healthcare provider." 3 "Feeling tired is normal when you exercise a lot." 4 "As we age, exercising is a challenge; and fatigue is normal."

3 (If an antacid is needed, it must be taken either 2 hours before or 2 hours after the drug to avoid interference with drugabsorption. An antacid is fine to take, however the more specific instructions of when to take the antacid should be provided to the client. Antidysrhythmics can be taken with food of GI upset occurs.)

A client with a history of gastroesophageal reflux asks the nurse if it is okay to take over the counter medication for heartburn with the newly prescribed antidysrhythmic drug. What is the nurse's best response? 1 "An over the counter antacid is fine to take with your antidysrhtythmic." 2 "It's best to take the antidysrhythmic on an empty stomach if heartburn occurs." 3 "Take an antacid, if needed, 2 hours before or 2 hours after the antidysrhythmic." 4 "You can take an antacid along with the antidysrhythmic 30 minutes before eating."

2

A nurse administers which medication to a patient who shows signs of a common adverse reaction to lindane 1% [Kwellada]? 1 Epinephrine 2 Phenobarbital 3 Famotidine 4 Albuterol

3

A nurse assesses an adult patient who has all of these manifestations. Which one should the nurse associate with scabies infestation? 1 Reddened scalp with hair loss 2 Skin ulcerations around the ankles 3 Irritation of the skin at the wrists and elbows 4 Visible nits (ie, eggs) on hair shafts

1 (Medications that lower gastric acidity, such as famotidine [Pepcid], can reduce absorption of oral itraconazole [Sporanox]. Those agents should be given at least 1 hour before itraconazole or 2 hours after. The other time administrations would interfere with absorption of itraconazole.)

A nurse is administering an oral dose of itraconazole [Sporanox] to a patient at 10:00 AM. The nurse should administer a prescribed dose of famotidine [Pepcid] at which time? 1 9:00 AM 2 10:00 AM 3 10:30 AM 4 11:00 AM

A patient who has been taking sildenafil [Viagra] has developed angina. The provider has ordered isosorbide dinitrate. What is the nurse's primary intervention?

Advise the patient not to take the sildenafil [Viagra].

diet for digoxin

Advise the patient to eat foods high in potassium, such as fresh and dried fruits, fruit juices, and vegetables, including potatoes.

The nurse would most likely administer the combination product isosorbide dinitrate/hydralazine [BiDil] to patients of which ethnic heritage?

African American Isosorbide dinitrate/hydralazine [BiDil] is approved for African Americans who have moderate to severe symptoms. Although it may be given to Asian Americans, Native Americans, or Mexican Americans, it is only approved for a specific group.

While instructing on proper hand-washing technique, which information is most beneficial?

After applying soap and water, rub hands together for at least 15 seconds.

A nurse is providing care to a patient with gout who presents with a fever, rash, eosinophilia, kidney failure, and pancytopenia. Which antigout drug would the nurse suspect has led to this patient's clinical manifestations?

Allopurinol

A patient on thrombolytic therapy experiences severe bleeding. The nurse anticipates the administration of which medication?

Aminocoproic Acid

A 51-year-old male patient has been prescribed lovastatin 40 mg PO each evening to help lower his low-density lipoprotein (LDL) cholesterol. In addition to lovastatin, this patient also takes pantoprazole for gastroesophageal reflux disease (GERD), amiodarone for atrial fibrillation, tamsulosin for benign prostatic hyperplasia, and lisinopril for hypertension. Which medication could cause a potential drug interaction with lovastatin?

Amiodarone

The nurse is preparing to administer a maintenance dose of amiodarone. Which dose would the nurse administer?

Amiodarone 400 mg daily Once arrhythmia has been controlled, amiodarone is lowered to 400 mg once daily.

4 (Itraconazole may cause liver injury, and although a causal link has not been identified, patients need to be informed about symptoms to report. These include jaundice, nausea, and right upper abdominal pain. It is not necessary to take diphenhydramine, wear sunscreen, or avoid citrus products while taking itraconazole.)

A nurse is teaching a patient who is scheduled to start taking itraconazole [Sporanox]. Which statement by the patient would indicate understanding of the teaching? 1 "I'll take diphenhydramine [Benadryl] before this medication so I don't have a reaction." 2 "It's important to remember to wear sunscreen while taking this medicine." 3 "I'll avoid citrus foods, such as oranges and grapefruits, while taking this medication." 4 "If I notice my skin turning yellow or feel any nausea, I'll notify my healthcare provider."

2 (Nystatin is an antifungal medication that is used for candidiasis of the skin, mouth, esophagus, intestine, and vagina. It can be administered orally and topically and will heal mouth lesions from oral candidiasis. Nystatin has no effect on nasal congestion and cough production. It does not cause urticaria.)

A nurse planning care for a patient who is receiving nystatin [Mycostatin] should establish which outcome on the care plan? 1 Relief of nasal congestion 2 Decrease in mouth pain 3 Productive cough 4 Absence of urticaria

The nurse is preparing warfarin for several patients. For which patient would the nurse be most concerned in administering warfarin?

An alcoholic patient with liver disease

1

A nurse should provide which instruction about the application of the medication permethrin 5% [Elimite] to a patient who has scabies? 1 "Apply the medication to the entire body surface in one application." 2 "Rub the medication into your palms and apply it to the area of infestation." 3 "Discard any infested bedding and clothing." 4 "Do not bathe for 48 hours after applying the medication topically."

The nurse is caring for a patient with cryptorchidism who is 28 years old and taking testosterone to treat his condition. What statement by this patient would lead the nurse to believe that he has understood the teaching provided about the drug? A)"My body hair may increase." B)"My sexual desire may increase." C)"My voice may become higher." D)"My skin may become clear and soft."

Ans:A Feedback: Androgenic effects include acne, edema, hirsutism (increased hair distribution), deepening of the voice, oily skin and hair, weight gain, decrease in breast size, and testicular atrophy. Testosterone does not make the skin clear and soft, it does not make the voice higher, and the testicular atrophy is more likely to decrease rather than increase libido.

A 20-year-old female patient has been diagnosed with multiple sclerosis. What drug will most likely be prescribed? A)Baclofen (Lioresal) B)Cyclobenzaprine (Flexeril) C)Metaxalone (Skelaxin) D)Orphenadrine (Banflex)

Ans:A Feedback: Baclofen is used for treatment of muscle spasticity associated with neuromuscular diseases such as multiple sclerosis. Cyclobenzaprine, metaxalone, and orphenadrine are used for relief of discomfort associated with painful, acute musculoskeletal conditions.

The nurse is caring for four patients. Which patient would the nurse expect to have a faster recovery period based only on the process of mitosis? A)A 32-year-old female patient who had surgery for ulcerated colitis B)A 72-year-old man who had surgery for colon cancer C)A 28-year-old woman who had breast reduction surgery D)A 65-year-old man who had surgery for breast cancer

Ans:A Feedback: Cells lining the GI tract reproduce very quickly (72 hours) compared with breast tissue, which takes 2 to 3 months to reproduce. The older the person is, the longer it will take for recovery due to the aging process that reduces rate of circulation of blood cells carrying oxygen to and from cells.

What hormone enters the cell and reacts with a receptor inside the cell to change messenger ribonucleic acid and affect the cell's function? A)EstrogenB)InsulinC)Calcitonin D)Thyroid-stimulating hormone

Ans:A Feedback: Estrogen enters the cell and reacts with a receptor site inside of the cell to make changes and produce an action. This does not happen quickly, and it may take months to years to produce the changes. Estrogen, calcitonin, and thyroid-stimulating hormone react with specific receptor sites on the cell membrane to stimulate change and action within the cell.

The nurse is teaching a class for his or her peers about glucocorticoids. What will the nurse say is initially blocked, resulting in the drug's anti-inflammatory action? A)Arachidonic acid B)Phagocytes C)Lymphocytes D)Antibodies

Ans:A Feedback: Glucocorticoids block the actions of arachidonic acid, which leads to a decrease in the formation of prostaglandins and leukotrienes. They also impair the ability of phagocytes to leave the bloodstream and move to injured tissues; they inhibit the ability of lymphocytes to act within the immune system, including blocking the production of antibodies. Blocking arachidonic acid is, however, the initial action.

A 16-year-old boy is diagnosed with delayed onset of puberty and the physician has ordered testosterone, intramuscular (IM), once every 2 weeks. What nursing intervention would be important to the patient? A)Discuss changes that will occur in his body. B)Have patient fast before injection. C)Have patient reduce protein intake. D)Decrease exercise while on this hormonal treatment.

Ans:A Feedback: It is important for this patient to understand what will happen and the changes he will see to reduce the anxiety that could occur if he didn't understand. Discuss the development of masculine characteristics as well as common adverse effects such as acne. Having the patient fast before the injection would not be necessary, nor would decreasing exercise or reducing protein intake.

A 69-year-old man is prescribed testosterone. The patient is found to have hypertension and a history of congestive failure after assessment by the nurse. What is this patient at increased risk for? A)Fluid retention B)Impotence C)Liver failure D)Kidney failure

Ans:A Feedback: Older adults often have hypertension and other cardiovascular disorders that may be aggravated by sodium and water retention associated with androgens and anabolic steroids. Testosterone would not increase the risk of impotence. Liver and kidney failure could be exacerbated by the drug if they were preexisting conditions but since that is not indicated by the question, this would be a lower risk than fluid retention.

The nurse is teaching the patient about a newly prescribed systemic antifungal drug. What sign or symptom will the nurse instruct the patient to report to the provider immediately? A)Unusual bruising and bleeding B)Constipation or diarrheaC)Red and dry eyesD)Increased appetite with weight gain

Ans:A Feedback:Unusual bruising and bleeding can be an indication of hepatic toxicity, which should be reported immediately. Yellowing of the eyes, not redness, and tearing are also indicative of hepatic toxicity. Usually GI symptoms include nausea and vomiting with antiviral drugs, which could cause decreased appetite and weight loss. These symptoms should be reported if they persist but are not emergency symptoms to report immediately.

The nurse is caring for a patient treated with flumazenil (Anexate) for benzodiazepine toxicity. After administering flumazenil what will the nurse carefully assess for? A)Agitation, confusion, and seizures B)Cerebral hemorrhage and dystonia C)Hypertension and renal insufficiency D)Hypotension, dysrhythmias, and cardiac arrest

Ans:A Feedback: Administration of flumazenil blocks the action of benzodiazepines. If the patient has been taking these medications for an extended period of time, the blockage of the drug's effects could precipitate an acute benzodiazepine withdrawal syndrome with symptoms including agitation, confusion, and seizures. Anexate does not cause cerebral hemorrhage and dystonia, hypertension, renal insufficiency, hypotension, dysrhythmias, and cardiac arrest.

By what route would the nurse administer amphotericin B? A)Intravenously B)Intramuscularly C)Orally D)Topically

Ans:A Feedback: Amphotericin B is only administered by the IV route. It cannot be given intramuscularly, orally, or topically.

The nurse learns a patient receiving a new prescription for oxandrolone takes a lipid- lowering medication daily. What will the nurse tell the patient about this drug interaction? A)Lipid-lowering drug becomes much less effective. combination

Ans:A Feedback: Anabolic steroids may alter lipid metabolism and cause a lack of effectiveness for lipid- lowering agents. Lipid-lowering medications do not impact anabolic steroids and there is no increased risk for toxicity of either drug.

A patient comes to the clinic to receive a Botox injection in her forehead. The patient has adult acne across her forehead. What is the nurse's priority action? A)Hold the injection and consult the health care provider. B)Cleanse the area well with an antibacterial soap. C)Apply a topical antibiotic after administering the Botox. D)Provide patient information about post- Botox injection care.

Ans:A Feedback: Botulinum toxins should not be injected into any area with an active infection because of the risk of exacerbation of the infection. As a result, the nurse would hold the injection and consult with the physician, with the expectation the medication would be held until the acne resolved. Cleansing the area well, applying a topical antibiotic, and providing information about postinjection care would not resolve the problem and are not indicated.

Parents bring a 15-year-old boy into the clinic. The parents tell the nurse that there is a family history of schizophrenia and they fear their son has developed the disease. What symptoms, if described by the family, would support their conclusion? A)"He hears and interacts with voices no one else can hear." B)"He is overactive and always so excitable." C)"He falls asleep in the middle of a sentence." D)"He cannot concentrate and his grades are suffering."

Ans:A Feedback: Characteristics of schizophrenia include hallucinations, paranoia, delusions, speech abnormalities, and affective problems. Overactivity and excitement are associated with mania. Falling asleep suddenly describes narcolepsy. Difficulty concentrating and failing grades is associated with attention deficient disorders.

A local bioterrorism medical team is learning about germ warfare. The team is instructed that a fluoroquinolone may be used to prevent an outbreak of anthrax infection. What fluoroquinolone would the nurse be most likely to administer for this purpose? A)Ciprofloxacin (Cipro) B)Gemifloxacin (Factive) C)Norfloxacin (Noroxin) D)Sparfloxacin (Zagam)

Ans:A Feedback: Ciprofloxacin (Cipro) is the most widely used fluoroquinolone and is indicated for the prevention of anthrax infection. Gemifloxacin and sparfloxacin are most useful in treating acute episodes of chronic bronchitis and community-acquired pneumonia. Norfloxacin is recommended only for certain types of urinary tract infections.

A 75-year-old patient is brought to the emergency department by his family. The family relates that the patient is complaining of confusion, seizures, and abnormal perception of movement. The nurse reviews all of the medication bottles found in the house and suspects the patient overdosed on what medication? A)Benzodiazepine B)Antihypertensive C)Sedative D)Analgesic

Ans:A Feedback: Common manifestations of benzodiazepine toxicity include increased anxiety, psychomotor agitation, insomnia, irritability, headache, tremor, and palpitations. Less common but more serious manifestations include confusion, abnormal perception of movement, depersonalization, psychosis, and seizures. These symptoms are not found in association with options B, C, or D.

When chemotherapeutic agents interfere with cellular physiology, it results in what? A)Cellular death or alterations B)DiffusionC)EndocytosisD)Homeostasis

Ans:A Feedback: Drugs may alter the cell membrane, causing the cell to rupture and die or they may deprive the cell of certain nutrients, altering the proteins that the cell produces. This could interfere with normal cell functioning and cell division. Diffusion is the movement of a substance from a region of higher concentration to a region of lower concentration. Endocytosis involves gathering of material into a cell. Homeostasis refers to keeping the cytoplasm stable within the cell membrane. Diffusion, endocytosis, and homeostasis are not the result of chemotherapeutic agents but may be impacted by the agent.

How does ephedrine act on the body? A)Stimulates the release of norepinephrine B)Acts indirectly on beta-adrenergic receptor sites C)Stimulates the release of dopamine D)Acts indirectly on alpha-adrenergic receptor sites

Ans:A Feedback: Ephedrine stimulates the release of norepinephrine from nerve endings and acts directly on adrenergic receptor sites. Therefore, the other options are incorrect.

The nurse attributes what assessment finding to the use of androgens by the male patient? A)Testicular atrophy B)Increased fertility C)Increased urination D)Hoarseness

Ans:A Feedback: In adult men, adverse effects include inhibition of testicular function, gynecomastia, testicular atrophy, priapism, baldness, and change in libido. Increased fertility, increased urination, and hoarseness would not be expected assessment findings.

The nurse is caring for a newborn who was delivered from a woman who took benzodiazepines for anxiety during the last 2 months of her pregnancy after her husband was killed in war. What will the nurse assess for in this newborn? A)Newborn withdrawal syndrome B)Hepatic dysfunctionC)Failure to thriveD)Learning deficiencies

Ans:A Feedback: Neonatal withdrawal syndrome may result in a baby born to a mother who was taking benzodiazepines in the final weeks of pregnancy. The neonate may be given very small doses of benzodiazepines that are withdrawn gradually to prevent symptoms. Hepatic dysfunction in the neonate is not associated with use of benzodiazepines. Failure to thrive and learning deficiencies would be long-term problems and are not assessed during the neonatal period.

When spinal reflexes involve synapses with interneurons within the spinal cord, what physiological adjustments are made? A)Coordinate movement and position B)Adjust response and recovery C)Adjust to upright position D)Coordinate balance

Ans:A Feedback: Other spinal reflexes may involve synapses with interneurons within the spinal cord, which adjust movement and response based on information from higher brain centers to coordinate movement and position. Spinal reflexes do not adjust response and recovery, adjust the body to the upright position, or coordinate balance.

The nurse is caring for a patient who is scheduled for abdominal surgery in the morning and is scheduled to receive rocuronium (Zemuron). The patient asks the nurse to describe the adverse effects of rocuronium. What would the nurse describe for the patient? A)"This drug is associated with pulmonary hypertension." B)"This drug contains benzyl alcohol." C)"This drug is associated with bradycardia." D)"This drug is associated with an increased heart rate."

Ans:A Feedback: Rocuronium may be associated with pulmonary hypertension. Cisatracurium (Nimbex) contains benzyl alcohol; Atracurium (Tracrium) is associated with bradycardia; and Pancuronium (Pavulon) is associated with an increased heart rate.

What helmintic infestation occurs in tropical areas and is carried by snails? A)Schistosomiasis B)Platyhelminths C)Trichinosis D)Filariasis

Ans:A Feedback: Schistosomiasis is a common problem in many tropical areas where the snail that is necessary in the life cycle of the fluke lives. Trichinosis is caused by eating undercooked pork and can occur in any part of the world. Filariasis and platyhelminths are not restricted to tropical areas.

What substances move freely in and out of a cell by diffusion? A)Electrolytes B)Enzymes C)Hormones D)Proteins

Ans:A Feedback: Sodium, potassium, calcium, carbonate, oxygen, bicarbonate, and water move freely in and out of cells. These substances move through channels or pores in the cell membrane through movement from a region of higher concentration to a region of lower concentration. Hormones, enzymes, and proteins are considered carriers. If a substance cannot move freely on its own, it may attach itself to another carrier to be diffused.

A public health nurse is speaking to parents of first graders. When discussing worm infection, the nurse will explain that the most common type found in U.S. school-aged children is what? A)Pinworms B)Roundworms C)Threadworms D)Whipworms

Ans:A Feedback: The most common worm infection encountered in U.S. school-aged children is pinworms. These worms are endogenous to the area and easily spread. Roundworms, whipworms, and threadworms are not as common.

The patient presents to the emergency department with muscle spasms in the back. What types of injury would the nurse recognize can result in muscle spasm? (Select all that apply.) A)Overstretching a muscle B)Wrenching a jointC)Tearing a tendon or ligament D)Breaking a bone E)Exercising too vigorously.

Ans:A, B, C Feedback: Muscle spasms often result from injury to the musculoskeletal system (e.g., overstretching a muscle, wrenching a joint, tearing a tendon or ligament). These injuries can cause violent and painful involuntary muscle contractions. Breaking a bone or exercising would not cause muscle spasms unless one of the other options was involved.

The nurse is preparing a class on the endocrine system for students. What benefit is served by the positioning of the hypothalamus in the brain? (Select all that apply.) A)Close to other important areas of the brain B)Able to influence and be influenced by emotions and thoughts C)Poorly protected by the blood-brain barrier D)Floats within ventricles of the brain E)Protected from the limbic system

Ans:A, B, C Feedback: Situated at the base of the forebrain, the hypothalamus receives input from virtually all other areas of the brain, including the limbic system, cerebral cortex and the special senses that are controlled by the cranial nerves: smell, sight, touch, taste, hearing. Because of its positioning, the hypothalamus is able to influence, and be influenced by, emotions and thoughts. The hypothalamus also is located in an area of the brain that is poorly protected by the blood-brain barrier, so it is able to act as a sensor to various electrolytes, chemicals, and hormones that are in circulation and do not affect other areas of the brain. It does not float within the ventricles of the brain, and it is located to allow input from the limbic system.

The nurse, working in the preoperative holding area, is caring for a 70-year-old patient who is scheduled to receive succinylcholine as part of general anesthesia. When collecting the nursing history, what condition would require the nurse to notify the anesthesiologist of the need for caution? A)Bone fracture B)MalnutritionC)Fluid volume overload D)Narrow-angle glaucoma E)Pregnancy

Ans:A, B, DFeedback: Succinylcholine should be used with caution in patients with fractures because the muscle contractions it causes might lead to additional trauma; in patients with narrow-angle glaucoma or penetrating eye injuries because intraocular pressure increases. Extreme caution is necessary in the presence of genetic or disease-related conditions causing low plasma cholinesterase levels (e.g., cirrhosis, metabolic disorders, carcinoma, burns, dehydration, malnutrition, hyperpyrexia, thyroid toxicosis, collagen diseases, exposure to neurotoxic insecticides).

A 3-year-old girl with a diagnosis of spasticity caused by cerebral palsy has been admitted to the unit. The physician has ordered dantrolene to see if it relieves the spasticity in the child's arms and hands. The nurse would schedule this child for what routine screenings? A)Central nervous system and gastrointestinal (GI) function B)Respiratory and cardiovascular (CV) function C)Growth and development D)Renal and hepatic function

Ans:AFeedback: Children prescribed dantrolene should be routinely and regularly screened for central nervous system and gastrointestinal (including hepatic) toxicity. Growth and development should be routinely screened in all children. Renal, respiratory, and CV screening is not indicated.

A patient with severe spasticity sees his physician. The physician orders dantrolene. In what circumstances is the drug dantrolene contraindicated? A)Spasticity that contributes to upright position B)Spasticity that involves both legs C)Spasticity that involves the arm and the leg on the same side D)Spasticity that contributes to mobility

Ans:AFeedback: Dantrolene is contraindicated in the presence of any known allergy to the drug. It is also contraindicated in the following conditions: spasticity that contributes to locomotion, upright position, or increased function, which would be lost if that spasticity was blocked; active hepatic disease, which might interfere with metabolism of the drug and because of known liver toxicity; and lactation because the drug may cross into breast milk and cause adverse effects in the infant. The other options would not contraindicate the medication.

When fluoxymesterone (Androxy) is administered to a 14-year-old boy for hypogonadism, what is the expected result? A)Enlarged sex organs B)Decreased skin thickness C)Increased protein metabolism D)Increased sperm production

Ans:AFeedback: In prepubertal boys, administration of male sex hormone-like drugs will stimulate development of masculine characteristics and cause development of the male sexual organs. Production of sperm will occur when the boy enters puberty. These drugs are not administered to decrease skin thickness or increase protein metabolism.

The nurse is admitting a mental health patient and collects the medication history. The patient says he takes Haldol, midodrine, hydrochlorothiazide, acetaminophen, and Cymbalta. The nurse will call the provider to discuss what dangerous drug combination? A)Haldol and midodrine B)Hydrochlorothiazide and midodrine C)Cymbalta and midodrine D)Acetaminophen and midodrine

Ans:AFeedback: Midodrine can precipitate increased drug effects of digoxin, beta-blockers, and many antipsychotics. Such combinations should be avoided. The other drug combinations do not pose any immediate concerns.

The physician has ordered olanzapine (Zyprexa) for a new patient. What laboratory test should be done before administration of olanzapine? A)Blood glucoseB)Urine specific gravity C)CholesterolD)Hemoglobin and hematocrit

Ans:AFeedback: Olanzapine has been associated with weight gain, hyperglycemia, and initiation or aggravation of diabetes mellitus. Other options are not necessary for patients taking olanzapine unless a secondary diagnosis indicates a need.

32. Nursing care for the postoperative patient requiring long-term glucocorticoid therapy will be directed at overcoming what adverse effect of the drug? A)Poor wound healing B)Inflammation C)Autoimmune response D)Lack of mobility

Ans:AFeedback: Patients taking long-term glucocorticoid therapy will have impaired wound healing so nursing care is directed toward promoting healing. The drug has an anti-inflammatory effect so that would not need to be overcome. There is no autoimmune response or lack of mobility so these do not have to be overcome.

The nurse is discussing the endocrine system with a class of nursing students. What substance would the nurse label as a hormone? A)Acetylcholine B)Norepinephrine C)Nucleic acid D)Serotonin

Ans:B Feedback: A hormone is secreted directly into the bloodstream and travels from the site of production to react with specific receptor sites to cause an action. Norepinephrine, which is a neurotransmitter, is a hormone when it is produced in the adrenal medulla, secreted into circulation, and travels to norepinephrine receptor sites to cause an effect. Acetylcholine and serotonin are neurotransmitters, but are not hormones. Nucleic acid is used to build deoxyribonucleic acid and ribonucleic acid.

The nurse is caring for a patient who received succinylcholine during surgery. The nurse would expect the patient to spend more time in the postanesthesia care unit due to prolonged paralysis and inability to breathe if the patient was from what ethnic group? A)American Japanese B)Alaskan Eskimos C)Native Americans D)Hawaiian natives

Ans:B Feedback: Alaskan Eskimos belong to a genetic group that is predisposed to low plasma cholinesterase levels, making them susceptible to prolonged paralysis after succinylcholine use. The other ethnic groups do not have this genetic predisposition.

The nurse admits a 1-year-old child to the pediatric intensive care unit (ICU) with cryptococcal meningitis. What drug will the nurse anticipate receiving an order for to treat this child? A)Amphotericin B (Fungizone) B)Fluconazole (Diflucan) C)Griseofulvin (Fulvicin) D)Ketoconazole (Nizoral)

Ans:B Feedback: Fluconazole is used in the treatment of cryptococcal meningitis and is safe to use in a 1-year-old child. Amphotericin B has many unpleasant adverse effects and is very potent, so it would not be the first or best medication to administer initially but would be reserved for use if fluconazole was not effective. Griseofulvin is given to treat tinea pedis and tinea unguium in children. Ketoconazole is not given to children younger than 2 years because safety has not been established.

Which drug does not have a recommended pediatric dose? A)Pimozide (Orap) B)Lithium salts (Lithotabs) C)Haloperidol (Haldol) D)Risperidone (Risperdal)

Ans:B Feedback: Lithium does not have a recommended pediatric dose; the drug should not be administered to children younger than 12 years old. Pimozide, haloperidol, and risperidone all have recommended pediatric doses.

The nurse gives a class at the local high school on the use of anabolic steroids. The nurse explains that one of the most serious and all too common side effects of using these drugs without a prescription and medical follow-up is what? A)Renal stonesB)DeathC)CirrhosisD)Malignant hyperthermia

Ans:B Feedback: Prolonged use of high doses may cause potentially life-threatening conditions, placing the patient at risk of death. Conditions such as peliosis hepatis, hepatic neoplasms, and hepatocellular carcinoma are often seen with high-dose street use of these drugs. Renal stones, cirrhosis, and malignant hyperthermia are not associated with the use of anabolic steroids.

A mother brings her child to the clinic where the child is diagnosed with hookworms. The mother asks how the child got hookworms. What would the nurse tell the mother is the route of entry for hookworm? A)InhalationB)Contact with skinC)Ingestion of undercooked foods D)Blood-borne exposure

Ans:B Feedback: The larvae penetrate the skin and then enter the blood and within about a week, reach the intestine. Inhalation, ingestion, and blood- borne exposure are incorrect.

The nurse is caring for a patient in intensive care unit receiving IV lorazepam (Ativan) to reduce anxiety related to mechanical ventilation. While injecting the medication the nurse notes a decrease in blood pressure and bradycardia. What is the nurse's priority action? A)Discontinue drug administration. B)Give the IV drug more slowly.C)Notify the patient's health care provider. D)Document the reaction to the drug.

Ans:B Feedback: The nurse's priority action is to slow the rate of injection because rapid injection of benzodiazepines can result in hypotension and bradycardia and can lead to cardiac arrest.

What receptors in the body stimulate the hypothalamus to release antidiuretic hormone (ADH)? A)Diuretic receptors B)Osmoreceptors C)Alpha receptors D)Nicotinic receptors

Ans:B Feedback: The osmoreceptors in the hypothalamus stimulate the release of ADH. There is no such thing as a diuretic receptor. Alpha receptors are associated with the sympathetic nervous system and nicotinic receptors are associated with the parasympathetic nervous system.

What hormones does the adrenal medulla secrete? A)Renin and erythropoietin B)Norepinephrine and epinephrine C)Epinephrine and dopamine D)Dopamine and serotonin

Ans:B Feedback:The adrenal medulla is actually part of the sympathetic nervous system (SNS). It is a ganglion of neurons that releases the neurotransmitters norepinephrine and epinephrine into circulation when the SNS is stimulated.

A patient is taking aminophylline for their chronic obstructive pulmonary disease. The patient is about to undergo emergency surgery and will receive an neuromuscular junction (NMJ) blocker as part of the procedure. It is important for the nurse to take what action? A)Make sure the patient receives the aminophylline on a regular schedule to maintain therapeutic levels. B)Monitor the patient very closely for signs of early arousal and return of muscle function. C)Carefully explain all that is going on because the patient will be unable to talk. D)Switch the patient to theophyllines before the procedure begins.

Ans:B Feedback: Aminophylline can cause a decreased effectiveness of NMJ blockers, leading to reduced paralysis and early return of movement. If a patient has emergency surgery and has been taking aminophylline, the patient should be carefully monitored for early arousal and return of movement. The patient will not be awake during surgery using an NMJ blocker and will be intubated to ensure respirations. Aminophylline and other xanthine derivatives like the theophyllines will have the same effect.

A patient has been prescribed sildenafil citrate. What should the nurse teach the patient about this medication? A)Take the medication with a glass of grapefruit juice. B)The drug should be taken 1 hour before attempting intercourse. C)Facial flushing or headache should be reported to the physician immediately. D)A dose exceeding 80 mg will result in a change of vision, making everything appear blue.

Ans:B Feedback: The drug should be taken approximately 1 hour before intercourse to allow adequate time for absorption and therapeutic effects to occur. Facial flushing, mild headache, indigestion, and running nose are common side effects of sildenafil citrate and do not need to be reported unless they become acute. The "blue haze" that occurs with the 100-mg dosage is transient (it lasts about 1 hour). Grapefruit juice should be avoided 2 days before until 2 days after taking the medication because it prolongs the drugs metabolism and excretion.

The patient's body modulates pain perception as a result of the production of what in the intermediate lobe of the pituitary gland? A)Antidiuretic hormone (ADH) B)EndorphinsC)Adrenocorticotropic hormone (ACTH) D)Oxytocin

Ans:B Feedback: Endorphins and enkephalins are produced by the intermediate lobe of the pituitary gland. Oxytocin and ADH are produced by the posterior pituitary gland, and ACTH is produced by the anterior pituitary gland.

When hormones, formed within the cell, move across the cell membrane, the process is called what? A)Endocytosis B)Exocytosis C)Phagocytosis D)Pinocytosis

Ans:B Feedback: Exocytosis is the movement of substances such as waste products, hormones, and neurotransmitters out of the cell. Pinocytosis is the movement of nutrients and needed substances into the cell through specific receptors on the cell surface. Phagocytosis involves the destruction of engulfed proteins or bacteria. Endocytosis involves incorporation of material into the cell.

The pharmacology instructor is discussing the histocompatibility of the cell. What is the importance of a cell's histocompatibility antigen? A)It reproduces cells when other cells die. B)It recognizes cells as self-cells that belong in the body. C)The antigen produces antibodies to viral invaders. D)The antigen stimulates the production of white blood cells.

Ans:B Feedback: The histocompatibility antigens are proteins that are seen on the top of the cell membrane. T cells use these antigens as the identifying proteins that identify a cell as a self-cell. If these antigens are not present on a cell membrane, the T cells will destroy that cell, determining that it is foreign. The histocompatibility antigens are not involved in reproduction. They do not produce antibodies nor do they stimulate white blood cell production.

The nurse evaluates teaching as effective when a patient taking a benzodiazepine states, A)"I should always take the medication with meals." B)"I should not stop taking this drug without talking to my health care provider first." C)"I cannot take aspirin with this medication." D)"I will have to take this medication for the rest of my life."

Ans:B Feedback: The patient makes a correct statement when saying the drug should not be stopped without talking to the health care provider first because withdrawal of benzodiazepines require careful monitoring and should be gradually withdrawn. Medications do not have to be taken with food, aspirin is not contraindicated, and the medication need only be taken while the condition being treated continues. Patients with anxiety may only need the medication for a few weeks whereas those with a seizure disorder may take it for longer periods of time.

What are the simplest nerve pathways in the body? A)Arc reflexesB)Spinal reflexes C)Afferent nerve reflexes D)Spindle gamma loop

Ans:B Feedback: The spinal reflexes are the simplest nerve pathways that monitor movement and posture. Arc reflexes and afferent nerve reflexes are distracters for this question. Spindle gamma loops respond to stretch receptors.

A group of nursing students are developing a presentation on hormones. What hormone will the students' presentation identify as regulating the metabolic rate and influencing the growth and development of the body? A)Parathyroid hormone or parathormone B)Thyroid hormoneC)CortisolD)Insulin

Ans:B Feedback: Thyroid hormone regulates the metabolic rate of the body and greatly influence growth and development. Parathormone, cortisol, and insulin do not regulate the metabolic rate or influence growth and development.

The nurse is caring for a patient who is taking a benzodiazepine. The nurse knows that caution should be used when administering a benzodiazepine to the elderly because of what possible adverse effect? A)Acute renal failure B)Unpredictable reactions C)Paranoia D)Hallucinations

Ans:B Feedback: Use benzodiazepines with caution in elderly or debilitated patients because of the possibility of unpredictable reactions and in patients with renal or hepatic dysfunction, which may alter the metabolism and excretion of these drugs, resulting in direct toxicity. Dosage adjustments usually are needed for such patients. Acute renal failure, paranoia, and hallucinations are not commonly related to therapy with these medications in the elderly.

A patient who has a tinea infection calls the clinic and complains of intense local burning and irritation with use of a topical antifungal drug. Even before asking the patient, the nurse suspects he or she is applying what medication? A)Butoconazole (Gynazole I) B)Ciclopirox (Loprox) C)Econazole (Spectazole) D)Haloprogin (Halotex)

Ans:C Feedback: Econazole can cause intense local burning and irritation in treatment of tinea infections. Butoconazole is used to treat vaginal Candida infections. Ciclopirox is used to treat toenail and fingernail tinea infections and does not produce intense burning and irritation. Haloprogin is used to treat athlete's foot, jock itch, and ringworm infections and is not associated with burning or irritation.

Hypnotic drugs are used to aid people in falling asleep. What physiological system does a hypnotic act on to be effective in helping a patient to sleep? A)Limbic system B)Sympathetic nervous system C)Reticular activating system D)Lymph system

Ans:C Feedback: Hypnotics are used to help people fall asleep by causing sedation. Drugs that are effective hypnotics act on the reticular activating system and block the brain's response to incoming stimuli. Hypnosis, therefore, is the extreme state of sedation, in which the person no longer senses or reacts to incoming stimuli. The other options are incorrect.

A patient with high cholesterol is taking lovastatin (Mevacor). What drug would the nurse question if it was ordered for this patient? A)Nifedipine (Procardia) B)Ciprofloxacin (Cipro) C)Itraconazole (Sporanox) D)Oxazepam (Serax)

Ans:C Feedback: Itraconazole is an azole antifungal drug that has been associated with severe cardiovascular events when taken with lovastatin. Nifedipine, ciprofloxacin, and oxazepam have no drug interactions with lovastatin. Nifedipine is an antihypertensive drug whose effects can be increased when taken with cimetidine. The effects of ciprofloxacin are altered when taken with antacids and theophyllines. Oxazepam is an antianxiety drug that should not be taken with alcohol or theophyllines.

What antiepileptic medication might the nurse administer to treat bipolar disorder? A)Apriprazole (Abilify) B)Cyclobenzaprine (Flexeril) C)Lamotrigine (Lamictal) D)Temazepam (Restoril)

Ans:C Feedback: Lamotrigine is an antiepileptic agent used for long-term maintenance of patients with bipolar disorders because it decreases occurrence of acute mood episodes. Apriprazole is an atypical antipsychotic and is not an antiepileptic medication. Flexeril is a muscle relaxant and Temazepam is a hypnotic agent. None of these medications are indicated for the treatment of bipolar disorder.

A 32-year-old female patient is admitted to the floor with a superinfection. Her orders read tigecycline (Tygacil) 100 mg IV followed by 50 mg IV every 12 hours infused over 30 to 60 minutes for 5 days. What would be important for the nurse to educate this patient about? A)Analgesics B)Antihistamines C)Contraceptives D)Decongestants

Ans:C Feedback: Many antibiotics interfere with the effectiveness of oral contraceptives and unplanned pregnancies can occur. Women should be advised to use a barrier form of contraceptives when taking this drug. No known serious drug-drug interactions involve analgesics, antihistamines, or decongestants.

A mother of a 3-year-old child brings her child to the clinic. The child is diagnosed with pinworms. What drug would be the best choice for the patient? A)Pyrantel (Pin-Rid) B)Ivermectin (Stromectol) C)Mebendazole (Vermox) D)Albendazole (Albenza)

Ans:C Feedback: Mebendazole is the most commonly used anthelmintic for pinworms because it is available in a chewable tablet. This is a good choice for the 3-year-old patient. Pyrantel is also prescribed for pinworms but is not available in a chewable form. Ivermectin is prescribed for treatment of threadworm disease and albendazole is given to treat active lesions caused by pork tapeworm and cystic disease of the liver, lungs, and peritoneum caused by dog tapeworm.

Which of these body cells has the greatest number of mitochondria? A)Tibia bone cells B)Breast tissue C)Cardiac muscle D)Subcutaneous skin

Ans:C Feedback: Mitochondria are very abundant in cells that consume energy. The cardiac muscle cells, which must work continually to keep the heart contracting, contain a great number of mitochondria. Milk-producing cells in breast tissue, which are normally dormant, contain very few. Cells of bone and of subcutaneous tissue do not consume a great deal of energy; therefore, they have smaller numbers of mitochondria than cardiac muscle.

A patient is to have surgery and it is planned that atracurium (Tracrium) is to be used as an adjunct to general anesthesia. How will the atracurium work? A)Act as agonist to acetylcholine B)Stops depolarization in the axion C)Act as antagonist to acetylcholine D)Stops repolarization in the axion

Ans:C Feedback: Nondepolarizing neuromuscular junction blockers compete with acetylcholine (ACh) for the ACh receptor site and after they occupy the site, stimulation cannot occur. This results in paralysis because the muscle cannot respond. Other options are incorrect.

A clinic nurse is caring for a 66-pound child who has acute otitis media. The physician has ordered ceftibuten (Cedax) 9 mg/kg per day PO for 10 days. The drug comes in an oral suspension of 90 mg/5 mL. How many mL will the nurse administer? A)5 mL B)10 mL C)15 mL D)20 mL

Ans:C Feedback: First, using the formula: 2.2 lb/1 kg = 66 lb/X kg, determine the child's weight in kg (66/2.2 = 30 kg). Next, determine the desired dose by using the formula: amount of prescribed drug times weight in kg (9 mg/kg times 30 kg = 270 mg). To determine the volume of medication to administer, use the formula: amount of drug available/volume available = amount of drug prescribed/volume to administer (90 mg/5 mL = 270 mg/X mL, 90mg/(X) = 1,350 mg/mL, X = 15 mL).

The nurse is caring for a patient who works night shift from 2200 (10 pm) to 0600 (6 am) and normally sleeps from 0800 (8 am) until 1600 (4 pm) each day. The nurse would teach this patient to take his or her corticosteroid at what time of the day? A)06:00 (6 am) B)08:00 (8 am) C)16:00 (4 pm) D)22:00 (10 pm)

Ans:C Feedback: If a person works all night and goes to bed at 8 am, arising at 4 pm to carry on the day's activities before going to work at 10 pm, the hypothalamus will release corticotropin- releasing hormone at about 4 pm in accordance with the new sleep-wake cycle. It usually takes 2 or 3 days for the hypothalamus to readjust. A patient on this schedule who is taking replacement corticosteroids would then need to take them at 4 pm, or on arising. All other options would not be optimal.

The nurse is caring for four patients. Which patient would have the highest risk for hepatotoxicity from dantrolene (Dantrium)? A)An 87-year-old man who is taking a cardiac glycosideh B)A 32-year-old man who is taking an antipsychotic drug C)A 65-year-old woman who is on hormone replacement therapy D)A 48-year-old woman who is taking an antihypertensive agent

Ans:C Feedback: If dantrolene is combined with estrogen, the incidence of hepatocellular toxicity is increased. This combination should be avoided. Nothing indicates that patients taking a cardiac glycoside, an antipsychotic drug, and an antihypertensive would have serious adverse effects when combined with dantrolene therapy.

The patient is prescribed sildenafil 25 mg PO one hour before sexual intercourse is planned. The patient returns for follow-up care and says that 25 mg did not produce an erection so he increased the dosage. How much of an increase would be enough to concern a nurse? A)50 mg B)75 mg C)100 mg D)25 mg

Ans:C Feedback: Normal dosage range is 25 to 100 mg so the nurse should not be concerned unless the dosage exceeded 100 mg.

The nurse is teaching the soon-to-be- discharged patient, diagnosed with schizophrenia, about his medications. What is a priority teaching point for this patient? A)The patient must eat three nutritious meals daily. B)Over-the-counter medications may be taken with antipsychotic drugs. C)Cough medicines potentiate the actions of antipsychotic drugs. D)Alcohol consumption should be avoided.

Ans:DFeedback: Alcohol consumption should be avoided because it increases the central nervous system (CNS) effects of the drug and may cause excessive drowsiness and decreased awareness of safety hazards in the environment. Some patients may find it easier and more effective to eat five small meals rather than three nutritious meals. While promoting good nutrition is good practice, it is not the priority. Drug-drug interactions with antipsychotic drugs are common so the nurse would teach the patient not to take any medication without consulting with the doctor or a pharmacist to make sure it is safe.

What would be a priority nursing action related to the care of a patient taking albendazole (Albenza)? A)Check blood pressure, pulse, and respirations B)Weigh the patientC)Monitor renal function D)Encourage small, frequent meals

Ans:CFeedback: It is important that the patient's kidney function be monitored because a serious adverse effect of this drug is renal failure. Even though vital signs, weight, and nutrition are important and should be monitored, if the patient exhibits any signs of renal failure the drug should be stopped immediately.

What is the function of the mitochondria within the cell? A)Convert small substances into energy B)Convert hormones into secretory substances C)Produce energy in the form of adenosine triphosphate (ATP) D)Move electrolytes into and out of a cell

Ans:CFeedback: Mitochondria are rod-shaped organelles that produce energy in the form of ATP for use by cells. They do not convert small substances into energy; they do not convert hormones into secretory substances; and they do not move electrolytes into and out of a cell.

A 9-year-old boy is taking testosterone injections for treatment of hypogonadism. What should be measured every 6 months on this child? A)Liver function test (LFT) B)Cholesterol levelC)VisionD)hand and wrist radiographs

Ans:DFeedback: Because of the effects of these hormones on epiphyseal closure, children should be closely monitored with hand and wrist radiographs before treatment and every 6 months after treatment. It would not be necessary to measure LFTs, cholesterol levels, or the child's vision.

The nurse is providing discharge teaching to a patient who is being sent home on oral tetracycline (Sumycin). What instructions should the nurse include? A)Take the medication only once a day. B)Check pulse rate and hold the drug if lower than 60 beats per minute (bpm). C)Take the drug on an empty stomach. D)Take the medication with 2 ounces of water.

Ans:CFeedback: Tetracycline should be taken on an empty stomach 1 hour before or 2 hours after meals with a full 8 ounces of water to ensure full absorption. Tetracycline is usually taken at least once every 12 hours. Checking the pulse and holding the dose if below 60 bpm is an action specific to the use of cardiac glycosides.

A 78-year-old woman, who lives alone and is forgetful, is being seen by her home health nurse. In reviewing the patient's medication, the nurse discovers that the patient is taking Azithromycin (Zithromax) for urethritis. Why would this be a good choice of antibiotics for this patient? A)The half-life of the drug is 3 to 7 hours. B)It is taken only once a day. C)It has very few adverse effects. D)It can be given without consideration to drug-drug interactions.

Ans:B Feedback: Given that the patient is "forgetful" and lives alone, a daily dose would likely promote improved compliance. Azithromycin can be administered once daily because the half-life is 68 hours. Azithromycin is associated with GI adverse effects and can cause pseudomembranous colitis; neurological symptoms can occur as well. Azithromycin (Zithromax) may adversely interact with cardiac glycosides, oral anticoagulants, theophyllines, carbamazepine, and corticosteroids to name a few agents.

