Final Pharm

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. A patient who has a viral upper respiratory infection reports having a runny nose and a cough that prevents sleep and asks the nurse to recommend an over-the-counter medication. Which medication will the nurse recommend? a. Diphenhydramine [Benadryl] b. Fexofenadine/pseudoephedrine [Allegra-D] c. Guaifenesin [Mucinex] d. Phenylephrine drops

. A patient who uses an inhaled glucocorticoid for chronic asthma calls the nurse to report hoarseness. What will the nurse do? a. Ask whether the patient is rinsing the mouth after each dose. b. Request an order for an antifungal medication. c. Suggest that the patient be tested for a bronchial infection. d. Tell the patient to discontinue use of the glucocorticoid.

1. A nurse is preparing to administer an antibiotic to a patient with methicillin-resistant Staphylococcus aureus (MRSA). The nurse would expect the healthcare provider to order which antibiotic? a. Daptomycin [Cubicin] b. Levofloxacin [Levaquin] c. Norfloxacin [Noroxin] d. Ciprofloxacin [Cipro]

1. A nurse is providing education about tetracycline [Sumycin]. Which statement by the patient best demonstrates understanding of the administration of this medication? a. "I should not take this medication with milk or other dairy products." b. "I should not worry if I experience an acnelike rash with this medication." c. "I should take an antacid, such as Tums, if I experience gastrointestinal distress." d. "I should take this antibiotic with a calcium supplement to improve absorption."

1. A nurse transcribes a new prescription for potassium penicillin G given intravenously (IV) every 8 hours and gentamicin given IV every 12 hours. Which is the best schedule for administering these drugs? a. Give the penicillin at 0800, 1600, and 2400; give the gentamicin [Garamycin] at 1800 and 0600. b. Give the penicillin at 0800, 1600, and 2400; give the gentamicin [Garamycin] at 1200 and 2400. c. Give the penicillin at 0600, 1400, and 2200; give the gentamicin [Garamycin] at 0600 and 1800. d. Give the penicillin every 8 hours; give the gentamicin [Garamycin] simultaneously with two of the penicillin doses.

1. A patient admitted to the emergency department with abdominal pain tells the nurse he has been taking kava. Which action is the nurse's priority at this time? a. Review liver function studies. b. Assess breath sounds and respiratory effort. c. Monitor cardiovascular status. d. Review complete blood count results.

1. A patient begins using timolol [Timoptic] to treat primary open-angle glaucoma (POAG). The nurse gives a dose and notes that the patient develops shortness of breath. The nurse assesses the patient and auscultates wheezes in both lungs. The nurse will ask this patient about a history of which condition? a. Asthma b. Atrioventricular heart block c. Pulmonary hypertension d. Sinus bradycardia

1. A patient has a Pseudomonas aeruginosa infection that is sensitive to aminoglycosides, and the prescriber orders gentamicin. The patient tells the nurse that a friend received amikacin [Amikin] for a similar infection and wonders why amikacin was not ordered. What will the nurse tell the patient? a. "Amikacin is given when infectious agents are resistant to other aminoglycosides." b. "Amikacin is more vulnerable to inactivation by bacterial enzymes." c. "Amikacin is a narrow-spectrum drug and will probably not work for this infection." d. "Gentamicin is less toxic to the ears and the kidneys."

1. During a routine screening, an asymptomatic, pregnant patient at 37 weeks' gestation learns that she has an infection caused by Chlamydia trachomatis. The nurse will expect the provider to order which drug? a. Azithromycin b. Doxycycline c. Erythromycin ethylsuccinate d. Sulfisoxazole

10. A child with an upper respiratory infection caused by B. pertussis is receiving erythromycin ethylsuccinate. After 2 days of treatment, the parent asks the nurse why the child's symptoms have not improved. Which response by the nurse is correct? a. "Erythromycin eliminates the bacteria that causes the infection, but not the toxin that causes the symptoms." b. "We may need to add penicillin or another antibiotic to increase the antimicrobial spectrum." c. "We will need to review the culture sensitivity information to see whether a different antibiotic is indicated." d. "Your child may have developed a suprainfection that we need to culture and treat."

10. A nurse counsels a patient who is to begin taking gamma-hydroxybutyrate [Xyrem] for narcolepsy. It is important for the nurse to warn the patient that respiratory depression is a potential risk with concomitant use of: a. alcohol. b. beta blockers. c. caffeine. d. nicotine.

10. A nurse is teaching a group of patients about weight management options. Which statement by the patient indicates a need for further teaching? a. "Although some drugs often show benefits, these benefits do not outweigh the risks." b. " Antiobesity drugs should be used only as adjuncts to a comprehensive weight loss program of diet and exercise." c. "Most patients regain lost weight when antiobesity drugs are discontinued." d. "The side effects of most of these drugs are too uncomfortable to maintain compliance."

10. A nursing student asks a nurse why chemotherapeutic agents are given intermittently instead of continuously. The nurse will tell the student that intermittent dosing: a. allows normal cells to recover and repopulate. b. catches malignant cells in latent phases. c. increases cancer cell kill and speeds up treatment. d. suppresses drug resistance in tumor cells.

10. A patient complains of painful urination. A physical examination reveals vesicles on her labia, vagina, and the foreskin of her clitoris. The nurse will expect to teach this patient about which medication? a. Acyclovir [Zovirax] b. Azithromycin [Zithromax] c. Metronidazole [Flagyl] d. Tinidazole [Tindamax]

10. A patient has a systemic candidal infection, and the provider has ordered oral fluconazole [Diflucan] 400 mg on day 1 and 200 mg once daily thereafter. What will the nurse do? a. Administer the drug as ordered. b. Contact the provider to discuss cutting the dosing in half. c. Contact the provider to discuss giving 400 mg on all days. d. Contact the provider to discuss giving the drug intravenously.

10. A pregnant patient with fever, flank pain, and chills has a history of two previous bladder infections before getting pregnant. She is allergic to several antibiotics. She reports having taken methenamine successfully in the past. What will the nurse tell her? a. "This agent is not effective against infections of the upper urinary tract." b. "This antiseptic agent is safe for use during pregnancy and has no drug resistance." c. "This drug is linked to many serious birth defects and is not recommended during pregnancy." d. "You will need to take this medication with meals to avoid gastric upset."

10. An alert child is brought to the emergency department after ingesting gasoline. The nurse will prepare to administer which treatment to minimize poison absorption in this child? a. Activated charcoal b. Chelation therapy c. Gastric lavage with aspiration d. Whole bowel irrigation

10. An older adult patient comes to an ophthalmology clinic complaining of increased difficulty reading in dim light. The provider examines the patient and notes three large yellow deposits under the patient's cornea. The nurse will expect the provider to order which treatment for this patient? a. High doses of vitamins C and E, betacarotene, and zinc b. Laser therapy c. Pegaptanib [Macugen] d. Photodynamic therapy

11. A patient asks a nurse about ways to minimize side effects of chemotherapy. Which response is correct? a. "Avoid contact with people who are ill." b. "Take antiemetics immediately after receiving chemotherapy." c. "Treat fevers immediately with ibuprofen." d. "Use a firm-bristled toothbrush to stimulate gums."

11. A patient has lamivudine-resistant hepatitis B and has been taking entecavir [Baraclude] for 2 years. The patient asks the nurse why the provider has recommended taking the drug for another year. What will the nurse tell the patient? a. "Entecavir can reverse fibrosis and cirrhosis of the liver when taken long term." b. "It is necessary to continue taking entecavir to avoid withdrawal symptoms." c. "The drug will be given until the infection is completely eradicated." d. "You will need to continue taking entecavir to prevent lactic acidosis and hepatotoxicity."

11. A patient who is taking nelfinavir [Viracept] calls the nurse to report moderate to severe diarrhea. What will the nurse expect the provider to recommend? a. An over-the-counter antidiarrheal drug b. Immediate discontinuation of the nelfinavir c. Reducing the dose of nelfinavir by half d. Taking the nelfinavir with food to avoid side effects

11. A patient with colorectal cancer is admitted to the hospital oncology unit to receive cetuximab [Erbitux]. The nurse notes that the prescriber has not ordered any other medications. The nurse will contact the prescriber to request an order for which medication in order to minimize cetuximab's side effects? a. Diphenhydramine [Benadryl] b. Epinephrine c. Ondansetron [Zofran] d. Magnesium supplements

11. Before giving methenamine [Hiprex] to a patient, it is important for the nurse to review the patient's history for evidence of which problem? a. Elevated blood urea nitrogen and creatinine b. History of reactions to antibiotic agents c. Possibility of pregnancy d. Previous resistance to antiseptic agents

12. A nurse is discussing methicillin-resistant Staphylococcus aureus (MRSA) with a group of nursing students. Which statement by a student correctly identifies the basis for MRSA resistance? a. "MRSA bacteria have developed PBPs with a low affinity for penicillins." b. "MRSA bacteria produce penicillinases that render penicillin ineffective." c. "MRSA occurs because of host resistance to penicillins." d. "MRSA strains replicate faster than other Staphylococcus aureus strains."

12. A nurse is explaining to nursing students why a cephalosporin is used in conjunction with an aminoglycoside for a patient with an infection. Which statement by a student indicates understanding of the teaching? a. "Cephalosporins enhance the actions of aminoglycosides by weakening bacterial cell walls." b. "Cephalosporins prevent neuromuscular blockade associated with aminoglycosides." c. "Cephalosporins prolong the postantibiotic effects of the aminoglycosides so doses can be decreased." d. "Cephalosporins reduce bacterial resistance to aminoglycosides."

12. A nurse is preparing to administer timolol [Timoptic] eye drops to a patient who has open angle glaucoma. The nurse notes that the patient has a history of chronic obstructive pulmonary disease (COPD). The nurse will contact the provider to discuss changing to which medication? a. betaxolol b. carteolol c. levobunolol d. metipranolol

12. A nurse is providing teaching for a patient who will begin taking clarithromycin ER [Biaxin XL] to treat an Helicobacter pylori infection. Which statement by the patient indicates understanding of the teaching? a. "I may experience distorted taste when taking this medication." b. "I should take 1 tablet twice daily for 10 days." c. "I should take this medication on an empty stomach." d. "This medication does not interact with other drugs."

12. A patient comes to the clinic and receives valacyclovir [Valtrex] for a herpes-zoster virus. The nurse instructs the patient to take the medication: a. without regard to meals. b. without any dairy products. c. each morning. d. on an empty stomach.

12. A patient with chronic myeloid leukemia (CML) begins treatment with imatinib [Gleevec]. Which statement by the patient indicates understanding of this medication? a. "Resistance to this drug may develop over time." b. "The intensity of side effects is dose dependent." c. "This drug does not have significant drug interactions." d. "This drug must be given intravenously."

13. A patient who is taking gentamicin and a cephalosporin for a postoperative infection requests medication for mild postsurgical pain. The nurse will expect to administer which of the following medications? a. Acetaminophen b. Aspirin c. Ibuprofen d. Morphine

13. A patient with high-risk factors for tuberculosis will begin therapy for latent TB with isoniazid and rifampin. The nurse learns that this patient takes oral contraceptives. The nurse will counsel this patient to discuss ____ with her provider. a. another birth control method b. reducing the rifampin dose c. reducing the isoniazid dose d. increasing the oral contraceptive dose

14. A patient is receiving gentamicin once daily. A nursing student asks the nurse how the drug can be effective if given only once a day. The nurse explains drug dosing schedules for aminoglycosides. Which statement by the student indicates a need for further teaching? a. "Gentamicin has a longer half-life than other aminoglycosides." b. "Large doses given once daily yield higher peak levels." c. "The postantibiotic effect lasts for several hours." d. "There is less risk of ototoxicity and nephrotoxicity with large daily doses."

14. Which side effect of clindamycin [Cleocin] causes the most concern and may warrant discontinuation of the drug? a. Diarrhea b. Headache c. Nausea d. Vomiting

15. A nurse is teaching a patient who will undergo chemotherapy with fluorouracil [Adrucil] to treat a solid tumor. Which statement by the patient indicates understanding of this chemotherapeutic agent's actions? a. "Fluorouracil acts to deprive cancer cells of thymidylate needed to make DNA." b. "Fluorouracil causes accumulation of adenosine, which inhibits DNA synthesis." c. "Fluorouracil disrupts the biosynthesis of nucleic acids." d. "Fluorouracil inhibits DNA polymerase in cancer cells."

15. A patient who is being treated for HIV infection has a 5-mm area of induration after a routine TST. The patient's chest radiograph is normal, and there are no other physical findings. The nurse will expect this patient to begin treatment with which drugs? a. Isoniazid and rifabutin b. Isoniazid and rifampin c. Isoniazid and rifapentine d. Isoniazid and pyrazinamide

15. The nurse is preparing to administer amphotericin B intravenously. The nurse will expect to pretreat the patient with which medications? a. Acetaminophen [Tylenol], diphenhydramine [Benadryl], and meperidine [Demerol] b. Aspirin, diphenhydramine [Benadryl], and meperidine [Demerol] c. Ibuprofen [Motrin], diphenhydramine [Benadryl], and meperidine [Demerol] d. Morphine sulphate [Morphine] and acetaminophen ]Tylenol]

16. A hospitalized patient is being treated for tuberculosis with a drug regimen that includes pyrazinamide. The patient complains of pain in the knee and shoulder joints. The nurse will contact the provider to request an order for: a. ibuprofen. b. renal function tests. c. discontinuation of the pyrazinamide. d. measurement of uric acid levels.

17. A patient is about to begin therapy with ethambutol. The nurse knows that, before initiating treatment with this drug, it is important to obtain which test(s)? a. Color vision and visual acuity b. Complete blood cell (CBC) count c. Hearing testing and a tympanogram d. Hepatic function tests

17. A patient is receiving tobramycin three times daily. A tobramycin peak level is 4.5 and the trough is 1.2. What will the nurse do? a. Give the next dose as ordered. b. Hold the next dose and notify the provider. c. Monitor the patient for signs of nephrotoxicity. d. Tell the patient to report tinnitus.

18. A patient who is taking drugs to treat HIV has tuberculosis and has been on a four-drug regimen for 3 months without improvement in symptoms. Which drug will the nurse anticipate that the provider will add to this patient's regimen? a. bedaquiline [Sirturo] b. capreomycin [Capastat Sulfate] c. ethionamide [Trecator] d. pyridoxine

18. Which superficial mycosis is generally treated with oral antifungal agents? a. Tinea capitis b. Tinea corporis c. Tinea cruris d. Tinea pedis

2. A 43-year-old patient with a strong family history of breast cancer considers taking tamoxifen [Nolvadex] for cancer prevention. Which assessment finding is a possible contraindication? a. History of deep vein thrombosis (DVT) b. History of osteoporosis c. Hyperlipidemia d. Prior hysterectomy

2. A 65-year-old patient who receives glucocorticoids for arthritis is admitted to the hospital for treatment of a urinary tract infection. The prescriber has ordered intravenous ciprofloxacin [Cipro]. Before administering the third dose of this drug, the nurse reviews the bacterial culture report and notes that the causative organism is Escherichia coli. The bacterial sensitivity report is pending. The patient complains of right ankle pain. What will the nurse do? a. Withhold the dose of ciprofloxacin and notify the provider of the patient's symptoms. b. Instruct the patient to exercise the right foot and ankle to minimize the pain. c. Question the patient about the consumption of milk and any other dairy products. d. Request an order to increase this patient's dose of glucocorticoids.

2. A nurse is teaching a class at a community center on communicable diseases. Which statement by a member of the class best demonstrates understanding of the epidemiology of head lice? a. "All socioeconomic groups are at risk for this infestation." b. "Head lice affect only people in crowded environments." c. "Head lice are transmitted only by direct person-to-person contact." d. "The infestation can be acquired from house pets."

2. A nurse is teaching a course in bioterrorism to a group of military nurses. Which statement by a military nurse indicates understanding of the teaching? a. "Although smallpox has been eradicated, it remains a threat." b. "Anthrax is spread rapidly from person to person." c. "Pneumonic plague is not transmitted from person to person." d. "Terrorists spreading tularemia would most likely put it in the water supply."

2. A nurse is teaching a group of nursing students about cancer treatment. Which statement by a student indicates an understanding of the characteristics of cancer cells? a. "Cancer cells are characterized by unrestrained growth and division." b. "Division of cancer cells is characteristically rapid." c. "Malignant cells of solid tumors do not invade other tissues." d. "Telomerase is an enzyme produced by cancer cells that promotes metastases."

2. A nurse is teaching a patient about a medication that alters sympathetic nervous system functions. To evaluate understanding, the nurse asks the patient to describe which functions the sympathetic nervous system regulates. Which answer indicates the need for further teach-ing? a. "The digestive functions of the body" b. "The cardiovascular system" c. "The fight-or-flight response" d. "Body temperature"

2. A patient asks a nurse which weight-loss diet is most effective. Which response by the nurse is appropriate? a. "Low-fat diets may be easiest for weight loss, because fat has a higher concentration of calories than proteins and carbohydrates." b. "Most diets don't work very well for long-term maintenance, so you should ask your provider about medications to lose weight." c. "You should be able to lose 30 to 40 pounds in the first 6 months of an effective weight-loss diet." d. "You should select a diet that has a higher fat ratio to prevent hunger between meals."

2. A patient has an infection caused by Pseudomonas aeruginosa. The prescriber has ordered piperacillin and amikacin, both to be given intravenously. What will the nurse do? a. Make sure to administer the drugs at different times using different IV tubing. b. Suggest giving larger doses of piperacillin and discontinuing the amikacin. c. Suggest that a fixed-dose combination of piperacillin and tazobactam [Zosyn] be used. d. Watch the patient closely for allergic reactions, because this risk is increased with this combination.

2. A patient is diagnosed with an infection caused by Staphylococcus aureus, and the prescriber orders intravenous gentamicin and penicillin (PCN). Both drugs will be given twice daily. What will the nurse do? a. Administer gentamicin, flush the line, and then give the penicillin. b. Give the gentamicin intravenously and the penicillin intramuscularly. c. Infuse the gentamicin and the penicillin together to prevent fluid overload. d. Request an order to change the penicillin to vancomycin.

2. A pregnant adolescent patient asks the nurse whether she should continue to take her prescription for tetracycline [Sumycin] to clear up her acne. Which response by the nurse is correct? a. "Tetracycline can be harmful to the baby's teeth and should be avoided." b. "Tetracycline is safe to take during pregnancy." c. "Tetracycline may cause allergic reactions in pregnant women." d. "Tetracycline will prevent asymptomatic urinary tract infections."

3. A 20-year-old female patient has suprapubic discomfort, pyuria, dysuria, and bacteriuria greater than 100,000/mL of urine. Which are the most likely diagnosis and treatment? a. Uncomplicated lower urinary tract infection treatable with short-course therapy b. Complicated lower urinary tract infection treatable with single-dose therapy c. Uncomplicated upper urinary tract infection requiring 14 days of oral antibiotics d. Complicated upper urinary tract infection requiring parenteral antibiotics

3. A patient asks a nurse how to know whether dietary supplements are safe. The nurse will tell this patient that: a. any standards addressing safety merely regulate labeling and manufacturing processes. b. manufacturers must provide the FDA with efficacy claims prior to marketing their supplements. c. the DSHEA requires labeling that prohibits claims of treatment of specific diseases or conditions. d. the FDA must approve dietary supplements prior to marketing them in the United States.

3. A patient is being treated for a systemic fungal infection with amphotericin B [Abelcet] and will be discharged home from the hospital to complete every other day infusions of the medication for 6 to 8 weeks. The nurse provides discharge teaching before dismissal. Which statement by the patient indicates a need for further teaching? a. "I may experience headaches and pain in my lower back, legs, and abdomen." b. "I may need to take potassium supplements while taking this drug." c. "I should take acetaminophen and diphenhydramine before each infusion." d. "I will need to have blood drawn for serum creatinine and BUN levels every 3 to 4 days."

3. A patient is receiving intravenous vincristine [Oncovin]. The patient complains of pain at the IV insertion site. The nurse examines the site and notes an area of erythema and edema. What will the nurse do? a. Change the IV site and notify the provider of the extravasation. b. Contact the provider to suggest using a different chemotherapeutic agent. c. Obtain an order for a topical anesthetic to minimize discomfort. d. Slow the rate of infusion to reduce the patient's discomfort.

3. A patient will be discharged from the hospital with a prescription for TMP/SMZ [Bactrim]. When providing teaching for this patient, the nurse will tell the patient that it will be important to: a. drink 8 to 10 glasses of water each day. b. eat foods that are high in potassium. c. take the medication with food. d. take folic acid supplements.

3. A pediatric patient ingested a narcotic analgesic at a grandparent's house 15 minutes before arriving in the emergency department. The nurse is preparing to administer activated charcoal. Which statement by the nurse is correct? a. "The charcoal will cause the child's stools to be black." b. "The charcoal should absorb about 37% of the drug." c. "The charcoal will make the child vomit the medication." d. "We will need to give the charcoal several times for it to work."

3. An adolescent patient comes to the clinic complaining of a burning sensation upon urination and a pus-like discharge from the penis. The nurse is correct to suspect that the patient has which disorder? a. Gonorrhea b. Herpes simplex c. Nongonococcal urethritis d. Syphilis

3. The nurse is caring for a patient receiving intravenous acyclovir [Zovirax]. To prevent nephrotoxicity associated with intravenous acyclovir, the nurse will: a. hydrate the patient during the infusion and for 2 hours after the infusion. b. increase the patient's intake of foods rich in vitamin C. c. monitor urinary output every 30 minutes. d. provide a low-protein diet for 1 day before and 2 days after the acyclovir infusion.

3. The nurse is caring for a patient who is HIV positive and has a previous history of drug and alcohol abuse. The patient is being treated with combination therapies, including didanosine [Videx]. Which laboratory findings would most concern the nurse? a. Increased serum amylase and triglycerides and decreased serum calcium b. Decreased serum amylase and serum triglycerides and increased serum calcium c. Decreased hemoglobin and hematocrit d. Increased serum amylase, decreased triglycerides, and increased platelets

4. A 50-year-old patient with a body mass index (BMI) of 26 and a waist circumference (WC) of 37 who smokes asks a nurse about drugs for weight loss. She tells the nurse, "I keep trying to eat less, but it doesn't work." What will the nurse do? a. Ask her to begin keeping a log of her food intake and activities. b. Counsel her to quit smoking to reduce her health risk. c. Suggest she begin walking every day to increase the number of calories burned. d. Tell her she is a candidate for drug therapy and suggest she contact her provider.