The nurse explains the purpose of the negative feedback system used by the endocrine system is what? A)To change the environment of the pituitary gland B)To regulate hormone release C)To maintain hormone concentration at a certain level D)To control the action of hormones

Ans:CFeedback: The negative feedback system is a control system in which increasing levels of a hormone lead to decreased levels of releasing and stimulating hormones, leading to decreased hormone levels, which stimulates the release of releasing and stimulating hormones; it allows tight control of the endocrine system. It does not involve changing the environment or control the action of hormones.

The nursing students are studying sympathomimetic drugs. How do these drugs act on the body? A)Stimulate beta receptors and block alpha- receptors B)Stimulate alpha-receptors and block beta- receptors C)Block adrenergic receptorsD)Stimulate both alpha and beta-receptors

Ans:D Drugs that are generally sympathomimetic are called alpha-agonists (stimulate alpha- receptors) and beta-agonists (stimulate beta- receptors). These agonists stimulate all of the adrenergic receptors; that is they affect both alpha and beta-receptors.

A patient is having outpatient surgery that should last only 45 minutes. The patient is planning to go home immediately after the surgery is complete. What nondepolarizing neuromuscular junction blocker will most likely be used as an adjunct therapy to general anesthesia for this patient? A)Atracurium (Tracrium) B)Cisatracurium (Nimbex) C)Pancuronium (Pavulon) D)Rocuronium (Zemuron)

Ans:D Fedback: Rocuronium has a rapid onset of action and a short duration, making it a drug of choice for outpatient surgical procedures when the patient will be leaving to go home and will need to be awake, alert, and mobile. Atracurium, cisatracurium, and pancuronium are associated with longer paralysis and recovery.

Why is it important for a nurse to inquire about any foreign travel of a patient with a suspected lymphatic or hematologic disorder? A)To determine the varied sexual history of the patient, if any B)To determine the potential exposure to infectious agents C)To determine whether the patient has had any blood transfusions D)To determine whether the patient adopted any specific dietary habits

Ans:B Feedback: Knowledge of recent travel can help the nurse to pinpoint potential exposure to helminths, parasites, or other infection exposure common in the area visited. The nurse should specifically ask about foreign travel to countries where malaria or parasitic roundworms are common. Sexual history, dietary habits, or any blood transfusions that the patient may have had before would not be adequately explored by questioning travel history.

A 55-year-old man presents at the clinic complaining of erectile dysfunction. The patient has a history of diabetes mellitus. The physician orders tadalafil (Cialis) to be taken 1 hour before sexual intercourse. The nurse reviews the patient's history before instructing the patient on the use of this medication. What disorder (or condition) would contraindicate the use of tadalafil (Cialis)? A)Cataracts B)Penile implant C)Hypotension D)Lung cancer

Ans:B Feedback: Patients with a penile implant should not take tadalafil. Patients with cataracts, hypotension, or lung cancer may take tadalafil if needed but should do so with caution and should be carefully monitored for adverse effects.

When a cell uses energy to move ions against an electrical or chemical gradient, what is the process called? A)Passive transport B)Neutral transport C)Cotransport D)Active transport

Ans:D Feedback: Active transport is what happens when cells use energy to move ions against an electrical or chemical gradient. Passive transport is another term for diffusion. There is no such thing as neutral transport. Cotransport is when the sodium ion and the solute are transported in the same direction.

The nurse is teaching the mother of a child diagnosed with attention-deficit hyperactivity disorder how to administer methylphenidate (Ritalin). When would the nurse instruct the mother to administer this drug? A)"Administer at lunch every day." B)"Administer at breakfast every day." C)"Administer at dinner every day." D)"Administer at bedtime."

Ans:B Feedback: Several long-acting formulations of methylphenidate have become available that allow the drug to be given only once a day. It should always be given in the morning because administration at dinnertime or bedtime could result in insomnia.

The nursing instructor is discussing helmintic infections with the nursing students. How would the instructor explain the action of anthelmintic drugs? A)Destroy the nervous system of the invading worm B)Act on metabolic pathways that are present in the invading worm C)Interfere in the reproductive cycle of the invading worm D)Cause fatal mutations in the deoxyribonucleic acid of the invading worm

Ans:B Feedback: The anthelmintic drugs act on metabolic pathways that are present in the invading worm, but that are absent or significantly different in the human host. Other options are incorrect descriptions of how anthelmintic drugs work.

Why would the nurse expect the patient with liver disease to receive a smaller dose of benzodiazepines? A)Excretion of the drug relies on liver function. B)The drugs are metabolized extensively in the liver. C)They are lipid soluble and well distributed throughout the body. D)The drugs are well absorbed from the gastrointestinal tract.

Ans:B Feedback: The benzodiazepines are metabolized extensively in the liver. Patients with liver disease must receive a smaller dose and be monitored closely. Excretion is primarily through the urine. All of the answer options are true, but only the fact that the benzodiazepines are metabolized in the liver explains why a patient with liver disease would require smaller dosages.

An 85-year-old man who is a resident in an extended-care facility has athlete's foot. After applying an antifungal cream, what is the nurse's next action? A)Wipe away excess medication from the affected area. B)Wrap a sterile kling dressing around both feet. C)Elevate the feet for 30 minutes. D)Apply clean dry socks.

Ans:DFeedback: Clean dry socks should be applied when treating athlete's foot to help eradicate the infection because they will keep the feet dry as well as prevent the cream from being wiped away. A kling dressing is not necessary as it would bind the feet and interfere with mobility and increase the risk of systemic absorption. Medication should not be removed once applied, and there is no need to elevate the feet unless another medical condition warrants this action.

The cell membrane has embedded within it a series of peripheral proteins that function in several ways. One of these proteins is known as a receptor site. What does this receptor site do? A)Maintains contact with outside proteins to prevent lysis of the cell wall B)Maintains contact with inside proteins to prevent lysis of the cell wall C)Reacts with specific chemicals inside the cell to stimulate a reaction outside the cell D)Reacts with specific chemicals outside the cell to stimulate a reaction within a cell

Ans:D Feedback: Embedded in the cell membrane are a series of peripheral proteins with several functions. One type of protein located on the cell membrane is known as a receptor site. This protein reacts with specific chemicals outside the cell to stimulate a reaction within a cell. Receptor sites do not prevent lysis of the cell wall nor do they stimulate a reaction outside of the cell.

What drug would the nurse administer orally without the need to question when treating infections caused by Candida albicans? A)Amphotericin B (Abelcet) B)Tolnaftate (Tinactin) C)Griseofulvin (Fulvicin) D)Fluconazole (Diflucan)

Ans:D Feedback: Fluconazole is available for oral use and is effective in treating C. albicans. Amphotericin B is reserved for severe and potentially fatal infections, so it would not be used for a C. albicansinfection. Tolnaftate is used to treat athlete's foot and is applied topically, not given orally. Griseofulvin is applied topically and is used to treat tinea, not C. albicans.

A patient is receiving isosorbide dinitrate [Isordil] 20 mg 3 times per day for management of newly diagnosed stable angina. Which assessment finding would require an immediate nursing intervention?

An increase in the resting heart rate to 110 beats/min from baseline rates of 72 beats/min Because nitrates lower blood pressure, isosorbide dinitrate [Isordil] can activate the baroreceptor reflex, causing sympathetic stimulation of the heart; this negates the benefits of treatment with nitrates, because it increases the cardiac oxygen demand. For these reasons, addressing the tachycardia becomes the nurse's immediate priority. A decrease in blood pressure would be expected, and there is no indication the patient is experiencing side effects of decreased cardiac output. Headache is an adverse effect and should be treated (eg, with acetaminophen [Tylenol]), but it does not require immediate intervention. Increased frequency of urination requires follow-up, but it is not the immediate concern.

The nurse is preparing to administer a daily dose of digoxin [Lanoxin]. What is the priority nursing intervention?

Analyze heart rate and rhythm

The nurse is preparing to administer a daily dose of digoxin [Lanoxin]. What is the priority nursing intervention?

Analyze heart rate and rhythm. Before giving digoxin [Lanoxin], the nurse should assess heart rate and rhythm. The dosage will be held and the prescriber notified if the heart rate is below 60 beats/min or if the cardiac rhythm has changed. Digoxin [Lanoxin] can cause bradycardia and electrical changes in the heart.

What are the common adverse effects of the antiviral drug ribavirin? Select all that apply. 1 Anemia 2 Conjunctivitis 3 Peripheral neuropathy 4 Orthostatic hypotension 5 Bone marrow suppression

Anemia Conjunctivitis

A nurse administering flecainide to a patient with sustained ventricular tachycardia will monitor the patient for which adverse drug effect?

Angioedema

The nurse is instructing a patient about potential adverse effects of a prescribed angiotensin-converting enzyme (ACE) inhibitor. For which adverse effect should the patient seek immediate medical attention?

Angioedema Angioedema is a potentially fatal reaction that develops in up to 1% of patients. A dry, nonproductive cough is an adverse reaction but is not life-threatening. If fatigue does occur, it is not life-threatening. Diarrhea is not an adverse effect.

What therapeutic effect will the nurse assess for in the male patient taking anabolic steroids? A)Thinning of the skin B)Body hair loss C)Increase in red blood cells (RBCs) and hemoglobin D)Gynecomastia

Ans C: Feedback: Therapeutic effects include promotion of body tissue-building processes, reverse catabolic or tissue-destroying processes, and increased hemoglobin and red blood cell mass. Thinning of the skin and body hair loss are not associated effects of anabolic steroids. Gynecomastia is an adverse effect and would not be a therapeutic effect for which the drug was administered.

The nurse admitted a 25-year-old woman to the unit. What would be the most important thing for the nurse to assess before administering ketoconazole? A)Complete blood count (CBC) and blood glucose B)Eating and sleeping habits C)Height and weightD)Renal and hepatic function

Ans:D Feedback: It would be important for the nurse to know the patient's CBC, blood glucose level, eating and sleeping habits, and height and weight. All of these factors could help determine a specific dosage. However, the most important factor would be the patient's renal and hepatic function because hepatic or renal toxicity could occur quickly if the organs are not functioning properly.

The nurse is caring for four patients. Which patient would the nurse know that clozapine (Clozaril) is contraindicated for? A)17-year-old adolescent B)23-year-old with diabetes insipidus C)32-year-old with osteoarthritis D)45-year-old with bone marrow depression

Ans:DFeedback: Clozapine is associated with bone marrow suppression, a life-threatening decrease in white blood cells. Because of their wide- ranging adverse effects, antipsychotic drugs may cause or aggravate various conditions. They should be used very cautiously in patients with liver damage, coronary artery disease, cerebrovascular disease, Parkinsonism, bone marrow depression, severe hypotension or hypertension, coma, or severely depressed states. Options A, B, and C are incorrect.

The nurse is caring for a patient who is receiving pancuronium (Pavulon) to facilitate mechanical ventilation. The patient is also receiving a barbiturate. How will the nurse administer these two medications? A)They can be mixed and given in the same syringe. B)Administer IM quickly after mixing the two drugs. C)Shake vigorously when mixed in one syringe. D)If given together, a precipitate may form.

Ans:DFeedback: Do not mix this drug with any alkaline solutions such as barbiturates because a precipitate may form, making it inappropriate for use. Pancuronium is only given IV. Shaking does not prevent precipitation.

While caring for a diabetic patient, the nurse explains that normally insulin is produced by the pancreas and does what when reacting with the human cell? A)Metabolizes glucose B)Allows water to enter the cell C)Alters cellular messenger ribonucleic acid (RNA) D)Changes the cell permeability to glucose

Ans:DFeedback: Insulin reacts with specific receptor sites on the cell membrane to change the cell's permeability to glucose to allow glucose to enter the cell. It does not affect water transport or messenger RNA. Insulin does not metabolize glucose but rather helps it move into the cell where it supplies energy for cellular activity.

Melanocyte-stimulating hormone (MSH) released from the anterior pituitary is important in humans because of its suspected ability to do what? A)Block the perception of pain B)Change the color of skin in some environments C)Stimulate fat mobilizationD)Stimulate nerve growth and development

Ans:DFeedback: MSH might be important for nerve growth and development in humans. Animals use MSH to change skin color as part of protective camouflage, but it does not have this effect in humans. Lipotropins stimulate fat mobilization. Endorphins and enkephalins are hormones that block the perception of pain.

A nurse is teaching a young mother about administering pyrantel (Pin-Rid, others) to her 5-year-old child. What will the nurse emphasize about how the agent is given? A)In 3 doses as a 1-day treatment B)In a morning dose and an evening dose for 3 days C)B.I.D. for 10 days D)Give only once

Ans:DFeedback: Pyrantel is administered orally as a single dose. Albendazole is prescribed for hydatid disease and is given twice a day for 8 to 30 days of treatment. Mebendazole is used in the treatment of diseases caused by pinworms, roundworms, whipworms, and hookworms and is given in a morning and evening dose for 3 days. Praziquantel is used to treat schistosomes and is taken in three doses as a 1-day treatment.

Two types of ribosomes exist within a cell. Ribosomes that are not bound to the endoplasmic reticulum exist throughout the cytoplasm of the cell and produce proteins with what purpose? A)Bind themselves to the Golgi apparatus B)Bind to produce the endoplasmic reticulum C)Denature unnecessary enzymes within the cell D)Contribute to the structure of the cell

Ans:DFeedback: Ribosomes that are not bound to the surface of the endoplasmic reticulum exist throughout the cytoplasm. These free-floating ribosomes produce proteins that are important to the structure of the cell and some of the enzymes that are necessary for cellular activity. Free- floating ribosomes do not bind themselves to Golgi apparatus; produce endoplasmic reticulum; or denature any part of the cell or its contents.

A 22-year-old female is diagnosed with mycobacterial tuberculosis. The physician orders rifampin (Rifadin) 600 mg PO daily. What should the nurse question the patient about? A)Her dietB)Sun exposureC)Type of exercise she does D)Use of contact lenses

Ans:DFeedback: Some antimycobacterial drugs can cause discoloration of body fluids. The orange tinged discoloration can cause permanent stain to contact lenses. The patient should avoid wearing them while on the antimycobacterial therapy. With antimycobacterial drugs there is not a concern is warranted about photosensitivity or exercise. However, due to the GI adverse effects, the nurse may want to discuss an appropriate diet if the patient experiences GI upset after beginning treatment.

A 12-year-old patient with a complicated skin infection has been admitted to the pediatric unit. The physician has ordered Ertapenem (Invanz). What is the nursing priority? A)Transcribe the order to the medication administration record (MAR). B)Perform hand hygiene before preparing the medication. C)Assess the patient's renal and hepatic functions. D)Question the order by calling the physician who prescribed it.

Ans:D Feedback: The nurse should call the physician and question the order Because this drug is not recommended for children younger than 18 years of age. Following clarification of the order, the drug would be transcribed and listed in the MAR. The nurse would then wash her hands before preparing the drug for administration. Assessment of renal and hepatic function is good practice before administering any medication but is not the nursing priority.

In what age group are adrenergic agonists contraindicated? A)Older adults B)Adolescents C)Children D)No age group

Ans:D Feedback: The use of adrenergic agonists varies from ophthalmic preparations for dilating pupils to systemic preparations used to support patients experiencing shock. They are used in patients of all ages. Therefore, the other options are incorrect responses.

The nurse alerts the patient to what adverse effect of tizanidine (Zanaflex) that could cause injury? A)Constipation B)Dry mouth C)Fatigue D)Hypotension

Ans:D Feedback: Tizanidine has been associated with hypotension, which could be a safety risk especially if the patient is also taking an antihypertensive drug. Constipation, dry mouth, and fatigue are common adverse effects that do not pose a safety risk.

A patient presents at the emergency department with respiratory depression and excessive sedation. The family tells the nurse that the patient has been taking medication throughout the evening and gives the nurse an almost empty bottle of benzodiazepines. What other adverse effects would the nurse assess this patient for? A)Seizures B)Tachycardia C)Headache D)Coma

Ans:D Feedback: Toxic effects of benzodiazepines include excessive sedation, respiratory depression, and coma. Flumazenil (Anexate) is a specific antidote that competes with benzodiazepines for benzodiazepine receptors and reverses toxicity. Seizures, tachycardia, and headache would not normally be associated with benzodiazepine toxicity.

What anthelmintics would the nurse expect will be readily absorbed from the gastrointestinal (GI) tract? (Select all that apply.) A)Mebendazole B)Pyrantel C)Albendazole D)Praziquantel E)Ivermectin

Ans:D, E Feedback: Praziquantel and ivermectin are readily absorbed from the GI tract. Mebendazole, pyrantel, and albendazole are not.

The nurse is caring for an African American patient who received a kidney transplant and receives methylprednisolone for immunosuppression. What is the nurse's priority assessment specific to this patient? A)Assessing capillary refill time B)Assessing cardiac rhythm C)Assessing white blood cell count D)Assessing blood glucose levels

Ans: DFeedback: African Americans develop increased toxicity to the corticosteroid methylprednisolone— particularly when it is used for immunosuppression after renal transplantation. This toxicity can include severe steroid-induced diabetes mellitus. A priority intervention with this patient is monitoring blood glucose levels. Assessment of capillary refill time and cardiac rhythm would not be indicated by the data supplied about this patient. White blood cell counts should be monitored on any patient receiving long-term corticosteroids but is not specific to this patient.

A female athlete is using high doses of anabolic steroids to enhance her performance. The nurse warns this patient that such use of anabolic steroids is likely to result in what? A)Masculinization B)Immobility of joints C)Obesity D)Hypotension

Ans: A Feedback: Adverse effects in women include masculinization effects, hirsutism, and deepening of the voice. A woman using anabolic steroids would not expect it to result in joint immobility, obesity, or hypotension.

A patient with heart failure has developed a cough while taking an angiotensin-converting enzyme (ACE) inhibitor. The health care provider discontinued the ACE inhibitor and prescribed an angiotensin II receptor blocker (ARB) as an alternative to the ACE inhibitor. The patient continues to have symptoms of heart failure despite using an ARB. Which medication should the nurse anticipate will be prescribed?

BiDil [Isosorbide Dinitrate and Hydralazine]

The nurse is administering captopril to a patient with heart failure. Which best describes the effects of this drug?

Blocks production of angiotensin II Captopril an angiotensin-converting enzyme (ACE) inhibitor, blocks production of angiotensin II, decreases release of aldosterone, and suppresses degradation of kinins. By suppressing production of angiotensin II, ACE inhibitors cause dilation of arterioles and veins.

Which statement is an accurate description of the mechanism of action for verapamil?

Blocks the slow influx of calcium ions into slow calcium channels

Which description regarding the action of methimazole, a drug prescribed for hyperthyroidism, is accurate? Increases the basal metabolic rate Increases thyroid hormones production Blocks thyroid hormone synthesis Slows heart rate through the sinoatrial (SA) node

Blocks thyroid hormone synthesis

Which phrase describes the action of propylthiouracil (PTU) when prescribed for hyperthyroidism? Decreases metabolism by increasing cellular sensitivity to thyroxine Blocks thyroxine conversion to triiodothyronine (T3) in peripheral tissues Inhibits synthesis of thyroid hormone by blocking iodine uptake Reduces production of thyroid stimulating hormone (TSH) from the pituitary

Blocks thyroxine conversion to triiodothyronine (T3) in peripheral tissues

Which assessment finding is most important for the nurse to obtain before administering hydralazine [Apresoline]?

Blood Pressure Hydralazine [Apresoline] is a vasodilator that causes arteriolar dilation, decreased resistance, and decreased blood pressure. Monitoring of the blood pressure and heart rate is the highest assessment priority.

The nurse administers candesartan [Atacand] to a patient. Which assessment finding should the nurse use as a clinical indicator of the therapeutic effectiveness of the medication?

Blood pressure reduction All angiotensin receptor blockers (ARBs), such as candesartan [Atacand], are approved for hypertension. Reduction in blood pressure equals those seen with angiotensin-converting enzyme (ACE) inhibitors. ARBs will decrease pulmonary congestion. Because ARBs promote vasodilation, the nurse expects the patient's extremities to be warm and pink from increased perfusion. In contrast to ACE inhibitors, ARBs do not cause clinically significant hyperkalemia.

A continuous infusion of sodium nitroprusside has been stopped. Which effect on the patient's blood pressure would the nurse anticipate?

Blood pressure will increase. The nurse would anticipate the patient's blood pressure to increase to pretreatment levels within minutes when a sodium nitroprusside infusion is stopped due to the total duration and half-life of the drug.

The nurse is caring for a patient taking foscarnet. What will the nurse monitor to identify potential side effects of this medication? 1 Platelets 2 Stool guaiac 3 Hemoglobin and hematocrit 4 Blood urea nitrogen and creatinine

Blood urea nitrogen and creatinine

A patient with a ventricular dysrhythmia is to receive lidocaine. The health care provider prescribes a lidocaine bolus at 250 mg, which may be repeated in 5 minutes. This is to be followed by a maintenance lidocaine drip at 2 mg/minute for 24 hours. For which part of the prescription will the nurse require clarification?

Bolus dose of 250 mg The bolus dose should be between 50 to 100 mg. This dose can be repeated in 5 minutes. 250 mg is too high for a single dose.

A patient receives isophane suspension, also known as neutral protamine Hagedorn insulin at 8:00 AM. The patient eats breakfast at 8:30 AM, lunch at noon, and dinner at 6:00 PM. At what time is this patient at the highest risk for hypoglycemia?

Breakfast eaten at 8:30 AM would cover the onset of isophane insulin suspension, also known as neutral protamine Hagedorn, and lunch will cover the 2:00 PM time frame. If the patient does not eat a midafternoon snack, however, the neutral protamine Hagedorn insulin may peak just before dinner without sufficient glucose on hand to prevent hypoglycemia.

amphotericin B (abelcet)

Broad spectrum antifungal Only given by IV route Nephrotoxic -- reversible kidney damage in 80% -- Stop or lower dose if Cr >3.5 -- Give lots of fluids, 500mL fluid over 2 hrs, then give tylenol, benadryl (counteract pro-inflammatory rx), given through central line over 4 hours - not compatible with NS - flush lines with dextrose Electrolyte imbalance -- Low K and Mg -- low potassium levels affect the heart Anemia - may need blood transfusion Administration: -- phlebitis, (use central lines b/c have to give a long time) -- fever/chills -- If get Rigers (uncontrollable shakes) - give demerol then potassium and magnesium. Now comes in lipid formulas which are more expensive but have less side effects

The nursing instructor is talking with her class of students about the female reproductive system. A student is trying to understand the role of progesterone in the body. What nonreproductive affect does progesterone have on the body? A)Decreased body temperature B)Decreased appetite C)Anti-insulinD)Increased uterine motility

C Feedback: Progesterone has an anti-insulin effect to generate a higher blood glucose concentration to allow for rapid diffusion of glucose to the developing embryo. Body temperature and appetite are increased by progesterone. Uterine motility is decreased to provide increased chance that implantation can occur.

Ms. Jones reports episodes of joint and muscle pain to the nurse. What would the nurse's priority action be?

Call the health care provider and request a prescription for an antinuclear antibody (ANA) panel. Given the history of treatment with hydralazine, it is important to complete an ANA panel to evaluate for the adverse effect of systemic lupus erythematosus-like syndrome.

The nurse is caring for a patient who is receiving enteral feedings because of dysphagia. The healthcare provider prescribes isosorbide mononitrate [Imdur] 60 mg SR daily via the enteral tube. What is the most appropriate action by the nurse?

Call the healthcare provider about an alternate form of nitrate for administration. The nurse should contact the prescriber for an alternate form of nitrate, such as a non-sustained-release pill, transdermal patch, topical ointment, or immediate release. Because isosorbide mononitrate [Imdur] is a sustained-release pill, it cannot be crushed. Because the patient has dysphagia, attempting to administer the pill orally could result in aspiration. Sustained-release tablets must be administered whole.

trichinosis

Caused by Trichinella worm. The life cycle spent entirely within the body of a mammalian host. Humans can contract the parasite by eating raw or inadequately cooked pork or bear meat; the cyst envelope is digested in the stomach and small intestine, and larvae are liberated. Final development occurs when the coiled larvae are encysted in the skeletal muscle. Symptoms may be unnoticeable or extreme depending on how many larvae were ingested. Drugs of choice: albendazole, and prednisone

The nurse is caring for a patient receiving hydralazine [Apresoline]. The healthcare provider prescribes propranolol [Inderal]. The nurse knows that a drug such as propranolol often is combined with hydralazine for what purpose? A. To reduce the risk of headache B. To improve hypotensive effects C. To prevent heart failure D. To protect against reflex tachycardia

D. To protect against reflex tachycardia Hydralazine is a vasodilator that lowers blood pressure, but it also can trigger reflex tachycardia. Beta blockers, such as propranolol, are added to the regimen to normalize the heart rate.

A patient who has been taking warfarin for chronic atrial fibrillation was advised by a friend to consume a low-protein diet. Which change in warfarin dosage would the nurse anticipate?

Decrease

Which phrase describes the goal of cinacalcet drug therapy? Increase calcium absorption and blood levels. Decrease parathyroid hormone (PTH) production in the body. Activate vitamin D for the body's use. Decrease and normalize calcium levels.

Decrease and normalize calcium levels

A patient is prescribed lisinopril [Prinivil] 40 mg by mouth once a day for hypertension. For which therapeutic effect should the nurse monitor?

Decrease in blood pressure The therapeutic effect of angiotensin-converting enzyme (ACE) inhibitors is to reduce blood pressure in patients with hypertension. ACE inhibitors do not affect patients' heart rate. Dizziness and fainting are symptoms of hypotension. ACE inhibitors do not affect oxygen saturation.

A patient is prescribed to receive an initial dose of amiodarone 800 mg and a maintenance dose of warfarin 8 mg. Which action would the nurse expect when notifying the health care provider about the order?

Decrease the dose of warfarin.

A patient is prescribed to receive an initial dose of amiodarone 800 mg and a maintenance dose of warfarin 8 mg. Which action would the nurse expect when notifying the health care provider about the order?

Decrease the dose of warfarin. Amiodarone can increase the level of warfarin. The dose of warfarin may need to be decreased.

The patient with which medical condition will most likely benefit from lidocaine administered intravenously?

Decreased heart rate Quinidine, a Class IA antidysrhythmic drug, slows the conduction rate and prolongs repolarization, which decreases heart rate such as in atrial fibrillation with rapid ventricular response. Decreasing heart rate is a therapeutic effect. However, the nurse will need to monitor for heart rate less than 60 beats/minute, indicating bradycardia, which is a side effect of quinidine.

TMP SMX

Decreased resistance to permethrin has occurred when administered with _____/_____ (kill bacteria in lice used to make B vit they need to live)

Which phrase describes the action of cinacalcet when prescribed to balance calcium levels in the body? Elevates parathyroid hormone (PTH) levels and increases calcium absorption from the intestines Decreases PTH by increasing calcium receptor sensitivity in the body Activates vitamin D, which is needed for PTH production and absorption of calcium Enhances the production of parathyroid hormones, which stimulate kidney excretion of calcium

Decreases PTH by increasing calcium receptor sensitivity in the body

A patient is being treated with digoxin for atrial fibrillation. Which finding would concern the nurse?

Development of second-degree block Digoxin prolongs the PR interval as a result of the slowed atrioventricular (AV) conduction. Development of second-degree block is a contraindication for digoxin.

Digoxin

Digoxin is primarily used for heart failure. Digoxin can also be used for atrial fibrillation/flutter and PSVT. Digoxin is not effective against ventricular dysrhythmias, such as supraventricular tachycardia/fibrillation.

Subsequent Dosing Assessment for digoxin

Digoxin levels must be closely monitored due to the narrow range between therapeutic and toxic levels. Assess apical pulse for 1 minute. If 60 beats/min or less, withhold drug and contact health care provider. Digoxin levels should be evaluated 6 to 8 hours after administration or just before the next dose. Therapeutic serum level: 0.8 to 2 ng/mL; toxic serum level: greater than 2 ng/mL.

Extra caution must be taken when patients take Class IV antidysrhythmic drugs and digoxin, concurrently

Digoxin suppresses impulse conduction through the AV node, thereby increasing the risk of AV block. Patients receiving both Class IV antidysrhythmic drugs and digoxin should be monitored closely. Class IV antidysrhythmic drugs increase plasma levels of digoxin by about 60%, which increases the risk of digoxin toxicity.

The nurse is teaching about nondihydropyridine calcium channel blockers. Which medication would the nurse include?

Diltiazem

Which inhibitory neurotransmitter is involved in Parkinson's disease (PD)?

Dopamine is the inhibitory neurotransmitter involved in PD. The disease is characterized by low concentrations of dopamine. Acetylcholine is an excitatory neurotransmitter that counteracts the effects of dopamine. The adrenergic glands on the kidney release adrenaline. Oxytocin is released by the pituitary gland; it is a not a neurotransmitter.

Which phrase indicates therapeutic effectiveness of cinacalcet prescribed for hyperparathyroidism? Slowing progression of osteoporosis Increasing parathyroid hormone level Diminishing muscle spasm and twitching Down trending of calcium blood levels toward normal

Down trending of calcium blood levels toward normal

The nurse is completing discharge teaching, Which includes the direction, "Do not stop the angiotensin-converting enzyme (ACE) inhibitor abruptly" Which effect would the nurse tell the patient to expect if the medication were stopped suddenly?

Dramatic increase in BP ( The patient's blood pressure can rebound and become very hypertensive if the medication is stopped abruptly. This is called rebound hypertension)

The nurse is completing discharge teaching, which includes the direction, "Do not stop the angiotensin-converting enzyme (ACE) inhibitor abruptly." Which effect would the nurse tell the patient to expect if the medication were stopped suddenly?

Dramatic increase in blood pressure

threadworm

Drug of choice for _______ infestation: - ivermectin - Inhabit small intestine, can be very dangerous - common in southern U.S.

mebendazole

Drug of choice for helminthiasis: _____________ Most intestinal roundworms Prevents uptake of glucose by susceptible intestinal worms, which causes slow death (doesn't affect our glucose levels, however) Poorly absorbed, remains in gut, plasma levels remain low Avoid in 1st trimester d/t limited data ** may take up to 3 days for parasite to be cleared d/t slow death

permethrin

Drug of choice for scabies = ________ - 1 dose of ivermectin is also effective but not approved by FDA - other drugs: crotamiton, malathion, lindane ** Intense itching occurs for a week or 2 after SUCCESSFUL TX - educate!

The nurse is caring for a patient undergoing chemotherapy for breast cancer. Which should the nurse recognize as the rationale for using more than one chemotherapy drug simultaneously?

Drug resistance occurs less frequently.

permethrin, malathion

Drugs for body lice: ________ and ________ If these topical tx fail, oral ivermectin may be used

giant roundworm

Drugs of choice for ______ _______ infestation: - albendazole, mebendazole, ivermectin

pinworm

Drugs of choice for ______ infestation: - albendazole, mebendazole, pyrantel pamoate * sx: perianal itching * entire household should be treated at same time

hookworm

Drugs of choice for _______ infestation: - albendazole, mebendazole, pyrantel pamoate - Nausea, vomiting and abd pain may occur with infestation - Attach to wall of small intestine and suck blood

3 (Schistosomiasis (a blood fluke infestation) has acute and chronic phases. In the chronic phase, the infestation predominates in the vascular system, producing portal hypertension and hepatosplenomegaly. Pruritic dermatitis and vision disturbances are findings seen in onchocerciasis (river blindness). Bowel obstruction is seen in fasciolopsiasis (intestinal fluke infestation).)

During the chronic phase of infestation with schistosomiasis, it is most important for the nurse to monitor the patient for what? 1 Pruritic dermatitis 2 Vision disturbances 3 Hepatosplenomegaly 4 Bowel obstruction

The nurse should be on heightened alert for the signs and symptoms of digoxin toxicity.

During the first 1 to 2 hours after administration, assess apical pulse for bradycardia and ECG or cardiac monitor for dysrhythmias (excessive slowing of pulse may be first clinical sign of toxicity). During loading dose, assess for signs of toxicity (GI disturbances and neurologic abnormalities). Monitor serum potassium, magnesium, calcium, and renal function. Assess for signs and symptoms of digitalis toxicity (anorexia, nausea, vomiting, bradycardia, cardiac dysrhythmias, and visual disturbances). Report symptoms immediately to the health care provider.

A patient scheduled for surgery is to have a nondepolarizing neuromuscular junction (NMJ) blocker as adjunctive anesthesia. The nurse will have cause for concern about prolonged paralysis if the patient has been taking what medication? A)An aminoglycoside B)AminophyllineC)A barbiturate anesthetic D)A cephalosporin

Feedback: Combining nondepolarizing NMJ blockers with aminoglycosides can result in prolonged paralysis, and this combination should be avoided. This interaction does not occur with barbiturate anesthetics, cephalosporins, or aminophylline.

The home health nurse provides patient teaching to his or her patient who is taking oral prednisolone. The nurse provides what instruction to reduce the occurrence of nausea? A)"Take with a meal."B)"Take 1 hour before meals."C)"Take before bedtime."D)"Split the dose into two equal doses."

Feedback: Steroids, taken on an empty stomach, would exacerbate the nausea. If the patient takes only one dose per day, it should be taken immediately after breakfast. If spaced throughout the day, eating something before taking the pill will reduce risk of nausea. Timing is dictated by frequency of administration, and if only taken once daily, the medication should be taken in the morning (so bedtime is inappropriate). Splitting the dose would decrease effectiveness and would be inappropriate for the nurse to suggest because it is outside the scope of nursing practice. Taking the medication before meals would mean it was being taken on an empty stomach.

The adrenal cortex responds to adrenocorticotropic hormone (ACTH), which responds to corticotropin-releasing hormone (CRH) from the hypothalamus in a daily pattern called what? A)Pituitary rhythm B)hypothalamic-pituitary axis C)Diurnal rhythm D)Circadian rhythm

Feedback: The adrenal cortex responds to ACTH released from the anterior pituitary. ACTH, in turn, responds to CRH released from the hypothalamus. This happens regularly during a normal day in what is called "diurnal rhythm." Pituitary rhythm is a distracter; the term does not exist. The hypothalamic- pituitary axis involves the interaction between the two glands. Circadian rhythm involves when people prefer to be most active, such as people who say they are "morning people."

A patient with ventricular tachycardia and a pulse is to receive lidocaine. Before administering lidocaine the nurse will assess for which contraindications to lidocaine?

First-degree atrioventricular block Second-degree Mobitz I atrioventricular block Wolff-Parkinson-White (WPW) syndrome

Which antifungal inhibits the formation of ergosterol, a major sterol in the fungal cell membrane?

Fluconazole- interferes with the cytochrome P450 (CYP450) enzyme that is needed to convert lanosterol to ergosterol; ergosterol is needed by the fungal cell wall.

Which corticosteroid is the treatment of choice for a patient with Addison disease

Fludrocortisone

Which corticosteroid is the treatment of choice for a patient with Addison disease?

Fludrocortisone

Which statement about fludrocortisone is accurate?

Fludrocortisone possesses both mineralocorticoid and glucocorticoid activity.

Before the administration of quinidine, the nurse will review the patient's medication list for which other drugs that can prolong the QT interval?

Fluoxetine Taking fluoxetine and quinidine concomitantly can prolong QT interval. CiprofloxacinTaking ciprofloxacin and quinidine concomitantly can prolong QT interval. Flecainide Taking flecainide and quinidine concomitantly can prolong QT interval. Ondansetron Taking ondansetron and quinidine concomitantly can prolong QT interval.

A 62-year-old patient has been prescribed fenofibrate and rosuvastatin for dyslipidemia. This patient also has type 2 diabetes managed with metformin and glipizide. Which teaching points will a nurse provide to ensure this patient safely and effectively receives therapy with fenofibrate?

Follow up with the health care provider for monitoring of lipids and liver function tests. Exercise, eat a diet low in cholesterol and fat, and log interventions in a lifestyle diary. Report any muscle pains, severe abdominal pain, or decreased urination to a health care provider immediately.

Which foods would the nurse advise patients on long-term fludrocortisone for Addison's disease to include in their diet? Foods rich in potassium Foods high in vitamin C Foods that are sugar-free Foods low in calcium and vitamin D

Foods rich in potassium

A nurse teaches a patient taking a monoamine oxidase inhibitor (MAOI) about important dietary restrictions. Which foods will the nurse caution the patient to avoid?

Foods that contain tyramine can produce a hypertensive crisis in individuals taking MAOI antidepressants. Many aged foods, such as cheese, contain tyramines. The other foods are not contraindicated while taking MAOIs, as they do not contain tyramine.

Class IV Antidysrhythmic Drugs determine baseline data

For all patients a thorough history and physical assessment should be conducted. History includes use of pharmacologic and nonpharmacologic therapies. Additionally, the nurse should evaluate the blood pressure and pulse rate and assess liver and kidney function by reviewing relevant laboratory data. Obtain a baseline ECG to compare periodically during the treatment. Obtain baseline weight.

The nurse is teaching the patient how to administer insulin. What information is essential to include in the plan? For the most consistent absorption, inject the insulin into the abdomen." "Avoid administering the insulin into your arm." "Inject the insulin at a 30-degree angle between the fat and muscle." "Do not mix any insulins in the same syringe."

For the most consistent absorption, inject the insulin into the abdomen." The abdomen has the most consistent absorption because the blood flow to the subcutaneous tissue typically is not as affected by muscular movements as it could be in the arm or thigh. Insulin can be administered in the arm. The patient should be instructed to inject insulin at a 45- to 90-degree angle, not a 30-degree angle. Most insulins can be mixed.

1, 2, 4, 5

Frequent sites of helminth infestation occur in which areas of the body? (Select all that apply.) 1 Intestine 2 Lymphatic system 3 Brain 4 Blood vessels 5 Liver

The nurse is caring for a patient who has congestive heart failure. The patient's medical history indicates that the patient has a history of chronic kidney disease with a low glomerular filtration rate. Which drug would the nurse anticipate to be prescribed for the patient?

Furosemide [Lasix] Furosemide [Lasix] is especially useful in patients with severe renal impairment, since, unlike the thiazides, the drug can promote diuresis even when renal blood flow and glomerular filtration rate (GFR) are low. The use of thiazides (metolazone or hydrochlorothiazide or methyclothiazide) is not effective with a low GFR.

The nurse is administering several different diuretics. Which drug will produce the most diuresis in a patient?

Furosemide [Lasix] Furosemide [Lasix] is the most potent diuretic. Drugs that act early in the nephron have the opportunity to block the greatest amount of solute reabsorption. Furosemide [Lasix] works at the loop of Henle; as a result, furosemide [Lasix] produces the greatest diuresis. Hydrochlorothiazide [Microzide] works on the early distal convoluted tubule so does not have the capacity to excrete as much sodium and water as a loop diuretic and is less effective. Triamterene [Dyrenium] and spironolactone [Aldactone] work at the distal nephron so do not have the ability to excrete as much sodium and water as loop diuretics.

A patient who has been taking digoxin for several months is now complaining about changes to vision. Which action would the nurse take?

Further inquire about the vision changes.

A patient who has been taking digoxin for several months is now complaining about changes to vision. Which action would the nurse take?

Further inquire about the vision changes. Vision changes may be normal in this patient, but digoxin can alter vision, such as seeing green, yellow, or purple halos. Therefore the nurse should inquire about the vision changes.

For which adverse response would the nurse monitor in a patient taking octreotide for acromegaly? Severe bone pain Anaphylaxis reaction Acute hypoglycemia Gallbladder dysfunction

Gallbladder dysfunction

Herbal preparations with Interactions with Class IV Antidysrhythmic Drugs

Ginkgo and ginseng inhibit the metabolism of Class IV antidysrhythmic drugs. Hawthorn causes increased cardiac action potential and prolonged QT interval. St. John's wort should be avoided concomitantly with Class IV antidysrhythmic drugs. St. John's wort decreases the bioavailability.

The nurse is preparing to administer an oral dose of digoxin [Lanoxin]. The apical pulse rate is 64. What nursing action is most appropriate?

Give the medication

Lesinurad must be ___

Given with a xanthine oxidase inhibitor such as allopurinol; it cannot be given alone

Which action facilitates cinacalcet absorption? Giving with meals Taking on an empty stomach Sublingual administration Using a skin patch

Giving with meals

A 58-year-old male patient is being initiated on gemfibrozil 600 mg PO twice daily for dyslipidemia management. He also takes glipizide for diabetes, hydrochlorothiazide and lisinopril for hypertension, simvastatin for dyslipidemia, and sildenafil for erectile dysfunction. Which medications that this patient is currently taking may interact with gemfibrozil?

Glipizide Simvastatin

Glucocorticoids vs corticosteroids

Glucocorticoids affect carbohydrate metabolism, and mineralocorticoids regulate electrolytes -(Gluco=glucose)

Which statement accurately describes corticosteroids?

Glucocorticoids affect carbohydrate metabolism, and mineralocorticoids regulate electrolytes.

Which laboratory test would give the most accurate evidence of a diabetic patient's treatment compliance and glucose management over the past few months?

Glycosylated hemoglobin (HbA1c) HbA1c indicates glucose concentrations over the past 3 to 4 months and thus demonstrates patient compliance and illness management over time. The serum albumin test helps to determine the level of natural protein in blood. The fasting serum glucose test helps to assess whether the patient has elevated blood glucose concentrations. A 2-hour postprandial blood glucose test determines the amount of glucose in the blood after a meal.

When teaching a patient about amiodarone, the nurse should advise the patient to avoid which food or drink?

Grapefruit juice Grapefruit juice can inhibit the metabolism of several antidysrhythmics, such as amiodarone, disopyramide, and quinidine. It is not necessary to restrict gluten, poultry, and whole milk from the patient's diet.

Which statement is accurate regarding the interaction between verapamil and grapefruit juice?

Grapefruit juice can inhibit the metabolism of verapamil.

In addition to treating primary growth failure, somatropin has therapeutic uses in which situations? Select all that apply. Growth failure caused by chronic renal failure Cachexia or wasting with AIDS Growth failure caused by thyroid hormone deficiency In cases in which an antiaging drug is desired Muscle building and athletic performance enhancement Growth enhancement in children with Turner syndrome

Growth failure caused by chronic renal failure Cachexia or wasting with AIDS Growth enhancement in children with Turner syndrome

A health care provider prescribes diltiazem 10 mg intravenous push for persistent atrial fibrillation with a ventricular rate of 115 beats/min. While preparing the diltiazem, the nurse notices the patient is on digoxin 0.125 mg and metoprolol 25 mg. Which action will the nurse take?

Hold the diltiazem. The nurse would hold the diltiazem until the prescription can be clarified with the health care provider. Giving diltiazem to a patient who is already taking digoxin and metoprolol could suppress the cardiac function and cause severe bradycardia, decrease atrioventricular conduction, and decrease cardiac contractility. Beta blockers and diltiazem should be administered several hours apart to minimize the risk of cardiosuppression.

Before administering diltiazem, the nurse observes the patient's pulse at 54 beats/min on the cardiac monitor. Which action will the nurse take next?

Hold the drug

Before administering diltiazem, the nurse observes the patient's pulse at 54 beats/min on the cardiac monitor. Which action will the nurse take next?

Hold the drug.

A nurse is preparing to administer a beta blocker to a patient who has the following vital signs: blood pressure 118/68 mm Hg; heart rate 54 beats/min; and respiratory rate 14 breaths/minute. Which action would the nurse take?

Hold the medication. Beta blockers lower heart rate and blood pressure. A heart rate of 54 beats/min is bradycardic. The nurse should hold the drug and then call the health care provider for further action.

A patient who is prescribed propranolol complains of swelling to the feet. Which action would the nurse take?

Hold the propranolol. Swelling of the feet could be an indication of heart failure. Propranolol can cause heart failure by blocking beta1 receptors. Heart failure is a contraindication for propranolol; therefore the nurse would hold the medicine and notify the health care provider.

A patient receiving calcitriol for low blood calcium is prescribed verapamil for hypertension. Which action would the nurse take? Monitor calcium blood levels before giving verapamil. Give both of the drugs as directed. Schedule the calcitriol for 0900 and verapamil for 2100. Hold the verapamil and notify the health care provider.