4. A nurse is caring for a premature infant who has received poractant alfa [Curosurf] 2.5 mL/kg via direct intratracheal instillation to prevent respiratory distress syndrome. The infant demonstrated initial improvement after the dose but has begun to deteriorate. Which treatment will the nurse expect the neonatologist to order? a. A repeat dose of 1.25 mL/kg of poractant alfa b. A repeat dose of 2.5 mL/kg of poractant alfa c. A repeat dose of 5.0 mL/kg of poractant alfa d. Administration of high-dose glucocorticoids

4. A nurse is discussing the care of a patient with cancer with a nursing student. The patient is about to begin chemotherapy with a bifunctional alkylating agent. Which statement by the student indicates an understanding of this chemotherapeutic agent? a. "Alkylating agents are toxic to tissues that have rapidly dividing cells." b. "Bifunctional alkylating agents cannot form cross-links in DNA." c. "Resistance to alkylating agents is rare." d. "This drug needs to be given as a prolonged infusion."

4. A patient has been using latanoprost [Xalatan] ophthalmic drops. The patient tells the nurse, "My eyes used to be greenish-brown, but now they're brown." What will the nurse do? a. Reassure the patient that this is a harmless side effect. b. Report this toxic effect to the patient's provider. c. Tell the patient that this indicates an increased risk of migraine headaches. d. Tell the patient that this effect will reverse when the medication is withdrawn.

4. A patient is diagnosed with a lung infection caused by P. aeruginosa. The culture and sensitivity report shows sensitivity to all aminoglycosides. The nurse knows that the rate of resistance to gentamicin is common in this hospital. The nurse will expect the provider to order which medication? a. Amikacin [Amikin] b. Gentamicin c. Paromomycin d. Tobramycin

4. The nurse is assessing a patient who is malnourished and has a history of poor nutrition. The patient reports difficulty seeing at night. This patient is likely to be deficient in which fat-soluble vitamin? a. A (retinol) b. D c. E (alpha-tocopherol) d. K

5. A child with an ear infection is not responding to treatment with amoxicillin [Amoxil]. The nurse will expect the provider to order: a. amoxicillin-clavulanic acid [Augmentin]. b. ampicillin. c. nafcillin. d. penicillin G [Benzylpenicillin].

5. A nurse is teaching a group of nursing students about how cytotoxic anticancer drugs affect normal cells. Which statement by a student indicates an understanding of this teaching? a. "Cytotoxic drugs lack tissue specificity." b. "Cytotoxic drugs have a high degree of selective toxicity." c. "Differences between cancer cells and normal cells are qualitative." d. "Neoplastic cells and normal tissue cells are very different."

5. A nurse is teaching a parent about treating a child for scabies. Which statement by the parent indicates understanding of the treatment? a. "I should wash all bedding and clothing as well as applying the medicine." b. "I will apply the cream to the visible burrows and areas of itching." c. "More than one application of the cream may be needed." d. "The cream may cause systemic side effects."

5. A patient with HIV and mucocutaneous HSV is being treated with foscarnet after failing treatment with acyclovir. After 2 weeks, the patient's dose is increased to 90 mg/kg over 2 hours from 40 mg/kg over 1 hour. The patient reports numbness in the extremities and perioral tingling. What will the nurse do? a. Notify the provider and request an order for a serum calcium level. b. Notify the provider of potential foscarnet overdose. c. Request an order for a creatinine clearance level. d. Request an order of IV saline to be given before the next dose.

5. A patient with HIV who takes protease inhibitors develops tuberculosis and will begin treatment. Which drug regimen will be used for this patient? a. Isoniazid, pyrazinamide, ethambutol + rifabutin b. Isoniazid, pyrazinamide, ethambutol c. Isoniazid, rifampin, pyrazinamide, ethambutol d. Isoniazid + rifabutin

5. A patient with a history of renal calculi has fever, flank pain, and bacteriuria. The nurse caring for this patient understands that it is important for the provider to: a. begin antibiotic therapy after urine culture and sensitivity results are available. b. give prophylactic antibiotics for 6 weeks after the acute infection has cleared. c. initiate immediate treatment with broad-spectrum antibiotics. d. refer the patient for intravenous antibiotics and hospitalization.

5. A patient with ocular hypertension will begin using brimonidine [Alphagan] for long-term reduction of increased ocular pressure (IOP). The nurse teaches the patient about this medication. Which statement by the patient indicates understanding of the teaching? a. "After using the drops, I should wait 15 minutes before putting in contacts." b. "Because this is a topical medication, drowsiness will not occur." c. "I will not have cardiovascular side effects when using this medication." d. "If my eyes begin to itch or turn red, it means I am allergic to this drug."

5. A provider has ordered ceftriaxone 4 gm once daily for a patient with renal impairment. What will the nurse do? a. Administer the medication as prescribed. b. Contact the provider to ask about giving the drug in divided doses. c. Discuss increasing the interval between doses with the provider. d. Discuss reducing the dose with the provider.

6. A child is admitted to the hospital after a routine lead screen reveals an elevated serum lead level. The prescriber has ordered edetate calcium disodium (calcium EDTA) as a chelating agent. During this drug treatment, the nurse will expect to: a. collect a daily urine specimen. b. give the medication on an empty stomach. c. monitor the child's heart rate and blood pressure. d. request orders for liver function tests.

6. A patient is admitted to the unit for treatment for an infection. The patient receives IV amikacin [Amikin] twice a day. When planning for obtaining a peak aminoglycoside level, when should the nurse see that the blood is drawn? a. 30 minutes after the IV infusion is complete b. 1 hour after the IV infusion is complete c. 1 hour before administration of the IV infusion d. A peak level is not indicated with twice-daily dosing.

6. A patient newly diagnosed with tuberculosis asks the nurse why oral medications must be given in the clinic. The nurse will tell the patient that medications are given in the clinic so that: a. clinic staff can observe adherence to drug regimens. b. nurses can monitor for drug toxicities. c. providers can adjust doses as needed. d. the staff can ensure that the U.S. Food and Drug Administration (FDA) regulations are met.

6. A patient who is receiving intravenous ciprofloxacin for pneumonia develops diarrhea. A stool culture is positive for Clostridium difficile. The nurse will expect the provider to: a. add metronidazole [Flagyl]. b. increase the dose of ciprofloxacin. c. restrict dairy products. d. switch to gemifloxacin.

6. A prescriber has ordered cefoxitin for a patient who has an infection caused by a gram-negative bacteria. The nurse taking the medication history learns that the patient experienced a maculopapular rash when taking amoxicillin [Amoxil] several years earlier. What will the nurse do? a. Administer the cefoxitin and observe for any side effects. b. Give the cefoxitin and have epinephrine and respiratory support available. c. Request an order for a different, nonpenicillin, noncephalosporin antibiotic. d. Request an order to administer a skin test before giving the cefoxitin.

6. An adult who has been self-medicating, using nutritional therapy for an elevated cholesterol level, complains of repeated episodes of flushing. The nurse suspects that the patient has been taking: a. niacin. b. thiamine. c. riboflavin. d. pyridoxine.

7. A female patient has come to the STD clinic and has been diagnosed with a Trichomonas vaginalis infection. What education should be provided to this patient? a. Male partners should always be treated, even if they are asymptomatic. b. The applicator for the vaginal gel should be washed after each application. c. The infection is not completely eliminated with the medication. d. The medication should be taken twice daily for 2 weeks.

7. A nurse is teaching a patient who works with heavy metals and who is about to begin taking a chelating agent to treat heavy metal poisoning. Which statement by the patient indicates a need for further teaching? a. "This drug will not affect any metals already bound to cells in my body." b. "This drug will bind with the metals to form less toxic molecules." c. "This type of drug can block the metal from binding with molecules in my body." d. "When the drug forms a chelate with the metal, the chelate can be excreted safely."

7. A patient has a positive urine culture 1 week after completion of a 3-day course of antibiotics. The nurse anticipates that the prescriber will: a. begin a 2-week course of antibiotics. b. evaluate for a structural abnormality of the urinary tract. c. initiate long-term prophylaxis with low-dose antibiotics. d. treat the patient with intravenous antibiotics.

7. A patient who has a brain tumor will receive a nitrosourea agent. A nursing student asks why this type of drug is used for this type of cancer. The nurse will tell the student that nitrosoureas are useful because they: a. are lipophilic. b. are bifunctional alkylating agents. c. have a broad spectrum of antineoplastic characteristics. d. have delayed bone marrow suppression.

7. A patient who has been receiving intravenous gentamicin for several days reports having had a headache for 2 days. The nurse will request an order to: a. discontinue the gentamicin. b. obtain a gentamicin trough before the next dose is given c. give an analgesic to control headache discomfort. d. obtain renal function tests to evaluate for potential nephrotoxicity.

7. A patient will be discharged home to complete treatment with intravenous cefotetan with the assistance of a home nurse. The home care nurse will include which instruction when teaching the patient about this drug treatment? a. Abstain from alcohol consumption during therapy. b. Avoid dairy products while taking this drug. c. Take an antihistamine if a rash occurs. d. Use nonsteroidal anti-inflammatory drugs (NSAIDs), not acetaminophen, for pain.

8. A nurse is attending a conference about terrorism and emergency response. During a discussion of radiation emergencies, the use of potassium iodide is reviewed. When should potassium iodide be administered to be most effective after exposure to radiation? a. Immediately after exposure b. Within 48 hours after exposure c. Within 72 hours after exposure d. The time frame is not important

8. A nurse is preparing to administer medications to a patient recently started on delavirdine [Rescriptor]. Which concurrent prescription should the nurse question before administration? a. Alprazolam [Xanax] b. Diphenhydramine [Benadryl] c. Morphine d. Penicillin

8. A patient who has undergone surgical removal of a solid tumor has just begun chemotherapy. The patient experiences severe nausea and vomiting as well as alopecia. The nurse will expect the provider to: a. continue the chemotherapeutic agent at the same dose. b. decrease the dose of chemotherapy to minimize side effects. c. order lab tests to evaluate for the presence of residual cancer cells. d. stop the chemotherapy because the tumor has been removed.

8. A patient will begin chemotherapy with cisplatin. Which medications will the nurse expect to administer to offset this agent's side effects? a. Amifostine [Ethyol], diuretics, and antiemetics b. Antiemetics, vitamin B12, and glucocorticoids c. Dexamethasone, antiemetics, and vistonuridine d. Folic acid, gabapentin, and vitamin B12

8. A patient with a urinary tract infection is given a prescription for TMP/SMZ. When reviewing the drug with the patient, the nurse learns that the patient has type 1 diabetes mellitus and consumes alcohol heavily. What will the nurse do? a. Contact the provider to request a different antibiotic for this patient. b. Obtain frequent blood glucose determinations while giving TMP/SMZ. c. Suggest that the patient take a potassium supplement while taking TMP/SMZ. d. Tell the patient to avoid excessive fluid intake while taking TMP/SMZ.

8. A patient with advanced cancer of the prostate begins treatment with leuprolide [Lupron Depot] injections and will receive 7.5 mg IM once per month. After the first injection, the patient experiences an increase in cancer symptoms. What will the nurse tell the patient? a. Desensitization to the drug over time will result in a decrease in these symptoms. b. The dose of leuprolide may have to be increased to 22.5 mg per month. c. These symptoms indicate a need for surgical castration to treat the cancer. d. This is a sign that the patient's cancer is getting worse.

8. A patient with no known drug allergies is receiving amoxicillin [Amoxil] PO twice daily. Twenty minutes after being given a dose, the patient complains of shortness of breath. The patient's blood pressure is 100/58 mm Hg. What will the nurse do? a. Contact the provider and prepare to administer epinephrine. b. Notify the provider if the patient develops a rash. c. Request an order for a skin test to evaluate possible PCN allergy. d. Withhold the next dose until symptoms subside.

8. The nurse is obtaining a history from a patient who discloses daily use of St. John's wort in addition to prescription drugs. Which effect of this dietary supplement would most concern the nurse? a. It accelerates the metabolism of some drugs. b. It enhances the effects of digoxin. c. It counteracts the effects of CNS depressants. d. It increases the risk of bleeding.

9. A male patient with hepatitis C will begin triple drug therapy with pegylated interferon alfa 2a [Pegasys], ribavirin [Ribasphere], and boceprevir [Victrelis]. The patient tells the nurse that his wife is pregnant. What will the nurse tell him? a. Boceprevir is contraindicated in males whose partners are pregnant. b. He should use a barrier contraceptive when having sex. c. He should use dual drug therapy with pegylated interferon alfa and ribavirin only. d. This combination drug therapy is safe for him to use.

9. A patient is admitted to a hospital for treatment for first-time symptoms of mania and is exhibiting euphoric mania. Which medication will the provider order? a. Lithium [Lithobid] b. Olanzapine [Zyprexa] c. Risperidone [Risperdal] d. Divalproex sodium [Valproate]

9. A patient is to undergo orthopedic surgery, and the prescriber will order a cephalosporin to be given preoperatively as prophylaxis against infection. The nurse expects the provider to order which cephalosporin? a. First-generation cephalosporin b. Second-generation cephalosporin c. Third-generation cephalosporin d. Fourth-generation cephalosporin

9. A patient is treated for Phthirus pubis with permethrin 1% lotion. Two days after using the lotion as directed, the patient calls to report increased itching, erythema, and edema of the pubic skin. What will the nurse tell the patient? a. This is an expected effect of the treatment and will subside. b. This represents an allergic reaction to the lotion. c. The patient should ask the provider about using malathion 0.5% lotion. d. The patient should repeat the permethrin now and contact the provider if no improvement is seen.

9. A patient with cancer who is receiving chemotherapy develops a fever. The patient's chest radiograph is normal. The patient's neutrophil count is 750/mm3. The nurse expects the provider to: a. begin empiric therapy with intravenous antibiotics. b. obtain cultures and wait for results before prescribing antibiotics. c. order colony-stimulating factor to minimize neutrophilia. d. reassure the patient that serious infection is unlikely.

A nurse educator is conducting a continuing education class on pharmacology. To evaluate the learning of the nurses in the class, the nurse educator asks, "Which drug name gives in-formation about the drug's pharmacologic classification?" Which is the correct response? a. Amoxicillin b. Tylenol c. Cipro d. Motrin

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

A nurse is caring for a patient receiving intrathecal baclofen [Lioresal]. The patient is unresponsive. After asking a coworker to contact the provider, the nurse anticipates performing which intervention? a. Preparing to support respirations b. Administering an antidote to baclofen c. Administering diazepam to prevent seizures d. Obtaining an electrocardiogram

A nurse is discussing how beta blockers work to decrease blood pressure with a nursing student. Which statement by the student indicates a need for further teaching? a. "Beta blockers block the actions of angiotensin II." b. "Beta blockers decrease heart rate and contractility." c. "Beta blockers decrease peripheral vascular resistance." d. "Beta blockers decrease the release of renin."

A nurse is preparing to give an antibiotic to a patient who reports being allergic to antibiotics. Before giving the medication, what will the nurse do first? a. Ask whether the patient has taken this antibiotic for other infections b. Question the patient about allergies to other medications c. Request an order for a lower dose of the antibiotic d. Request an order for an antihistamine

A nurse is providing education to a patient who will begin taking alendronate [Fosamax]. Which complication should the patient be instructed to report immediately? a. Difficulty swallowing b. Dizziness c. Drowsiness d. Pallor

A nurse is teaching a group of nurses about Parkinson's medications. The nurse is correct to state that one side effect associated with pramipexole [Mirapex] that is less likely to occur with other dopamine agonists is: a. sleep attacks. b. dizziness. c. hallucinations. d. dyskinesias.

A nurse is teaching a patient about the use of sildenafil [Viagra] for erectile dysfunction. Which statement by the patient indicates understanding of the teaching? a. "If my erection lasts longer than 4 hours, I should contact my provider." b. "I should not use nitroglycerin within 12 hours of using sildenafil." c. "I should take this drug about 15 minutes before sexual activity." d. "This drug may cause me to have an erection when I don't want one."

A nurse is teaching a patient who will begin taking verapamil [Calan] for hypertension about the drug's side effects. Which statement by the patient indicates understanding of the teaching? a. "I may become constipated, so I should increase fluids and fiber." b. "I may experience a rapid heart rate as a result of taking this drug." c. "I may have swelling of my hands and feet, but this will subside." d. "I may need to increase my digoxin dose while taking this drug."

A nursing student asks why albuterol, which is selective for beta2 receptors, causes an increased heart rate in some patients. How should the nurse respond? a. "Adrenergic agonists can lose their selectivity when given at higher doses." b. "Bronchodilation lowers blood pressure, which causes a reflex tachycardia." c. "Some patients metabolize the drug differently and have unusual side effects." d. "Systemic effects are intensified with inhaled doses."

A patient has been receiving intravenous ketorolac 30 mg every 6 hours for postoperative pain for 4 days. The patient will begin taking oral ketorolac 10 mg every 4 to 6 hours to prepare for discharge in 1 or 2 days. The patient asks the nurse whether this drug will be prescribed for management of pain after discharge. The nurse will respond by telling the patient that the provider will prescribe a(n): a. different nonsteroidal anti-inflammatory drug for home management of pain. b. fixed-dose opioid analgesic/nonsteroidal anti-inflammatory medication. c. lower dose of the oral ketorolac for long-term pain management. d. intranasal preparation of ketorolac for pain management at home.

A patient has been taking methadone [Dolophine] for 5 months to overcome an opioid addiction. The nurse should monitor the patient for which of the following electrocardiographic changes? a. Prolonged QT interval b. Prolonged P-R interval c. AV block d. An elevated QRS complex

A patient has begun taking dimethyl fumarate [Tecfidera] to treat relapsing MS and calls the clinic to report flushing of the skin with itching and burning sensations. What will the nurse recommend to this patient? a. "Take a non-enteric-coated aspirin 30 minutes before each dose." b. "The provider will order an antihistamine to treat this symptom." c. "Try taking the medication on an empty stomach." d. "You should notify the provider immediately."

A patient has received two doses of dinoprostone [Prepidil] to initiate labor. It has been 6 hours since the last dose. The nurse assesses the patient and notes that the cervix is ripe and dilated to 4 cm, but contractions are diminishing in intensity and frequency. What will the nurse expect to do? a. Administer oxytocin. b. Monitor urine output. c. Prepare for a cesarean section. d. Watch closely for fetal distress.

A patient is about to undergo a procedure to harvest hematopoietic stem cells from the bone marrow. Which medication will the nurse anticipate giving before this procedure? a. Filgrastim [Neupogen] b. Pegfilgrastim [Neulasta] c. Oprelvekin [Neumega] d. Sargramostim [Leukine]

A patient is beginning therapy with oral methotrexate [Rheumatrex] for rheumatoid arthritis. The nurse will teach this patient about the importance of: a. having routine renal and hepatic function tests. b. limiting folic acid consumption. c. reporting alopecia and rash. d. taking the medication on a daily basis.

A patient is diagnosed with peptic ulcer disease. The patient is otherwise healthy. The nurse learns that the patient does not smoke and that he drinks 1 or 2 glasses of wine with meals each week. The nurse anticipates that the provider will prescribe which drugs? a. Amoxicillin [Amoxil], clarithromycin, and omeprazole [Prilosec] b. Amoxicillin [Amoxil], metronidazole [Flagyl], and cimetidine [Tagamet] c. Clarithromycin, metronidazole [Flagyl], and omeprazole [Prilosec] d. Tetracycline, cimetidine [Tagamet], and lansoprazole [Prevacid]

A patient is recovering from a myocardial infarction but does not have symptoms of heart failure. The nurse will expect to teach this patient about: a. ACE inhibitors and beta blockers. b. biventricular pacemakers. c. dietary supplements and exercise. d. diuretics and digoxin.

A patient receiving botulinum toxin injections to control muscle spasticity asks how the drug works. The nurse knows that this drug affects the transmitter acetylcholine by: a. inhibiting its release. b. interfering with its storage. c. preventing its reuptake. d. promoting its synthesis.

A patient who has been taking an SSRI tells the nurse that the drug has caused reduced sexual performance, weight gain, and sedation. The nurse will suggest that the patient ask the provider about using which drug? a. Bupropion [Wellbutrin] b. Imipramine [Tofranil] c. Isocarboxazid [Marplan] d. Trazodone [Oleptro]

A patient who has chronic allergies takes loratadine [Claritin] and develops a severe reaction to bee stings. The patient asks the nurse why the antihistamine did not prevent the reaction. What will the nurse say? a. "Allergy symptoms that are severe are caused by mediators other than histamine." b. "H1 blockers do not prevent the release of histamine from mast cells and basophils." c. "Second-generation H1 blockers contain less active drug and do not work in severe reactions." d. "Severe allergic reactions occur through actions on muscarinic receptors."

A patient who has just found out she is pregnant tells the nurse she wants to quit smoking. She asks about pharmacologic aids to help her quit. The nurse is correct to tell her what? a. "Nicotine replacement therapy is harmful, but it is safer than smoking, so it can be used." b. "Psychosocial support is the only recommended treatment for smoking cessation during pregnancy." c. "Varenicline [Chantix] is safe to use during pregnancy." d. "You should try to taper off your smoking gradually, because none of the drugs are safe."

A patient who has recently immigrated to the United States from an impoverished country appears malnourished. The patient's folic acid levels are low, and the vitamin B12 levels are normal. The nurse expects this patient's treatment to include: a. a diet high in folic acid. b. intramuscular folic acid. c. oral folic acid and vitamin B12. d. oral folic acid supplements.

A patient who is an active alcoholic is admitted to the hospital for surgery. The nurse reviewing orders for this patient would be correct to question which postoperative medication for this patient? a. Acetaminophen b. Diazepam c. Morphine d. Thiamine

A patient with Parkinson's disease is taking levodopa/carbidopa [Sinemet] and reports occasional periods of loss of drug effect lasting from minutes to several hours. The nurse questions the patient further and discovers that these episodes occur at different times related to the medication administration. The nurse will contact the provider to discuss: a. administering a catechol-O-methyltransferase (COMT) inhibitor, such as entacapone. b. adding the DA-releasing agent amantadine to the regimen. c. giving a direct-acting dopamine agonist. d. shortening the dosing interval of levodopa/carbidopa.

A patient with Stage C heart failure (HF) who has been taking an ACE inhibitor, a beta blocker, and a diuretic begins to have increased dyspnea, weight gain, and decreased urine output. The provider orders spironolactone [Aldactone]. The nurse will instruct the patient to: a. avoid potassium supplements. b. monitor for a decreased heart rate. c. take extra fluids. d. use a salt substitute instead of salt.