Hold the verapamil and notify health care provider (verpamil is a calcium channel blocker)

Hydralazine heart failure: adjunct therapy

Hydralazine is also available as a combination drug in a tablet also containing isosorbide dinitrate (a vasodilator). This combination is sold as BiDil. It is used primarily as adjunct therapy in treatment of heart failure in African American patients.

A patient is admitted to the emergency department with acute adrenal crisis. Which drug would the nurse anticipate administering? Fludrocortisone Pasireotide Hydrocortisone Metyrapone

Hydrocortisone

The nurse is reviewing the home medication list with the patient. The nurse should recognize that hydrochlorothiazide is used primarily for which condition?

Hypertension The primary indication for hydrochlorothiazide is hypertension, a condition for which thiazides are often the drugs of first choice. Hydrochlorothiazides are also used for edema, diabetes insipidus, and protection against postmenopausal osteoporosis, but the primary indication is hypertension.

Which condition is an absolute contraindication to the administration of thyroid replacement preparations? Pregnancy History of diabetes Hypertension Hyperthyroidism

Hyperthyroidism

A nurse is reviewing laboratory results on a patient who is taking oral digoxin. Which electrolyte imbalance would the nurse associate with digoxin toxicity?

Hypokalemia

Which changes in laboratory values can occur while taking fludrocortisone? Hypoglycemia Hyponatremia Hypokalemia Hypocalcemia

Hypokalemia

A nurse is reviewing laboratory results on a patient who is taking oral digoxin. Which electrolyte imbalance would the nurse associate with digoxin toxicity?

Hypokalemia Hypokalemia enhances the risk of cardiotoxicity caused by digoxin.

Digoxin serum electrolytes

Hypokalemia and hypomagnesemia may precipitate digitalis toxicity.

The nurse provides care for a patient who receives lidocaine by spinal injection. Which nursing intervention is most important when caring for this patient?

Hypotension is the most significant complication with spinal anesthetics. Monitoring the blood pressure is an essential nursing intervention. Supine positioning is required for only spinal injections, not epidural injections. A double tourniquet is used for regional anesthesia. Hypertension is not an anticipated outcome.

Corticosteroid levels are regulated by ___

Hypothalamic-Pituitary-Adrenal (HPA) axis -negative feedback system -corticosteroids are produced as they are needed and are not stored for later use

Which statement made by Ms. Sanders indicates a good understanding of the adverse effects of hydrocortisone and fludrocortisone therapy? "As my condition improves, I can decrease my dose." "These medicines have very few side effects when used as directed." "I must have my blood checked regularly to assess for side effects of my medication." "I must have my cholesterol checked regularly to assess for side effects of my medication."

I must have my blood checked regularly to assess for side effects of my medication

Which statement by the patient indicates an understanding of taking hydrocortisone as replacement therapy for Addison's disease? "I must take this medication on a daily basis as instructed." "This medication is intended to cure my Addison's disease over time. "My health care provider will taper my dose over 1 to 2 weeks before stopping it completely." "My health care provider will allow me to stop taking the medicine as soon as I feel better."

I must take this medication on a daily basis as instructed

A patient is being discharged 2 days after being treated with alteplase for acute myocardial infarction (MI). Which statement made by the patient indicates a need for additional teaching?

I will need to continue to shave with an electric razor

A patient with a mechanical heart valve has been taking warfarin. The patient tells the nurse that vegetables and fruits have been added to the diet. Which effect will most likely occur with the increase in fruit and vegetable intake?

INR will decrease

A nurse is preparing to administer alteplase. The nurse would gather equipment knowing that alteplase would be administered by which route?

IV

Hydralazine hypertensive crisis

IV administration reserved for a hypertensive crisis as an alternative agent with a dose of 10 to 20 mg every 4 to 6 hours.

A patient is admitted to the emergency department with a blood pressure of 222/110 mm Hg. For which reason would the nurse anticipate intravenous (IV) beta blocker administration?

IV beta blockers have immediate effects

Administration of adenosine

IV push should be administered undiluted and rapidly (over 1 to 2 sec). Before administering adenosine, flush the IV line with 0.9% NaCl to prevent precipitation of particulate matter. Flush with 20 mL 0.9% NaCl after the rapid IV bolus.

Hydrocortisone is prescribed to a patient newly diagnosed with Addison's disease. When reviewing current medications taken by the patient, the nurse is aware that hydrocortisone could increase the action of which drugs? Select all that apply. Ibuprofen, a nonsteroidal antiinflammatory drug, for pain Omeprazole, an H2 receptor antagonist Alendronate, a bisphosphonate, for osteoporosis Metformin, an antidiabetic drug Simvastatin, a statin or HMG CoA reductase inhibitor, for hyperlipidemia Furosemide, a loop diuretic

Ibuprofen, a nonsteroidal antiinflammatory drug, for pain Metformin, an antidiabetic drug Furosemide, a loop diuretic

Before administering adenosine, the nurse should do the following:

Identify the dysrhythmia. Assess apical pulse and blood pressure. Determine whether specific symptoms are present and whether the symptoms are related to tachydysrhythmias.Assess the patient's symptoms.Determine whether the patient is stable.Determine whether the rhythm is regular or irregular.Assess whether the QRS complex is narrow or wide.Determine whether the patient is in sinus tachycardia, supraventricular tachycardia, or atrial fibrillation with rapid ventricular response (RVR). Assess for altered mental status, continuing chest pain, hypotension, or other signs of shock.

Which teaching points would a nurse share with a patient newly prescribed the ethinyl estradiol plus etonogestrel vaginal ring (NuvaRing®) who has never received hormonal contraception before?

If it is expelled during treatment weeks, it may be washed off with warm water and reinserted. She should vaginally insert the ring between day 1 and day 5 of the menstrual cycle, even if she is bleeding. The ring should be replaced every 3 weeks, removing for 1 week at the end of this time frame before inserting a new one. If the ring is expelled for more than 3 hours during week 1 or 2 of use, she should reinsert the ring and use backup contraception for 7 days.

A patient with Addison's disease is upset about weight gain and wants to stop taking hydrocortisone and fludrocortisone. Which response would the nurse make? "Weight gain is a side effect of the medication. You may need to seek counseling." "It is fine to stop taking your medicine as long as you carefully monitor your glucose levels." "If you stop taking the medications, you may have severe side effects." "Begin to taper your dosage and check with your health care provider about an exercise program that you can begin."

If you stop taking the medications, you may have severe side effects

A nurse is caring for a patient who has been prescribed clomiphene citrate for infertility. The patient also takes methyldopa for hypertension. Which outcome would a nurse anticipate may come from the drug interaction between methyldopa and clomiphene citrate?

Impaired fertility due to an increase in prolactin

A child has an infestation of scabies. Which area should the nurse assess first when evaluating for improvement of the condition?

In children, scabies is most likely to appear on the head, neck, and buttocks. In adults, the most common sites of infestation are the wrists, elbows, nipples, navel, genital region, and webs of the fingers.

Sodium Nitroprusside metabolism

In the liver

Which phrase describes the action of desmopressin? Increases water reabsorption in kidney collecting ducts Regulates blood pressure by direct vasodilation Promotes elimination of sodium and water Increases thirst and promotes intake of water

Increases water reabsorption in kidney collecting ducts

Which is the most appropriate action for the nurse who is told that a patient typically takes his glipizide (Glucotrol) with food? Immediately check the patient's blood glucose level. Inform the patient that it is better to take the medication 30 minutes before a meal. Inform the patient that the medication must be taken 15 minutes after a meal. Immediately call the health care provider.

Inform the patient that it is better to take the medication 30 minutes before a meal. Food inhibits the absorption of glipizide (Glucotrol), the only sulfonylurea agent that should be given 30 minutes before a meal. The blood glucose level does not have to be taken right away. The medication is not to be taken after a meal. The health care provider does not have to be called; the nurse should intervene.

A patient receiving the adrenergic medication clonidine [Catapres] reports experiencing dry mouth. What should be included in the plan of care for this patient?

Inform the patient that these are common adverse effects of the medication. Dry mouth is one of the most common adverse effects of adrenergic medications such as clonidine so the patient should be made aware of this. Restricting dietary fiber intake, limiting fluids, and incorporating a psyllium-based product in the patient's diet will not help with the complaint of dry mouth.

A patient who is treated with zidovudine develops blistering rashes, fever, and myalgia. What should the nurse do first? 1 Ask the patient to take bed rest. 2 Administer antipyretic medications. 3 Administer antihistamine medications. 4 Inform the primary health care provider.

Inform the primary health care provider.

A patient has been prescribed acyclovir. What precautionary measure should the nurse implement to minimize kidney damage associated with this drug? 1 Use the solution within 24 hours 2 Infuse acyclovir over at least 1 hour 3 Provide ice chips during the infusion 4 Assess the intravenous site frequently for redness

Infuse acyclovir over at least 1 hour - As a means of reducing the risk of crystalluria and renal tubule damage, the nurse infuses acyclovir over at least 1 hour, because renal damage is associated with too rapid infusion of this drug.

Which phrases accurately describe gemfibrozil's mechanism of action?

Inhibition of hepatic triglyceride synthesis Suppression of free fatty acid release from adipose tissue Activation of peroxisome proliferator-activated receptor-alpha in the liver

Which description of clomiphene citrate's mechanism of action is accurate?

Inhibits estrogen receptors in the hypothalamus and pituitary gland to secrete more FSH and LH to stimulate ovulation

Which phase describes the action of octreotide drug therapy? Inhibits growth hormone release Normalizes urine output Promotes normal blood pressure Mimics action of growth hormones

Inhibits growth hormone release

Vasodilators general teachings

Instruct patients that it may take 1.5 to 3 months for a desired therapeutic response to occur with PO medications. Teach patients to stop smoking because smoking increases vasospasm. Inform patients who take minoxidil for more than 4 weeks that excessive hair growth may develop on legs, face, arms, and back.

Vasodilators diet

Instruct patients to take medication with meals if gastrointestinal (GI) problems occur. Inform patients not to consume alcohol while taking a vasodilator because a hypotensive reaction may occur.

A female patient with Addison's disease has started taking fludrocortisone in addition to hydrocortisone. She calls the clinical nurse to report feet swelling and a headache. Which action should the nurse take? Reassure the patient that this is an expected response to drug. Encourage the patient to rest with feet elevated for about an hour. Instruct the patient to come to the clinic for further evaluation. Advise the patient to hold the drug and wait 24 hours before resuming.

Instruct the patient to come to the clinic for further evaluation

A nurse is required to administer propranolol to a patient for the treatment of heart failure. The nurse checks the patient's apical pulse rate and blood pressure before administration of the drug and observes that the pulse rate is below 60 bpm. What nursing intervention should the nurse perform in this case? A. provide proper ventilation to the patient B. provide oxygen support to the patient C.delay drug administration for some time D.withhold the drug administration and contact the provider

D

A patient with a history of elevated triglycerides and LDL cholesterol begins taking nicotinic acid. The patient reports uncomfortable flushing of the face, neck, and ears when taking the drug. What will the nurse advise the patient? A.Ask your provider about taking an immediate-release form of the medication. B.Ask your provider about assessing your serum uric acid levels which may be elevated C.You should stop taking the Niacin immediately since this is a serious adverse effect. D.You should take 325 mg of aspirin a half hour before each dose of Niacin to prevent this effect

D

The nurse is working in the emergency department when a patient with a head injury develops increased intracranial pressure. Which drug would the nurse anticipate administering?

Mannitol [Osmitrol] Intracranial pressure (ICP) that has been elevated by cerebral edema can be reduced with mannitol [Osmitrol]. The drug lowers ICP because its presence in the blood vessels of the brain creates an osmotic force that draws edematous fluid from the brain into the blood. Metolazone [Zaroxolyn] and hydrochlorothiazide [Microzide] are thiazide-like diuretics; spironolactone [Aldactone] is a potassium-sparing diuretic; they are of little benefit in reducing cerebral edema.

A patient of Asian descent was prescribed chloroquine. Which action by the nurse would be appropriate?

Many Asian persons have increased risk of ocular disease while taking chloroquine

Digoxin interaction with verapamil, quinidine, amiodarone, dronedarone , cyclosporine, azole antifungals

Mechanism: Decrease clearance Result: Digoxin levels increased by 50%; digoxin dose should be reduced by 50%Amiodarone may increase concentration/toxicity

Digoxin interaction with potassium- depleting diuretics

Mechanism: Excrete fluid and electrolytes in urine Result: Increased digoxin toxicity

Digoxin interacts with antidysrhythmic calcium (IV)

Mechanism: Increase cardiac irritability Result: Increased digoxin toxicity

Which hormonal contraceptive has the longest elimination half-life?

Medroxyprogesterone acetate injection (Depo Provera®)

The nurse has just administered the initial dose of enalapril [Vasotec] to a newly admitted patient with hypertension. What is the priority nursing intervention over the next several hours?

Monitor blood pressure. First-dose hypotension is a serious potential adverse effect of angiotensin-converting enzyme (ACE) inhibitors such as enalapril [Vasotec]. Monitoring the blood pressure is the priority nursing intervention. If hypotension develops, the nurse will place the patient in the supine position and possibly increase intravenous fluids. The other interventions may be appropriate for this patient; however, in the hours immediately after the first dose of an ACE inhibitor, monitoring of the blood pressure is most important.

The healthcare provider prescribes an intravenous dose of diltiazem [Cardizem] for treatment of a patient with atrial fibrillation. What is the priority nursing intervention?

Monitor electrocardiogram. Monitor the electrocardiogram (ECG) continuously during intravenous (IV) administration of diltiazem [Cardizem] for atrioventricular (AV) block, sudden reduction in heart rate, and prolongation of the PR or QT interval. Cardioversion is not necessary; however, the nurse should have equipment for cardioversion available. Baseline laboratory studies are needed for liver and kidney function. Increased urinary output is not an adverse effect of diltiazem [Cardizem].

The nurse is administering intravenous lidocaine [Xylocaine] to a patient with a ventricular dysrhythmia. Which is the priority nursing intervention to prevent a potential complication with this drug?

Monitor the electrocardiogram (ECG). Continuous electrocardiogram (ECG) monitoring is required during lidocaine [Xylocaine] infusions to evaluate cardiac response and adjust dosage accordingly and detect toxicity. Blood counts are not necessary, because lidocaine [Xylocaine] is not linked to blood dyscrasias. Preferably Lidocaine [Xylocaine] is given intravenously (IV) rather than intramuscularly (IM). Sudden onset of chest pain is a sign of arterial embolism, which is a possible adverse effect of quinidine, not lidocaine [Xylocaine]. Naloxone [Narcan] is a reversal agent for opioids and is not used with lidocaine [Xylocaine].

Which classes of drugs are used in the treatment of angina pectoris? Select all that apply.

Nitrates Beta Blockers Calcium Channel Blockers Nitrates and nitrites minimize the frequency of angina attacks by dilating all blood vessels. Beta blockers are effective after a myocardial infarction to minimize the negative effects of catecholamines. Calcium channel blockers help decrease the afterload and reduce the workload of the heart. Diuretics are not prescribed for the treatment of angina pectoris but to increase the patient's fluid output. Antihistamines are used to reduce the physiologic and pharmacologic effects of histamine.

Which value indicates the effectiveness of levothyroxine? Increased heart rate Normal calcium levels Normal thyroid stimulating hormone (TSH) and T4 Decreased respiratory rate

Normal thyroid stimulating hormone (TSH) and T4

Digoxin cardiac system

Note history of dysrhythmias, hypotension, abnormal heart sounds, or abnormal ECG findings.

A patient who has a pulmonary embolism is prescribed alteplase. The review of the patient history reveals an ischemic stroke 4 months ago. Which action would the nurse take?

Notify the health care provider

The health care provider is considering prescribing a patient ritonavir. The patient tells the nurse about recently being diagnosed with type 2 diabetes mellitus. What is the nurse's highest priority action? 1 Instruct the patient to keep an accurate glucose log. 2 Notify the health care provider of the new information. 3 Instruct the patient to monitor blood sugars more often. 4 Notify the pharmacist that a larger dose will be needed.

Notify the health care provider of the new information. - The health care provider should be notified of this new information. Patients with diabetes mellitus or hyperglycemia may experience an exacerbation of their condition during ritonavir treatment.

A patient has been receiving subcutaneous heparin every 12 hours. The patient is scheduled to have a lumbar puncture at 0900. Which action is the nurse's priority?

Notify the health care provider the patient is receiving heparin. The health care provider needs to know when the patient last received heparin. Heparin therapy is contraindicated in patients who will be undergoing a lumbar puncture. The patient is at increased risk for bleeding due to heparin, and hematoma can develop during or after the puncture.

A nurse is preparing to administer clopidogrel and aspirin to a patient who has an altered CYP2C19 gene. Which action would the nurse take?

Notify the health care provider. Nurses would identify high-risk patients for potential complications from drugs. Patients with an altered CYP2C19 gene are poor metabolizers of clopidogrel, which places them at higher risk for complications; therefore the nurse would contact the health care provider to verify the prescription.

The nurse is caring for a patient who is scheduled to begin treatment with carvedilol [Coreg]. While updating the history, the patient tells the nurse that he experiences frequent attacks of asthma. What is the nurse's highest priority action?

Notify the healthcare provider of this information. Carvedilol [Coreg] should be used with caution in patients with a history of asthma. The priority for the nurse is to notify the healthcare provider of this information.

The laboratory calls to report a drop in the platelet count to 90,000/mm3 for a patient receiving heparin for the treatment of postoperative deep vein thrombosis (DVT). Which action by the nurse is the most appropriate?

Notify the healthcare provider to discuss the reduction or withdrawal of heparin. The nurse should notify the healthcare provider to discuss the reduction or withdrawal of heparin. Heparin-induced thrombocytopenia (HIT) is a potential immune-mediated adverse effect of heparin infusions that can prove fatal. HIT is suspected when the platelet counts fall significantly. A platelet count below 100,000/mm3 would warrant discontinuation of the heparin.

A nurse is caring for a patient who is taking an angiotensin-converting enzyme (ACE) inhibitor and develops a dry, nonproductive cough. What is the nurse's priority action?

Notify the healthcare provider. Angiotensin-converting enzyme inhibitors prevent the breakdown of bradykinin, frequently causing a nonproductive cough. Angiotensin-receptor blocking agents do not block this breakdown, thus minimizing this annoying side effect. The healthcare provide should switch the patient to a different medication if the side effect cannot be tolerated.

Which instruction will be included in the discharge teaching for a patient with a transdermal nitroglycerin patch?

"Apply the patch to a hairless, nonfatty area of the upper torso or arm." A nitroglycerin patch should be applied to a hairless, nonfatty area for the best and most consistent absorption rates. The sites should be rotated to prevent skin irritation. Headache is a brief side effect of the therapy, but it soon diminishes. Nitroglycerin [Nitro-Bid] is administered via the sublingual route to relieve chest pain.

A patient who is being discharged on diltiazem tells the nurse that cooking with herbs and taking supplements has improved the patient's physical stamina. Which response by the nurse is appropriate?

"Certain supplements can alter the therapeutic effects of diltiazem."

The nurse is providing education to a patient who is being discharged on valsartan. Which patient responses indicate that more education is required?

"Which one of those medications is for my blood pressure?" "I have to take it with food or it won't work." "I take it only when my blood pressure is over 180/80 mm Hg."

pyrantel pamoate

- active against intestinal nematodes (roundworms) - causes spastic paralysis of intestinal parasites - GI reactions and possible CNS effects

ivermectin

- active against many nematodes (roundworms) - only 2 approved uses in the U.S - Also used to kill mites and lice MOA: disrupts nerve traffic and muscle function SE: Mazotti reaction - pruritus, rash, fever, bone joint pain, and lymph node tenderness Should be avoided during pregnany

enterobiasis (pinworms)

- at night they try to come out of anal area - intense itching

benzyl alcohol

- used as topical treatment of head lice in patients 6 months and older - first and only drug that kills lice by suffocation - no effect on ova - must be applied twice

By which mechanisms does amphotericin B induce its therapeutic effects?

-Binds to fungal cell wall -Increases cell wall permeability -Causes fungal intracellular contents to leak out of the cell

Which categories can be used for classifying glucocorticoids?

-Duration of action -Route of administration -Natural versus synthetic analog -Potential for sodium and water retention

Which categories can be used for classifying glucocorticoids?

-Duration of action -Route of administration -Natural vs synthetic analog -Potential for sodium and water retention

Which statements describe the therapeutic uses of aspirin?

-Dysmenorrhea -Fever -Inflammation -Pain -Platelet aggregate inhibitor

Which antiseptics should the nurse choose to prepare intact skin before an invasive procedure? Select all that apply.

-Ethanol (ethyl alcohol) -Povidone-iodine [Betadine] -Chlorhexidine gluconate [Hibiclens]

Colchicine MOA

-Given for gout -inhibits microtubule assembly to block activation of the inflammasome, a key player in the activation of the inflammatory process -also blocks the chemotaxis (chemical attraction to the inflammatory site) of microtubule-base inflammatory cells

Which statement represents a treatment goal during all phases of HIV disease? Select all that apply.

-Improved quality of life -Reduction of sexual HIV transmission -Restoration or preservation of immune function -Reduction of HIV-related morbidity and mortality

Which side/adverse effects and/or laboratory results would a nurse monitor for while a patient is receiving fludrocortisone?

-Swelling in extremities -Hyperglycemia -Hypertension -Decreased bone mineral density

A nurse discovers that a patient has a cardiac output of 5 L/min. What else should the nurse assess to determine cardiac output besides stroke volume? 1 Heart rate 2 Blood pressure 3 Cardiac preload 4 Cardiac afterload

1

The nurse is caring for a patient who takes an angiotensin-converting enzyme (ACE) inhibitor. If the patient develops a persistent nonproductive cough, what should the nurse do?

Notify the provider of the new development. Angiotensin-converting enzyme (ACE) inhibitors prevent the breakdown of bradykinins, frequently causing a nonproductive cough. The patient should be switched to a different medication if the side effect cannot be tolerated. The cough will not subside in a few days. This is not a sign of infection but is a known side effect of ACE inhibitors. Medications will not make the cough subside.

Which antifungal is applied topically for candidal diaper rash?

Nystatin

Ivermectin, 15, 5

ONLY ORAL medication for ectoparasitic infestation (off-label use - has not gone through FDA approval for infestation) Disrupts nerve and muscle function of parasite Highly effective against adult lice and mites Not for patients under ___kg or ___ yrs

An older female patient admitted to the hospital with fatigue, weight loss, and lack of appetite states that she has not been taking the prescribed calcitriol. Her serum calcium level 8.3 mg/day. Which focused assessment should the nurse complete? Compare the results of a standing and lying blood pressure. Use a pen light to check pupil dilation and accommodation. Check for nonpitting edema in the lower extremities. Observe for hand spasms when taking the blood pressure.

Observe for hand spasms when taking the blood pressure

Which medication is most likely to cause constipation? 1. Diltiazem 2. Isradipine 3. Nifedipine 4. Amlodipine

1. Diltiazem (Calcium channel blockers (CCBs) also block calcium channels in intestinal smooth muscles, decreasing motility and causing constipation. Nifedipine, amlodipine, and isradipine, which are dihydropyridine CCBs, cause less risk of constipation than diltiazem and verapamil.)

A patient asks the nurse why dronedarone needs to be taken with food. The nurse responds knowing that bioavailability of dronedarone is at which level without food?

4%

Duration of action of ibuprofen

4-6 hours

A patient taking propranolol complains of dizziness when getting out of bed. Which action would the nurse take first?

Obtain blood pressure and heart rate. Propranolol has a negative chronotropic property to the heart and reduces the workload of the heart. Bradycardia and hypotension can occur. The nurse must first assess the patient, which should include blood pressure and heart rate on a patient who is taking propranolol. The dosage may need to be changed or switched to another beta blocker.

A patient taking hydrocortisone therapy reports muscle twitching and cramps. Which intervention would the nurse take? Obtain calcium level. Obtain potassium level. Assess for symptoms of withdrawal. Ask when drug was last taken.

Obtain calcium level

How many days does it take for platelet aggregation to return to baseline once clopidogrel is discontinued?__ days

5 days

A nurse is caring for a patient who is receiving 4 mg of intravenous methylprednisolone. What equivalent dose of prednisone in milligrams would this patient receive at discharge?

5 mg

Diltiazem distribution

70-80% protein bound

Pharmacodynamic Profile hydralazine

Onset: PO 20 to 30 min; intramuscular (IM) 10 to 30 min; IV 5 to 30 min Peak: PO 1 to 2 hr; IM 1 hr; IV 10 to 80 min Duration: PO 2 to 4 hr; IM 2 to 6 hr; IV up to 12 hr Half-life: 3 to 7 hr

Pharmacodynamic Profile Minoxidil

Onset: PO 30 min Peak: 2 to 3 hr Duration: 48 to 120 hr Half-life: 4.2 hr

Which patients does a nurse determine cannot safely receive treatment with the ethinyl estradiol plus etonogestrel vaginal ring (NuvaRing®)?

A 36 year old with hepatitis A A 37 year old with complicated mitral valve prolapse A 36 year old who smokes one pack of cigarettes per day

Which patient cannot safely receive therapy with fludrocortisone?

A 40-year-old patient with pulmonary aspergillosis

Which patients would a nurse determine can safely receive treatment with a statin in the absence of any other factors?

A 48-year-old patient with hyperthyroidism A 55-year-old patient with type 2 diabetes mellitus

3 (Assess first. Amiodarone can be absorbed in fat and manifest as a bluish discoloration. Before assuming the client is cyanotic, the nurse should fully assess the client. If the client's assessment findings are consistent with hypoxia, the next steps include oxygen application, notifying the HCP, and possible crash cart retrieval. )

A client visiting the clinic has been taking amiodarone for several months. The nurse observes a bluish discoloration in the client's skin. What is the nurse's first action? 1 Call for crash cart. 2 Apply non-rebreather oxygen mask. 3 Apply pulse oximeter. 4 Call the healthcare provider.

4

A nurse should teach a patient who has pediculosis that which item poses a safety hazard when used with the medication malathion [Ovide]? 1Shampoo 2 Straight razor 3 Nylon clothing 4 Hair dryer

Which are the primary regulatory systems of arterial pressure? Select all that apply. A Renal system B Pulmonary system C P450 enzyme system D Autonomic nervous system E Renin-angiotensin-aldosterone system

A, D, E

A patient who is prescribed lisinopril asks the nurse," Will this drug help the swelling in my legs?" Which nursing response is appropriate? A. "Lisinopril may help the edema from progressing, as this drug suppresses aldosterone, Which promotes sodium and water excertion." B. "Lisinopril has little effect on the renin-angiotensin-aldosterone system, so it won't help edema. " C. "Lisinopril blocks the release of aldosterone so it could make the edema worse." D. "Lisinopril is used for HTN, and does not affect fluid balance."

A. ( Lisinopril does suppress the release of aldosterone, Which promotes sodium and water excretion. With an increase in sodium and water excretion, the edema Should not progress, however, a diuretic may still be required in conjunction with the angiotensin-converting enzyme (ACE) inhibitor

The nurse is caring for a patient who has been receiving intravenous sodium nitroprusside [Nitropress] for 3 days. Which assessment data indicate the patient may be experiencing thiocyanate toxicity? A. Sudden confusion B. Difficulty breathing C. Erythematous rash D. Gastrointestinal bleeding

A. Sudden confusion When nitroprusside is given for several days, thiocyanate may accumulate, which can cause adverse effects. These effects, which involve the central nervous system (CNS), include disorientation, psychotic behavior, and delirium. Difficulty breathing, erythematous rash, and gastrointestinal bleeding are not adverse effects related to thiocyanate toxicity.

Verapamil peak

PO IR: 1-2hr PO ER:5-11 hr IV: 5 min

Diltiazem half life

PO IR: 3.3-5 hr PO ER: 5-10 hr IV: 3-4 hr (single dose)

Diltiazem Duration

PO IR: 4-12 hr PO ER: N/A IV: variable

The nurse is preparing to administer unfractionated heparin to three patients. Which patient would the nurse be most concerned about when administering heparin?

Patient with activated thromboplastin time (aPTT) value of 98 seconds The nurse will be concerned about this patient. An aPTT value of 98 seconds is above the therapeutic range. Normal aPTT value is 25 to 38 seconds. With heparin, the aPTT value should be 1.5 to 2 times the normal range. Ninety-eight seconds is more than twice of the upper limit of 76 seconds. The nurse should not administer heparin.

Vasodilators Identify High-Risk Patients

Patients on vasodilators have a high fall risk due to the risks associated with decreased blood pressure and orthostatic hypotension. Education and safety interventions should be implemented. Older adults are particularly susceptible to the effects of vasodilators, especially hypotension, dizziness, and syncope.

A nurse is developing a plan of care for a patient with Addison's disease who is taking hydrocortisone. Which intervention is of the highest priority for this patient's care plan?

Patients with adrenal insufficiency require lifelong replacement doses of glucocorticoids. Failure to increase the dosage at times of stress and illness can be life threatening. Wearing a medical ID bracelet, carrying injectable and oral forms of glucocorticoid, and dividing the daily glucocorticoid dose are important for a patient taking hydrocortisone, but they are not priorities over understanding the need to increase the dose during times of stress.

During the assessment of a pregnant patient, a nurse finds that the patient has active genital herpes lesions. What is the best strategy to prevent the spread of infection to the newborn? 1 Administering folic acid supplements to the patient 2 Performing a cesarean section for the patient during labor 3 Delivering the child during the eighth month of pregnancy 4 Administering intravenous antiviral medications to the patient

Performing a cesarean section for the patient during labor

The use of dronedarone is contraindicated in patients with which condition?

Permanent atrial fibrillation Dronedarone is contraindicated in patients who have permanent atrial fibrillation and severe, decompensated heart failure.

Which drug would the nurse administer to a 4-month-old patient with lice?

Permethrin can be used for patients 2 months and older. Spinosad can be used for patients at least 4 years old. Malathion can be used for patients at least 6 years old. Benzyl alcohol can be used for patients at least 6 months old.

Which characteristic of cancer cells can be described as "unresponsiveness to feedback mechanisms that control cellular growth in healthy tissue?"

Persistent proliferation

Which adverse effect can occur if amiodarone is diluted to a concentration of more than 2 mg/mL for intravenous administration?

Phlebitis Concentrations of amiodarone greater than 2 mg/mL can cause peripheral vein phlebitis.

A patient who has been admitted for a hypertensive crisis is prescribed hydralazine. Which nursing intervention is the priority?

Place a fall-risk armband on the patient

A patient who has been admitted for a hypertensive crisis is prescribed hydralazine. Which nursing intervention is the priority?

Place a fall-risk armband on the patient.

Which concerns would the nurse address when teaching patients about long-term hydrocortisone therapy for Addison's disease? Select all that apply. Potential infections Drug interactions Weekly blood draws Medication compliance Significant diet restrictions

Potential infections Drug interactions Medication Compliance

A patient has been newly prescribed theophylline for asthma management. In addition to theophylline, the patient is also receiving prednisone. Which drug interaction between theophylline and prednisone does a nurse anticipate for this patient?

Prednisone will interact with theophylline, causing decreased effects of prednisone

A patient has been newly prescribed theophylline for asthma management. In addition to theophylline, the patient is also receiving prednisone. Which drug interaction between theophylline and prednisone does a nurse anticipate for this patient?

Prednisone will interact with theophylline, causing decreased effects of prednisone.

The nurse is about to administer fluconazole to a young adult for vulvovaginal fungal infection. Which priority assessment is needed?

Pregnancy test - fluconazole is contraindicated in pregnancy

A patient who is hospitalized following a planned orthopedic surgery has been taking a routine dose of lisinopril since the operative day. What action will the nurse take when a sudden onset of facial swelling is noted?

Prepare to administer epinephrine subcutaneously ( Sudden facial swelling associated with the use of an angiotensin-converting enzyme (ACE) inhibitor indicates the onset of angioedema, a serious adverse effect of the drug. Epinephrine is administered subcutaneously emergently to manage the symptoms

A patient who is hospitalized following a planned orthopedic surgery has been taking a routine dose of lisinopril since the operative day. Which action will the nurse take when a sudden onset of facial swelling is noted?

Prepare to administer epinephrine subcutaneously.

A nurse is preparing clopidogrel for several patients. Patients with which conditions should receive the drug?

Prevention of thrombosis Acute coronary syndrome Coronary artery stents

Which drug would the nurse anticipate administering to a patient diagnosed with malaria?

Primaquine, with or without antibiotics

What should the nurse assess in a patient who is prescribed metformin [Glucophage] for treatment of type 2 diabetes?

Renal function As metformin [Glucophage] is excreted by the kidneys, it is necessary to assess the patient's renal function. If the patient's kidneys are not able to excrete the drug, it will accumulate in the patient's system, thereby causing lactic acidosis. One of the adverse effects of metformin [Glucophage] is weight loss, not weight gain. Headaches are not caused by metformin [Glucophage]. Cholesterol levels may be high in some diabetic patients but can be treated with medications and lifestyle changes.

Place the steps of the renin-angiotensin-aldosterone system (RAAS) in order.

Renin forms angiotensin I. Angiotensin-converting enzyme converts angiotensin I to angiotensin II. Angiotensin II, a potent vasoconstrictor, triggers the adrenal cortex to secrete aldosterone. Aldosterone enhances excretion of potassium and resorption of sodium and water in the kidneys, increasing blood volume. NOT SURE

Which phrase describes the therapeutic goal of desmopressin drug therapy? Promoting diuresis Restoring fluid balance Relieving urinary retention Constricting blood vessels

Restoring fluid balance

A patient receiving amphotericin B would be instructed to immediately report which adverse effect of the medication?

Ringing of the ears -Amphotericin B is associated with ototoxicity

The stool reports of a patient confirm gastroenteritis. Which viral infection should the nurse suspect the patient to have? Select all that apply. 1 Rotaviruses 2 Adenoviruses 3 Papovaviruses 4 Hepadnaviruses 5 Norwalk-like viruses

Rotaviruses Norwalk-like viruses

The nurse assesses an adult patient in the primary care clinic. Which symptom, if exhibited by the patient, should the nurse associate with scabies infestation?

Scabies (mites) causes irritation when the female mite burrows beneath the skin at the wrists, elbows, nipples, navel, genital area, and webs of the fingers. Reddened scalp and skin ulcerations are unrelated to any type of ectoparasitic infestation. Visible nits on hair shafts are seen with head lice infestation.

albendazole

Second choice for helminthic infections: ____________ Many cestode and nematode parasites Inhibits uptake of glucose Poorly absorbed - absorbed better with HIGH FAT MEAL Generally well tolerated 16% mild to moderate liver impairment Bone marrow suppression Teratogenic

While administering lidocaine, the nurse will monitor for which adverse drug effect?

Seizure

Celecoxib MOA

Selective COX-2 inhibitor

A child is receiving somatropin for growth failure. During follow-up visits, which data would the nurse monitor? Select all that apply. Blood glucose level for hypoglycemia Serial changes in height and weight chart Blood calcium levels for hypocalcemia Presence of antirecombinant human growth hormone (anti-rhGH) antibodies Thyroid levels for hypothyroidism Side effects of therapy reported by family.

Serial changes in height and weight chart Presence of antirecombinant human growth hormone (anti-rhGH) antibodies Thyroid levels for hypothyroidism Side effects of therapy reported by family.

The nurse is teaching a class on angiotensin receptor blockers (ARBs). What would the nurse include in the teaching?

ARBs lower blood pressure by preventing vasoconstriction. ARBs prevent angiotensin II from stimulating the release of aldosterone. ARBs can prevent angiotensin II from inducing structural changes to the heart. ARBs are generally well absorbed. Valsartan crosses the placenta and can cause fetal death.

4

According to recommendations from the American Academy of Pediatrics (AAP), if resistance is not suspected, the treatment of choice for lice is what? 1 Malathion 2 Benzyl alcohol 3 Ivermectin 4 1% permethrin

The nurse is preparing to administer a loading dose of digoxin to a patient in atrial fibrillation with a heart rate of 130 beats/minute. Which statement describes the rationale for the loading dose?

Achieve therapeutic effect of Digoxin more quickly

Which action describes how fludrocortisone raises the blood pressure in persons with Addison's disease? Acts as a pressor on blood vessels Increases sodium elimination Increases thirst and water intake Decrease cortisol levels in the blood

Acts as a pressor on blood vessels

A cancer patient who is on chemotherapy reports severe nausea and vomiting. Which action would be most beneficial to the patient?

Administer ondansetron [Zofran].

Which action would the nurse take when administering extended-release niacin?

Administer with food to maximize bioavilability

The nurse is preparing to administer methylphenidate to the child admitted to the pediatric unit after breaking a leg when jumping off the garage roof at home. Where will the nurse find the medication? A)In the patient's drawerB)In the refrigeratorC)At the patient's bedsideD)In the controlled substance cabinet

Ans:D Feedback: Methylphenidate is a controlled medication due to risk for physical and psychological dependence. As a result, the drug would be found in the controlled substance cabinet.

A 72-year-old patient presents at the emergency department with respiratory depression and excessive sedation. The family tells the nurse that the patient has been taking medication throughout the evening. The nurse suspects benzodiazepine overdose and would expect what drug to be ordered? A)Valium B)Phenergan C)Hydroxyzine D)Flumazenil

Ans:D Feedback: Toxic effects of benzodiazepines include excessive sedation, respiratory depression, and coma. Flumazenil is an antidote for the benzodiazepines. Hydroxyzine is an antihistamine with anticholinergic effects and would not be appropriate for this patient. Valium would enhance the effects of benzodiazepines. Phenergan is not indicated for this patient; it is similar in actions to hydroxyzine.

For what purpose would the nurse choose to administer a hypnotic instead of another classification of antianxiety drug? A)Treating insomniaB)Treating seizure disorder C)Treating panic attachD)Treating confusion and agitation

Ans:DFeedback: Hypnotics are used to help people fall asleep by causing sedation. Drugs that are effective hypnotics act on the reticular activating system (RAS) and block the brain's response to incoming stimuli. Hypnotics would not be the most effective drugs to treat seizure disorders, panic attack, or confusion with agitation.

Which drug class can cause severe adverse effects when taken concurrently with antiprotozoal drugs?

Anticoagulants -their effects will be increased and put the pt at higher risk of bleeding

Nystatin

Antifungal agent primarily for candidiasis

Storage of adenosine

Any portion of the drug not used should be discarded because the drug does not contain preservatives. The drug should be stored at room temperature. Solution should appear clear. Do NOT refrigerate, as cold will cause crystallization. If crystallization occurs, warm to room temperature, and the crystals will dissolve.

Digoxin baseline rhythm and pulse rate

Apical pulse rate should be taken for a full minute. If pulse is 60 beats/min or less, contact the health care provider.

Which statement accurately describes inflammation?

Arachidonic acid is released upon injury to yield inflammation, swelling, and headache. -Upon injury, arachidonic acid is released from cell membranes and undergoes metabolism through both the prostaglandin and leukotriene pathways to yield pain, inflammation, headache, and other inflammatory responses

Which NSAID may cause Reye's syndrome in children?

Aspirin

A patient presents to the emergency department with intense itching, ringing in the ears, changes in breathing pattern, and dizziness. The patient's daughter reports that she believes the patient had a seizure and overdosed on a home medication before the ambulance arrived. Which drug toxicity would the nurse suspect as the cause of these manifestations after reviewing the patient's home medication list?

Aspirin OD

Digoxin neurologic system

Assess for history of headaches, fatigue, confusion, or convulsions. Assess level of alertness and orientation.

A patient is prescribed digoxin to treat heart failure. Which biochemical parameter should be assessed by the nurse to ensure safe drug administration?

Serum potassium concentration Hypokalemia, usually diuretic induced, is the most frequent underlying cause of dysrhythmias. The nurse should monitor serum potassium concentrations. Because potassium competes with digoxin, when potassium levels are low, binding of digoxin to Na+, K+-ATPase (sodium, potassium-ATPase) increases. This increase can produce excessive inhibition of Na+, K+ -ATPase with resultant toxicity. Digoxin does not have any effect on liver enzymes, blood glucose, or serum calcium. Therefore, assessment of these parameters is not necessary before administering digoxin.

The nurse is providing teaching education to a patient who is being discharged with prescriptions for clopidogrel and aspirin. The patient tells the nurse that fresh garlic is used to season many of the foods eaten. Which response would the nurse make?

Avoid garlic - it can increase chance of bleeding

Which teaching is appropriate for a patient receiving oral amiodarone?

Avoid prolonged sun exposure. Patients on amiodarone should avoid prolonged sun exposure and wear sunscreen when out in the sun. An infrequent side effect of long-term amiodarone is skin discoloration. The skin may develop a blue-gray color.

Which potential symptoms resulting from treatment with a combined hormonal contraception (CHC) would a nurse teach a patient to report immediately to the health care provider?

Severe abdominal pain Chest pain or shortness of breath Severe leg pain or swelling in the calf or thigh Severe headaches, dizziness, speech difficulties Eye disorders such as blurry vision or loss of vision

Which symptom, if reported by a patient recently started on quinidine, would the nurse find most concerning?

Shortness of breath Shortness of breath following initiation of quinidine therapy may be a symptom of a pulmonary embolus. A clot, dislodged from the atria once sinus rhythm is reestablished, can travel to the pulmonary system and can be fatal. This symptom would be the most concerning to the nurse.

A patient taking clonidine daily was unable to refill the medication and presents to the emergency department with rebound hypertension. What assessment data will the nurse anticipate?

Sinus Tachycardia

The nurse is reviewing the medication list for a patient admitted with a hypertensive emergency. Which drug would the nurse anticipate for administration that produces both venous and arteriolar dilation?

Sodium nitroprusside

After receiving parenteral somatropin for over a year, Tommy's mother asks about taking the drug by mouth. The nurse's response would be based on which information? Growth hormone deficit impairs swallowing. Oral administration is less efficient than injections. Somatropin is only administered parenterally. Oral somatropin is contraindicated in children.

Somatropin is only administered parenterally

A nurse caring for a patient receiving alirocumab notices the injection site is warm and red. Which rationale would the nurse have, and which action would the nurse take?

Some patients develop neutralizing antibodies when receiving alirocumab, which have been associated with a higher incidence of injection site reactions. Document the reaction.

The nurse teaches the patient taking methimazole to report which symptom to the primary health care provider immediately? Heart rate of 100 Dry skin Weight gain Sore throat

Sore throat - agranulocytosis

A patient who is resistant to several antiretroviral therapies is prescribed maraviroc. What substance in the patient's history would decrease the therapeutic effect of the drug? 1 Ginger 2 St. John's wort 3 Acetaminophen 4 Oral contraceptives

St. John's wort

A patient experiencing hypertensive crisis has been receiving intravenous sodium nitroprusside for the past 5 days. The patient is restless and is no longer able to answer common questions. Which nursing intervention is appropriate?

Stop administration of sodium nitroprusside.

General drug adherence for digoxin

Stress the importance of taking the medication exactly as prescribed. A nurse may visit to ensure that medications are properly taken. Inform the patient of possible food/herbal drug interactions. Due to the many drug interactions that could occur, over-the-counter (OTC) medications should not be taken without approval from the health care provider. Keep drugs out of reach of small children. Childproof bottles should be requested. Take the medication at the same time every day. Take a missed dose if no more than 12 hours have passed from the time the drug was to have been taken. Do not double up on next dose. Contact the health care provider for further instructions. Never abruptly stop taking the medication.

What hormone causes ovulation to occur? A)Adrenocorticotropic hormone (ACTH) B)Luteinizing hormone (LH) C)Prolactin D)Follicle-stimulating hormone (FSH)

B Feedback: When the circulating estrogen level rises high enough, it stimulates a massive release of LH from the anterior pituitary causing one of the developing follicles to burst and release the ovum with its stored hormones into the system. ACTH targets the adrenal corticosteroid hormone, which helps prepare the body for the "fight or flight" response. Prolactin is responsible for milk production and FSH in combination with LH stimulate follicles on the outer surface of the uterus to grow and develop and also stimulates the release of estrogen and progesterone.

The nurse is writing a plan of care for a patient receiving an alpha-specific adrenergic agonist. What should this plan of care include? A)Monitoring the patient for diarrhea B)Monitoring blood pressure and heart rate every 2 to 4 hours C)Assessing skin turgor for dehydration D)Assessing for fatigue and lethargy

B Sympathetic stimulation will cause hypertension and increased heart rate so it is important these be monitored. Sympathetic stimulation will also result in increased sweating, decreased gastrointestinal activity, and a sense of anxiety and heightened awareness. Diarrhea, dehydration, fatigue, and lethargy would not be expected.