A patient with allergic rhinitis is taking a compound product of loratadine/pseudoephedrine [Claritin-D] every 12 hours. The patient complains of insomnia. The nurse notes that the patient is restless and anxious. The patient's heart rate is 90 beats per minute, and the blood pressure is 130/85 mm Hg. The nurse will contact the provider to: a. discuss using an intranasal glucocorticoid and loratadine [Claritin]. b. report acute toxicity caused by pseudoephedrine. c. suggest using an agent with a sympathomimetic drug only. d. suggest using a topical decongestant to minimize systemic symptoms.

A patient with cerebral palsy has severe muscle spasticity and muscle weakness. The patient is unable to take anything by mouth. The nurse is correct to anticipate that which medication will be ordered for home therapy? a. Baclofen [Lioresal] b. Dantrolene [Dantrium] c. Diazepam [Valium] d. Metaxalone [Skelaxin]

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

A patient with lung cancer receives filgrastim [Neupogen] after chemotherapy to reduce neutropenia. The patient reports a moderate degree of bone pain. What will the nurse do? a. Obtain an order to administer acetaminophen. b. Request an order for a complete blood count (CBC). c. Request an order to reduce the dose of filgrastim. d. Suspect metastasis of the cancer to the bone.

A patient with migraines is started on a beta blocker. The nurse explains the benefits of taking the medication for migraines. Which statement by the patient indicates an understanding of the medication's effects? a. "I need to take it every day to reduce the frequency of migraines." b. "I will take it as needed to get relief from migraines." c. "I will take it to shorten the duration of my migraines." d. "I will take this drug when a migraine starts."

A patient with pheochromocytoma is admitted for surgery. The surgeon has ordered an alpha-blocking agent to be given preoperatively. What does the nurse understand about this agent? a. It is ordered to prevent perioperative hypertensive crisis. b. It prevents secretion of catecholamines by the adrenal tumor. c. It reduces contraction of smooth muscles in the adrenal medulla. d. It is given chronically after the surgery to prevent hypertension.

A pediatric nurse is teaching nursing students about medication administration in children. Which statement by a student indicates an understanding of the teaching? a. "Drugs effective in adults may not work in children, even if the dose is proportional for weight and size." b. "Infants metabolize drugs more quickly than do older children and adults." c. "Side effects of drugs in children are similar to side effects of drugs in adults." d. "The known differences in drug effects in children versus those in adults are related to the size of the patient."

A postpartum patient is receiving methylergonovine to prevent hemorrhage. The nurse assesses the patient and notes a heart rate of 76 beats per minute, a respiratory rate of 16 breaths per minute, and a blood pressure of 120/80 mm Hg. The patient's uterus is firm. The patient complains of mild to moderate cramping. Bleeding is minimal. What will the nurse do? a. Continue to monitor and tell the patient to report increased cramping. b. Notify the provider of possible uterine hypertonicity. c. Notify the provider of the patient's blood pressure. d. Request an order to administer the methylergonovine intravenously.

A pregnant patient asks the nurse about the safe use of medications during the third trimester. What will the nurse tell her about drugs taken at this stage? a. They may need to be given in higher doses if they undergo renal clearance. b. They require lower doses if they are metabolized by the liver. c. They are less likely to cross the placenta and affect the fetus. d. They are more likely to cause anatomical defects if they are teratogenic.

A psychiatric nurse is caring for a drug-addicted patient. The nurse knows that the ideal goal of drug rehabilitation for this patient is: a. abstinence from the drug. b. decreasing episodes of relapse. c. minimizing drug cravings. d. reduction of drug use.

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

A surgical patient is receiving succinylcholine [Anectine] with an inhalation anesthetic. The patient is intubated, has an indwelling urinary catheter, and has ongoing monitoring of vital signs. Which symptom during the perioperative period is cause for concern? a. Elevated temperature b. Increased urine output c. Muscle paralysis d. No response to painful stimuli

An infant who receives a drug that does not produce CNS side effects in adults exhibits drowsiness and sedation. The nurse understands that this is because of differences in which physiologic system in infants and adults? a. Blood-brain barrier b. First-pass effect c. Gastrointestinal absorption d. Renal filtration

An older adult patient who has cancer and Alzheimer's disease is crying but shakes her head "no" when asked about pain. The prescriber has ordered morphine sulfate 2 to 4 mg IV every 2 hours PRN pain. It has been 4 hours since a dose has been given. What will the nurse do? a. Administer 4 mg of morphine and monitor this patient's verbal and nonverbal responses. b. Give 2 mg of morphine for pain to avoid increasing this patient's level of confusion. c. Request an order for a nonopioid analgesic or an antidepressant adjuvant analgesic. d. Withhold any analgesic at this time and reassess the patient in 30 to 60 minutes.

In a discussion of drug-drug interactions, which would be the best example of a beneficial inhibitory interaction? a. Naloxone [Narcan] blocking morphine sulfate's actions b. Antacids blocking the action of tetracycline [Sumycin] c. Propanolol [Inderal] blocking the effects of albuterol d. Cholestyramine blocking the actions of antihypertensive drugs

The nurse receives an order to give morphine 5 mg IV every 2 hours PRN pain. Which action is not part of the six rights of drug administration? a. Assessing the patient's pain level 15 to 30 minutes after giving the medication b. Checking the medication administration record to see when the last dose was administered c. Consulting a drug manual to determine whether the amount the prescriber ordered is appropriate d. Documenting the reason the medication was given in the patient's electronic medical record

The spouse of a patient who is newly diagnosed with Alzheimer's disease asks the nurse if medications will prevent the need for nursing home care. Which response by the nurse is cor-rect? a. "Drugs to treat Alzheimer's disease may slow the progression of memory loss." b. "Drugs may be effective to stop the pro-gression of the disease if they are initiated early in the disease." c. "Medications to treat Alzheimer's disease are effective for treating core symptoms of the disease." d. "Medications for Alzheimer's disease are effective in reducing cognitive impair-ment."

Which medication should be used for asthma patients as part of step 1 management? a. albuterol b. omalizumab c. salmeterol d. fluticasone

. A nurse is teaching nursing students about the use of nonproprietary names for drugs. The nurse tells them which fact about nonproprietary names? a. They are approved by the FDA and are easy to remember. b. They are assigned by the U.S. Adopted Names Council. c. They clearly identify the drug's pharma-cologic classification. d. They imply the efficacy of the drug and are less complex.

1. A nurse is working with a group of patients. One patient states, "My goal is to reduce my weight from 280 pounds to 230 pounds in 6 months." What response by the nurse would be most appropriate for this patient? a. "Most weight loss occurs in the first 6 months, so you should try to reduce your weight to 200 pounds." b. "Safe and maintainable weight loss should be about 10% of body weight in 6 months." c. "That is a realistic goal for your weight-reduction program." d. "Weight loss of more than 20 pounds in 6 months could be dangerous."

1. A nursing student asks about the differences between cell-cycle phase-specific chemotherapeutic agents and those that are cell-cycle phase nonspecific. What will the nurse explain? a. Cell-cycle phase-nonspecific drugs are less toxic. b. Cell-cycle phase-specific drugs do not harm "resting" cells. c. Cell-cycle phase-specific drugs should be given at specific intervals. d. Neither type is toxic to cells in the "resting" G0 phase.

1. A nursing student asks the nurse what differentiates antiestrogen drugs from aromatase inhibitors in the treatment of breast cancer. What is the correct response by the nurse? a. Antiestrogen drugs decrease the risk for thromboembolic events. b. Antiestrogen drugs increase the risk for endometrial cancer. c. Aromatase inhibitors block the production of estrogen by the ovaries. d. Aromatase inhibitors can be used for tumor cells that lack estrogen receptors.

1. A patient is taking oral ketoconazole [Nizoral] for a systemic fungal infection. The nurse reviews the medication administration record and notes that the patient is also taking omeprazole [Prilosec] for reflux disease. What action should the nurse take? a. Administer the omeprazole 1 hour before the ketoconazole. b. Administer the omeprazole at least 2 hours after the ketoconazole. c. Confer with the prescriber about a potential hazardous interaction. d. The nurse should not administer omeprazole to a patient receiving ketoconazole.

1. A patient who has pulmonary arterial hypertension (PAH) is receiving epoprostenol [Flolan] at a rate of 210 ng per minute using a portable pump. The patient weighs 70 kg. The patient calls the clinic to report headache, nausea, and vomiting. The nurse will counsel the patient to: a. decrease the infusion to 100 ng per minute. b. discuss these side effects with the provider. c. prepare for a hospital admission. d. stop the infusion and contact the provider.

1. A patient with HIV contracts herpes simplex virus (HSV), and the prescriber orders acyclovir [Zovirax] 400 mg PO twice daily for 10 days. After 7 days of therapy, the patient reports having an increased number of lesions. The nurse will expect the provider to: a. extend this patient's drug therapy to twice daily for 12 months. b. give intravenous foscarnet every 8 hours for 2 to 3 weeks. c. increase the acyclovir dose to 800 mg PO 5 times daily. d. order intravenous valacyclovir [Valtrex] 1 gm PO twice daily for 10 days.

1. A young patient is brought to the emergency department by friends, who say they found him unresponsive at his home. The prescriber suspects that the patient was poisoned. During the assessment, the man mumbles a word and becomes comatose. The nurse should immediately prepare to administer: a. activated charcoal. b. intravenous dextrose. c. intravenous flumazenil [Romazicon]. d. syrup of ipecac.

10. A patient is about to begin treatment for latent tuberculosis. The patient is an alcoholic, has difficulty complying with drug regimens, and has mild liver damage. What will the nurse tell this patient? a. "You must stop drinking before adequate treatment can begin." b. "You must take isoniazid with close monitoring of hepatic function." c. "You must take rifampin daily for 4 months." d. "You will begin a regimen of isoniazid and rifampin."

10. A patient is receiving an intraperitoneal aminoglycoside during surgery. To reverse a serious side effect of this drug, the nurse may expect to administer which agent? a. Amphotericin B b. Calcium gluconate c. Neuromuscular blocker d. Vancomycin

10. A patient receiving a cephalosporin develops a secondary intestinal infection caused by Clostridium difficile. What is an appropriate treatment for this patient? a. Adding an antibiotic, such as vancomycin [Vancocin], to the patient's regimen b. Discontinuing the cephalosporin and beginning metronidazole [Flagyl] c. Discontinuing all antibiotics and providing fluid replacement d. Increasing the dose of the cephalosporin and providing isolation measures

10. A patient who is malnourished has scaling, cracked skin on the arms and face. The patient is irritable, anxious, and has difficulty sleeping. The patient complains of soreness of the tongue and mouth. When teaching this patient about vitamin therapy for this disorder, the nurse will tell the patient to report which side effects? a. Abdominal cramps and diarrhea b. Flushing, dizziness, and nausea c. Migraine headaches d. Numbness of feet and hands

10. A patient with hepatitis B begins treatment with adefovir [Hepsera] and asks the nurse how long the drug therapy will last. The nurse will tell the patient that the medication will need to be taken for: a. a lifetime. b. an indefinite, prolonged period of time. c. 48 weeks. d. until nephrotoxicity occurs.

10. An older adult patient with chronic obstructive pulmonary disease (COPD) develops bronchitis. The patient has a temperature of 39.5°C. The nurse will expect the provider to: a. obtain a sputum culture and wait for the results before prescribing an antibiotic. b. order empiric antibiotics while waiting for sputum culture results. c. treat symptomatically, because antibiotics are usually ineffective against bronchitis. d. treat the patient with more than one antibiotic without obtaining cultures.

10. The nurse would be correct to state that the purpose of angiogenesis inhibitors is to: a. kill existing cancer cells directly. b. suppress the formation of new blood vessels in tumors. c. enhance the size of collateral vessels. d. enhance red cell development in the bone marrow.

11. A patient is taking erythromycin ethylsuccinate for a chlamydial infection and develops vaginal candidiasis. The prescriber orders ketoconazole to treat the superinfection. What will the nurse do? a. Administer the erythromycin and the ketoconazole as ordered. b. Contact the provider to discuss changing to a different antifungal medication. c. Contact the provider to discuss increasing the dose of erythromycin. d. Contact the provider to suggest using erythromycin stearate.

11. A patient who has scabies is treated with permethrin 5% cream. The patient calls the nurse 1 week after treatment to report continued intense itching. What will the nurse tell this patient? a. "This is a hypersensitivity reaction to the permethrin." b. "This is the body's normal response to the scabies mites." c. "You will need a second treatment of the permethrin." d. "You will need to take ivermectin to clear up the infestation."

11. A patient will begin taking phentermine and topiramate [Osymia] to help with weight loss and asks the nurse why the second ingredient is necessary. Which is the correct response by the nurse? a. "Topiramate helps reduce the risk of seizures that can occur with phentermine." b. "Topiramate helps produce feelings of satiety to augment the drug effects." c. "Topiramate increases the appetite suppression caused by phentermine." d. "Topiramate increases the rate of weight loss by acting as a stimulant."

12. A hospitalized patient with cancer is receiving chemotherapy and reports oral pain. Inspection of this patient's oral mucosa reveals erythema and inflammation without denudation or ulceration. The nurse understands that: a. chemotherapy will have to be stopped until healing of the oral mucosa occurs. b. the patient can use a mouthwash with a topical anesthetic to control pain. c. the patient will need an antifungal agent to treat Candida albicans. d. the patient will need systemic opioids to control discomfort.

12. A patient has been taking phentermine and topiramate [Osymia] for 6 months for weight loss. The nurse weighs the patient and notes a 3% weight loss since beginning the drug. The nurse will expect the prescriber to: a. continue the current dosage for 4 more weeks. b. discontinue the drug. c. increase the drug dosage. d. switch to another nonamphetamine agent.

12. A patient is receiving intravenous voriconazole [Vfend]. Shortly after the infusion starts, the patient tells the nurse, "Colors look different, and the light hurts my eyes." What will the nurse do? a. Observe the patient closely for the development of hallucinations. b. Reassure the patient that these effects will subside in about 30 minutes. c. Stop the infusion and notify the provider of CNS toxicity. d. Tell the patient that this is an irreversible effect of the drug.

12. The nurse is preparing to discharge a patient with HIV who will continue to take enfuvirtide [Fuzeon] at home. The nurse is providing patient education about the medication. What information about the administration of enfuvirtide is most appropriate for the patient? a. The importance of injecting the drug into two alternating sites daily b. How to reconstitute and self-administer a subcutaneous injection c. The importance of taking the drug with high doses of vitamin E d. Likely drug interactions between enfuvirtide and other antiretroviral drugs

13. A nurse is teaching a group of nursing students about influenza prevention. Which statement by a student indicates understanding of the teaching? a. "I may develop a mild case of influenza if I receive the vaccine by injection." b. "I should receive the vaccine every year in October or November." c. "If I have a cold I should postpone getting the vaccine." d. "The antiviral medications are as effective as the flu vaccine for preventing the flu."

13. The nurse is caring for a patient who has been receiving vinorelbine [Navelbine] for about 5 days. Which assessment finding in this patient would cause the nurse to withhold the next dose and notify the prescriber? a. Alopecia b. Dyspnea and cough c. Neutrophil count of 1200/mm3 d. Peripheral neuropathy

13. The nurse is preparing to administer a first dose of ado-trastuzumab emtansine [Kadcycla] to a patient who has metastatic breast cancer. Which nursing action is correct? a. Administer a test dose with an antihistamine. b. Ensure that the patient has HER2-positive disease. c. Infuse the initial dose over 30 to 45 minutes. d. Review renal function tests.

14. A nursing student asks a nurse about the recommendations for vitamin supplements to prevent cancer. Which statement by the student indicates a need for further teaching? a. "Foods rich in antioxidant vitamins may confer protection by other means." b. "Observational studies provide clear proof that some antioxidants reduce the risk of cancer." c. "Randomized controlled studies have not demonstrated cancer prevention benefits." d. "Some vitamins have an increased cancer risk associated with too low and too high amounts."

14. A patient has a positive test for influenza type A and tells the nurse that symptoms began 5 days before being tested. The prescriber has ordered oseltamivir [Tamiflu]. The nurse will tell the patient that oseltamivir: a. may decrease symptom duration by 2 or 3 days. b. may not be effective because of the delay in starting treatment. c. may reduce the severity but not the duration of symptoms. d. will alleviate symptoms within 24 hours of the start of therapy.

14. A patient is about to begin treatment for latent tuberculosis with a short course of daily rifampin. The patient asks why rifapentine [Priftin] cannot be used, because it can be given twice weekly. What will the nurse tell this patient about rifapentine? a. It is more toxic than rifampin. b. It is not approved for treatment of latent TB. c. It is not well absorbed and thus not as effective. d. It will stain contact lenses orange.

14. A patient who has leukemia is receiving chemotherapy and develops severe anemia. The provider has ordered hospitalization and blood transfusions. The patient asks the nurse about using erythropoietin (epoetin alfa) instead. What will the nurse tell this patient? a. "Ask your provider about ordering erythropoietin instead of a transfusion." b. "Erythropoietin (epoetin alfa) can make your leukemia worse." c. "Erythropoietin is used to prolong life in patients with myeloid malignancies." d. "You will probably receive erythropoietin along with the transfusion."

14. A patient who is taking ketoconazole tells the nurse that her periods have become irregular. What will the nurse tell her? a. This indicates that she should begin taking oral contraceptives. b. This is caused by a reversible effect on estradiol synthesis. c. This is a serious side effect that warrants discontinuation of the drug. d. This is a sign of hepatic toxicity, and the drug dose should be lowered.

15. A nurse is preparing to administer a dose of gentamicin to a patient who is receiving the drug 3 times daily. The nurse will monitor ____ levels. a. peak b. peak and trough c. serum drug d. trough

17. A nurse is teaching a nursing student about dalfopristin/quinupristin [Synercid]. Which statement by the student indicates an understanding of the teaching? a. "Patients should stop taking the drug if they experience joint and muscle pain." b. "Patients taking this drug should have blood tests performed frequently." c. "Patients who are allergic to penicillin should not take this drug." d. "This drug will be administered intravenously over a 30- to 60-minute period."

17. A patient is receiving fluorouracil [Adrucil] as a continuous intravenous dose to treat a solid tumor. The patient reports soreness and blisters in the mouth, loose stools, and tingling of the hands and feet. What will the nurse do? a. Contact the provider to discuss bolus dosing instead of continuous dosing. b. Discontinue the medication and contact the provider to report these symptoms. c. Reassure the patient that these are expected, uncomfortable side effects. d. Request an order for dexamethasone to treat these side effects.

18. A patient who has urinary bladder cancer will begin receiving the chemotherapeutic agent valrubicin [Valstar]. What will the nurse do when administering this drug? a. Administer the drug intravenously using a large bore needle and tubing. b. Ensure that the tubing used to administer the drug does not contain polyvinyl chloride. c. Monitor the patient closely for a variety of systemic drug adverse effects. d. Use a normal saline or sterile water diluent to dilute the medication.

19. A patient with severe community-acquired pneumonia has been prescribed telithromycin [Ketek]. Which aspect of the patient's medical history is of concern to the nurse? a. Anemia b. Myasthenia gravis c. Renal disease d. Strep. pneumoniae infection

2. A nurse is caring for a patient who is receiving amphotericin B [Abelcet] for a systemic fungal infection. In spite of receiving diphenhydramine and acetaminophen before initiation of treatment, the patient has fever and chills with rigors. The nurse will contact the provider to discuss the addition of which drug? a. Aspirin b. Dantrolene c. Hydrocortisone d. Omeprazole

2. A nursing student asks a nurse what the NMBER system that rates dietary supplements means. The nurse responds that the NMBER system: a. describes the chemistry, toxicology, pharmacology, and uses of supplements. b. helps consumers evaluate the safety and efficacy of products. c. provides free information about clinical trials and epidemiologic studies of products. d. provides funding for research on complementary and alternative medicine.

2. The nurse provides teaching for a patient who will begin taking bosentan [Tracleer] for pulmonary arterial hypertension (PAH). Which statement by the patient indicates a need for further teaching about this medication? a. "I may take this medication with or without food." b. "I may develop irreversible liver damage while taking this drug." c. "I should not take cyclosporine while taking this medication." d. "I will need to have lab tests every month while taking this drug."

3. A 45-year-old patient with a family history of breast cancer is considering using tamoxifen [Nolvadex] for cancer prevention. The nurse performs a health history and learns that the woman had a child when she was 35 years old, that she has not had a hysterectomy, and that she experienced DVT when she was pregnant. What will the nurse tell the patient? a. Because of her family risk and late childbearing, this drug is a good choice for her. b. Her history of DVT outweighs any possible benefits she may have with this drug. c. Since she has not had a hysterectomy, the risk of endometrial cancer is too great. d. When she turns 50 years old, this drug will carry fewer risks for her.

3. A nurse assisting a nursing student with medications asks the student to describe how penicillins (PCNs) work to treat bacterial infections. The student is correct in responding that penicillins: a. disinhibit transpeptidases. b. disrupt bacterial cell wall synthesis. c. inhibit autolysins. d. inhibit host cell wall function.

3. A patient is receiving chemotherapy. Seven days after a dose, the patient's neutrophil count is 1000 cells/mm3. The nurse will tell this patient: a. that hospitalization is necessary to provide infection prophylaxis. b. that the provider will probably repeat the lab work in 3 to 5 days. c. to ask the provider about skipping the next dose of chemotherapy. d. to report any symptoms such as pus, abscesses, or cough.

3. A patient will receive oral ciprofloxacin [Cipro] to treat a urinary tract infection. The nurse provides teaching for this patient. Which statement by the patient indicates a need for further teaching? a. "I may have abdominal pain and nausea, but these are usually mild." b. "I should take this medication with food or milk to improve absorption." c. "I should stop taking the medication immediately if I experience heel pain." d. "I will need to use sunscreen every time I go outdoors."

3. A woman complains of burning on urination and increased frequency. The patient has a history of frequent urinary tract infections (UTIs) and is going out of town in 2 days. To treat the infection quickly, the nurse would expect the healthcare provider to order: a. aztreonam [Azactam]. b. fosfomycin [Monurol]. c. trimethoprim/sulfamethoxazole [Bactrim]. d. vancomycin [Vancocin].

4. A nurse is discussing adenosine with a nursing student. Which statement by the student indicates a need for further teaching? a. "Adenosine acts by suppressing action potentials in the SA and AV nodes." b. "Adenosine can be used to prevent paroxysmal supraventricular tachycardia and Wolff-Parkinson-White syndrome." c. "Adenosine has a half-life that lasts only a few seconds and must be given intravenously." d. "Adenosine is not effective for treating atrial fibrillation, atrial flutter, or ventricular dysrhythmias."

4. A nurse is performing a preoperative drug history on a patient who is admitted to the hospital for surgery. To evaluate the risk of hemorrhage, the nurse will ask the patient about antiplatelet and anticoagulant medications as well as which dietary supplement? a. Coenzyme Q-10 b. Ginkgo biloba c. Ma Huang (ephedra) d. St. John's wort

4. A nurse is teaching a nursing student what is meant by "generations" of cephalosporins. Which statement by the student indicates understanding of the teaching? a. "Cephalosporins are assigned to generations based on their relative costs to administer." b. "Cephalosporins have increased activity against gram-negative bacteria with each generation." c. "First-generation cephalosporins have better penetration of the cerebrospinal fluid." d. "Later generations of cephalosporins have lower resistance to destruction by beta-lactamases."

4. A patient is diagnosed with periodontal disease, and the provider orders oral doxycycline [Periostat]. The patient asks the purpose of the drug. What is the nurse's response? a. "It is used because of its anti-inflammatory effects." b. "It inhibits collagenase to protect connective tissue in the gums." c. "It reduces bleeding and the pocket depth of oral lesions." d. "It suppresses bacterial growth in the oral mucosa."

4. A patient taking stavudine [Zerit] telephones the clinic and reports numbness and tingling in the hands and feet. What should the nurse tell the patient? a. The numbness is an expected side effect of the medication and will diminish once the drug is withdrawn. b. The medication will probably be stopped, and the patient should come into the clinic for further evaluation. c. The dose may be too high, and the patient should cut the tablet in half. d. The patient should take the medication on a full stomach to reduce absorption of the drug.

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

5. A nurse provides teaching to a patient who will begin taking oral cyclophosphamide to treat non-Hodgkin's lymphoma. Which statement by the patient indicates an understanding about how to minimize side effects while taking this drug? a. "I don't need to worry about bone marrow suppression with this drug." b. "I should drink plenty of fluids while taking this drug." c. "I should take this drug on an empty stomach." d. "If I shampoo less often, I can prevent hair loss."

5. An adolescent patient with mild cervicitis is diagnosed with gonorrhea. The nurse will expect the provider to order which drug(s)? a. Azithromycin [Zithromax], 1 gm PO once, and doxycycline [Vibramycin], 100 mg PO twice daily for 7 days b. Ceftriaxone [Rocephin], 250 mg IM once, and azithromycin [Zithromax], 1 gm PO once c. Ceftriaxone [Rocephin], 125 mg IM once d. Doxycycline [Vibramycin], 100 mg IV twice daily for 12 days

5. The nurse is caring for a patient in the oncology unit who was recently diagnosed with advanced renal carcinoma. The nurse prepares to administer aldesleukin [Proleukin] as part of the treatment regimen. What is the primary adverse effect of this drug? a. Hypertension b. Capillary leakage syndrome c. Hyperglycemia d. Hyperuricemia

6. A member of a community disaster response team received the smallpox vaccine 3 weeks ago and sees a nurse for a follow-up appointment. The nurse examines the area and should expect to see a: a. necrotic vesicle. b. small area of scarification. c. small, fluid-filled blister. d. red bump.

6. A patient has a positive test for hepatitis C and is admitted to the hospital. The admission laboratory tests reveal a normal ALT, and a liver biopsy is negative for hepatic fibrosis and inflammation. The nurse will prepare this patient for: a. dual therapy with pegylated interferon alfa and ribavirin. b. no medication therapy at this time. c. pegylated interferon alfa only until ALT levels are elevated. d. triple drug therapy with pegylated interferon alfa, ribavirin, and boceprevir.

6. A patient has a viral sinus infection, and the provider tells the patient that antibiotics will not be prescribed. The patient wants to take an antibiotic and asks the nurse what possible harm could occur by taking an antibiotic. Which response by the nurse is correct? a. "Antibiotics are mutagenic and can produce changes that cause resistance." b. "Even normal flora can develop resistance and transfer this to pathogens." c. "Host cells become resistant to antibiotics with repeated use." d. "Patients who overuse antibiotics are more likely to have nosocomial infections."

6. A patient who has received a prescription for orlistat [Xenical] for weight loss asks the nurse how the drug works. The nurse will tell the patient that orlistat works by: a. altering how the body stores energy. b. reducing the body's absorption of fats. c. increasing the body's metabolic rate. d. suppressing the appetite.

6. A patient will begin taking immunosuppressant drugs for rheumatoid arthritis. The nurse will caution this patient to avoid which dietary supplement? a. Black cohosh b. Echinacea c. Feverfew d. Glucosamine

6. A patient will begin taking tamoxifen [Nolvadex] to treat breast cancer. The nurse performs a medication history and learns that the patient is taking sertraline [Zoloft] for depression. The nurse will tell the patient to contact her provider to ask about: a. increasing her dose of sertraline. b. changing from sertraline to escitalopram [Lexapro]. c. switching from sertraline to fluoxetine [Prozac]. d. decreasing her dose of tamoxifen.

6. The nurse is performing a physical assessment on a patient who is receiving treatment with abacavir, zidovudine, and lamivudine [Trizivir]. The patient complains of fatigue. Upon further assessment, the nurse finds a rash and notes that the patient has a temperature of 101.1°F. What is the nurse's best course of action? a. Tell the patient that this is an expected response to these medications and to continue the agents as prescribed. b. Have the patient hold the medications and arrange for an immediate evaluation by the prescriber. c. Have the patient continue the abacavir but discontinue the other two agents for 3 weeks. d. Instruct the patient to continue all three medications and administer an antihistamine for the symptoms.

7. A patient comes to a clinic for tuberculosis medications 2 weeks after beginning treatment with a four-drug induction phase. The patient's sputum culture remains positive, and no drug resistance is noted. At this point, the nurse will expect the provider to: a. change the regimen to a two-drug continuation phase. b. continue the four-drug regimen and recheck the sputum in 2 weeks. c. obtain a chest radiograph and consider adding another drug to the regimen. d. question the patient about adherence to the drug regimen.

8. A nurse performing an admission history on a patient learns that the patient is taking orlistat [Xenical], warfarin [Coumadin], and levothyroxine [Synthroid]. What will the nurse do? a. Contact the provider to discuss increasing the warfarin dose. b. Give the levothyroxine at least 4 hours before giving the orlistat. c. Suggest that the patient avoid fatty foods while taking these medications. d. Tell the patient to take the orlistat on an empty stomach.

8. A patient who has been taking gentamicin for 5 days reports a headache and dizziness. What will the nurse do? a. Request an order for a gentamicin peak level. b. Suspect ototoxicity and notify the prescriber. c. Tell the patient to ask for help with ambulation. d. Tell the patient to report any tinnitus.

8. A patient with a history of congestive heart failure and renal impairment has esophageal candidiasis. Which antifungal agent would the nurse anticipate giving to this patient? a. Amphotericin B [Abelcet] b. Fluconazole [Diflucan] c. Itraconazole [Sporanox] d. Voriconazole [Vfend]

8. A prescriber has ordered deferasirox [Exjade] to treat iron overload associated with chronic blood transfusions. The nurse learns that the patient takes cholestyramine to reduce cholesterol. The nurse will contact the provider to request an order to: a. increase the cholestyramine dose. b. increase the deferasirox dose. c. monitor cholesterol levels. d. monitor liver function tests.

8. The nurse is caring for a patient who is receiving vancomycin [Vancocin]. The nurse notes that the patient is experiencing flushing, rash, pruritus, and urticaria. The patient's heart rate is 120 beats per minute, and the blood pressure is 92/57 mm Hg. The nurse understands that these findings are consistent with: a. allergic reaction. b. red man syndrome. c. rhabdomyolysis. d. Stevens-Johnson syndrome.

8. Which patient should begin treatment for tuberculosis? a. A patient with HIV and a tuberculin skin test result of a 4-mm region of induration b. A recent immigrant from a country with a high prevalence of TB with a 10-mm region of induration c. A patient with no known risk factors who has a job-related tuberculin skin test result of a 12-mm area of induration d. An intravenous drug abuser with a tuberculin skin test result of a 5-mm region of induration

9. A nurse discusses ginger root with a pregnant patient who asks about the risks and benefits of using ginger root to treat morning sickness during pregnancy. Which statement by the patient indicates a need for further teaching? a. "Ginger root can cause GI disturbance in high doses." b. "Ginger root can decrease my risk of bleeding." c. "Ginger root is effective in treating morning sickness." d. "Ginger root may affect fetal sex hormones."

9. A patient admitted to the hospital is using metronidazole [Flagyl] 0.75% gel. The nurse understands that this agent is used to treat which condition? a. Chlamydia trachomatis b. Gardnerella vaginalis c. Haemophilus ducreyi d. Trichomonas vaginalis

9. A patient who takes the loop diuretic ethacrynic acid is given intravenous gentamicin for an infection. After several days of treatment with gentamicin, the nurse reviews the patient's most recent laboratory results and notes a gentamicin trough of 2.1 mcg/mL and normal blood urea nitrogen (BUN) and serum creatinine levels. The nurse will question the patient about: a. gastrointestinal (GI) symptoms. b. headache, dizziness, or vertigo. c. presence of rash. d. urine output.

9. A patient with advanced prostate cancer will begin treatment with leuprolide [Lupron]. The provider has ordered flutamide to be given as adjunct therapy. The patient asks the nurse why both drugs are necessary. The nurse will tell the patient that: a. flutamide reduces the side effects, such as hot flushes, caused by leuprolide. b. flutamide suppresses initial tumor flare caused by leuprolide. c. leuprolide helps to reduce the toxicity of flutamide. d. the combination of both drugs increases cancer survival.

9. A patient with cancer is taking rasburicase [Elitek] to treat hyperuricemia and develops neutropenia with fever and respiratory distress on the fourth day of treatment. The nurse caring for this patient will expect to: a. administer allopurinol instead of rasburicase. b. continue giving the drug and monitor the patient's symptoms closely. c. tell the patient that this drug should never be used again. d. tell the patient that these symptoms indicate severe sepsis.

9. A patient with severe allergic conjunctivitis who has been using cromolyn ophthalmic drops for 2 days calls the nurse to report persistence of the symptoms. When the nurse explains that it takes several weeks for maximum benefit to occur, the patient asks if there is something else to use in the meantime. The nurse will suggest that the patient discuss which drug with the provider? a. An ophthalmic demulcent b. H1-receptor antagonists c. Glucocorticoid drops d. Ocular decongestants

A nurse caring for a patient receiving heparin therapy notes that the patient has a heart rate of 98 beats per minute and a blood pressure of 110/72 mm Hg. The patient's fingertips are purplish in color. A stat CBC shows a platelet count of less than 100,000 mm3. The nurse will: a. administer oxygen and notify the provider. b. discontinue the heparin and notify the provider. c. request an order for protamine sulfate. d. request an order for vitamin K (phytonadione).

A nurse is caring for a patient in the intensive care unit who is receiving intravenous lidocaine. The patient is drowsy and confused and reports numbness of the fingers and toes. Which standing order will the nurse initiate at this time? a. Administer diazepam. b. Reduce the rate of infusion. c. Discontinue the infusion. d. Prepare for mechanical ventilation.

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

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

A nurse is explaining to a nursing student how clomiphene [Clomid] works to improve fertility. Which statement by the student indicates a need for further teaching? a. "Clomiphene blocks estrogen receptors to cause increased secretion of gonadotropins." b. "Clomiphene directly stimulates the ovary, causing follicular maturation and ovulation." c. "If follicular maturation is the only result of clomiphene therapy, human chorionic gonadotropin may be given." d. "If the pituitary gland cannot produce LH and FSH, clomiphene will not be effective."

A nurse is teaching a group of nursing students about irreversible cholinesterase inhibitors. Which statement by a student indicates understanding of the teaching? a. "Diazepam is given to reverse inhibition of cholinesterase when overdose occurs." b. "Irreversible cholinesterase inhibitors are rapidly absorbed by all routes." c. "These agents are often used to treat glaucoma." d. "Toxic doses of these agents produce an anticholinergic crisis."

A nurse is teaching a group of nursing students about the use of memantine [Namenda] for Alzheimer's disease. Which statement by a student indicates understanding of the teaching? a. "Memantine is indicated for patients with mild to moderate Alzheimer's disease." b. "Memantine modulates the effects of glu-tamate to alter calcium influx into neu-rons." c. "Memantine prevents calcium from leav-ing neurons, which improves their func-tion." d. "Memantine and donepezil combined may stop progression of Alzheimer's disease."

A nurse is teaching a patient about a drug that induces P-glycoprotein. The nurse will explain that this drug may cause which effect on other drugs? a. Decreased absorption in the intestines b. Decreased elimination through the kidneys c. Increased brain exposure d. Increased fetal absorption

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

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

A patient has been experiencing side effects with a combination oral contraceptive, and her provider has ordered a different combination product. The nurse will instruct the patient to do what? a. Begin taking the new product immediately. b. Change products at the beginning of her next cycle. c. Stop taking the old OC 1 week before starting the new OC. d. Use an alternate method of contraception for 1 month before starting the new OC.

A patient has heart failure and is taking an ACE inhibitor. The patient has developed fibrotic changes in the heart and vessels. The nurse expects the provider to order which medication to counter this development? a. Losartan b. Eplerenone c. metoprolol d.aliskiren

A patient has seasonal allergies and needs an antihistamine to control symptoms. The patient likes to have wine with dinner occasionally and wants to know which antihistamine will be the safest to take. The nurse will tell the patient to discuss which medication with the provider? a. Cetirizine [Zyrtec] b. Fexofenadine [Allegra] c. Levocetirizine [Xyzal] d. Loratadine [Claritin]

A patient has undergone a primary percutaneous coronary intervention with a stent placement. The provider has ordered a daily dose of 81 mg of aspirin and clopidogrel. The patient asks the nurse how long the medications must be taken. What will the nurse tell this patient about the medication regimen? a. This drug regimen will continue indefinitely. b. The clopidogrel will be discontinued in one year and the aspirin will be given indefinitely. c. The aspirin will be discontinued in one year and the clopidogrel will be given indefinitely. d. Both drugs will be discontinued in one year.

A patient is taking bismuth subsalicylate [Pepto-Bismol] to prevent diarrhea. The nurse performing an assessment notes that the patient's tongue is black. What will the nurse do? a. Assess further for signs of gastrointestinal (GI) bleeding. b. Reassure the patient that this is an expected side effect of this drug. c. Request an order for liver function tests to evaluate for hepatotoxicity. d. Withhold the drug, because this is a sign of bismuth overdose.

A patient is wheezing and short of breath. The nurse assesses a heart rate of 88 beats per minute, a respiratory rate of 24 breaths per minute, and a blood pressure of 124/78 mm Hg. The prescriber orders a nonspecific beta agonist medication. Besides evaluating the patient for a reduction in respiratory distress, the nurse will monitor for which side effect? a. Hypotension b. Tachycardia c. Tachypnea d. Urinary retention

A patient tells a nurse that antihistamines help relieve cold symptoms and wants to know why they are not recommended or prescribed for this purpose. The nurse tells the patient that antihistamines provide only mild relief from some cold symptoms by: a. anticholinergic properties that decrease rhinorrhea. b. blocking H1 receptors in nasal passages. c. reducing secretions at H2 receptor sites. d. having sedative effects, which help patients rest and sleep.

A patient tells a nurse that she is thinking about getting pregnant and asks about nutritional supplements. What will the nurse recommend? a. A balanced diet high in green vegetables and grains b. 400 to 800 mg of folic acid per day c. A multivitamin with iron d. Vitamin B12 supplements

A patient who experiences motion sickness is about to go on a cruise. The prescriber orders transdermal scopolamine [Transderm Scop]. The patient asks the nurse why an oral agent is not ordered. The nurse will explain that the transdermal preparation: a. can be applied as needed at the first sign of nausea. b. has less intense anticholinergic effects than the oral form. c. is less sedating than the oral preparation. d. provides direct effects, because it is placed close to the vestibular apparatus of the ear.

A patient who has diabetes mellitus is diagnosed with schizophrenia and the provider orders thioridazine. The patient asks the nurse why the provider hasn't ordered olanzapine [Zyprexa], which the patient has seen advertised on television. Which response by the nurse is the most important reason that this patient is not receiving olanzapine? a. "Olanzapine is more expensive than thior-idazine." b. "Olanzapine causes more metabolic side effects than thioridazine." c. "Thioridazine has fewer side effects than olanzapine." d. "Thioridazine has a faster onset of action than olanzapine."

A patient who has just learned she is pregnant has stopped using a prescription medication that she takes for asthma because she doesn't want to harm her baby. What will the nurse tell her? a. That asthma medications will not affect the fetus b. That her baby's health is dependent on hers c. To avoid taking medications during her pregnancy d. To resume the medication in her second trimester

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

A patient who is an alcoholic is prescribed disulfiram [Antabuse] to help prevent relapse and the nurse provides teaching about the use of this drug. Which statement by the patient indicates understanding of the teaching? a. "I may use alcohol in cooking since heating foods destroys the alcohol." b. "I should avoid shaving lotion and mouthwashes that contain even small amounts of alcohol." c. "If I decide to drink, I should stop taking the disulfiram at least one week prior to consuming alcohol." d. "If I use alcohol, the effects will be uncomfortable but are not dangerous."

A patient who is taking a first-generation antipsychotic (FGA) drug for schizophrenia comes to the clinic for evaluation. The nurse observes that the patient has a shuffling gait and mild tremors. The nurse will ask the patient's provider about which course of action? a. Administering a direct dopamine antago-nist b. Giving an anticholinergic medication c. Increasing the dose of the antipsychotic drug d. Switching to a second-generation antipsy-chotic drug

A patient will begin taking atorvastatin [Lipitor] to treat elevated LDL levels. The patient asks the nurse what to do to minimize the risk of myositis associated with taking this drug. What will the nurse counsel this patient? a. "Consume an increased amount of citrus fruits while taking this drug." b. "Take vitamin D and coenzyme Q supplements." c. "Ask your provider about adding a fibrate medication to your regimen." d. "Have your creatine kinase levels checked every 4 weeks."

A patient with angina who is taking ranolazine [Ranexa] has developed a respiratory infection and a dysrhythmia. The provider has ordered azithromycin [Zithromax] for the infection and amlodipine for the dysrhythmia. A nursing student caring for this patient tells the nurse that the patient's heart rate is 70 beats per minute, and the blood pressure is 128/80 mm Hg. The nurse asks the student to discuss the plan for this patient's care. Which action is correct? a. Observe the patient closely for signs of respiratory toxicity. b. Question the order for azithromycin [Zithromax]. c. Report the patient's increase in blood pressure to the provider. d. Request an order for a different calcium channel blocker.

A patient with bipolar disorder has frequent manic episodes alternating with depressive episodes. The prescriber orders risperidone [Risperdal] in addition to the lithium [Lithobid] that the patient is already taking. The patient asks the nurse why another drug is needed. The nurse will tell the patient that the risperidone is used to: a. elevate mood during depressive episodes. b. help control symptoms during manic epi-sodes. c. manage tremors associated with lithium use. d. prevent recurrence of depressive episodes.

A postoperative patient is being discharged home with acetaminophen/hydrocodone [Lortab] for pain. The patient asks the nurse about using Tylenol for fever. Which statement by the nurse is correct? a. "It is not safe to take over-the-counter drugs with prescription medications." b. "Taking the two medications together poses a risk of drug toxicity." c. "There are no known drug interactions, so this will be safe." d. "Tylenol and Lortab are different drugs, so there is no risk of overdose."

A postoperative patient reports pain, which the patient rates as an 8 on a scale from 1 to 10 (10 being the most extreme pain). The prescriber has ordered acetaminophen [Tylenol] 650 mg PO every 6 hours PRN pain. What will the nurse do? a. Ask the patient what medications have helped with pain in the past. b. Contact the provider to request a different analgesic medication. c. Give the pain medication and reposition the patient to promote comfort. d. Request an order to administer the medication every 4 hours.

A postoperative patient will begin anticoagulant therapy with rivaroxaban [Xarelto] after knee replacement surgery. The nurse performs a history and learns that the patient is taking erythromycin. The patient's creatinine clearance is 50 mL/min. The nurse will: a. administer the first dose of rivaroxaban as ordered. b. notify the provider to discuss changing the patient's antibiotic. c. request an order for a different anticoagulant medication. d. request an order to increase the dose of rivaroxaban.

A prescriber has ordered pilocarpine [Pilocar]. A nurse understands that the drug stimulates muscarinic receptors and would expect the drug to have which action? a. Reduction of excessive secretions in a postoperative patient b. Lowering of intraocular pressure in pa-tients with glaucoma c. Inhibition of muscular activity in the bladder d. Prevention of hypertensive crisis

A provider has ordered captopril [Capoten] for a patient who has hypertension. The patient reports a history of swelling of the tongue and lips after taking enalapril [Vasotec] in the past. Which action by the nurse is correct? a. Administer the captopril and monitor for adverse effects. b. Hold the dose and notify the provider. c. Request an order to administer fosinopril instead of captopril. d. Reassure the patient that this is not a serious side effect.

A woman who is breast-feeding her infant must take a prescription medication for 2 weeks. The medication is safe, but the patient wants to make sure her baby receives as little of the drug as possible. What will the nurse tell the patient to do? a. Give the baby formula as long as the mother is taking the medication b. Take the medication immediately after breast-feeding c. Pump breast milk and feed the baby by bottle d. Take the medication 1 hour before breast-feeding

An adult male patient will begin androgen therapy for testicular failure. Which statement by the patient indicates understanding of the treatment regimen? a. "I will need to have x-rays of my hands and feet every 6 months." b. "My libido may improve while I am taking this medication." c. "Taking this drug may lead to the development of prostate cancer." d. "This will restore fertility, so I can have a child."

The U.S. Food and Drug Administration (FDA) recommends genetic testing of patients receiving certain medications. Genetic testing helps prescribers: a. better establish a drug's therapeutic index. b. determine whether a patient is a rapid or slow metabolizer of the drug. c. identify racial characteristics that affect psychosocial variation in drug response. d. produce a drug that is tailored to an individual patient's genetic makeup.