The nurse is teaching a patient who has just been prescribed a vasodilator. Which statement by the patient indicates that the teaching was effective? A. "I can take this medication in the morning to reduce nighttime urination." B. "I will rise slowly when changing from a sitting to a standing position." C. "My heart rate may slow down with this drug. I will call if my pulse is below 60." D. "I need to increase my intake of fluids and foods that are high in fiber."

B. "I will rise slowly when changing from a sitting to a standing position." Vasodilators may cause postural hypotension and reflex tachycardia. Patients should be taught to move slowly when changing positions to prevent dizziness.

A patient with type 1 diabetes mellitus asks, "Why can't I take a sulfonylurea like my friend who has diabetes?" What is the nurse's best response?

Sulfonylurea agents reduce serum glucose levels by increasing beta-cell stimulation for insulin release, decreasing hepatic glucose production, and increasing insulin sensitivity. It is administered for type 2 diabetes mellitus but will not be effective in type 1. Not all patients with type 2 diabetes require insulin, but patients with type 1 diabetes require insulin.

The patient with type 1 diabetes mellitus asks, "Why can't I take a sulfonylurea like my friend who has diabetes?" What is the nurse's best response? "Sulfonylurea increases beta-cell stimulation to secrete insulin, and with your type of diabetes, the beta cells do not contain insulin. This medication will not work for you." "You must be mistaken. If your friend has diabetes mellitus, she is taking insulin." "Sulfonylurea will lower your blood sugar too much, and you will be hypoglycemic." "You are unable to store glucose, because you do not have insulin, and sulfonylurea helps with glucose storage."

Sulfonylurea increases beta-cell stimulation to secrete insulin, and with your type of diabetes, the beta cells do not contain insulin. This medication will not work for you." Sulfonylurea agents reduce serum glucose levels by increasing beta-cell stimulation for insulin release, decreasing hepatic glucose production, and increasing insulin sensitivity. It is administered for type 2 diabetes mellitus but will not be effective in type 1.

candida, dermatophytes

Superficial mycoses are caused by ______ and _________

Which cardiovascular condition is treated with nondihydropyridine calcium channel blockers?

Supraventricular tachycardia Calcium channel blockers are indicated for supraventricular tachycardia, atrial dysrhythmias, hypertension, and angina.

A patient is prescribed hydralazine [Apresoline] for the treatment of essential hypertension. Which expected adverse effects should the nurse discuss with the patient? (Select all that apply.) A. Nausea B. Fatigue C. Dizziness D. Headache E. Joint pain

B. Fatigue C. Dizziness D. Headache Some of the common adverse effects of hydralazine include fatigue, dizziness, and headache. Nausea is associated with minoxidil. Joint pain is not a common adverse effect of hydralazine.

A patient has a new prescription for calcitriol. Which pre-administration assessment would the nurse complete? Review thyroid stimulating hormone (TSH) lab for elevated levels. Determine whether signs of an infection are present. Survey the current serum calcium level. Examine for evidence of a thyroid storm.

Survey the current serum calcium level

A female patient has been taking ethinyl estradiol plus norgestimate tablets (Ortho Tri-Cyclen®) for contraception. She was recently prescribed rifampin for the prevention of tuberculosis because her husband was recently diagnosed with the infection. Which nursing interventions would be appropriate to address the reduction in contraception efficacy?

Switch to another form of contraception. Increase the estrogen dosage in the combined hormonal contraception (CHC). Advise her to monitor for breakthrough bleeding, which might indicate lack of CHC effect. Advise the patient to use a second form of contraception like a condom while receiving rifampin.

fluconazole (diflucan)

Systemic May be given orally or parenteral route Less toxic than Ampho B Primarily Fungistatic YEAST INFECTIONSq LOTS of drug-drug interactions! CYP450 Adverse Effects Common: GI (N/V/D) Anaphylaxis Stevens-Johnson syndrome Liver injury Administration IV and PO dosages are the same

itraconazole (Sporanox)

Systemic May be given topically, orally or parenteral route Less toxic than Ampho B **LOTS of drug-drug interactions! CYP450 Adverse Effects Common: GI (N/V/D) Cardiosuppression Liver injury Administration Cola (drug does better with acidic envr.) Give 1 hr before drugs that raise gastric pH

The nurse is caring for a patient who has been prescribed trimethoprim/sulfamethoxazole (TMP/SMZ). Which complication might the nurse expect to find in the patient?

TMP/SMZ belongs to the sulfonamide class of drugs. It causes the accumulation of potassium levels and may cause hyperkalemia. Therefore, the nurse would expect the patient to have an increase in potassium levels. TMP/SMZ increases the elimination of sodium and may cause hyponatremia. TMP/SMZ may enhance the secretion of insulin and decrease blood glucose levels, resulting in hypoglycemia. TMP/SMZ has antibacterial activity and decreases the white blood cell count.

In the failing heart, arterial pressure falls, stimulating the baroreceptor reflex to increase sympathetic nervous system activity. The nurse understands increased sympathetic activity will produce which response?

Tachycardia Increased sympathetic activity results in an increased heart rate (tachycardia), increased contractility, increased venous tone, and increased arteriolar tone (elevated blood pressure). Sympathetic stimulation also causes bronchodilation (not bradypnea) and possibly hyperglycemia.

Which time of day is best for taking a thyroid replacement drug? Before breakfast After meals With meals At bedtime

Before breakfast

Class IV Antidysrhythmic Drugs general teaching

Take exactly as prescribed because drug adherence is essential. Swallow SR formulations whole, without crushing or chewing. Increased fluid intake is encouraged, unless contraindicated. Minimize constipation by increasing dietary fluid and fiber. Limit or avoid caffeine intake, which can increase risk for irregular or rapid heartbeat. Avoid alcohol and tobacco. Alcohol can intensify hypotensive reaction, and tobacco promotes vasoconstriction. Avoid grapefruit juice because it can inhibit the intestinal and hepatic metabolism of the Class IV antidysrhythmic drugs and increase levels of the drugs. Monitor blood pressure and heart rate before taking a Class IV antidysrhythmic drugs. Do not abruptly stop taking the drug. Chest pain may occur.

A female patient who has been taking levothyroxine comes for a follow-up visit. The nurse notices that the patient's hands are shaking slightly and she is having difficulty sitting quietly. Which action would the nurse take first? Document the findings in the medical record. Take her vital signs and compare to previous reading. Inquire about how she is taking her medication. Ask if something has happened to make her anxious.

Take her vital signs and compare to previous reading.

Patients taking anthelmintics should be advised to perform hygiene how?

Take showers instead of baths, because baths can help helminths travel from one area of the body through the water and back onto/into the skin

A patient taking dabigatran complains of dyspepsia. Which instruction would the nurse provide to the patient?

Take the drug with food

Which instruction is appropriate for a patient taking dronedarone?

Take the drug with food. Dronedarone should be taken with food or snack to minimize gastrointestinal distress.

What is the primary benefit of spironolactone [Aldactone] in patients with heart failure?

Blockage of aldosterone receptors

A patient with new onset atrial fibrillation asks the nurse how dronedarone will help with the heart. The nurse answers knowing that dronedarone has which mechanism of action?

Blocks potassium channels Dronedarone primarily blocks potassium channels. It can also block sodium and calcium channels and beta-adrenergic receptors.

Which phrase describes the action of metyrapone drug therapy in a patient with Cushing's disease? Regulates and normalizes blood glucose levels Suppresses adrenocorticotropic hormone (ACTH) production to lower cortisol levels Treats headaches associated with Cushing's disease Blocks process of cholesterol conversion to cortisol

Blocks process of cholesterol conversion to cortisol

What is the dose-limiting toxicity of ganciclovir treatment? 1 Pancreatitis 2 Renal toxicity 3 Peripheral neuropathy 4 Bone marrow suppression

Bone marrow suppression

A 64-year-old patient has been prescribed cholestyramine in addition to statin therapy to provide additional lipid-lowering effects. In addition to dyslipidemia, this patient has hypertension, atrial fibrillation, a partial bowel obstruction, and a history of myocardial infarction from 1 year ago. Which of the patient's current medical conditions alerts the nurse to contact the health care provider about avoiding the initiation of cholestyramine?

Bowel Obstruction

Which infestations can cause lymphatic obstruction resulting in elephantiasis? Select all that apply.

Brugiasis and Wuchereriasis are filarial nematodes that can cause lymphatic obstruction resulting in elephantiasis (usually of the scrotum or legs). Trichinosis is connected primarily with gastrointestinal symptoms. Enterobiasis is usually asymptomatic, and ancyclostomiasis is connected with anemia.

A patient taking amantadine is experiencing anxiety and dizziness. What intervention should the nurse perform first? 1 Call the health care provider. 2 Request a consultation for counseling. 3 Take the patient's blood pressure sitting and standing. 4 Evaluate the patient for other central nervous system effects from the medication.

Take the patient's blood pressure sitting and standing. - The side effects and adverse reactions to amantadine include insomnia, nervousness, lightheadedness, anorexia, nausea, anticholinergic effects, orthostatic hypotension, and blurred vision. The nurse should evaluate the patient for orthostatic hypotension first to address safety issues. Nervousness is a known side effect of amantadine and is not necessarily an indication that the patient requires counseling. Additionally, the safety concern of orthostatic hypotension would be the first priority before other interventions.

Praziquantel is effective in patients who have which type of helminth?

Tapeworms

Class IV Antidysrhythmic Drugs side effects

Teach patients how to monitor their heart rate and blood pressure. Advise patients to notify their health care provider regarding adverse cardiac effects, including weight gain, bradycardia, and shortness of breath. Teach patients to monitor their extremities for signs of edema and to notify their health care provider of any positive findings. This could indicate heart failure. Tell patients that they may experience side effects of nausea, vomiting, constipation, or headache, which should be reported to the health care provider if severe. Instruct patients to report skin rash or irritations. Stevens-Johnson syndrome is an adverse drug effect of Class IV antidysrhythmic drugs.

Which statement about the pharmacokinetic parameters of testosterone is accurate?

Testosterone undergoes hepatic metabolism and beta-oxidation.

What drug would the nurse expect to administer if beta-specific adrenergic agonist effects are desired to prevent bronchospasm during anesthesia? A)Dobutamine (Dobutrex) B)Ephedrine (generic) C)Isoproterenol (Isuprel) D)Phenylephrine (Neo-Synephrine)

C Isoproterenol is a beta-specific adrenergic agonist used to prevent bronchospasm during anesthesia. Phenylephrine is an alpha-specific adrenergic agonist. Both dobutamine and ephedrine are alpha- and beta-adrenergic agonists.

When a patient's renin-angiotensin-aldosterone system is activated, which responses would the nurse expect? Select all that apply. A Dilation of veins B Diuresis by the kidneys C Constriction of arterioles D Retention of water by the kidneys E Constriction of renal blood vessels

C, D, E

A nurse is reviewing a patient's medications and realizes that gemfibrozil and warfarin are to be administered concomitantly. Which effect will the nurse anticipate in this patient? A.decreased levels of gemfibrozil B.reduced anticoagulant effects C.increased anticoagulant effects D. increased levels of gemfibrozil

C. (Gemfibrozil displaces warfarin from the plasma albumin, thereby increasing anticoagulant effects. The level of gemfibrozil will not be increased or decreased. The anticoagulation effects will not be reduced, because free-floating drug is present in the system; the dosage of warfarin may have to be reduced.)

Which assessment finding is most important for the nurse to obtain before administering hydralazine [Apresoline]? A. Peripheral pulses B. Homans' sign C. Blood pressure D. Capillary refill

C. Blood pressure Hydralazine is a vasodilator that causes arteriolar dilation, decreased resistance, and decreased blood pressure. Monitoring of the blood pressure and heart rate is the highest assessment priority.

A patient with hypertensive emergency is admitted to the hospital. Which medication should the nurse be prepared to administer to this patient? A. Minoxidil [Loniten] B. Hydralazine [Apresoline] C. Sodium nitroprusside [Nipride] D. Hydralazine and isosorbide dinitrate [BiDil]

C. Sodium nitroprusside [Nipride] Intravenous sodium nitroprusside has an immediate effect and is the drug of choice for hypertensive emergencies. Minoxidil and hydralazine are used for blood pressure control.

For which reasons would the nurse monitor older adults taking heparin more closely for bleeding?

Capillary walls are more fragile skin is thinner

Potential drug interactions between mefloquine and beta blockers

Cardiac dysthymias

A patient who took neutral protamine Hagedorn (NPH) insulin at 8:00 AM reports feeling weak and tremulous at 5:00 PM. Which action should the nurse take first?

Check the patient's capillary blood sugar. The patient is showing symptoms of hypoglycemia at 5:00 PM. NPH has a peak action of 8 to 10 hours after administration. Based on the duration of action of NPH insulin, the patient's hypoglycemic symptoms are from the 8:00 AM injection of NPH insulin. It may also be necessary to take the patient's blood pressure, but the nurse is aware of the risks for hypoglycemia with insulin administration. Insulin should not be administered until the patient's blood sugar is determined. Lying down with the legs elevated will not help the hypoglycemic patient.

Which teaching would the nurse provide to a patient receiving clonidine who reports xerostomia?

Chew gum to help with discomfort

When the nurse teaches high school students about sexually transmitted diseases (STDs), which infection will the nurse identify as the most common STD?

Chlamydia

Which drug is considered a bile-acid sequestrant?

Cholestyramine

A patient is diagnosed with cytomegalovirus (CMV) retinitis. Which drug should the nurse expect to administer to this patient? 1 Ribavirin 2 Cidofovir 3 Acyclovir 4 Amantadine

Cidofovir - Cidofovir is an antiviral drug that is used to treat CMV infection. It is effective against CMV retinitis.

The nurse is teaching a new nurse about the pharmacokinetics of oral clonidine. Which teachings would the nurse include?

Clonidine is lipid soluble and well absorbed. Metabolism of clonidine occurs in the liver.

Which statements are accurate with respect to the pharmacokinetic profile of colesevelam?

Colesevelam is not absorbed upon oral administration. drug is excreted in feces

Before administering quinidine, the nurse would assess the patient for which contraindication?

Complete Heart Block

What is the primary assessment the nurse should make for a patient who is taking ganciclovir sodium? 1 Input and output 2 Bowel elimination 3 Blood urea nitrogen 4 Complete blood count

Complete blood count - Bone marrow suppression is a dose-limiting toxicity of ganciclovir, and a complete blood count should be monitored.

Hydrocortisone is a synthetic steroid with a structure identical to which hormone? Insulin Cortisol Androgens Mineralocorticoids

Cortisol

Which statement accurately describes the glucocorticoid that is secreted from the adrenal cortex along with its effect in the body?

Cortisol, which impacts carbohydrate metabolism

Sodium Nitroprusside distribution

Crosses placenta

Hydralazine distribution

Crosses placenta; highly protein bound (89%)

Excess use of glucocorticoids can cause ___

Cushing's syndrome

2 (Therapeutic effects, in general for antidysrhythmic drugs, include improved cardiac output, decreased chest discomfort, decreased fatigue, improved vital signs, skin color, and urinary output, and conversions of irregularities to normal rhythm.)

The client who is receiving antidysrhythmic drugs exhibits increased cardiac output, increased activity tolerance, blood pressure 130/75, pulse 86, and has voided 400 mL of urine during the past 8-hour shift. What is the nurse's best action? 1 Notify the healthcare provider. 2 Document the findings in the client's medical record. 3 Increase the continuous intravenous fluid rate. 4 Place the client in Trendelenburg to improve venous return.

Which rationale accurately describes a nurse's concern for the initiation of meloxicam, a nonsteroidal antiinflammatory drug (NSAID), in a patient taking lisinopril and metformin concurrently?

The combination of lisinopril and meloxicam may lead to reduced antihypertensive effects, increasing the patient's blood pressure

Which administration considerations would be given to a nurse who is caring for a patient initiated on clomiphene citrate?

The dose may be taken with or without food. The maximum number of sequential cycles of clomiphene citrate is three. The initial dose of 50 mg once daily and may be increased by 50 mg/day for a second course if ovulation does not occur. Ovulation typically occurs within 5 to 10 days after the last dose, and intercourse should take place at least every other day.

Which teaching points would a nurse share with a patient who has diabetes and is initiated on a gel formulation of testosterone?

The drug can be transferred to others if is not completely dry. The patient should not abruptly discontinue therapy with testosterone. The patient should monitor his weight and report any weight gain of more than 5 lbs in a week. The patient should have his testosterone levels monitored within 2 to 4 weeks after starting the drug.

Which rationale would the nurse provide for limiting high-fat foods in a patient prescribed cinacalcet for hyperparathyroidism? Cardiovascular disorders are associated with eating high fat foods. High fat foods interfere with drug absorption. The drug effects are increased with high-fat foods. Foods high in fat increase nausea when given with cinacalcet.

The drug effects are increased with high-fat foods

The nursing instructor is discussing the physiology of pregnancy with her clinical group. What hormone, produced during pregnancy, would the instructor tell the students helps to maintain the pregnancy until birth of the fetus? A)High levels of estrogen only B)High levels of estrogen, low levels of progesterone C)Low levels of estrogen, high levels of progesterone D)High levels of estrogen and progesterone

D Feedback: In a pregnant woman, both estrogen and progesterone hormones have specific functions. High levels of both hormones are needed for the maintenance of pregnancy.

Which key points regarding the storage and handling of alirocumab are important for a nurse to follow to ensure the drug is safely and effectively administered?

The drug should be stored in the refrigerator The drug should be discarded if particulate matter is present. The drug should be allowed to warm to room temperature for 30 minutes before administration.

Which statements about the therapeutic use and pharmacodynamic parameters of clomiphene citrate are accurate?

The drug's elimination half-life is 5 to 7 days. Clomiphene citrate's duration of action is 30 days. The drug is indicated for use in women with persistent ovulatory dysfunction to stimulate ovulation. When administered to women with polycystic ovary syndrome (PCOS) who are on metformin, the success rate of ovulation is increased.

Drug interactions for vasodilator

The frequency of drug interactions is low for the vasodilator drugs. When hydralazine is used with other antihypertensive drugs, excessive hypotension can occur.

Which antiviral drug causes lipodystrophy as a major adverse effect? 1 Darunavir 2 Zalcitabine 3 Zidovudine 4 Didanosine

Darunavir - Protease inhibitors such as darunavir cause lipodystrophy, or redistribution of fat stores under the skin, resulting in cosmetically undesirable outcomes.

Which description of the mechanism of action of clonidine is accurate?

Decreases peripheral vascular resistance and decreases cardiac output

Warfarin is appropriate for patients with which conditions?

Deep vein thrombosis mechanical heart valves pulmonary embolus thromboembolic stroke

Potential drug interactions between digoxin & chloroquine

Dig toxicity

B Acetaminophen (Tylenol) does not cause gastric distress as do aspirin, ibuprofen, naproxen sodium, and glucocorticoids.

Discharge teaching for a patient receiving glucocorticoids will include the preferred use of which medication for pain management? A. Aspirin B. Acetaminophen (Tylenol) C. Ibuprofen (Motrin) D. Naproxen sodium (Naprosyn)

Digoxin distribution

Distributed throughout the body with highest concentration in the heart, kidneys, intestine, liver, stomach, and skeletal muscle. It is 20%-30% protein bound.

Digoxin gastrointestinal system (GI)

Document any changes in appetite and/or complaints of nausea, diarrhea, or vomiting.

Digoxin visual and sensory system

Document baseline vision and changes in vision, such as green, yellow, or purple halos surrounding peripheral field of vision.

Which technique is most appropriate regarding mixing insulin when the patient must administer 30 units regular insulin and 70 units NPH insulin in the morning? Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. Draw the medication into two separate syringes but inject into the same spot. Administer these insulins at least 10 minutes apart, so that you will know when they are working. Use the Z-track method for administration.

Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could cause an alteration in the onset of action of the regular insulin. The medications do not have to be in separate syringes and can be administered together. Z-track is an IM technique.

whipworm

Drug of choice for ______ infestation: - albendazole

A (Adenosine must be given as rapidly as possible, followed by a 50-mL normal saline flush in order to get all of the medication into the circulation quickly since the half-life of adenosine is less than 10 seconds.)

The nurse is reviewing emergency protocols and administration of adenosine (Adenocard). What is a vitally important task to remember when administering adenosine? Give it as a rapid intravenous push. Give it at the highest port in the IV tubing. Offer it with food or milk. Prepare to set up for an intravenous drip infusion.

C, D Prednisone (Deltasone), which is a synthetic glucocorticoid, should be administered in the early morning because the adrenal glands secrete the maximum amount of hormones during the early morning. This helps to prevent adrenal suppression. Glucocorticoids can cause gastrointestinal (GI) distress and should be administered with milk or food to minimize GI upset. This medication should not be administered on an empty stomach because it would enhance the effects of gastric irritation. It should not be administered early in the evening because the adrenocortical secretion levels are low during evenings. This drug is ulcerogenic; hence the administration of aspirin and other nonsteroidal anti-inflammatory drugs should be avoided, which otherwise would cause gastric irritation and gastric bleeding.

The nurse is teaching a patient who has been prescribed a daily oral dose of prednisone (Deltasone) about the medication regimen. How will the nurse tell the patient to take this medication to ensure safe administration? Select all that apply. A. Take on an empty stomach B. Take in the early evening C. Take in the early morning D. Take with milk or food E. Take with aspirin

2 (Class III drugs, such as amiodarone, prolong repolarization in phase 3. Verapamil is a class IV calcium channel blocker that depresses phase 4 depolarization. Lidocaine is a class I membrane-stabilizing antidysrhythmic. Atenolol is a class II beta blocker that depresses phase 4 of depolarization.)

The nurse recognizes which drug as a Class III antidysrhythmic? 1 Verapamil 2 Amiodarone 3 Lidocaine 4 Atenolol

2

The nurse should recognize that which organ is the most frequent site of helminthic infestation? 1 Stomach 2 Intestine 3 Heart 4 Kidneys

Vasodilators side effects

Educate patients to report side effects (e.g., flushing, headaches, and dizziness) to the health care provider. Advise patients to change positions often, but slowly, to prevent orthostatic hypotension. When a patient is taking high doses of a vasodilator, orthostatic hypotension is a common occurrence.

metronidazole (Flagyl)

Effective against several protozoal species Also effective against anaerobic bacteria Given PO or IV - don't give faster than an hour Common AE: nausea, HA, dry mouth, metallic taste, insomnia, vertigo, weakness Rare AE: SJS, encephalopathy, aseptic meningitis Tints urine a darker brown

There are also common foods and herbal supplements that interact with digoxin.

Ephedra may increase the risk of dysrhythmias. Licorice and ginseng can increase digoxin toxicity. St. John's wort can lead to subtherapeutic effects of digoxin. Large amounts of high-fiber foods (bran, pectin) can decrease the absorption of oral digoxin. Digoxin should be administered 1 hour before or 2 hours after a high-fiber meal.

A patient who takes ergotamine for migraines calls the clinic to report numbness in the feet, which are also cold and pale. Which response by the nurse is appropriate?

Ergotamine can cause ischemia due to the constriction of arteries in the limbs. Gangrene can result if treatment is not received immediately. It is not appropriate to tell the patient to wait to seek care until an appointment with the provider or to place the feet in hot water because this may not be effective, and permanent damage may result from the a subsequent delay in treatment. The constriction is not a permanent vascular change, it may be reversed by discontinuing the medication.

Which condition is seen in a patient with hyperosmolar nonketotic syndrome (HHNS)?

Extreme hyperglycemia Extreme hyperglycemia triggers hyperosmolar nonketotic syndrome (HHNS). Acute pancreatitis is an inflammation of the pancreas. This usually happens due to chronic alcohol abuse or due to a gallstone becoming lodged in the pancreatic ducts. Headaches are not caused by HHNS. A patient with HHNS may have electrolyte imbalances, which may cause dehydration and weight loss, not weight gain.

Which patient symptoms should cause the nurse to be concerned about digoxin [Lanoxin] toxicity? (Select all that apply.)

Fatigue Vomiting Blurred vision

The home health nurse is caring for a 77- year-old male patient who has just been discharged from the hospital. The patient is receiving an infusion of dobutamine (Dobutrex) to treat congestive heart failure. What is the priority nursing assessment? A)Capillary refill time and vital signs B)Effectiveness of comfort measures C)Dietary intake and hydration D)Compliance with treatment plan

Feedback: Dobutamine, although it acts at both receptor sites, has a slight preference for beta1- receptor sites. It is used in the treatment of heart failure because it can increase myocardial contractility without much change in rate and does not increase the oxygen demand of the cardiac muscle, an advantage over all of the other sympathomimetic drugs. Assessing capillary refill time and vital signs will allow the nurse to assess perfusion as an indicator of the effectiveness of the infusing drug. Dietary intake, compliance with treatment plan, and effectiveness of comfort measures are all important assessments but the priority assessment is perfusion.

B (Ibutilide is specifically indicated only for treatment of recent-onset atrial fibrillation and flutter.)

The patient has been prescribed ibutilide (Corvert), a class III antiarrhythmic drug. The nurse is aware that this drug has been prescribed for which reason? Treatment of PSVT Conversion of recent-onset atrial fibrillation and flutter Conversion of life-threatening ventricular arrhythmias Treatment of dysrhythmias in patients with acute renal failure

Which assessment finding would the nurse report as a complication related to volume expansion in a patient who is prescribed vasodilator therapy?

Fine rales on lung auscultation

The charge nurse is teaching a new nurse about beta blockers. Which teaching would the nurse include?

First-generation beta blockers are nonselective and block beta1 and beta2 receptors.

What should the nurse review about an antihyperlipidemic medication with the client when completing discharge counseling? (Select all that apply.) frequency of administration there is nothing to review correct dose drug name dosage form

Frequency of administration correct dose drug name dosage form

Antimalarial drugs can also be ___

Given prophylactically to prevent malarial infection

Which drugs are anticipated to interact with prednisone?

HCTZ Metformin

The nurse is preparing to give ergotamine. This agent is effective against headaches of which origin?

Headaches caused by hypertension, hyperthyroidism, and disorders of the eye, ear, nose, sinuses, and throat should be treated based on their underlying cause. Ergotamine is effective against headaches that are assumed to be migraine or cluster headaches. Also, ergotamine is a vasoconstrictor and is contraindicated in an individual with high blood pressure or other cardiac ailments.

A nurse would question a prescription for verapamil in a patient diagnosed with which condition?

Heart Failure

Octreotide should be used with caution in patients with which disorders? Select all that apply. Asthma Heart failure Thyroid deficiency Hepatic impairment Psychiatric disorders Chronic kidney disease

Heart Failure Hepatic Impairment Chronic kidney disease

Which nursing assessment would be of highest priority when administering a beta blocker?

Heart Rate

A nurse would question a prescription for verapamil in a patient diagnosed with which condition?

Heart failure

The nurse notes Mr. Allen, who is taking verapamil, has edema to his ankles and feet. Which medical condition would the nurse suspect as the cause? CASE STUDY DETAILS

Heart failure Class IV antidysrhythmic drugs, such as verapamil, could cause heart failure. Swelling of the ankles and feet could be an early indicator of heart failure.

A patient is on chemotherapy. Following periodic lab work, the nurse instructs the patient to use a soft-bristled toothbrush and to avoid activities that may increase risk of injury. What is the rationale for the nurse's instructions?

The patient has developed thrombocytopenia.

Which patient finding would cause the nurse to hold the 8 AM dose of verapamil [Calan]?

The patient has hypotension. A patient who is scheduled to receive verapamil [Calan], a calcium channel blocker (CCB), should have blood pressure and pulse assessed prior to administration. Hypotension would be a reason to hold the drug. Verapamil [Calan] is given for atrial flutter. Patients with angina may receive CCBs for their vasodilating effects. Tachycardia is not a reason to hold the drug; CCBs decrease the heart rate.

A nurse is preparing to administer heparin intravenously (IV) to a patient who was admitted with an acute pulmonary embolus. Which response by the nurse is appropriate when the patient asks why the drug is given IV rather than orally?

Heparin is poorly absorbed by the gastrointestinal (GI) tract. Heparin is poorly absorbed by the GI tract and is therefore not available in an oral form. It is given parenterally (IV or SQ).

A patient who was started on continuous intravenous heparin for a pulmonary embolus complains of "a lot of bruises" and "pink urine." Laboratory values show that platelets have decreased from 225,000 mm3 to 75,000 mm3. Which condition would the nurse most likely consider with these signs and symptoms?

Heparin-induced thrombocytopenia (HIT) from heparin Significant decrease in platelets can indicate HIT. With decreased platelets, evidence of bleeding, such as multiple bruises and hematuria (blood in urine), can occur.

The nurse is preparing to administer dabigatran. Dabigatran would be most appropriate for a patient with which medical condition?

Hepatic Dysfunction

Which microorganism is directly affected by acyclovir? 1 Herpes zoster 2 Proteus vulgaris 3 Pneumocystis carinii 4 Staphylococcus aureus

Herpes zoster

A patient is admitted for bleeding caused by an overdose of dabigatran. Which drug will the nurse anticipate administering?

Idarucizumab

Hydralazine metabolism

In the liver

Which instruction will the nurse provide on avoiding side effects related to diltiazem?

Increase dietary fiber

Which instruction will the nurse provide on avoiding side effects related to diltiazem?

Increase dietary fiber.

A patient is taking verapamil [Calan]. Which instruction should the nurse give the patient to help prevent a common adverse effect of this drug?

Increase fluid and fiber intake. Constipation may occur with verapamil [Calan]. Advise patients that constipation can be minimized by increasing dietary fluid and fiber. Verapamil [Calan] does not cause photosensitivity, so sunscreen is not needed. Verapamil [Calan] does not cause weight loss, so an increase in calories is not needed. Verapamil [Calan] does not cause diarrhea, so a skin barrier cream is not needed.

Which effect would a nurse be concerned with for a patient who is receiving ibuprofen in addition to alendronate, a bisphosphonate?

Increased risk for GI bleeding

A patient who has received a prescription for lovastatin asks the nurse why grapefruit and grapefruit juice should ideally be avoided. Which explanation would the nurse provide?

Increases risk for rhabdomyolysis

The nurse is preparing to administer captopril to a patient. Which patient action would cause the nurse to hold the medication?

The patient is eating breakfast.

The nurse is planning care for an 18-year-old woman with acne who is scheduled to start taking isotretinoin. The nurse should establish which outcomes on the plan of care? Select all that apply.

Isotretinoin has demonstrated teratogenic effects and must not be used during pregnancy. All female patients must use two effective forms of birth control and have one negative pregnancy test result before monthly refills. iPLEDGE is a risk-management program used by the prescriber, pharmacist, and patient to ensure that the patient will not become pregnant while taking isotretinoin. Triglyceride levels should be measured periodically, because they may become elevated with the treatment. Depression and suicide are rare effects without direct causal links to isotretinoin, but patients should still be taught to report any signs of depression to a clinician.

4

It is important for the nurse to monitor a patient for the Mazzotti reaction if the patient takes which medication? 1 Praziquantel [Biltricide] 2 Diethylcarbamazine [Hetrazan] 3 Pyrantel [Pin-X] 4 Ivermectin [Stromectol]

Vasodilators: Obtain Patient History

It is important to understand that patients taking vasodilators may also be placed on a diuretic to prevent volume expansion and fluid retention. Assess baseline heart rate and blood pressure before administration. Patients receiving sodium nitroprusside are likely in an intensive care setting to treat a hypertensive crisis.

A patient is taking clonidine 0.1 mg twice a day and questions if the medication is safe during pregnancy. Which response would the nurse provide?

It is not recommended for pregnant women

The nurse will anticipate administering a second dose of adenosine shortly after the first dose because the drug is effective for which time frame?

Less than 10 seconds

Which statement accurately describes the pharmacokinetic parameters for levonorgestrel used as emergency contraception?

Levonorgestrel is excreted in both urine and feces.

The nurse administers NPH insulin at 8 AM. What intervention is essential for the nurse to perform? Assess the patient for hyperglycemia by 10 AM. Monitor fingerstick at 2 PM. Make sure patient eats by 5 PM. Administer the insulin via IV pump

Make sure patient eats by 5 PM NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia. The patient needs to eat by 5 PM. The patient would not be at high risk for hypoglycemia at 10 AM. A fingerstick is not necessary at 2 PM. The insulin should not be routinely administered IV.

Digoxin interacts with cholestyramine colestipol sucralfate

Mechanism: Decrease oral absorption Result: Reduced therapeutic effect

Which is a rare but potentially fatal complication of metformin use in the management of type 2 diabetes mellitus?

Metformin inhibits mitochondrial oxidation of lactic acid and thereby can cause lactic acidosis, a medical emergency with a 50% mortality rate. Fortunately, lactic acidosis is rare when metformin is used in recommended doses and by patients with good renal function.

Octreotide is prescribed to a patient newly diagnosed with acromegaly. When reviewing current medications taken by the patient, the nurse is aware that octreotide could decrease the action of which drugs? Ibuprofen, a nonsteroidal antiinflammatory drug Omeprazole, an H2 receptor antagonist Metformin, a non-insulin antidiabetic drug Loratadine, an antihistamine for allergies

Metformin, a non-insulin antidiabetic drug

A nurse is caring for a patient who has been prescribed oral methyltestosterone therapy for infertility. This patient also takes warfarin and lisinopril. Which outcome and intervention are recommended to manage a potential drug interaction with methyltestosterone?

Methyltestosterone may increase the effects of warfarin; decrease the dosage of warfarin.

Which antiprotozoal is effective for treatment of trichomaniasis?

Metronidazole

Minoxidil distribution

Minimal protein binding

The nurse is reviewing absorption of vasodilators. Which nursing statement is appropriate?

Minoxidil is absorbed well with oral administration.

A patient's rhythm is now asystole after receiving adenosine. Which action would the nurse take?

Monitor the patient

Which nursing action is the prioritywhen administering lisinopril to Mr. Lowe for the first time?

Monitoring for marked hypotension

Before starting the lisinopril for Mr. Lowe, which assessment data requires nursing intervention first? CASE STUDY DETAILS

Mr. Lowe takes ibuprofen daily for arthritis.

The nurse is conducting teaching for a patient who is being discharged on digoxin. What patient statement indicates the need for further teaching?

My weight will go up and down

Which drug is used for treating acromegaly? Simvastatin Somatropin Vasopressin Octreotide

Octreotide

systemic (fungal infections)

Often Immunocompromised Host (HIV pts, transplant pts) Examples: Coccidiomycosis Histoplasmosis Cryptococcus Aspergillosis Treatment difficult prolonged (at least 6 wks) toxic drug therapy

Pharmacodynamic Profile adenosine

Onset: 20 to 30 sec Peak: Immediate Duration: Less than 10 sec Half-Life: Less than 10 sec

Pharmacodynamic Profile of digoxin

Onset: 30 to 120 min for PO Peak: 1 to 3 hr for PO and IV Duration: 3 to 4 days for PO and IV Half-Life: 1 to 3 days for PO and IV

Pharmacodynamic Profile Sodium Nitroprusside

Onset: IV 1 to 2 min Peak: IV 2 min Duration: IV 1 to 10 min Half-life: 2 min

An adult patient has been taking a glucocorticoid for more than 1 year. Which adverse effect will the nurse monitor for in this patient?

Osteoporosis with possible fractures

Which defects may lead to hyperuricemia (which in turn can lead to gout)?

Overproduction or underexcretion of uric acid

Diltiazem onset

PO IR: 0.5-1hr PO ER: N/A IV:3 min

Verapamil onset

PO IR: 1-2 hr PO ER: 5 hr IV: 1-5 min

A patient who is receiving heparin therapy has bruises covering the abdomen as well as red-colored urine. What does the nurse need to assess?

Platelet level The patient's platelet level should be assessed when he or she receives heparin and then develops bruises and blood in the urine. The patient may have type II heparin-induced thrombocytopenia (HIT). The patient's medication would need to be changed. Although over-the-counter medications may potentiate bleeding, they are not likely to cause these symptoms. Acetaminophen and urinary tract infections should not cause these symptoms.

Which therapeutic effect does digoxin have on the heart?

Positive inotropic Negative dromotropic Negative chronotropic

Which channels along the cell's membrane do adenosine affect?

Potassium Adenosine stimulates the adenosine-sensitive potassium channels in the sinoatrial node and internodal tracts.

A patient with a history of heart failure is taking both a diuretic and digoxin. Which substance would the nurse anticipate administering to this patient?

Potassium Supplement

Class III antidysrhythmic drugs are also classified as which type of blockers?

Potassium channel blockers Class III antidysrhythmics are also known as potassium channel blockers. They also block sodium and calcium cell receptors. Blocking the various channels reduces AV conduction and delays repolarization.

The nurse is caring for a patient who takes spironolactone [Aldactone] and quinapril [Accupril] for treatment of heart failure. What finding indicates a potential interaction between these two drugs?

Potassium level of 5.7 mEq/L

A patient with a history of heart failure is taking both a diuretic and digoxin. Which substance would the nurse anticipate administering to this patient?

Potassium supplement

Digoxin drug/herbal history

Potassium-wasting diuretic or cortisone drug may cause hypokalemia. Low potassium levels enhance action of digoxin, increasing risk of digitalis toxicity. Potassium supplements may be needed.

The nurse is caring for several patients. Which patient will need teaching about treatment of hypertension?

The patient with a systolic pressure consistently above 140 mm Hg Hypertension is defined as a persistent systolic pressure of greater than 140 mm Hg and or a diastolic pressure greater than 90 mm Hg. A patient is not diagnosed with hypertension after one episode of an elevated pressure.

itraconazole

The prototype of Azole antifungals is __________ - Inhibits the synthesis of ergosterol = increased membrane permeability and leakage of cellular components. Drug of choice for: blastomycosis, histoplasmosis, paracoccidioidomycosis, and sporotrichosis. And an alternative to amphotericin for: aspergillosis, candidiasis, and coccidioidomycosis. - undergoes extensive hepatic metabolism (lose 40% of dose in urine) - take with food and/or cola to increase absorption - GI sx most common SE - Serious: cardiac suppression and liver injury

After reviewing the chart of a patient with hypertension who is receiving angiotensin-converting enzyme inhibitors, which finding will cause the nurse to notify the provider?

Pregnancy test positive The nurse must notify the provider about the pregnancy test. Angiotensin-converting enzyme (ACE) inhibitors can cause serious fetal harm especially during the second and third trimesters of pregnancy, and hence, must not be given to pregnant women. ACE inhibitors—along with angiotensin receptor blockers (ARBs) and direct renin inhibitors (DRIs)—are the only antihypertensive drugs specifically contraindicated during pregnancy. Afebrile means not having a temperature, which is normal. The patient's history of following the DASH diet is appropriate and healthy. A slightly decreased potassium level, while abnormal, is not as urgent as a positive pregnancy test, and ACE inhibitors are potassium sparing so they may help raise the level.

By which action does calcitriol treat hypoparathyroidism? Promotes calcium absorption from the intestines and reabsorption from the kidney Stimulates releases of calcium from the liver into the GI tract for absorption Activates vitamin D, which is needed for absorption of calcium through the gut Promotes bone calcium deposition to treat osteoporosis and lower blood calcium levels.

Promotes calcium absorption from the intestines and reabsorption from the kidney

A patient newly diagnosed with hyperthyroidism is pregnant. Which antithyroid drug should be used during first trimester? Methimazole Calcitriol Cinacalcet Propylthiouracil (PTU)

Propylthiouracil (PTU)

The nurse informs a male patient that testosterone therapy may promote cancer growth in which organ?

Prostate

itraconazole, fluconazole

Prototypes of the antifungals (AZOLES):

A patient has crabs. The nurse should tell the patient to apply the medication to which area?

Pubic area

Which of Mr. Allen's vital sign findings will indicate to the nurse to hold the verapamil?

Pulse of 56 beats/min Calcium channel blockers should be held when the pulse is below 60 beats/minutes or when systolic blood pressure is 90 mm Hg or lower.

A nurse is reviewing home medications with a patient at the time of admission and learns the patient is taking 2 mg of clonidine twice a day. Which nursing intervention would be the priority?

Question the dosage - too high for maintenance dose

Which products can increase the risk for digoxin toxicity?

Quinidine Dronedarone Ginseng

Hydralazine absorption

Readily absorbed with oral (PO) administration

While obtaining a medical history, the nurse finds that the patient taking warfarin eats a spinach salad for lunch every day. Which teaching point would the nurse provide for this patient?

The salad may decrease warfarins effectiveness

Due to the extremely short half-life and duration of action, the adverse effects of adenosine resolve very quickly. Patients should be instructed as follows:

They may experience brief chest pressure, nausea, lightheadedness, head or neck pain, or shortness of breath. These symptoms will resolve quickly. Flushing/headache may occur temporarily after administration. Continued chest pain, lightheadedness, head or neck pain, or difficulty breathing should be reported immediately.

A patient has been on a sodium nitroprusside infusion for 6 days and starts talking about the color of the sky while pointing to the ceiling. What does the nurse suspect?

Thiocyanate toxicity Thiocyanate may build up in patients who are receiving sodium nitroprusside for more than 3 days. When thiocyanate builds, the patient can become confused and show delirium. Patients who are receiving sodium nitroprusside for longer periods of time should have plasma thiocyanate laboratory values monitored and kept below 0.1 mg/mL. The nurse would suspect thiocyanate toxicity.

When providing patient discharge instructions related to somatropin, which information would the nurse include? "You'll take two pills by mouth every morning." "This medication is injected under the skin or in a muscle" "This medication comes as a rectal suppository." "You will receive this drug weekly by IV infusion."

This medication is injected under the skin or in a muscle

A patient is scheduled to start taking insulin glargine [Lantus]. Which information should the nurse give the patient regarding this medication?

This medication provides blood glucose control for 24 hours. Insulin glargine is administered as a once-daily subcutaneous injection for patients with type 1 and type 2 diabetes. It is used for basal insulin coverage, not mealtime coverage. It has a prolonged duration, up to 24 hours, with no peaks. Blood glucose monitoring is still an essential component to achieve tight glycemic control.

Hydralazine excretion

Through kidneys, in urine

A patient has been diagnosed with Pseudomonas aeruginosa. Which penicillins are extended-spectrum penicillins that treat bacteria such as P. aeruginosa? Select all that apply.

Ticarcillin and piperacillin are the only two extended-spectrum penicillins available. Oxacillin is a narrow-spectrum penicillin. Ampicillin and amoxicillin are broad-spectrum penicillins.

The nurse is taking care of a patient who has been prescribed tigecycline. The nurse knows the patient may exhibit adverse effects similar to those of which class of antibiotics?

Tigecycline is the first representative of a new class of antibiotics, the glycyclines. It is a tetracycline derivative made to overcome drug resistance and is active against many drug-resistant strains. It has adverse effects similar to those of the tetracyclines. The glycyclines are not similar to the penicillins, macrolides, or cephalosporins.

The heart undergoes cardiac remodeling during the initial phase of heart failure. Which cardiac geometric change occurs during heart failure?

Ventricular wall thickening

The heart undergoes cardiac remodeling during the initial phase of heart failure. Which structural change occurs with heart failure?

Ventricular wall thickening An increase in ventricular wall thickness, also called ventricular hypertrophy, is characteristic of the remodeling process during the initial phase of heart failure. The ventricles also dilate and become more spherical (less cylindric). This change in cardiac shape typically occurs after cardiac injury under the influence of the neurohormonal systems, such as the sympathetic nervous system and renin-angiotensin-aldosterone system.

The nurse is caring for a patient prescribed digoxin [Lanoxin] for heart failure. Which finding would require immediate attention by the nurse?

Vomiting and Diarrhea

Which parameters will a nurse ensure have been assessed before administering prednisone to a patient newly diagnosed with systemic lupus erythematous?

Weight sodium glucose bp presence of preexisting edema

A patient who was prescribed amiodarone is concerned about developing heart failure. Which clinical manifestations would the nurse instruct the patient to report that are indicative of heart failure?

Weight Gain Swelling Difficulty Breathing

Which patient parameters would a nurse inquire about when a patient returns to have his testosterone levels monitored?