The nurse is caring for a pregnant patient who is in labor. The woman reports having had mild preeclampsia with a previous pregnancy. The nurse notes that the woman has a blood pressure of 168/102 mm Hg. The nurse will contact the provider to request an order for which drug? a. Angiotensin-converting enzyme (ACE) inhibitor b. Hydralazine (Apresoline) c. Magnesium sulfate d. Sodium nitroprusside

The nurse is providing education to a patient with ulcerative colitis who is being treated with sulfasalazine [Azulfidine]. What statement by the patient best demonstrates understanding of the action of sulfasalazine? a. "It treats the infection that triggers the condition." b. "It reduces the inflammation." c. "It enhances the immune response." d. "It increases the reabsorption of fluid."

The nurse is providing patient education to a patient who will begin taking fludrocortisone [Florinef] as adjunctive therapy to hydrocortisone. Which statement by the patient indicates understanding of the teaching? a. "I should move from sitting to standing slowly." b. "I should report any swelling of my hands and feet." c. "I should report weight loss to my provider." d. "I should report excessive urine output."

The nurse knows that which immunosuppressants are among the most effective? a. Azathioprine [Imuran] and everolimus [Zortress] b. Cyclosporine [Sandimmune] and tacrolimus [Prograf] c. Methotrexate [Rheumatrex] and muromonab-CD3 [Orthoclone OKT3] d. Sirolimus [Rapamune] and methylprednisolone

Two nurses are discussing the major differences between physostigmine [Antilirium] and neostigmine [Prostigmin]. One nurse correctly makes which statement about physostigmine [Antilirium]? a. "It is not effective for treating poisoning by muscarinic blocking drugs." b. "It can readily cross the blood-brain barrier." c. "It does not cause any side effects." d. "It can be given by all routes."

What occurs when a drug binds to a receptor in the body? a. It alters the receptor to become nonresponsive to its usual endogenous molecules. b. It increases or decreases the activity of that receptor. c. It gives the receptor a new function. d. It prevents the action of the receptor by altering its response to chemical mediators.

. A pregnant patient is in premature labor. Which class of drug will she be given? a. Alpha1 agonist b. Anticholinergic c. Beta2 agonist d. Beta2 antagonist

1. A patient presents to the emergency department with complaints of chills, severe flank pain, dysuria, and urinary frequency. The patient has a temperature of 102.9°F, a pulse of 92 beats per minute, respirations of 24 breaths per minute, and a blood pressure of 119/58 mm Hg. The nurse would be correct to suspect that the patient shows signs and symptoms of: a. acute cystitis. b. urinary tract infection. c. pyelonephritis. d. prostatitis.

1. A patient reported to have been exposed to mustard gas is brought to the emergency department. The patient's skin is red and swollen with small blisters, and the patient's eyes are red and tearing. The patient has a runny nose and a dry, barking cough. What should the nurse's initial action be? a. Prepare for renal dialysis. b. Provide oxygen and prepare for mechanical ventilation. c. Remove the patient's clothing and clean the skin with soap and water. d. Rush the patient to the intensive care unit for cardiorespiratory monitoring.

1. A patient who is receiving a final dose of intravenous (IV) cephalosporin begins to complain of pain and irritation at the infusion site. The nurse observes signs of redness at the IV insertion site and along the vein. What is the nurse's priority action? a. Apply warm packs to the arm, and infuse the medication at a slower rate. b. Continue the infusion while elevating the arm. c. Select an alternate intravenous site and administer the infusion more slowly. d. Request central venous access.

1. The nurse is caring for a patient who is human immunodeficiency virus (HIV) positive and is taking high doses of zidovudine [Retrovir]. The nurse is providing patient education about the adverse effects of the medication. Which statement by the patient demonstrates a need for further teaching? a. "I may experience fatigue from anemia." b. "I may be more susceptible to infection from neutropenia." c. "I may have a deficiency of vitamin B6." d. "I may have a deficiency of folic acid."

1. The nurse wants to evaluate a nursing student's understanding of chemotherapy. The nurse asks, "Which factor would be a major obstacle to successful chemotherapy?" What is the student's best response? a. "The patient's reluctance about the doses administered." b. "The patient's degree of nausea." c. "The toxicity of anticancer drugs to normal tissues." d. "The difficulty attaining and maintaining venous access."

10. A parent has been instructed to apply a combination product of pyrethrins with piperonyl butoxide [RID] to treat head lice in a child. The parent asks the nurse why it is necessary to repeat the application in 9 days. The nurse will respond by telling the parent that: a. a second treatment helps combat medication resistance. b. the dose needed to kill lice is too toxic to use all at once. c. the combination is active only against adult lice and not ova. d. the second dose helps rid the hair of nits and ova.

10. The nurse is caring for a patient who is receiving an infusion of botulinum antitoxin after consuming botulinum toxin in contaminated food. The patient has developed double vision, slurred speech, and upper body muscle weakness. The patient's spouse asks the nurse what the antitoxin will do. Which response is correct? a. "The antitoxin is an antidote to the botulinum toxin." b. "This medication helps restore strength in weakened muscles." c. "This infusion will help prevent further nerve damage." d. "The antitoxin will reverse the symptoms within a couple of days."

10. The nurse is caring for a patient who is taking a protease inhibitor (PI). Upon review of the laboratory test results, the nurse notes that the patient has newly elevated plasma triglycerides and cholesterol. The nurse expects that the prescriber will manage these levels with: a. lovastatin [Mevacor]. b. simvastatin [Zocor]. c. modified diet and exercise. d. Pancrease.

11. A nursing student asks a nurse how cancer cells become resistant to methotrexate [Rheumatrex]. The nurse is correct to respond by saying that cancer cells acquire resistance to methotrexate by: a. reduced production of transporter that pumps methotrexate out of cells. b. reduced synthesis of dihydrofolate reductase. c. reduced uptake of methotrexate into cells. d. increased ability to convert the drug to a polyglutamated form.

11. A patient has been taking isoniazid [Nydrazid] for 4 months for latent tuberculosis. The patient reports bilateral tingling and numbness of the hands and feet, as well as feeling clumsy. The nurse expects the provider to: a. discontinue the isoniazid. b. lower the isoniazid dose and add rifampin. c. order pyridoxine 100 mg per day. d. recheck the tuberculin skin test to see whether it worsens.

11. A patient shows signs and symptoms of conjunctivitis. Which aminoglycoside would the nurse expect to be ordered? a. Amikacin [Amikin] b. Kanamycin [Kantrex] c. Neomycin [Neomycin] d. Paromomycin [Humatin]

11. A patient with an infection caused by Pseudomonas aeruginosa is being treated with piperacillin. The nurse providing care reviews the patient's laboratory reports and notes that the patient's blood urea nitrogen and serum creatinine levels are elevated. The nurse will contact the provider to discuss: a. adding an aminoglycoside. b. changing to penicillin G. c. reducing the dose of piperacillin. d. ordering nafcillin.

11. Which B vitamin deficiency is associated with cheilosis, glossitis, vascularization of the cornea, and itchy dermatitis of the scrotum and vulva? a. Niacin (nicotinic acid) b. Pyridoxine (vitamin B6) c. Riboflavin (vitamin B2) d. Thiamine (vitamin B1)

12. A nurse is caring for a patient who takes an ACE inhibitor and an ARB medication who will begin taking TMP/SMZ to treat a urinary tract infection. Which serum electrolyte will the nurse expect to monitor closely? a. Calcium b. Chloride c. Potassium d. Sodium

12. A patient who is known to be a heavy drinker is brought to the emergency department with ataxia and confusion. The patient cannot remember the events of the previous day. The examination reveals nystagmus, and the patient reports having double vision. The nurse will expect to administer which vitamin to this patient? a. Ascorbic acid (vitamin C) IV b. Intramuscular pyridoxine (vitamin B6) c. Intravenous thiamine (vitamin B1) d. Nicotinic acid (niacin) PO

13. A nurse is preparing to administer intramuscular penicillin to a patient who is infected with T. pallidum and notes that the order is for sodium penicillin G. Which action is correct? a. Administer the drug as prescribed. b. Contact the provider to discuss administering the drug intravenously. c. Contact the provider to discuss changing the drug to benzathine penicillin G. d. Request an order for piperacillin instead of penicillin G.

13. A patient received 500 mg of azithromycin [Zithromax] at 0800 as a first dose. What are the usual amount and time of the second dose of azithromycin? a. 250 mg at 2000 the same day b. 500 mg at 2000 the same day c. 250 mg at 0800 the next day d. 500 mg at 0800 the next day

13. The parent of a 5-year-old child who has had four urinary tract infections in the past year asks the nurse why the provider doesn't just order an antibiotic for the child's current symptoms of low-grade fever, flank pain, and dysuria since these are similar symptoms as before. Which is the most important reason given by the nurse? a. "Your child may need to be hospitalized for treatment." b. "Your child may need a urine culture before and after treatment." c. "Your child may need tests to assess for urinary tract abnormalities." d. "Your child may need additional medications, such as urinary tract antiseptics."

14. The nurse on an oncology unit prepares to administer the fourth cycle of docetaxel [Taxotere] to a patient with breast cancer. Which clinical finding would cause the nurse to withhold the dose and call the prescriber? a. Alanine transaminase (ALT) 1.2 times the upper limit b. Alkaline phosphatase 2 times the upper limit c. Neutrophil count below 1500/mm3 d. Creatinine clearance of 130 mL/min/1.73 m2

15. An immunocompromised child is exposed to chickenpox and the provider orders valacyclovir [Valtrex] to be given orally three times daily. The nurse will contact the provider to change this order for which reason? a. Valacyclovir is not used as varicella prophylaxis. b. The dosage is too high for this indication. c. The drug may cause serious adverse effects in immunocompromised patients. d. Valacyclovir is not approved for use in children.

16. A patient is receiving tobramycin 3 times daily. The provider has ordered a trough level with the 8:00 AM dose. The nurse will ensure that the level is drawn at what time? a. 4:00 AM b. 7:00 AM c. 7:45 AM d. 8:45 AM

16. A patient who has been taking linezolid [Zyvox] for 6 months develops vision problems. What will the nurse do? a. Reassure the patient that this is a harmless side effect of this drug. b. Tell the patient that blindness is likely to occur with this drug. c. Tell the patient that this symptom is reversible when the drug is discontinued. d. Tell the patient to take tyramine supplements to minimize this effect.

16. A patient will begin taking an immunosuppressant medication. The nurse learns that the patient has a history of frequent candidal infections. The nurse will expect the provider to order which drug as prophylaxis? a. Fluconazole [Diflucan] b. Ketoconazole c. Posaconazole [Noxafil] d. Voriconazole [Vfend]

17. A nursing student asks a nurse about flucytosine [Ancobon]. Which statement by the nurse is correct? a. "Flucytosine has a broad antifungal spectrum." b. "Irreversible neutropenia and thrombocytopenia may occur with this drug." c. "Resistance is common with this medication." d. "Severe hepatic injury is common and limits this drug's use."

19. A child has ringworm of the scalp. A culture of the lesion reveals a dermatophytic infection. The nurse teaching the child's parents about how to treat this infection will include which statement? a. "Adverse effects of the medication include itching, burning, and erythema." b. "Apply the topical medication daily until at least 1 week after the rash is gone." c. "Your child will need to take this oral medication for 6 to 8 weeks." d. "You will use an antifungal shampoo to treat this infection."

2. A patient is brought to the emergency department after ingestion of an unknown substance. The patient has been vomiting and complains of abdominal pain. The nurse observes that the patient's oral mucous membranes are dry, the heart rate is 88 beats per minute, and the blood pressure is 90/60 mm Hg. The nurse will prepare to initially: a. administer an antiemetic. b. give activated charcoal. c. infuse normal saline as an IV bolus. d. obtain blood for toxicology testing.

2. A patient who is pregnant has a history of recurrent genital herpesvirus (HSV). The patient asks the nurse what will be done to suppress an outbreak when she is near term. The nurse will tell the patient that: a. antiviral medications are not safe during pregnancy. b. intravenous antiviral agents will be used if an outbreak occurs. c. oral acyclovir [Zovirax] may be used during pregnancy. d. topical acyclovir [Zovirax] must be used to control outbreaks.

2. A patient who is taking immunosuppressant medications develops a urinary tract infection. The causative organism is sensitive to sulfonamides and to another, more expensive antibiotic. The prescriber orders the more expensive antibiotic. The nursing student assigned to this patient asks the nurse why the more expensive antibiotic is being used. Which response by the nurse is correct? a. "Immunosuppressed patients are folate deficient." b. "Patients who are immunosuppressed are more likely to develop resistance." c. "Sulfonamides are bacteriostatic and depend on host immunity to work." d. "Sulfonamides intensify the effects of immunosuppression."

20. A patient will begin treatment with posaconazole [Noxafil] to treat oropharyngeal candidiasis that has not responded to fluconazole. The provider has ordered 200 mg three times daily. Which action by the nurse is correct? a. Administer the drug as ordered. b. Contact the provider to discuss decreasing the dose to twice daily. c. Discuss a 400-mg twice daily drug regimen with the provider. d. Suggest to the provider that this dose may be too high for this indication.

3. A nurse administers timolol [Timoptic] ophthalmic drops to a patient who has glaucoma. The patient reports stinging of the eyes shortly after the drops were administered. What will the nurse do? a. Monitor the patient's heart rate, respiratory rate, and blood pressure. b. Notify the provider that the patient shows signs of angle-closure glaucoma. c. Reassure the patient that these are localized, reversible effects of the drug. d. Request an order for an antihistamine to treat this allergic response to the drug.

3. A nurse is counseling a group of patients who are beginning a weight-loss diet. The nurse discusses the role of exercise in weight management. Which statement by a patient indicates a need for further teaching? a. "Exercise has a greater role in weight-loss maintenance than in weight loss itself." b. "Exercise helps by reducing abdominal fat and improving cardiovascular fitness." c. "Once I lose weight, I can reduce the amount of time per week I exercise." d. "I should begin with at least 30 minutes of exercise per day, 5 days per week."

3. A nurse is reviewing the culture results of a patient receiving an aminoglycoside. The report reveals an anaerobic organism as the cause of infection. What will the nurse do? a. Contact the provider to discuss an increased risk of aminoglycoside toxicity. b. Continue giving the aminoglycoside as ordered. c. Request an order for a different class of antibiotic. d. Suggest adding a penicillin to the patient's drug regimen.

3. A nurse responds when a patient asks why the smallpox vaccine is no longer given. Which statement by the patient indicates a need for further teaching? a. "The smallpox vaccine can cause serious side effects." b. "The smallpox vaccine can confer protection when given after exposure." c. "The smallpox vaccine is too expensive to give routinely." d. "The smallpox vaccine may cause live virus to spread to others."

3. A patient recently began receiving clindamycin [Cleocin] to treat an infection. After 8 days of treatment, the patient reports having 10 to 15 watery stools per day. What will the nurse tell this patient? a. The provider may increase the clindamycin dose to treat this infection. b. This is a known side effect of clindamycin, and the patient should consume extra fluids. c. The patient should stop taking the clindamycin now and contact the provider immediately. d. The patient should try taking Lomotil or a bulk laxative to minimize the diarrheal symptoms.

3. A patient with a history of heart disease develops pulmonary arterial hypertension (PAH), and the provider is considering prescribing sildenafil [Revatio]. The nurse caring for this patient will perform a careful drug history and notify the provider if the patient is taking which medication? a. A beta blocker b. A calcium channel blocker c. Nitroglycerin d. Warfarin

3. A public health nurse visits with the parents of a child who has body lice. It is most important that the nurse tell the parents that: a. body lice are transmitted by direct person-to-person contact. b. treatment of skin surfaces will eradicate the infestation. c. all clothing and bedding must be disinfected. d. lice burrow into the body, and vigorous scrubbing is required to remove them.

3. The nurse is teaching a nursing student about the mechanism by which antimicrobial agents achieve selective toxicity. Which statement by the student indicates a need for further teaching? a. "Some agents disrupt the bacterial cell wall." b. "Some agents act to block the conversion of para-aminobenzoic acid (PABA) to folic acid." c. "Some agents cause phagocytosis of bacterial cells." d. "Some agents weaken the cell wall, causing cell wall lysis."

4. A child has received amoxicillin [Amoxil] for three previous ear infections, but a current otitis media episode is not responding to treatment. The nurse caring for this child suspects that resistance to the bacterial agent has occurred by which microbial mechanism? a. Alteration of drug target molecules b. Antagonist production c. Drug inactivation d. Reduction of drug concentration at the site of action

4. A group of people has been exposed to ricin by inhalation of ricin mist. When preparing to receive these victims in the emergency department, nurses will prepare to: a. administer antidotes. b. give chelating agents. c. provide respiratory support. d. start hemodialysis.

4. A newborn infant has been given erythromycin ophthalmic ointment as a routine postpartum medication. The infant's mother learns that she has a C. trachomatis infection and asks the nurse if her baby will need to be treated. Which response by the nurse is correct? a. "The erythromycin ointment will prevent your baby from developing conjunctivitis." b. "Without additional treatment, your baby could develop blindness." c. "Your baby will need to be treated with oral erythromycin." d. "Your baby will need to take doxycycline [Vibramycin] for 10 days."

4. A nurse is teaching a group of nursing students how to examine children in a day care center for pediculus humanus capitis (head lice). Which statement by a student indicates understanding of this teaching? a. "Adult lice are easily visible on the hair shaft." b. "Children from lower socioeconomic families are more likely to have lice." c. "I may observe hives, boils, and impetigo on the child's scalp if lice are present." d. "I should be careful to prevent the lice from jumping into my hair."

4. A nurse provides teaching for a patient with cytomegalovirus (CMV) retinitis who will receive the ganciclovir ocular implant [Vitrasert]. Which statement by the patient indicates a need for further teaching? a. "My vision may be blurred for 2 to 4 weeks after receiving the implant." b. "Surgical placement of the implant is an outpatient procedure." c. "The implant will remain in place permanently." d. "The implant will slow progression of CMV retinitis."

4. A patient is being treated with amphotericin B [Abelcet] for a systemic fungal infection. After several weeks of therapy, the provider orders flucytosine [Ancobon] in addition to the amphotericin. The nurse understands that the rationale for this combination is that it: a. broadens the antifungal spectrum. b. improves the effectiveness of the amphotericin B. c. lowers the dose of amphotericin B and reduces toxicity. d. treats fungal central nervous system (CNS) infection.

5. A nurse is discussing intravenous amphotericin B treatment with a nursing student who is about to care for a patient with a systemic fungal infection. Which statement by the student indicates a need for further teaching? a. "A test dose of amphotericin B may be given to assess the patient's reaction." b. "If I see any precipitate in the IV solution, I should stop the infusion immediately." c. "Infusions of amphotericin B should be administered over 1 to 2 hours." d. "The IV site should be rotated frequently to reduce the risk of phlebitis."

5. A nurse is teaching a patient who is about to begin drug therapy with orlistat [Xenical]. The patient, whose BMI is 28, has hypertension and type 2 diabetes mellitus. Which statement by the patient indicates understanding of the teaching? a. "Dark urine and light-colored stools are expected side effects with this drug." b. "I should stop taking this drug once my blood pressure and serum glucose have stabilized." c. "I will need to take a multivitamin containing fat-soluble vitamins every day." d. "If I have fatty or oily stools or fecal incontinence I should stop taking this drug."

5. A nursing student asks a nurse to clarify the differences between the mechanisms of spontaneous mutation and conjugation in acquired resistance of microbes. What will the nurse say? a. Conjugation results in a gradual increase in resistance. b. Conjugation results in random changes in the microbe's DNA. c. Spontaneous mutation leads to resistance to only one antimicrobial agent. d. Spontaneous mutation can transfer DNA from one organism to another.

5. A patient in her twenties has frequent urinary tract infections, and her prescriber suggests drinking cranberry juice. She asks the nurse how drinking this can help. The nurse will tell her that cranberry juice: a. acidifies the urine to slow the growth of the bacteria. b. helps treat established infections. c. prevents bacteria from adhering to the urinary tract wall. d. reduces the odor of the urine.

5. A patient with type 2 diabetes mellitus takes glipizide. The patient develops a urinary tract infection, and the prescriber orders TMP/SMZ. What will the nurse tell the patient? a. Patients with diabetes have an increased risk of an allergic reaction. b. Patients taking TMP/SMZ may need increased doses of glipizide. c. The patient should check the blood glucose level more often while taking TMP/SMZ. d. The patient should stop taking the glipizide while taking the TMP/SMZ.

5. To prevent yellow or brown discoloration of teeth in children, tetracyclines should not be given: a. to children once the permanent teeth have developed. b. to patients taking calcium supplements. c. to pregnant patients after the fourth month of gestation. d. with dairy products or antacids.

6. A 30-year-old male patient reports having two to four urinary tract infections a year. What will the nurse expect to teach this patient? a. "Make sure you void after intercourse and drink extra fluids to stay well hydrated." b. "We will treat each infection as a separate infection and treat with short-course therapy." c. "You will need to take a low dose of medication for 6 months to prevent infections." d. "You will need to take antibiotics for 4 to 6 weeks each time you have an infection."

6. A nurse explains to a patient with cancer why it is difficult to achieve 100% cell kill to cure cancer with chemotherapy. Which statement by the patient indicates a need for further teaching? a. "It is necessary to continue giving the same dose of chemotherapeutic agents throughout therapy, even if toxicity occurs." b. "Symptoms of cancer often disappear before all malignant cells are eradicated." c. "The immune system attacks chemotherapeutic agents and renders them impotent." d. "The immune system often fails to recognize cancer cells as foreign."

6. A nurse is discussing vesicant chemotherapeutic agents with a nursing student. Which statement by the student indicates a need for further teaching about this type of drug? a. "Extravasation of this type of drug may result in the need for skin grafts." b. "If an IV line used for a vesicant drug infiltrates, it must be discontinued immediately." c. "These drugs may be administered orally as well as intravenously." d. "This type of drug may not be infused at a site of previous irradiation."

6. A nurse is teaching a patient who will begin using a fixed-dose preparation of dorzolamide and timolol [Cosopt] for open-angle glaucoma. Which statement by the patient indicates a need for further teaching? a. "Blurred vision, tearing, or eye dryness may occur with this medication." b. "I may experience a bitter taste in my mouth after instilling these eye drops." c. "I will need to instill two eye drops 3 times daily in each eye." d. "If I notice redness in my eyes or eyelids, I should stop using these drops."

6. A patient has been taking narcotic analgesics for chronic pain for several months. The nurse caring for this patient notes that the prescribed dose is higher than the recommended dose. The patient has normal vital signs, is awake and alert, and reports mild pain. What does the nurse recognize about this patient? a. This patient exhibits a negative placebo effect with a reduced response to the drug. b. This patient has developed a reaction known as tachyphylaxis because of repeated exposure to the drug. c. This patient has developed pharmacodynamic tolerance, which has increased the minimal effective concentration (MEC) needed for analgesic effect. d. This patient produces higher than normal hepatic enzymes as a result of prolonged exposure to the drug.

6. A patient has completed treatment with lindane shampoo for pediculosis, but the infestation has not been eradicated. The patient asks the nurse about repeating the treatment. What will the nurse tell the patient? a. A second treatment may be administered in 2 to 4 weeks. b. Lindane continues to have residual effects for several weeks after treatment. c. Repeat use of this drug may cause serious side effects. d. The patient should ask the prescriber to order lindane cream for a second treatment.

6. A patient is diagnosed with pelvic inflammatory disease (PID). Which treatment regimen is most appropriate for reducing the risk of sterility in this patient? a. Azithromycin [Zithromax], 1 gm PO once, and cefoxitin, 2 gm IM once in the clinic b. Ceftriaxone [Rocephin], 250 mg IM once, with doxycycline [Vibramycin], 100 mg PO twice daily for 14 days as an outpatient c. Doxycycline [Vibramycin], 100 mg IV twice daily, and cefoxitin, 2 gm IV every 6 hours in the hospital d. Doxycycline [Vibramycin], 100 mg PO twice daily for 14 days, and metronidazole [Flagyl], 500 mg PO twice daily for 14 days in the hospital

6. A patient is receiving intravenous potassium penicillin G, 2 million units to be administered over 1 hour. At 1900, the nurse notes that the dose hung at 1830 has infused completely. What will the nurse do? a. Assess the skin at the infusion site for signs of tissue necrosis. b. Observe the patient closely for confusion and other neurotoxic effects. c. Request an order for serum electrolytes and cardiac monitoring. d. Watch the patient's actions and report any bizarre behaviors.

6. A patient is to begin taking doxycycline to treat a rickettsial infection. Which statement by the patient indicates a need for teaching about this drug? a. "I should consult my provider before using laxatives or antacids while taking this drug." b. "I should not take a calcium supplement or consume dairy products with this drug." c. "I should take this drug with food to ensure more complete absorption." d. "If I get diarrhea, I should stop taking the drug and let my provider know immediately."

6. A patient with second-degree burns is treated with silver sulfadiazine [Silvadene]. A nursing student asks the nurse about the differences between silver sulfadiazine and mafenide [Sulfamylon], because the two are similar products, and both contain sulfonamides. What does the nurse tell the student about silver sulfadiazine? a. It causes increased pain when the medication is applied. b. It has a broader spectrum of antimicrobial sensitivity. c. It has antibacterial effects related to release of free silver. d. It suppresses renal excretion of acid, causing acidosis.

7. A nurse is preparing to administer a second infusion of trastuzumab [Herceptin] to a patient who has breast cancer. The patient tells the nurse that she experienced chills, fever, pain, and nausea after her first infusion. What will the nurse do? a. Contact the provider to request a CBC to assess for neutropenia. b. Ensure that oxygen and respiratory support measures are readily available. c. Reassure the patient that these symptoms will diminish with each infusion. d. Request an order for an electrocardiogram.

7. A nurse is quizzing a nursing student who is preparing to care for a patient with cystic fibrosis. The patient uses inhaled tobramycin [TOBI], dornase alfa [Pulmozyme], ibuprofen, and salmeterol [Serevent Diskus]. Which statement by the student indicates understanding of this patient's drug regimen? a. "Dornase alfa is used as needed to decrease viscosity of sputum." b. "Ibuprofen is used to minimize pleuritic pain associated with coughing." c. "Salmeterol acts by causing bronchodilation and improving ciliary function." d. "Tobramycin is given via a metered-dose inhaler to avoid systemic side effects."

7. A nursing student asks a nurse to explain the differences between amphotericin B [Abelcet] and the azoles group of antifungal agents. Which statement by the nurse is correct? a. "Amphotericin B can be given orally or intravenously." b. "Amphotericin B increases the levels of many other drugs." c. "Azoles have lower toxicity than amphotericin B." d. "Only the azoles are broad-spectrum antifungal agents."

7. A nursing student asks a nurse why pegylated interferon alfa is used instead of regular interferon for a patient with hepatitis C. The nurse will tell the student that pegylated interferon: a. decreases the need for additional medications. b. has fewer adverse effects than interferon. c. is administered less frequently than interferon. d. may be given orally to increase ease of use.

7. A patient is about to receive penicillin G for an infection that is highly sensitive to this drug. While obtaining the patient's medication history, the nurse learns that the patient experienced a rash when given amoxicillin [Amoxil] as a child 20 years earlier. What will the nurse do? a. Ask the provider to order a cephalosporin. b. Reassure the patient that allergic responses diminish over time. c. Request an order for a skin test to assess the current risk. d. Suggest using a desensitization schedule to administer the drug.

7. A patient is admitted to the hospital with fever, cough, malaise, and weakness. Forty-eight hours later, the symptoms have become progressively worse, and they progress to severe respiratory distress, septicemia, and hemorrhagic meningitis. The nurse recognizes these signs and symptoms as: a. tularemia. b. smallpox. c. inhalation anthrax. d. pneumonic plague.

7. A patient who is taking doxycycline for a serious infection contacts the nurse to report anal itching. The nurse will contact the provider to discuss: a. adding an antihistamine to the patient's drug regimen. b. ordering liver function tests to test for hepatotoxicity. c. prescribing an antifungal drug to treat a superinfection. d. testing the patient for a C. difficile secondary infection.

7. A patient will begin taking iron supplements to treat anemia. The nurse will recommend that the patient take the iron with which food to facilitate absorption? a. Cereal b. Dairy products c. Orange juice d. Red meats

7. A recent campaign, initiated by the Centers for Disease Control (CDC), to delay the emergence of antibiotic resistance in hospitals, has what as one of its objectives? a. Allowing patients to stop antibiotics when symptoms subside b. Allowing prescribers to develop their own prescribing guidelines c. Increased adherence to prescribed antibiotics d. Increased use of antibiotics among parents of young children

7. These patients are receiving chemotherapy. Which patient should the nurse see first? a. The patient with lightly bleeding gums b. The patient with nausea and vomiting c. The patient with a fever of 100.3°F d. The patient with diarrhea and stomatitis

7. Which statement by a patient about to begin taking orlistat [Xenical] for weight loss therapy indicates an understanding of this drug's actions? a. "I can eat as much as I want and still lose weight." b. "I should avoid fat-soluble vitamin supplements while taking this drug." c. "If I take a bulk-forming laxative, I can reduce the incidence of fecal incontinence." d. "If I take the drug 4 times daily instead of twice daily, I will lose weight faster."

8. A patient has had dilation of the eyes with an anticholinergic agent. What will the nurse say when preparing this patient to go home after the examination? a. "Systemic side effects will not occur with this agent." b. "You may experience an increased heart rate, but this is a harmless side effect." c. "You may need to wear dark glasses until this medication wears off." d. "You will be able to read as soon as the exam is completed."

8. A patient is admitted to the hospital with fever, headache, malaise, joint pain, and enlarged lymph nodes. Blood cultures are positive for Treponema pallidum. The nurse recognizes this as which type of syphilis? a. Congenital b. Primary c. Secondary d. Tertiary

8. A pregnant female patient with bacteriuria, suprapubic pain, urinary urgency and frequency, and a low-grade fever is allergic to sulfa, ciprofloxacin, and amoxicillin. The nurse knows that the best alternative for treating this urinary tract infection is with: a. cephalexin [Keflex]. b. fosfomycin [Monurol]. c. methenamine [Hiprex]. d. nitrofurantoin [Macrodantin].

9. A 6-week-old infant who has not yet received immunizations develops a severe cough. While awaiting nasopharyngeal culture results, the nurse will expect to administer which antibiotic? a. Clindamycin [Cleocin] b. Doxycycline [Vibramycin] c. Erythromycin ethylsuccinate d. Penicillin G

9. A female patient with diabetes who is obese will begin taking lorcaserin [Belviq] to help with weight loss. What will the nurse include when teaching this patient about this drug? a. "This drug is safe to take if you become pregnant." b. "This drug does not have serious adverse effects." c. "You may need to check your blood glucose levels more often." d. "You will need to increase your insulin dose to prevent hyperglycemia."

9. A healthcare worker who is asymptomatic has a screening TST result of 10 mm of induration during a pre-employment physical. What will the nurse reading this test tell the patient? a. "This is a negative test, so you are cleared for employment." b. "You have latent TB and will need to take isoniazid for 6 to 9 months." c. "You need to have a chest radiograph and a sputum culture." d. "You will begin taking a four-drug regimen to treat tuberculosis."

9. A patient has an infection caused by Streptococcus pyogenes. The prescriber has ordered dicloxacillin PO. What will the nurse do? a. Administer the medication as ordered. b. Contact the provider to suggest giving the drug IV. c. Question the need for a penicillinase-resistant penicillin. d. Suggest ordering vancomycin to treat this infection.

9. A patient will begin taking dimercaprol [BAL in Oil] for arsenic poisoning. The nurse performs a medical history on this patient. Which aspect of the patient's history would cause the most concern? a. Anemia b. Lead exposure c. Peanut allergy d. Peptic ulcer disease

9. A patient with bronchitis is taking TMP/SMZ, 160/800 mg orally, twice daily. Before administering the third dose, the nurse notes that the patient has a widespread rash, a temperature of 103°F, and a heart rate of 100 beats per minute. The patient looks ill and reports not feeling well. What will the nurse do? a. Administer the dose and request an order for an antipyretic medication. b. Withhold the dose and request an order for an antihistamine to treat the rash. c. Withhold the dose and notify the provider of the symptoms. d. Request an order for intravenous TMP/SMZ, because the patient is getting worse.

9. A patient with histoplasmosis is being treated with itraconazole [Sporanox]. The nurse will teach this patient to report which symptoms? a. Gynecomastia and decreased libido b. Headache and rash c. Nausea, vomiting, and anorexia d. Visual disturbances

9. A patient with hyperlipidemia has been told by the provider to take extra niacin. The nurse will tell the patient to: a. increase servings of poultry, fish, and cereals. b. take nicotinamide supplements. c. take nicotinic acid supplements. d. take tryptophan supplements.

9. A patient with non-Hodgkin's lymphoma is about to begin chemotherapy with a massive dose of methotrexate [Rheumatrex]. The nurse will expect to administer which medication concurrently with this drug? a. Dexamethasone b. Folic acid c. Leucovorin d. Vitamin B12

A 4-year-old child is brought to the emergency department with symptoms of nausea and vomiting and a weak, thready pulse of 120 beats per minute after ingesting several cigarettes at home. The nurse caring for this child will expect to provide which treatment? a. Gastric lavage b. Hemodialysis c. Respiratory support d. Vasoconstrictors

A child will begin taking methylphenidate [Ritalin] for attention-deficit/hyperactivity disorder. Important baseline information about this patient will include: a. results of an electrocardiogram (ECG). b. family history of psychosis. c. height and weight. d. renal function.

A clinic patient who has cirrhosis of the liver develops hypervolemic hypernatremia. Which medication will the nurse expect the provider to order? a. Conivaptan [Vaprisol] b. Desmopressin [DDAVP] c. Tolvaptan [Samsca] d. Vasopressin [Pitressin]

A nurse is administering drug X to a patient. The drug information states that the drug acts by activating receptors in the peripheral nervous system by increasing transmitter synthesis. The nurse understands that the effect of this drug is to: a. activate axonal conduction. b. enhance transmitter storage. c. increase receptor activation. d. synthesize supertransmitters.

A nurse is caring for a patient in the immediate postoperative period after surgery in which a spinal anesthetic was used. The patient has not voided and complains of headache. The patient has a pulse of 62 beats per minute, a respiratory rate of 16 breaths per minute, and a blood pressure of 92/48 mm Hg. Which action by the nurse is appropriate? a. Contact the anesthetist to request an order for ephedrine. b. Have the patient sit up to relieve the head-ache pain. c. Lower the head of the bed to a 10- to 15-degree head-down position. d. Obtain an order for a urinary catheter for urinary retention.

A nurse is discussing fibrinolytic therapy for the acute phase of STEMI management with a group of nursing students. Which statement by a student indicates understanding of this therapy? a. "Fibrinolytics are effective when the first dose is given up to 24 hours after symptom onset." b. "Fibrinolytics should be given once cardiac troponins reveal the presence of STEMI." c. "Fibrinolytics should be used with caution in patients with a history of cerebrovascular accident." d. "Patients should receive either an anticoagulant or an antiplatelet agent with a fibrinolytic drug."

A nurse is discussing the use of cocaine as a local anesthetic with a nursing student. Which statement by the student indicates understanding of this agent? a. "Anesthetic effects develop slowly and persist for several hours." b. "Cocaine is a local anesthetic adminis-tered by injection." c. "Vasoconstrictors should not be used as adjunct agents with this drug." d. "When abused, cocaine causes physical dependence."

A nurse is preparing a patient to go home from the emergency department after receiving sutures for a laceration on one hand. The provider used lidocaine with epinephrine as a local anesthetic. Which symptom in this patient causes the most concern? a. Difficulty moving the fingers of the af-fected hand b. Inability to feel pressure at the suture site c. Nervousness and tachycardia d. Sensation of pain returning to the wound

A nurse is preparing to teach a forgetful older adult patient about a multiple drug regimen to follow after discharge from the hospital. To help promote adherence, what will the nurse do? a. Ask the patient to share the teaching with a neighbor or friend soon after discharge. b. Give the patient detailed written information about each drug. c. Cluster medication administration times as much as possible. d. Make sure the patient understands the actions and side effects of each drug.

A nurse is providing teaching to a patient newly diagnosed with partial seizures who will begin taking oxcarbazepine [Trileptal]. The patient also takes furosemide [Lasix] and digoxin [Lanoxin]. Which statement by the patient indicates understanding of the teaching? a. "I may need to increase my dose of Trileptal while taking these medications." b. "I may develop a rash and itching, but these are not considered serious." c. "I should report any nausea, drowsiness, and headache to my provider." d. "I should use salt substitutes instead of real salt while taking these drugs."

A nurse is teaching a male adult patient about the use of testosterone gel. Which statement by the patient indicates an understanding of the teaching? a. "I should apply this to my forearms and neck after showering." b. "I should keep treated areas exposed to the air so that they can dry." c. "I should not let my child touch the gel to prevent behavioral problems." d. "I should not swim or bathe for 3 to 4 hours after applying the gel."

A nurse is teaching a nursing student who wants to know how aspirin and nonaspirin first-generation NSAIDs differ. Which statement by the student indicates a need for further teaching? a. "Unlike aspirin, first-generation NSAIDs cause reversible inhibition of cyclooxygenase." b. "NSAIDs do not increase the risk of myocardial infarction and stroke; however, unlike ASA, they do not provide protective benefits against those conditions." c. "Unlike aspirin, first-generation NSAIDs do not carry a risk of hypersensitivity reactions." d. "Unlike aspirin, first-generation NSAIDs cause little or no suppression of platelet aggregation."

A nurse is teaching an adolescent female patient about 28-day monophasic combination oral contraceptives. The provider has instructed the patient to begin taking the pills on the first Sunday after the onset of her next period. What will the nurse tell the patient? a. "If breakthrough spotting occurs, you should begin taking a new pack of pills." b. "Protection from pregnancy will begin immediately." c. "Use another form of contraception for the next month." d. "You may take the pills at different times of day."

A nursing student is preparing to give a medication that has a boxed warning. The student asks the nurse what this means. What will the nurse explain about boxed warnings? a. They indicate that a drug should not be given except in life-threatening circumstances. b. They provide detailed information about the adverse effects of the drug. c. They alert prescribers to measures to mitigate potential harm from side effects. d. They provide information about antidotes in the event that toxicity occurs.

A patient asks a nurse why a friend who is taking the same drug responds differently to that drug. The nurse knows that the most common variation in drug response is due to differences in each patient's: a. drug receptor sites. b. hypersensitivity potential. c. metabolism of drugs. d. psychosocial response.

A patient claims to get better effects with a tablet of Brand X of a drug than with a tablet of Brand Y of the same drug. Both brands contain the same amount of the active ingredient. What does the nurse know to be most likely? a. Advertising by pharmaceutical companies can enhance patient expectations of one brand over another, leading to a placebo effect. b. Because the drug preparations are chemi-cally equivalent, the effects of the two brands must be identical. c. Tablets can differ in composition and can have differing rates of disintegration and dissolution, which can alter the drug's ef-fects in the body. d. The bioavailability of a drug is deter-mined by the amount of the drug in each dose.

A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation of the lungs reveals crackles bilaterally, and the serum potassium level is 6 mEq/L. Which diuretic agent ordered by the prescriber should the nurse question? a. Bumetanide [Bumex] b. Furosemide [Lasix] c. Spironolactone [Aldactone] d. Hydrochlorothiazide [HydroDIURIL]

A patient has had blood pressures of 150/95 mm Hg and 148/90 mm Hg on two separate office visits. The patient reports a blood pressure of 145/92 mm Hg taken in an ambulatory setting. The patient's diagnostic tests are all normal. The nurse will expect this patient's provider to order a. furosemide and spironolactone b.propanaolol c.hydrochlorothiazide d.nitroprusside sodium

A patient in her twenties with Graves' disease who takes methimazole [Tapazole] tells a nurse that she is trying to conceive and asks about disease management during pregnancy. What will the nurse tell her? a. Methimazole is safe to take throughout pregnancy. b. Propylthiouracil should be taken throughout her pregnancy. c. The patient should discuss changing to propylthiouracil from now until her second trimester with her provider. d. The patient should discuss therapy with iodine-131 instead of medications with her provider.

A patient is being treated for chemotherapy-induced nausea and vomiting (CINV) with ondansetron [Zofran] and dexamethasone. The patient reports getting relief during and immediately after chemotherapy but has significant nausea and vomiting several days after each chemotherapy treatment. What will the nurse do? a. Contact the provider to discuss increasing the dose of ondansetron. b. Suggest giving prolonged doses of dexamethasone. c. Suggest adding aprepitant [Emend] to the medication regimen. d. Tell the patient to ask the provider about changing the ondansetron to aprepitant.

A patient is diagnosed with anxiety after describing symptoms of tension, poor concentration, and difficulty sleeping that have persisted for over 6 months. Which medication will the nurse expect the provider to order for this patient? a. Alprazolam [Xanax] b. Amitriptyline [Elavil] c. Buspirone [Buspar] d. Paroxetine [Paxil]

A patient is receiving intravenous gentamicin. A serum drug test reveals toxic levels. The dosing is correct, and this medication has been tolerated by this patient in the past. Which could be a probable cause of the test result? a. A loading dose was not given. b. The drug was not completely dissolved in the IV solution. c. The patient is taking another medication that binds to serum albumin. d. The medication is being given at a fre-quency that is longer than its half-life.

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

A patient is taking gentamicin [Garamycin] and furosemide [Lasix]. The nurse should counsel this patient to report which symptom? a. Frequent nocturia b. Headaches c. Ringing in the ears d. Urinary retention

A patient receives a drug that has a narrow therapeutic range. The nurse administering this medication will expect to do what? a. Administer the drug at intervals longer than the drug half-life. b. Administer this medication intravenously. c. Monitor plasma drug levels. d. Teach the patient that maximum drug ef-fects will occur within a short period.

A patient receives a neuromuscular blocking agent before a procedure. The patient's eyes close. The nurse knows this is a sign that the patient: a. has fallen asleep. b. has received a toxic dose of the medication. c. is beginning to feel the drug's effects. d. may need mechanical ventilation.

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

A patient reports becoming "immune" to a medication because it no longer works to alleviate symptoms. The nurse recognizes that this decreased effectiveness is likely caused by: a. antagonists produced by the body that compete with the drug for receptor sites. b. decreased selectivity of receptor sites, resulting in a variety of effects. c. desensitization of receptor sites by continual exposure to the drug. d. synthesis of more receptor sites in response to the medication.

A patient reports having occasional periods of tremors, palpitations, nausea, and a sense of fear, which usually dissipate within 30 minutes. To treat this condition, the nurse anticipates the provider will prescribe a drug in which drug class? a. Benzodiazepines b. Monoamine oxidase inhibitors c. Selective serotonin reuptake inhibitors d. Tricyclic antidepressants

A patient tells the nurse that she takes aspirin for menstrual cramps, but she does not feel that it works well. What will the nurse suggest? a. The patient should avoid any type of COX inhibitor because of the risk of Reye's syndrome. b. The patient should increase the dose to a level that suppresses inflammation. c. The patient should use a first-generation nonsteroidal anti-inflammatory medication instead. d. The patient should use acetaminophen because of its selective effects on uterine smooth muscle.

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

A patient who has a lower back injury exhibits muscle spasms. The provider orders cyclobenzaprine [Flexeril] 10 mg three times a day. What will the nurse include when teaching this patient about this drug? a. "This drug carries some risk of developing hallucinations and psychotic symptoms." b. "This medication may cause your urine to turn brown, black, or dark green." c. "You may experience blurred vision, dry mouth, or constipation." d. "You will need to have liver function tests performed while taking this medication."

A patient who has developed postmenopausal osteoporosis will begin taking alendronate [Fosamax]. The nurse will teach this patient to take the drug: a. at bedtime to minimize adverse effects. b. for a maximum of 1 to 2 years. c. while sitting upright with plenty of water. d. with coffee or orange juice to increase absorption.

A patient who has erectile dysfunction asks a nurse whether sildenafil [Viagra] would be a good medication for him to take. Which aspect of this patient's history would be of most concern? a. Benign prostatic hypertrophy b. Mild hypertension c. Occasional use of nitroglycerin d. Taking finasteride

A patient who has type 2 diabetes will begin taking glipizide [Glucotrol]. Which statement by the patient is concerning to the nurse? a. "I will begin by taking this once daily with breakfast." b. "It is safe to drink grapefruit juice while taking this drug." c. "I may continue to have a glass of wine with dinner." d. "I will need to check my blood sugar once daily or more."

A patient who is receiving a factor VIII concentrate to treat hemophilia A develops hives, a low-grade temperature elevation, and a stuffy nose. The nurse will prepare to: a. administer subcutaneous epinephrine. b. give an antipyretic medication. c. give oral diphenhydramine. d. provide respiratory support.