Weight changes Mood alterations blood glucose readings blood pressure chanfes

A patient with atrial fibrillation is being discharged on verapamil. Which symptoms will the nurse instruct the patient to report to the health care provider?

Weight gain Dyspnea Swelling to feet and ankles

A patient who was prescribed amiodarone is concerned about developing heart failure. Which clinical manifestations would the nurse instruct the patient to report that are indicative of heart failure?

Weight gain Swelling Difficulty breathing

A nurse is assessing a patient who has been taking metoprolol. Which assessment finding would be most concerning?

Weight gain of 4lbs in 24 hours Metoprolol decreases the force of ventricular contraction, which can worsen preexisting heart failure. A weight gain of 4 lb within 24 hours is indicative of fluid retention.

digoxin and warfarin

What are the two very significant drugs which have interactions with Amiodarone?

3 (The most appropriate outcome criteria when taking antidysrhythmic medications is that the client's symptoms of dysrhythmia and subsequent decreased cardiac output are decreased and/or alleviated. The client's peripheral pulses should be equal, strong, and regular bilaterally with warm, pink extremities. Weight gain of 5 pounds or more in one week is of concern, and the prescriber should be notified. Heart failure may be developing or worsening if the client already has known heart failure. The systolic blood pressure should be > 90 mm Hg.)

What is the most appropriate outcome criteria for a client who has been prescribed an antidysrhythmic medication? 1 Palpated radial pulses > pedal pulses 2 Weight gain in one week 5 lb 3 Cardiac output increased 4 Systolic blood pressure 90 mm Hg

2 (When antidysrhythmic drugs are administered, the nurse should monitor vital signs, especially pulse rate and blood pressure. If the pulse is lower than 60 beats/min, notify the prescriber.)

What is the most important assessment to complete before the nurse administers an antidysrhythmic medication? 1 Respiratory rate 2 Pulse 3 Auscultate lungs 4 Temperature

B In response to stress, the adrenal cortex secretes increased amounts of glucocorticoids and the adrenal medulla secretes increased amounts of epinephrine. Working together, glucocorticoids and epinephrine help to augment and increase the blood glucose concentration, blood pressure, coagulation factors, and oxygenation as part of the fight-or-flight mechanism (stress response). Thus they provide more fuel for cells. Cortisol increases oxygen delivery to the vital organs by increasing the blood flow. Blood coagulability also increases.

What role does the release of cortisol play in the stress response? A. Decreases oxygen delivery B. Provides more fuel for cells C. Reduces blood flow to vital organs D. Decreases coagulability of blood

Propranolol is prescribed to a patient for heart failure. Which assessment finding would concern the nurse?

Wheezing Propranolol, a nonselective beta blocker, can cause bronchoconstriction. Wheezing is an indication of bronchoconstriction.

C Fludrocortisone (Florinef) has mineralocorticoid properties, resulting in sodium and fluid retention along with potassium excretion, leading to hypokalemia. Hyponatremia is an adverse effect of adrenal crisis. Hypercalcemia is an adverse effect to teriparatide (Forteo). The most common adverse effect of fertility drugs is hypovolemia.

When assessing for potential adverse effects of fludrocortisone (Florinef), what are signs and symptoms the nurse should monitor in a patient? A. Hyponatremia B. Hypercalcemia C. Hypokalemia D. Hypovolemia

C Fludrocortisone (Florinef) has mineralocorticoid properties, resulting in sodium and fluid retention along with potassium excretion. Calcium levels are not a concern.

When assessing for potential side effects of fludrocortisone (Florinef), what is a priority for the nurse to monitor? A. Serum sodium levels for potential hyponatremia B. Serum calcium levels for hypercalcemia C. Serum potassium levels for hypokalemia D. Intake and output for potential fluid volume deficit

A child with nocturnal enuresis has a new prescription for desmopressin. Which statement describes desmopressin's duration of action? This drug duration of action is variable, but usually 6 hours. When given at bedtime, the drug effects should last through the night. If fluid is limited before bedtime, it can last for 24 hours. The drug lasts about 4 hours. An additional dose will be needed during the night.

When given at bedtime, the drug effects should last through the night. (8-12hrs)

3 (Grapefruit juice can inhibit the metabolism of several antidysrhythmics such as amiodarone, disopyramide, and quinidine. The other food and drink options are not as necessary to restrict in the client's diet.)

When preparing a teaching plan for client started on amiodarone, which food or drink should the nurse advise the client to avoid? 1 Gluten 2 Poultry 3 Grapefruit juice 4 Whole milk

1, 5

Which statements about the use of benzyl alcohol [Ulesfia] to treat head lice does the nurse identify as true? (Select all that apply.) 1 Benzyl alcohol kills lice by suffocation. 2 Benzyl alcohol is a one-time treatment. 3 Resistance to benzyl alcohol is common. 4 Benzyl alcohol is approved for topical treatment of head lice in patients age 1 year or older. 5 Benzyl alcohol is generally well tolerated.

1, 2, 3

Which statements does the nurse include when teaching a patient about ectoparasites? (Select all that apply.) 1 Most ectoparasites that infest humans live on the skin and hair. 2 Some ectoparasites live on clothing and bedding and move to the host to feed. 3 The main ectoparasites that infest humans are mites and lice. 4 Infestation with lice is known as scabies. 5 Infestation with mites is known as pediculosis.

The nurse is assessing a patient with amebiasis who has been prescribed an antiprotozoal drug. Which category of medication, if prescribed for the patient, would prompt the nurse to hold the medication and contact the provider?

While assessing a patient with amebiasis who has been prescribed antiprotozoal drugs, the nurse should check the medical history of the patient to identify and prevent the adverse effects caused by drug interaction. Antiprotozoal drugs interact with anticoagulants such as warfarin and increase the risk of bleeding by decreasing the inactivation anticoagulants. Analgesics can be administered with caution in patients for relief of joint pain. Antibiotics can be administered along with antiprotozoal drugs for synergistic effects. Antiemetics do not interact with antiprotozoal drugs, so they are safe to be administered.

Which should be included in the discharge instructions for a patient taking levothyroxine? "You will need to change positions slowly." "Soon you will gradually wean yourself off of this medication." "You will need to have lab work done periodically." "You will need to palpate your thyroid gland daily."

You will need to have lab work done periodically

What was the first nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) used to treat human immunodeficiency virus (HIV) infection?

Zidovudine is the first NRTI used to treat HIV. Delavirdine, efavirenz, and nevirapine are non-nucleoside reverse transcriptase inhibitors (NNRTIs).

azoles

______ are: - broad spectrum antifungals - have lower toxicity than amphoterecin, and may be given by mouth DISADVANTAGE: inhibit cytochrome P450 enzymes = increased levels of many other drugs Used for systemic infections: Itraconazole, ketoconazole, fluconazole, voriconazole, posaconazole

nystatin

______ is a polyene antibiotic used only for candidiasis * Drug of choice for - intestinal candidiasis

Which advantages are associated with the use of progestin-only products (POPs) compared with combined hormonal contraceptives (CHCs)?

Relative safety of contraception Reversibility of contraception, except the depot POP

benzyl alcohol, 6

_______ _______ Approved for ages ___mos and older Kills by SUFFOCATION No effect on ova; retreatment needed AE: itching, eye irritation, application site irritation and numbness

Which teaching would the nurse include for a patient receiving a transdermal clonidine patch?

Remove one patch before applying another

drug interactions

_______ ________ of amphotericin B: - Other nephrotoxic drugs (aminoglycosides, cyclosporin, NSAIDS) increase risk of kidney damage - Flucytosine - Amphotericin potentiates the antifungal action of this drug, making them a good combo

polyene

_______ antibiotics include Amphotericin B and Nystatin for fungal infections.

flucytosine

_______ is a pyrimidine analog - used for serious infections by Candida and C. neoformans - almost always used in combo with amphotericin - Narrow spectrum - Most serious SE = bone marrow suppression - hepatotoxicity - monitor renal function

drug interactions

________ _________ with itraconazole: 1. Inhibition of hepatic drug metabolizing enzymes: - ImportAant: cisapride, pimozide, dofetilide, quinidine - Also: cyclosporin, digoxin, warfarin, sulfonylureal hypoglycemics 2. Drugs that raise gastric pH - anatacids, H22 antagonists, PPIs - greatly reduce absorption of itraconazole (admin 1 hr before or 2 hr after)

nematodes

________ infections: Ascariasis (giant roundworm) Enterobiasis (pinworm) Ancylostomiasis and Necatoriasis (hookworm) Trichuriasis (whipworm) Stronglyloidiasis (threadworm)

trematode

________ infections: Schistosomiasis (blood fluke) Fascioliasis (liver fluke) Fasciolopsiasis (intestinal fluke)

cestode

________ infections: Taeniasis (beef and pork tapeworm) Diphyllobothriasis (fish tapeworm)

diethylcarbamazine

________ is the drug of choice for filarial infestations MOA: reduces muscular activity, and alters surface properties of parasites - Primary SE = minor, secondary SE = more serious, but transient

amphotericin B

_________ ___ is active against a broad spectrum of pathogenic fungi and is the drug of choice for most SYSTEMIC mycoses. - it is HIGHLY TOXIC (related to sterols) -- Infusion reactions and renal damage -- hypokalemia and bone marrow suppression - Binds to components of fungal cell membrane increasing permeability - can be fungistatic or fungicidal - treatment commonly lasts 6-8wks - Also drug of choice for leishmaniasis - Must be administered IV

Pyrethrins, Piperonyl Butoxide, 2

_________ and _____________ (RID, Licide) ** Pubic lice and head lice Effective against adult parasites RETREATMENT needed in 9 days AE: irritation to eyes and mucous membranes (especially when using for head lice) Comb out nits after tx Approved for ____yrs and older

echinocandins

__________ disrupt fungal CELL WALL instead of cell membrane. - must be given parenterally - narrow spectrum - used for aspergillus and candida species First: caspofungin

A patient has been prescribed tenofovir. After taking the drug for 3 days, the patient contacts the nurse to report experiencing muscle pain and weakness. What is the nurse's highest priority action? 1 Reassure the patient that the symptom is time limited and will resolve. 2 Instruct the patient to hold doses of the medication until further notice. 3 Reassure the patient that this is an expected side effect of the medication. 4 Instruct the patient to self-medicate with a nonsteroidal antiinflammatory medication.

Instruct the patient to hold doses of the medication until further notice. - The patient should not take any more doses of the medication until the health care provider can evaluate the patient. Muscle pain and weakness may be related to lactic acidosis, a serious adverse effect of the medication.

Side effects for digoxin

Instruct the patient to report side effects: nausea, vomiting, headache, diarrhea, and visual disturbances, including diplopia.

The spouse of a patient receiving desmopressin calls the clinic to report that her husband is not feeling well and is nauseated and confused. Which action would the nurse take? Reassure the spouse that these symptoms are temporary and should resolve soon. Instruct the spouse to bring the patient to the clinic for further evaluation. Tell the spouse to hold the medication for a day and then resume therapy. Encourage spouse to have the patient drink orange juice or an electrolyte solution and rest.

Instruct the spouse to bring the patient to the clinic for further evaluation.

Which long-acting insulin mimics natural, basal insulin with its duration of 24 hours?

Insulin glargine [Lantus] Insulin glargine [Lantus] has a duration of action of 24 hours with no peaks, mimicking natural, basal insulin secretion by the pancreas. Insulin aspart [NovoLog] is a rapid-acting human insulin analog used to lower blood glucose, which has a different dosage. Regular insulin [Humulin R] has its duration of action of 6 to 10 hours, with a peak plasma concentration of 2.5 hours. Ultralente insulin [Humulin U] has an active duration of 28 hours.

Which patient assessment findings would the nurse associate with potential digoxin toxicity?

Reports of blurry vision reports of halos around objects disoriented person, place, and time vomiting

A patient is noted to be experiencing a cardiac dysrhythmia. Which parameter would the nurse use to administer a bolus dose of diltiazem?

Intravenously slowly over 2 minutes Diltiazem intravenous should be administered slowly over 2 minutes while monitoring the cardiac rhythm for any changes in rate or rhythm.

Amiodarone is contraindicated in a patient with which hypersensitivity?

Iodine allergy Amiodarone is contraindicated in patients with iodine allergy.

A patient gets severe itching after going to bed. In addition, there are small dotted lines on the wrists and elbows. Which condition would be most likely?

Scabies

A 29-year-old woman with hypertension had unprotected sexual intercourse about 36 hours ago. Which statement accurately explains whether this patient is a candidate for emergency contraception?

She is a candidate for emergency contraception because it may be taken within 72 hours of unprotected sexual intercourse.

Which tissue types are common primary tissues that are affected by infection with the Trichophyton spp?

Skin & scalp

Which instruction would the nurse give the patient who is about to travel to a malaria risk country?

Start antimalarial meds 2 weeks before arrival in that country

Which instruction would the nurse provide a patient about the proper administration of extended-release diltiazem?

Swallow whole without crushing or chewing.

In which division of the nervous system are catecholamines blocked by metoprolol, resulting in drowsiness?

Sympathetic nervous system

The nurse administers a prescribed dose of intravenous verapamil to a patient with a baseline blood pressure (BP) of 210/110 mm Hg at 0800. Which BP reading would the nurse expect to see 15 minutes after administration?

The BP will start to increase, returning to baseline within 10 to 20 minutes.

3 (Itraconazole [Sporanox] has negative inotropic actions and may cause a transient decrease in the ventricular ejection fraction, thus precipitating heart failure. Pedal edema is a symptom of heart failure, and the nurse should assess for it. Skin rash, hair loss, and joint pain are unrelated to the use of itraconazole.)

It is most important for the nurse to assess a patient taking itraconazole [Sporanox] for the development of what? 1 Hair loss 2 Skin rash 3 Pedal edema 4 Joint pain

A patient newly diagnosed with type 1 diabetes asks a nurse, "How does insulin normally work in my body?" The nurse should base his or her response on which understanding of the mechanism of insulin?

It promotes the passage of glucose into cells. The hormone insulin promotes the passage of glucose into cells where it is metabolized for energy. Insulin does not stimulate the pancreas to reabsorb glucose or synthesize amino acids into glucose. It does not stimulate the liver to convert glycogen into glucose.

A patient is prescribed mebendazole to treat for roundworms. Which statement by the patient indicates an accurate understanding of when the parasites will be eradicated from the body?

It will take about 3 days for my body to be rid of worms

Before administering digoxin, the nurse would conduct a thorough assessment, knowing that digoxin accumulates the highest in which areas of the body?

Kidney Intestine Heart Skeletel Muscle

Which drug would the nurse anticipate being prescribed to Ms. Weston after she is diagnosed with hypothyroidism? CASE STUDY DETAILS Propylthiouracil Methimazole Calcitriol Levothyroxine

Levothyroxine

A patient who is prescribed quinidine, a Class I antidysrhythmic drug, tells the nurse that "long, hot baths are enjoyable at the end of a long work day." Which teaching will the nurse provide to the patient regarding long, hot baths?

Long, hot baths should be avoided because quinidine can lower the blood pressure. Quinidine, while an antidysrhythmic drug, can also lower blood pressure. Long, hot baths promote vasodilation, which can worsen hypotension. Therefore the patient should avoid long, hot baths.

2

The healthcare provider orders albendazole [Albenza] 400 mg twice daily × 10 days. What will the daily dose of albendazole be? 1 400 mg 2 800 mg 3 1200 mg 4 1600 mg

2 (The SA node is the pacemaker because it can spontaneously depolarize easier and faster than the other areas. )

The nurse knows that which structure in the heart is referred to as the "pacemaker"? 1 AV node 2 SA node 3 Pukinje fibers 4 Bundle of His

3

The nurse recognizes which term as representative of infestation with giant roundworms? 1 Strongyloidiasis 2 Enterobiasis 3 Ascariasis 4 Trichuriasis

Which statins are significantly metabolized by CYP3A4

Lovastatin Simvastatin Atorvastatin

A patient is receiving amiodarone. During patient teaching, the nurse will explain the importance of drug toxicity knowing amiodarone accumulates in which organs?

Lungs Liver

A patient is receiving amiodarone. During patient teaching, the nurse will explain the importance of drug toxicity knowing amiodarone accumulates in which organs?

Lungs & Liver

Which generation of cephalosporins is highly resistant to beta-lactamases? Select all that apply.

Third-, fourth-, and fifth-generation cephalosporins are highly resistant to beta-lactamases. Most first-generation cephalosporins are destroyed by beta-lactamases, and second-generation cephalosporins are less sensitive to destruction than the first generation.

A cancer patient is receiving a combination of cancer drugs. How should the nurse interpret this finding?

This prevents drug resistance.

A patient is on the tenth day of a clopidogrel regimen and presents with a temperature of 102.1oF and total urine output of 200 mL over 24 hours. The patient is disoriented. Which adverse effect would the nurse suspect?

Thrombotic thrombocytopenia purpura (TTP) reaction TTP is a condition characterized by thrombocytopenia, neurologic symptoms, and fever. Most cases occur during the first 2 weeks of treatment and require urgent treatment.

For which purpose should the nurse administer aliskiren to a patient with hypertension?

To reduce blood pressure Aliskiren is approved only for hypertension. Aliskiren does not prevent stroke or myocardial infarction, nor does it reduce diabetic nephropathy.

fluconazole

Tx for Vulvovaginal Candidiasis ___________one tablet X 1 dose

terbinafine (lamisil), itraconazole (Sporanox)

Tx for onychomycosis ( 2 meds) - Oral therapy for 3-6 mon

Adenosine distribution

Unknown

Adenosine excretion

Unknown

Adenosine metabolism

Unknown

mebendazole

Used for: - drug of choice for most intestinal roundworms - clears infestation of pinworms, hookworms, giant roundworms MOA: inhibits glucose uptake by helminths - only 5-10% absorbed orally - Pregnant patients should avoid

Flucytosine (Ancobon)

Used in combo with Ampho B (allows for lower dose of ampho B) Tx for candidiasis and cryptococcus neoformans converted to 5FU-antimetabolite (drug used for cancer therapy) MOA: Disrupts fungal DNA and RNA Adverse Effects Bone Marrow suppression (MONITOR! especially when taking in conjunction with Ampho B) Hepatotoxicity

antihelmintics

Used to treat parasitic worm infestation Nematodes (roundworms) Cestodes (tapeworms) Trematodes (flukes) Most common site: intestines Most prevalent areas: sites of poor sanitation Treatment: not always indicated

Which action enhances the effectiveness of levothyroxine for the patient with hypothyroidism? Using levothyroxine at a consistent time each day Crushing and chewing levothyroxine tablets Taking levothyroxine 30 minutes after a meal Drinking milk with each dose of levothyroxine

Using levothyroxine at a consistent time each day

What will the nurse monitor to evaluate the effectiveness of antiviral agents administered to treat human immunodeficiency virus infection? 1 Viral load 2 Lymphocyte counts 3 Red blood cell counts 4 Megakaryocyte counts

Viral load

Which instruction will the nurse share with the patient taking testosterone by gel [AndroGel]?

Wash hands after applying.

The nurse would include which statement when teaching a patient about insulin glargine (Lantus)? "You should inject this insulin just before meals because it is very fast-acting." "The duration of action for this insulin is approximately 8 to 10 hours, so you will need to take it twice a day." "You can mix this insulin with Lente insulin to enhance its effects." "You cannot mix this insulin with any other insulin in the same syringe.

You cannot mix this insulin with any other insulin in the same syringe." nsulin glargine (Lantus) is a long-acting insulin with a duration of action up to 24 hours. It should not be mixed with any other insulins. The insulin is not fast-acting.

Hydralazine causes

a dilation of arterioles, which causes a decrease in peripheral resistance and arterial blood pressure. Although this drug was widely used in the past, newer antihypertensive agents have replaced much of its use.

Vasodilators are contraindicated in patients with

a known drug allergy. Other contraindications include acute myocardial infarction (MI), head injury, cerebral edema, hypotension, and coronary artery disease. If heart failure is present secondary to diastolic dysfunction, vasodilators may also be contraindicated.

What is the most appropriate outcome criteria for a patient who has been prescribed a calcium channel blocker?

absence of chest pain (decreases force of contraction and dilate arteries)

Patient may experience short duration of asystole. Have the crash cart by the patient before administering

adenosine

Glucocorticoids

affect metabolism of carbohydrates, fats, and proteins

A nurse is providing patient education to a patient as part of her work in a fertility clinic. The nurse explains possible reasons for infertility. When explaining how the ovaries are involved in conception, what will the nurse stress? A)Ova quickly degenerate and most are absorbed in the body before the age of 12. B)The ovaries at birth contain all of the ova that a woman will have. C)Ova aggregate, causing millions to be contained in a storage site called a follicle. D)Follicles produce only estrogen; the uterus produces progesterone.

b It would be important to explain that the woman's ova do not increase or decrease from birth to childbearing years. The nurse will stress that all the ova that a woman will have will be present at birth. The patient should understand that if she does not ovulate 1 month or for several months, it is not because she has done something to her body to cause this. Ova slowly degenerate over a lifetime or they are released once a month until menopause is complete. Each ovum is contained in a storage site called a follicle, which produces the female sex hormones, estrogen and progesterone.

Because of the potential for serious cardiac effects, minoxidil has a

black box warning, and its use is reserved for severe hypertension, when other safer drugs have failed.

CCBs work by

blocking the slow inward flow of calcium ions into the slow (calcium) channels in the cardiac conduction tissue. Conduction is limited to the atria and the atrioventricular (AV) node, where conduction is prolonged, and the tissues are made more refractory to stimulation. CCBs have little effect on the ventricular tissues.

pubic, head

pyethrins plus piperonyl butoxide is used to remove _____ and _____ lice - active against adults but not ova - approved for 2 years old and older

Five cardinal signs of inflammation

redness swelling heat pain loss of function

The nurse must be aware of the proper preparation, dosage, and administration when handling adenosine. Adenosine is available in a

solution (3 mg/mL) to be used for IV bolus administration. It should be injected IV as close to the heart as possible (e.g., antecubital fossa), followed immediately by a saline flush. The first dose is 6 mg, given over 1 to 2 seconds. If no response is noted in 1 to 2 minutes, a dose of 12 mg may be administered and repeated one time 1 to 2 minutes after the most recent dose. If the patient is going to respond, it should occur as soon as adenosine reaches the AV node.

The therapeutic uses for hydralazine are

specific to essential hypertension, hypertensive crisis, and heart failure. It has largely been replaced by newer antihypertensive agents; however, when used, hydralazine is combined with other drugs for treatment of essential hypertension, including a beta blocker and possibly a diuretic.

Based on its pharmacokinetic profile, which counseling point would a nurse provide a patient who has been prescribed gemfibrozil?

take daily - 30 minutes before meals

A patient states that clopidogrel is causing an upset stomach. Which instruction would the nurse provide?

take with food

GI effects of chloroquine can be minimized by

taking with meals

The nurse assesses a patient who takes quinine for signs of cinchonism, a syndrome characterized by what

tinnitus, h/a, visual disturbances, nausea and diarrhea

A patient with type 1 diabetes mellitus has been ordered insulin aspart [NovoLog] 10 units at 7:00 AM. Which nursing intervention should the nurse perform after administering this medication?

Make sure the patient eats breakfast immediately. Insulin aspart [NovoLog] is a rapid-acting insulin that acts in 15 minutes or less. It is imperative that the patient eat as the insulin starts to work. The patient should have had a fingerstick blood sugar test done before receiving the medication. There is no need to check the urine. This medication is given subcutaneously.

A patient with type 1 diabetes mellitus has been ordered insulin aspart (Novolog) 10 units at 7:00 AM. What nursing intervention will the nurse perform after administering this medication? Perform a fingerstick blood sugar test. Have the patient void and dipstick the urine. Make sure the patient eats breakfast immediately. Flush the IV.

Make sure the patient eats breakfast immediately. Insulin aspart (Novolog) is a rapid-acting insulin that acts in 15 minutes or less. It is imperative that the patient eat as it starts to work. The patient should have had a fingerstick blood sugar test done before receiving the medication. There is no need to check the urine. This medication is given subcutaneously.

Fludrocortisone is sometimes used with hydrocortisone as therapy for Addison's disease. Which rationale for the addition of fludrocortisone is accurate? Manage fluid and electrolyte balance Facilitate elimination of excessive fluid Promote immunosuppression Regulate the body's glucose balance

Manage fluid and electrolyte balance

Which instruction should the nurse provide to the parent of a child with an enterobiasis (pinworm) infestation?

"All other members of the family need to be treated because this is easily transmitted."

A patient who was found unconscious was found to have a large, acute pulmonary embolism and was given alteplase. The patient's family asks the nurse why alteplase was given rather than warfarin. Which response would the nurse make?

"Alteplase is a thrombolytic that is used to dissolve large clots to restore circulation. Warfarin only prevents clots from forming."

A patient who is taking digoxin states, "I take this medication for my high blood pressure." How would the nurse respond to educate the patient?

"Digoxin is used for heart failure and atrial fibrillation."

A patient has been taking metoprolol IR for 6 weeks. Current assessment data includes a heart rate of 72 beats per minute and blood pressure of 126/74 mm Hg. The patient reports occasional dizziness, insomnia, and fatigue. Which recommendation will the nurse provide for this patient?

"It is important to discuss these symptoms with the health care provider." These are side effects of this drug, and the patient should be instructed to discuss them with the health care provider.

A patient newly diagnosed with diabetes asks, "How does insulin normally work in my body?" Which response by the nurse is correct?

"It promotes the passage of glucose into cells for energy." Insulin promotes the passage of glucose into cells, where it is metabolized for energy. During or after a meal, the glucose that is ingested stimulates the pancreas to secrete insulin. Insulin stimulates the synthesis of proteins and not amino acids. Insulin stimulates the liver to convert glucose to glycogen.

malathion

- Kills lice and their ova - Used for head lice in people 6 years and older

albendazole

- only 2 approved uses in the U.S. - MOA: prevents microtubule-dependent uptake of glucose (prevents formation of microtubules) - Take with fatty meal to increase absorption - Monitor for liver impairment, bone marrow suppression - Should NOT be used in pregnancy

Which antigout therapies inhibit xanthine oxidase?

-Allopurinol -Febuxostat

Which of the antifungal drugs are classified as echinocandins?

-Micafungin -Capsofungin

Classes of anti fungal drugs

-Polyenes -Azoles -Antimetabolites -Echinocandies -Misc

Which parameters will a nurse ensure have been assessed before administering prednisone to a patient newly diagnosed with systemic lupus erythematous?

-Weight & vitals -Any presence of edema -Sodium, potassium, glucose levels

Frequent sites of helminth infestation occur in which area(s) of the body? Select all that apply.

-blood stream -liver -intestine -lymphatic system

The nurse is preparing to administer an oral dose of digoxin [Lanoxin]. The apical pulse rate is 64. Which nursing action is most appropriate? 1 Give the medication. 2 Obtain a serum digoxin level. 3 Notify the healthcare provider. 4 Assess for signs of digoxin toxicity.

1

The nurse should recognize that which drug only dilates arterioles? 1 Hydralazine 2 Nitroglycerin 3 Isosorbide dinitrate 4 Sodium nitroprusside

1

The nurse who is caring for a patient with heart failure informs the patient that, "This drug will increase the contractions of your heart." Which drug is the nurse administering? 1 Digoxin 2 Carvedilol 3 Bisoprolol 4 Verapamil

1

Calcium channel blockers (CCBs) work by reducing calcium influx into the cells of the heart and blood vessels. Calcium channels are coupled to which type of autonomic nervous system receptors? 1. Beta 1 2. Beta 2 3. Alpha 1 4. Alpha 2

1. Beta 1 (Calcium channels are coupled to beta 1-adrenergic receptors in the heart. For that reason, CCBs affect the heart in ways similar to those of beta blockers. Both types of drugs cause a decrease in the force of contraction, heart rate, and cardiac impulse conduction.)

A patient with angina pectoris has been prescribed nifedipine. Which possible adverse effects should the nurse expect with this medication? Select all that apply. 1. Headache 2. Constipation 3. Nausea and vomiting 4. Edema of ankles and feet 5. Overgrowth of gum tissue

1. Headache 4. Edema of ankles and feet 5. Overgrowth of gum tissue (Some adverse effects of nifedipine are headache, edema of ankles and feet, and gingival hyperplasia (overgrowth of gum tissue). Nifedipine causes very little constipation. Nausea and vomiting are common side effects of clevidipine.)

Which statement accurately describes the pharmacodynamics of ezetimibe?

1/2 life is 22 hrs

Which time frame represents the anticipated elimination half-life of most testosterone products?

10 to 100 minutes

A patient has received a medication that constricts the blood vessels. What effect will this have on the blood pressure? 1 Will decrease 2 Will be elevated 3 Will stay the same 4 Will fluctuate wildly

2

A patient has taken a medication that causes the arterioles to dilate. What will likely happen to the cardiac afterload? 1 It will rise. 2 It will decrease. 3 It will stay the same. 4 It will fluctuate wildly.

2

A patient is given medication to make the blood vessels constrict. The nurse understands that what occurs with this medication? 1 Blood flow increases. 2 Resistance increases. 3 Vessel diameter enlarges. 4 Blood pressure decreases.

2

After being taught about digoxin, which statement from the staff indicates more teaching is needed? 1 "Digoxin has a positive inotropic effect." 2 "Digoxin is a first-line drug for heart failure." 3 "Digoxin when used by women may actually shorten life." 4 "Digoxin can help with heart failure, but it does not prolong life."

2

An unlicensed assistive personnel asks the nurse how the blood gets back to the heart. How should the nurse respond? 1 "By way of two-way valves." 2 "By way of the venous pump." 3 "By way of dilation in the venous walls." 4 "By way of the positive pressure in the right atrium."

2

Which hemodynamic system serves as a reservoir for circulating blood? 1 Heart 2 Veins 3 Lungs 4 Arteries

2

Which patient receiving losartan [Cozaar] should be monitored closely while receiving this therapy? 1 The patient with constipation 2 The patient with an elevated creatinine level 3 The patient with a heart rate of 90 beats/min 4 The patient with a potassium level of 3.4 mEq/L

2 Losartan [Cozaar] has been shown to be beneficial in patients with hypertension and heart failure. Patients with renal or hepatic dysfunction should be assessed carefully due to the potential for toxicity and increased side effects. An elevated creatinine level is an indication of renal dysfunction. The other findings are not.

clotrimazole, nystatin

2 drugs used for superficial mycoses:

Teach the patient to check weight daily and to report weight gain of

2 lb in 24 hours or 5 lb or more in 1 week to the health care provider.

candida, dermatophytic

2 superficial mycoses: _________ Infections Usually in mucous membranes and moist skin Chronic infections may involve scalp, skin, and nails __________ infections (eg, ringworm) Usually confined to skin, hair, and nails More common than Candida infections in nails

Which are actions of angiotensin II? Select all that apply. 1. Dilates vessels 2. Raises blood pressure 3. Causes cardiac remodeling 4. Catalyzes angiotensinogen 5. Stimulates aldosterone release

2. Raises blood pressure 3. Causes cardiac remodeling 5. Stimulates aldosterone releases (The most prominent actions of angiotensin II are vasoconstriction (not dilation) and stimulation of aldosterone release. Both actions raise blood pressure. In addition, angiotensin II can act on the heart and blood vessels to cause remodeling and hypertrophy. Renin catalyzes angiotensinogen.)

The nurse is administering several medications at 8 a.m. Which medication will decrease blood pressure by blocking angiotensin II receptor sites? 1. Enalapril 2. Valsartan 3. Eplerenone 4. Furosemide

2. Valsartan (Valsartan is an angiotensin II receptor blocker that is indicated for management of hypertension. Furosemide is a loop diuretic. Eplerenone is an aldosterone antagonist. Enalapril is an angiotensin-converting enzyme inhibitor.)

Which statement is true regarding the renin-angiotensin-aldosterone system? 1. Renin is the by-product of angiotensinogen catalysis. 2. Angiotensinogen is catalyzed by renin into angiotensin 1. 3. Angiotensinogen catalyzes the conversion of angiotensin I and angiotensin II. 4. ACE concerts angitoentsinogen to angiotensin I.

2.Angiotensinogen is catalyzed by renin into angiotensin 1. (Angiotensinogen is catalyzed by renin into angiotensin I (inactive). ACE converts angiotensin I into angiotensin II (active).)

To be effective for treating chickenpox, acyclovir should be initiated within how many hours of the appearance of the rash? 1 8 2 16 3 24 4 56

24

Complete the equation: Cardiac output = Volume of blood ejected at each heartbeat × ____. 1 Preload 2 Afterload 3 Heart rate 4 Stroke volume

3

The heart undergoes cardiac remodeling during the initial phase of heart failure. Which structural change occurs with heart failure? 1 Ventricular atrophy 2 Ventricular constriction 3 Ventricular wall thickening 4 Ventricles become more cylindric

3

The natriuretic peptides serve to protect the cardiovascular system from which condition? 1 Hypotension 2 Hypovolemia 3 Volume overload 4 Myocardial infarction

3

The nurse is administering a drug to a patient with heart failure and states, "This drug can help you live longer." Which medication did the nurse administer? 1 Digoxin 2 Nesiritide 3 Carvedilol 4 Furosemide

3

The nurse is administering captopril to a patient with heart failure. Which best describes the effects of this drug? 1 Constricts arterioles and veins 2 Increases release of aldosterone 3 Blocks production of angiotensin II 4 Increases production of angiotensin II

3

Which area should the nurse assess to best determine systemic circulation function? 1 Heart 2 Lungs 3 Periphery 4 Lymph nodes

3

The nurse will most likely administer a combination drug of hydralazine and isosorbide dinitrate to patients belonging to which ethnic group? 1. Asian American 2. Native American 3. African American 4. Mexican American

3. African American (Hydralazine is also available in fixed-dose combination with isosorbide dinitrate (a vasodilator) sold as BiDil. BiDil is the first drug product approved for treating a specific ethnic group—namely, African Americans.)

The renin-angiotensin-aldosterone system plays an important role in maintaining blood pressure. Which compound in this system is most powerful at raising blood pressure? 1. Renin 2. Angiotensin I 3. Angiotensin II 4. Angiotensin III

3. Angiotensin II (Angiotensin II is a potent vasoconstrictor. It participates in all the pathways regulated by the renin-angiotensin-aldosterone system. Angiotensin I is a precursor to angiotensin II; angiotensin III is formed by degradation of angiotensin II and is less potent. Renin catalyzes the conversion of angiotensinogen to angiotensin I.)

A staff member asks how calcium channel blockers (CCBs) work. Which response should the nurse provide? 1. CCBs increase arterial pressure 2. CCBs block reabsorption of sodium 3. CCBs relax vascular smooth muscle 4. CCBs have a positive inotropic effect

3. CCBs relax vascular smooth muscle (By blocking calcium channels, CCBs inhibit muscle contraction in the coronary arteries and peripheral arteries, resulting in relaxed vascular smooth muscle (vasodilation). CCBs have a negative inotropic effect by blocking calcium entry, which decreases the force of contractions. CCBs have no direct role in sodium activity. Vasodilation from CCBs decrease arterial pressure.)

Which patient finding would cause the nurse to hold the 8 a.m. dose of verapamil? 1. The patent has atrial flutter. 2. The patient has tachycardia. 3. The patient has hypotension. 4. The patient has angina pectoris.

3. The patient has hypotension. (A patient who is scheduled to receive verapamil, a calcium channel blocker (CCB), should have blood pressure and pulse assessed prior to administration. Hypotension would be a reason to hold the drug. Verapamil is given for atrial flutter. Patients with angina may receive CCBs for their vasodilating effects. Tachycardia is not a reason to hold the drug; CCBs decrease the heart rate.)

Which dose of salicylate can cause severe toxicity in a patient?

300-500 mg/kg

For which patients is the use of an angiotensin-converting enzyme (ACE) inhibitor contraindicated?

32-year-old female patient who is 4 months pregnant 62-year-old male patient with a history of renal artery stenosis 29-year-old female patient with a potassium level of 5.2 mEq/L

For which patients is the use of an angiotensin-converting enzyme (ACE) inhibitor contraindicated?

32-year-old female patient who is 4 months pregnant ACE inhibitors are contraindicated in pregnancy. 62-year-old male patient with a history of renal artery stenosis ACE inhibitors are contraindicated with renal artery stenosis. 29-year-old female patient with a potassium level of 5.2 mEq/L ACE inhibitors are contraindicated with high serum potassium.

A patient is prescribed lisinopril [Prinvil] as part of the treatment plan for heart failure. Which finding indicates the patient is experiencing the therapeutic effect of this drug? 1 Jugular vein distention 2 Potassium level of 3.5 mEq/L 3 + 2 edema of the lower extremities 4 Crackles in the lungs are no longer heard

4 Because angiotensin-converting enzyme (ACE) inhibitors promote venous dilation, they provide the therapeutic effect of reducing pulmonary congestion and peripheral edema. Absence of previously heard crackles would be an indicator of effectiveness. Edema and jugular vein distention are manifestations of heart failure. A potassium level of 3.5 mEq/L is a normal value.

The nurse is administering several medications at 8 AM. Which medication will decrease blood pressure by blocking angiotensin II receptor sites? 1 Enalapril 2 Furosemide 3 Eplerenone [Inspra] 4 Valsartan [Exforge]

4 Valsartan [Exforge] is an angiotensin II receptor blocker (ARB) that is indicated for management of hypertension. Furosemide is a loop diuretic. Eplerenone [Inspra] is an aldosterone antagonist. Enalapril is an angiotensin-converting enzyme (ACE) inhibitor.

A patient asks the nurse why dronedarone needs to be taken with food. The nurse responds knowing that bioavailability of dronedarone is at which level without food?

4% Dronedarone's bioavailability without food is low at 4%. To increase the available drug for the body to use (bioavailability), dronedarone must be taken with food. Food, especially high-fat food, increases the bioavailability to 15%. The rest of dronedarone is bound to protein, which is then excreted.

Which medication works by preventing angiotensin II from binding with its receptor sites? 1. Quinapril 2. Aliskiren 3. Elperenone 4. Candesartan

4. Candesartan (Candesartan is an angiotensin II receptor blocker and thus prevents the binding of angiotensin II at its receptor sites. Quinapril is an angiotensin-converting enzyme inhibitor, aliskiren is a direct renin inhibitor, and eplerenone is a selective aldosterone receptor blocker.)

The nurse is administering 8:00 a.m. medications for hypertension. Which drugs should the nurse identify as aldosterone antagonists? Select all that apply. 1. Losartan 2. Alikiren 3. Benazepril 4. Eplerenone 5. Spironolactone

4. Eplerenone 5. Spironolactone (Eplerenone and spironolactone are both aldosterone antagonists. Aliskiren is a direct renin inhibitor. Losartan is an angiotensin II receptor blocker (ARB), and benazepril is an angiotensin-converting enzyme (ACE) inhibitor.)

The nurse is caring for a patient prescribed aliskiren. How does this medication lower blood pressure? 1. It prevents angiotensin II from binding to its receptors. 2. It selectively blocks aldosterone receptors in the kidneys. 3. It blocks the conversion of angiotensin I to angiotensin II. 4. It inhibits the conversion of angiotensinogen to angiotensin I.

4. It inhibits the conversion of angiotensinogen to angiotensin I. (Aliskiren was the first direct renin inhibitor on the market. It binds with renin and thus inhibits the conversion of angiotensinogen to angiotensin I. The other items describe angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and selective aldosterone receptor blockers.)

The nurse is preparing to administer minoxidil 5 mg orally. What is the only cardiovascular indication for this medication? 1. Heart failure 2. Angina pectoris 3. Myocardial infarction 4. Sever hypertension

4. Sever hypertension (Because of its serious adverse effects, minoxidil is reserved for patients who have failed to respond to safer drugs. The only cardiovascular indication for minoxidil is severe hypertension.)

The nurse is caring for a patient receiving hydralazine. The health care provider prescribes propranolol. A drug such as propranolol is often combined with hydralazine for which purpose? 1. To prevent heart failure 2. To reduce the risk of headache 3. To improve hypotensive effects 4. To protect against reflex tachycardia

4. To protect against reflex tachycardia. (Hydralazine is a vasodilator that lowers blood pressure, but it can also trigger reflex tachycardia. Beta blockers, such as propranolol, are often added to the regimen to normalize the heart rate.)

Based on equivalent dosing, a nurse recalls that 4 mg of intravenous methylprednisolone is equal in potency to ___ prednisone

5 mg

The nurse is preparing to administer heparin intravenously (IV). Which response by the nurse would be appropriate when the patient asks when the medication will start working?

5-10 minutes

In which time frame can amiodarone produce a therapeutic effect?

50 days Amiodarone has a duration of 50 days.

Verapamil distribution

90% protein bound

Which serum lab value should be assessed for a patient who is taking heparin? A. aPTT B.INR C.Serum Potassium D.PT

A

Which patients are good candidates for fenofibric acid?

A 66-year-old patient with phenylketonuria A 48-year-old patient with iron-deficiency anemia

2 (Bradycardia is an adverse effect of lidocaine (Xylocaine), which the nurse should monitor for in the patient. Anorexia is an adverse effect of quinidine (Quinidex), but is not associated with lidocaine. Bronchospasm is a potential side effect of beta blockers. Prodysrhythmic effects are observed in patients who are taking propafenone (Rythmol).)

A nurse is caring for a patient who is taking lidocaine (Xylocaine). Which adverse effect should the nurse monitor for in the patient? 1 Anorexia 2 Bradycardia 3 Bronchospasm 4 Prodysrhythmic effect

Which nurse should not be assigned to treat a patient who is receiving ribavirin in an aerosol formulation? 1 A nurse who is pregnant 2 A nurse who has a low-grade fever 3 A nurse who has not had chickenpox 4 A nurse on light duty because of a back injury

A nurse who is pregnant

A A common adverse effect of steroid therapy is hyperglycemia. Therefore, the nurse should look for uncontrolled diabetes mellitus in the patient. Rheumatoid arthritis is a chronic autoimmune disorder that commonly causes inflammation and tissue damage in joints and it is not directly linked with steroid therapy. Destruction of red blood corpuscles leads to septic shock. Steroid therapy is a remedy for chronic obstructive pulmonary disease.

A patient is about to receive steroid therapy. What symptoms should the nurse assess? A. Uncontrolled diabetes mellitus B. Rheumatoid arthritis C. Septic shock D. Chronic obstructive pulmonary disease

How can the nurse determine if a patient will tolerate an amphotericin B infusion?

Administer a test dose

Viral hepatitis is the most common liver disorder. Which strains of hepatitis can cause chronic hepatitis? Select all that apply.

All six hepatitis viruses can cause acute hepatitis, but only B, C, and D also cause chronic hepatitis.

A patient with diabetes is prescribed levothyroxine for hypothyroidism. Which action from the health care provider should the nurse anticipate occurring for this patient? No change to current diabetic treatments A decrease in the patient's dose of insulin A change from insulin to an oral diabetic drug An increase in the patient's dose of insulin

An increase in the patients dose of insulin

The nurse provides teaching to a patient with chronic obstructive pulmonary disease who has been prescribed budesonide (Pulmicort) two puffs and fluticasone (Flovent) three puffs t.i.d. The nurse evaluates that further teaching is needed when the patient makes what statement? A)"Take all five puffs as quickly as possible." B)"Replace the inhalers before they run out." C)"Rinse the mouth after taking the medication." D)"Continue medication even when symptoms start to subside."

Ans:A Feedback: The nurse needs to review how to administer the drug via inhalation because the patient must hold the medication in the airways as long as possible before exhaling and should not try to rush the treatment. The other statements are correct and would not require clarification.

There can be interference with cancer chemotherapy in what phase of the cell cycle? A)G0 phase B)G1 phase C)G2 phase D)S phase

Ans:A Feedback: During the G0 phase, the cell is stable. Cells in this phase can interfere with cancer chemotherapy because these drugs usually work on actively dividing cells, leaving resting cells mostly untouched. When the resting cells are stimulated to become active and regenerate, the cancer can return. This is the reason that cancer chemotherapy regimens are complicated and extended over a period of time. In the G1 phase, a cell is stimulated to emerge from its resting phase. During this time, the cell synthesizes the substances needed for DNA formation. The S phase involves the actual synthesis of DNA, and during the G2 phase, the cell produces all the substances that are required for the manufacture of the mitotic spindles.