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

A patient who travels frequently for business reports occasional instances of being unable to fall asleep. The patient tells the nurse that job demands require staying up late and then getting up early for meetings. The nurse expects that the provider will prescribe which medication for this patient? a. Flurazepam b. Trazodone [Desyrel] c. Zaleplon [Sonata] d. Zolpidem [Ambien]

A patient will begin taking etanercept [Enbrel] for severe rheumatoid arthritis. The patient has been taking methotrexate [Rheumatrex]. The patient asks if the etanercept is stronger than the methotrexate. The nurse will tell the patient that etanercept ____ methotrexate. a. has synergistic effects with b. helps reduce adverse effects associated with c. is better at delaying progression of joint damage than d. has fewer adverse effects than

A patient with a seizure disorder is admitted to the hospital and has a partial convulsive episode shortly after arriving on the unit. The patient has been taking phenytoin [Dilantin] 100 mg three times daily and oxcarbazepine [Trileptal] 300 mg twice daily for several years. The patient's phenytoin level is 8.6 mcg/mL, and the oxcarbazepine level is 22 mcg/mL. The nurse contacts the provider to report these levels and the seizure. What will the nurse expect the provider to order? a. A decreased dose of oxcarbazepine b. Extended-release phenytoin c. An increased dose of phenytoin d. Once-daily dosing of oxcarbazepine

A patient with bipolar disorder takes lamotrigine [Lamictal]. Which statement by the patient would prompt the nurse to hold the drug and notify the prescriber for further assessment? a. "I get a little dizzy sometimes." b. "I had a headache last week that lasted for about an hour." c. "I've broken out in a rash on my chest and back." d. "Last night I woke up twice with a bad dream."

A patient with chronic hypertension is admitted to the hospital. During the admission assessment, the nurse notes a heart rate of 96 beats per minute, a blood pressure of 150/90 mm Hg, bibasilar crackles, 2+ pitting edema of the ankles, and distension of the jugular veins. The nurse will contact the provider to request an order for which medication? a. ACE inhibitor b. Digoxin [Lanoxin] c. Furosemide [Lasix] d. Spironolactone [Aldactone]

A patient with endometriosis is being treated with the gonadotropin-releasing hormone (GnRH) agonist leuprolide [Lupron Depot]. A nurse is teaching the patient about the drug. Which statement by the patient indicates understanding of the teaching? a. "I can continue to take the medication if I get pregnant." b. "I can expect the medication to cure my symptoms." c. "I may have menopausal-like symptoms when taking this medication." d. "I will need to take the medication for several years."

A patient with schizophrenia shows suicidal behaviors, and the provider orders clozapine [Clozaril]. The nurse teaches the family about the medication and its side effects. Which statement by a family member indicates a need for further teaching about this drug? a. "Blood counts are necessary for several weeks after discontinuation of the drug." b. "Fever, sore throat, and sores in the mouth should be reported immediately." c. "If the ANC is less than 3000, the drug will be discontinued permanently." d. "Use of this drug requires weekly evalua-tion of blood work."

A patient's provider has recommended a bulk-forming laxative for occasional constipation. Which statement by the patient indicates understanding of the teaching about this agent? a. "I can take this medication long term." b. "I should not take this drug if I have diverticulitis." c. "I should take each dose with a full glass of water." d. "This drug can cause severe diarrhea."

A postoperative patient reports pain in the left lower extremity. The nurse notes swelling in the lower leg, which feels warm to the touch. The nurse will anticipate giving which medication? a. Aspirin b. Clopidogrel [Plavix] c. Enoxaparin [Lovenox] d. Warfarin [Coumadin]

A prescriber orders ramipril [Altace] for an obese patient with type 2 diabetes mellitus who has developed hypertension. The nurse provides teaching before dismissing the patient home. Which statement by the patient indicates understanding of the teaching? a. "I am less likely to develop diabetic nephropathy when taking this medication." b. "I should check my blood sugar more often, because hyperglycemia is a side effect of this drug." c. "Taking this medication helps reduce my risk of stroke and heart attack." d. "This medication will probably prevent the development of diabetic retinopathy."

A surgical nurse is caring for a patient who is receiving isoflurane [Forane]. Which is true about this inhalation anesthetic? a. Patients receiving isoflurane will not require mechanical ventilation. b. Postoperative nausea and vomiting are greater with isoflurane than with other inhalation anesthetics. c. Propofol is used for induction to minimize cough prior to administering isoflurane. d. This drug promotes greater relaxation of skeletal muscle than other inhalation anesthetics.

A woman in labor receives meperidine [Demerol] for pain. The nurse caring for the infant will observe the infant closely for: a. congenital anomalies. b. excessive crying and sneezing. c. respiratory depression. d. tremors and hyperreflexia.

A woman who is nursing a newborn develops postpartum depression and her provider orders sertraline [Zoloft] to treat her symptoms. The patient is concerned about the safety of this medication for her infant. What will the nurse tell her about this medication? a. To stop nursing while taking the medication b. To expect symptoms of colic and poor weight gain in the baby c. That sertraline is safer than other antidepressants for nursing mothers d. To ask her provider about switching to fluoxetine [Prozac] instead

A young adult patient has been taking an antidepressant medication for several weeks and reports having increased thoughts of suicide. The nurse questions further and learns that the patient has attempted suicide more than once in the past. The patient identifies a concrete plan for committing suicide. The nurse will contact the provider to discuss: a. changing the medication to another drug class. b. discontinuing the medication immediately. c. hospitalizing the patient for closer monitoring. d. requiring more frequent clinic visits for this patient.

An infant is receiving a medication that has a narrow therapeutic range. The nurse reviews the medication information and learns that the drug is excreted by the kidneys. When giving the medication, the nurse will assess the infant for: a. decreased effectiveness of the drug. b. shorter period of the drug's effects. c. signs of drug toxicity. d. unusual CNS effects.

Parents ask the nurse why an over-the-counter cough suppressant with sedative side effects is not recommended for infants. Which response by the nurse is correct? a. "Babies have a more rapid gastric empty-ing time and don't absorb drugs well." b. "Cough medicine tastes bad, and infants usually won't take it." c. "Infants are more susceptible to central nervous system effects than are adults." d. "Infants metabolize drugs too rapidly, so drugs aren't as effective."

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

The nurse is caring for a patient after recent renal transplantation. The patient is taking sirolimus [Rapamune] to prevent transplant rejection. What other medications would the nurse expect the patient to be taking? a. Rifampin and ketoconazole b. Carbamazepine and phenobarbital c. Cyclosporine and glucocorticoids d. Amphotericin B and erythromycin

The nurse is caring for a patient who begins to complain of shortness of breath. The nurse assesses the patient and notes 3+ pitting edema bilaterally in the lower extremities. Which medication taken by the patient causes the most concern? a. Epoetin alfa b. Filgrastim (granulocyte colony-stimulating factor) c. Oprelvekin (interleukin-11) d. Sargramostim (granulocyte-macrophage colony-stimulating factor)

The nurse is discussing home management with a patient who will begin taking an alpha-adrenergic antagonist for hypertension. Which statement by the patient indicates understanding of the teaching? a. "I need to stop the medication if my heart rate increases." b. "I should not drive while taking this medication." c. "I should take the first dose at bedtime." d. "I will stop taking the medication if I feel dizzy."

What is a desired outcome when a drug is described as easy to administer? a. It can be stored indefinitely without need for refrigeration. b. It does not interact significantly with other medications. c. It enhances patient adherence to the drug regimen. d. It is usually relatively inexpensive to produce.

Which types of drugs taken by a pregnant patient are more likely to have effects on a fetus? a. Drugs that are highly polar b. Ionized drugs c. Lipid-soluble drugs d. Protein-bound drugs

1. A child is seen in a clinic with a chief complaint of itching, especially at night. The nurse observes small ridges and dotted lines of erythema on the child's neck and buttocks. The nurse will expect the provider to order which medication initially? a. Benzyl alcohol [Ulesfia] b. Ivermectin [Stromectol] c. Malathion [Ovide] d. Permethrin [Elimite]

1. A nurse is discussing nutrition with a patient who expresses concern about not always consuming vitamins in amounts consistent with the recommended dietary allowances (RDAs). What will the nurse tell this patient? a. The RDA is only an estimate of the amount of vitamins required and does not represent a scientific number. b. The RDA is the amount of vitamin needed by 50% of the population regardless of age or gender. c. The RDA represents the highest amount that can be consumed safely, so amounts less than this can be sufficient. d. The RDA represents an average, so low intake one day can be compensated for by increased amounts on another day.

1. A nurse is obtaining a drug history from a patient about to receive sulfadiazine. The nurse learns that the patient takes warfarin, glipizide, and a thiazide diuretic. Based on this assessment, the nurse will expect the provider to: a. change the antibiotic to TMP/SMZ. b. increase the dose of the glipizide. c. monitor the patient's electrolytes closely. d. monitor the patient's coagulation levels.

1. A nurse is performing a physical assessment on a patient with tuberculosis who takes rifampin [Rifadin]. What would be an expected finding? a. Crystalluria b. Myopathy c. Peripheral neuropathy d. Red-orange-tinged urine

1. A pregnant patient is treated with trimethoprim/sulfamethoxazole (TMP/SMZ) [Bactrim] for a urinary tract infection at 32 weeks' gestation. A week later, the woman delivers her infant prematurely. The nurse will expect to monitor the infant for: a. birth defects. b. hypoglycemia. c. rash. d. kernicterus.

1. The nurse has been caring for a patient who has been taking antibiotics for 3 weeks. Upon assessing the patient, the nurse notices the individual has developed oral thrush. What describes the etiology of the thrush? a. Antibiotic resistance b. Community-acquired infection c. Nosocomial infection d. Superinfection

10. A nurse is caring for an African American patient who has been admitted to the unit for long-term antibiotic therapy with sulfonamides. The patient develops fever, pallor, and jaundice. The nurse would be correct to suspect that the patient has developed: a. Stevens-Johnson syndrome. b. kernicterus. c. hepatotoxicity. d. hemolytic anemia.

10. The nurse is preparing to administer medication to a patient receiving cyclophosphamide [Cytoxan]. To protect against the side effect of hemorrhagic cystitis, the nurse would expect to administer which drug? a. Decadron b. Diphenhydramine [Benadryl] c. Leucovorin d. Mesna [Mesnex]

10. The parent of an infant with otitis media asks the nurse why the prescriber has ordered amoxicillin [Amoxil] and not ampicillin [Unasyn]. What will the nurse tell the parent? a. Amoxicillin is a broader spectrum antibiotic than ampicillin. b. Amoxicillin is not inactivated by beta-lactamases. c. Ampicillin is associated with more allergic reactions. d. Ampicillin is not as acid stable as amoxicillin.

11. A nurse is teaching a patient diagnosed with wet ARMD who will begin receiving bevacizumab [Avastin]. Which statement by the patient indicates a need for further teaching? a. "I should be able to improve my visual acuity by using this drug." b. "I should report eye pain and photophobia to my provider if they occur." c. "This drug will help suppress the growth of new blood vessels." d. "This medication will not reduce the risk of blindness."

11. A patient has a skin infection and the culture reveals methicillin-resistant Staphylococcus aureus (MRSA). What is an appropriate treatment for this patient? a. Cefaclor b. Cefazolin c. Cefotaxime d. Ceftaroline

11. A patient has an invasive aspergillosis infection. Which antifungal agent is the drug of choice for this infection? a. Amphotericin B b. Fluconazole [Diflucan] c. Posaconazole [Noxafil] d. Voriconazole [Vfend]

11. The nurse is caring for a child who has ingested a toxic amount of aspirin. The provider orders an intravenous drug that will increase pH in the blood and urine. The nurse understands that this effect is necessary to: a. decrease the gastric absorption of aspirin. b. decrease the lipid solubility of aspirin. c. increase the serum protein binding of as-pirin. d. increase the urinary excretion of aspirin.

12. A patient is about to begin treatment with isoniazid. The nurse learns that the patient also takes phenytoin [Dilantin] for seizures. The nurse will contact the provider to discuss: a. increasing the phenytoin dose. b. reducing the isoniazid dose. c. monitoring isoniazid levels. d. monitoring phenytoin levels.

12. A patient who has cystic fibrosis has a Pseudomonas aeruginosa infection and the provider has ordered aztreonam [Cayston]. What will the nurse teach this patient about administration of this drug? a. Administer the drug intramuscularly twice daily. b. Give a daily dose every day for 28 days and then stop. c. Inhale the powdered drug as ordered three times each day. d. Use the nebulizer to administer the drug three times daily.

12. A patient who is taking nitrofurantoin calls the nurse to report several side effects. Which side effect of this drug causes the most concern and would require discontinuation of the medication? a. Anorexia, nausea, and vomiting b. Brown-colored urine c. Drowsiness d. Tingling of the fingers

12. A patient will receive intrathecal liposomal cytarabine [DepoCyt] to treat acute myelogenous leukemia. The provider has ordered the concurrent administration of dexamethasone. The nurse understands that this is given to: a. prevent bone marrow suppression. b. prevent hair loss and stomatitis. c. reduce the incidence of pulmonary edema. d. reduce the severity of chemical arachnoiditis.

13. A patient asks how she can consume optimal amounts of folate, because she is trying to get pregnant. The nurse will advise this patient to do what? a. Eat foods naturally high in folate. b. Stop worrying, because folate is present in many foods. c. Take synthetic folate on an empty stomach. d. Take synthetic folate in addition to foods high in folate.

13. A patient has just been diagnosed with cancer and will begin chemotherapy. The patient asks the nurse about the possibility of nausea and vomiting. The nurse will tell the patient that: a. nausea and vomiting can be avoided by having a snack before chemotherapy. b. nausea and vomiting are common side effects and will abate over time. c. nausea and vomiting are common and will be treated with antiemetics when they occur. d. the provider will order drugs to help prevent nausea and vomiting before each dose.

13. A provider has ordered oral voriconazole [Vfend] for a patient who has a systemic fungal infection. The nurse obtains a medication history and learns that the patient takes phenobarbital for seizures. The nurse will contact the provider to discuss which possibility? a. Administering intravenous voriconazole b. Reducing the dose of phenobarbital c. Reducing the dose of voriconazole d. Using a different antifungal agent

15. A patient develops CDAD. Which antibiotic is recommended for treating this infection? a. Chloramphenicol b. Clindamycin [Cleocin] c. Linezolid [Zyvox] d. Vancomycin

16. A patient will begin receiving vincristine [Oncovin] to treat Hodgkin's lymphoma. Which side effect(s) will the nurse tell the patient to report immediately? a. Diarrhea, nausea, and vomiting b. Hair loss c. Headaches d. Tingling of the extremities

18. A child has been receiving chloramphenicol for a Neisseria meningitidis central nervous system (CNS) infection. The nurse administers the dose and subsequently notes that the child has vomited and appears dusky and gray in color. The child's abdomen is distended. What will the nurse do? a. Contact the provider for an order to obtain a chloramphenicol level. b. Notify the provider that the child's meningitis is worsening. c. Recognize this as initial signs of a C. difficile infection. d. Stop the infusion immediately and notify the provider.

2. A nurse is teaching a group of adolescent students about sexually transmitted diseases. Which statement by a student indicates understanding of infections caused by C. trachomatis? a. "C. trachomatis conjunctivitis in newborns can result in blindness." b. "The CDC recommends screening for chlamydial infections in all sexually active men." c. "Treatment for C. trachomatis should be initiated when infections are symptomatic." d. "Women with asymptomatic Chlamydia trachomatis infections can become sterile."

2. A nursing student asks the nurse to discuss the differences between POAG and angle-closure glaucoma. Which statement by the nurse is correct? a. "Angle-closure glaucoma may be asymptomatic until irreversible damage has occurred." b. "Both types are more common in African American patients." c. "Drug therapy is the definitive treatment for angle-closure glaucoma." d. "Early treatment with prostaglandin analogs can stop the progression of POAG."

2. A patient on an oncology unit has been receiving ifosfamide [Ifex] for a few days. Before administering the next dose, the nurse reviews the patient's laboratory test results. Which finding would cause the nurse to hold the dose? a. Elevated white blood cell count b. Low hemoglobin and hematocrit levels c. Low levels of ketones in the urine d. Microscopic hematuria

2. A patient who has drug-sensitive tuberculosis has completed 2 months of the standard four-drug therapy and asks the nurse how long he will have to take medication. Which response by the nurse is correct? a. "As long as you remain symptomatic, you will not have to take more medication." b. "The four-drug regimen will continue for 3 more months." c. "You will have to take maintenance drugs indefinitely." d. "You will need to take only two drugs for the next 4 months."

2. A pregnant patient is discussing nutrition and vitamin supplements with the nurse. Which statement by the patient indicates an understanding of the use of nutrition and supplements during pregnancy? a. "I can get adequate folic acid by consuming foods fortified with synthetic folate." b. "I need reduced amounts of vitamin C while pregnant to lower my risk of hemorrhage." c. "I should take vitamin K so my baby won't be vitamin K deficient at birth." d. "Excessive amounts of vitamin A [retinol] can cause birth defects in my baby."

2. An older male patient comes to the clinic with complaints of chills, malaise, myalgia, localized pain, dysuria, nocturia, and urinary retention. The nurse would most likely suspect that the patient has: a. acute cystitis. b. urinary tract infection. c. pyelonephritis. d. prostatitis.

2. The nurse is caring for a patient on a medical-surgical unit who has a fever of unknown origin. The prescriber has ordered a broad-spectrum antibiotic. Which intervention is the priority? a. Administering the antibiotic immediately b. Administering antipyretics as soon as possible c. Delaying administration of the antibiotic until the culture results are available d. Obtaining all cultures before the antibiotic is administered

2. The nurse is caring for a patient who is HIV positive and is taking zidovudine [Retrovir]. Before administering the medication, the nurse should monitor which laboratory values? a. Ketones in the urine and blood b. Serum immunoglobulin levels c. Serum lactate dehydrogenase d. Complete blood count (CBC)

2. Which cephalosporin may be used to treat meningitis? a. Cefaclor b. Cefazolin c. Cefoxitin d. Cefotaxime

21. A nurse is caring for a patient who has a superficial fungal infection and notes that the provider has ordered 200 mg of ketoconazole [Nizoral] 200 mg PO once daily. Which action by the nurse is correct? a. Administer the drug as ordered. b. Contact the provider to discuss twice daily dosing. c. Discuss a 400-mg daily drug regimen with the provider. d. Request an order for a different antifungal medication.

3. A child is diagnosed with rickets. The nurse knows that this child is most likely deficient in which vitamin? a. Niacin (nicotinic acid) b. Thiamin (vitamin B1) c. Vitamin C (ascorbic acid) d. Vitamin D

3. A nurse reads a tuberculin skin test on a patient and notes a 6- to 7-mm area of induration. The patient is a young adult who has recently immigrated from a country with a high prevalence of tuberculosis. The patient has no other risk factors. The nurse will expect the provider to: a. begin treating this patient with a two-drug regimen of isoniazid and rifampin. b. order a chest radiograph and a sputum culture to assess for active tuberculosis. c. order a nucleic acid amplification test of the patient's sputum. d. reassure the patient that this is not considered a positive test result.

3. A patient who has seasonal allergies in the spring and fall asks the nurse about oral antihistamines. Which response by the nurse is correct? a. "Anticholinergic effects are more common with second-generation antihistamines." b. "First-generation antihistamines, such as diphenhydramine [Benadryl], are more effective." c. "Make sure you take antihistamines only when you have symptoms to minimize side effects." d. "You should take oral antihistamines daily during each allergy season to get maximum effects."

4. A child with otitis media has had three ear infections in the past year. The child has just completed a 10-day course of amoxicillin [Amoxil] with no improvement. The parent asks the nurse why this drug is not working, because it has worked in the past. What will the nurse tell the patient? a. "Amoxicillin is too narrow in spectrum." b. "The bacteria have developed a three-layer cell envelope." c. "The bacteria have developed penicillin-binding proteins (PBPs) that have a low affinity for penicillins." d. "The bacteria have synthesized penicillinase."

4. A nurse teaches a patient about sulfonamides. Which statement by the patient indicates a need for further teaching? a. "I need to drink extra fluids while taking this medication." b. "I need to use sunscreen when taking this drug." c. "I should call my provider if I develop a rash while taking this drug." d. "I should stop taking this drug when my symptoms are gone."

4. A parent brings a child to the emergency department, because the child drank a solution containing ferrous sulfate. The nurse will prepare for: a. administration of activated charcoal. b. gastric lavage. c. peritoneal dialysis. d. whole-bowel irrigation.

4. A patient is beginning treatment for active tuberculosis (TB) in a region with little drug-resistant TB. Which treatment regimen will be used initially? a. Isoniazid and pyrazinamide b. Isoniazid, pyrazinamide, and ethambutol c. Rifampin, pyrazinamide, and ethambutol d. Isoniazid, rifampin, pyrazinamide, and ethambutol

4. A patient who is taking calcium supplements receives a prescription for ciprofloxacin [Cipro] for a urinary tract infection. The nurse will teach this patient to: a. consume extra fluids while taking the ciprofloxacin to prevent hypercalciuria. b. stop taking the calcium supplements while taking the ciprofloxacin. c. take the two medications together to increase the absorption of both. d. take the calcium either 6 hours before or 2 hours after taking the ciprofloxacin.

4. A patient who is taking morphine for pain asks the nurse how a pain medication can also cause constipation. What does the nurse know about morphine? a. It binds to different types of receptors in the body. b. It can cause constipation in toxic doses. c. It causes only one type of response, and the constipation is coincidental. d. It is selective to receptors that regulate more than one body process.

4. A patient with cancer has a tumor composed mostly of G0 cells. When teaching this patient about the disease, the nurse will make which statement? a. "Cells in this patient's type of tumor will proliferate rapidly." b. "Chemotherapeutic agents that are not toxic to other tissues may be used." c. "This type of tumor is especially sensitive to chemotherapy." d. "This tumor will be managed primarily with surgery."

4. A premenopausal woman has ER-positive breast cancer, and her prescriber has ordered tamoxifen [Nolvadex]. She asks the nurse if anastrozole [Arimidex] would work better for her. What will the nurse tell her? a. Anastrozole is more likely to cause hot flushes than tamoxifen. b. Anastrozole is more likely to promote endometrial carcinoma. c. Cancer recurrence is higher with anastrozole. d. Until she is postmenopausal, anastrozole will not be effective.

4. A young, nonpregnant female patient with a history of a previous urinary tract infection is experiencing dysuria, urinary urgency and frequency, and suprapubic pain of 3 days' duration. She is afebrile. A urine culture is positive for more than 100,000/mL of urine. The nurse caring for this patient knows that which treatment is most effective? a. A 14-day course of amoxicillin with clavulanic acid [Augmentin] b. A 7-day course of ciprofloxacin [Cipro] c. A single dose of fosfomycin [Monurol] d. A 3-day course of trimethoprim/sulfamethoxazole [Bactrim]

5. A nurse is preparing to administer oral ofloxacin to a patient. While taking the patient's medication history, the nurse learns that the patient takes warfarin and theophylline. The correct action by the nurse is to request an order to: a. reduce the dose of ofloxacin. b. increase the dose of ofloxacin. c. increase the dose of theophylline. d. monitor coagulation levels.