The nurse is caring for a child receiving a central nervous system (CNS) stimulant who was admitted to the pediatric intensive care unit following repeated seizures after a closed head injury. The physician orders phenytoin to control seizures and lorazepam to be administered every time the child has a seizure. What is the nurse's priority action? A)Call the doctor and question the administration of phenytoin. B)Call the doctor and question the administration of lorazepam. C)Wait 24 hours before beginning to administer phenytoin. D)Wait 24 hours before beginning to administer lorazepam.

Ans:A Feedback: The combination of CNS stimulants with phenytoin leads to a risk of increased drug levels. Patients who receive such a combination should be monitored for toxicity. There is no contraindication for use of lorazepam.

The pharmacology instructor is discussing antimicrobials with the nursing class. What would the instructor tell the students about the mechanism of action of antimicrobials? (Select all that apply). A)Preventing cell division B)Causing cell death C)Inhibiting cell wall synthesis D)Causing leakage of cell wall allowing fluid to leak in E)Inhibiting synthesis of ribonucleic acid (RNA)

Ans:A, B, C Feedback: Sites of cellular action of carbapenems, ketolides, lincosamides, aztreonam, penicillins, sulfonamides, tetracyclines, and antimycobacterials. Carbapenems, ketolides, and lincosamides change protein function and prevent cell division or cause cell death. Aztreonam alters cell membranes to allow leakage of intracellular substances and causes cell death; it does not cause leakage of fluid into the cell. Penicillins prevent bacteria from building their cells during division. Sulfonamides inhibit folic acid synthesis for RNA and deoxyribonucleic acid production but does not inhibit RNA synthesis

What are the primary uses of neuromuscular junction blockers (NMJ) blockers? (Select all that apply.) A)To facilitate endotracheal intubation B)To sedate patient for general anesthesia C)To prevent injury during electroconvulsive therapy D)To provide greater ease in extubating patient E)To facilitate mechanical ventilation

Ans:A, C, EFeedback: NMJ blockers are primarily used as adjuncts to general anesthesia, to facilitate endotracheal intubation, to facilitate mechanical ventilation, and to prevent injury during electroconvulsive therapy. NMJ blockers do not sedate the patient who will be paralyzed after administration but will remain alert unless another medication is given. These medications would not be given before extubation because respiratory muscles would be paralyzed, resulting in the inability to breathe.

The nurse administers promethazine (Phenergan) to the patient before sending the patient to the preoperative holding area. What is the rationale for administration of this drug? A)SedationB)Oral secretions C)Hypotension and bradycardia D)Confusion

Ans:AFeedback: Antihistamines (promethazine, diphenhydramine [Benadryl]) can be very sedating in some people. They are used as preoperative medications and postoperatively to decrease the need for narcotics. Promethazine is not given for hypotension, bradycardia, confusion, or oral secretions.

When causing depolarization of the muscle membranes, what neurotransmitter interacts with the nicotinic cholinergic receptors leading to the release of calcium ions? A)AcetylcholineB)SerotoninC)D-gluconamidoethyl methacrylate (GAMA) D)Epinephrine

Ans:AFeedback: At the acetylcholine receptor site on the effector's side of the synapse, the acetylcholine interacts with the nicotinic cholinergic receptors causing the depolarization. Serotonin, GAMA, and epinephrine are not part of muscle contraction and relaxation.

The nurse administers prednisone orally at 8 am. When would the nurse expect the drug to reach peak effect? A)9 to 10 am B)12 to 1 pm C)8:30 to 9:00 am D)4 to 6 pm

Ans:AFeedback: Prednisone's peak effect occurs 1 to 2 hours after administering the drug. If given at 8 am, the expected peak would occur between 9 and 10 am.

A patient is taking low-dose corticosteroids on a long-term basis for chronic obstructive pulmonary disease. The nurse assesses this patient knowing prolonged use of corticosteroids puts the patient at risk for what? A)Adrenal stormB)Adrenal atrophyC)Stunted growth D)Hypothalamic insufficiency

Ans:B Feedback: Prolonged use of corticosteroids suppresses the normal hypothalamic-pituitary axis and leads to adrenal atrophy from lack of stimulation. The other options are all distracters for this question with no connection to long-term use of corticosteroids.

What classification of medication will the nurse administer concurrently with amphotericin B (Fungizone) to help minimize the adverse reactions to this medication? A)SedativesB)Antipyretics C)Beta-adrenergic blockers D)Diuretics

Ans:BFeedback: Amphotericin B is often given with antipyretics to improve patient comfort and to minimize adverse reactions. Sedatives, beta- adrenergic blockers, and diuretics are not indicated for use with amphotericin B unless the patient has a coexisting diagnosis that would indicate a need for these drugs.

A patient with a gram-negative infection is being treated with an aminoglycoside. What system should the nurse expect to monitor closely while the patient is taking this medication? A)Respiratory system B)Ophthalmic system C)Renal system D)Musculoskeletal system

Ans:C Feedback: Renal function should be tested daily because aminoglycosides depend on the kidney for excretion and if the glomerular filtration rate (GFR) is abnormal it may be toxic to the kidney. The results of the renal function testing could change the daily dosage. Aminoglycosides do not usually adversely affect respiratory, hepatic, or musculoskeletal function, although baseline data concerning these systems is always needed.

When giving beta-specific adrenergic agonists, at what age is an adult dose given? A)10 years B)11 years C)12 years D)13 years

Ans:C Feedback: Adult doses are given to children who are 12 years and older (see dosages in Table 30.3, page 497.) Therefore, the other options are incorrect.

The nurse is caring for a patient who experiences anxiety and insomnia and is prescribed benzodiazepines. When developing the plan of care, what would be an appropriate nursing diagnosis related to potential adverse effects of the drug? A)Provide patient teaching about drug therapy. B)Anxiety related to drug therapy. C)Risk for injury related to central nervous system (CNS) effects. D)Avoid preventable adverse effects, including abuse and dependence.

Ans:C Feedback: The most appropriate nursing diagnosis related to adverse effects of the drug is risk for injury related to CNS effects because benzodiazepines can have many CNS adverse effects. Anxiety is the condition for which drug therapy is prescribed not related to drug therapy. Patient teaching and avoiding adverse effects are interventions and not nursing diagnoses.

What would the nurse assess for when benzodiazepines are abruptly stopped? A)Urinary retention and change in sexual functioning B)Dry mouth, constipation, nausea, and vomiting C)Nausea, headache, vertigo, malaise, and nightmares D)In most cases nothing significant

Ans:CFeedback: Abrupt cessation of these drugs may lead to a withdrawal syndrome characterized by nausea, headache, vertigo, malaise, and nightmares. When benzodiazepines are stopped abruptly the likelihood of withdrawal symptoms increases with the length of time the patient took the medication. Urinary retention, change in sexual functioning, dry mouth, constipation, nausea, and vomiting are all common adverse effects of the medications classified as benzodiazepines.

For what reason might a nurse administer androgen injections to a 9-year-old boy? A)Ovarian atrophy B)Dwarfism C)Acromegaly D)Hypogonadism

Ans:D Feedback: Androgens are used pharmacologically to treat hypogonadism or to increase protein growth and red blood cell production. Androgens are not used in a male to treat ovarian atrophy. Androgens are not used to treat dwarfism or acromegaly.

An woman is prescribed androgens. The nurse teaches the patient to anticipate what effect from the drug? A)Atrophy of breasts B)Rapid bone growth C)Loss of pubic hair D)Nervousness

Ans:D Feedback: Antiestrogen effects—flushing, sweating, vaginitis, nervousness, and emotional lability—can be anticipated when these drugs are used in women. When androgens are administered to women you would not expect the results to include atrophy of the breasts, rapid bone growth, or loss of pubic hair.

Which muscle relaxant was found to be embryotoxic in animal studies? A)Carisoprodol (Soma) B)Botulinum toxin A (Botox) C)Cyclobenzaprine (Flexeril) D)Dantrolene (Dantrium)

Ans:D Feedback: Dantrolene crosses the placenta and was found to be embryotoxic in animal studies. Botulinum toxin A, carisoprodol, and cyclobenzaprine are not known to be embryotoxic.

The nurse is caring for a patient who has not been able to sleep. The physician orders a barbiturate medication for this patient. What adverse effect should the nurse teach the patient about? A)Double vision B)ParanoiaC)TinnitusD)Thinking abnormalities

Ans:D Feedback: The most common adverse effects are related to general central nervous system (CNS) depression. CNS effects may include drowsiness, somnolence, lethargy, ataxia, vertigo, a resembling a "hangover," thinking abnormalities, paradoxical excitement, anxiety, and hallucinations. Barbiturate drugs generally do not cause double vision, paranoia, or tinnitus.

A patient has stepped on a rusty nail and is exhibiting signs of muscle rigidity and contractions. The patient's wife called the emergency department (ED) and the triage nurse told her to bring him in. The ED nurse will have which drug available for administration when the patient arrives? A)Carisoprodol (Soma) B)Cyclobenzaprine (Flexeril) C)Metaxalone (Skelaxin) D)Methocarbamol (Robaxin)

Ans:D Feedback: The patient is exhibiting signs of tetanus and methocarbamol (Robaxin) is indicated for treatment. Carisoprodol, cyclobenzaprine, and metaxalone are not used to treat tetanus.

When a 5-year-old patient is prescribed oxandrolone (Oxandrin) to promote weight gain, how would the nurse expect the drug to be administered? A)Long-term B)Short-term C)Continuous D)Intermittent

Ans:D Feedback: Oxandrin is given intermittently to pediatric patients and should not be used on a daily basis for short, long, or continuous therapy.

An older adult African American patient comes to the clinic and is diagnosed with generalized anxiety disorder (GAD). The physician orders oral flurazepam 30 mg. What is the nurse's priority action? A)Teach the patient about the prescribed medication. B)Administer the first dose of medication. C)Tell patient to take first dosage after driving home. D)Talk to the physician about the dosage.

Ans:DFeedback: If an anxiolytic or hypnotic agent is the drug of choice for an African American patient, the smallest possible dose should be used, and the patient should be monitored very closely during the first week of treatment. Dosage adjustments are necessary to achieve the most effective dose with the fewest adverse effects. In addition, older adults also require careful titration of dosage. Older patients may be more susceptible to the adverse effects of these drugs, from unanticipated central nervous system (CNS) adverse effects including increased sedation, dizziness, and even hallucinations. Dosages of all of these drugs should be reduced and the patient should be monitored very closely for toxic effects and to provide safety measures if CNS effects do occur. As a result, the priority action is to talk to the physician about the dosage. The other actions may be appropriate after a proper dosage is ordered.

Which description of the therapeutic use of hydrocortisone in Addison's disease is accurate? As an antiinflammatory agent To modulate allergic response As replacement cortisol therapy To promote immunosuppression

As replacement cortisol therapy

In what part of the conduction pathway in a healthy heart is the electrical impulse delayed to provide time for the blood to fill the ventricles?

Atrioventricular node Impulses originate in the sinoatrial (SA) node and then travel through the atrioventricular (AV) node to reach the ventricles. The impulse is delayed at the AV node to provide time for the ventricles to fill before they contract.

A male patient is admitted to the emergency department (ED) with chest pain. The patient is diagnosed with angina pectoris. He is being discharged with an order for nitroglycerin SL PRN. What action should the nurse take when the patient reports chest pain? A.Apply a nitroglycerin transdermal patch to the patient's back. B.Administer a tablet under the patient's tongue and repeat the action in 5 and 10 minutes if the pain has not subsided. C.Place 2 nitroglycerin tablets under the patient's tongue and call the physician. D.Have the client swallow a tablet and repeat in 10 minutes.

B

The nurse is caring for a patient receiving a nitroprusside [Nipride] intravenous infusion. The patient's wife asks why furosemide [Lasix] is being prescribed along with this drug. The nurse's response is based on which concept? A. Furosemide will help reduce reflex tachycardia. B. Many vasodilators cause retention of sodium and water. C. Thiocyanate may accumulate in patients receiving nitroprusside. D. Vasodilators can cause serious orthostatic hypotension.

B. Many vasodilators cause retention of sodium and water. Nitroprusside is a potent vasodilator that can cause retention of sodium and water. Furosemide, a diuretic, often is combined with nitroprusside to reduce the risk of edema and fluid retention. Furosemide does not reduce reflex tachycardia. Thiocyanate can accumulate in patients receiving nitroprusside, but furosemide does not help prevent or treat that. Vasodilators can cause serious orthostatic hypotension, but that is not the rationale for adding furosemide to the regimen.

A patient with healing stab wounds to the arms and legs is brought to the emergency department with complaints of chest pain. The patient was diagnosed with acute myocardial infarction, and alteplase was prescribed. The nurse would closely monitor the patient for which complications following the administration of alteplase?

Bleeding

Which plasma lipoprotein level is most Concerning when considering the risk of coronary atherosclerosis? A: elevated cholesterol B. elevated HDL C. elevated LDL D. elevated VLDL

C

NSAIDs inhibit ___

COX-1 and COX-2

B (Calcium channel blockers cause coronary vasodilation, a negative inotropic effect, a negative chronotropic effect, and a negative dromotropic effect.)

Calcium channel blockers have which pharmacodynamic effect? Positive inotropic effect Coronary vasodilation Positive chronotropic effect Shortened refractory period

The nurse is teaching a course on calcium channel blockers. Which description of the mechanism of action will the nurse provide?

Calcium channel blockers prevent contraction of smooth muscle and allow dilation of the coronary arteries.

How are cephalosporins like penicillins? Select all that apply.

Cephalosporins have a mechanism of action like penicillins; they are both bactericidal antibiotics, activate autolysin enzymes, bind to penicillin-binding proteins (PBPs), and are active only against bacteria undergoing growth and division. Only penicillin takes up excess water and causes the cell wall to rupture.

A 58-year-old male patient has been prescribed ezetimibe 10 mg PO each evening. In addition to ezetimibe, he takes simvastatin for dyslipidemia, tamsulosin for benign prostatic hyperplasia, levothyroxine for hypothyroidism, and cyclosporine for plaque psoriasis. Which drug that the patient is currently taking does a nurse identify as potentially interacting with ezetimibe, and what is the reason for the reaction?

Cyclosporine; the combination of cyclosporine and ezetimibe increases levels of ezetimibe and risk for side/adverse effects.

A patient is receiving cancer chemotherapy. Which type of drug is the nurse administering?

Cytotoxic agents

Which technique should the nurse implement when performing hand hygiene before starting an intravenous (IV) catheter on a patient?

Decontaminate the hands with an alcohol-based handrub and allow to dry.

A patient with cancer who is neutropenic is hospitalized. Which action by the nursing assistant requires the supervising nurse to intervene?

Delivering a fresh fruit basket to the patient's room

ringworm

Dermatophytic infections are also known as ____________ - Tinea pedis - Tinea corporis - Tinea cruris - Tinea capitis

A patient contracted a parasitic infection after traveling outside the United States. Before administering an anthelmintic drug, which action would the nurse take to ensure appropriate treatment?

Determine which large parasite is invading the patient. -anthelmintic drugs are very organism specific

A patient is being treated with digoxin for atrial fibrillation. Which finding would concern the nurse?

Development of second-degree block

A patient who was admitted with deep vein thrombophlebitis is complaining of difficulty breathing and chest pain. What is the most likely cause of these symptoms?

Embolus to the lungs A thrombus can become an embolus and travel to the lungs. This pulmonary embolus can cause chest pain and difficulty breathing. It is not likely that fatigue, anxiety, or a medication reaction would cause chest pain and dyspnea in this case.

Which phrases accurately describe the rationale for using colesevelam instead of cholestyramine or colestipol?

Fewer gastrointestinal effects Lower drug-drug interaction potential Lack of reduced absorption of fat-soluble vitamins

A, C (Potential side effects from amiodarone include photosensitivity, bluish skin discoloration, hyperthyroidism, hypothyroidism, and decreased libido.)

For which potential adverse effects would the nurse monitor patients prescribed amiodarone? (Select all that apply.) A Bluish skin discoloration B Diarrhea C Hypothyroidism D Photosensitivity E Hypertension

A nurse is preparing to administer levothyroxine. Which finding would require further assessment? Calcium level of 9.5 mg/dL Heart rate of 110 beats/min Potassium level of 3.5 mEq/dL Blood pressure 104/70 mm Hg

Heart rate of 110 bpm

When teaching a patient about the most common side effects of hydrocortisone, which information would the nurse include? Select all that apply. Heartburn or indigestion Insomnia and mood swings Increased bone pain Delayed wound healing Nasal congestion and cough Increased bruising

Heartburn or indigestion Insomnia and mood swings Delayed wound healing

Which statements regarding pharmacodynamics and pharmacokinetics of statins are accurate?

Hepatocytes increase the number of low-density lipoprotein (LDL) receptors in response to decreased cholesterol synthesis by statins to remove cholesterol from circulation. Statins reduce cholesterol production through inhibition of hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase.

Cinacalcet would be used with caution in patients with which condition? History of seizure disorder Elevated blood calcium levels Elevated parathyroid hormone levels Chronic renal failure with dialysis

History of seizure disorder

The nurse is assessing a patient with a new prescription for digoxin. Which assessment data are contraindications or cautions for digoxin therapy?

History of ventricular tachycardia Potassium 3.1 mEq/L History of renal failure

A health care provider prescribes diltiazem 10 mg intravenous push for persistent atrial fibrillation with a ventricular rate of 115 beats/min. While preparing the diltiazem, the nurse notices the patient is on digoxin 0.125 mg and metoprolol 25 mg. Which action will the nurse take?

Hold the diltiazem.

The nurse is teaching a patient who is being discharged on hydralazine. Which patient statement indicates understanding?

If I keep smoking, I will continue to have pain from vasospasm."

Adenosine absorption

Immediately taken up by red blood cells (RBCs) and tissues after intravenous (IV) administration

Minoxidil metabolism

In the liver

Digoxin excretion

In urine (50%-80%)

The nurse should educate a patient with pelvic inflammatory disease (PID) about which potential long-term complication of PID?

Infertility

Before administering digoxin, the nurse would conduct a thorough assessment, knowing that digoxin accumulates the highest in which areas of the body?

Kidney Intestine Heart Skeletal muscle

Digoxin interacts with beta blockers

Mechanism: Block beta receptors in the heart Result: Enhanced bradycardic effect of digoxin May have additive effect on slowing AV nodal conduction

Digoxin interacts with calcium channel blockers

Mechanism: Block calcium channels in the myocardium Result: Enhanced bradycardic and negative inotropic effects of digoxin May have additive effect on slowing AV nodal conduction

A patient takes tacrolimus [Prograf]. Which drug prescription will cause the nurse to notify the provider?

NSAIDS

allylamines

Name the drug class whose MOA is to interfere with ergosterol biosynthesis by inhibiting the fungal enzyme squalene epoxidase. (Accumulation of squalene is toxic to fungi.)

Which side effect commonly occurs with cinacalcet drug therapy? Frequent seizures Dry mouth and thirst Nausea and vomiting Frequent urination

Nausea and vomiting

Verapamil duration

PO IR: 6-8 hr PO ER: 24 hr IV:10-20 min

Diltiazem Peak

PO IR:2-3 hr PO ER: 10-18hr IV: 15 min

Adenosine is a common medication to treat

PSVT. However, contraindications do exist. There are few drug interactions. Nurses must be aware of medications patients are taking along with their comorbidities.

Older patients taking didanosine are at a higher risk than younger patients for which adverse effect?

Pancreatitis is the major dose-limiting toxicity associated with didanosine and occurs in 3-17% of patients with an increased incidence with higher doses and in older patients.

ectoparasites

Parasites that feed on external surface of host. Ex: mites and lice

The nurse will prepare to administer adenosine to a patient with which dysrhythmia?

Paroxysmal supraventricular tachycardia Adenosine is indicated for paroxysmal supraventricular tachycardia. It is not effective in atrial or ventricular dysrhythmias.

Which patient group should receive the Zostavax vaccine? 1 Children 2 Newborns 3 Pregnant patients 4 Patient 50 years of age and older

Patient 50 years of age and older

For which patient would the nurse anticipate administering heparin?

Patient diagnosed with atrial fibrillation A patient with atrial fibrillation is a high risk for blood clots. An anticoagulant, such as heparin, prevents the formation of blood clots.

A patient is diagnosed with syphilis. What is the treatment of choice for this condition?

Penicillin G

An insurance company is requiring a patient receiving pitavastatin 2 mg to switch to another statin to receive coverage. Which statins and doses are therapeutically equivalent to pitavastatin 2 mg?

Pravastatin 40 mg Simvastatin 20 mg Rosuvastatin 5 mg

A patient who is hospitalized following a planned orthopedic surgery has been taking a routine dose of lisinopril since the operative day. Which action will the nurse take when a sudden onset of facial swelling is noted?

Prepare to administer epinephrine subcutaneously

Which effect on the electrocardiogram (ECG) will the nurse expect to see in a patient who is receiving a Class IV antidysrhythmic drug?

Prolonged PR interval Class IV antidysrhythmic drugs prolong PR intervals, which delays the atrioventricular conduction, thereby decreasing the heart rate.

Which antimalarial drug can cause folate deficiency?

PyrimEthan in

Which medication is indicated for Plasmodium falciparum infection, which causes a type of malaria that affects the brain?

Quinine

Sodium Nitroprusside absorption

Rapid IV absorption (hypotensive effect in less than 2 minutes)

Digoxin absorption

Rapidly absorbed following oral administration

Minoxidil absorption

Rapidly absorbed with PO administration

Which effects are advantages to the use of nonoral combined hormonal contraceptives (CHCs) over oral CHC?

Reduced drug interaction potential Rapidly achieved serum hormone levels Decreased fluctuations of hormone levels in blood

Which teaching points would a nurse share with a patient who is taking levonorgestrel 0.75 mg PO BID for two doses for emergency contraception?

Remember to take the second dose within 12 hours of the first dose. Once implantation occurs, emergency contraception is not effective. Emergency contraception does not protect against sexually transmitted infections. Nausea, vomiting, and heavier menstruation may occur with emergency contraception.

A nurse is preparing to administer a non-human immunodeficiency virus antiviral drug to an infant. Before administering the drug, the nurse asks the family if any close family members are pregnant. What is the patient's diagnosis? 1 Herpes virus infection 2 Influenza virus infection 3 Cytomegalovirus infection 4 Respiratory syncytial virus infection

Respiratory syncytial virus infection - Respiratory syncytial virus (RSV) infection is a viral infection that is treated with ribavirin. RSV is not usually treated in adults, and the drug is strictly contraindicated in pregnant woman and their male partners, because the drug has teratogenic effects.

Which drug is used to manage viral pneumonia in a patient with respiratory syncytial virus? 1 Ribavirin 2 Flucytosine 3 Amantadine 4 Griseofulvin

Ribavirin

A patient has been diagnosed with respiratory syncytial virus (RSV). The nurse anticipates administration of which drug(s)? Select all that apply.

Ribavirin (inhaled) and palivizumab are used for the treatment of RSV. Ganciclovir is useful in the treatment of cytomegalovirus. Oseltamivir is used for the treatment of influenza A and influenza B. Entecavir is a nucleoside analog used in the treatment of hepatitis B virus.

Which teaching is appropriate for a patient being discharged with a prescription for subcutaneous heparin?

Shave with an electric razor

A child has contracted chickenpox and is treated successfully. Which infection is the child prone to develop as an adult? 1 Shingles 2 Retinitis 3 Gastroenteritis 4 Kaposi sarcoma

Shingles

The nurse monitors the electrical activities of the heart while administering intravenous digoxin because of which potential effects to the heart?

Shortening of QR intervals Depression of ST segments Inversion of T waves

A patient who is receiving verapamil asks the nurse how the drug helps the heart. The nurse responds knowing that verapamil has which mechanisms of action?

Slowing of sinoatrial (SA) node automaticity Delay of AV nodal conduction Reduction of myocardial contractility

Amiodarone is an effective antidysrhythmic drug because it has which mechanisms of action?

Slows AV conduction Blocks potassium channels Blocks calcium channels

A (Sodium channel blockers are classified as class I drugs)

Sodium channel blockers are considered which class of antidyshythmic drugs? Class I Class II Class III Class IV

Digoxin metabolism

Some by liver

Which group of college students does the nurse most need to include in a teaching session on the risks of anabolic steroid abuse?

Students who are on athletic teams

PO Administration for digoxin

Tablets can be crushed. It can be administered with or without meals.

Which medications are part of the amphetamine family of drugs? Select all that apply.

The medications included in the amphetamine family of drugs include amphetamine, lisdexamfetamine, methamphetamine, and dextroamphetamine. Dystroamphetamine is not a medication.

A nurse is providing care to a patient with chronic kidney disease (CKD) who has been prescribed methylprednisolone. Which statement describes the appropriate nursing action for this patient and the rationale for this action?

The nurse should monitor for side effects because methylprednisolone is renally excreted.

A patient has been prescribed prednisone 10 mg PO daily for worsening systemic lupus erythematous (SLE). The patient is also on hydroxychloroquine (for SLE) and warfarin (for venous thromboembolism). Which effect does the nurse anticipate will occur if prednisone is administered to this patient?

The prednisone will interact with warfarin, increasing the effects of warfarin.

children

The treatment of choice for ______ with pediculosis is: 1% permethrin pyrethrins with piperonyl butoxide

A nurse reviews the cardiac monitor on a patient who is receiving dronedarone for paroxysmal atrial fibrillation. Which cardiac dysrhythmia would most alarm the nurse?

Torsades de pointes

A nurse reviews the cardiac monitor on a patient who is receiving dronedarone for paroxysmal atrial fibrillation. Which cardiac dysrhythmia would most alarm the nurse?

Torsades de pointes Dronedarone prolongs the PR and QT interval and widens the QRS complex. These effects to the heart increase the risk of torsades de pointes, a ventricular dysrhythmia.

Which statements about the pharmacodynamic and pharmacokinetic of digoxin toxicity are correct?

Toxicity can occur easily due to the narrow therapeutic range of digoxin. The half-life and duration of digoxin are very long. Digoxin increases myocardial contraction, which increases cardiac output. Oral digoxin begins to work in 30 minutes to 2 hours.The nurse will include this teaching because oral digoxin does begin to work (onset) in 30 minutes to 2 hours.

In the failing heart, arterial pressure falls, stimulating the baroreceptor reflex to increase sympathetic nervous system activity. The nurse understands increased sympathetic activity will produce which response?

Trachycardia

superficial mycoses

Treatment of _______ ________: Many OTC formulas available Common problem -- About 75% of all female patients get a "yeast infection" at least once in a lifetime Antifungal agent preferred depends on the part of the body involved Creams, ointments, suppository, troche, "swish and spit" Commonly used drugs clotrimazole (Mycelex) - ordered as troshe (suck on it) nystatin (Mycostatin)

nystatin, clotrimazole, ampho B

Tx for oral candidiasis (thrush) - 3 meds

Transmission route of trichomaniasis

Unprotected sex

Sodium Nitroprusside excretion

Urine

By which routes is dronedarone excreted?

Urine Feces

The nurse is caring for a patient receiving nitrates for relief of angina. Which pharmacodynamic action is responsible for the relief of anginal pain with nitrates?

Vasodilation leads to decreased preload, which decreases oxygen demand. The primary action of nitroglycerin is vasodilation, which leads to decreased venous return, decreased ventricular filling, and decreased preload, thus reducing oxygen demand on the heart.

Which condition will the nurse suspect for a patient who is prescribed amiodarone?

Ventricular tachycardia

Which condition will the nurse suspect for a patient who is prescribed amiodarone?

Ventricular tachycardia Amiodarone is indicated for life-threatening ventricular dysrhythmias, such as ventricular tachycardia. Amiodarone has properties of Class I to IV antidysrhythmic drugs; has vasodilatory effects; blocks sodium, potassium, and calcium channels; and blocks beta receptors.

3

Which medication is the treatment of choice for most intestinal roundworms? 1 Albendazole [Albenza] 2 Pyrantel [Pin-X] 3 Mebendazole [Vermox] 4 Ivermectin [Stromectol]

Adenosine stimulates the

adenosine-sensitive potassium channels in the sinoatrial (SA) node and internodal tracts. The use of adenosine results in specific effects on the heart and the electrocardiogram (ECG). The nurse must be aware of these effects and understand how adenosine is used therapeutically.

Methylxanthines, such as aminophylline, theophylline, and caffeine, block receptors for

adenosine. Patients who are taking aminophylline, theophylline, or caffeine need larger doses of adenosine, and even then adenosine may not be effective. Dipyridamole, an antiplatelet drug, blocks cellular uptake of adenosine and can thereby intensify its effects.

An obese 84-year-old patient is taking simvastatin 10 mg PO each evening. In addition to dyslipidemia, the patient has hypertension, diabetes, and hypothyroidism. Which factors increase this patient's risk for rhabdomyolysis?

advanced age hypothyroidism

Warfarin binds with which molecule in the body? keratin platelets ferritin albumin

albumin (99% protein bound)

Asystole can occur with

amiodarone. The patient must be on a continuous cardiac monitor, and the nurse should be prepared to administer cardiopulmonary resuscitation if asystole does not spontaneously convert.

A patient is scheduled to start taking sildenafil [Viagra]. The nurse should recognize that the patient is at risk for developing an adverse cardiac event if the patient's history reveals which condition?

angina

PO verapamil and diltiazem are indicated for

angina pectoris and essential hypertension. In patients with atrial fibrillation or flutter, verapamil may be used along with digoxin to control the ventricular rate. Sustained-release (SR) formulations must be swallowed whole; crushing and/or chewing is not advised. SR formulations are used in the setting of essential hypertension. Verapamil PO: 240 to 480 mg/day in 3 to 4 divided doses Diltiazem PO: 120 to 360 mg once daily

A patient on subcutaneous anticoagulant calls the clinic about a cut received on the hand. Which initial action would the nurse tell the patient to take?

apply direct pressure for 5-10 minutes

Topical corticosteroids

are often used to treat skin, eye, and ear inflammatory conditions.

Mineralocorticoids

are responsible for the regulation of electrolytes, or mineral salts, in the body

Inhaled corticosteroids

are used in the management of respiratory diseases such as asthma.

In combination usually with isosorbide dinitrate, hydralazine can be used

as a short-term option to decrease afterload in patients experiencing heart failure.

This agent is highly effective for both prophylaxis and treatment of malaria caused by chloroquine-resistant plasmodia

atovaquone/proguanil

Verapamil and diltiazem are indicated for the treatment of

atrial flutter, atrial fibrillation, and paroxysmal supraventricular tachycardia. Ventricular rate is slowed by the suppression of impulse conduction through the AV node, which prevents the atria from driving the ventricles at an excessive rate. Verapamil and diltiazem are also indicated for the treatment of hypertension

Adenosine interaction with food

avoid caffeine ( may decrease effect)

Which teaching points would a nurse share with a 33-year-old female patient who was prescribed statin therapy?

avoid pregnancy Gastrointestinal distress can be minimized by taking with food and/or with at least 6 to 8 oz of water. Ensure she is getting plenty of exercise and a diet rich in vegetables, fruits, and fiber to help lower cholesterol levels.

Verapamil and diltiazem block the flow of

calcium into the cell via the slow calcium channels, which slows the sinoatrial (SA) nodal automaticity (negative chronotropic effect), delays the AV nodal conduction (negative dromotropic effect), and reduces myocardial contractility (negative inotropic effect). These effects are identical to those of beta blockers, which also promote calcium channel closure in the heart. The principal effect on the electrocardiogram (ECG) is prolongation of the PR interval, which reflects delayed AV conduction. Decrease in contractility assists the dilation of coronary and systemic arteries. The total peripheral resistance, blood pressure, and cardiac workload are decreased.

The drug of choice for mild to moderate acute attack caused by chloroquine-sensitive strains of P.falciparum or P. vivax is

chloroquine

This antibacterial is used as an adjunct to quinine to treat malaria caused by chloro-resistant P. falciparum or P. vivax

clindamycin

Which drug would a nurse anticipate may require additional monitoring because of reduced absorption of vitamins A, D, E, and K?

colestipol

A nurse receives a prescription for gemfibrozil for a patient who is also receiving cyclosporine (posttransplant) and amoxicillin (infection). What is the rationale for the nurse's intervention to contact the health care provider?

combination can cause nephrotoxicity

Adverse drug effects result from the blockade of calcium channels in the heart or smooth muscle of the intestine or from vasodilation. Adverse effects include

constipation, bradycardia, heart block, hypotension, dyspnea, facial flushing, and edema of the ankles and feet. Other adverse effects include acute renal failure and Stevens-Johnson syndrome.

scabies

contagious skin disease transmitted by the itch mite

Remember, sodium nitroprusside is a very potent vasodilator. Patients receiving sodium nitroprusside for hypertensive emergencies require

continuous monitoring and will be cared for in an intensive care setting. The nurse will often titrate this medication according to the health care provider's prescription to a given blood pressure. By adjusting the rate of infusion, the blood pressure can be lowered. It is important to monitor carefully to avoid a precipitous drop in blood pressure.

Sodium nitroprusside can cause

cyanide poisoning due to the metabolism by-products of the drug. This is more common in patients with liver disease. The chances of cyanide poisoning are lower with slower infusion of the drug.

A nurse should recognize which as an indicator of P. falciparum malaria

dark urine, weakness and anemia

It is important for the nurse to evaluate for therapeutic response from vasodilator administration. When administered for hypertension, vasodilators should

decrease blood pressure. The nurse will also need to evaluate the patient for potential adverse and side effects from vasodilator administration.

The nurse will monitor for which therapeutic effect while administering quinidine?

decreased heart rate

Beta blockers and Class IV antidysrhythmic drugs have the same effects on the heart, which includes

decreased heart rate, AV conduction, and contractility. Beta blockers and Class IV antidysrhythmic drugs should be administered several hours apart to minimize the risk of cardiosuppression.

After administration, adenosine significantly

decreases the automaticity of the SA node and slows conduction through the AV node. It also interrupts AV reentry pathways. After adenosine administration, brief asystole is usually apparent on the ECG. Rarely is asystole sustained.

Caution is advised in patients with acute myocardial infarction, acute myocarditis, and severe pulmonary disease for what

digoxin

Teach the patient how to check pulse rate before taking

digoxin and to notify the health care provider if pulse rate is ≤60 beats/min, >100 beats/min, or irregular.

Cardiotoxicity is the major adverse drug effect of

digoxin. Hypokalemia, usually resulting from concurrent therapy with diuretics, enhances the risk of cardiotoxicity. Potassium levels must be monitored closely and kept within normal range (3.5 to 5 mEq/L). Other adverse effects include GI disturbances and central nervous system (CNS) changes. GI disturbances include anorexia, nausea, vomiting, and diarrhea. Changes to the CNS include depression, delirium, and hallucinations. These unwanted effects may signify impending toxicity and should be reported to the health care provider. Changes to vision, such as blurred vision or seeing yellow, can also occur with digoxin toxicity.

A known drug allergy is a contraindication for

digoxin. Other contraindications to consider include heart failure resulting from diastolic dysfunction, ventricular tachycardia/fibrillation, and SA blocks, such as second- or third-degree heart block. Digoxin can promote or worsen bradycardia.

The PR interval on an ECG is prolonged due to the slowed AV conduction produced by

digoxin. The ventricles are also affected, resulting in accelerated repolarization, which causes the QR interval to possibly shorten. ST segment depression also occurs frequently, and the T wave may be inverted or depressed. The QRS complex experiences little change.

Digoxin can also cause

dysrhythmias because digoxin can increase automaticity in the Purkinje fibers

Of all the CCBs, only the two in the nondihydropyridine subclass, verapamil and diltiazem, are used to treat

dysrhythmias.

Vasodilators the nurse should monitor patients for

eflex tachycardia, postural hypotension, and expansion of blood volume (secondary to prolonged decrease of blood pressure). The nurse should be aware that increased blood volume can cancel the beneficial effects of the vasodilator. To prevent this, patients often receive combination therapy with a diuretic, which prevents volume expansion and fluid retention. The nurse should assess lung sounds, edema, and skin turgor, monitoring carefully for signs of fluid retention.

Adenosine reduces the time for

electrical conduction through the atrioventricular (AV) node. As a result of this action, it is indicated for converting PSVT to sinus rhythm.

The nurse notes that quinine can

enhance atrioventricular conduction, causing dangerous increase in ventricular rate

A nurse should recognize that a patient who has which condition is at risk of developing an adverse reaction to mefloquine

epilepsey

Patients taking vasodilators are at increased risk for

falls. They should be educated about symptoms of hypotension (dizziness, lightheadedness) and instructed to sit or lie down if they experience these symptoms. Patients should also be informed that hypotension side effects can be decreased by transitioning slowly from a supine or seated position to an upright position

Side effects and adverse drug effects of adenosine are

few because of its extremely short half-life and duration of action. If unwanted effects occur, they usually last less than 1 minute. The most common side effects include facial flushing, nausea, dyspnea, and chest pressure.

The patient continues to bleed after receiving vitamin K for warfarin toxicity. The nurse anticipates administering which product to a patient who is not responding to vitamin K?

fresh frozen plasma

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

give a second dose of nitroglycerin in 5 minutes (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. Transdermal delivery systems are not useful for terminating an ongoing attack. Dosing at 10-minute intervals is incorrect. If the patient fails to respond or if the pain intensifies, intravenous nitroglycerin may be indicated.)

Toxicity of the central nervous system with mefloquin is characterized by

hallucinations, depression and suicidal ideation

A patient has Pediculus humanus capitis. What should the nurse assess first when evaluating for improvement of the condition?

head

Common side effects of digoxin include

headache and hypotension.

Class IV antidysrhythmic drugs are generally well tolerated. Some common side effects include

headache, fatigue, drowsiness, edema, nausea, and rash.

Minoxidil side effects

headache, fatigue, nausea, vomiting, reflex tachycardia, pruritus, and hypertrichosis. Hypertrichosis is excessive growth of hair, usually starting on the face and then developing on the arms, legs, and back. This side effect is common in those who take the drug for 4 weeks or more.

Hydralazine side effects

headache, tremors, dizziness, anxiety, nausea, vomiting, anorexia, diarrhea, and reflex tachycardia.

Evaluate the effectiveness of the antidysrhythmic drugs by comparing

heart rate and rhythm with the baseline. Note any troublesome side effects. Also note any adverse drug effects and report them to the health care provider.

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: improve coronary artery perfusion increase the heart rate to improve myocardial contractility. help relax peripheral arterioles to reduce afterload. increase the QT interval.

help relax peripheral arterioles to reduce afterload (CCBs promote relaxation of peripheral arterioles, resulting in a decrease in afterload, which reduces the cardiac oxygen demand. CCBs do not improve coronary artery perfusion. CCBs reduce the heart rate and suppress contractility; they do not affect the QT interval.)

Patients with G6PD deficiency are at risk for

hemolysis with primaquin or quinine administration

Class IV antidysrhythmic drugs should also be used with caution in patients with

hepatic dysfunction because these drugs are extensively metabolized in the liver.

Contraindications for Class IV antidysrhythmic drugs include

hypersensitivity, acute myocardial infarction, pulmonary congestion, Wolff-Parkinson-White syndrome, severe hypotension, cardiogenic shock, sick sinus syndrome, or second- or third-degree AV block. Class IV antidysrhythmic drugs should be used with caution in patients with preexisting heart failure.

Vasodilators can be used to treat many conditions, including

hypertension, angina, and heart failure. There are many different drugs that can cause vasodilation. Some of these drugs cause vasodilation by affecting arterioles, while others affect veins. There are some drugs that actually cause vasodilation of both arterioles and veins. For example, nitroglycerin, which is classified as a nitrate, causes vasodilation, acting primarily in venous circulation, which reduces preload and overall myocardial demand. Understanding how a drug produces vasodilation is key for the health care provider to determine the appropriate vasodilating drug.

Sodium nitroprusside is the drug of choice for

hypertensive emergencies.

Digoxin toxicity can occur with

hypokalemia, which can worsen cardiac dysrhythmias.

Evaluate the therapeutic effects of Class IV antidysrhythmic drugs (CCBs) while minimizing adverse drug effects such as

hypotension, bradycardia, and heart block. Monitor for any evidence of heart failure, such as dyspnea, swelling to the extremities, and adventitious lung sounds. The patient should also be evaluated for any evidence of prolonged QT interval or chest pain. Determine drug adherence. Because the liver metabolizes Class IV antidysrhythmic drugs extensively, assess for any hepatic dysfunction, such as elevated liver enzymes and right upper quadrant abdominal pain.

Adverse effects of sodium nitroprusside include

hypotension, bradycardia, cyanide poisoning, and thiocyanate toxicity.

Calcium channel blockers are metabolized in the liver.It is true that A patient taking a newly prescribed calcium channel blocker states, "I can't seem to get my shoes to fit. My feet feel puffy." Which nursing response is appropriate?

i will contact the healthcare provider, you may need a diuretic

Which type of medication will the nurse most likely administer to prevent organ rejection after a patient has undergone a kidney transplant?

immunosuppressants

Minoxidil adverse effects

include severe rebound hypertension on withdrawal in children, heart failure, pulmonary edema, pericardial effusion, hypotension, and Stevens-Johnson syndrome. When vasodilators are administered, blood pressure decreases, which causes the retention of sodium and water, creating peripheral edema. A diuretic may be prescribed to prevent volume expansion.

Adverse effects of hydralazine

include shock, leukopenia, agranulocytosis, hepatotoxicity, and thrombocytopenia.

A desired effect on the heart from the use of digoxin is

increased myocardial contractility without increasing demands for oxygen (positive inotropic effect).

river blindness

infection of skin and eyes by round worm O. volvulus - can cause blindness - Drug of choice: ivermectin

pediculosis

infestation with lice

For a hypertensive crisis, parenteral hydralazine can be

injected to quickly decrease blood pressure.

Minoxidil produces more

intensive vasodilation than hydralazine but also causes more severe adverse reactions. Minoxidil has a black box warning regarding the potential for serious cardiac adverse effects. Sodium nitroprusside has a black box warning regarding the risk for hypotension and cyanide toxicity.

The nurse should recognize that which organ is the most frequent site of helminthic infestation?

intestine

Sodium nitroprusside is an

intravenous (IV), very strong vasodilator, used for hypertensive emergencies. This drug causes venous and arterial dilation and begins to work immediately with IV administration.

The patient must be on a cardiac monitor if administering

intravenous Class IV antidysrhythmic drugs. The nurse administering the drug should be able to see the cardiac monitor to determine the effects of the drug.

The nurse is caring for a patient who is receiving prescribed digoxin and diltiazem. Which assessment data alerts the nurse to a potential interaction?

irregular heart rate

Prednisone

is the most commonly prescribed oral corticosteroid,

Clinical cure for malaria results from

killing plasmodia in erythrocytes

Which laboratory values will a nurse ensure are ordered for a patient as part of monitoring after a dosage adjustment of colesevelam?

lipid panel liver enzymes

Inflammatory process (leukotriene pathway)

lipoxygenases convert arachidonic acid to leukotrienes, which cause inflammation, bronchospasms, vasopermeability, and vasoconstriction

Diltiazem metabolism

liver

Verapamil metabolism

liver

Which information is necessary to collect as baseline data before the administration of nitroglycerin? (Select all that apply.) location of the anginal pain intensity of the attacks last time voiding frequency of the attacks factors that precipitate the attacks

location of the anginal pain intensity of the attacks frequency of the attacks factors that precipitate the attacks

Many drugs interact with digoxin. Drugs that

lower serum potassium or magnesium levels can predispose patients to digoxin toxicity. The most significant drug-drug interactions occur with amiodarone, quinidine, and verapamil. These drugs can increase serum levels of digoxin by 50%, thus greatly increasing the risk of digoxin toxicity.

The principle application of quinine is

malaria caused by chloroquine-resistant P. falciparum

Adenosine interaction with methylxanthines (ex: theophylline)

may decrease effect

Adenosine interaction with carbamazepine

may increase degree of heart block caused by adenosine

Adenosine interaction with dipyridamole, nicotine

may increase effect

Toxicity of the central nervous system is of most concern with this agent

mefloquin

methylprednisolone

most common injectable corticosteroid

A patient taking atorvastatin is experiencing the adverse effect of myositis. Which manifestations would a nurse expect to see in this patient?

muscle inflammation muscle pain creatine kinase (CK) elevation

The patient has been placed on aspirin as an antiplatelet drug. Which side effect is the patient most likely to experience?

nausea Nausea accompanied by vomiting is an expected side effect of treatment with aspirin. Chest pain, edema, and itching are side effects that are more likely to be seen with the use of clopidogrel.

About which adverse effect will a nurse counsel a patient who is receiving colesevelam?

none - no adverse effects expected

Adenosine interaction with herbal

none significant

The nurse is providing teaching to a client who is at risk for hyperlipidemia. The nurse tells the client that hyperlipidemia has many risk factors. The nurse knows that which risk factors can be controlled or modified? Inactivity, stress, gender, smoking, height Gender, obesity, family history, and smoking Obesity, inactivity, diet, and smoking Stress, family history, and obesity

obesity, inactivity, diet and smoking

Which discharge teaching is appropriate to give a patient who has been prescribed warfarin?

obtain emergency care if you do not stop bleeding within 5-10 minutes Check with your health care provider before taking any new medications, including over-the-counter medications and herbals Notify your health care provider if you will be using tobacco products

Administration of vasodilators requires

ongoing nursing assessment. Some vasodilators, such as sodium nitroprusside, require continuous monitoring in an intensive care setting.

Which route of administration for verapamil is appropriate for maintenance therapy?

oral

Which form of nitroglycerin is likely to have a large first-pass effect?

oral Oral nitroglycerin goes to the liver and is metabolized before it can become active in the body. As a result, a large amount of nitroglycerin is removed from circulation. This is known as a large first-pass effect. Sublingual nitroglycerin has an onset of action of 2 to 3 minutes and is absorbed quickly because the area under the tongue is highly vascular. Transdermal nitroglycerin has an onset of action of 30 to 60 minutes. It is used for long-term management of angina pectoris because it allows for the continuous, slow delivery of nitroglycerin. Intravenous nitroglycerin is quickly absorbed in the blood; it has an onset of action of 1 to 2 minutes.

The preference for digoxin administration is the

oral route. The patient should receive a total of 1 to 1.5 mg orally over the first 24 hours divided into three or four doses. Afterward, the oral maintenance dose should be between 0.125 to 0.5 mg/day. In patients experiencing renal dysfunction or deficiency, the dose should be decreased.

A 57-year-old patient who has osteoporosis after menopause is prescribed 1500 mg of calcium per day and 2000 IU per day of vitamin D for 3 months. After these 3 months, the nurse finds little improvement in the patient's condition. Which assessment finding could be a cause of the patient's condition?

patient smokes and drinks alcohol

Sodium nitroprusside is extremely

potent and can cause excessive hypotension if administered too quickly.

The nurse notes darkened urine of the patient being administered primaquine, as this is a sign of

presence of hemoglobin in the urine and possibly severe hemolysis

The agent of choice for preventing relapse of vivax malaria is

primaquine

The nurse knows this drug would be employed to eradicate P. vivax from the liver, preventing relapse

primaquine

Verapamil excretion

primarily in urine

For digoxin given intravenously, patient safety should be

priority. Proper rate of administration is imperative. Some institutions may require cardiac monitoring during administration of IV digoxin.

The nurse knows that quinine can cause

profound hypoglycemia via stimulation of pancreatic beta cells

Chloroquine is also the drug of choice for

prophylaxis (suppressive therapy)

Which assessment is most important for the nurse to obtain prior to administering digoxin to a patient with heart failure?

pulse It is crucial to measure the patient's pulse before administering digoxin because digoxin causes a decrease in heart rate. In fact, if the heart rate is below 60, digoxin cannot be given. Respiratory rate is not a priority before administration of digoxin because it does not cause respiratory depression. Blood pressure is not as important as pulse because digoxin increases the strength of cardiac contractions. Weight in kilograms is not necessary before administering digoxin.

Which adverse effects would the nurse teach the patient to report during thrombolytic therapy?

rapid heartbeat rashes dizziness lightheadedness

Reflex tachycardia is

reflex stimulation of the heart due to the decrease in blood pressure that causes increased cardiac workload and myocardial oxygen demand. Patients usually receive a beta blocker in combination with hydralazine or minoxidil to prevent reflex tachycardia. Use of hydralazine can also result in an acute rheumatoid syndrome that mimics systemic lupus erythematosus (SLE). Symptoms include fever, joint pain, muscle pain, pericarditis, and nephritis. This most often presents in patients who metabolize the drug slowly; however, it is rare when the dosage is maintained below 200 mg/day. Symptoms are often reversible; however, they can be long lasting (for 6 months or more). An antinuclear antibody (ANA) panel can be used to assess for this side effect.

Which phrases describe reported benefits of prescribing novel oral anticoagulants (NOACs) instead of warfarin?

requent laboratory monitoring is not required for NOACs. Genetics do not alter the effectiveness of NOACs. Comorbid conditions do not affect the effectiveness of NOACs. Diet does not affect the effectiveness of NOACs.

Minoxidil is used in patients who have not responded well to

safer drugs. Minoxidil is indicated for severe hypertension, and it produces a very intense vasodilation. Minoxidil is only added to a drug regimen after maximum therapeutic dosages of a diuretic and two other antihypertensives are used.

Adenosine is contraindicated in patients who have

second- or third-degree heart block, atrial flutter or fibrillation, sick sinus syndrome, or ventricular tachycardia, as well as in those with a known allergy.

Hydralazine works by

selective dilation of arteries and arterioles. It causes the vascular smooth muscle (VSM) to relax, which decreases peripheral resistance and, in turn, lowers blood pressure and decreases afterload. Heart rate and myocardial contractility increase, primarily due to reflex mechanisms.

Grapefruit juice can inhibit metabolism of Class IV antidysrhythmic drugs, raising

serum drug levels with potential toxicity.

Minoxidil is used for

severe hypertension that is unresponsive to other therapy. It has serious adverse effects and is reserved only for patients who have not responded to other safer drugs.

IV quinindine is the treatment of choice for

severe malaria caused by p.vivax and p.falciparum

Which factor in a patient's history is most likely related to the development of Pediculus humanus capitis?

sharing hairbrushes and hats

At a follow-up appointment, a patient who is taking hydralazine for hypertension reports feeling lightheaded and dizzy when standing up. What teaching will the nurse provide?

sit on the edge of the chair and stand up slowly

Which factor should a nurse recognize as one that would increase the risk of thromboembolic phenomena arising from oral contraceptive use?

smoking

The nurse notes significant widening of the QRS complex on ecg for the patient on IV Quinidine Gluconate, the infusion should be

temporarily slowed

Sodium nitroprusside can also cause

thiocyanate toxicity. This is also caused by the metabolism of the drug, and over several days of administration, thiocyanate can accumulate. Symptoms of thiocyanate toxicity include psychotic behavior and delirium. If a patient received sodium nitroprusside for more than 3 days, monitoring of plasma thiocyanate levels is required.

Arteminisinin derivatives are most effective drugs for

treating falciparum malaria (eg artemether and artesunate)

spinosad

treatment of head lice - - more effective than permethrin but more expensive

A patient who is taking sustained-release diltiazem is having difficulty swallowing the medication. What teaching is appropriate?

try taking the medication whole in applesauce or pudding

Diltiazem excretion

urine

crotamiton

used to treat scabies aka Eurex

Intranasal corticosteroids

useful in managing allergic rhinitis.

Verapamil half-life

variable for all routes and formulations

Sodium nitroprusside directly acts on

venous and arterial smooth muscle, producing vasodilation. This decreases peripheral resistance and afterload, increasing cardiac output.

A patient who has begun using transdermal nitroglycerin for angina reports occasional periods of tachycardia. The nurse will expect the prescriber to order: digoxin to slow the heart rate. immediate discontinuation of the nitroglycerin. verapamil as an adjunct to nitroglycerin therapy. periods of rest when the heart rate increases

verapimil as an adjunct to nitroglycerin therapy. (Nitroglycerin lowers blood pressure by reducing venous return and dilating the arterioles. The lowered blood pressure activates the baroreceptor reflex, causing reflex tachycardia, which can increase cardiac demand and negate the therapeutic effects of nitroglycerin. Treatment with a beta blocker or verapamil suppresses the heart to slow the rate. Digoxin is not recommended. Discontinuation of the nitroglycerin is not indicated. Resting does not slow the heart when the baroreceptor reflex is the cause of the tachycardia.)

What will the nurse monitor to evaluate the effectiveness of antiviral agents administered to treat human immunodeficiency virus infection?

viral load All antiretroviral agents work to reduce the viral load, which is the number of viral RNA copies per milliliter of blood. While the other labs may be monitored at one time or another depending on the other medications used or patient condition, the most relevant answer to the effectiveness of the antiretroviral medication is the viral load.

Diltiazem absorption

well absorbed with oral administration

Verapamil absorption

well absorbed with oral administration

Patients who take anticoagulant, antiplatelet, and thrombolytic drugs are at risk for bleeding?

ys

Which lipid parameters would a nurse expect to be reduced with niacin?

Triglycerides Lipoprotein Total cholesterol Low-density lipoprotein (LDL) cholesterol

Which parameters are expected to decrease with statins?

Triglycerides Total cholesterol Apolipoprotein Low-density lipoprotein (LDL) cholesterol

Which non-nucleoside reverse transcriptase inhibitors (NNRTIs) can cause central nervous system (CNS) effects? Select all that apply.

Two of the NNRTIs, efavirenz and rilpivirine, can both cause CNS effects. Etravirine, delavirdine, and nevirapine do not have central nervous system (CNS) effects.

Which parameter would the nurse follow when administering adenosine to a patient to treat supraventricular tachycardia?

Undiluted and rapidly over 1 to 2 seconds as close to the heart as possible Adenosine should be administered undiluted as rapidly as possible over 1 to 2 seconds as close to the heart as possible, such as the antecubital fossa. It is then followed immediately with 20 mL of normal saline flush.

Minoxidil excretion

Urine and feces

Which data would the nurse monitor to evaluate therapeutic effectiveness of desmopressin therapy? Pain scale Blood glucose Blood pressure Urine output

Urine output

IV Administration for digoxin

Use digoxin immediately. Should give IV slowly over a minimum of 5 minutes. May administer undiluted or diluted with a minimum of fourfold volume of sterile water for injection or D5W. Using less than four times dilution may result in drug precipitation.

The nurse administers intravenous desmopressin at 0730. During which time frame would the nurse anticipate giving another dosage of this drug? 0830 to 1030 1000 to 1200 1530 to 1930 0730 the next day

1530 to 1930

A 25-year-old female patient is being discharged from the hospital on valsartan after a hypertensive crisis. Which information would the nurse include in the discharge teaching?

"Be sure to change positions slowly, especially when you get up in the morning." "Take your blood pressure at home to evaluate effectiveness of the medication." "Use contraceptives while taking valsartan."

A patient who has hypertension and asthma asks, "Why can't I take a beta blocker for my hypertension?" Which nursing response is appropriate?

"Beta blocker medications can cause bronchospasm, which can trigger an asthma attack." Nonselective beta blockers have effects on beta1 and beta2 receptors and can cause bronchospasm, so they are contraindicated in patients who have asthma. Cardioselectivity of beta1 blockers does not confer absolute protection from bronchoconstriction, so these drugs are not recommended.

A patient who is being discharged on diltiazem tells the nurse that cooking with herbs and taking supplements has improved the patient's physical stamina. Which response by the nurse is appropriate?

"Certain supplements can alter the therapeutic effects of diltiazem." The nurse would provide teaching on drug-drug, drug-herb, and drug-food interactions. Grapefruit juice, ginkgo, ginseng, hawthorn, and St. John's wort could increase the drug level of diltiazem, increasing the risk of side or adverse effects. The patient should consult with the health care provider or pharmacist before consuming any herb.

Which should the nurse include in a teaching plan for a patient receiving digoxin therapy?

"Digoxin toxicity can cause dysrhythmias." Digoxin toxicity can mimic practically all types of dysrhythmias. Varying degrees of atrioventricular (AV) block are among the most common. Ventricular flutter and ventricular fibrillation are the most dangerous. Digoxin causes dysrhythmias by increasing automaticity in the atria, ventricles, and His-Purkinje system, and by decreasing conduction through the AV node. With proper treatment, digoxin-induced dysrhythmias can almost always be controlled.

Which instruction should the nurse provide when teaching a patient to mix regular insulin and neutral protamine Hagedorn (NPH) insulin in the same syringe?

"Draw up the clear regular insulin first, followed by the cloudy NPH insulin." To ensure a consistent response, only NPH insulin is appropriate for mixing with a short-acting insulin. Unopened vials of insulin should be refrigerated; current vials can be kept at room temperature for up to 1 month. Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could alter the pharmacokinetics of subsequent doses taken out of the regular insulin vial. NPH insulin is a cloudy solution, and it should always be rotated gently to disperse the particles evenly before loading the syringe. Subcutaneous injections should be made using one region of the body (eg, the abdomen or thigh) and rotated within that region for 1 month.

The clinical coordinator instructs the nursing student to care for a patient with malaria. Which information should the clinical coordinator provide regarding pharmacologic management of malaria?

"Drug resistance can be found in the malarial patient."

The nurse is explaining to a patient the way that hydralazine lowers blood pressure. Which nursing statement is appropriate?

"Hydralazine lowers peripheral vascular resistance, which lowers blood pressure."

Which statements made by the patient indicate a need for more teaching about dronedarone?

"I can take this without regard to food." "If I forget to take a dose, I can double it." "It is normal to develop swelling to the feet."

Teaching is provided to a patient who is prescribed metoprolol after a myocardial infarction. Which response by the patient indicates a need for additional teaching?

"I do not need to check my heart rate before taking the drug." Metoprolol is a beta blocker and can lower the heart rate. This patient requires additional teaching.

The patient refuses to take metoprolol because of its effects on the lungs. The nurse explains that metoprolol will not affect the lungs because it affects which type of cell receptors?

Beta1

A patient was started on intravenous (IV) heparin at 1200 pm. When will the nurse assess the activated thromboplastin time (aPTT)?

1800 aPTT should be assessed 4 to 6 hours after the initiation of heparin to ensure adequate dosing. Values should be 1.5 to 2 times that of the patient's baseline.

In the failing heart, arterial pressure falls, stimulating the baroreceptor reflex to increase sympathetic nervous system activity. The nurse understands increased sympathetic activity will produce which response? 1 Bradypnea 2 Tachycardia 3 Hypotension 4 Hypoglycemia

2

Which statement by Mr. Torres indicates an understanding of the possible side effects of adenosine?

"I might feel some chest pressure, but it will not last long." The patient might experience brief chest pressure with adenosine. Other symptoms the patient may feel include nausea, lightheadedness, head or neck pain, or shortness of breath because of the brief periods of asystole. Because the half-life is less than 10 seconds, these symptoms should resolve quickly.

A patient is being discharged on extended-release (ER) metoprolol. Which statement by the patient indicates an understanding of metoprolol ER?

"I should take the drug whole." Metoprolol ER should be taken whole, without crushing or chewing the medicine.

A nurse is preparing quinidine to administer to a patient with ventricular dysrhythmia. Which dose of quinidine would cause the nurse to notify the health care provider before administering?

100 mg every 4 hours The usual dose for quinidine is 324 to 648 mg every 8 to 12 hours. This dose is too low, and the nurse would be expected to notify and discuss with the health care provider before administering the drug.

The nurse is administering valsartan to a patient with hypertension at 0800. Based on the onset of the drug, at which time will the nurse anticipate an effect on the patient's blood pressure?

1000

The nurse is administering an intravenous (IV) dose of digoxin at 1130. At which time would the nurse anticipate the onset of the drug?

1140 The nurse would anticipate the onset at 1140 because the onset of IV digoxin is 5 to 30 minutes.

The nurse administered a dose of lisinopril at 0800, and the patient's blood pressure was 189/96 mm Hg. Based on the pharmacodynamics of the drug, at which time would the nurse anticipate the greatest reduction in blood pressure?

1400

The nurse administered a dose of lisinopril at 0800, and the patient's blood pressure was 189/96 mm Hg. Based on the pharmacodynamics of the drug, at which time would the nurse anticipate the greatest reduction in blood pressure?

1400 At 1400, the nurse would anticipate peak effects of the drug, as this is 6 hours after administration, and the peak effect occurs within 6 to 8 hours.

The nurse administered a dose of lisinopril at 0800, and the patient's BP was 189/96 mmHg. Based on the pharmacodynamics of the drug, at what time would the use anticipate the greatest reduction in blood pressure?

1400 (At 1400, the nurse old anticipate peak effects of the drug, as this is 6 hours after administration, and the peak effect occurs within 6 to 8 hours. )

For which patients is the use of an angiotensin-converting enzyme (ACE) inhibitor contraindicated? A. 32 year-old female patient who is 4 months pregnant B. 62 year-old male patient with a history of renal artery stenosis c. 56 year-old male patient with a history of coronary artery disease D. 29 year-old female patient with a potassium level of 5.2mEq/L E. 36 year-old patient with type 1 Diabetes mellitus (Choose all that apply)

A,B,C -contraindicated in pregnancy - contraindicated with renal artery stenosis - indicated with high serum potassium

The nurse is teaching a class on angiotensin receptor blockers (ARBs). What would the nurse include in the teaching? A. ARBs lower blood pressure by preventing vasoconstriction B. ARBs prevent angiotensin Il from stimulating the release of aldosterone C. ARBs inhibit the conversion of angiotensin 1 to angiotensin 11 D. ARBs are generally well absorbed E. valsartan crosses the placenta and can cause fetal death F. ARBs can prevent angiotensin 11 from inducing structural changes to the heart (Choose all that apply)

A,B,D,E,F

The nurse is providing education to a patient who is being discharged on valsartan. Which patient responses indicate that more education is required? A. "Which one of those medications is for my blood pressure." B. "I take it at about the Same time each day." C."I have to take it with food or it won't work" D. "I take it only when my BP is over 180/80 mmHg" E. "I will immediately call 911 or my healthcare provider if my face begins to swell."

A,C,D

The nurse is teaching a course on the mechanism of action of angiotensin-converting enzyme (ACE) inhibitors. Which teaching will the nurse include?

ACE inhibitors suppress conversion of angiotensin I to angiotensin II

A patient in a hypertensive crisis is being started on a continuous sodium nitroprusside [Nipride] infusion. Which interventions are essential before the nurse administers nitroprusside [Nipride]? (Select all that apply.) A. Obtain a baseline weight and weigh daily. B. Prepare for arterial line insertion. C. Discontinue the infusion when blood pressure is controlled. D. Observe for signs of hypertrichosis during the infusion. E. Cover the solution with an opaque bag.

A. Obtain a baseline weight and weigh daily. B. Prepare for arterial line insertion. E. Cover the solution with an opaque bag. A Nipride infusion is ordered in micrograms/kilogram/minute. Knowing the patient's weight is essential for calculating the appropriate dose. Also, tracking daily weights and comparing them with the baseline values helps the nurse determine whether the adverse effect of fluid retention has developed. An arterial line allows for continuous and accurate measurement of blood pressure. Because light degrades nitroprusside, the infusion solution should be covered. The infusion should not be discontinued abruptly, because the blood pressure will return to the pretreatment levels within minutes. Hypertrichosis (excessive hair growth) is a side effect of minoxidil.

IV Incompatibilities of adenosine

Adenosine is incompatible with all drugs. It is incompatible with all solutions, except the following: 0.9% NaCl, D5W, Ringer's lactate, or abciximab.

Adenosine

Adenosine is the drug of choice for treating paroxysmal supraventricular tachycardia (PSVT). PSVT begins in an area above the ventricles with the heart rate often exceeding 150 beats/min.

C (The only therapeutic indication of use for adenosine is the treatment of PSVT.)

Adenosine is used to treat which condition? Atrial fibrillation Atrial flutter Paroxysmal supraventricular tachycardia (PSVT) Second-degree atrioventricular block

A patient remains in supraventricular tachycardia after administration of adenosine 6 mg. Which action would the nurse anticipate taking?

Administer adenosine 12 mg in 1 to 2 minutes after the previous dose.

A patient remains in supraventricular tachycardia after administration of adenosine 6 mg. Which action would the nurse anticipate taking?

Administer adenosine 12 mg in 1 to 2 minutes after the previous dose. If the patient is does not respond to the first dose of adenosine within 1 to 2 minutes, then the nurse would prepare to administer adenosine 12 mg.

A patient is prescribed clopidogrel and aspirin at 9:00 a.m. Which action would the nurse take?

Administer both drugs at 0900

What is the nurse's best action when finding a patient with type 1 diabetes mellitus unresponsive, cold, and clammy? Administer subcutaneous regular insulin immediately. Administer glucagon. Start an insulin drip. Draw blood glucose level and send to the laboratory.

Administer glucagon Glucagon stimulates glycogenolysis, raising serum glucose levels. The patient is showing signs of hypoglycemia.

Which action related to drug administration will a nurse expect to take for a patient with unstable ventricular tachycardia?

Administer initial intravenous dose of amiodarone over 10 minutes.

The nurse admits a patient newly diagnosed with schizophrenia to the inpatient mental health unit. What is the priority reason for why the nurse includes the family when collecting the nursing history? A)The patient may not be able to provide a coherent history. B)The patient may not be able to speak due to reduced level of consciousness. C)The family will feel better if they are included in the process. D)The patient will be less anxious if the family listens while he answers questions.

Ans:A Feedback: Schizophrenia, the most common psychosis, is characterized by delusions, hallucinations, and inappropriate responses to stimuli. As a result, the patient may be unable to provide a coherent history and may be unaware of his behaviors considered dysfunctional. There is no reason to suspect the patient cannot speak and reducing anxiety is not the priority rationale for including family. While family is included in treatment, the goal is to treat the patient and not make the family feel better if actions were not in the patient's best interests.

56.For what reason might the nurse administer sildenafil to a woman? A)Pulmonary arterial hypertension B)Sexual dysfunctionC)Breast cancerD)Endometriosis

Ans:A Feedback: Sildenafil is used to treat erectile dysfunction in the presence of sexual stimulation in men and to treat pulmonary arterial hypertension in women. It is not used for sexual dysfunction, breast cancer, or endometriosis in women.

A patient has been diagnosed with roundworms and is to be treated with albendazole. A priority nursing assessment of this patient would be to determine if the patient is taking what? A)Cimetidine (Tagamet) B)Pioglitazone (Actos) C)Alprazolam (Xanax) D)Loperamide (Imodium)

Ans:A Feedback: The adverse effects of albendazole, which are already severe, may increase if the drug is combined with dexamethasone, praziquantel, or cimetidine. These combinations should be avoided if at all possible; if they are necessary, patients should be monitored closely for the occurrence of adverse effects. Pioglitazone is an oral antidiabetic agent that could be taken with albendazole. Loperamide is an antidiarrheal drug that may be used for treatment of diarrhea as a result of the mebendazole and pyrantel. Alprazolam should not be a concern.

The patient's anterior pituitary hormone secretion is impacted by time of day and activity level, which the nurse assesses as what? A)Diurnal rhythm B)Physiological rhythm C)Circadian rhythm D)Biannual rhythm

Ans:A Feedback: The anterior pituitary hormones are released in a rhythmic manner into the bloodstream. Their secretion varies with time of day (often referred to as diurnal rhythm) or with physiological conditions, such as exercise or sleep. A biannual rhythm would be twice a year. Circadian rhythm is indicated by when the patient prefers to sleep or wake, such as those who describe themselves as "morning people." There is no such thing as a physiological rhythm.

What organ should the nurse recognize as the coordinating center for the nervous and endocrine responses to internal and external stimuli? A)Hypothalamus B)Pituitary gland C)Thyroid gland D)Parathyroid gland

Ans:A Feedback: The hypothalamus is the coordinating center for the nervous and endocrine responses to internal and external stimuli. The pituitary, thyroid, and parathyroid glands all play an important role in maintaining homeostasis, but they do not connect the nervous and endocrine systems.

A child was diagnosed with attention-deficit hyperactivity disorder and methylphenidate was prescribed for treatment to be taken once a day in a sustained release form. On future visits what is a priority nursing assessment for this child? A)Weight and height B)Breath sounds and respiratory rate C)Urine output and kidney function D)Electrocardiogram (ECG) and echocardiogram

Ans:A Feedback: The nurse needs to carefully track this child's weight and height because the drug can cause weight loss, anorexia, and nausea that could result in slowed or absent growth. There would be no need to monitor breath sounds, respiratory rate, urine output, and kidney function. Although arrhythmias may occur as an adverse effect necessitating an ECG, there is no need to perform echocardiograms.

A 68-year-old male patient tells the nurse that he has been unable to get an erection for the past 6 months and he guesses his sex life is over. The provider orders diagnostic testing to determine whether sildenafil (Viagra) is appropriate for the patient. What is the most correct nursing diagnosis for this patient? A)Sexual dysfunctionB)Disturbed body imageC)Ineffective sexuality pattern D)Disturbed tactile sensory perception

Ans:A Feedback: The patient is experiencing sexual dysfunction so that would be the most appropriate nursing diagnosis. The patient did not discuss feeling let down by or unhappy with his body so disturbed body image is incorrect. The effectiveness of sexual pattern is not known. No problem with sensory perception is indicated by this question.

A patient on the unit has a deep decubitus ulcer. The family asks why the nurse debrides the ulcer and removes the dead cells. What is the nurse's best response to explain to the family why debridement is performed? A)The lysosomes released by the dead cells in the area continue to kill other cells, destroying more tissue. B)The dead cells no longer contain histocompatible antigens causing a greater inflammatory response. C)Removing dead tissue forces oxygen to enter the damaged cells to regenerate them and to promote healing. D)The doctor ordered the procedure to be performed so it is done the way it is ordered because orders are always followed.

Ans:A Feedback: When a cell dies, its cell membrane ruptures and the lysosomes release lysozymes, which dissolve protein. When many cells die, lysozymes accumulate and dissolve the proteins that the dead cells leave behind, but the lysozymes also destroy the cell membrane of healthy cells in the area. Those cells then die, releasing lysozymes, which destroy more cells, and a vicious cycle occurs. A decubitus ulcer is an area of many dead cells, which are killing healthy cells. The area needs to be scraped clean to remove the dead cells so that the lysozymes will stop destroying healthy cells and allow oxygen to return to the area through the capillary bed, which allows healing to occur. Many treatments exist for decubitus ulcers, all of which depend on the return of blood flow to the area and removal of the dead tissue. No procedure should ever be performed only because it was ordered. The nurse should understand why each procedure is needed.

What is an appropriate nursing diagnosis for a patient with tapeworm? A)Imbalanced nutrition: less than body requirements B)Chronic pain C)Constipation D)Impaired mobility

Ans:A Feedback:Tapeworm affects the body's ability to absorb food products and weight loss and malnutrition often follow unless treatment is received promptly. As a result, the best nursing diagnosis is imbalanced nutrition: less than body requirements. Patients with tapeworm are often symptom-free but may experience some abdominal discomfort and distention as well as weight loss so they do not have chronic pain, constipation, or impaired mobility.

The mother of a child diagnosed with attention-deficit syndrome receives a prescription for a central nervous system (CNS) stimulant to treat her child. The mother asks the nurse, "I don't understand why we're giving a stimulant to calm him down?" What is the nurse's best response to this mother? A)"It helps the reticular activating system (RAS), a part of the brain, to be more selective in response to incoming stimuli." B)"It helps energize the child so they use up all of their available energy and then they can focus on quieter stimuli." C)"No one truly understands why it works but it has been demonstrated to be very effective in treating ADHD." D)"The drugs work really well and you will see a tremendous change in your child within a few weeks without any other treatment."

Ans:A Feedback: The paradoxical effect of calming hyperexcitability through CNS stimulation seen in attention-deficit syndrome is believed to be related to increased stimulation of an immature RAS, which leads to the ability to be more selective in response to incoming stimuli. CNS stimulants do not cause the child to use all his energy, the effect is thought to be understood, and telling the mother the drug just works without any explanation is not appropriate and may result in noncompliance with pharmacology therapy if the mother does not understand why the drug is given.

The nurse is caring for an older adult in the long-term care facility who has begun to display signs of anxiety and insomnia. What is the priority nursing action? A)Assess the patient for physical problems. B)Call the provider and request an antianxiety drug order. C)Increase the patient's social time, encouraging interaction with others. D)Suggest the family visit more often to reduce the resident's stress level.

Ans:A Feedback: The patient should be screened for physical problems, neurological deterioration, or depression, which could contribute to the insomnia or anxiety. Only after physical problems are ruled out would the nurse consider nondrug measures such as increased socialization with other residents or family members. If nothing else is effective, pharmacological intervention may be necessary.

The nurse is caring for a pregnant patient. What hormone must be secreted to cause uterine contractions? A)Oxytocin B)ADHD C)Estrogen D)Enkephalins

Ans:A Feedback: The pituitary is made up of three lobes: anterior, intermediate, and posterior. The posterior lobe stores two hormones produced by the hypothalamus, ADH and oxytocin. Oxytocin stimulates uterine smooth muscle contraction in late phases of pregnancy and also causes milk release or "let down" reflex in lactating women. The posterior lobe does not store estrogen or enkephalins. ADHD (i.e., attention deficit hyperactivity disorder is a disease process, not a hormone.

The pharmacology instructor is discussing adrenergic agonists with the nursing class. Which drugs would the instructor tell the nursing students are generally indicated for the treatment of shock, bronchospasm, and some types of asthma? A)Sympathomimetic drugs B)Beta-blocking drugs C)Parasympathetic stimulating drugs D)Anticatecholamine drugs

Ans:A Feedback: These drugs generally are indicated for the treatment of hypotensive states or shock, bronchospasm, and some types of asthma. Beta-blocking drugs, parasympathetic stimulating drugs, and anticatecholamine drugs are not the drugs of choice in these situations.

A 4-year-old is admitted to the emergency department in shock after a motor vehicle accident. The patient weighs 12.5 kg. What would be the minimum safe dose of adrenalin if the pediatric dose is 0.005 to 0.01 mg/kg IV? A)0.0625 mg B)0.075 mg C)0.08 mg D)0.085 mg

Ans:A Feedback: To calculate the minimum dosage, multiply the child's weight in kg by the lower dosage range; 12.5 × 0.005 = 0.0625 mg.

What would be important for the nurse to teach the parents of a pediatric patient about the use of topical corticosteroids? A)"Apply the medication sparingly." B)"Apply directly to open lesions." C)"After applying cover with a bandage." D)"Reapply as often as needed to keep the rash coated with the medication."

Ans:A Feedback: Topical use of corticosteroids should be limited in children, because their body surface area is comparatively large, so that the amount of the drug absorbed in relation to weight is greater than in an adult. Apply sparingly and do not use in the presence of open lesions. Do not occlude treated areas with dressings or diapers, which may increase the risk of systemic absorption.

The 22-year-old patient tells the nurse he doesn't have trouble obtaining and maintaining an erection but wonders if taking Viagra would improve the sexual experience anyway. What is the nurse's best response? A)"The only thing Viagra does is improve blood flow to the penis to make it erect." B)"Viagra improves stamina and sensation, making the sexual experience better." C)"Viagra has its greatest effect if both the man and woman take it at the same time." D)"Viagra does nothing to improve the sexual experience."

Ans:A Feedback: Viagra improves blood flow into the penis and that is its only effect. It does not improve stamina or sensation. Research has indicated it has no effect on women's sexual response. To say only that Viagra does nothing would not provide adequate information for the patient.

The nurse is teaching the patient who will require long-term corticosteroid therapy how to reduce the risk of infection. What suggestions will the nurse include? A)"Avoid large crowds of people tightly packed together." B)"Avoid working in areas with other people." C)"Avoid exercising to reduce risk of injury." D)"Avoid touching other people who may carry germs."

Ans:A Feedback: With long-term therapy, the importance of avoiding exposure to infection—crowded areas, people with colds or the flu, activities associated with injury—should be stressed. If an injury or infection should occur, the patient should be encouraged to seek medical care. These patients do not need to avoid work, exercise, or touching others but they should use good hand hygiene to avoid infection from these sources.

The nurse is caring for a patient who received a new diagnosis of cancer. The patient exhibits signs of a sympathetic stressreaction. What signs and symptoms will the nurse assess in this patient consistent with an acute reaction to stress? (Select all that apply.) A)Profuse sweatingB)Fast heart rateC)Rapid breathing D)HypotensionE)Inability to interact with others

Ans:A, B, C Feedback: Anxiety is often accompanied by signs and symptoms of the sympathetic stress reaction that may include sweating, fast heart rate, rapid breathing, and elevated blood pressure. Chronically anxious people may be afraid to interact with other people but this is not usually seen in an acute stress reaction.

A nurse would anticipate that which dysrhythmia will likely develop when adenosine is administered?

Asystole

A nursing student asks the pharmacology instructor for ways to minimize the emergence of drug-resistant microbial agents. What would be an appropriate response by the instructor? (Select all that apply.) A)Avoid the use of broad-spectrum antibacterial drugs when treating trivial or viral infections. B)Use narrow-spectrum agents if they are thought to be effective. C)Do not use vancomycin unnecessarily. D)Prescribe antibiotics when the patient believes they are warranted. E)Start the antibiotics, do culture and sensitivity tests, and provide patient education.

Ans:A, B, C Feedback: To prevent or contain the growing threat of drug-resistant strains of bacteria, it is very important to use antibiotics cautiously, to complete the full course of an antibiotic prescription, and to avoid saving antibiotics for self-medication in the future. You would not give antibiotics every time the patient wants them, nor would you do a culture and sensitivity test after starting antibiotics. Therefore, Options D and E are incorrect.

The nurse assesses the patient who had an abrupt withdrawal of benzodiazepines for withdrawal syndrome and would recognize what symptoms as part of the syndrome? (Select all that apply.) A)Headache B)Nightmares C)Malaise D)Bradycardia E)Hypotension

Ans:A, B, C Feedback: Abrupt cessation of benzodiazepines may lead to a withdrawal syndrome characterized by nausea, headache, vertigo, malaise, and nightmares. Withdrawal symptoms may be caused by the abrupt separation of benzodiazepine molecules from their receptor sites and the resulting acute decrease in gamma-aminobutyric acid (GABA) neurotransmission. Because GABA is an inhibitory neurotransmitter, less GABA may produce a less inhibited central nervous system (CNS) and therefore symptoms of hyperarousal or CNS stimulation. The nurse would not categorize hypotension or bradycardia as indicating benzodiazepine withdrawal.

The nurse is giving discharge instructions to a patient who just had Botox A injections around her eyes. What adverse effects would the nurse include in her discharge instructions? (Select all that apply.) A)Respiratory infections B)Flu-like syndrome C)Droopy eyelids D)Cough E)Diarrhea

Ans:A, B, C Feedback: Adverse effects associated with use of botulinum toxin type A for cosmetic purposes include headache, respiratory infections, flu- like syndrome, and droopy eyelids in severe cases. Adverse effects do not include cough or diarrhea.

When studying for a pharmacology exam, a student asks her peers which agents affect both alpha- and beta-receptor sites. What would be an appropriate response to this student? (Select all that apply.) A)Dobutamine (Dobutrex) B)Epinephrine (Adrenalin, Sus-Phrine) C)Dopamine (Intropin)D)Clonidine (Catapres)E)Albuterol (Proventil)

Ans:A, B, C Feedback: Agents that affect both alpha- and beta- receptor sites include dobutamine, dopamine, ephedrine, epinephrine, and norepinephrine. Clonidine is an alpha-specific adrenergic agonist; albuterol is a beta-specific adrenergic agonist.

When making a presentation on the cell, what would the students say are the main parts of the cell? (Select all that apply.) A)The nucleusB)The cytoplasm C)The cell membrane D)The mitochondria E)The organelles

Ans:A, B, C Feedback: The cell is composed of a nucleus, which contains genetic material and controls the production of proteins by the cell; a cell membrane, which separates the inside of the cell from the outside environment; and cytoplasm, which contains various organelles important to cell function. The mitochondria and the organelles are units within the cytoplasm but are not main parts of the cell.

The nurse is caring for a patient who has been taking androgens and has been admitted to the ICU following a car accident. What lab results will the nurse interpret as more indicative of androgen therapy than actual disease states? (Select all that apply.) A)Decreased thyroid functionB)Increased creatinine levelsC)Increased creatinine clearance D)Elevated liver enzymesE)Increased white blood cell (WBC) count

Ans:A, B, C Feedback: While a patient is taking androgens, thyroid function may be decreased, as well as increased creatinine and creatinine clearance, results that are not associated with disease states. These effects can last up to 2 weeks after the discontinuation of therapy. Elevated liver enzymes may indicate a potentially life- threatening effect that has been documented is hepatocellular cancer. Increased WBC count would indicate an infection. Increased liver enzymes and WBC are not associated with androgen therapy but instead indicate a disease state.

The nurse is teaching a class for nurses working in prenatal clinics about the danger associated with use of benzodiazepines during pregnancy and explains that what fetal anomalies result from maternal use of benzodiazepines during the first trimester of pregnancy? (Select all that apply.) A)Cleft lip or palate B)Inguinal hernia C)Cardiac defects D)Microencephaly E)Gastroschises

Ans:A, B, C, D Feedback: Benzodiazepines are contraindicated in pregnancy because a predictable syndrome of cleft lip or palate, inguinal hernia, cardiac defects, microcephaly, or pyloric stenosis occurs when they are taken in the first trimester. Gastroschises, when the abdominal organs are found outside the abdominal cavity, is not associated with use of benzodiazepine use in the first trimester.

The nurse assesses the young adult athlete who has been taking anabolic steroids to enhance his performance. What findings would the nurse associate with this practice? (Select all that apply.) A)Personality changes B)Sexual dysfunction C)Increased serum lipid levels D)Cardiomyopathy E)Weight loss

Ans:A, B, C, D Feedback: Cardiomyopathy, hepatic carcinoma, personality changes, and sexual dysfunction are all associated with the excessive and off- label use of anabolic steroids for athletic performance enhancement. Adverse effects associated with prescription use include inhibition of testicular function, gynecomastia, testicular atrophy, priapism, baldness, change in libido, serum electrolyte changes, liver dysfunction, insomnia, and weight gain, not weight loss.

What reasons can the nurse give for why barbiturates are no longer considered the mainstay for treatment of anxiety? (Select all that apply.) A)Adverse effects are more severe. B)There is an increased risk of physical tolerance. C)There is an increased risk of psychological dependence. D)The most common adverse effects are related to cardiac arrhythmias. E)Hypersensitivity reactions can sometimes be fatal.

Ans:A, B, C, E Feedback: The adverse effects caused by barbiturates are more severe than those associated with other, newer sedatives/hypnotics. For this reason, barbiturates are no longer considered the mainstay for the treatment of anxiety. In addition, the development of physical tolerance and psychological dependence is more likely with the barbiturates than with other anxiolytics. The most common adverse effects are related to central nervous system (CNS) depression. Hypersensitivity reactions to barbiturates are sometimes fatal.

The nurse is preparing to contact the physician for an antibiotic order for the patient's infection. What information will the nurse be prepared to provide for the physician to choose the proper antibiotic? A)First day of infection symptoms B)Culture and sensitivity test results C)The patient's intake and output for past 2 days D)Results of complete blood count with differential

Ans:B Feedback: Antibiotics are best selected based on culture results that identify the type of organism causing the infection and sensitivity testing that shows what antibiotics are most effective in eliminating the bacteria. First day of symptoms of infection is likely already known if culture and sensitivity testing has been performed. Although measurement of intake and output is one indicator of renal function, a blood-urea-nitrogen test and assessment of creatinine levels would be better ways of assessing renal function, which will be used to determine dose of medication but not for selection of the correct antibiotic. The white blood cell count and differential would indicate the possibility of an infection but are not needed in choosing the proper antibiotic.

The nurse, providing teaching about a typical antipsychotic newly prescribed for the patient, cautions against use of alcohol with the drug by explaining it will have what effect? A)Prolonged QT interval B)Increased central nervous system (CNS) depression C)Increased anticholinergic effects D)Increased gastrointestinal (GI) adverse effects

Ans:B Feedback: Antipsychotic-alcohol combinations combinations result in an increased risk of CNS depression, and antipsychotic- anticholinergic combinations lead to increased anticholinergic effects, so dosage adjustments are necessary. Patients should not take thioridazine or ziprasidone with any other drug associated with prolongation of the QT interval. Increase in GI adverse effects is not associated with concurrent use of alcohol.

A 28-year-old patient has been prescribed penicillin for the first time. What nursing diagnosis would be most appropriate for this patient? A)Acute pain related to gastrointestinal (GI) effects of the drug B)Deficient knowledge regarding drug therapy C)Imbalance nutrition: less than body requirements related to multiple GI effects of the drug D)Constipation

Ans:B Feedback: Because this is the first time the patient has taken penicillin, she is likely to have limited knowledge about the drug. She may not understand the importance of taking the medication as ordered to increase effectiveness of the drug or to report adverse effects. because the patient has not started the drug yet, there is no way to know what adverse effects, if any, she will experience. Only if she develops acute pain related to GI effects of the drug would this be appropriate. If GI symptoms develop it may lead to imbalanced nutrition, but that remains to be seen. No indication about constipation exists.

The 63-year-old male patient receives a prescription for androgens. The nurse evaluates that the patient understood drug teaching when he makes what statement? A)"If I experience acne, I will contact my physician immediately." B)"If I experience flushing, sweating, nervousness, or emotional lability I'll know it's the drug." C)"I will report any difficulty urinating such as trouble starting my flow." D)"These pills may make my skin turn yellow but it will go away when the drug is stopped."

Ans:B Feedback: Benign prostatic hypertrophy, a common problem in older men, may be aggravated by androgenic effects that may enlarge the prostate further, leading to urinary difficulties and increased risk of prostate cancer. Nurses should teach these men the signs and symptoms of prostatic enlargement and the importance of reporting these manifestations immediately to prevent worsening of symptoms. Acne need not be reported immediately. Flushing, sweating, nervousness, and emotional lability are more usually experienced by women. Yellowing of the skin may be an indication of liver disease, which should be reported immediately

The nurse is caring for a patient who has a sedative hypnotic ordered. The nurse would consider this drug contraindicated if the patient had what disorder? A)Neurological diseases B)Liver failure C)Endocrine disorders D)Heart disease

Ans:B Feedback: Benzodiazepines undergo extensive hepatic metabolism. In the presence of liver disease, the metabolism of most benzodiazepines is slowed, with resultant accumulation and increased risk of adverse effects. Neurological disorders, endocrine disorders, and heart disease are not contraindications for the use of benzodiazepines.

A young woman attends a "Botox Party" and is injected with botulinum toxin type A to decrease "frown lines" between her eyebrows. Later that evening the patient is admitted to the emergency department and is hysterical, because she cannot move her eyebrows. The nurse explains that that toxin causes what? A)"The toxin causes muscle death, which smoothes wrinkles in the area." B)"The toxin causes muscle paralysis, preventing movement and relieving wrinkles." C)"The drug is a toxin to nerves in the area." D)"The drug is a permanent muscle relaxant and the muscles will never move again."

Ans:B Feedback: Botulinum toxin types A and B bind directly to the receptor sites of motor nerve terminals and inhibit the release of acetylcholine, leading to local muscle paralysis. These two drugs are injected locally and used to paralyze or prevent the contractions of specific muscle groups. The action smoothes wrinkles in the area, but does not cause muscle death. The effect is temporary and does not cause nerve death. The other options are false statements.

When compared with benzodiazepines, buspirone (BuSpar) stands out as unique among antianxiety drugs because of what factor? A)Increases the central nervous system (CNS) depression of alcohol and other drugs. B)Lacks muscle relaxant and anticonvulsant effects. C)Causes significant physical and psychological dependence. D)Rapidly absorbed from the gastrointestinal (GI) tract and metabolized in the liver.

Ans:B Feedback: Buspirone, a newer antianxiety agent, has no sedative, anticonvulsant, or muscle-relaxant properties, and its mechanism of action is unknown. However, it reduces the signs and symptoms of anxiety without many of the central nervous system effects and severe adverse effects associated with other anxiolytic drugs. Most of the antianxiety drugs are rapidly absorbed from the GI tract, metabolized in the liver, have a significant drug-drug interaction with alcohol and other drugs, and can result in psychological dependence.