5. A nurse preparing to administer intravenous gentamicin to a patient notes that the dose is half the usual dose for an adult. The nurse suspects that this is because this patient has a history of: a. antibiotic resistance. b. interpatient variation. c. liver disease. d. renal disease.

5. A nursing student asks a nurse working in the newborn nursery how vitamin K deficiency is treated in newborns. Which response by the nurse is correct? a. "A newborn infant's intestinal flora will produce vitamin K." b. "If coagulation studies show a bleeding disorder, oral menadione is given." c. "Menadione is given intravenously shortly after delivery." d. "Phytonadione is given intramuscularly immediately after delivery."

5. A patient overdosed on aspirin several hours ago and is brought to the emergency department. The nurse assists with supportive care and then asks the provider about an order for which drug? a. Activated charcoal b. Ammonium chloride c. Fomepizole [Antizol] d. Sodium bicarbonate

5. A patient who is taking didanosine [Videx] reports nausea, vomiting, and abdominal pain. What will the nurse recommend to this patient? a. "Take the drug with food to minimize these side effects." b. "Stop taking the drug immediately and resume taking it once your symptoms subside." c. "Take the medication in the evening to avoid experiencing these kinds of symptoms." d. "You will need laboratory tests to determine if these are serious effects of the drug."

5. A pregnant patient begins active labor at 30 weeks' gestation. The provider orders dexamethasone 6 mg intramuscularly to be given twice daily for 4 doses. The patient asks the nurse what effect this drug will have on the fetus. The nurse will tell her that the dexamethasone is given to: a. improve cognitive function in the fetus. b. improve fetal neuromotor development. c. increase fetal weight and length. d. increase lung development in the fetus.

5. Terrorists have detonated a "dirty bomb" in a shopping center. Nurses are called to the site to assist with triage of victims. Besides treating injuries incurred from the blast itself, the priorities for treatment for most of the victims will include: a. administering potassium iodide as soon as possible. b. giving Prussian blue and monitoring electrolytes. c. monitoring urine and stool samples for radioactivity. d. removing clothing and bathing victims.

6. A patient has come to the clinic with tinea corporis, and the prescriber has ordered clotrimazole. When educating the patient about this medication, the nurse will include which statement? a. "Apply the medication over the entire body twice daily for 2 weeks." b. "Sun exposure will minimize the drug's effects." c. "This drug is effective after a single application." d. "Use the medication for at least 1 week after the symptoms have cleared."

6. A patient with cystic fibrosis uses inhaled tobramycin [TOBI] 300 mg every 12 hours in repeating cycles of 4 weeks on and 4 weeks off. The patient reports hoarseness and tinnitus. The nurse will tell the patient that: a. an intravenous form may be used to avoid hoarseness. b. hearing loss may occur with continued use of the drug. c. the provider will need to monitor renal function closely. d. these are common side effects of this medication.

7. A nurse in an ophthalmology clinic instills an anticholinergic agent into a patient's eyes. The nurse provides teaching when the patient asks the reason for the drops. Which statement by the patient indicates a need for further teaching? a. "The drops help prevent my lenses from moving during the exam." b. "The drops will cause me to have blurred vision and sensitivity to light." c. "These drops allow the ophthalmologist to see inside my eyes." d. "This medication anesthetizes my eyes so that the exam won't be painful."

7. A nurse is discussing microbial resistance among sulfonamides and trimethoprim with a nursing student. Which statement by the student indicates a need for further teaching? a. "Bacterial resistance to trimethoprim is relatively uncommon." b. "Resistance among gonococci, streptococci, and meningococci to sulfonamides is high." c. "Resistance to both agents can occur by spontaneous mutation of organisms." d. "Resistance to sulfonamides is less than resistance to trimethoprim."

7. A parent has used permethrin [Nix] twice to treat head lice in a child. Two weeks after the last treatment, head lice are again found in the child's hair. The parent asks the nurse what to do. The nurse will recommend asking the child's provider about which therapy? a. Applying lindane 1% shampoo b. Cutting the child's hair c. Ordering permethrin 5% [Elimite] d. Using benzyl alcohol [Ulesfia]

7. A patient starting therapy with efavirenz [Sustiva] asks about the timing of the medication with regard to meals. What patient education about the administration of this medication should the nurse provide? a. The drug must be taken within 30 minutes after a meal. b. The drug is best taken with a high-fat meal. c. The drug can be taken anytime without regard to meals. d. The drug should be taken once daily on an empty stomach.

7. A patient will begin taking drugs for hyperlipidemia. The patient asks about using flaxseed supplements to increase fiber. What will the nurse tell this patient? a. Not to use defatted flaxseed b. That flaxseed helps with the absorption of medications c. That flaxseed is not recommended d. To take the flaxseed 1 hour before taking the drug

7. A provider orders intravenous moxifloxacin [Avelox] for a patient who has sinusitis. Before administering the drug, the nurse will review this patient's chart for: a. a history of asthma. b. concurrent use of digoxin. c. concurrent use of warfarin. d. recent serum electrolyte levels.

8. A female patient who has hepatitis C is being treated with pegylated interferon alfa and ribavirin [Ribasphere]. It will be important for the nurse to teach this patient that: a. if she gets pregnant, she should use the inhaled form of ribavirin [Virazole]. b. if she is taking oral contraceptives, she should also take a protease inhibitor. c. she should use a hormonal contraceptive to avoid pregnancy. d. she will need a monthly pregnancy test during her treatment.

8. A hospitalized patient who is taking demeclocycline [Declomycin] reports increased urination, fatigue, and thirst. What will the nurse do? a. Contact the provider to report potential toxic side effects. b. Notify the provider to discuss changing the medication to doxycycline. c. Perform bedside glucometer testing to evaluate the serum glucose level. d. Provide extra fluids and reassure the patient that these are expected side effects.

8. A nurse is caring for a patient who recently immigrated from a Third World country. The patient is thin and appears malnourished. The nurse notes that the patient has loose and missing teeth, gingivitis, and bleeding gums. The patient has multiple sores and ecchymoses. The nurse will expect the provider to order: a. cyanocobalamin (vitamin B12). b. high-dose nicotinic acid. c. intramuscular thiamine for 1 to 2 weeks. d. intravenous ascorbic acid.

8. A patient has a localized skin infection, which is most likely caused by a gram-positive cocci. Until the culture and sensitivity results are available, the nurse will expect the provider to order a ____-spectrum ____ agent. a. broad; systemic b. broad; topical c. narrow; systemic d. narrow; topical

8. An adult patient with sickle cell anemia is being treated for a severe acute crisis with an opioid analgesic, a glucocorticoid, and hydroxyurea. The patient's complete blood count reveals neutrophils 2000/mm3, platelets 85,000/mm3, reticulocytes 85,000/mm3, and a hemoglobin of 4.2 gm/dL. What will the nurse anticipate doing? a. Decreasing the glucocorticoid dose b. Increasing the glucocorticoid dose c. Increasing the hydroxyurea dose d. Stopping the hydroxyurea

8. The nurse is caring for a patient who will begin receiving intravenous ciprofloxacin [Cipro] to treat pyelonephritis. The nurse learns that the patient has a history of myasthenia gravis. Which action by the nurse is correct? a. Administer the ciprofloxacin and monitor the patient for signs of muscle weakness. b. Ask the provider whether the ciprofloxacin can be given orally. c. Request an order for concurrent administration of metronidazole [Flagyl]. d. Suggest that the provider order a different antibiotic for this patient.

8. Two days after a child is treated with permethrin [Nix] for head lice, a parent calls the clinic to report seeing nits and a few live lice on the child's scalp. The nurse will tell the parent to: a. ask the provider about using benzyl alcohol [Ulesfia]. b. cut the areas of the child's hair where nits are present. c. retreat the child's hair with permethrin [Nix]. d. use a fine-toothed comb to remove nits and live lice.

9. A parent asks a nurse if the provider will prescribe an antibiotic for a child who attends school with several children who have strep throat. The child is complaining of a sore throat and has a fever. What will be the nurse's response? a. "Because strep throat is likely, your child should be treated empirically." b. "With good hand washing, your child should not get strep throat." c. "Your child probably has strep throat, so your provider will order an antibiotic." d. "Your child should come to the clinic to have a throat culture done today."

9. After starting an antiviral protease inhibitor, a patient with HIV telephones the nurse, complaining, "I'm so hungry and thirsty all the time! I'm urinating 10 or 12 times a day." The nurse recognizes these findings to be consistent with: a. pancreatic infiltration by HIV. b. allergic reaction. c. nonadherence to the antiviral regimen. d. hyperglycemia.

9. The nurse is providing smallpox vaccinations after determining that an individual who works for a local military laboratory was exposed. After administering the vaccine, how should the nurse instruct the individual to care for the site? a. Cover the site with a bandage. b. Leave the site open to the air. c. Cover the site with a nonpermeable, occlusive dressing. d. Cover the site with sterile gauze and tape the edges.

9. Which patient with a urinary tract infection will require hospitalization and intravenous antibiotics? a. A 5-year-old child with a fever of 100.5°F, dysuria, and bacteriuria b. A pregnant woman with bacteriuria, suprapubic pain, and fever c. A young man with dysuria, flank pain, and a previous urinary tract infection d. An older adult man with a low-grade fever, flank pain, and an indwelling catheter

A 7-year-old child who is otherwise healthy is receiving mecasermin [Increlex] replacement therapy to treat severe primary deficiency of insulin-like growth factor-1 (IGF-1). The child develops tonsillar hypertrophy. The nurse anticipates that the provider will recommend: a. antibiotics. b. reducing the dose of mecasermin. c. discontinuing the mecasermin. d. tonsillectomy.

A female patient taking an ACE inhibitor learns that she is pregnant. What will the nurse tell this patient? a. The fetus most likely will have serious congenital defects. b. The fetus must be monitored closely while the patient is taking this drug. c. The patient's prescriber probably will change her medication to an ARB. d. The patient should stop taking the medication and contact her provider immediately.

A nurse is caring for a patient who has myasthenia gravis. The prescriber has ordered neostigmine [Prostigmin]. An important initial nursing action before administration of the medication includes assessing: a. the ability to raise the eyelids. b. level of fatigue. c. skeletal muscle strength. d. swallowing ability.

A nurse is caring for an older adult patient who has Alzheimer's disease. The patient is taking a cholinesterase inhibitor drug. Which side effects would concern the nurse? a. Confusion and memory impairment b. Dizziness and headache c. Nausea, vomiting, and diarrhea d. Slowed heart rate and lightheadedness

A nurse is caring for four patients. The nurse would be concerned about which patient developing a substance use disorder? a. A college student who reports having experimented with marijuana in the past year b. An older adult patient with terminal cancer who requires twice the normal dose of morphine for pain relief c. A patient in moderate to severe pain after a total hip replacement who asks for pain medication an hour before the next dose is due d. A patient whose history indicates the use of prescription narcotic analgesics for back and headache pain

A nurse is teaching a group of nursing students about neurotransmitters. Which statement by a student about acetylcholine indicates a need for further teaching? a. "It activates three cholinergic receptor subtypes." b. "It has effects in the parasympathetic, sympathetic, and somatic nervous sys-tems." c. "It is used at most junctions of the periph-eral nervous system." d. "Its transmission is terminated by reuptake into the cholinergic nerve termi-nal."

A nurse is teaching a group of nursing students about the differences between pure opioid agonists and agonist-antagonist opioids. Which statement by a student indicates understanding of the teaching? a. "Agonist-antagonist opioids act as agonists at mu receptors only." b. "Agonist-antagonist opioids are effective for treating cancer pain." c. "Agonist-antagonist opioids enhance the effects of pure agonists." d. "Pure agonists act as agonists at both mu receptors and kappa receptors."

A patient administers interferon beta-1a SQ [Rebif] 22 mcg/0.5 mL three times each week. The patient calls the nurse to report unrelieved itching and erythema at the injection site, despite the use of topical hydrocortisone for several weeks. What will the nurse tell this patient to do? a. Apply ice to the injection site before and after the injection. b. Ask the provider to reduce the dose of interferon beta to 8.8 mcg/0.2 mL. c. Discuss using a prescription-strength hydrocortisone product with the provider. d. Take oral diphenhydramine [Benadryl].

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

A patient asks a nurse why drugs that have been approved by the FDA still have unknown side effects. What will the nurse tell the patient? a. Testing for all side effects of a medication would be prohibitively expensive. b. Patients in drug trials often are biased by their preconceptions of a drug's benefits. c. Researchers tend to conduct studies that will prove the benefits of their new drugs. d. Subjects in drug trials do not always rep-resent the full spectrum of possible pa-tients.

A patient begins taking nifedipine [Procardia], along with metoprolol, to treat hypertension. The nurse understands that metoprolol is used to: a. reduce flushing. b. minimize gingival hyperplasia. c. prevent constipation. d. prevent reflex tachycardia.

A patient has been receiving intravenous penicillin for pneumonia for several days and begins to complain of generalized itching. The nurse auscultates bilateral wheezing and notes a temperature of 38.5°C (101°F). Which is the correct action by the nurse? a. Administer the next dose and continue to evaluate the patient's symptoms. b. Ask the prescriber if an antihistamine can be given to relieve the itching. c. Contact the prescriber to request an order for a chest radiograph. d. Hold the next dose and notify the prescriber of the symptoms.

A patient has been taking warfarin [Coumadin] for atrial fibrillation. The provider has ordered dabigatran etexilate [Pradaxa] to replace the warfarin. The nurse teaches the patient about the change in drug regimen. Which statement by the patient indicates understanding of the teaching? a. "I may need to adjust the dose of dabigatran after weaning off the warfarin." b. "I should continue to take the warfarin after beginning the dabigatran until my INR is greater than 3." c. "I should stop taking the warfarin 3 days before starting the dabigatran." d. "I will stop taking the warfarin and will start taking the dabigatran when my INR is less than 2."

A patient is about to receive prednisone for tendonitis. The nurse reviewing the chart would be concerned about which of the following in the patient's medical history? a. Asthma and allergic rhinitis b. Gouty arthritis c. Seborrheic dermatitis d. Systemic fungal infection

A patient is being treated with warfarin [Coumadin] to prevent thrombus. The patient develops hyperuricemia, and the provider orders allopurinol [Zyloprim]. The nurse will contact the provider to discuss ____ the ____ dose. a. increasing; allopurinol b. increasing; warfarin c. reducing; allopurinol d. reducing; warfarin

A patient is experiencing toxic side effects from atropine, including delirium and hallucinations. Which medication will the nurse expect to administer? a. Donepezil [Aricept] b. Edrophonium [Reversol] c. Neostigmine [Prostigmin] d. Physostigmine

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

A patient stops taking a proton pump inhibitor (PPI) after 6 weeks of therapy for treatment of peptic ulcer disease. The patient reports symptoms of dyspepsia to the nurse. The nurse will tell this patient to: a. come to the clinic to be tested for Clostridium difficile. b. resume taking the PPI, because long-term therapy is necessary. c. resume taking the PPI until symptoms resolve completely. d. try an antacid to see whether it relieves these symptoms.

A patient takes an ACE inhibitor to treat hypertension and tells the nurse that she wants to become pregnant. She asks whether she should continue taking the medication while she is pregnant. What will the nurse tell her? a. Controlling her blood pressure will decrease her risk of preeclampsia. b. Ask the provider about changing to an ARB during pregnancy. c. Continue taking the ACE inhibitor during her pregnancy. d. Discuss using methyldopa instead while she is pregnant.

A patient who has a history of asthma experiences three or four migraine headaches each month. The patient uses sumatriptan [Imitrex] as an abortive medication and has developed medication overuse headaches. The patient asks the nurse what can be done to prevent migraines. The nurse will suggest that the patient discuss which preventive medication with the provider? a. Botulinum toxin b. Meperidine [Demerol] c. Timolol d. Topiramate [Topamax]

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

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

A patient who has begun using transdermal nitroglycerin for angina reports occasional periods of tachycardia. The nurse will expect the prescriber to order: a. digoxin [Lanoxin] to slow the heart rate. b. immediate discontinuation of the nitroglycerin. c. periods of rest when the heart rate increases. d. verapamil as an adjunct to nitroglycerin therapy.

A patient who has had abdominal surgery has been receiving morphine sulfate via a patient-controlled analgesia (PCA) pump. The nurse assesses the patient and notes that the patient's pupils are dilated and that the patient is drowsy and lethargic. The patient's heart rate is 84 beats per minute, the respiratory rate is 10 breaths per minute, and the blood pressure is 90/50 mm Hg. What will the nurse do? a. Discuss possible opiate dependence with the patient's provider. b. Encourage the patient to turn over and cough and take deep breaths. c. Note the effectiveness of the analgesia in the patient's chart. d. Prepare to administer naloxone and possibly ventilatory support.

A patient who has obsessive-compulsive disorder (OCD) has been undergoing behavioral therapy but continues to exhibit symptoms that interfere with daily life. Which intervention will the nurse expect the provider to order for this patient? a. Alprazolam [Xanax] b. Buspirone [Buspar] c. Deep brain stimulation d. Fluoxetine [Paxil]

A patient who has undergone treatment for alcoholism several times, with relapse occurring shortly after each treatment, has just completed detoxification. The patient requests a medication to help maintain abstinence. Which drug will the nurse expect the provider to prescribe? a. Acamprosate [Campral] b. Chlordiazepoxide [Librium] c. Disulfiram [Antabuse] d. Naltrexone [ReVia]

A patient who is at risk for osteoporosis will begin taking the selective estrogen receptor modulator raloxifene [Evista]. Which statement will the nurse include when teaching this patient about the medication? a. Raloxifene reduces the risk of thromboembolism. b. The drug is associated with an increased risk of breast cancer. c. Use of this drug increases the risk of endometrial carcinoma. d. Vasomotor symptoms are a common side effect of this drug.

A patient who is recovering from a STEMI 3 months prior is in the clinic for a follow-up evaluation. The patient is taking 81 mg of aspirin, a beta blocker, and an ACE inhibitor daily and uses nitroglycerine as needed for angina. The patient's BMI is 24.5 kg/m2, and serum LDL is 150 mg/dL. The patient has a blood pressure of 135/80 mm Hg. What will the nurse expect the provider to order for this patient? a. An antihypertensive medication b. Counseling about a weight loss diet c. Discontinuing the ACE inhibitor d. High-dose statin therapy

A patient who wants to quit smoking has begun taking varenicline [Chantix]. The patient reports experiencing mood swings and depression and a desire to cause harm to herself. What will the nurse tell this patient? a. "These symptoms are common and will disappear over time." b. "These symptoms may indicate an underlying psychiatric disorder." c. "You may need an increased dose to overcome these symptoms of nicotine withdrawal." d. "You should notify your provider of these symptoms immediately."

A patient will begin using a transdermal preparation of a muscarinic antagonist for overactive bladder (OAB). The nurse teaches the patient what to do if side effects occur. Which state-ment by the patient indicates the need for further teaching? a. "I can use sugar-free gum for dry mouth." b. "I may need laxatives for constipation." c. "I should keep the site covered to prevent other people from getting the medicine." d. "I will take Benadryl for any itching caused by a local reaction to the patch."

A patient will receive intravenous midazolam [Versed] combined with fentanyl while undergoing an endoscopic procedure. The nurse is explaining the reasons for this to a nursing student before the procedure. Which statement by the student indicates understanding of the teaching? a. "The patient may appear anxious and restless during the procedure." b. "The patient will be unconscious during the procedure." c. "The patient will not need cardiorespiratory support during the procedure." d. "The patient will not remember the procedure."

A patient with a history of elevated triglycerides and LDL cholesterol begins taking nicotinic acid [Niacin]. The patient reports uncomfortable flushing of the face, neck, and ears when taking the drug. What will the nurse advise the patient? 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."

A patient with antidiuretic hormone deficiency is receiving desmopressin (DDAVP). The nurse will teach this patient to: a. avoid grapefruit juice. b. increase sodium intake. c. monitor blood pressure. d. reduce fluid intake.

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

A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why is the nurse concerned? a. The beta blocker can cause insulin resistance. b. Using the two agents together increases the risk of ketoacidosis. c. Propranolol increases insulin requirements because of receptor blocking. d. The beta blocker can mask the symptoms of hypoglycemia.

A postmenopausal patient is at high risk for developing osteoporosis. The patient's prescriber orders raloxifene [Evista], and the nurse provides teaching about this drug. Which statement by the patient indicates understanding of the teaching? a. "I may experience breast tenderness while taking this drug." b. "I may experience fewer hot flashes while taking this drug." c. "I should discontinue this drug several weeks before any surgery." d. "I should walk as much as possible during long airline flights."

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

A young adult patient is admitted to the hospital for evaluation of severe weight loss. The nurse admitting this patient notes that the patient has missing teeth and severe tooth decay. The patient's blood pressure is 160/98 mm Hg. The patient has difficulty answering questions and has trouble remembering simple details. The nurse suspects abuse of which substance? a. Cocaine b. Ecstasy c. Marijuana d. Methamphetamine

An adult patient will begin taking atomoxetine [Strattera] for attention-deficit/hyperactivity disorder. What will the nurse teach this patient? a. Appetite suppression does not occur, because this drug is not a stimulant. b. Stopping the drug abruptly will cause an abstinence syndrome. c. Suicidal thoughts may occur and should be reported to the provider. d. Therapeutic effects may not be felt for 1 to 3 weeks after beginning therapy.

Tadalafil [Cialis] was prescribed 4 weeks ago for a patient with erectile dysfunction. The patient also takes prazosin [Minipress] for hypertension. Which statement by the patient best demonstrates understanding of the use of tadalafil [Cialis]? a. "I can take this up to 2 times a day, just before intercourse." b. "I have a little renal trouble, so I should take a higher dose." c. "I should take this medication with food." d. "I should take this medication no more than once a day."

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

The parent of a child with cerebral palsy reports that the child has pebble-like stools most of the time and seems uncomfortable if several days have passed between stools. The nurse will suggest that the parent discuss which medication with the child's provider? a. Bisacodyl [Dulcolax] suppositories b. Magnesium citrate c. Methylcellulose [Citrucel] d. Polyethylene glycol [MiraLax]

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

Final Pharm

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