The nurse is caring for a patient with abnormal calcium levels. What thyroid hormone does the nurse expect this will impact? A)Aldosterone B)Calcitonin C)Erythropoietin D)Insulin

Ans:B Feedback: Calcitonin is produced and secreted by the thyroid gland in direct response to serum calcium levels. Aldosterone is an adrenocorticoid hormone that is released in response to adrenocorticotropic hormone. Erythropoietin is released by the juxtaglomerular cells in the kidney in response to decreased pressure or decreased oxygenation of the blood flowing into the glomerulus. Insulin is produced by the pancreas in response to varying blood glucose levels.

The pharmacology instructor is explaining to their class the difference between the "typical" and the "atypical" groups of antipsychotic drugs. What medication would the instructor explain to the students has fewer extrapyramidal effects and greater effectiveness than older antipsychotic drugs in relieving negative symptoms of schizophrenia? A)Chlorpromazine (Thorazine) B)Clozapine (Clozaril) C)Thiothixene (Navane) D)Haloperidol (Haldol)

Ans:B Feedback:Advantages of clozapine include improvement of negative symptoms without causing the extrapyramidal effects associated with older antipsychotic drugs. Chlorpromazine is a typical antipsychotic, one of the older drugs, which does cause the extrapyramidal effects. Navane is part of the thioxanthene group of typical antipsychotics. This group of drugs has low sedative and hypotensive effects but can cause extrapyramidal effects. Haloperidol is a butyrophenone group drug used in psychiatric disorders. Usually, it produces a relatively low incidence of hypotension and sedation and a high incidence of extrapyramidal effects.

A patient, who is 77 years old, is admitted with a diagnosis of dementia. Haloperidol (Haldol) has been ordered for this patient. What nursing considerations would govern the nurse's actions? (Select all that apply.) A)It is classed as an atypical antipsychotic. B)A lowered dosage is indicated for older adult. C)It often has a hyperactive effect on patients. D)It should not be used to control behavior with dementia. E)It should only be given every other day.

Ans:B, DFeedback: Haloperidol is classified as a typical antipsychotic with a high risk of extrapyramidal effects and lower risk for hypotension and sedation. Older patients may be more susceptible to the adverse effects of antipsychotic drugs. All dosages need to be reduced and patients monitored very closely for toxic effects and to provide safety measures if central nervous system effects do occur. They should not be used to control behavior with dementia. Haloperidol does not have a hyperactive effect on patients; it should not be given on an every-other-day schedule.

An elderly patient has received a neuromuscular junction blocker during surgery. What would be an appropriate nursing diagnosis for this patient? A)Excess fluid volumeB)Risk for impaired skin integrity C)Deficient fluid volume D)Chronic confusion

Ans:BFeedback: An elderly or frail patient will need extra nursing care to prevent skin breakdown during the period of paralysis because skin tends to be thinner and more susceptible to breakdown. Therefore, risk of impaired skin integrity would be an appropriate nursing diagnosis. Fluid excess or deficit should not be a concern and the patient may be acutely confused when awakening, but there is no reason to think he or she would remain chronically confused if he was not before surgery.

The nurse is caring for a patient diagnosed with a condition resulting in inadequate production of cholecystokinin. What would the nurse expect to find when assessing this patient? A)Elevated serum sodium and reduced serum potassium levels B)Decreased bowel sounds C)Increased numbers of red blood cells D)Increased serum calcium levels

Ans:BFeedback: Cholecystokinin is secreted by the intestine and decreases gastric movement resulting in diminished bowel sounds as well as stimulation of bile and pancreatic juice secretion. Aldosterone causes sodium retention and potassium excretion. Erythropoietin increases red blood cell production. Parathyroid hormone causes an increase in serum calcium levels.

The pharmacology instructor is discussing nondepolarizing neuromuscular junction blockers (NMJ) blockers with the nursing class. How would the instructor explain the action of nondepolarizing NMJ blockers? A)Blocks acetylcholine (ACh) from acting B)Acts like ACh then prevents repolarization C)Takes the place of ACh in the depolarizing/repolarizing process D)Stops depolarization in the axion

Ans:BFeedback: Depolarizing NMJ blockers cause muscle paralysis by acting like ACh. They excite (depolarize) the muscle and prevent repolarization and further stimulation. Options A, C, and D are incorrect.

A 66-year-old female patient is on long-term oral glucocorticoid therapy to treat chronic obstructive pulmonary disease. When providing drug teaching, the nurse will inform this patient that she is at particular risk for what? A)HyponatremiaB)Spontaneous fractures C)Respiratory depression D)Ineffective temperature regulation

Ans:BFeedback: Only spontaneous fractures are considered an adverse effect of glucocorticoids; this patient would be at increased risk because her age and gender put her at higher risk for osteoporosis, which also has the adverse effect of spontaneous fractures. Long-term glucocorticoid therapy is not associated with hyponatremia, respiratory depression, or ineffective temperature regulation.

Some hormones react with specific receptor sites on a cell membrane and stimulate what? A)MeiosisB)Cyclic adenosine monophosphate (cAMP) C)Increase in hormonal inactivity D)Decrease in hormonal activity

Ans:BFeedback: Some hormones react with specific receptor sites on a cell membrane to stimulate the nucleotide cAMP within the cell to elicit an effect. Hormones that react with specific receptor sites do not stimulate miosis, or a change in amount of hormonal activity, either an increase or decrease, which would be regulated by a negative feedback mechanism.

A patient is extremely dehydrated from vomiting and diarrhea causing his or her blood to become hypertonic. What effect does the nurse expect this will have on the red blood cells? A)They will swell and eventually rupture. B)Red blood cells will migrate to the bone narrow. C)The cells will shrink and shrivel, decreasing their oxygen-carrying ability. D)The red cells will precipitate out of circulation.

Ans:C Feedback: A hypertonic solution will draw the water out of the red blood cell, causing it to shrink and shrivel, decreasing the oxygen carrying ability of the red blood cell. A hypotonic solution would result in water moving into the red blood cell, causing it to swell and burst. Red blood cells will not migrate back to the bone marrow or precipitate out of circulation.

The nurse is caring for a patient who is being maintained on mechanical ventilation. Atracurium is administered to limit the resistance to mechanical ventilation. What is the nurse's priority assessment? A)Hypotension B)Tachycardia C)Bradycardia D)Increased secretions

Ans:C Feedback: Bradycardia is a common adverse effect associated with atracurium. The nurse should monitor the patient regularly to avoid serious adverse effects. Increased secretions and hypotension are common with tubocurarine. Option B is a distracter.

Estrogen enters the cell and reacts with a receptor site. What is the final result of this reaction? A)Deoxyribonucleic acid (DNA) is affected. B)Ribonucleic acid enters the cell nucleus. C)Alteration in cellular function D)Changes messenger RNA

Ans:C Feedback: Estrogen enters the cell and reacts with a receptor site inside the cell to change messenger RNA, which enters the cell nucleus to affect cellular DNA, and the final result is an alteration in the cell's function.

A 17-year-old male patient with athlete's foot is extremely upset that he cannot get rid of it. He calls the clinic and asks the nurse whether the doctor can give him an antibiotic to "cure the infection." What should the nurse include in the explanation of treatment for fungal infections? A)"Fungi differ from bacteria in that the fungus has flexible cell walls that allow for free transfer into and out of the cell." B)"Protective layers contain sterols, which change the membrane permeability." C)"The composition of the protective layers of the fungal cell makes the organism resistant to antibiotics." D)"Fungi cell walls contain Candida, which makes the cells rigid.

Ans:C Feedback: The nurse should tell the patient that the composition of the protective layers of the fungal cell makes the organism resistant to antibiotics so that antibiotics would not have any positive effect. Fungi do differ from bacteria, but the fungus has rigid cell walls that allow for free transfer in and out of the cell. The protective layers contain ergosterol, not Candida, that helps keep the cell wall rigid, not permeable.

A nurse receives an order for clonidine (Catapres) for a 25-year-old pregnant woman. What is the nurse's priority action? A)Weigh the patient to obtain correct dose/kg/day. B)Have a second nurse check the dose before administering the drug. C)Consult with the physician about the order. D)Make sure the patient is wearing a fetal monitor.

Ans:C Feedback: The nurse would consult with the physician to ensure awareness of the pregnancy and desire to administer this drug. There are no adequate studies about use during pregnancy and lactation, so use should be reserved for situations in which the benefit to the mother outweighs any potential risk to the fetus or neonate. The nurse should question the prescriber regarding this order. It would not be necessary to implement the other options.

A patient who is using a topical antifungal agent to treat mycosis calls the clinic to report a severe rash that is accompanied by blisters. What will the nurse instruct the patient to do? A)"Continue the drug as the prescription indicates." B)"Scrub the rash with soap and water." C)"Stop using the drug immediately." D)"Decrease the amount of the medication used."

Ans:C Feedback: The patient should stop using the drug. The rash could indicate sensitivity to the drug or worsening of the condition being treated. Scrubbing the rash could cause further irritation and increase the risk for other infections. Continuing the drug could cause further complications. Decreasing the medication would be ineffective in treating the infection while continuing to risk further complications.

When administering a topical antifungal via the vaginal route, what action would the nurse take? A)Place the patient in left lateral Sims' position. B)Applied using sterile technique C)Administered high into the vagina. D)Insert a tampon after insertion.

Ans:C Feedback: Vaginal antifungals should be administered high into the vagina. The patient should be placed in a recumbent position for insertion. Clean technique (not sterile) should be used. Inserting a tampon after administration is not necessary.

The nurse is preparing a patient for surgery who will receive a neuromuscular junction blocker during the procedure. It is important for the nurse to review the patient's medication history for concurrent use of what? A)Angiotensin-converting enzyme (ACE) inhibitors B)Beta blockers C)Calcium channel blockers D)Montelukast

Ans:C Feedback: When calcium channel blockers are used concurrently with neuromuscular junction blockers, the patient is at increased risk of prolonged paralysis. The dose of the neuromuscular junction blocker should be lowered if this combination cannot be avoided and the patient should be monitored closely. There is no anticipated drug-drug interaction with ACE inhibitors, beta blockers, or montelukast.

The nurse is caring for a patient who is diagnosed with protein-deficient malnutrition. Why would an order to administer androgens to this patient be appropriate? A)Androgens reduce the body's requirement for protein. B)Androgens increase the body's absorption of protein from the bowel. C)Androgens stimulate protein production and decrease protein breakdown. D)Androgens reduce carbohydrate metabolism and promote lipid absorption.

Ans:C Feedback: Androgens are a form of the male sex hormone called testosterone. They affect electrolytes, stimulate protein production, and decrease protein breakdown, which will help to reverse the patient's protein malnutrition in addition to a high-protein diet. They do not reduce the body's need for protein, increase protein absorption from the bowel, or impact carbohydrate and lipid metabolism.

The nurse provides teaching about amphotericin B (Fungizone) for an 82-year-old patient. The nurse evaluates the patient understood teaching when he says he could develop what condition? A)Diabetes B)Liver necrosis C)Kidney damage D)Pancreatitis

Ans:C Feedback: Amphotericin B is nephrotoxic so the patient needs to understand the risk of kidney damage. Other risks of amphotericin B include bone marrow suppression; GI irritation with nausea, vomiting, and potentially severe diarrhea; anorexia and weight loss; and pain at the injection site with the possibility of phlebitis or thrombophlebitis, but it does not cause diabetes, liver necrosis, or pancreatitis.

According to the sliding filament theory, what is the initial action in a muscle contraction? A)Troponin is freed and prevents actin and myosin from reacting with each other. B)Calcium binds to troponin, which causes the release of actin and myosin binding sites. C)Actin and myosin molecules react with each other sliding along the filament and making it shorter. D)Muscle filament relaxes or slides back to the resting position.

Ans:C Feedback: Actin and myosin molecules react with each other again and again, sliding along the filament and making it shorter. This is a contraction of the muscle fiber according to the sliding filament theory. As the calcium is removed from the cell during repolarization of the muscle membrane, the troponin is freed and once again prevents the actin and myosin from reacting with each other. The muscle filament then relaxes or slides back to the resting position. Muscle tone results from a dynamic balance between excitatory and inhibitory impulses to the muscle.

The patient is prescribed oxandrolone 2.5 mg twice a day and is told to increase the dosage to gain weight to a maximum of 20 mg/d. If each tablet contains 2.5 mg, how many tablets would the nurse tell the patient he may take per day to avoid exceeding the 20 mg/d maximum? A)4B)6C)8D)10

Ans:C Feedback: Calculate the number of tablets required to administer 20 mg by dividing 20 mg by 2.5 mg. 20/2.5 = 8 tablets

The nurse administers danazol (Danocrine) be a woman for what purpose? A)Reverse folic acid deficiencies B)Increase hair growth C)Decrease symptoms of endometriosis D)Prevent toxic shock syndrome.

Ans:CFeedback: Danazol may be used in women to prevent or treat endometriosis or fibrocystic breast disease. Danazol is not prescribed for increased hair growth, to reverse folic acid deficiencies, or to prevent toxic shock syndrome.

The nurse explains the end result of the hypothalamus in regulating the central nervous system (CNS), autonomic nervous system (ANS), and endocrine system is what? A)Regulation of the negative feedback system B)Creation of a diurnal rhythm C)Maintenance of homeostasis D)Production of prolactin-inhibiting factor (PIF)

Ans:C Feedback: The hypothalamus maintains internal homeostasis by sensing blood chemistries and by stimulating or suppressing endocrine, autonomic, and CNS activity. In essence, it can turn the ANS and its effects on or off. The negative feedback system is one way homeostasis is maintained. When the hypothalamus senses a need for a particular hormone, it secretes a releasing factor directly into an area such as the anterior pituitary. This causes the area to produce a hormone. When the hypothalamus senses a rising level of the hormone it stops secreting the releasing factor, which decreases the hormone production. When this occurs the hypothalamus senses the falling hormone level and the releasing factor is secreted again. This process is how the hormone level is maintained. Diurnal rhythm refers to the release of hormones at various times of the day. PIF, produced by the hypothalamus, acts as a regulator to shut off production of hormones when levels become too high.

A researcher is studying chromosomal disorders. What part of the human cell would the researcher be interested in studying? A)Cytoplasm B)Membrane C)Nucleus D)Organelles

Ans:C Feedback: The nucleus of a cell contains all of the genetic material that is necessary for cell reproduction. The nucleus also contains genes or sequences of deoxyribonucleic acid (DNA). Genes are responsible for the formation of messenger ribonucleic acid (mRNA) and transcription RNA, which are involved in production of proteins unique to the cells. This is the area where chromosomal disorders originate. The cell cytoplasm lies within the cell membrane and is the site of activities of cellular metabolism and special cellular functions. The organelles are contained within the cytoplasm and are structures with specific functions. They include the mitochondria, endoplasmic reticulum, free ribosomes, Golgi apparatus, and lysosomes. The membrane is a thin barrier, which separates the intracellular fluid from the extracellular fluid and is essential for cellular integrity; it also maintains cell homeostasis.

A patient comes to the clinic and is diagnosed with a vaginal fungal infection. The nurse provides patient information for self- administration of a vaginal antifungal medication. What will the nurse include in the instructions? A)"Insert low into the opening of the vagina." B)"Discontinue use during menstruation." C)"Remain recumbent for at least 15 minutes after insertion." D)"Rub the cream into the vaginal wall after insertion."

Ans:C Feedback: The patient should remain recumbent at least 10 to 15 minutes after the medication is deposited high in the vagina so that leakage will not occur and absorption will take place. The effectiveness of the medication is determined by the consistent application for each specified dose for maximal results. The nurse would instruct the patient to continue the medication during menstruation. Stopping the drug and restarting it later can lead to the development of resistant strains of the drug. The cream need not be rubbed into the vaginal wall as it will coat the wall naturally after insertion.

What supplement would be safest for a diabetic female athlete wishing to improve athletic performance? A)Bee pollen B)Damiana C)Wild yam D)Spirulina

Ans:C Feedback: Wild yam is an estrogen-like herb used to increase athletic performance, slow the aging process, and improve energy and stamina. It can be toxic to the liver and may cause breast pain but is the safest of these supplements. Bee pollen is associated with serious allergic reactions and random studies have found wide variety of ingredients in each product. Damiana interferes with antidiabetic agents so it would not be appropriate for this patient. Spirulina may contain toxic metals and can cause serious reactions in children and pets. It interferes with vitamin B12absorption and there are no studies to prove it is effective in the claims it makes.

What is the priority reason for the nurse to consider questioning an order for tetracycline in a child younger than 8 years of age? A)Children younger than 8 years of age cannot take tetracyclines. B)Weight-bearing joints have been impaired in young animals given the drugs. C)Tetracyclines can damage developing teeth and bone in children younger than 8 years of age. D)Liver and kidney function may be damaged when it is given to children under 8 years of age.

Ans:C Feedback:Use tetracyclines with caution in children younger than 8 years of age because they can potentially damage developing bones and teeth. Although the drug does not cause damage to liver and kidneys, it may be contraindicated in patients with hepatic or renal dysfunction because it is concentrated in the bile and excreted in the urine. Fluoroquinolones, not tetracyclines, are generally contraindicated for use in children (i.e., those younger than 18 years of age) because weight-bearing joints have been impaired in young animals given the drugs. Clindamycin (Dalacin C) warrants monitoring hepatic and renal function when it is given to neonates and infants. Trimethoprim- sulfamethoxazole (Nu-Cotrimox) is used in children, although children younger than 2 months of age have not been evaluated. Children under 8 years of age can take tetracycline, but it should be used with caution.

The anatomy and physiology instructor is discussing reflex systems with the prenursing class. What system would the instructor say causes a muscle fiber contraction that relieves the stretch? A)Arch reflex systemB)Spinal reflex system C)Spindle gamma loop system D)Stretch receptor system

Ans:CFeedback: A spindle gamma loop system responds to stretch receptors or spindles on muscle fibers to cause a muscle fiber contraction that relieves the stretch. In this system, nerves from stretch receptors form a synapse with gamma nerves in the spinal cord, which send an impulse to the stretched muscle fibers to stimulate their contraction. These reflexes are responsible for maintaining muscle tone and keeping an upright position against the pull of gravity and are important in helping venous return when the contracting muscle fibers massage veins to help move the blood toward the heart. The arch reflex system and the stretch receptor system are distracters for this question. The spinal reflex system is not the reflex systems that respond to stretch receptors in the body.

A patient is diagnosed with an ascaris infection. The patient asks what the best way is to prevent ascaris infections. What is the nurse's best response? A)"Wash hands before eating."B)"Do not share hairbrushes or hats." C)"Wash fresh fruits and vegetables before eating." D)"Avoid heavily populated areas."

Ans:CFeedback: Ascaris infection occurs where sanitation is poor. Eggs in the soil are ingested with vegetables or other improperly washed foods containing the worm. The patients may be unaware until a worm in their stool is seen or the patient becomes quite ill. Teaching patients the importance of washing fresh fruit and vegetables will help them reduce risk of infection. Washing hands, avoiding sharing hairbrushes or hats, and being aware in populated areas will reduce the risk of other infections but do not relate to ascaris.

A patient is being discharged home from the hospital after receiving treatment for pneumonia. The patient is going home and continuing to take the same drugs he or she was taking before he or she was hospitalized. These drugs include an antianxiety medication and a medication for insomnia. The home care nurse is following this patient. On the initial visit what is the nurse's priority teaching point? A)The names and purposes of medications prescribed B)How to contact the provider if needed C)The importance of taking medications for insomnia only occasionally D)Warning signs that may indicate serious adverse effects

Ans:D Feedback: The home care nurse should provide thorough patient teaching, with a priority teaching point being the warning signs the patient may experience that indicate a serious adverse effect. Although this may have been discussed by the discharging nurse in the hospital, this is essential information for the patient to thoroughly understand. By the time the home care nurse visits, the patient should already have filled the prescriptions and know the names and purposes of the medications prescribed from the hospital nurse but it is a good idea to review this information, although it is not a priority. Medications for insomnia should be taken as prescribed. The patient should have received the provider's contact information when leaving the hospital but the home care nurse may need to review this, even though it is not the priority teaching point.

A student asks the pharmacology instructor if there is a way to increase the benefits and decrease the risks of antibiotic therapy. What would be an appropriate response by the instructor? A)Taking drugs not prescribed for the particular illness tends to maximize risks and minimize benefits. B)Never use antibiotics in combination with other prescriptions or in combination with other antibiotics. C)Maximize antibiotic drug therapy by administering the full dose when the patient has a fever. D)Use antibiotics cautiously and teach patients to complete the full course of an antibiotic prescription.

Ans:D Feedback: To prevent or contain the growing threat of drug-resistant strains of bacteria, it is very important to use antibiotics cautiously, to complete the full course of an antibiotic prescription, and to avoid saving antibiotics for self-medication in the future. A patient and family teaching program should address these issues, as well as the proper dosing procedure for the drug (even if the patient feels better) and the importance of keeping a record of any reactions to antibiotics. Thus, taking drugs not prescribed for the particular illness tends to maximize risks and minimize benefits. Also, if the infection is viral, antibacterial drugs are ineffective and should not be used.

A patient asks the nurse if he or she should use a topical antifungal. The nurse is aware that the most important contraindication to topical antifungals is what? A)Hepatic impairmentB)Renal impairmentC)Congestive heart failureD)Known allergy to any of the antifungal drugs

Ans:D Feedback: Topical antifungals are not absorbed systemically so they are not metabolized and excreted. As a result, the only contraindication would be an allergy to the drug. Hepatic and renal impairment and congestive heart failure would not be a contraindication because these drugs do not enter the bloodstream and impact these organ systems.

The nurse assesses the patient taking anabolic steroids for what serious adverse effects? A)Elevated blood urea nitrogen (BUN) B)Elevated blood glucose level C)BradycardiaD)Jaundice

Ans:D Feedback: Anabolic steroids all have black box warnings as alerts to the potentially serious effects of liver tumors, hepatitis, and blood lipid level changes that might be associated with increased risk of coronary artery disease. As a result, the nurse should assess for jaundice that could be an early indication of liver dysfunction. Elevated BUN, blood glucose levels, and bradycardia are not commonly reported adverse effects.

What criteria can the nurse use to describe all hormones? A)They are produced in very large amounts. B)They circulate until they are used by receptor cells. C)They are secreted directly into the tissue where they react. D)They travel in the blood to specific receptor sites.

Ans:D Feedback: Hormones are chemicals that are produced in the body and meet specific criteria. All hormones are produced in very small amounts and are secreted directly into the bloodstream. They travel in the blood to specific receptor sites throughout the body and are immediately broken down.

A patient in shock is receiving an infusion of dopamine when it is discovered that an extravasation has occurred. What drug should be on standby for this occurrence? A)Phenylephrine B)Propranolol C)Phenylalanine D)Phentolamine

Ans:D Feedback: Maintain phentolamine on standby in case extravasation occurs; infiltration of the site with 10 mL of saline containing 5 to 10 mg of phentolamine is usually effective in saving the area. Phenylephrine, propranolol, and phenylalanine are not indicated for use when extravasation occurs.

The nurse assesses a newly admitted patient and finds the muscle tone in his left leg has sustained muscle contraction. How will the nurse document this finding? A)Tonus B)Flaccid C)Atonic D)Spastic

Ans:D Feedback: Muscle spasticity is defined as a sustained muscle contraction. Soft and flabby muscle tone is defined as atonic. A limp muscle without tone is described as flaccid. The state of readiness, known as muscle tone (tonus), is produced by the maintenance of some of the muscle fibers in a contracted state.

How would the nurse describe selective toxicity? A)Selective toxicity interferes with a biochemical reaction common to many different organisms. B)Selective toxicity will decrease invading bacteria by interfering with the pathogens' ability to reproduce. C)Selective toxicity will eliminate bacteria by interrupting protein synthesis and damaging the pathogen's cell wall. D)Selective toxicity is the ability of the drug to kill foreign cells without causing harm to one's own body cells.

Ans:D Feedback: The choice of antibiotics in a clinical situation is determined by assessing which drug will affect the causative organism and lead to the fewest adverse effects. Selective toxicity is the ability of the drug to kill foreign cells without causing harm to the human body cells. How the antibiotic works to kill bacteria varies by drug type and may reduce the ability to reproduce, damage the cell wall, or interfere with a biochemical reaction, but this is a description of how the antibiotic works and does not describe selective toxicity

When taking the history of a patient, which information should alert the nurse to a possibility of trichinosis?

Ate undercooked pork

The most common adverse effects include the following: of adenosine

Atrial tachydysrhythmias AV block Cardiac arrest Ventricular dysrhythmias Atrial fibrillation Bronchospasm Adenosine frequently causes asystole for a few seconds. No treatment is required due to the short half-life of the drug.

Which drug can further decrease heart rate when taken with amiodarone?

Beta blockers Drug-drug interactions with beta blockers can further decrease heart rate when taken with amiodarone.

Before the nurse administers isosorbide mononitrate [Imdur], what is a priority nursing assessment?

Assess blood pressure. Isosorbide mononitrate [Imdur] is a vasodilator and thus can cause hypotension. It is important to assess blood pressure before administering.

A nurse is preparing to administer digoxin to a patient who is complaining of nausea. Which action is the nurse's priority?

Assess for bradycardia.

The nurse is assessing a patient who is taking verapamil for atrial fibrillation and notes 1+ edema to the ankles and feet. Which action would the nurse take?

Assess for heart failure

Which action should the nurse take when caring for a patient receiving triamterene [Direnium]?

Assess potassium levels Triamterene [Direnium] is a potassium-sparing diuretic. The nurse should monitor potassium for potential hyperkalemia. Urine output should be assessed more frequently than every other day. Hypoglycemia and hypernatremia are not common adverse effects of this drug.

Before administering digoxin, which action will the nurse take?

Assess the apical pulse.

The nurse is assessing a patient who is taking verapamil for atrial fibrillation and notes 1+ edema to the ankles and feet. Which action would the nurse take?

Assess the patient for heart failure

A patient is taking hydrochlorothiazide [Microzide]. On assessment, the nurse notes that the patient has muscle weakness, cramping, and leg discomfort. What should be the nurse's first intervention?

Assess the serum potassium level Hydrochlorothiazide [Microzide] can cause hypokalemia, characterized by muscle weakness, cramping, and leg discomfort. The nurse should immediately assess the patient's serum potassium level to determine the course of action. Giving calcium supplements does not reduce the symptoms caused by potassium deficiency. The patient is experiencing hypokalemia, not hypernatremia; reducing salt is for hypernatremia. Reducing the dose of the medication will not help restore the electrolyte balance.

Which self-assessment technique would the nurse include when teaching a patient about using methimazole for hyperthyroidism? Assessing pulse rate Counting respirations Inspecting skin for discolorations Keeping a dietary record

Assessing pulse rate

What is true regarding treatment of a hospitalized patient with pelvic inflammatory disease (PID)?

Because multiple organisms are likely to be involved in PID, drug therapy must provide broad coverage. No single drug can do this, so combination therapy is required. Because PID can be difficult to treat, and because the consequences of failure can be severe (eg, sterility), many experts recommend that all patients receive intravenous antibiotics in a hospital.

C (Antiarrhythmic drugs can cause both hypotension and bradycardia; therefore it is important to assess blood pressure and apical pulse before administration. Peripheral pulses are not as reliable as the apical pulse assessment.)

Before administering a dose of an antidysrhythmic drug to an assigned patient, which assessments would be of highest priority? Urine output and specific gravity Temperature and pulse rate Apical pulse and blood pressure Peripheral pulses and level of consciousness

Which teaching points would a nurse share with a patient newly prescribed the ethinyl estradiol plus norelgestromin patch (Ortho Evra®) who is switching from an oral combined hormonal contraception (CHC)?

Before applying, the patient should ensure the skin is dry and free from lotions, creams, or oils. Apply the patch on the first day of the menstrual cycle when bleeding occurs. No backup contraception is needed. If the patch comes off and has not been off for more than 24 hours, it should be reattached. Backup contraception is not needed. If the patch comes off and remains off for more than 24 hours, a new cycle should be started with backup contraception needed for 7 days.

Which outcome should a nurse include in the plan of care for a patient who is to start taking chloroquine [Aralen] prophylactically

Begin oral therapy 1 week before expected exposure

A 16-year-old girl comes to the clinic complaining of severe menstrual cramps. The girl is concerned about the pain and worried that "something is wrong." The nurse explains to the patient that she has cramping during her menstrual period because of what? A)An increase in the levels of estrogen and progesterone, which cause uterine contractions B)Low levels of plasminogen in the uterus that cause the shedding of the lining of the uterus C)Prostaglandins in the uterus, which stimulate uterine contractions to clamp off vessels as the lining of her uterus sheds D)An increase in progesterone and a decrease of estrogen cause the lining of the uterus to slough away

C Feedback: Prostaglandins in the uterus stimulate uterine contractions to clamp off vessels in the lining of the uterus, which is the cause of the cramping. The decrease of estrogen and progesterone after the involution of the corpus luteum triggers the release of follicle- stimulating hormone (FSH) and luteinizing hormone (LH). The decreased levels of FSH and LH cause the inner lining of the uterus to slough off because the vascular system is no longer being stimulated. High, not low, levels of plasminogen in the uterus prevent clotting of the lining as the vessels shear off.

A staff member asks how calcium channel blockers (CCBs) work. Which response should the nurse provide?

CCBs relax vascular smooth muscle. By blocking calcium channels, CCBs inhibit muscle contraction in the coronary arteries and peripheral arteries, resulting in relaxed vascular smooth muscle (vasodilation). CCBs have a negative inotropic effect by blocking calcium entry, which decreases the force of contractions. CCBs have no direct role in sodium activity. Vasodilation from CCBs decrease arterial pressure.

A patient with a history of alcoholism is being treated for a urinary tract infection. A prescription for which cephalosporins would cause the nurse to question the provider?

Cefazolin (used to treat cellulitis, urinary tract infections, pneumonia, endocarditis, and biliary tract infections) and cefotetan (used to treat bacterial infections in many different parts of the body and given before certain types of surgery to prevent infections) can cause a serious state of alcohol intolerance. If a patient taking either of these drugs ingests alcohol, a serious disulfiram-like reaction can occur. Since this can be dangerous, a patient using these cephalosporins must not consume alcohol in any form. Cefadroxil is used to treat strep throat, skin, and urinary tract infections and does not produce a potentially serious alcohol intolerance. Cefdinir is usually used to treat bronchitis, otitis media, sinus infections, pneumonia, cellulitis, and strep throat, and it does not cause a potentially serious alcohol intolerance. Ceftaroline is usually used to treat pneumonia rather than a urinary tract infection, and it does not cause a potentially serious alcohol intolerance.

Which is considered the most widely used group of antibiotics because of their bactericidal nature, resistance to beta-lactamases, and activity against a broad spectrum of pathogens?

Cephalosporins are considered the most widely used antibiotics because of their bactericidal nature, their resistance to beta-lactamases, and their activity against a broad spectrum of pathogens. Aminoglycosides and penicillins are bactericidal. Penicillins, aminoglycosides, and tetracyclines are considered narrow-spectrum antibiotics.

The nurse is caring for a patient with newly diagnosed hypertension who has been prescribed metoprolol. Which teaching would the nurse include?

Change positions slowly

The patient is admitted for the management of a hypertensive emergency. The healthcare provider prescribes sodium nitroprusside [Nipride] drug therapy. What is the priority nursing action during this treatment? A. Observe for respiratory depression. B. Monitor the electrocardiogram for tachycardia. C. Initiate oxygen therapy via nasal cannula at 2 L/min. D. Adjust the intravenous infusion rate to the blood pressure response.

D. Adjust the intravenous infusion rate to the blood pressure response. The nurse will adjust the rate of infusion based on the patient's blood pressure. Respiratory depression is not associated with administration of this drug. Oxygen therapy is not necessary and nitroprusside causes very little tachycardia.

The nurse is preparing to administer minoxidil [Loniten] 5 mg orally. What is the only cardiovascular indication for this medication? A. Heart failure B. Myocardial infarction C. Angina pectoris D. Severe hypertension

D. Severe hypertension Because of its serious adverse effects, minoxidil is reserved for patients who have failed to respond to safer drugs. The only cardiovascular indication for minoxidil is severe hypertension.

4 (Amiodarone has two very significant drug interactions, namely with digoxin and warfarin. Clients often refer to anticoagulants as "blood thinners." The nurse should verify which medication the client is taking, then notify the healthcare provider. When amiodarone is prescribed in clients taking warfarin, it is recommended to reduce the dose of warfarin by 50% at the start of warfarin therapy. Amiodarone adverse effects include visual halos, photophobia, and dry eyes; but wearing eyeglasses is not a contraindication. Amiodarone is an antidysrhythmic, and there should be no cross sensitivities with antibiotics. The client may get faint at the site of needles, however the priority of care is to eliminate dysrhythmias. The nurse can provide emotional reassurance and compassionately administer the amiodarone to help reduce the client's fears. )

The health care provider has prescribed amiodarone for a client with ventricular dysrhythmias. The nurse verifies the client's medical history and should notify the healthcare provider when the client states 1 "I wear eyeglasses to read print up close." 2 "I break out in a rash when I take antibiotics." 3 "I get faint when I see needles." 4 "I take a blood thinner so I don't get clots."

1 (All antidysrhythmics can be taken with food to relieve an upset stomach. Antacids should be taken 2 hours before or 2 hours after taking the antirhythmic drugs in order to avoid interfering with drug absorption. The client should be instructed to notify the prescriber if any type of rash or breathing problems develop. These may be signs of hypersensitivity or a systemic lupus erythematous-like syndrome that can develop in about 30% of clients taking procainamide long-term.)

The healthcare provider discontinues a client's quinidine and prescribes procainamide. The client asks the nurse about the possible side effects of this medication. What is the nurse's best response? 1 "Take this medication with food to relieve an upset stomach." 2 "Taking an antacid with this medication will relieve digestive problems." 3 "Benadryl can be taken with the medication if you develop a rash or breathhing problems." 4 "Use over the counter steroid cream if a red, swollen rash occurs."

The nurse reports which assessment finding as contributing to the cardioprotective effect in a patient receiving metoprolol?

The heart rate decreased from 130 to 98 beats/min. Metoprolol slows the conduction through the atrioventricular node, thereby decreasing the heart rate.

C (Patients taking amiodarone must have baseline and serial pulmonary function tests in order to monitor for potential pulmonary toxicity.)

The most severe adverse effects of amiodarone are evidenced in which body system? Renal Hepatic Pulmonary Hematologic

1, 2, 5 (Terbinafine [Lamisil] is highly active against dermatophytes and is used to eradicate fungal infection of the nails (onychomycosis) and as topical therapy for ringworm infections (tinea corporis, tinea pedis). It is not effective against oropharyngeal and vulvovaginal candidiasis.)

The nurse identifies terbinafine [Lamisil] as useful for treating which conditions? (Select all that apply.) 1 Onychomycosis 2 Tinea corporis 3 Oropharyngeal candidiasis 4 Vulvovaginal candidiasis 5 Tinea pedis

A The primary health care provider would prescribe nasal administration of glucocorticoids to manage rhinitis associated with polyps as well as to prevent the recurrence of polyps. Long-term glucocorticoid therapy is effective in managing and preventing the recurrence of polyps. A 1-week tapered course of oral corticosteroid may be prescribed along with glucocorticoid nasal spray. Antibiotics are prescribed to control any underlying infections before corticosteroid therapy is initiated, but they are less effective in preventing the recurrence of polyps after surgical removal. Deep-breathing exercises may cause temporary relief, and these are very challenging in such patients. Grape and citrus fruit juices help in tissue repair and healing. They will not cause the polyps to recur.

The nurse is caring for a patient who has undergone nasal surgery for the removal of polyps. Which treatment strategy will the nurse expect to be used to prevent the recurrence of polyps? A. To administer glucocorticoids to the patient B. To administer antibiotics to the patient C. To suggest deep-breathing exercises D. To avoid drinking grape and citrus fruit juices

1 (The most serious adverse effect of this drug is pulmonary toxicity, which involves a clinical syndrome of progressive dyspnea and cough accompanied by damage to the alveoli.)

The nurse is caring for patient who is being treated with amiodarone (Cordarone). The nurse notes that the patient is experiencing a hacking cough. The highest priority action on the part of the nurse is to 1 notify the physician regarding this symptom. 2 administer the cough syrup that has been ordered. 3 document the findings in the patient's chart. 4 administer medication to help the patient rest.

The nurse is administering pasiriotide to a patient with Cushing's disease secondary to a pituitary tumor. Which phrase describes the rationale for using this drug? To decrease inflammation before surgery To shrink the pituitary tumor To block production of adrenocorticotropic hormone (ACTH) To increase retention of sodium

To block production of ACTH

Which phrase describes the therapeutic goal in using octreotide to treat acromegaly? To control acromegaly symptoms To cure this health alteration To reverse the disease process To prepare the person for surgery

To control acromegaly symptoms

A patient who recently started taking warfarin asks the nurse why laboratory work needs to be obtained every 3 to 4 days. Which response would the nurse provide?

To ensure adequate dosing

The nurse is assessing a pregnant patient who has active herpes simplex virus type 2 (HSV-2). What precautions should the nurse suggest to the patient to ensure the newborn's safety? 1 To receive a vaccination 2 To take antiviral therapy in first trimester 3 To increase the intake of iron supplements 4 To give birth via cesarean section (C-section)

To give birth via cesarean section (C-section) - Patients infected with HSV-2 are usually recommended to give birth via C-section to prevent the baby from contracting the infection.

C (Grapefruit juice can also inhibit the metabolism of quinidine, which increases the risk of cinchonism, or quinism, which is a pathological condition caused by an overdose of quinidine or its natural source, cinchona bark. Quinine is medically used to treat malaria..)

To prevent the occurrence of cinchonism in a patient prescribed quinidine, what does the nurse emphasize as important? Wear sunscreen. Change positions slowly. Avoid drinking grapefruit juice. Increase dietary intake of potassium.

3 (Flucytosine [Ancobon] is used for serious infections caused by Candida and Cryptococcus neoformans. Bone marrow suppression may cause fatal agranulocytosis, so symptoms of bruising, fever, and fatigue could indicate life-threatening conditions. The other statements are true; however, they are not the priority concern. Flucytosine [Ancobon] is usually combined with amphotericin B. Treatment may require ingestion of 10 capsules 4 times per day. Taking these pills for a short time helps to reduce nausea. Hepatotoxicity is mild and reversible; liver function is monitored while the patient is receiving treatment)

When providing teaching for a patient starting flucytosine [Ancobon] therapy, the nurse identifies what as the priority concern? 1 "You will have weekly blood draws to monitor your liver function." 2 "Another very strong medication may be needed in addition to this one." 3 "You'll need to report any symptoms of bruising, fever, and fatigue." 4 "The dose is 10 pills, so take a few at a time over a 15-minute interval." .

3, 4

When teaching a patient about albendazole [Albenza] therapy, the nurse will include which statements? (Select all that apply.) 1 "Take the medication on an empty stomach." 2 "The drug is safe to use during pregnancy." 3 "Liver function tests should be done before and periodically during treatment." 4 "The drug is generally well tolerated." 5 "Use of the drug causes paralysis in the helminth."

Class IV Antidysrhythmic Drugs identify high risk patients

When used to manage dysrhythmias, verapamil and diltiazem should be given only after checking and documenting pulse rates and blood pressures. The nurse should withhold the drug if the heart rate is 60 beats/min or less, systolic blood pressure is 90 mm Hg or lower, or if tachydysrhythmia occurs; the nurse should then contact the health care provider for further instructions.

4

Which antifungal agent is used as a one-time oral dose to treat vaginal yeast infections? 1 Nystatin [Mycostatin] 2 Caspofungin [Cancidas] 3 Voriconazole [Vfend] 4 Fluconazole [Diflucan]

griseofulvin

Which antifungal, active only against dermatophytes, acts by depositing in newly formed keratin and disrupting microtubule structure?

B (Calcium channel blockers are effective in treating both hypertension and dysrhythmias secondary to their negative inotropic and chronotropic effects.)

Which class of drugs is used to treat both hypertension and dysrhythmias? Sodium channel blockers Calcium channel blockers Angiotensin-converting enzyme (ACE) inhibitors Direct-acting vasodilators

lindane

Which ectoparasiticide agent is not used first line for scabies or pediculosis, due to neurotoxicity/seizures, and requires a Medication Guide if dispensed?

2

Which factor in a patient's history is most likely related to the development of Pediculus humanus capitis? 1 Lower socioeconomic status 2 Sharing of hairbrushes and hats 3 Multiple sexual partners 4 Contact with infested pets

2, 3

Which factors increase a person's risk of acquiring a helminthic infestation? (Select all that apply.) 1 Loss of rectal sphincter tone 2 Poor water sanitation 3 Cost of treatment medication 4 Inadequate vitamins in the diet 5 Pre-existing hepatic disease

2

Which instruction should a nurse provide to the parent of a child with an enterobiasis (pinworm) infestation? 1 "Chills and fever are likely, so regular doses of an anti-inflammatory medication will help." 2 "All other members of the family need to be treated, because this is easily transmitted." 3 "Don't allow your child to go barefoot until the treatment regimen is completed." 4 "Make sure all meat, especially pork, is thoroughly cooked to prevent relapse."

A Glucocorticoids play a major role in carbohydrate, lipid, and protein metabolism within the body. They are produced in increasing amounts during stress. They cause an increase in serum sodium and serum glucose concentrations, thus precipitating hypernatremia and hyperglycemia as adverse effects, respectively. They are used as immunosuppressants. Hence they are not involved in stimulating defense mechanisms; rather, they suppress them.

Which statement about glucocorticoids is most relevant? A. They influence carbohydrate, fat, and protein metabolism. B. They are not produced during stressful situations. C. They decrease serum sodium and glucose concentrations. D. They stimulate defense mechanisms to produce immunity.

2, 3, 5

Which statement will the nurse include when teaching a patient about ivermectin [Stromectol] therapy? (Select all that apply.) 1 "Apply the drug directly to the ectoparasite infestation." 2 "A second dose of the drug usually is needed." 3 "Resistance to the drug is uncommon." 4 "Ivermectin is considered a first-choice drug for treating head lice." 5 "The most common adverse effects are headache and abdominal pain."

The electrical conduction system of the heart is also noticeably affected

by digoxin, as is cardiac automaticity. Digoxin reduces dysrhythmias by its effects on the SA and AV node (negative chronotropic and dromotropic effects). Digoxin also decreases conduction through the AV node by acting as a direct depressant on the AV node.

What hormone stimulates the release of the follicle-stimulating hormone (FSH) from both male and female glands? A)Growth hormone-releasing hormone (GHRH) B)Thyrotropin-releasing hormone (TRH) C)Gonadotropin-releasing hormone (GnRH) D)Prolactin-releasing hormone (PRH)

c The male and female glands respond to luteinizing hormone (LH) and FSH, which are released from the anterior pituitary in response to stimulation from GnRH that is released from the hypothalamus. GHRH stimulates the release of the growth hormone, which targets cell growth. TRH stimulates the thyroid-stimulating hormone, which targets the thyroid gland. PRH stimulates the release of prolactin, which is necessary for milk production.

IV verapamil and diltiazem are used in the setting of

cardiac dysrhythmias. Injections should be administered evenly (over 2 to 3 minutes). Patients must be monitored for changes in heart rate and for ECG changes, including AV block and prolonged PR or QT interval. The ability to perform cardioversion and cardiac pacing should be immediately available. Verapamil IV: Bolus: 0.075 to 0.15 mg/kg over 2 min; followed by second bolus of 0.15 mg/kg if needed. Maintenance: 0.005 mg/kg/min Diltiazem IV: Bolus: 0.25 mg/kg IV bolus over 2 min; followed by second bolus of 0.35 mg/kg over 2 min Maintenance: 10 mg/hr; increase by 5 mg/hr for max 15 mg/hr as needed

Minoxidil works by producing

direct vasodilation to arterial smooth muscle; it has little effect on veins.

For which side effects would the nurse monitor in a patient taking ezetimibe?

dizziness myalgia abdominal pain

Side effects of sodium nitroprusside include

dizziness, headache, nausea, vomiting, and irritation at injection site.

A nurse provides teaching about which antibiotic to a patient requiring prophylaxis for chloroquine-resistant malaria

doxycycline

Adenosine is used as the

drug of choice for PSVT. Adenosine is not effective in ventricular dysrhythmias, atrial fibrillation, or atrial flutter.